All Entries Tagged With: "electronic medical record"
One facility employs ’scribes’ to ease transition from paper to electronic records
Today’s USA Today has an interesting article about one hospital’s transition to an electronic system from using paper records. The University of Virginia Medical Center has been employing scribes to aid doctors in capturing the necessary information that comes out of a consult or appointment with a patient. The scribes follow physicians to these consults and use laptops to type notes into the electronic medical record (EMR). Then the physicians sign off that the information is correct after he or she has finished speaking with the patient. That way physicians can give all of their attention to their patients and don’t have to worry about filling in fields in the EMR.
Leah Binder, CEO of the Leapfrog Group, told the paper that this model may work for now at the facility, but she doubted it would see widespread adoption. This is because there’s a chance for mistakes to enter the patient’s record, even if physicians read over the record.
The article said this was the only facility in the country to use scribes during the paper-to-electronic switch. Have you ever heard of this idea? Has your hospital developed some other creative method for easing the transition?
Medical imaging putting patients at risk?
The Boston Globe has an interesting article today about the dangers of medical imaging. A study in the August New England Journal of Medicine shows that 70% of adults have undergone some sort of medical scan that exposed them to radiation in the past three years. While the majority of those radiation doses were relatively low, 20% received moderate doses. What’s more, 2% of adults received high or very high doses. This means they were exposed to more radiation than workers in the healthcare and nuclear industries are allowed to be exposed to annually, putting them at a higher risk for developing cancer.
This is mainly because of the number of medical scans has increased dramatically in the U.S. in the past two decades. Of course, the information contained in a medical scan often warrants its occurrence. Images have gotten clearer and patients who know that imaging is an option often request they have one. However, the researchers in this study are asking how many scans is too many.
Brigham and Women’s Hospital in Boston is adding information to its electronic medical record system that will allow physicians to see how many medical scans a patient has undergone within the Partners system (which owns the hospital) to allow physicians to make more informed decisions about scheduling further scans. This is a fairly advanced option, one that many health systems in the U.S. do not use. However, the cumulative effects of radiation may soon warrant this type of monitoring system on a larger scale.
You can read the full article here. Do any of your patients ever express fear about the amount of radiation they are receiving from medical scans? Do you as a healthcare provider ever have reservations about ordering a scan for that reason?
The difficulties of moving to an electronic system: One hospital’s experience
Children’s Hospital of Pittsburgh’s electronic system is one of the best in the nation, reports Yahoo News/ The Associated Press. However, it took seven years of effort on the part of all staff members at that facility to get where it is today. Many facilities are now in a race against the clock to becoming paperless by 2014, the year the U.S. government has decided it wants all hospitals in the country to be on an electronic system. Currently about 1.5% of the nation’s 6,000 hospitals can be considered fully electronic, reports Yahoo News/ The Associated Press.
Children’s started first in 2002 with the installation of electronic prescribing. From there it’s incorporated the use of bar coding for patient and medication identification, dashboards to easily monitor and compare data, and a system-wide electronic medical record system that easily allows the hospital and its outpatient facilities to be connected. Lastly, the hospital moved to a new facility earlier this year. To read more about the hospital’s transition, click here.
Of course, the last step is not an option for many hospitals. How would you rate your hospital’s transition to an electronic system? Non-existent? Perhaps you have incorporated some facets of an electronic system (bar coding, e-prescribing), but not all?
Physician buy-in can work wonders for EHR implementation
If your hospital is struggling to get its electronic health record (EHR) off the ground, you might want to take a look at the role your physicians are playing in its success (or lack thereof). This article from my colleague Lisa Eramo from HealthLeaders Media explains how physician participation with and support of an electronic health record can really make or break a hospital’s foray into health information technology.
However, with new government requirements, EHR is no longer a nice to have, but a must have in the coming years. Those hospitals without some sort of EHR are losing out on incentive money from the American Recovery and Reimbursement Act. Whether they like it or not, physicians are going to have to be using some form of EHR in the near future.
The Health Information Management and Systems Society created its HIMSS EMR Analytics Model in 2005 to delineate the stages of EHR adoption. Eramo says in her article that many hospitals struggle with step #5, which says the EHR will have an effect on patient safety, and more specifically by closing the loop on medication administration. This is most likely because it involves communication from various caregivers- physicians, pharmacists, and nurses.
How a patient’s medical history is taken is key to physician/patient relationship
Part of ensuring patients have a safe stay or visit to your facility is making sure they are comfortable with their care providers and that any information about their conditions has been interpreted correctly. Central to that occurring is the medical interview, or exchange of information that takes place between a provider of care (usually a doctor) and the patient.
This American Medical News ethics piece highlights how physicians can overcome the introduction of the computer into this exchange of information. Since electronic medical records have become more prominent in the past few years, an increasing amount of information from medical interviews is put directly onto the computer, leaving less opportunities for physicians to make that emotional connection with a patient.
Before bringing the computer into the conversation, the article suggests that physicians concentrate on cultivating the exchange of information between them and their patients. By restating back to patients what doctors think they heard and inviting any follow-up reponse, physicians can form the medical history together with the patient and make any corrections necessary. Then, and only then, should the computer come into the picture as a means to house this “data” coming from the medical interview.
Additionally, physicians often ask questions that elicit a narrow response, often yes or no. Instead, physicians should seek to draw a story out of their patients and combine that with their clinical backgrounds to make the most complete picture of a patient’s condition.
To read more technicques and the full article, click here. The piece was written by Frederic W. Platt, MD, clinical professor of medicine, University of Colorado, Denver, School of Medicine and regional consultant for the Institute for Healthcare Communication.
New York hospital to offer personal health records for patients
New York Presbyterian Hospital, which is responsible for caring for 20% of all of New York City’s patients at its clinics, will be launching a new personal health record program to help patients better manage their own care, reports The New York Times. Although certain health plans around the country have partnered with technology providers to offer their plan members the chance to fill out their own personal health records, this instance represents the first attempt by a hospital to do so with its patients.
At first it will just roll the plan out to heart patients, although eventually the hospital intends to involve many more patients. Patients will be trained on how to use the personal health record while they are in the hospital.
Although the Obama Administration’s focus is on improving electronic medical records, and not personal health records, the two both can simplify healthcare and keep patients safer, the article says.
Gulf Coast leads nation in pushing health records online
Although Hurricane Katrina will most be remembered for the devastation it brought to the New Orleans area, it did force the area to become much more open to the idea of using electronic health records. In fact, the Gulf Coast is leading the nation now in moving patient records into an online format. The need to do so became apparent when residents of the area were forced to move to other regions of the country, often without knowing which medications they were taking or what their treatment regimen consisted of. Additionally, many paper records were completely lost.
The Mississippi Coast Health Information Exchange (MCHIE) is helping the areas physicians and hospitals get a jump start on the Federal initiative to convert patient records to electronic records. You can read more about this initiative from The SunHerald by clicking here.
Has your hospital or facility become of an RHIO (Regional Health Information Organization)? How have staff members and patients alike taken to the initiative?
Cost of electronic health records a deterrent for hospital use
We’ve heard much about electronic health records over the past few months, especially since the U.S. government intends to spend a significant amount of money helping hospital systems install them. And it turns out, an overwhelming majority of hospitals and hospital systems will need that money to even make a foray into the electronic world. The New England Journal of Medicine published a study yesterday that shows that overall, a meager 1.5% of hospitals in the U.S. have a fully functional, top of the line electronic health system. A slightly larger percent (7.6) of hospitals have some sort of EHR functioning in at least one or a few areas, and computer-physician order entry is used by 17% of hospitals.
The main reason that only 1.5% of hospitals are using EHRs is the cost, the article says. Also, those involved in researching the topic think that although there is going to be a lot of money available to help implement more fully-functioning EHRs, the current lack of EHRs will be a significant barrier to moving ahead with healthcare goals that depend electronic health information technology. Interoperability–having EHRs among many hospitals and hospital systems that can talk to each other–is another big concern.
Although this number is a lot lower than I thought, it does not completely surprise me. Most staff members at hospitals with whom I speak either do not have EHRs, or have one for the emergency department, or another department–not for the entire hospital.
EMR stimulus dollars being put to work in Florida
The Tampa Bay area will soon be part of a program to convert physician’s to using electronic medical records. Called “PaperFree Tampa Bay,” the program is a public and private partnership, using the stimulus money and resources from both the University of South Florida (USF) and EMR provider Allscripts. USF is deploying 100 medical software trainers in the Tampa Bay area to help train physicians on how to use EMRs and assist in getting them up and running. The program’s goal is to convert 100% of doctors to using EMRs, though it is not specified by when.
Currently, 10% of the country’s physicians write prescriptions electronically. However, under federal law, those doctors not using EMRs by 2012 will be subject to penalty, and physicians have a monetary incentive to start using EMRs. The Obama administration has been vocal about implementing EMRs and touting their benefits–reduced medical errors being a big one. There has been some push back by doctors who cite not only the cost of switching to an electronic system, but other downsides, discussed in last week’s blog post.
Click here to read an article about the program from Tampa Bay Online.
EMR: Friend or Foe?
For all of the arguments made in the last decade–and more recently by the Obama administration–to jump on the electronic medical record (EMR) bandwagon, there are still many arguments against holding the technology as an industry savior. This Time.com piece, written by Scott Haig, illustrates many of the pitfalls that are often overlooked when talking about how EMRs can improve healthcare. And though the argument for incorporating EMRs into hospitals and clinics is often the cost savings associated with them, Haig points out that those savings are mostly for the practices using EMRs, not the patient.
Though using EMRs brings up larger issues, such as privacy questions and the complexities of building an electronic system for the entire nation when individual health systems can’t get their own technologies to always “talk” to each other, EMRs make it difficult for physicians to prescribe special directions for a patient. They also often push doctors into billing for diagnoses that a patient may not have, which ultimately costs the patient more money. However, a more expensive diagnosis will reward the health system with a higher reimbursement payment. Additionally, physicians are constantly reminded when they might be ordering a test or a treatment for a patient who is not considered “sick” enough to receive that treatment, based on algorithms within the EMR. Does the physician wait for that patient to become sicker, simply to give that patient the treatment he or she thinks is necessary–or does he or she eat the costs of this treatment that might not be reimbursed? Haig points out that with a paper system, hospitals had to deal with this question after the treatment had been prescribed.
With the buzz around EMRs that is surely to get bigger over the next few years, there are sure to be many voices speaking on behalf of their benefits and drawbacks of implementing a fully electronic system. What are your opinions on this technology? Has your employer already confronted many of the issues Haig points to in his article?
