All Entries Tagged With: "electronic medical record"
Technology, devices and equipment: More than just a purchase
One topic keeps popping up in the patient safety world, and in my humble opinion, I think we’re going to see much more of it. It’s the topic of how the devices we use in hospitals are understood and used. Technology and state-of-the-art equipment have the potential to make healthcare efficient and safer, but only if we slow down to learn how to use it, and in some cases clean it, correctly. I have this feeling that we are getting a bit ahead of ourselves with buying shiny new stuff, not worrying enough about continuing education of proper use, training, cleaning, and maintenance of equipment.
More than one hospital told me they had to take a step backward and re-implement handoffs after implementing electronic medical records. So much was documented in real time, staff often forgot to have conversations about the patient, leaving out a critical time to ask and answer questions.
Alarm fatigue is a prime example of too much technology at once, without forethought of potential side effects. Not only are nurses (understandably) tuned out, but the alarms add to the noisy environment in which the patient is trying to recover.
Endoscopy and colonoscopy equipment that hasn’t been cleaned according to guidelines are causing hospitals and physician offices to send thousands of regretful letters warning patients they may have been exposed to a host of bloodborne pathogens.
And I’ve already written extensively on whether radiation technology’s exponential expansion is too much to handle. We are getting better pictures, but at what cost? The radiation is getting stronger. Just because we can, doesn’t necessarily mean we should. And, there is debate as to whether technicians are undergoing enough training to use complex machinery. Machines only do what we tell them, and if we tell them incorrectly—especially in the case of radiation therapy—we are certainly doing more harm than good.
To echo a well known web-spewing superhero, with the power of new equipment and technology comes great responsibility. Providers should be educated and trained on using the equipment around them properly, and ensure they are well cleaned and maintained. We cannot afford to get distracted by wondrous EMRs or equipment. We must remember that it is all a means to an end that is better care. If the means actually makes care less safe, we are failing.
We need to be constantly asking ourselves whether we are doing everything possible to ensure new technology and equipment make a safer environment for patient care.
Electronic medical record goals are unrealistic, many physicians and hospitals say
Feedback from some of the nation’s most advanced hospitals indicates that many facilities will not be able to meet the government’s “meaningful use” requirements in relation to electronic medical records (EMR), reports The New York Times. “Meaningful use” refers to a set of requirements regarding EMRs that hospitals and physicians must meet to receive incentive payments through Medicare and Medicaid.
Physicians at these institutions, some of which have had EMRs instituted for years, say that the government’s requirements are difficult to meet and may in fact discourage users from attempting to achieve “meaningful use” because there is no reimbursement for partial credit. The advanced requirements have been put in place to meet a strict deadline set by President Barack Obama, and by 2015, hospitals and physicians will be penalized if they do not use EMRs.
To read more from The New York Times, click here.
What is the buzz at your facility about “meaningful use?” Are you meeting it? Is your hospital even trying to meet it?
AHA report says many hospitals will face fines for not complying with “meaningful use” in relation to EMRs
As part of legislation passed in 2009, all hospitals must be achieving “meaningful use” by 2015, or they may face penalties from the government. Meaningful use is a phrase that refers to the requirement that hospitals be “meaningful users” of health information technology.
To accomplish this, there are several aspects of an electronic medical record (EMR) for which hospitals are responsible for implementing. Medicare is providing incentive payments between fiscal years 2011 and 2016 for those facilities that do meet the requirements of meaningful use.
However, a new TrendWatch report, released recently by the American Hospital Association (AHA), shows that many hospitals will not be able to meet the requirements for meaningful use by 2015. In fact more than half of facilities surveyed earlier this year by the AHA say they will not be able to meet the current meaningful use requirements, which were released in a proposed rule in January 13, 2010.
Even if facilities want to take advantage of the quality improvement opportunities that EMRs afford hospitals (reducing adverse events, improving patient flow, reducing the number of hospital readmissions), they will be unable to do so because of the time requirements, resources necessary, and strict definitions in place in the current proposed meaningful use rule, says the report.
You can download the full report here. Do you think your facility will be able to meet the meaningful use requirement as it stands now? Do you stand to incur a penalty?
NEJM Perspective: EHR’s biggest benefit will be minimizing diagnostic errors
As the United States ramps up its adoption of electronic health records (EHR) and all of the health information technology that accompanies EHRs one of the largest benefits will be the minimization of diagnosis errors, according to a recent “Perspective” published in the New England Journal of Medicine (NEJM) . The authors, Gordon D. Schiff, MD, and David W. Bates, MD, assert that electronic documentation, when redesigned appropriately, will ultimately benefit the patient and physician by helping the physician rule out numerous diagnoses, as well as stay current with the stifling amount of medical education and advances that are available to caregivers.
The authors outline seven ways in which EHRs will reduce rates of diagnosis error.
- Filtering and organizing information that might help the physician make a better diagnosis
- Serving as a place where physicians can document their diagnoses, including possibilities of other potential diagnoses and thoughts on a patient’s illness
- Facilitating ongoing assessment and documentation of a patient’s primary diagnosis, including the allowance of multiple physicians and specialists to comment in one space
- Allowing for the easier creation of physicians’ ‘problem lists’
- Ensuring accurate communication between providers, as well as test ordering and result tracking
- Incorporating checklists more often into their interfaces, to prompt physicians with questions that could help in diagnosis
- Taking a stronger role in managing the follow-up visits with patients.
I’ve posted about diagnosis error in the past, and have been educated somewhat on how big of a problem it actually is. It’s not as easy for hospitals to get their proverbial hands around an issue like diagnosis error as it is preventing patient falls, or something of that nature, but it is an important one for the medical community to address. If EHRs are going to be as fully integrated into patient care as they are supposed to be within the next ten years, hopefully some or most of these authors’ thoughts about preventing diagnosis error will also be reality.
Governmental agencies release electronic health records standards
Last week, the Centers for Medicare and Medicaid Services and the Office of the National Coordinator for Health released two regulations that provided the definition of “meaningful use” of electronic health records (EHRs) as well as the standards to improve the efficiency of health information technology used nationwide by hospitals and physicians. The regulations will go into effect 30 days after being published in the Federal Register, and the public will have a 60-day comment period.
An article published in HealthLeaders Media last week further explains the December 30, 2009 announcement. The Department of Health and Human Services was given through the end of 2009 to create a set of standards regarding EHR technology by the American Recovery and Reinvestment Act of 2009.
Essentially, the standards give some structure to collecting, sharing, and using electronic data contained in EHRs. There was also careful consideration given to patient privacy rights. You can read the full article by clicking here.
In related news, the National Quality Forum (NQF) released a set of 70 measures that encourage incremental use of electronic data to improve quality. There are three tiers of the measures:
- Level one measures include from one electronic administrative source (claims data)
- Level two measures include merged data from multiple administrative sources (claims data)
- Level three measures include data from common electronic data sources
Although this may not directly affect your job in patient safety, do you see these rules as having a larger effect on your organization?
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.
