All Entries Tagged With: "health information technology"
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.
New and different challenges emerge between patient and physician with Internet advances
A recent commentary in the New England Journal of Medicine summarizes well the problems and benefits that the Internet has brought to American healthcare. Written by Pamela Hartzband, MD, and Jerome Groopman, MD, the commentary describe the Internet as the technological advance that has had the most profound effect on their clinical practices since they have been physicians. Because of its ability to provide vast amounts of true and misinformation, the Internet has given patients the ability to inform themselves about potential sicknesses for the better or for the worse. Hospitals have used the Internet to connect with patients more often and more efficiently; this too can have negative and positive consequences.
From a patient safety standpoint, I think learning how to harness the power of the Internet and all of the information contained on it is going to be one of the major challenges in the next ten years. Also, physicians and healthcare organizations will have to decide how they themselves view the Internet and want to interact with it. If patients cannot decipher what is true and what is false, is it physician’s responsibility to inform them? Perhaps this will become the job of a care manager- to act as a liaison to the patient and also keep in touch with physicians and caregivers about the information patients are seeking.
How do you view the Internet in conjunction with patient care? Is it a hinderance or an opportunity for improved care?
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?
Patients of the future will demand increased communication, be more informed consumers
In the future, healthcare providers can expect more informed patients who want their care team members to be more open to communicating via e-mail and other Internet platforms. They will also be more knowledgeable about potential treatment options, their own health records, and want to know upfront about the costs that will be incurred with medical care. According to this new HealthLeaders Media article, patients of the future will be more savvy, informed customers.
My colleague Gienna Shaw addresses some of the reasons why many of these attributes, some that patients exhibit today, are going to become commonplace in the future. Using technology to communicate with patients will be a must as a new generation of patients who communicate through e-mail, text, and instant message will expect their physicians to do the same. Those same patients will be accessing their own personal health records as more hospitals and insurance companies provide them, putting them more in touch with their plan of care. These expectations, along with other developments, will put caregivers and patients in more of a partnership.
Check out her article for some more thoughts on what tomorrow’s (or next year’s or decade’s) patients will look like. Do you agree with these points? What do you think patients of the future will expect from their healthcare?
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 research finds electronic prescribing saves time, money
Talk about efficiency: new research shows that electronic prescribing systems, on average, reduced the time required for a provider to place an order from 41.2 minutes to 27 seconds. In a study published in the May issue of the Journal of the American College of Surgeons, researchers found that electronic prescribing might improve quality of care through drastically improved prescribing efficiency.
The research is timely, as the Institute of Medicine has called for the use of electronic prescribing systems in all healthcare organizations by 2010. Though rates of medication errors in the study were not greatly affected, the greater efficiency, as well as the fact that personnel no longer needed to clarify and transcribe written orders into an accessible format, may free up time to focus on better quality of care, according to the study’s press release. It also saves money-the implementation of the systems eliminated 11 positions out of 56 at the Mayo Clinic Hospital where the study took place.
Do you have electronic prescribing? Why or why not? If you do, what do you think of it?
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: 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?
