Selected excerpts from post-gazette.com article:

More and more studies are questioning the efficacy of electronic health records, and the U.S. Food and Drug Administration has begun collecting reports involving electronic health and IT errors, some of which have resulted in death…

The thing about these systems is that it doesn’t really look like they’re getting any cheaper,” he said. “And the upgrades and the upkeep represents a very significant cost, especially in outpatient clinics.”

Of those, 163 contained mistakes that could have led to “adverse drug events.” Most errors were mistakes of omission — a doctor left out an important piece of data.

Notably, this “is consistent with the literature on manual handwritten prescription error rates,” the report said. But the larger point is computerized systems do not automatically outperform paper ones. [referring to: Errors associated with outpatient computerized prescribing systems. JAMIA, 2011; DOI: 10.1136/amiajnl-2011-000205]

For an industry that relies on data and evidence-based measurements to make decisions on the clinical and pharmaceutical side, there isn’t a lot of evidence supporting the notion that electronic health records produce cheaper care or better outcomes.

I think the article outlines some of the significant problems that need to be addressed before a truly effective EHR system can be utilized. We’re forcing the healthcare industry to implement a technology that they’re simply not ready for. The IT infrastructure in healthcare is built on marbles and is still years behind the consumer market in all but the most advanced facilities. In addition we continue to struggle to standardize information. We first need to understand what the information will look like before we begin forcing everyone to use it.

There’s no question in my mind that sharing information across the healthcare continuum is paramount to providing safe, efficient, cost effective healthcare. However, there are some key pieces of the puzzle missing. Without those pieces we’re not going to get the whole picture, and that’s a problem.

 

EHR outlook: “Patients are still worried about how secure their data will be when stored in an EHR systems, a new study suggests. Xerox Corporation found that of 2,720 poll respondents:

  • 80% were concerned with stolen personal information
  • 64% were concerned with lost, damaged or corrupted files
  • 62% were concerned with the misuse of information”

I’m not surprised by the numbers. In general people are afraid of change and the unknown. With that said, I think all you need to do is walk a patient through the paper processes that we use now to give them some insight into how bad things really are. Stolen and lost personal and medical information is a major problem within the current healthcare system. It’s not uncommon in any given week to hear about patient records that have been lost or stolen. And as far as misuse of information, well lets just say that’s all too common as well.

The advantages to an EHR outweigh the concerns listed above. Just sayin’.

 

I am a fan of web-based healthcare applications, including EHRs. I especially like the web-based EHR available from Practice Fusion. The application is full featured, easy to use and free. I spent a little time playing with it back in June 2010. One of the things I noted during my review was that “there appears to be no cross checking between allergies and newly entered medications.” As a pharmacist this was pretty important. Well, I’m happy to say that allergy checking no longer appears to be an issue.

EHR Bloggers: “We’re excited to bring you a major new feature for your EHR account today: drug-drug and drug-allergy interaction alerts. It’s a frequently requested enhancement and also a big step towards Meaningful Use. And, like all our features, this clinical decision support system (CDSS) is entirely free.

Drug Interaction Alerts
You will now be automatically alerted when a drug you are adding, prescribing or refilling interacts with another drug or with an allergy listed in the patient’s chart. The following video shows you how to set permissions, heed alerts and override alerts. “

To gain access and begin using the Practice Fusion EHR simply sign up for a free account here. I would encourage any practitioner that needs a robust, easy to use EHR system to give Practice Fusion a look. It’s a solid application.

I was going to try the new feature for myself, but forgot my credentials; how embarrassing.

 

EMR Daily News: “Recording and charting changes in vital signs has been identified as one of the core areas that will be measured for meaningful use incentives. The new Intelligent Medical Devices HIMSS Analytics white paper, sponsored by Lantronix (NASDAQ: LTRX), and posted on the HIMSS Analytics website, details progress on these efforts. The research suggests that just one-third of hospitals in the HIMSS Analytics sample on medical device utilization indicated they had an active interface between medical devices at their organization and their electronic medical record (EMR).”
Continue reading »

 

I came across an interesting article recently in the International Journal of Biomedical Engineering and Technology1. The article discusses the difficulties in designing an EMR system capable of providing optimal access to data elements while remaining efficient and user friendly.  It was a good look at the current state of healthcare data exchange.

Abstract:

This paper discusses how to share medical information between heterogeneous applications via web services. Our design theory is based on a real-options framework, performance analysis and experience building iRevive, a working web-services-enabled pre-hospital documentation application. The trade-offs between efficiency and flexibility are examined in the context of exchanging information based on emerging standards in the healthcare world. These trade-offs are quantified using a real-options approach. We illustrate the importance of uncertainty in deciding the architecture enabling an application to access medical information from Electronic Medical Records (EMRs).

Continue reading »

 

Practice Fusion is a company based out of San Francisco that offers a free web-based electronic medical record (EMR), or is it electronic health record (EHR). To the best of my knowledge Practice Fusion was founded in 2005 and has been rapidly expanding ever since. Practice Fusion offers its EMR software free of charge in exchange for putting up with a few advertisements. The advertisements are non-obtrusive and don’t appear to get in the way of any of the application’s functionality. In fact, I didn’t even notice them. The best part of this revenue model is that it makes the software freely accessible to any physician that would like to use it. In addition, users are not required to install any new hardware of software. Very nice.
Continue reading »

 

EMR Daily News: “Greenbranch Publishing announces the Second Edition of the breakthrough book for practices eager to minimize the costs, confusion and outright risks of choosing and implementing an Electronic Medical Record system. Keys to EMR/EHR Success: Selecting and Implementing an Electronic Medical Record, 2nd Edition by Ronald Sterling, CPA, MBA, paperback, 304 pages, ISBN: 978-0-9827055-0-6, list price – $139.00

The 1st Edition of Keys to EMR Success, was the HIMSS Book of the Year Award winner. In this revised Edition, nationally recognized expert Ron Sterling has included new chapters on EHR and Malpractice Risk, ARRA and Meaningful Use as well as detailed coverage of conversion issues for practices that have an old EMR.

“There is no question,” says Sterling, “that the selection and implementation of an EHR is a ‘bet-the-practice’ proposition. If you fail, you end up with more costs and greater frustration. Yet, few practices will be able to avoid implementing EHRs.

I looked for the book in the usual places, i.e. Amazon, Barnes and Noble, etc. I found the first addition, but no luck on the second. I even had hopes of finding it in electronic format for the Nook, Kindle or even the iPad. Nope. So if you want to purchase the book you’ll need to go directly to the Greenbranch Publishing website.

While contemplating purchasing this book something occured to me. With the length of time it takes to publish a book, how relative would this material be to the current state of EHR/EMR implementation? Technology is moving at lightning speed. Maybe it’s time to consider a new way of disseminating information like this. Just a thought.

 

Medication reconciliation is defined by JCAHO as “the process of comparing a patient’s medication orders to all of the medications that the patient has been taking. This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions.” The process should be fairly straight forward, but it is actually very difficult and time consuming.
Continue reading »

 

InformationWeek Healthcare: “The rollout is believed to be the nation’s largest EMR deployment to date, said North Shore LIJ CIO John Bosco. The health system serves five million people in the New York metro area, operating 14 hospitals, 18 long-term care facilities, five home-health agencies, dozens of outpatient centers, and a hospice network. Under the North Shore LIJ Electronic Health Record initiative, 1,200 staff physicians and 5,800 affiliated physicians will be offered subsidized EMR systems. EMR software will be provided by Allscripts and hosted using a cloud-based model by an unnamed Allscripts partner, Bosco said.” – The article goes on to say that North Shore LIJ will subsidize approximately 85% of the cost and allow physicians to keep any reimbursement earned under the ARRA. I’d say that is a pretty smart move on the part of LIJ. After all, getting physicians to use new technology is a difficult process. With this offer LIJ will get EMR use entrenched in the minds of approximately 7000 physicians in the New York area. It will be very interesting to see how things go over the next 5 years.

 

The American Recovery and Reinvestment Act (ARRA) has created quite a flutter of activity in healthcare during the past several months. I can’t remember a time when something was such a popular topic. Everywhere you look, Twitter, Facebook, personal blogs, professional blogs, and so on are talking about how to demonstrate “meaningful use” and get their hot little hands on some cash.

While the idea is sound, the implementation has something to be desired. The overwhelming attention to the definition of “meaningful use” and the looming 2011 timeline has created some unwanted side effects to the ARRA. Hospitals have started throwing project plans in reverse for significant revision or throwing them out the window and starting over all together. Projects that may have been in the pipeline for months, or years, are now taking a back seat to the ARRA requirements. Project development and timelines are involved processes that are designed to work around several variables such as capital budgets, current software and hardware specs, and available human resources.

Many healthcare systems have yet to develop a plan to implement many of the requirements necessary to meet the ARRA “meaningful use” criteria. If a healthcare systems wasn’t ready to begin the process at any time over the past several years what makes the US government think they’ll be ready just because they say so? Is the infrastructure in place? Do they have the resources to not only implement, but support the new systems as well? These are all questions that people should be asking. I for one am disappointed in our facility as we have decided to immediately move forward with projects that weren’t slated for another 18-24 months. To make this happen other projects have been placed lower in the priority queue, creating a lack of resources that risk jeopardizing the quality of both implementations.

Healthcare systems should not be directed down a path that they feel unprepared to face. Doing so will only invite failure.

© 2012 Jerry Fahrni Suffusion theme by Sayontan Sinha