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.
Read more…
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.
EMR Daily News: “Hypatia Research, LLC today released a report entitled “What Healthcare CIOs Need to Know About ARRA & EHR: Healthcare Technology Solutions & Service Providers”. Beyond the obvious value of centralized access to patient data, Hypatia Research discerned that electronic records systems provide health providers with multiple benefits: 1. ACCURACY& ERROR-CHECKS; 2. REPORTING; 3. MEDICAL NOWLEDGE-BASE; 4. NEAR-TIME ACTIONABLE INSIGHT” - If your CIO needs a research firm to understand what an electronic records system should provide, then you’re healthcare system is in deep doo-doo. This is all basic stuff that should have been on the radar long ago.
Healthcare IT Consultant Blog: “It appears Caretools has thought of this, offering its iChart EHR for the iPhone, immediately available to anyone on the iTunes store. Before you scoff that it must be a limited-functionality, toy of an EHR, consider this: it offers ePrescribing, transmission of lab reports, ICD9-compliant billing code functionality, and a sophisticated menu system to quickly create SOAP and Procedure notes. It might not be CCHIT-certified (yet) or guarantee your eligibility for “meaningful use” funding, but at such a low price point, it could be a great way to get your physicians comfortable with standard EHR functionality.” – I took a quick jaunt over to the Caretools website and gave the application the once over. I think it’s pretty cool. At a mere $139.99 it’s about the cheapest EMR system you’re going to find on the market. You can read more about it at the iPhone Life website. Next thing you know, you’ll even be able to make phone calls directly from your iPhone.
Healthcare IT Consultant: “Buoyed by the encouraging use of its PHR and Twitter based Clinical Trial matching service, TrialX is readying to release its iPhone application this month. This application, designed for doctors and patients, further underscores TrialX’s commitment to drive technology enabled consumer-driven healthcare. Using the TrialX iPhone App, doctors can search for clinical trials that their patients may be eligible for and email the results to the patients right away. They can filter clinical trials by location, medical condition, treatment, institution conducting the trial and other parameters. Similarly, patients and/or their loved ones can use this application to search for clinical trials. A video demo and screenshots of the new application are available at TrialX Mobile (http://trialx.com/mobile).” - You can search for clinical trials at the TrialX website as well. In addition, TrialX can identify clinical trials that may fit your condition based on your Google Health or MicrosoftVault profile. Take a second to browse around their site, it’s pretty slick.
Healthcare IT Consultant Blog: “Pharmacists’ representatives have claimed that use of private health record services such as Google Health and Microsoft HealthVault could risk fragmentation of electronic patient records. The Royal Pharmaceutical Society of Great Britain said “the proliferation of these systems and indiscriminate use” could lead to information on drug allergies, possible interactions, duplications or dose adjustments not being available when it was needed. The society, which was responding to a consultation by the Nuffield Council on Bioethics on medical profiling and online medicine, said there could be “serious patient safety implications”. It argued that the single health record supports the seamless transfer of care between primary and secondary settings and promoted multi- disciplinary working.” - I don’t necessarily agree with “the society” about personal health records. Personal health records – like medication lists carried in wallets, purses, and pockets – serve as additional information to an already detailed health system record. The technology is in its infancy and further growth and development should be encouraged. I believe it empowers the individual with enough control to become interested in their own care. I wouldn’t remove a patient allergy from the pharmacy system based solely on the information in a patient’s personal medical record, but would certainly investigate the opposite. First hand information directly from the patient is a valuable commodity. I remember interviewing patients upon admission to Long/Moffit Hospital on the UCSF campus when I was a 4th year pharmacy student. Many times asking the right questions led to the patient remembering something they had forgotten. If that information would have been in a digital personal medical record, the patient’s lack of memory becomes a non-issue. UCSF had the luxury of 30 pharmacy students running around talking to patients. Most hospitals aren’t so lucky.
The Healthcare IT Guy: “Physicians know that better exists. They have experienced Google, Amazon and e-Bay. Game lovers know that Electronic Arts’ “Tiberium,” now 15 years old, exceeds the capabilities of their professional health care software. They know from Yahoo and MSN the value of configuring a home page suited to delivering niche-information of their own preference. They know from using Word and Word Perfect that they can create precision documents merely by tweaking a template. They know they can use voice commands to make a phone call on their Blackberry. They know that they can find drug information more easily on Google than proprietary software. They suspect that if their EHRs and EMRs had physician-specific home page functionality, that they could drop and drag orders, answer FAQs, dictate letters, and save time with templates with many fewer clicks. Ordering medications should be as safe and uncomplicated as using E*Trade.” – Once again I ask you, healthcare vs. consumer tech, who’s more advanced? In reality a good EHR/EMR should be like a microwave oven; just open the door, push a few buttons, and pull out your finished product in 30 seconds. Most people don’t worry about how the microwave oven works, they just use it. Like the rest of use, physicians want simplistic design with ultimate functionality. Who can blame them, really, but they will have to give a little as the technology is still in it’s infancy within healthcare. For some yet to be determined reason, healthcare is always behind other industries when it comes to high-tech. Read the entire article if you get the opportunity, it contains some great information.
EMR Daily News: “A new KLAS report takes a closer look at the latest release of the Meditech electronic medical record (EMR) software and whether it’s a viable solution to help Meditech’s more than 2,000 clinical customers reach the meaningful use threshold. The release of Meditech 6.0 brings with it high expectations for making the software better suited for physician use, which is a key aspect of the federal government’s definition of meaningful use and a traditional weakness of Meditech systems. According to the KLAS report “Meditech Version 6: A Strong Step Forward?”, early adopters of version 6 are reporting positive results, including an improved user interface and easier navigation, but many obstacles still stand in the way of widespread adoption. “Meditech has long struggled with deep CPOE adoption, and version 6 is geared toward addressing that gap,” said Jason Hess, KLAS general manager of clinical research and author of the Meditech report. “However, several issues will likely impact how quickly version 6 is rolled out to the Meditech customer base.”
Read more…
EMR and HIPAA: “However, the thing that hit me most was that the computer was so rarely in the middle of my wife and baby’s care. At all of the most important points the computer wasn’t even really present. Other sophisticated technical devices were there, but the computer and the EMR were no where to be seen. No EMR when they measured her contractions. No EMR when they gave her a spinal tap (don’t ask me the real technical terms). No EMR when the doctor was performing the c-section. The first time I saw an EMR was actually when we took my new born baby into another room to do all the necessary weighing, immunizations, etc.” – Nursing units where babies are delivered (insert naming convention here: “OB”, “Mother-Baby”, “Post-Partum”, etc) often use some form of EMR, but it may not be the same one as the rest of the facility. One thing I’ve learned during my involvement in several projects here at the hospital is that “OB” does everything just a little bit differently. When we implemented Pyxis and eliminated floor stock, they fought us every step of the way. When we implemented Alaris pumps, they fought us every step of the way. As we move forward with barcode medication administration (BCMA), they are fighting us every step of the way. The same was true during the meeting to discuss our implementation plans for CPOE. The argument is always the same, “that just won’t work for us because we’re different”. I think every nursing unit feels that way at first, but most come around after they give the technology a fair evaluation. Every unit has little nuances; it just takes some time to work through them. Now, if I could only figure out how to make OB feel same way.{sigh}
