Apparently some pharmacists are worried about personal health records

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.

One physician’s less than stellar opinion of EMRs

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.

Meditech Version 6 – Does glitz and glam equal better functionality?

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.”
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Interesting observation about EMR and babies

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}

EHR breach in Canada blamed on virus, aye.

Healthcare IT News: ALBERTA, CANADA – Officials are saying that a virus is to blame for compromising thousands of patient medical records at Alberta Health Services. The virus impacted AHS’ network and Netcare, Alberta’s electronic health record, from May 15-29 before it was detected and removed, said officials. The virus is said to be a new variant of a Trojan horse program called Coreflood, which is designed to steal data from an infected computer and send it to a server controlled by a hacker. Coreflood captures passwords and data the user of the computer accesses. AHS has identified two groups who are potentially at risk – patients whose health information was accessed in Netcare through an infected computer, and employees who accessed personal banking and email accounts from work using an infected computer.” – I’d like to know a little more detail on how the virus was introduced into the system, the operating system being used, etc. Computer viruses are particularly problematic in healthcare where IT departments invest significant resources, both physical and financial, in stopping these malicious attacks.

Defining and Testing EMR Usability

Healthcare IT News: “The Healthcare Information and Management Systems Society’s EHR Usability Task Force has released a white paper focusing on the level of usability in electronic medical records and their implementation at healthcare organizations. “Defining and Testing EMR Usability: Principles and Proposed Methods of EMR Usability Evaluation and Rating” identifies usability of software in an EMR as “one of the major factors and possibly the most important factor hindering widespread adoption of EMRs.” – A copy of the white paper can be found here.

Cool Technology for Pharmacy

Healthcare IT Consultant Blog: “VeriChip Corporation Outlines Current Applications and Potential Future Applications for its First-of-a-Kind Implantable RFID Implantable Microchip - VeriChip Corporation, a provider of radio frequency identification (RFID) systems for healthcare and patient-related needs, today provided additional comments regarding its VeriMedâ„¢ Health Link patient identification system following the recent passage of a bill by the Pennsylvania House of Representatives banning forced microchip implantation in humans, and also outlined its current and potential future applications for its RFID implantable microchip. The VeriMed Health Link system was cleared by the FDA in 2004 as a Class II medical device and is the first and only implantable microchip cleared by the FDA for patient identification. “
Continue reading Cool Technology for Pharmacy

ASHP Makes Recommendations for Definition of “Meaningful Use”

ASHP.org: “In a recent letter to the Office of the National Coordinator for Health Information Technology, ASHP said the definition of meaningful use should include the following three elements: interoperability of medication orders and prescriptions; medication decision support and continuous improvement; and the ability to report and quantify improved patient safety, quality outcomes, and cost-effectiveness in the medication-use process.” – Kind of vague, don’t you think. I expected a little more aggressive stance.


Bye bye paper medical records

HIT Consultant: “N.Y. medical group to ditch paper records by 2010 – Rep. Chris Lee toured the Buffalo Medical Group’s offices Monday as part of what he calls his effort to bring local ideas about health-care reform to Congress. Buffalo Medical Group, which handles 415,000 outpatients per year, is in the process of updating its data systems and patient records to a paperless electronic format. CEO Daniel Scully said the electronic records will replace a warehouse full of 5,000 boxes of patient record. Scully said he expects the transition to be complete by the end of 2010.” – I love this idea. It’s aggressive, it’s green and it’s much more efficient. Searching through a well indexed electronic database is much faster than looking through hundreds (possibly thousands) of paper files, no matter how well organized you are. How many times have you seen this order in a chart: “have the patient’s old medical records sent over”, or some equivalent phrase. That would be a thing of the past with a paperless electronic medical record.

The patient centered medical home and pharmacy

From the Pharmacy Technology Resources (PTR) blog:

“Patient Centered Medical Home” (PCMH) – is likely to be the best opportunity for aligning physician and patient frustration, demonstrated models for improving care, and private and public payment systems to produce the most profound transformation of the health care system this far. Wait a second – what about the Family Pharmacist or Consultant Pharmacist? How does pharmacy play into this model? What relationships are being formed today between the community retail pharmacy and these home-care physicians? What active correlation or network can be established nationally to group together seamless health-care services between the home-patient, the physician, and the pharmacy?

First – we’ll say – its ePrescribing with all the industry attention this mode of communication brings between doctors and pharmacists – however – I say it takes more than an electronic network to ensure the proper care is given to the patient. This medical home based model sounds similar to the model from the 1990’s of managed care that was about decreasing costs. Is this system designed to help patients instead of insurers? The relationship between the “local” doctor and the “local” pharmacy is imperative. We have come full circle – where in the 1950’s the relationship between physician and pharmacist was much more prevalent. Today – the home-care doctor can grab his iPhone and digitize the necessary communications with pharmacy for a seamless and completed transaction for the patient. But what about the relationship between the doctor and pharmacist and the periodic medication review for the home-care patient?”

As I have mentioned before, the technology to provide real-time access to patient data is currently available. This provides a genuine opportunity for pharmacist involvement in the medical home model. The PTR blog recommends pharmacists partner with local physicians using the PCMH model, and I think this is a great idea. This is a golden opportunity for all you pharmacists that want to expand your practice setting. What are you waiting for? The time is now.