Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and HIPAA for FREE!!

Patient Safety and EHR’s: Q&A with Two Companies Striving to Make a Difference – Breakaway Thinking

Posted on July 15, 2015 I Written By

The following is a guest blog post by Lori Balstad, Learning and Development Specialist at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Lori Balstad
While electronic health records (EHRs) have been in existence since the late 1960s, it wasn’t until almost 30 years later that the Institute of Medicine (IOM) concluded that healthcare would be safer with computerized physician order entry, estimating that 100,000 Americans die each year from preventable adverse events. Now in 2015, most have heard the frightening number of deaths per year due to medical errors—400,000—or more than 1,000 lost lives in the U.S. every day. Preventable medical errors cause the third most deaths in the U.S., right after heart disease and cancer. With many organizations either upgrading old systems or making the decision on their first EHR, it is critical that patient safety is the ultimate goal.

Enter two companies striving towards this goal on both sides of the process:  The Breakaway Group and Sociotechnologix.

The Breakaway Group, A Xerox Company, is committed to ensuring healthcare organizations gain value from technology.   Our innovative approach using “flight simulators” allows users to practice new workflows and reinforce the handoffs required to achieve the quality and safety outcomes they expect. Our research-based solution expedites end-user adoption of new technologies and using the EHR system to its full potential.  This results in fewer errors, and a higher level of care.  Healthcare professionals adopt new applications faster, giving back critical time for providers to do what they do best – care for patients.

Sociotechnologix works to help healthcare organizations understand the influence of culture and leadership on safety and quality of care.  The implementation of technology can create significant patient risk when not used correctly or when system issues are ignored post go-live.  Sociotechnologix uses a validated assessment to measure HIT safety.  This focus on organizational culture drives organizations to integrate quality initiatives into every aspect of care.  They recently launched a tool that allows providers to quickly and easily identify patient safety risks in their EHR.  The application called SafeHIT, provides detailed analytics on the safety, usability, and workflow, from the perspective of clinicians to prioritize safety issues. As sighted by Westat in a report for The Office of the National Coordinator for Health IT (ONC), “Examining health IT incidents within the context of the socio-technical model enables organizations to look beyond the incident to understand it in the context of the people who use the system and the other technologies and processes affected by health IT. Understanding these interactions enables high-reliability organizations to make improvements to their health IT systems when flaws in the systems are identified that can lead to patient harm.”


In the following Q&A, we discuss how EHRs impact patient safety and how each company hopes to improve it. The individuals interviewed from each company are Dr. Heather Haugen, CEO and Managing Director of The Breakaway Group, and Dr. Michael Woods, a Principal of Sociotechnologix, LLC.

Question #1: How must healthcare change to ensure proper use of EHRs for improved safety?

Heather: We must move beyond an implementation mindset.  The hard work begins when the technology is installed.  An EHR is simply one tool we can use to improve care processes.  It requires clinical leadership and a long term commitment to achieve the promise of the EHR- improved quality and safety.

Michael: No one would give their child a medication the FDA had not approved as safe and effective, yet we don’t think twice about having our child cared for in a hospital that has implemented an EHR whose safety and efficacy for patients (and users) hasn’t been systematically demonstrated. Clinical leaders and their organizations will not be able to optimize quality and patient safety without committing to a structured methodology to capture, track, and fix the EHR safety, usability, and workflow issues encountered daily on the frontline of care.

Question #2: Can you share examples of how your company helps improve patient safety?

Heather: We are witnessing a unique time in healthcare.  Healthcare leaders face an increasing number of competing priorities with fewer resources every year.  If we continue to quickly push more technology into clinical care processes without ensuring users are proficient, we will experience an increase in errors and negative impact on quality and safety.  By mimicking the clinical environment, we can easily assess end user proficiency in their actual workflow before they use the live system.  These clinicians are less likely to make an error and learn the system faster.  Giving clinicians time back to focus on the patient and properly use the tools results in safer care.

Michael: We use a sociotechnical approach to assess an organization’s overall patient safety. HIT is one of three components in our model, but it has profound impact on the other two, culture and process. In consulting to a number of organizations, we consistently found EHRs leave frontline caregivers frustrated, cognitively burdened (culture), and forcing workarounds (processes) to the EHR to ensure their patients aren’t harmed. We’ve never heard a frontline caregiver say, “Gosh, our HIT system is just so awesome — it’s so intuitive, easy to use, and safe for our patients.” On the other side of the fence, our data tells us our information technology (IT) colleagues are paralyzed by the sheer volume of (legitimate) frontline complaints (“tickets”), often with no way to categorize, prioritize, and track what issues are creating real safety risks, or which HIT usability issue is costing 10’s or even 100’s of thousands of dollars per year in lost efficiency. It’s for these reasons we created SafeHIT™, a mobile, SaaS-based application for real-time, frontline reporting and advanced analytics of HIT safety, usability, & workflow issues. SafeHIT brings the clinical and IT folks together collaboratively to solve HIT problems, leveraging in-App, bi-directional, highly secure communication.

Question #3: How can companies like The Breakaway Group and Sociotechnologix work together to improve patient safety?

Heather: Both organizations are passionate about improving patient safety through research-based solutions.  We understand patient safety is a complex issue that must be addressed from multiple touch points in the organization.  By pairing our solutions, an organization can address safety across the care continuum – from the leadership culture of safety to how providers use technology to deliver the highest quality of care.

Michael: Heather is spot-on. Sociotechnologix talks about EHR ROS – return on safety – an EHR system that actually helps the entire sociotechnical environment (culture, processes, and technology) be safer. Combining the methodologies and data streams from The Breakaway Group and Sociotechnologix creates a truly unique — and frankly, for the first time — complete approach to not just the initial EHR implementation, but ongoing and sustained EHR proficiency, safety, usability, and workflow optimization, while stopping the pandemic, ongoing lost efficiency costs associated with sub-optimal adoption and usability.


Many government organizations and institutions have also recognized the need to evaluate health IT’s role in patient safety over the last few years. The ONC has funded numerous reports and projects for this very reason and holds meetings with the Agency for Healthcare Research and Quality (AHRQ) to coordinate health IT and patient safety.  AHRQ has recently awarded $4 million in new research grants to improve the safety of health IT. More information can be found at healthit.ahrq.gov.

Focusing on processes to ensure better use of health IT, from the true adoption of applications to how they are being used in real time and what issues arise, will make us all safer and provide a better patient experience. The right intentions have been there for 50 years.  We’ve had successes and growth, and are getting better at defining the needs of patients, providers, and organizations to reach the ultimate goal of safety.

Xerox is a sponsor of the Breakaway Thinking series of blog posts. The Breakaway Group is a leader in EHR and Health IT training.

Interoperability of Electronic Health Records– Benefits and Opportunities – Breakaway Thinking

Posted on June 17, 2015 I Written By

The following is a guest blog post by Jennifer Bergeron, Learning and Development Manager at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Jennifer Bergeron
Electronic health records (EHR) aim to improve healthcare and processes for providers and patients on a number of fronts. In an ideal situation according to HealthIT.gov, the clinician benefits by having quick access to patient records and alerts, the ability to quickly and accurately report, and a path to safer prescribing. Patients should be able to spend less time filling out duplicative forms at clinics, have prescriptions sent automatically to pharmacies, and gain easier access to specialist referrals.

The International Journal of Innovation and Applied Studies points out that interoperability can work toward a resolution to several current problems including patient record accessibility and consolidation, and healthcare costs. As far as getting patient information and all available information when it’s needed, the report “estimated that 18% of medical errors that result in an adverse drug event were due to inadequate availability of patients’ information.” Healthcare costs are reduced when different entities can share and communicate common data and could save up to $77.8 billion annually.

Given the potential benefits, there are still opportunities to achieve interoperability. For example, not all healthcare organizations are using EHRs so data isn’t being collected consistently across the board. In 2014 there was an increase in the percentage of hospitals with EHRs. However, only 39% of physicians reported that they share data with other providers. Even though the data is available to share, some EHR users may still be living in a silo and haven’t reached full adoption. In addition, existing specification standards have not promoted interoperability. Even though there is data is available to share, few providers are tapping into that information.

To help increase data sharing, more attention is being paid to FHIR, or Fast Healthcare Interoperability Resources. FHIR stems from HL7 (Health Level Seven) data exchange and information modeling standards. HL7 has been around since 1987 to develop families of standards used to automate healthcare data sharing with the goal to improve patient care. FHIR builds upon the interoperability uses of HL7 and takes into consideration the changes in technology and requirements. According to the Office of the National Coordinator for Health Information Technology (ONC), FHIR is used to enable data access, is used as the container to return query results, and will be used to build necessary security and privacy controls.

FHIR combines what are called “resources” — also known as an instance of data – that define data and are used for specific content. Within a resource are characteristics including “a common way to define and represent them, building them from data types that define common reusable patterns of elements, a common set of metadata, and a human readable part.” Collected data can be used and exchanged, searched for individually or in groupings, analyzed and examined.

Interoperability and the role of FHIR is not yet clearly defined. Going forward, the roadmap for interoperability built by the ONC will be watched closely. Guidelines are broad at this point to allow appropriate decision-making as paths are forged. A group of organizations called the Argonaut Project has committed to working with FHIR. HI7.org defines the Argonaut Project as having the purpose of developing “a first-generation API (application programming interface) and Core Data Services specification to enable expanded information sharing for electronic health records, documents, and other health information based on the FHIR specification.”

APIs are at work behind the scenes when we’re accessing information online. Although healthcare is beginning to harness the power of APIs these interfaces are present everywhere in our day-to-day lives. For example, say you are listening to Spotify and want to connect that application with Facebook. An API helps make that translation of information from Spotify to Facebook happen.  Imagine the possibilities in the realm of data and healthcare. The development of APIs by the Argonaut Project is just the beginning stages of data sharing and interoperability.

In order to reach true interoperability and efficient use of FHIR, the first step is EHR adoption. Once data is captured into an EHR system, organizations can focus on data standards and clear data management, and have the ability to measure impacts to healthcare patients, providers, costs, and communication. Without the right, accurate data input, interpretation at the end of the process is not accurate or actionable. If clinicians are aware of how their engagement with data and proper input at the beginning of this process affects their practice, their patient’s experience and health, and healthcare on a broad spectrum, they can make a difference well into the future.

Xerox is a sponsor of the Breakaway Thinking series of blog posts. The Breakaway Group is a leader in EHR and Health IT training.

Healthcare Applies Innovation from Other Industries for Big Impact – Breakaway Thinking

Posted on March 18, 2015 I Written By

The following is a guest blog post by Jennifer Bergeron, Learning and Development Manager at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Jennifer Bergeron

Healthcare is applying innovations from other industries to make advancements in the study of disease, surgery, and research. If you’re fascinated by new ways to use everyday tools and at the same time make life easier, also known as lifehacks, you can appreciate the same concept in healthcare.

3D imaging, cellphone camera technology, and sonograms like those used in underwater navigation are all being used in healthcare. Let’s begin with a look at cellphone technology and one way it is being applied to healthcare.

UCLA researchers developed a lens-free microscope that, through a series of steps, allows tissue samples to be formed into a 3D image using a microchip that is the same type found in your cellphone camera. The image shows contrast so the researcher can see tissue depth. This lens-free microscope also offers a broader, clearer view than conventional microscopes. The result is that “the pathologist’s diagnosis using the lens-free microscopic images proved accurate 99% of the time”, according to a recent study.   In order to apply this same concept to disease, imagine that a researcher could isolate a section of diseased tissue, remove it from its environment, color code the tissue to easily spot abnormalities, and have the ability to study it from all angles.

Techradar.com reminds us that lasers, used in missile defense, in the world’s fastest camera (which takes 6.1 million pictures per second), in entertainment devices such as Blu-ray players, and in grocery check-out lines, are also used in surgery and diagnoses. Lasers can decrease the diagnosis time and cause less disruption to a patient’s comfort. Zero-dilation Scanning Laser Opthmalogy (cSLO), a new imaging technique, can diagnose a patient with diabetic retinopathy, which causes progressive damage to the retina, in as little as 3 minutes.

Technology is not only impacting the patient experience, but how caregivers are brought up to speed on new technologies. In fact, the founder of The Breakaway Group based the company’s electronic health record (EHR) learning concept on flight simulation. Flight simulators train pilots how to maneuver in extreme circumstances, situations that would be difficult to create in real life. At The Breakaway Group, we use simulation technology to increase adoption of EHRs by training providers, nurses, and healthcare professionals.

Speed to proficiency, one of four key adoption elements of The Breakaway Method, provides learners with real-life situations in a safe environment.  Learners can quickly experience many different circumstances, fail, and learn to complete tasks correctly, all without affecting patient outcomes. In addition, The Breakaway Group can cut classroom time in half on average by using simulations.

Healthcare is reaching into other industries to become more efficient and effective. Whenever information is shared and innovations are repurposed to make a process better, we all benefit.

Xerox is a sponsor of the Breakaway Thinking series of blog posts. The Breakaway Group is a leader in EHR and Health IT training.

Measuring Steps to Patient Empowerment – Breakaway Thinking

Posted on November 19, 2014 I Written By

The following is a guest blog post by Jennifer Bergeron, Learning and Development Manager at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Jennifer Bergeron

Trends and fads come and go. When they stick, it’s clear they address a consumer need, whether it’s a service, promise, or hope. Here at The Breakaway Group, A Xerox Company (TBG), we operate within a proven methodology that includes metrics, and it’s exciting to those of us who can’t get enough of good data. Most people find metrics interesting, especially when they understand how it relates to them, and the results are something they can control. Metrics are powerful.

To understand the power of data in shaping behaviors, consider the popularity of the self-monitoring fitness tracker or wearable technology. Even as their accuracy is scrutinized, sales in 2014 are predicted to land somewhere in the $14 billion range.1 Do mobile fitness trackers actually help people change their activity habits? Could doctors actually use the data to help their patients? Can companies be built on the concept of improving health with a wearable device? Not conclusively.2 Does a dedicated athlete need this kind of information? Some think not.3

So what is driving the growth of the fitness tracker market and what are these devices offering that creates millions of dedicated users? The answer is real-time data, personalized goals and feedback, and a sense of control; in other words, empowerment.

In the 70s and 80s, my grandparents spoke about their doctor as though he were infallible. They didn’t doubt, question, or even note what he prescribed, but took his advice and dealt with the outcomes. If healing didn’t progress as planned, my grandmother blamed herself, as though she’d failed him.

Jump ahead a few decades when more emphasis is being placed on collaboration. We expect our physicians to work with us, rather than dictate our treatment decisions.4 Section 3506 of the Affordable Care Act, the Program to Facilitate Shared Decision Making, states that the U.S. Department of Health and Human Services is “required to establish a program that develops, tests and disseminates certificated patient decision aids.”5 The intent is to provide patients and caregivers educational materials that will help improve communication about treatment options and decisions.6

Patient portals are important tools in helping to build this foundation of shared information. The portals house and track patient health data on web-based platforms, enabling patients and physicians to easily collaborate on the patient’s health management.7  Use of patient portals is a Meaningful Use Stage 2 objective.

The first measure of meeting this objective states that more than half the patients seen during a specified Electronic Health Record reporting period must have online access to their records. The second measure puts the spotlight on the patient and their use of that web-based information. MU Stage 2 requires that more than 5% of a provider’s patients must have viewed, downloaded, or transmitted their information to another provider in order for the provider to qualify for financial incentives from the Federal government.8

Empowered consumers want information immediately, whether it’s a restaurant review, number of steps taken in the last hour, how many calories they’ve burned, or their most recent checkup results. We like to weigh the input, make a decision, and then take action. Learning and information intake, no matter the topic, is expected to happen fast.

Metrics show us where we stand and how far we’ve come, which empowers us to keep going or make a change, and then measure again. We’re in an age of wanting to know but also wanting to know what to do next. The wearable device market has met a very real need of consumers. Whether or not fitness trackers make us healthier, whether or not our doctors know what to do with the information, or if this is information an athlete would really use, these devices can serve the purpose of putting many people in control of their own health, one measurable step at a time.

Sources:
1 Harrop, D., Das, R., & Chansin G. (2014) . Wearable technology 2014-2024: Technologies, markets, forecasts. Retrieved from http://www.idtechex.com/research/reports/wearable-technology-2014-2024-technologies-markets-forecasts-000379.asp

2 Hixon, T. (2014) . Are health and fitness wearables running out of gas? Retrieved from  http://www.forbes.com/sites/toddhixon/2014/04/24/are-health-and-fitness-wearables-running-out-of-gas/

3 Real athletes don’t need wearable tech. (2014) . Retrieved from http://www.outsideonline.com/outdoor-gear/gear-shed/tech-talk/Real-Athletes-Dont-Need-Wearable-Tech.html

4 Chen, P. (2012) . Afraid to speak up at the doctor’s office. Retrieved from  http://well.blogs.nytimes.com/2012/05/31/afraid-to-speak-up-at-the-doctors-office/?_r=0

5 Informed Medical Decisions Foundation. (2011-2014) .  Affordable care act. Retrieved from http://www.informedmedicaldecisions.org/shared-decision-making-policy/federal-legislation/affordable-care-act/

6 HealthcareITNews. (2014) . Patient pjortals. Retrieved from http://www.healthcareitnews.com/directory/patient-portals

7 Bajarin, T. (2014) . Where wearable health gadgets are headed. Retrieved from http://time.com/2938202/health-fitness-gadgets/

8 HealthIT.gov. (2014) . Patient ability to electronically view, download & transmit (VDT) health information. Retrieved from http://www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures-2/patient-ability-electronically-view-download-transmit-vdt-health-information

Xerox is a sponsor of the Breakaway Thinking series of blog posts. The Breakaway Group is a leader in EHR and Health IT training.

Eyes Wide Shut – Patient Engagement Pitfalls Prior to Meaningful Use Reporting Period

Posted on June 30, 2014 I Written By

Mandi Bishop is a hardcore health data geek with a Master's in English and a passion for big data analytics, which she brings to her role as Dell Health’s Analytics Solutions Lead. She fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

July 1, 2015 – the start of the Meaningful Use Stage 1 Year 2 reporting period for the hospital facilities within this provider integrated delivery network (IDN). The day the 50% online access measure gets real. The day the inpatient summary CCDA MUST be made available online within 36 hours of discharge. The day we must overcome a steady 65% patient portal decline rate.

A quick recap for those who haven’t followed this series (and refresher for those who have): this IDN has multiple hospital facilities, primary care, and specialty practices, on disparate EMRs, all connecting to an HIE and one enterprise patient portal. There are 8 primary EMRs and more than 20 distinct patient identification (MRN) pools. And many entities within this IDN are attempting to attest to Meaningful Use Stage 2 this year.

For the purposes of this post, I’m ignoring CMS and the ONC’s new proposed rule that would, if adopted, allow entities to attest to Meaningful Use Stage 1 OR 2 measures, using 2011 OR 2014 CEHRT (or some combination thereof). Even if the proposed rule were sensible, it came too late for the hospitals which must start their reporting period in the third calendar quarter of 2014 in order to complete before the start of the fiscal year on October 1. For this IDN, the proposed rule isn’t changing anything.

Believe me, I would have welcomed change.

The purpose of the so-called “patient engagement” core measures is just that: engage patients in their healthcare, and liberate the data so that patients are empowered to have meaningful conversations with their providers, and to make informed health decisions. The intent is a good one. The result of releasing the EMR’s compilation of chart data to recently-discharged patients may not be.

I answered the phone on a Saturday, while standing in the middle of a shopping mall with my 12 year-old daughter, to discover a distraught man and one of my help desk representatives on the line. The man’s wife had been recently released from the hospital; they had been provided patient portal access to receive and review her records, and they were bewildered by the information given. The medications listed on the document were not the same as those his wife regularly takes, the lab section did not have any context provided for why the tests were ordered or what the results mean, there were a number of lab results missing that he knew had been performed, and the problems list did not seem to have any correlation to the diagnoses provided for the encounter.

Just the kind of call an IT geek wants to receive.

How do you explain to an 84 year-old man that his wife’s inpatient summary record contains only a snapshot of the information that was captured during that specific hospital encounter, by resources at each point in the patient experience, with widely-varied roles and educational backgrounds, with varied attention to detail, and only a vague awareness of how that information would then be pulled together and presented by technology that was built to meet the bare minimum standards for perfect-world test scenarios required by government mandates?

How do you tell him that the lab results are only what was available at time of discharge, not the pathology reports that had to be sent out for analysis and would not come back in time to meet the 36-hour deadline?

How do you tell him that the reasons there are so many discrepancies between what he sees on the document and what is available on the full chart are data entry errors, new workflow processes that have not yet been widely adopted by each member of the care team, and technical differences between EMRs in the interpretation of the IHE’s XML standards for how these CCDA documents were to be created?

EMR vendors have responded to that last question with, “If you use our tethered portal, you won’t have that problem. Our portal can present the data from our CCDA just fine.” But this doesn’t take into account the patient experience. As a consumer, I ask you: would you use online banking if you had to sign on to a different website, with a different username and password, for each account within the same bank? Why should it be acceptable for managing health information online to be less convenient than managing financial information?

How do hospital clinical and IT staff navigate this increasingly-frequent scenario that is occurring: explaining the data that patients now see?

I’m working hard to establish a clear delineation between answering technical and clinical questions, because I am not – by any stretch of the imagination – a clinician. I can explain deviations in the records presentation, I can explain the data that is and is not available – and why (which is NOT generally well-received), and I can explain the logical processes for patients to get their clinical questions answered.

Solving the other half of this equation – clinicians who understand the technical nuances which have become patient-facing, and who incorporate that knowledge into regular patient engagement to insure patients understand the limitations of their newly-liberated data – proves more challenging. In order to engage patients in the way the CMS Meaningful Use program mandates, have we effectively created a new hybrid role requirement for our healthcare providers?

And what fresh new hell have we created for some patients who seek wisdom from all this information they’ve been given?

Caveat – if you’re reading this, it’s likely you’re not the kind of patient who needs much explaining. You’re likely to do your own research on the data that’s presented on your CCDA outputs, and you have the context of the entire Meaningful Use initiative to understand why information is presented the way it is. But think – can your grandma read it and understand it on HER own?

Another View of Privacy by Dr. Deborah C. Peel, MD

Posted on June 25, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I thought the following TEDx video from Deborah C. Peel, MD, Founder and Chair of Patient Privacy Rights, would be an interesting contrast with some of the things that Andy Oram wrote in yesterday’s post titled “Not So Open: Redefining Goals for Sharing Health Data in Research“. Dr. Peel is incredibly passionate about protecting patient’s privacy and is working hard on that goal.

Dr. Peel is also trying to kick off a hashtag called #MyHealthDataIsMine. What do you think of the “hidden privacy and data breaches” that Dr. Peel talks about in the video? I look forward to hearing your thoughts on it.

Is Your EMR Compromising Patient Privacy?

Posted on November 20, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

Two prominent physicians this week pointed out a basic but, in the era of information as a commodity, sometimes overlooked truth about EMRs: They increase the number of people with access to your medical data thousands of times over.

Dr. Mary Jane Minkin said in a Wall Street Journal video panel on EMR and privacy that she dropped out of the Yale Medical Group and Medicare because she didn’t want her patients’ information to be part of an EMR.

She gave an example of why: Minkin, a gynecologist, once treated a patient for decreased libido. When the patient later visited a dermatologist in the Yale system, that sensitive bit of history appeared on a summary printout.

“She was outraged,” she told Journal reporter Melinda Beck. “She felt horrible that this dermatologist would know about her problem. She called us enraged for 10 or 15 minutes.”

Dr. Deborah Peel, an Austin psychiatrist and founder of the nonprofit group Patient Privacy Rights, said she’s concerned about the number of employees, vendors and others who can see patient records. Peel is a well-known privacy advocate but has been accused by some health IT leaders of scaremongering.

“What patients should be worried about is that they don’t have any control over the information,” she said. “It’s very different from the paper age where you knew where your records were. They were finite records and one person could look at them at a time.”

She added: “The kind of change in the number of people who can see and use your records is almost uncountable.”

Peel said the lack of privacy causes people to delay or avoid treatment for conditions such as cancer, depression and sexually transmitted infections.

But Dr. James Salwitz, a medical oncologist in New Jersey, said on the panel that the benefits of EMR, including greater coordination of care and reduced likelihood of medical errors, outweigh any risks.

The privacy debate doesn’t have clear answers. Paper records are, of course, not immune to being lost, stolen or mishandled.

In the case of Minkin’s patient, protests aside, it’s reasonable for each physician involved in her care to have access to the complete record. While she might not think certain parts of her history are relevant to particular doctors, spotting non-obvious connections is an astute clinician’s job. At any rate, even without an EMR, the same information might just as easily have landed with the dermatologist via fax.

That said, privacy advocates have legitimate concerns. Since it’s doubtful that healthcare will go back to paper, the best approach is to improve EMR technology and the procedures that go with it.

Plenty of work is underway.

For example, at the University of Texas at Arlington, researchers are leading a National Science Foundation project to keep healthcare data secure while ensuring that the anonymous records can be used for secondary analysis. They hope to produce groundbreaking algorithms and tools for identifying privacy leaks.

“It’s a fine line we’re walking,” Heng Huang, an associate professor at UT’s Arlington Computer Science & Engineering Department, said in a press release this month “We’re trying to preserve and protect sensitive data, but at the same time we’re trying to allow pertinent information to be read.”

When it comes to balancing technology with patient privacy, healthcare professionals will be walking a fine line for some time to come.

Health Data: Little White Lie Detector

Posted on December 31, 2012 I Written By

Mandi Bishop is a hardcore health data geek with a Master's in English and a passion for big data analytics, which she brings to her role as Dell Health’s Analytics Solutions Lead. She fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

As we bring 2012 to a close and ponder the new year ahead, many of us make resolutions to change something in our lives, and frequently, that something is our health. According to the University of Scranton Journal of Psychology, 47% of Americans make New Years Resolutions. Of those, the #1 New Years Resolution for 2012 is to lose weight. Staying fit and healthy and quitting smoking also appear in the top 10. Each of these health-related resolutions translates into quantifiable healthcare data that is, or can be, captured and measured to assist the resolution-makers in achieving their goals. Our calorie consumption and burn can be calculated, our blood oxygen level monitored, our ratio of fat:lean muscle mass tracked over time. If only we were all a bit more like George Washington, and couldn’t tell a lie, the success rate for annual resolutions would be higher than 8%.

The inclination to tell little white lies to protect ourselves from inconvenient, uncomfortable truths exists in all of us. “Do these jeans make my butt look fat,” meets, “Of course not,” rather than, “Yes, your butt DOES look fat in those jeans – but it’s not the jeans’ fault.” “Can Timmy come play,” warrants, “We already have plans – let’s rain check,” in lieu of, “Your child is a brat who cannot enter my home because I prefer to keep all my hair rooted in my scalp.”

Many, if not most, of us extend these white lies to ourselves. The dress that fit last month but doesn’t today “shrunk at the dry cleaner”. Cigarettes only smoked during cocktail hour don’t really count as “smoking”. You count the time you spend standing to give office presentations as “exercise”. You “usually” eat healthy, except for the tell-tale McDonald’s bags in your garbage showing a once-a-day burger and fries habit.

What if there were a way to identify and hold you accountable for these self-delusions – a health data lie detector? Would you change your behavior? Could you achieve your healthy resolution? And might it have a quantifiable impact on healthcare cost if you did?

I had a partial thyroidectomy a few years ago. A year after my surgery, I found I had gained 7 pounds in 11 days, was feeling lethargic and was having difficulty sleeping. As a very active adult who meticulously maintained body weight for a decade, I was disturbed, and convinced that my symptoms were a result of my remaining thyroid tissue failing. I went to my primary care physician to request a hormone test.

The nurse and doctor both agreed that, in 90% of cases, the root cause of weight gain is diet, and they asked myriad questions, capturing all my answers in the clinical notes of their EMR: had I been eating differently, had I altered my exercise routine, had I been traveling. I was adamant that nothing had drastically changed. Given my fitness and history, they agreed to order the hormone test, and a blood vitamin test, as well.

All lab work came back normal. BETTER than normal. So I retraced every detail of my routine over those 11 days. And I discovered the culprit: office candy.

A bad meeting one day led to grabbing a handful of chocolates from one co-workers bowl, which became grabbing a handful of chocolates from each bowl I encountered on my department’s floor…several times a day. Did you know there are 35 calories in a single Hershey’s kiss? 220 calories in a handful of peanut M&Ms? 96 calories in a mini-Butterfinger bar? Turns out, I was eating between 500-700 calories a day in office candy. And that wasn’t all.

Along with the chocolate snacks, I’d fallen into some poor nutrition habits at meals. I started to consume other starchy carbs regularly: the pre-dinner bread basket at restaurants, pizza, pasta, sandwich bread. I didn’t feel I ate to excess, but I also didn’t take into account the difference in nutrient density between the mass quantities of fruits and vegetables I had been eating for years, and the smaller (yet still plentiful) quantities of processed starches I was currently eating.

The changes in diet likely disturbed my sleeping pattern and led to my lethargy, which in turn made my daily workouts less intense and effective at calorie-burning.

In short, my weight gain was legit, and the two doctor visits and the lab tests could have been avoided had I been completely honest with myself. I cost each actor in the healthcare system money with my self-deluding little white lie: the office administrative staff, the LRNP, the doctor, the medical coder, the lab, the insurance company, myself. There is also a per-transaction cost associated with each HIPAA-covered request that the doctors’ office EMR and lab information system generated. Given that I have only been to the doctor three times this year, and twice was for this weight gain concern, one could accurately conclude that 66% of my annual medical costs could have been avoided in 2012.

The health data exists within Meaningful Use-certified EMR systems to capture and communicate both the absolute data (height, weight, lab results, etc.) and the unstructured notes data (patient comments, doctor notes, responses to questionnaires, etc.). The capability to automatically compare the absolute with the unstructured data already exists. It wouldn’t take an inordinate amount of effort to program a lie detector to call out many of the most common little white lies.

What would happen to medical cost if we stopped lying to ourselves, and to our healthcare providers? And how high a percentage of the nation’s total healthcare bill could be avoided by this type of analysis? Better still, how much would the healthcare industry change if patients not only took responsibility for their own action/inaction, but modified their behaviors accordingly?

I’ll tell you what happened to me. I dropped the candy and starchy carbs, and I lost those 7 pounds. Keeping them off will be 2013’s New Years Resolution.

Patients and EMRs, EMR Value, and Healthy Food Guide: Around Healthcare Scene

Posted on November 18, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Hospital EMR and EHR

What do Patients Need From EMRs?

Meaningful Use Stage 3 requires that EMRs be accessible by both patients and providers for comments. This post contains several suggestions for what patient data must include. Some points discussed include links to medical information (to help identify unfamiliar terms), the ability to view information in different views, and mobile access to health information.

Adolescent Data Needs Stronger EMR Protections, Group Says

The AAP recently came out with a statement concerning the protection of adolescents in EMR. They believe that adolescents don’t enjoy the same protection as adults do, and this needs to change. To help with this, the AAP has presented a list of principals that should “govern” EMRs, PHRs, and HIEs. Some of the ideas include creating criteria for EMRs that meed standards for adolescent privacy, and flexibility within standards for protection of privacy for diagnoses, lab tests, etc. These new suggestions will place an added burden on EMR vendors.

EMR and EHR

EMR Value Diminished If Patients Can’t Access Care

A recent study was released that analyzed primary care practices in 10 countries around the world. While it indicated that more US physicians are using EMRs than in the past, a large percentage patients in the US are still struggling to pay for health treatments. This is well-below the numbers from other countries surveyed. This may suggest that even if EMR is in use, it doesn’t really matter if patients can’t afford getting help.

New Healthcare Facility Experiences IT Growing Pains

Jennifer Dennard recently has to visit a new facility in the area in order to treat an illness. She was pleasantly surprised with the facility, and recounts her experience here. However, she discusses some of the IT “growing pains” the facility is experiencing, such as still using paper prescriptions.

Smart Phone Health Care

Healthy Food Guide Uses MyPlate.Gov Standards to Track Calories

There are many mobile food diaries available, and a new one just hit the market. Healthy Food Guide puts a twist on the typical calorie counting idea, and helps its users make sure they are getting enough of each food group. There’s a few glitches here and there that need to be worked out, but it’s a neat little alternative to some of the other diaries out there, because of how simple and to the point it is.

EMR Vendors, Patient Privacy, and Election Day — #HITsm Chat Highlights

Posted on November 17, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Topic One: When EMR vendors leave the marketplace or discontinue a product, how can usability be sustained?

Topic Two: How do we protect patient privacy with payer-based HIEs?

 

Topic Three: How can we draw attention to patient safety in the U.S. prison system?

Topic Four: Are we over the election and back to business as usual with healthcare?