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Intermountain Uses EMR To Share Radiation Exposure

Posted on May 24, 2013 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

It’s a well-known and worrisome trend that patients are receiving potentially harmful doses of  radiation from tests such as CT scans. Generally speaking, though, neither patients nor clinicians know exactly how much radiation exposure an individual has received.

At Intermountain Healthcare, however,  they’re hoping to change this state of affairs. The Salt Lake City-based health system of 22 hospitals and 185 clinics is launching what the Wall Street Journal says is the first major effort to measure and report patients’ cumulative radiation exposure.

Intermountain’s effort is focused on the tests that produce the highest amount of radiation, including CT scans, nuclear medicine scans and interventional radiology exams of the heart, the WSJ reports.  As part of an effort to educate clinicians and patients about medical radiation, both will be able to access data on patient exposure levels through Intermountain’s EMR.

The idea behind listing a patient’s radiation exposure is to encourage both clinician and patient to consider the risks and benefits of a particular test and at times, avoid the test if the needed information can be obtained with a radiation-free test, the WSJ piece says.

In a typical year, Intermountain’s patients receive 220,000 CT scans and radiology procedures, so data that helps patient and doctor consider alternatives could conceivably have a meaningful effect, clinicians there say.

Intermountain is not the only hospital system to focus on tracking radiation doses. For example, Hospital Corporation of America, the largest for-profit hospital system, is kicking off a new “Radiation Right” campaign tracking patient doses, the newspaper reports. But it does seem to be the only chain sharing the data with patients via an EMR.

Realistically, these efforts are still in their infancy, as researchers don’t know how much of a cumulative dose of radiation directly increases cancer risk. Still, this does seem like an excellent use of the EMR as a collaborative tool engaging patients in making better-informed health decisions.

Is Meaningful Use a Floor or Ceiling?

Posted on June 9, 2011 I Written By

I was witness to an interesting discussion earlier this week at the Wisconsin Technology Network’s Digital Healthcare Conference in Madison, Wis.: Is meaningful use a floor or a ceiling?

One panelist, Judy Murphy, VP of information services at Aurora Health Care in Milwaukee, said Stage 1 meaningful use has caused the health system to alter its own IT plans by activating a patient portal and moving more toward interoperability sooner than intended. “We wouldn’t have decided to give electronic copies of clinical summaries at discharge [without meaningful use],” Murphy said.

But Murphy believes it’s a floor for many of the criteria, such as the requirement that 30 percent of patients have at least one medication order entered electronically. “No one would go into an implementation shooting so low,” she said. As a member of the Health IT Policy Committee as well as the Meaningful Use Workgroup of the Health IT Policy Committee, Murphy actually had a hand in shaping the standards. (Remember, though, the original proposal called for 10 percent for hospitals and 80 percent for physicians. The final Stage 1 rule set the threshold at 30 percent for both.)

Gartner analyst Vi Shaffer offered a counterpoint. “Meaningful use is not the floor,” she said. “All the existing quality measures that have been out there so long should be considered the floor.” Shaffer expressed frustration that so many 12-year-old National Quality Forum performance measures still haven’t been met.

According to Shaffer, the idea behind meaningful use is to “lift people up,” particularly when it comes to safety-net providers like critical-access hospitals. Shaffer said policymakers didn’t want to see “oligopolies” in local markets because smaller providers were forced to merge with large health systems because of EHR requirements.

Session moderator Dr. Barry Chaiken, chief medical officer at Docs Network Imprivata, and a former HIMSS chair, said he believes health IT will raise the norm for all providers and “lock in” better behaviors, suggesting that in some ways, meaningful use could be a floor.

By holding the conference in Madison, WTN was able to land the publicity-shy Judy Faulkner, CEO of Epic Systems in nearby Verona, Wis. Faulker noted that Epic shows a simpler version of its core EHR in overseas markets because the company had to add some functions for regulation and liability purposes in the U.S.

While plenty of providers are viewing meaningful use as a ceiling right now–perhaps an unattainable one–Murphy believes acceptance will come rapidly. “I think in 2015, we’re gonna look and say, ‘How did we even have healthcare without computers?'” Murphy said. She then said she had heard that HCA would attest this year to meaningful use at all of its U.S. hospitals.

Being the occasionally motivated reporter that I am, I tweeted this statement, asking for verification. Wouldn’t you know, HCA replied with this tweet: “Nearly all HCA facilities should achieve requirements 4 Stage I this yr. An exciting, important step for high-performance hcare!”

So maybe meaningful use is not a floor or ceiling, but the new norm.

What are your thoughts?

CORRECTION, June 13: Chaiken’s one-year contract with Imprivata is over, so he’s no longer affiliated with that company.