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EMR & Patient Safety, Meaningful EHR Measures, and the Patient Portal “Switch”

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What an important topic of discussion. In fact, it makes me want to look at writing a whole series of articles on the patient safety issues using an EMR and also the patient safety issues of not using an EMR. Much of it I’ll be covering in my EHR benefits series, but quite a different angle. Although, the ethics side of it could be really interested. I’m glad Dr. Wes is starting this discussion.


I keep wishing it was interoperability, but I do think we could go way too far when it comes to adding more measures and end up with measures that provide little to no value if we’re not careful.


I love that people think that implementing a patient portal is as easy as flipping a switch. I can have a full EMR at my fingertips in 2 minutes by signing up at one of the Free EHR, but that misses so many important parts of implementing an EMR. The same goes for a portal. It takes a little more thought to implement a patient portal than just flipping a switch.

January 20, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Top 10 Medical Technology Hazards List – “Top 10″ Health IT List Series

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This next list I found in my series of Top Health IT lists is going to be one that I think surprises quite a few people. It’s the list (PDF) of Top 10 Technology Hazards for 2012 by the ECRI. The Power Your Practice website did an interview with James P. Keller Jr. who works at the ECRI Institute about this list which is worth reading. Before the interview, they explain that the ECRI (Emergency Care Research Institute) was created in 1964 after a young boy in a Philadelphia ER passed away as a result of an improperly preserved defibrillator.

For this list, I’m not planning to go through each item, but I will list each item:
1. Alarm hazards
2. Exposure hazards from radiation therapy and CT
3. Medication administration errors using infusion pumps
4. Cross-contamination from flexible endoscopes
5. Inattention to change management for medical device connectivity
6. Enteral feeding misconnections
7. Surgical fires
8. Needlesticks and other sharps injuries
9. Anesthesia hazards due to incomplete pre-use inspection
10. Poor usability of home-use medical devices

The PDF document above goes into a lot more detail for each of these items including suggestions on ways to prevent these problems. I imagine many hospital safety organizations already know about these things and lists like this one.

Many are probably wondering why I’m bringing this list up on an EMR and HIPAA website. Besides the fact that the list is interesting on its own, I was also really intrigued that there’s nothing on the list that’s even remotely related to EMR & EHR software.

I’m sure if we sat down for just a little bit we could think of quite a few technology hazards related to EMR and EHR software. Not the least of which is EHR down time. I’m also reminded of this post I did earlier this year titled “EMR Perpetuates Misinformation.” Yet, EHR didn’t make the list…yet(?).

It will be interesting to watch this health technology hazards list over time to see if EHR software ever makes the list. I wonder how many hospital patient safety groups are worried about the safety of EHR software. I’ll have to get Katherine Rourke to dig into this over on Hospital EMR and EHR.

Be sure to read the rest of my Health IT Top 10 as they’re posted.

December 29, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Study Shows Value of NLP in Pinpointing Quality Defects

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For years, we’ve heard about how much clinical information is locked away in payer databases. Payers have offered to provide clinical summaries, electronic and otherwise, The problem is, it’s potentially inaccurate clinical information because it’s all based on billing claims. (Don’t believe me? Just ask “E-Patient” Dave de Bronkart.) It is for this reason that I don’t much trust “quality” ratings based on claims data.

Just how much of a difference there was between claims data and true clinical data hasn’t been so clear, though. Until today.

A paper just published online in the Journal of the American Medical Association found that searching EMRs with natural-language processing identified up to 12 times the number of pneumonia cases and twice the rate of kidney failure and sepsis as did searches based on billing codes—ironically called “patient safety indicators” in the study—for patients admitted for surgery at six VA hospitals. That means that hundreds of the nearly 3,000 patients whose were reviewed had postoperative complications that didn’t show up in quality and performance reports.

Just think of the implications of that as we move toward Accountable Care Organizations and outcomes-based reimbursement. If healthcare continues to rely on claims data for “quality” measurement, facilities that don’t take steps to prevent complications and reduce hospital-acquired infections could score just as high—and earn just as much bonus money—as those hospitals truly committed to patient safety. If so, quality rankings will remain false, subjective measures of true performance.

So how do we remedy this? It may not be so easy. As Cerner’s Dr. David McCallie told Bloomberg News, it will take a lot of reprogramming to embed natural-language search into existing EMRs, and doing so could, according to the Bloomberg story, “destabilize software systems” and necessitate a lot more training for physicians.

I’m no technical expert, so I don’t know how NLP could destabilize software. From a layman’s perspective, it almost sounds as if vendors don’t want to put the time and effort into redesigning their products. Could it be?

I suppose there is still a chance that HHS could require NLP in Stage 3 of meaningful use—it’s not gonna happen for Stage 2—but I’m sure vendors and providers alike will say it’s too difficult. They may even say there just isn’t enough evidence; this JAMA study certainly would have to be replicated and corroborated. But are you willing to take the chance that the hospital you visit for surgery doesn’t have any real incentive to take steps to prevent complications?

 

August 25, 2011 I Written By

Highly Functional EMRs Aren’t Necessarily High-Functioning

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I’ve just turned in a story for InformationWeek Healthcare about the new “Essentials of the U.S. Hospital IT Market, 6th Edition” report from HIMSS Analytics. That report details the progress hospitals and integrated delivery networks have made in IT over the past year and gives an update on how far along providers are according to the HIMSS Analytics EMR Adoption Model. That’s the seven-level scale (eight if you count Stage Zero) that measures adoption of various EMR components.

At the top of the scale, 1 percent of nonfederal hospitals in the U.S. attained Stage 7 in 2010, meaning that the EMR served as the legal medical record for all departments, was capable of exporting patient records as Continuity of Care Documents and had data warehousing and mining in place. That was up from 0.7 percent in 2009. The number of Stage 6 hospitals—with electronic clinician documentation, full clinical decision support and full PACS for radiology—doubled in the same time frame, from 1.8 percent in 2009 to 3.2 percent in 2010.

Here’s how the entire scale breaks down:

 

Actually, the EMRAM Web page shows newer numbers, through the 2011 second quarter. We’re up to 1.1 percent for Stage 7, 4 percent for Stage 6, 6.1 percent for Stage 5 and 12.3 percent for Stage 4. HIMSS considers Stage 4 to be the closest to the current requirements for “meaningful use” of EMRs.

It’s nice to see progress in installing technology and it’s nice to see hospitals using EMRs in a “meaningful” way, but that doesn’t mean there won’t be problems. As everyone in health IT knows, EMR certification, a prerequisite for meaningful use, does not measure usability, and this still is the first of three stages for meaningful use. That means we’re a long way from perfect, or even ideal. How do I know this?

The mother of a good friend of mine is now on dialysis and eventually will need a kidney transplant because she was given a medication that is contraindicated for Type 2 diabetes, which she suffers from. The harmful interaction resulted in her losing about 80 percent of normal kidney function. This happened at a HIMSS Analytics EMRAM Stage 7 hospital. Apparently, either the patient record didn’t show she was diabetic, the medication order didn’t get flagged, or the ordering physician, pharmacy and administering nurse all missed or ignored an alert. As the chart above illustrates, the medication loop should have been closed by Stage 5.

I’m not going to name the hospital or give any more details because there’s a good chance a malpractice suit is coming. I’m also aware of a medical informaticist with a long history of implementing and working with EMRs losing his mother due to a medical error that an EMR exacerbated. Again, I’ve been asked not to say more because of the legal ramifications.

It’s no secret that healthcare is in trouble. In this push to install technology and earn Medicare and Medicaid bonuses for meaningful use, we can’t take our eyes off the ultimate goal, creating a safer health system.

July 28, 2011 I Written By