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Study Shows Value of NLP in Pinpointing Quality Defects

Posted on August 25, 2011 I Written By

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?


EMR Quality Metrics

Posted on July 12, 2010 I Written By

John Lynn is the Founder of the 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 and 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’m completely fascinated by stats and metrics. I’m not sure what it is, but it’s like a drug for me. Looking at charts of what’s happening on my blog is like a little shot of adrenaline. Turns out that this isn’t just true for me. It’s true for many bloggers.

So, of course I was interested when I got an email talking about SOAPware EMR’s quality metrics. Ok, so I was a little misled by the title. At first, I thought I was going to see some really interesting metrics on how SOAPware EMR had improved the quality of patient care that was provided. I expected some really interesting initiatives and collaborations with doctors around improving patient care. Instead, it was a post about the quality of support that SOAPware offers their clients.

While not quite what I was hoping to see, it’s still really interesting to have a high level view of the type of support an EMR vendor offers. Finding an EMR company that provides top notch support is an essential part of selecting an EMR and I commend SOAPware for making what appears to be a sincere effort to measure and improve the support they offer.

Of course, they stopped short of publishing what would be the most interesting part of the survey results. Yes, I’m talking about the narrative answers to the question: “Any additional comments” That would likely be a pretty interesting read. They do address them generally when they say, “The negatives that we currently see in the comments are most often about appointments with support that were late, or return calls that had delayed response times. These are part of our growing pains, and we are taking actions to address these issues.”

I love seeing EMR companies taking a pro active role in providing great support for their EMR. Trust me. You don’t want to be using an EMR where you can’t get support from your EMR vendor.