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Preventable Issues Arise When Paper Documentation is Used

It’s an unfortunate truth that the health care system is not fool proof, and mistakes happen. Many of these mistakes happen because of paperwork that is lost, unreadable, or misplaced. Even with the implementation of EMRs across the country, many healthcare providers are still relying on paper for many aspects of their practice. Referral MD created an infographic that shows some of the current problems in healthcare related to using paper documents:

Pretty scary, if you ask me. Doctor’s are notorious for having terrible handwriting, but 7000 patients die a year because of it? And 30 percent of tests have to be reordered because the orders were misplaced? These statistics are startling, in large part because they are preventable. Those are only two of the facts presented in this infographic, and in combination with everything else, it makes me wonder why anyone that has an EMR would still use paper, and why the practices that don’t use EMRs haven’t started. It makes me not want to trust the system even more.

I can see how patients and doctors alike may find it hard to switch over. When I wasn’t given a physical, paper prescription to take to the pharmacy to get my son’s medication, I was a bit taken back, but it made things so much easier when I actually arrived at the pharmacy. I compare that to the many prescriptions and lab orders I lost during my pregnancy because I set it down and forgot to pick it up again, never to find it again until months later while doing some cleaning. It made me really wish my OB/GYN had electronic documents more incorporated into his practice. I’m curious to see if he has any EMR at all. Since he’s been a doctor for 40+ years, maybe he’s having a hard time making the switch.

It’s one thing if a person dies from a terminal illness, but to pass away because of a preventable mistake is uncalled for. I realize that no one is perfect. Everyone makes mistakes. But when a mistake could mean someone dying, a patient’s information being misused, or a HIPAA violation occurring, something is wrong. Hopefully as EMRs become better and more practices have them, paper documentation will become a thing of the past, and these mistakes, breeches, and all other issues that are related to using paper, will go that way as well.

November 5, 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.

Life After EMR Implementation

I spent a lifetime as an IT developer before I landed my present gig as technical writer in a health IT company. I can tell you from experience, that for many development teams, the implementation date is the biggie that the developers are racing against. And yet, the real fun often starts post-implementation. It’s not that different even with EMR implementation, you’ll be happy to know, at least according to this article at CMIO.net

According to the story, here’s what happened at Hospital Sisters Health System in Wisconsin and Illinois: A couple of months after their CPOE (Computerized Physician Order Entry) and EHR went live, the CIO received a letter with listing 38 issues faced by physicians using the EMR, with an ultimatum that these problems be fixed within two weeks. Half were known issues, and another quarter were training related. But even so, “The installation team was taken aback by the letter, including the physician champion.”

Now, not every IT project is like the one described but here are some lessons worth repeating from the Hospital Sisters example:

  • Prepare, prepare, prepare: That there will be unexpected issues is a given. The problem is not that issues crop up. How prepared you are – knowing how, when, who will handle glitches – is the difference between success and failure.
  • Train Your Users: I honestly get turned off when someone utters “It’s self-explanatory, really,” when it’s related to a software product. Yes, it might be, to you, tech geek, but not everyone was born with the chip embedded in their being. Expect to spend some time training your end users. Well-structured training sessions not only impart the know-how but can also be crucial rapport-building occasions with your buyers.
  • Support Your Users: After the initial euphoria of product launch, using your product might actually bring down the productivity some as users get used to using your product on a regular basis.
November 7, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now writes about healthcare, science and technology as well as traditional news features.

Health It in New Zealand Vs US: A Comparison

I’d been corresponding with a PR person for a story I’m doing on ambulatory exoskeletons. She dug me up on Twitter, figured I dabbled in a few things health IT and asked if I would be interested in a recently published report on how health IT influences New Zealand’s healthcare. Now, unbeknownst to her, I also have an abiding interest in all things Kiwi, having lived in Wellington for a brief bit of time, so I was curious to know what this report contained.

The press release introducing the report started with an endorsement from John D. Halamka, so that was a huge plus in its favor. It outlined things that New Zealand has done right:
– It has a population the size of Colorado, and ranks 23rd among OECD countries (Organization for Economic Cooperation and Development, basically all of Europe, Aus and NZ, US, Canada, Mexico and industrialized nations in Asia) but is ranked number 1 or number 2 in several healthcare categories, including overall quality care delivery (92%), EMR use by doctors (97%), use of computerized patient care reminders (92%)
– Demographically similar to the US in terms of urban/rural population split (86:14 NZ, 81:19 US), Information and Communication Technology development index, has lower physician, nurse and dentist density per 10,000 (NZ: 87,4,10 resply, US: 27, 98, 16 resply) but spends far less than the US on healthcare (NZ spends 9.8 percent of its GDP, US spends about 16 percent of its GDP)

There are far too many of these interesting compare and contrast stats for me to do justice to them in this little space, so I’ll suggest you read the report in its entirety (Do not look at Table 5 if you want to avoid serious heartburn). There are some interesting case studies towards the end of the report and plenty to keep you busy reading for quite some time.

For me, the most interesting part of the report dealt with how far NZ health infrastructure has come since its national medical IT policy was implemented in 2005. New Zealand, as the report states, has a single layer of national government, low population size, making it easier to implement a standard health IT policy. However, it’s also interesting what they’ve been able to achieve infrastructurally, which is the establishment of the National Health Index, the Health Practitioner Index and a Medical Warnings System.

To those of us who associate indices with performance, the National Health “Index” seems clunkily named, and is not a measure of how healthy Kiwis are. New Zealand’s NHI is really a kind of health ID assigned to each patient who uses the country’s health and disability support services. The report says children born in New Zealand are automatically assigned an NHI at birth and about 95 percent of the population have their NHI. Where the NHI comes handy is in tracking of patient medical records. Whether a patient moves from hospital to community to private care or any combination you can think of, all EMR documentation generated along the way reference the unique NHI for the patient. The same concept applies to Health Practitioner Index, which is again a unique ID identifying every medical practitioner in a myriad of medical professions.

The Medical Warnings System is probably the most interesting piece of the New Zealand health infrastructure. It is a system containing details of all significant medical conditions associated with the patient. A flag against the NHI tells health workers that the patient has, say, a significant medical condition, or is allergic to some medicines.

Put together, this report paints us a picture of where we could take US healthcare over the next few years – from a logical way to collect patient data under one ID to a comprehensive electronics warnings system that takes the guesswork out of care. (One could argue that the American SSN serves pretty much the same purpose, but we certainly don’t have a system where records are organized by SSN, or used by health workers to communicate with one another.)

October 24, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now writes about healthcare, science and technology as well as traditional news features.

EMRs and Templates: How to Avoid the Pitfalls of Boilerplating

On Kevin MD, there was a recent post about the problems associated with templating and John mentioned in his weekend EHR Twitter roundup. Some EMRs provide automation for notes so that a provider can check a few boxes regarding symptoms and have a patient note generated on the fly. While such a methodology works for a wide majority of patients a provider might see, it doesn’t for the one-off cases who present to the provider with certain problems and have something different going on. The author calls for a health IT products to function as decision support systems, meaning systems that allow for templating while at the same time encourage the provider to think through how a particular case might not fit the usual profile.

This study in Health Care Management Review pretty much comes down on templating. The study interviewed 78 physicians on how EMRs affect the skills of physicians. Yes, n=78 means we need to take this study with a pinch of salt, or more research is needed, but what’s revealed is pretty fascinating.

Physicians cut-and-paste too: Hey, I’m the last person to come down on using Ctrl-C/Ctrl-V. I’m doing it each time I write a blog post (albeit with attribution.) “A key dynamic with using EMRs involved the perceived ease by which a physician could use an EMR to “cut and paste” identical assessments of patients with similar clinical diagnoses or issues into several different patient records.”

It is better to get it “written” than right: Here’s something straight out of How to Write a Novel in 5 Days type self-motivation books. “The homogeneity of different patient visit notes convinced these PCPs that some physicians… favored the basic need to complete a patient EMR in a timely manner over the care management need to say something accurate and unique with regard to each individual visit.”

There’s way too much noise: Physicians interviewed recalled how specialists provided 6-8 line summaries of patients which contained everything a doctor needed to know about the patient’s visit – “[t]here was all signal, and no noise. Now as we review what specialists do in an EMR, and even what we do in primary care, what I miss is the narrative.” What you’re getting by checking a lot of boxes is copious documentation that says precious little, and makes you wade through the mire to get to the precious nuggets.

While I’m trying to poke some (I hope gentle) fun at the study’s findings, I’ve also been thinking along the lines of what features of an EMR system would help. One clue lies in the study itself: the physicians recalled how paper records forced them to dictate “certain amount of unique verbiage for transcription into a patient’s record.”

So maybe we need EMRs that:

  • combine voice recognition, so that the physician can continue to dictate patient notes
  • have Thesaurus like features to generate verbiage that at least uses interesting synonyms and phrases to give the appearance of uniqueness
  • don’t allow physicians to generate automated notes at all

What do you think will make things easier without boilerplating patient information?

October 10, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now writes about healthcare, science and technology as well as traditional news features.

Electronic Health and the Non-Digerati

Everytime we discuss something innovative and interesting to do with our lives, my friend comes up with yet another app or game we should design and market via the App Stores and live richly and happily forever. And I, true to my vaguely creative pursuits, always state that not every problem has a solution rooted in IT or mobile phones or the next iThingamajig. While this is a strange admission to make on a blog that is titled “EMR Thoughts”, bear with me. For example, there are entire classes of problems that IT cannot solve – such as whether the water in a village well is potable, or ensuring that there is enough food for a growing world populace, our collective Farmville skills notwithstanding.

Today I was reading John Moore’s report of the recent SFO Health2Con, where I felt he addressed a health version of the same discussion my friend and I have. More on that later. First the reviews.

Moore says:
– the Health2Con demos sported cleaner interfaces, better UI,
– had more realistic business models (fewer free/Freemium models).

On the not-so-great news side:
– mobile health is cheap and the “it” technology of the moment but Moore doesn’t think anyone’s figured out how to use it,
– demos rarely give enough detail to be instructive,
– And if he cannot deal with any more demos that call for gamification or Facebookization as a way to approach health (I hear him)

Then about midway through the post, he made a comment that made me sit up and take note:

“[Health IT Vendors] want to make a difference. That passion is contagious. Unfortunately, that passion appears to be confined to the digerati [digital literati]

Maybe the most disturbing part of the event was the on-stage interview with a mother of eight kids (she was white, middle age and clearly upper middle class) showing how her family is tapped into the quantified self movement with the various Apps they use to track their health and fitness. This is not representative of the broad swath of the American populace who are the ones that will drive our healthcare system off the proverbial cliff. It is that grandmother in Indiana who is caring for her diabetic, overweight husband, two grandchildren, a daughter suffering from an addiction and a son-in-law who is unemployed and has no health insurance that we need to talk to, have up on stage to tell us what they need to better manage their health and interaction with the healthcare system.”

Another post on iHealthbeat clearly examines the motivations behind our health IT thrust.

EMRs/EHRs will make healthcare efficient and reduce costs. Engaged, empowered patients will take charge of their own health and again bring down health costs. These are some assumptions we hold to be true.

The problem with these assumptions that they don’t take into account the non-IT savvy grandmother problem. How do we reach her and others like her? A particularly trenchant comment from commenter Kim Slocum on iHealthBeat says:

We know that half the US population consumes essentially all the nation’s health care resources.

I’m guessing that a large proportion of high car(sic) utilizers are also off-line and currently unreachable via this medium (e.g. dual eligibles and substantial fraction of the Medicare population). If that’s true, a lot of the “Health 2.0″ buzz is misguided if it is thought to be a vehicle to bend the cost curve via “consumer engagement.”

Something to think about. John Moore’s post is here, and the iHealthbeat post is here.

October 3, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now writes about healthcare, science and technology as well as traditional news features.

Who Owns Patient Data?

Recently, on The Healthcare Blog, there was a really interesting post by Dr. Marya Silberberg about why patient lab data should be liberated. She recommends lab results be sent to patients at the same time that they’re sent to doctors. Dr. Silberberg does an admirable job of looking at the patient data issue from both sides. From the patient’s perspective, it is really not that hard to understand. If you’ve ever transferred your (paper) records from one doctor to another, or you’ve spent a month or more waiting for your doctor’s office to call you with their interpretation of lab test results, you’ve known the pain. It’s your data, about your body, your health, and you really have no way to access it if you have something of a grinch gatekeeping the records at your doctor’s office.

I’m no doctor, but I get you too. There are way too many paranoid, entitled people in the world, and chances are they’re your patients. Handing patients their lab records is the best way to make sure your office is inundated with callers demanding to talk to the doctor right now, and many of them will just be non-emergency calls.

Having said that, I wasn’t a huge fan of commenter Dr Mike’s response to the post:

“If I ordered the test, the results should be returned to me first, if you ordered the test, the results can come to you. So go order your own lab tests and then you won’t have to wait for me to get through that mountain of paper on my desk. Not sure your insurer will want to play along as you play doctor though

Part of the problem is that patients don’t understand that I am not on retainer for them. In the good ol’ days the docs cared for their friends and neighbor’s and community, and had a personal and financial interest in each individual. But today I don’t have a contract with you, I have one with your insurer, and together the two of us have pretty much locked you out of the decision process, and you have allowed this to happen.”

 

Whoa, them’s fighting words. Patient data access doesn’t have to be an adversarial experience. If you, the doctor, are spending an inordinate amount of time explaining lab results to patients, it’s only fair you be compensated for your consultancy in some way. And you, the patient, must stop thinking of access to patient data as a zero-cost right you can exercise. A tiered insurance plan offering could very well take care of phone-consultancy and patient-lab-reporting costs. If I or a loved one had a condition that required me to look over lab reports and such, I would happily pay a few dollars extra a month for that privilege. And for all the concerns about how the average user can’t understand what the lab results say, it’s surely not impossible in this day and age that lab reports sent to non-medical recipients be in human readable form.

Check out the post here.

September 26, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now writes about healthcare, science and technology as well as traditional news features.

Welcome to the New EMR Thoughts!!

Thanks for stopping by the new EMR thoughts website. Our goal is to provide the best (or at least most random) thoughts about EMR and EHR on the net. There’s no guarantee what you might find on here. They might be long exposes on EMR and EHR or they might be a short one line sentence or quote. Probably more of the later though.

This will be an open place where myself and others will have the platform to express strong opinions and ideas. Sure we’ll be respectable and professional, but hopefully this blog will stretch the envelope a little bit and causes people to think a little bit harder about the future of EMR and EHR.

It may take us a little bit to get all set up, but watch for great Healthcare IT and EMR related content coming your way really soon. Until then, be sure to go and check out the other Healthcare Scene blogs.

April 14, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.