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Wednesday, September 12, 2012

“Federal funding of IT was a step in the right direction, but it has also created a guaranteed customer base for electronic medical records, so vendors have less incentive to improve their products to meet clinicians needs.”

Is ‘Meaningful Use’ Safe?
Despite CMS praise, clinicians are wary of health IT shortcomings
...Last November, the Institute of Medicine (IOM) released a scathing critique of HIT’s current ability to ensure patient safety. As the federal government invests billions of dollars to encourage hospitals and healthcare providers to adopt HIT, the IOM report said, improvements in care and safety are not yet established, and little evidence exists that quantifies the magnitude of the risk associated with HIT problems—partly because many HIT vendors discourage providers from sharing patient-safety concerns with nondisclosure and “hold harmless” provisions in contracts that shift the liability of unsafe HIT features to care providers...
...“Vendors typically regard usability of their products as a convenience request by clinicians; any errors are regarded as training issues for physicians,” Dr. Rogers says. “But the way that data is presented on a screen matters—if it is difficult to input or retrieve data and leads to cognitive or process errors, that’s a product redesign issue for which vendors should be held accountable.”

Dr. Koppel says many HIT systems originated from billing system applications “and were not initially designed with the clinical perspective in mind. Hospitalists have to be particularly focused on usability of HIT systems when it comes to patient-safety impacts. They’re not the canary in the coal mine, they’re the miners—often the teachers guiding other clinicians on HIT use.”...
Click the title for the link. Read the entire article. Discusses many of the issues that I've been airing since I started this blog. Per the title of this post, it's difficult to argue with critics who argue that the HITECH initiative has been in large measure a corporate welfare program in which already stressed EPs and EHs principally serve as conduits for federal dollars.

And here I am on numerous occasions, biting the hand that feeds me personally. Kinda like Jonathan Bush.


It being National Health IT Week in Washington, US House Rep. Phil Gingrey (R-GA), an OB/GYN and co-chair of the GOP Doctors Caucus, stopped in to express his support for EHRs, despite the fact that “lots of doctors aren’t happy with EHRs…they don’t want ‘em. There are physicians on the hill this week protesting meaningful use.” In response to an EHR vender asking exactly what could be done to help government drive adoption levels and support of EHRs among physicians, Rep. Gingrey said the equivalent of you tell me, suggesting that industry should answer the question, not Congress...
The problem isn’t that EHR technology is all bad, it’s that physicians have drastically different workflows and needs, and patient interaction in the context of EHRs only complicates thing further. It would appear that market forces alone have not sufficiently addressed these issues. Maybe Apple, which announced its iPhone 5 today, needs to get into the HIT game.
Interesting.Yeah, AppleCare America. The thought had occurred to me.

More from The Hospitalist.


Today’s EHRs can be thought of as monolithic and closed, with an all-or-nothing, static set of features. On the other hand, think of your smartphone and all the apps (modules) you openly download and, if desired, you delete. This is the vision of a healthy, open, modular EHR ecosystem:
  • Imagine a busy clinician providing real-time feedback about a negative or user-hostile feature in the EHR;
  • Imagine that feedback incorporated—in days or hours—by engineers to create a new version of the application;
  • Imagine a VTE prevention QI team conducting a Google-style search of a group of patients to determine rate of pharmacologic prophylaxis and average VTE risk of that group; and
  • Imagine a hospitalist having five apps to choose from to automatically calculate the readmission risk of a patient: You could choose the best one and delete the others.
  • The Office of the National Coordinator for Health Information Technology has awarded a series of grants through the Strategic Health IT Advanced Research Projects (SHARP) program to help solve the vexing problems of our closed, innovation-stifling EHR environment. The output of SHARP will be “improvements in the quality, safety, and efficiency of healthcare, through advanced information technology.”
It won’t happen overnight, but perhaps we can hold out hope that there will be a day when EHRs help, not hinder, the QI process.
Inflexible, Big-Box EHRs Endanger the QI Movement
Greg Maynard, MD, MSc, SFHM, senior vice president of SHM’s Center for Hospital Innovation and Improvement, recently provided testimony to the Office of the National Coordinator for Health Information Technology about the challenges current EHRs present to QI efforts and what features EHRs need to incorporate to better serve the needs of patients and clinicians. Dr. Maynard answered a few questions for The Hospitalist:

Q: What is it about current EHRs that make continuous improvement so difficult?

A: EHRs were built for fiscal and administrative purposes, not for quality improvement and safety. The administrative/fiscal roots of today’s IT systems lead to poor availability of clinical, quality, and safety data. In many medical centers and practices, the great majority of information available is months-old administrative data, which does not lend itself to rapid cycle improvement.

Q: Why is the PDSA cycle endangered in most systems?

A: EHRs often do not facilitate rapid-cycle, PDSA-style improvements on a small pilot scale. Most improvement teams get one shot to get the clinical decision support and data-capture tools correct after months of waiting in queue and development time. Any request for revisions and refinements is treated as a failure of the improvement team, and it is often difficult or impossible to pilot new tools in a limited setting.

Q: What features would you like to see in EHRs that would facilitate QI?

A: We need a user-friendly interface for clinicians and for data analysts/reporters. Other industries have common data formats to allow for sharing of information across disparate systems. We need the same capability for clinical information in healthcare. Also, a change in architecture of EHRs and other health IT tools that allows for not just interoperability but substitutable options is required. In the more “app”-like environment, innovation and flexibility would be the rule. An underlying architecture could have different plug-and-play modules for different functions. Some companies are overcoming the current barriers to provide wonderful, easy-to-generate and useful reports, but most are stymied by proprietary systems.
Great stuff. All true. "Other industries have common data formats to allow for sharing of information across disparate systems. We need the same capability for clinical information in healthcare." Pardon me if I don't hold my breath. Going to have to seriously reform the payment paradigm for that to happen.


New interactive "Cybersecurity Game" launched.

Pretty nice, actually (notwithstanding that the animated graphics are about three generations back). Good for staff who are visual learners. Has a lot of embedded links to authoritative resources in the scoring summary you get after completing it. You don't have to ID yourself (I signed in as "Charlie Tweeder"), and you can re-take it at will. You can get through it in 20-30 minutes. Worth your time if you work with ePHI.

Providers Nationwide Adopt Health IT

Check Out How HITECH Programs Are Helping
Are you interested in better understanding health IT and the transformative changes that electronic health/medical records are having in our nation's health care system? The Health IT Dashboard presents key information and data to enable collaborative monitoring of the impact of federal policies, programs, and research activities related to health IT. Return to this web site regularly to explore and download new datasets and statistics as they become available.

Top of the heap: Minnesota (with Wisconsin 1% behind, right on their heels). Bottom of the barrel: Puerto Rico, Louisiana, New Jersey, Mississippi, and my state, Nevada (at 23%).

Very nicely put together. You can drill down fairly far state-by-state, e.g., my service area to date:

Great job, ONC


Twitter is turning up many HIT nuggets for me.
Let’s make physicians more productive instead of stimulating health IT revenues
...Most of the CMS Meaningful Use reporting requirements do not contribute to the quality of patient care. That vacuum is a classic market opportunity for innovative healthcare startups to focus on physician needs for better physician-patient management, stress reduction and improved communications with less effort using modern tools like private social networking for healthcare.
Very busy, prolific HIT writer and doer. Like I don't already have enough to read and fathom.


ONC pushes back on the naysayers.

Now is the Time for Meaningful Use!
Dr. Farzad Mostashari, National Coordinator for Health Information Technology ,
Mat Kendall, Director, Office of Provider Adoption Support, ONC , and
Robert Tagalicod, Director, Office of E-Health Standards and Services, CMS

Recognizing the need to strike a balance between the urgency of modernizing our health care system and the pace of change that can be absorbed by providers and health IT vendors, CMS and ONC have implemented the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs in three stages, with each stage adding increased functionality and advanced concepts designed to improve patient care, enhance care coordination, and increase patient and family engagement. Released in July 2010, the final rules for Stage 1 focus on functionalities that support the electronic capture of data and allow patients to receive electronic copies of their own health record.

It’s important that providers take the steps now to register for the EHR Incentive Program on the CMS website. October 3, 2012, is the last day for eligible professionals who want to collect the maximum Medicare EHR incentive payment to begin their 90-day reporting period in 2012. Eligible professionals who wait until next year can still participate but will receive reduced incentives.

How Meaningful Use Can Improve Outcomes and Efficiencies

Many providers are already seeing how meaningful use of health IT like EHRs can help to improve outcomes and result in efficiencies, such as those who are working with the regional extension center (REC) established by the North Carolina Area Health Education Center Program (NC AHEC). Through the use of EHRs and features like clinical decision support and point of care reminders, the positive impact on quality of care has been significant...

Meaningful Use Stage 2

The Stage 2 Meaningful Use final rules we recently issued were intentionally designed to help providers implement health IT that will allow them to improve care and transform delivery. The Stage 2 rules focus on increasing standards-based health information exchange between providers and with patients. We expect that future stages of meaningful use will continue to advance health IT capabilities by focusing on advanced clinical decision support and patient engagement tools. The staged implementation of the meaningful use criteria is being leveraged to harmonize quality measures across federal agencies—all with the goal of improving care for patients and resulting in better health more generally and to simplify the process for providers so that they can focus on the needs of their patients....

Click the post title for the link.

More to come. Next week. Off to my niece's wedding.

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