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Are We There Yet? – In Healthcare Organizations
[By Richard J. Mata MD, MS]
Paper-based medical records have been in existence for centuries and their gradual replacement by computer-based records has been slowly underway for over twenty years in western healthcare systems.
Computerized information systems have not achieved the same degree of penetration in healthcare as is seen in other sectors such as finance, transportation, and the manufacturing and retail industries.
Further, deployment has varied greatly from country to country and from specialty to specialty and in many cases has revolved around local systems designed for local use.
The DHHS
In a 2005 DHHS study, national penetration of electronic health records (EHRs) may have reached over 90% in primary care practices in Norway, Sweden, and Denmark (2003), but has been limited to 17% of physician office practices in the U.S. (2001-2003). By 2011, and the ACA, this number may now be approaching 20-25% in the US but adoption may actually be slowing.
The ISMS Vision
According to the Illinois State Medical Society there is a “Sweeping Vision for EHRs”:
- EHRs will provide a comprehensive view of all patient information
- Quality of care will be improved.
- Physicians will more easily be able to review the “complete” medical record.
- An appropriately configured EHR system will provide “alerts” and “notices” to help health care providers incorporate best practices into patient treatments. Ideally clinical decision support should be built in and be evidence-based.
Medical errors can be reduced:
- Treatment and administrative costs will be reduced.
- Public health will be improved.
Defining Electronic Records Systems
The 2003 Institute of Medicine (IOM) Patient Safety Report describes an EHR as encompassing:
- a longitudinal collection of electronic health information for and about persons;
- [immediate] electronic access to person- and population-level information by authorized users;
- provision of knowledge and decision-support systems [that enhance the quality, safety, and efficiency of patient care] and
- support for efficient processes for health care delivery.
IOM Report
A 1997 IOM report, The Computer-Based Patient Record: An Essential Technology for Health Care provides a more extensive definition:
A patient record system is a type of clinical information system, which is dedicated to collecting, storing, manipulating, and making available clinical information important to the delivery of patient care. The central focus of such systems is clinical data and not financial or billing information. Such systems may be limited in their scope to a single area of clinical information (e.g., dedicated to laboratory data), or they may be comprehensive and cover virtually every facet of clinical information pertinent to patient care (e.g., computer-based patient record systems).
The EHR definitional model document developed by the Health Information and Management Systems Society (HIMSS, 2003) includes “a working definition of an EHR, attributes, key requirements to meet attributes, and measures or ‘evidence’ to assess the degree to which essential requirements have been met once EHR is implemented.”
IOM Re-Deux
In another IOM report, Key Capabilities of an Electronic Health Record System [Tang, 2003], identifies a set of eight core care delivery functions that EHR systems should be capable of performing in order to promote greater safety, quality and efficiency in health care delivery. The eight core capabilities that EHRs should possess are:
- Health information and data. Having immediate access to key information – such as patients’ diagnoses, allergies, lab test results, and medications – would improve caregivers’ ability to make sound clinical decisions in a timely manner.
- Result management. The ability for all providers participating in the care of a patient in multiple settings to quickly access new and past test results would increase patient safety and the effectiveness of care.
- Order management. The ability to enter and store orders for prescriptions, tests, and other services in a computer-based system should enhance legibility, reduce duplication, and improve the speed with which orders are executed.
- Decision support. Using reminders, prompts, and alerts, computerized decision-support systems would help improve compliance with best clinical practices, ensure regular screenings and other preventive practices, identify possible drug interactions, and facilitate diagnoses and treatments.
- Electronic communication and connectivity. Efficient, secure, and readily accessible communication among providers and patients would improve the continuity of care, increase the timeliness of diagnoses and treatments, and reduce the frequency of adverse events.
- Patient support. Tools that give patients access to their health records, provide interactive patient education, and help them carry out home monitoring and self-testing can improve control of chronic conditions, such as diabetes.
- Administrative processes. Computerized administrative tools, such as scheduling systems, would greatly improve hospitals’ and clinics’ efficiency and provide more timely service to patients.
- Reporting. Electronic data storage that employs uniform data standards will enable health care organizations to respond more quickly to federal, state, and private reporting requirements, including those that support patient safety and disease surveillance.”
Assessment
After reviewing the above, are we there yet in – 2011?
Conclusion
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Filed under: Information Technology | Tagged: EHRs, electronic medical records, Electronic Records Systems, EMRs, Health Information and Management Systems Society, HIMSS, Illinois State Medical Society, Richard Mata, The Computer-Based Patient Record |
The Leading Business Education Network for Doctors, Financial Advisors and Health Industry Consultants 
Nope – Not there yet!
According to Fox Five News, Emory University Healthcare [orthopedics clinic] here in Atlanta, just apologized to two thousand four-hundred patients for the accidental release, and theft, of partial medical record files with social security numbers attached.
The information was used to file false tax returns for illegal refunds. And, it was the IRS that notified Emory externally; not internally.
Dr. David E. Marcinko MBA
[Publisher-in-Chief]
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Ouch! I think that is probably the worst way possible to learn your business has suffered a data breach.
Darrell DK
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Predictable dangers of medical ID theft
“One patient nearly received a transfusion of the wrong kind of blood — a life-threatening mix up.
The cause? A bogus medical file that had been created by an identity thief. The criminal used the victim’s name to obtain medical care. The criminal’s blood type was recorded in the victim’s medical records, leading to the almost fatal mistake.”
From “Docs withhold records from victims of medical ID theft,” by Isaac Wolf – March 16. 2011.
http://www.therepublic.com/view/story/idtheft-medical031611/idtheft-medical031611/
———–
“There is a person who wants implants and crowns. The EHR and insurance coverage that the patient bought for $200 said that the previous owner was diabetic. No problem. The record is digital. Diagnoses and treatments can be changed along with medication allergies.
Do you see where this leads? If an unconscious person is admitted to an emergency room, contaminated electronic medical records could quickly kill the patient, and nobody would know why.”
From “Careful with that electronic health record, Mr. Leavitt,” by Darrell Pruitt – October 18, 2006.
http://wistechnology.com/articles/3407/
I told you so, ADA.
D. Kellus Pruitt DDS
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More on e-H[D]Rs
I’m bored, so let’s see if I can mix it up with overly-optimistic technophiles and e-HR vendors in dentistry.:
Yesterday, a local colleague called:
“Please don’t gloat, but my computer crashed and I’m thinking about going back to paper like you.”
He wanted to know where I purchase supplies for the time-tested, low-tech pegboard and ledger card bookkeeping system I never abandoned for computerization.
I use Sycom. It never crashes and cannot be hacked. In addition, since I’m not a HIPAA-covered entity, I don’t have to worry about inspections.
Anyone feel like responding to my tendency to gloat – just to get something rolling down the hill on this otherwise boring Wednesday?
Darrell K. Pruitt DDS
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Here’s an idea:
If interoperability and Evidence-Based Dentistry on an internet platform are indeed worthy goals that dentists and patients truly desire, why not incorporate FAX transmissions as an interface between dentists who have EDRs and dentists who will still keep paper records decades from now?
The technology is cheap, available and secure. What’s more, FAX transmissions are out of reach of HIPAA (up until the instant they are downloaded on a dentist’s computer).
Darrell K. Pruitt DDS
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Most CA Docs Using eEHRs
[A New Report]
A majority (55%) of California primary-care physicians now use electronic health-record systems, according to a new report from the California HealthCare Foundation. The 41-page report, “The State of Health Information Technology in California,” also showed, as has been found in similar surveys, that when it comes to IT adoption, the size of a physician practice matters.
For example, just 20% of solo practitioners have adopted an EHR, compared with 39% of practices with two to five physicians, 64% of groups with between six and 50 doctors, and 80% of groups that have 51 or more physicians. For all medical specialties and practice sizes, 48% of physicians in California have implemented EHR systems, according to the foundation.
Source: Joseph Conn, Health IT Strategist [5/10/11]
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Vaccinating against EHR myth
Please watch how I vaccinate the community against EHR myths one politically-correct reporter at a time. I injected the following comment into mlive.com. Would you believe that there is nobody other than me challenging widespread public deception concerning EHRs? Isn’t that scary? How awkward I must feel.
————–
I just couldn’t walk by mlive.com today without challenging harmful, biased news concerning e-prescribing. Yesterday, Lindsay Knake, writing for the Saginaw News posted “Saginaw physicians utilize e-prescriptions to increase patient safety, convenience.”
http://www.mlive.com/news/saginaw/index.ssf/2011/07/saginaw_physicians_utilize_e-p.html#comments
Ms. Knake must have slipped and fallen into a foul-smelling pile of bad information. Like so many in media these days, she’s become a tool of health information technology stakeholders like Blue Cross Blue Shield.
When listing selling points for e-prescriptions, she mentions “insurance” three times in two sentences: “The systems keep track of insurance, allergies and medications. This allows physicians to choose a medication that works with the patient’s insurance instead of prescribing a drug and waiting for a callback from the pharmacist if the insurance does not cover it.”
In addition, Saginaw physician Dr. Michael Slavin ominously points out that “Blue Cross Blue Shield also is encouraging physicians to use e-prescriptions.”
Patients don’t care about BCBS executives’ bonuses, and Dr. Slavin shouldn’t either. Let’s not forget that protecting patients from avoidable medication errors is much more important to society than using expensive and dangerous technology to protect doctors from BCBS’s arbitrary and capricious gotcha games – just to get paid what’s owed us for work that long ago left our offices.
For our patients’ sake, we can no longer afford to play insurer games we cannot win. BCBS will always have the advantage because we are accountable to our patients while BCBS executives aren’t.
Surprisingly, the e-prescription myth is hardly questioned by healthcare professionals who should be familiar with the importance of evidence based medicine. Without even the hope of evidence, Dr. Slavin carelessly repeats the common claim that “E-prescribing eliminates legibility issues with doctors’ notoriously bad handwriting.” So what about keystroke errors? Since Dr. Slavin’s selling point is nothing more than an opinion based on a fallible empirical conclusion, I would counter that it seems to me much less likely for one to draw a 3 when one meant to draw a 6 than to accidentally miss adjacent numbers on a keyboard. The question is, are keystroke mistakes any less dangerous than bad handwriting? Actual research results say no. As you might expect, Knake and Slavin’s politically correct opinions don’t hold up very well. (See “E-Prescribing Doesn’t Make The Grade – Outpatient electronic prescribing doesn’t cut out the common mistakes made in manual systems, study finds.” by Nicole Lewis in InformationWeek).
http://www.informationweek.com/news/healthcare/CPOE/231001032
“If you think electronic prescribing will solve the mistakes that occur when doctors hand-write prescriptions, think again. Findings from a study that assessed 3,850 computer-generated prescriptions show that 452, or 11.7%, contained a total of 466 errors. Of these, 163 (35%) were deemed to be potentially harmful. The researchers said these rates were not significantly better than those reported for handwritten prescribing systems “
If e-prescribing costs thousands of times more than paper prescriptions, yet fails to improve healthcare, how does it help anyone but software vendors and BCBS executives?
“Overall patient safety is increased.” – Dr. Michael Slavin. Rather than risk misleading patients, how about some evidence next time?
D. Kellus Pruitt DDS
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Lawmaker Urges Study of IT Error Rates
HHS should consider conducting a thorough study about the adoption, benefits, and cost-effectiveness of health information technology that also examines both human and technological error rates, Rep. Renee Ellmers (R-NC) suggested in a letter to HHS Secretary Kathleen Sebelius.
Ellmers, who chairs the House Small Business Committee’s Subcommittee on Healthcare and Technology, cited a study in the Journal of the American Medical Association that found of nearly 4,000 computer-generated prescriptions received by a pharmacy chain, about 12% contained errors—a number consistent with error rates in written prescriptions.
Source: Jessica Zigmond, Modern Healthcare [8/12/11
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NHS pulls plug on EHRs
Did I mention that the hits just keep coming?
“NHS pulls the plug on its £11bn IT system – After nine years and with billions already spent, doomed computer system is abandoned.” By Oliver Wright, Whitehall Editor.
http://www.independent.co.uk/life-style/health-and-families/health-news/nhs-pulls-the-plug-on-its-11bn-it-system-2330906.html
“The nine-year-old NHS computer project – the biggest civilian IT scheme ever attempted – has been in disarray since it missed its first deadlines in 2007. The project has been beset by changing specifications, technical challenges and clashes with suppliers, which has left it years behind schedule and way over cost.”
It looks like the US will catch up to the UK’s progress soon enough. Recently, Rep. Renee Ellmers noticed that EHRs here in the US are also failing to improve healthcare. So just days ago, she asked HHS Secretary Kathleen Sebelius to consider studying the benefits, cost and safety of HIT systems.
Remember: Don’t blame me for the bad news. I did my best to warn ADA leaders about their blunder years ago, but those good ol’ boys were just too damn important to listen.
D. Kellus Pruitt DDS
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Do EHRs Improve Clinical Outcomes?
[An Objective View]
Dr. Mata – The evidence to suggest that electronic health records really make a difference has not been overwhelming – until now!
http://www.informationweek.com/news/healthcare/EMR/231601081
Morris
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When patients see their medical record
It is a new world of sharing of information and there is no reason medicine shouldn’t be part of the change. Patients have access to research studies on-line as well as multiple medical websites to look things up. (Some are just junk and filled with ads).
If open records helps create a dialog about good health and allows patients to understand and take ownership of their own life it can only be a good thing.
http://www.kevinmd.com/blog/2012/01/patients-medical-record.html
What do you think?
Link
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2021 Update
How to take control of your medical records?
https://www.marketwatch.com/story/how-to-take-control-of-your-medical-records-11618597659?mod=mw_latestnews
Clive
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