FOOD FOR THOUGHT
William Watembo
I was browsing yahoo news and came across this interesting piece. Even
with all problems facing the US economy, some of Obama's priorities
include "doubling the production of alternative energy over three
years, updating most federal buildings to improve energy efficiency,
making medical records electronic, expanding broadband networks and
updating schools and universities". I emphasise the "making medical
records electronic".
Some food for thought??
William
Tim Cook
> I emphasise the "making medical
> records electronic".
>
> Some food for thought??
Thanks for this.
My thought is though that without "computability" and
"inter-operability" it'll just be more of the same.
The past 46+ years has shown us that simply turning medical records into
electronic formats doesn't really achieve much.
Cheers,
Tim
--
Timothy Cook, MSc
Health Informatics Research & Development Services
LinkedIn Profile:http://www.linkedin.com/in/timothywaynecook
Skype ID == timothy.cook
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Jackson Kubuke
Thanks.
> Subject: [EMR Data Use] Re: FOOD FOR THOUGHT
> From: timothyw...@gmail.com
> To: emr-data-u...@googlegroups.com
> Date: Sat, 10 Jan 2009 08:38:50 -0200
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Ngeno, Titus
Dear Tim and Jackson,
I thought I would add or two things to this observation,
There are a lot varying interests pitted against each other in health care, such as hospitals that are rewarded for minimizing the number of days a patient stays in the hospital versus doctors who are paid on a basis of the number of visits to a patient in the hospital.
"The hospital has a strong incentive to get you in and out. Its payment will be the same if it's one day or multiple days. The doctor has exactly the opposite incentive," he noted in a panel on "Getting Health Care Under Control: How IT Can Step Up To The Plate."
When electronic patient care records get implemented, it tends to be within one organization. Let take for example if a patient suffering from I.e prostate cancer travel from one hospital to a specialize hospital, your records does not travel with you. None universal healthcare system where almost 60% of health care is paid for by the federal government, giving it leverage to impose standards. But doctors, who need to make up the base of the electronic record pyramid, "don't directly benefit from electronic health care records" and still have little incentive to adopt them.
Titus Ngeno
Ngeno, Titus
Dear Global friends,
I thought this would cover most if not all what is in today’s HIT,
The tenets of that vision and visionary examples of how computers might support them are :
· Comprehensive patient data. Computers could identify and count home meds, then using RFID-encoded prescription information to assess patient compliance.
· Patient-specific clinical decision support. Instead of looking at paper EKG strips, the doctor sees them overlaid with an animated electronic model of the patient’s heart. Historical information is presented in a consistent format for easy comparison.
· Application of evidence-based practice guidelines and research into practice. Doctors can subscribe to medical literature alerts, download new clinical guidelines into their systems, and use them to construct a series of patient flowcharts to choose from, when will then update disease management dashboards, order sets, and pre-programmed reminders.
· Tools that can highlight patient and population problems. A doctor can review a dashboard of all their diabetic patients, with all measures of disease color-coded so that all patients can be quickly assessed visually and interventions planned. During the patient’s visit, the system chooses drugs based on their therapeutic class and insurance coverage.
· Rapid integration of devices and historical patient information as a "learning" system. Patients run applications on their smart phones that measure activity and post it to their Facebook page widget. Inhalers are Bluetooth-enabled to monitor compliance and provide alerts tied to activity and environmental factors.
· Integration of information from alternate care sites, such as the home. Diabetics wear continuous blood glucose sensors that suggest action and dial an emergency number on their cell phone if readings advance to dangerous levels.
· Empowerment of patients and families with personal health records, education, and provider communication. EHRs allow patient access via the Internet and have an interpretation function that gives a lay explanation comparable to what a physician would provide.
What’s wrong with today’s use of IT
· There’s a big disconnect between systems and clinical practice.
· Systems place too much emphasis on clinician data entry without giving them value in return.
· Implementation cycles are too long, often measured in decades.
· Clinicians spend too much time digging through raw data that systems dump in their laps, leaving them to figure out how to use it in thinking about the patient.
· Today’s systems are build on a transaction-heavy foundation, with minimal context or grading the importance of information.
· Decision support should provide cost analysis, grade the quality of information, and allow clinicians to simulate interventions before doing them for real.
· Systems should be designed as thinking systems with transactions built in, not as transaction systems with decision support bolted on.
· Caregivers should not have to manually enter data that is being collected by electronic sensors - systems should be self-documenting.
· Users should be able to pose questions and have retrievals query multiple databases without requiring data in them to be standardized.
· Physician-patient interactions should be captured by real-time transcription and camera/microphone recording with suitable privacy consideration.
· The government’s role should be to embrace quality improvement, not to promote specific technologies that lock users into inefficient workflows. Incentives should be aimed at infrastructure, hardware, and data mining.
· IT should not be promoted en masse to clinicians until it helps them do their jobs better.
· A wide variety of payers with their own rules wastes a lot of clinician time trying to get paid.
· Clinical systems require extensive training, unlike PC applications that follow standard UI design and require no training.
· When clinicians round, applications add little value to the discussion and its results aren’t recorded anywhere for later use.
· Provider IT investments should be evaluated within four IT domains: automation, connectivity, decision support, and data mining.
· Organizations should at least scan their paper documents to make them available electronically.
Observations
· Hospitals have a mix of paper and computer records, so users have to learn where to look.
· Work lists are usually managed on paper.
· Clinical systems were simply built to look like the paper they were supposed to replace, such as flowsheets.
· Documentation is after the fact.
· Clinical roles and responsibilities are not explicit.
· Clinical users value speed over everything else, but they don’t understand the systems that are supposed to support them.
· Legacy systems predominate, each with their own setup parameters and content, implemented with the goal of getting up and running rather than doing anything useful.
· Change management in hospitals means nobody moves ahead until the slowest party is ready.
· Biomedical devices were universally poorly integrated.
· Semantic interoperability is almost non-existent. Systems weren’t designed to guide users through the process of completing common fields with standard terminologies.
Recommendations
Evolution
· Focus on improving care, not on the technology.
· Seek incremental gain for incremental effort, rather than huge IT projects that take forever.
· Capture all the data you can.
· Design systems around human factors principles.
· Support the cognitive function of caregivers.
Revolution
· Design systems with disruptive change in mind, i.e. genomics, which are more easily supported with connected systems rather than monolithic, integrated, all-encompassing systems.
· Archive data in ways that future interpretation and analysis can yield new knowledge.
· Design technologies to eliminate ineffective work processes.
· Design systems that can put data into context.
Mr Titus Ngeno
Wish you a prosperous New Year!
Tunga Simbini
Interesting article indeed. This is useful in looking at EMR systems as in a state of constant evolution, more like the different stages of the capability maturity model. One other factor is ubiquity and pervasiveness in which the health care provider should not go out and look for the technology. It must be there always. And of course, coming from a developing country COST is a big factor. WIth time the cost should be reasonable to the user.
Interesting article, I must say.
Regards,
Tunga
T. Simbini
Medical Informatics
Zimbabwe
Mark Spohr
The most significant observation here is that current US Health IT systems do not offer cognitive support. The systems are focused on recording events but not USE of the data for decision support.
Information systems should be designed to present information so that it can be used to make decisions. This is particularly useful in developing countries where HR capacity is low.
If we can work to put 'cognitive support' features in our software, this will truly be an advance. Otherwise, we are just counting beans.
All the best,
Mark
Mark H. Spohr, MD
Technical Officer - Health Knowledge Systems
Health Care Informatics
IER/HSI
World Health Organization
20, Avenue Appia
CH-1211 Geneva 27
SWITZERLAND
+41 22 791 24 04
Mark Spohr, MD