Do EMRs Improve the Quality of Healthcare?
January 25, 2011
In a new study in the Archives of Internal Medicine, the hypothesis that electronic medical records would improve quality was not borne out. However, what was not picked up by most news stories about the article was that the data was from 2005-2007, 4 years old during a period of rapid adoption of EMRs. An accompanying editorial titled “Clinical Decision Support and Rich Clinical Repositories: A Symbiotic Relationship“, is critical of the report stating, “This lack of effect of CDS [clinical decision support] on provider behavior was surprising given the strong effects previously reported in randomized controlled trials of these systems.” These critics note that most of the guidelines which are more likely to be followed are immunizations rather than medication use which the study focused on. In conclusion, the editorial writers from the National Library of Medicine state, “Only when EHRs carry rich repositories can we expect EHRs to reach their promise and CDS to have measurable effects on a broad range of quality measures at the national level.”
My conclusion is that the use of clinical decision support within EMRs can impact quality on a national level but that early implementation of EMRs may take time to demonstrate this impact.
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Using Social Media to Promote Evidence-Based Practice
January 17, 2011
This concept is unique in health care social media. It goes beyond marketing or even engaging customers and on to the real impact on practice. It happens that this may more of a Canadian approach to social media. Freed of much of the health care marketing in the US, tying evidence-based practice to social media goes to the heart of the value of these tools. Perhaps it is also the influence of Cochrane on evidenced based practice in Canada and the UK and EU.
On a side note, check out Spigit, a new company all about innovation. Not specific to health care but if you look toward Canada again to the Innovation Cell. See also this post from TechCrunch on visualization in innovation. More on innovation soon for a book review on The Myths of Innovation.
Share this:A year in Review Perspective from Higher Education
January 6, 2011
Lev Gonick, CIO of Case Western Reserve University, has written 2011: The Year Ahead in IT, a fresh perspective looking forward instead of back. There are many parallels to healthcare.
1. The Big Picture: The State of the Global Economy and What It Means for IT on U.S. College Campuses (or, globalization and localization). He says that universities are tied to the cities they live in and community partnerships are crucial for global competitiveness. The same could be said for urban and academic medical centers.
2. How do you spell opportunity? A-U-S-T-E-R-I-T-Y (shared services and entrepreneurship). With greater austerity in health care, shared services and making IT a profit center through entrepreneurship are key to IT survival in healthcare as well.
3. Operational Excellence Is Good Enough (leveraging the cloud for strategic reengagement). Instead of a focus on operational excellence, moving toward cloud-based services and software/platform as a service. Healthcare continues to be skittish about the cloud but with the appropriate SLAs and security, may provide appropriate solutions.
4. We Go to University to Learn (mobility, simulations, gaming, and unified communications). Best quote: “While the rhetorical debates will continue, blended learning models based on hybrid pedagogies of face-to-face interactions with online exploration, discovery, reflection and mentoring are emergent realities.” This is emerging in education of health professionals and more experimentation should be welcomed.
5. Content is King… No, No, Platform Is King … No, No (learning management, publishing, and learning middleware). Another quote: “Given the maturity of the traditional course management platforms, the lethargic character of the academic publishing industry satisfied with its annuities in traditional textbooks, and the early state of e-books for learning, a new set of players in the area of student engagement, assessment, and support is likely to offer to stitch together the layers between the content and platform providers.”
6. I Used to Walk 10 Miles in Snowshoes to School (rich media and 21st-century learning). The move from text-centric learning to video conference, multimedia learning and more. The possibilities in healthcare are apparent and some are being utilized with YouTube and 3D anatomical models. Will holograms be next?
7. If We Hang In There We Will See an ROI on Our 8- and 9-Figure ERP Implementations (new models for administrative systems). Expensive enterprise systems moving to SaaS platforms changing the legacy of large implementations into short cycles of outsourced applications.
8. Consumer Sovereignty Can Be Stopped at the Gates of the Campus (governance and enterprise program management]. Sounds alot like centralized healthcare IT departments. “Frustration with the lack of agility, available resources and talents has led to a growing position that IT needs to get out of the way other than provisioning reliable network access, limited security and related regulatory and risk-mitigation roles.”
9. Overcoming the Myth of the University as Open. Global research endeavors requiring data sharing free faculty to go beyond the walls of the institution. Healthcare may be moving faster than the rest of the university community by translational research efforts and health information exchange as facilitators.
10. American Global Competitiveness and Research and Education Networks (IT and its contribution to reducing the town-gown divide).
Another quote true for healthcare: “IT and network engineering, and a commitment to supporting evaluation and at the same time catalyzing innovation, attracting investment and supporting the value of quality of life.”
With all the hype about mobile and clouds, it is refreshing to have a more thoughtful analysis of what is ahead.
Share this:Year in Review – Books of 2010
December 31, 2010
Following Kent Bottle’s lead in influential books in 2010, I decided to compose my own list:
- Chasing Medical Miracles The Promise and Perils of Clinical Trials. Tells it like it is – to be a participant in a clinical trial.
- Googled-The End of the World as We Know It – somewhat disappointing in that it discussed the advertising side of the business and less about the history of its technical evolution.
- DIYU: Epunks, Edupeneurs and the Coming Transformation of Higher Education. This book was recommended by a speaker at the J. Boye conference in Philadelphia. Questions the future viability of universities as they are undermined by Web 2.0 technology.
- Leading Geeks – Required reading for anyone who manages geeks, especially programmers. Helpful for anyone to understand the culture of geekdom, understanding the mindset of managing ambiguity and tearing down some stereotypes.
- The Singularity is Near by Ray Kurzweil – mind blowing futurism and undying optimism in technology even though this is from 2005 and 650 pages. The law of accelerating returns puts us on a fast track to the future. I am now following Kurweil’s Accelerating Intelligence blog.
- A Little Booklet About Health 2.0 – by Lucien Engelen. Brief but advancing health 2.0 concepts with a peak to the future from a European perspective.
- Long Tail: Why the Future of Business Is Selling Less of More – this lead to my blog post on Partnerships with Online Communities – The Long Tail, discussing some of the implications of the long tail in healthcare.
- The Collapse of Complex Societies – a venture into history and anthropology which I enjoy and blogged about: Declining Marginal Returns of Complexity
- Laugh, Sing and Eat Like a Pig by e-Patient Dave – a personal, signed gift from Dave himself when he visited Cleveland and had dinner with us.
- Connected for Health: The KP HealthConnect Story – Probably the best story of successful implementation of an EMR on a large scale basis with honest, realistic discussion of struggles and successes.
- Program or Be Programmed – Ten Commandments of the Digital Age – read appropriately as an ebook, makes some good points without being paranoid about technology’s growing role in our lives.
- The Bottom Billion: Why the Poorest Countries Are Failing and What Can be Done About It. Recommended by @Ciscoiii when visiting the World Bank in Washington, DC. Excellent analysis of failed states with recommendations at the UN level for solutions.
- Founding Faith: Providence, Politics, and the Birth of Religious Freedom – found this in Philadelphia at the Liberty Bell bookstore.
One on my shelf is Reading in the Brain: the New Science of How We Read.
More book reviews to come next year and many more will be on my Sony Reader.
Share this:Book Review: Program or Be Programmed – Ten Commandments of the Digital Age
December 30, 2010
This quick read by Douglas Rushkoff is less ominous than the title sounds but still thought provoking. The author does not advocate becoming a programmer per se but understanding the greater control and influence over our decisions that apps have on our everyday lives. Particularly the chapter on Choice: You May Always Choose None of the Above; here he emphasizes the need to be aware of and not locked into choices made for us. Whether it is Google search results/adwords or Amazon recommendations of what others have selected, were are ever so gently guided toward choices. It reminds me of the decades old book of Alvin Toffler, Overchoice. Even then he anticipated the problem of hundreds of choices of models and colors and didn’t anticipate the ability to search millions of products online. Maybe we need tools to help us in our choices to guide us to our preferences to reduce the number of choices. But understanding enough about how this tools are programmed frees us from a type of slavery to them.
In addition, there are chapters about online identity: Do Not Be Always On, Live in Person, Be Yourself, Do Not Sell Your Friends. Increasingly, the lines between our online and offline identities are becoming blurred. Some handle this better than others, but identity confusion occurs with the most distasteful evidence in cyber-bulling and getting lost in game worlds. The advice to retain our humanity is well founded.
While the book does not address health issues on the internet and social media in depth, there are some implications for ePatients and patient-physician relationships. These need to be based in reality, not the virtual world. These identities and relationships can be extended by apps and tools but not to the exclusion of real life.
Share this:2010 Year in Review
December 24, 2010
It has been a year full of travel and accomplishments. Here is a month-by-month review:
- January – hosted Lucien Engelen and others from Radboud UMCN Hospital in the Netherlands at the Cleveland Clinic for two days on everything from the group practice model to innovation and patient experience in two days.
- February- vacation in Naples, Florida
- March – HIMSS 2010 in Atlanta presenting twice and AMIA Clinical Research Informatics Symposium presenting a poster. Also visited the Googleplex. Stopped in Salt Lake City for a day on the way home.
- April – Toronto for the - TAHSN Education Day for Healthcare Communicators – spoke on social media
- May - J. Boye Conference in Philadelphia – spoke on social media in healthcare and published my first article in iHealthbeat “Social Media in Health Care: Barriers and Future Trends”
- June – Visited Washington, DC. Vacation and some consulting
- July – Attended the Leadership Institute of the Group on Information Leadership of the American Association of Medical Colleges in La Jolla, California for a week and became a fellow.
- August – brief vacation in Salt Lake City including the Bonneville Salt Flats
- September – Named a fellow in the Healthcare Information and Management Systems Society and named in a NIH grant on Risk Calculators
- October – Presented at Toledo (Ohio) Hospital on social media and attended the CTSA Innovative Informatics for Clinical and Translational Researchers at the NIH. Did live tweeting while attending the Cleveland Clinic Innovation Summit.
- November – coauthor of an article on a disease registry in the Clinical Journal of the American Society of Nephrology and another prespectives piece in iHealthbeat on the secondary use of EMR data.
- December – Second article on the chronic kidney disease registry published. A positive editorial by a well known informaticists about the registry published
Looking forward to more in the coming year – conferences, presentations, publications.
Share this:Editorial on Secondary Use of EMR Data
December 2, 2010
As a follow up to the recent article on the Cleveland Clinic Chronic Kidney Disease Registry, there is now an accompanying editorial by William Hersch of Oregon Health Sciences University titled: Electronic Health Records Facilitate Development of Disease Registries and More. He states, “Their study shows that the quality of data in the registry is comparable to that of the data that would come from a much more labor-intensive and expensive process of human abstraction. This registry will be used for quality improvement, clinical research, and other important tasks. ”
He also makes good points about the importance of CPOE in the process as well as the benefits of secondary use or “reuse” of data.
Share this:Secondary Use of EMR Data
December 1, 2010
Part of the value of EMRs is the secondary use of the rich clinical data. Quality studies are an obvious win. This week, a new article by Kaiser Permanente Medical Group used this data in one of several registries to analyze 80,000 Total Joint and 5000 ACL Reconstruction Procedures in the Journal of Bone and Joint Surgery. The data was collected “through standardized documentation at the point of care” and “supplemented with existing administrative data from our electronic health records and other independent databases.” See the registry database structure here.
Also published this week is a second article from the Cleveland Clinic Chronic Kidney Disease Registry regarding the eGFR definition. This is another example utilizing these registries with secondary data for addressing significant issues in medicine.
The HIMSS 2011 conference will feature a symposium on secondary use of data as well.
Share this:The Future of Coding
November 30, 2010
In Wired magazine this month, Clive Thompson talks about his own experience in developing a mobile app. Coding for the Masses is the new reality. In a way, many in the Web 2.0 world have been doing coding by creating blogs, wikis, communities such as Ning, with little or no technical training. Now tools for mobile apps allow for building tools for the handheld devices. He notes Scratch to Google’s App Inventor as the enablers of this new reality.
Related is the book Program or Be Programmed by Douglas Rushkoff. The same concept of empowerment comes through. More once I read the book. Implications for healthcare? Obvious – epatients going beyond advocacy to become app developers. Physicians and nurses developing apps for their own use or for their patients. Check out this post about creating a journal club with Google Reader and Facebook. Not mobile yet but maybe for the iPad?
Check out the HIMSS HIT X.O conference track which include HIT Geeks Got Talent? contest – live programming. I was on the planning committee for this innovative program track.
Also, from Wired magazine check out the redesign of medical test reports.
Share this:EMR Article Gets Positive Press
November 8, 2010
The article I coauthored in the Clinical Journal of the American Society of Nephrology, Development and Validation of an Electronic Health Record–Based Chronic Kidney Disease Registry, received a nice press release from the American Society of Nephrology which was picked up by both medical and health IT news sources:
- Medscape: CKD Registry Could Help Physicians Improve Patient Care
- Healthcare IT News: EHR-based registry could transform chronic kidney disease care
- Healthcare Informatics: ??????Study: Kidney Disease Registry Could Help Patient Care
Blogs:
- Science Centric: Health registry could transform chronic kidney disease care
- Drugs-Expert: Chronic Kidney Disease Care Could be Transformed by Health Registry
I think that this registry is a model for others which utilize EMR data to study disease and potentially transform care.
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