Posts Tagged ‘EMR’
Personal Trifecta
November 4, 2010
One of the advantages of having a personal blog is not only expressing one’s opinions but also promoting accomplishments. I have been fortunate to have three in recent months:
- coauthorship on a major article on a disease registry from EMR data - Development and Validation of an Electronic Health Record–Based Chronic Kidney Disease Registry, Clinical Journal of the American Society of Nephrology, Nov. 2010. Press Release:Health Registry Could Transform Chronic Kidney Disease Care
- named in an NIH grant: Refinement and Enhancement of a Web-Based Risk Calculator Deployment System
- named a Fellow in the Health Information and Management Systems Society (HIMSS)
Also, I became a fellow in the Group for Information Resources of the American Association of Medical Colleges this summer and reviewed a grant for a Dutch organization. Great opportunities and challenges keep coming. A great year.
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Impact of Accelerating Technologies
September 23, 2010
Singularity University is teaching the importance of accelerating technologies. It is teaching its students “to take advantage of exponential growth trends in order to create global change.” Salim Ismail, CEO of SU points out that many startups turn into billion dollar businesses in ever shortening time frames, sometimes as little as two years. And he says that many of the technologies we are learning today will be outdated by the time they are completed.
How will we manage this accelerated growth in technology? Is there anyway to keep abreast of it? Will only rapid development approaches be successful in the near term? What about legacy systems (like many EMRs) which take years to upgrade? Maybe events like the upcoming Health 2.o Hackathon will be the real future of healthcare technology.
What the Singularity video here:
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Connected for Health: The KP HealthConnect Story
September 16, 2010
In a new book edited by Louise Liang, the story of the comprehensive implementation of the EHR at Kaiser Permanent. The story begins in 2002 when George Halvorson, the new CEO, saw the need to implement the EHR not as a cost savings initiative but as a market differentiator. He laid down the challenge to accomplish this national implementation in 3 years. What this represented was not just a software implementation but an organizational change from 9 relatively independent regions to a single practice model centered around this technology. They developed the Blue Sky Vision with consumer centric focus including these themes: home as the hub, integration and leveraging, secure and seamless transition, and customization (perhaps better stated as patient-provider partnership).
The book not only provides a history of this organizational and technology change but also lays out a project management roadmap that can be emulated for smaller hospital systems and hospitals. Regardless of size, EHR implementations must take into consideration timeline, stakeholders and technical challenges. For Kaiser, the timeline affected the implementation in several ways, most notably in delaying customization of provider templates and smart forms until after the go live. Involving stakeholders, two chapters address the building of clinical content by physicians and nurses. They state, “clinicians won’t necessarily be faster, but they should be better” referring to improvements in patient safety and other clinical decision support aspects of the EHR. The role of the patient as a significant stakeholder is addressed in a chapter about My Health Manager, the MyChart product from Epic Systems which was implemented to included eVisits and patient-provider messaging.
Part of the vision from the initiation of project is value realization beyond utilizing the EHR in routine clinical practice.This involves aligning KP HealthConnect with KP values: high quality care, personal care, convenient and affordable. The three phases of value realization are: value creation, value requiring harvesting and transformation of care. This steps included everything from reducing duplication of services, to re-engineered workflows to developing metrics around best practices and clinical guidelines. Population care has become a reality including practice innovation. While most of the care management emphasizes primary care (including a chapter on Redesigning Primary Care), there is some material on specialty practices, such as, oncology.
Adding value for KP HealthConnect also means improving patient safety and enhancing research. In the safety realm, one of the most important concepts behind the EHR which should be true of every EHR is “Making the Right Thing Easy to Do.” This is where may EHR implementations fail, actually accomplishing quite the opposite and leading to open rebellion by clinicians. If the right thing is easy to do and especially easier than paper, then this single fact makes the cost worth the investment. In research, the efforts are still at early stages but include retrospective and prospective research, comparative effectiveness research and personalize medicine/genomics. As an adjunct to research, a chapter is devoted to the Archimedes Model as a future direction for KP. Utilizing EHR data, the model takes population studies to a new level by simulating clinical trials and developing mathematical predictive models.
Has Kaiser realized its Blue Sky Vision? The implementation was certainly accomplished on time but admittedly over budget (3.2 billion vs. 4 billion). At one point, the authors admit to the technical challenges which resulted in stopping the accelerated weekly implementations. Stress on the IT core systems forced a six month hold. Overall the book presents an optimistic view of EHR implementation, successful because of systematic, team approach including all regions and all professions. Many of the themes in the book are reminiscent of the optimism of Health Care Reform and EHRs which some times seem a distant dream with very gradual adoption.
Who should read this book? First, any hospital or healthcare system planning or in the midst of an EHR implementation. Second, hospital CIOs but perhaps more importantly, project managers. Project management professionals are the boots on the ground of EHR implementation and need to learn how to involve stakeholders and move past obstacles toward successful, on schedule implementation. Also, those interested in exploiting or harvesting the value of the value of the EHR in quality improvement, patient safety and research. Finally, clinicians who are involved in EHR implementations or governance will better appreciate the need for vision and the comprehensive impact of EHR on practice and potential practice innovation.
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Predicting Health IT Five Years Out
August 30, 2010
In an article in xConomy Seattle, there is a report from a meeting of the Washington Biotechnology and Biomedical Association, reporting on the future of Health IT. Some key predictions:
- “As we near 2015, many in the industry predict healthcare will see an integration of social media, cloud computing, and collaborative commons—creating resources that allow consumers to more actively engage with their health through information technology.”
- “primary care facilities and hospitals are not capitalizing on the existence of electronic resources to provide better care for patients and improve efficiency for healthcare providers”
- “Healthcare is the last bastion of mom and pop stores,” ?The first step in healthcare is to make everything digital,” “The next step is to takes what’s digital, and make sense of it—to make some intelligence out of the information you already have.”
- “Arguably healthcare is a data problem, and we’re trying “Scientists are not thinking of their data as an ingredient to the solution. They’re thinking of it as an ingredient to their next paper,”
- “researchers will have to amend not only what they do, but how they go about doing it—the emphasis will become less about research and clinical data, and more about how that data is stored, accessed, and used”
- “models could also use the power of social networks to give patients access to information and resources provided by other patients with similar conditionals—data that could help patients research and decide on a treatment plan, as well as help physicians make recommendations.”
- “One example would be using personalized data from electronic medical records, combined with data from available studies, to create individualized predictive care models.”
All great ideas held back by cottage industry attitudes and slow adoption of EHRs and PHRs. My only question is, why can’t we have this sooner than 5 years?
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Open Notes Project – Right Thing or Wrong Question
August 18, 2010
The discussion of having doctors notes on one’s care readily available electronically was stimulated by a recent New York Times article titled, Should Patients Read the Doctor’s Notes? Roni Zeiger of Google Health challenges whether this is the right question. For e-Patients, it is both the wrong question or obviously the right thing to do. Transparency of medical records, now written into health care reform, is the obvious right thing to do but will take time for physicians to catch up to the idea. Granted that few patients even have access to a PHR tethered to and EMR, but at least those that do should have access to notes in the long run. If patients are to be full participants in their health care and treatment, they should know their doctors observations and treatment plans. As Roni Zeiger says this is one of ”the best ways for the patient to understand and remember the doctor’s guidance.”
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IBM Initiative to Improve Healthcare Quality and Costs
August 6, 2010
Recently IBM announced a major initiative to address significant data problems in healthcare. Acknowledging the fact that data is in structured and unstructured format and from various sources, the task of integrating these data points into a individual dashboard format can enable better medical decision making. One tool to enable this kind of data integration is their text analytics tools LanguageWare™ (LW) and Cognos Content Analyzer (CCA). Both of these were acquisitions by IBM in the past few years and it appears that they are now integrated enough to be used with large data sets in health care. Analyzing unstructured information can benefit insurance companies as well. The tool looks like it combines natural language search and semantic technologies. The video illustrations the typical international approach of Big Blue.
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Models of Care: Can They be Copied?
January 28, 2010
Can good models of efficient care be emulated in other hospitals. Much has be touted about the Mayo Clinic, Cleveland Clinic and others. The lower costs of these models has been documented. See the Dartmouth Health Atlas report on chronic care (see table on page 9).
In a video on Huffington Post Video last month, the interview at the Cleveland Clinic about the successful EMR still questions whether this success can occur elsewhere. Yes, the implementation was expensive and expensive to maintain but the benefits over paper are quantifiable in terms of quality of care and improved outcomes. Maybe the lessons of successful EMRs have paved the way for others.
Finally, Dr. Cosgrove, CEO at the Cleveland Clinic is interviewed by Fox Business News at the Davos World Economic Forum. He again repeats his contention about the need to address obesity and health care costs. Again, a model or approach to care and costs which others can emulate.
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Our Pen-and-Paper Doctors
June 25, 2008
The New York Times has an editorial today on the need for physicians to adopt EMRs. It is in reaction to a report in the New England Journal of Medicine. The slow pace of fast change is happening in healthcare IT. Not devoting enough resources to health IT continues the short sited path of the past. The advantages are clear – get on board and devote the resources. Improved government incentives will help.
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Video on Paper Free Healthcare
February 29, 2008
AllScripts has posted a video on YouTube and invites discussion of this topic on their website:
www.allscripts.com/paperfree/
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3-D visualization tool for electronic health records
January 16, 2008
Another announcement about IBM innovation, this time in a 3-D image of the body to be integrated into EMRs. It is called the Anatomic and Symbolic Mapper Engine. How it works:
“A doctor first clicks the computer mouse on a particular part of the image, which triggers a search of the patient’s eHR to retrieve the relevant information. The patient’s information corresponding to that part of the image is then displayed, including text entries, lab results, and medical images, such as magnetic resource imaging. The doctor can zoom in on the image to retrieve selective information or narrow the search parameters by time or other factors.”
Can’t wait to see a demo.
A fascinating concept. Why not make it available to PHRs as well?
