August 5, 2011 1:48 PM
Posted by: AllinHIT
, clinical decision support
, Emergency department
, Emergency room
One hundred twenty four million people are treated in hospital emergency rooms each year. Unfortunately, there are common mistakes of diagnosis, which contributes to the ER department having the highest number of malpractice suits in the hospital. There is no doubt that implementing HIEs and clinical decision support systems (CDSS or CDS) at the ER level can reduce the most common diagnostic errors, hence reducing costs, and saving lives.
Aon Corporation, one of the largest insurance brokers, estimates that hospitals spent roughly 1 billion dollars in 2009 for malpractice suits related to the emergency department. Some of the most common mistakes are confusing indigestion with heart attacks, vertigo and migraines with stroke, viral gastroenteritis with meningitis, and heart attacks and seizures with pulmonary embolism. Careful to not place blame and point the fingers solely at the doctors or the hospital, it was found that, it most cases, the doctor was missing some key information, not readuly available at the time or point of care. This “gap” of information usually pertains to medical history, abnormal vitals (usually because of a gap in communication) and untimely lab and radiology reports.
If it’s not obvious how CDSS and HIEs will address these concerns, let me attempt to explain. One of the easiest reasons to digest concerns the lack of information. By working with and implementing an HIE, the ER doctors will have pertinent, up-to-date information on the patient’s medical history. Recent labs, allergies, meds, and diagnoses from their primary care physician is protected health information (PHI) that will allow the hospital to filter down to the correct problem, and possibly, hopefully, avoid spending critical time by not duplicating tests (whichi is also yet another cost savings!). Implementing CDSS will also require the hospital to develop an “order set” for each leading misdiagnosis.
For example, if a patient complains of indigestion, muscle strain, or anxiety, the system will automatically task the hospital with performing an electrocardiogram. You can easily tie the order set to symptoms, or even to a doctors diagnosis. This intelligence will reduce errors, save time, and save money. At a time where re-admissions are being challenged and accountable care organizations (ACOs) are forming, these systems and tools are crucial in moving us from a fee for service model to one of quality.
July 11, 2011 9:21 AM
Posted by: AllinHIT
, EHR adoption
, Quest Diagnostics
HHS and Quest Diagnostics recently announced that Quest will give away their Care360EHR, an EHR lite product, to physicians serving the minority community in Houston. This is in response to HHS’s challenge to EHR vendors earlier this year to address the “EHR digital divide”. As a former technology consultant with Quest, and being a minority myself, this is the exact win-win strategy I was pushing for.
Unbeknownst to most, the name of my firm, Webmenders was named after I read the Commerce Department’s telecommunications study, “Falling through the Net, Defining the Digital Divide” (http://www.ntia.doc.gov/ntiahome/fttn99/fttn.pdf). I will never forget a picture of a huge net containing an open hole, with minority people falling through it. At the time, I was Executive Director of the Orange County Florida Business Incubator, and with that community support I formed “NetMenders”. “NetMenders”, an effort to educate minorities on internet capabilities and increase access, was supported by Compaq and various community organizations. Although the funding and effort fell short in the end, the concept and effort led to my forever commitment, evident in the naming of my firm.
Back to HHS and Quest. I must applaud them both for providing EHRs and promoting access in Houston. However, I think it makes sense to officially expand the program to more areas (not giving away any secrets, but I hear similar deals are available!). Why is this a smart move for Quest? First of all, MedPlus, their technology subsidiary, has had difficulty reaching sales goals with their EHR product. Yes, it is a decent, certified, EHR lite product, easily deployed and piggy backing on the Care360 Lab Ordering and Information platform, installed in most physician offices. However, Quest is relying on lab sales representatives, with little incentive, to create the sales opportunity and fill the funnel. Secondly, as part of their strategy, Quest will increase lab revenue by giving away the product! By incorporating the lab ordering module into the office workflow, it makes it difficult to order from a lab competitor. You can say this will allow Quest to keep “desktop space”, giving them a competitive advantage.
Lastly, I just believe it’s the right thing to do; not only for Quest, but for other EHR vendors as well. If every EHR vendor adopted a minority health community equal to that now in Houston, we can really begin making a dent and finally take the necessary steps forward to narrow the gap of the digital divide.
July 8, 2011 1:33 PM
Posted by: AllinHIT
, EHR systems
, Physician adoption
Main Line Health, an integrated delivery system anchored with four acute care hospitals serving suburban Philadelphia, is doing its part to spur the adoption of EHRs in the community. Despite the relaxation of Stark Laws, ONC’s Meaningful Use stage 2 and ACO/PCHM models, few hospitals are offering subsidized EHR’s to their physician communities. Main Line’s EHR program should be commended, regardless of motives, for their community altruism and possibly having a positive effect on the rates of EHR adoption.
What makes this particularly attractive to the physician community is the elimination of “barriers to entry” variables, such as software costs, training, interfaces, etc. The program offers up-front funding, helping affiliated physicians adopt a suite of information technology applications beside a standard EHR. Main Line, purchasing 150 licenses from vendor eClinicalWorks, will also include an integrated practice management system (PMS), patient portal, clinical and financial analytics, mobile access and physician-to-physician communications (Direct Project will also do this for free). Another key feature, the importance of which I believe is constantly overlooked, is the physician-to-patient secure messaging for appointment reminders and lab/diagnostic imaging results! Other particulars that should be commended are a fast-track implementation program, designed to bring practices live in less than 12 weeks, where training is provided for a small fee (one of the onl up-front costs). Lastly, providers can repay the licenses if they receive EHR meaningful use incentive payments. Wow!
Main Line is offering this program for both a large physician affiliated base and for those that are non-affiliated. This fact has me asking: Why isn’t this model prominent at all hospitals, especially CAH’s? Not to say that offering one solution to a large physician base will necessarily fit the bill; as we all know, one size EHR does not fit all in terms of physician practices. However, as long as it’s a certified solution, at least it’s a daggone good start!
July 6, 2011 10:32 AM
Posted by: AllinHIT
The Journal of the American Medical Informatics Association, this week published a report detailing error rates for ePrescribing is the same as manual paper scripts. This was stunning to ePrescribe advocates, vendors, and users, who thought an 11% error rate for paper scripts will reduce significantly. However, after reading the cliff notes, I was not surprised the report is useless.
Upon hearing the news and prior to reading the cliff notes, I immediately had many questions. What years were reviewed in the study? What are the particulars pertaining to sample size, geography, and applications used? After reading the cliff notes of the report, searching for these answers, I’ve deemed this study useless and here is why.
First, not all ePrescribe programs are created equal! According to the report, some application out-performed others, some had an error rate of 5%, others were as high as 38%. There are ePrescribe applications that are not “fully informed”. A “fully informed” application automatically and regularly updates manufacturing dosage information, and co-pay information, hence reducing errors in that regard. The report noted that this was responsible for 60% of the errors reported! Notably, physicians typically aren’t aware that their application is not fully informed, which tends to further discussion on the importance of selecting these applications, including EHR’s. Additionally, this study used data from 2008, prior to Meaningful Use effect on eprescribing, requiring a fully informed application. Secondly, it must be noted that patient allergy information, key to not generating contra-indications, is typically not tracked and updated, during the initial use of ePrescribing. Hence, this increases errors to the pharmacy side, whereas, allergies are most likely tracked in perspective pharmacy systems.
Lastly, when I read the study examined data from Florida, I reflected on my work with ePrescribe Florida, a successful public private partnership that increased the adoption of electronic prescribing in the State, as I profiled previously, http://searchhealthit.techtarget.com/healthitexchange/allthingshit/wp-admin/post.php?action=edit&post=60). This was a time, we were at the peak of our efforts, when there were considerable ePrescribe trails, ePrescribe training, and other efforts that could possibly increase user errors. As a ePrescribe Florida stakeholder, and a consultant and trainer for Quest Diagnostics, I spent many hours watching a user, not change the default dosage information, for a script that should of been changed. Maybe they thought the default dosage was intuitive to a patients condition and physician’s notes (sounds like a CDSS feature!). Regardless, there were high user errors in Florida during this period of time, making this report useless for me today.
July 1, 2011 1:33 AM
Posted by: AllinHIT
The month of June ended with Medicare ePrescribing deadlines, Google’s announcement they are discontinuing their PHR, and Redspin’s 2010 PHI report analyzing security breaches. Typically, all of these topics would be fodder for blogging. However, it’s the recent deal in Pittsburgh that is the highlight of the month, which could also prove to have a long-lasting effect on the delivery model.
Pittsburgh based Highmark, a payer with over 3 million members, is buying financially strapped West Penn Allegheny Health System. Some have stated that adoption of Health IT and different delivery models (PCMH, ACO, telehealth, etc) would accelerate with high employer demand, forcing payors and physicians to act. This deal is a direct result of that demand, and will require a commitment to both a technology and a quality focused model. This commitment is evident by Highmark’s backup plan, if this acquisition doesn’t pass regulatory muster.
Knowing that this purchase will go through a rigorous regulatory review, Highmark has positioned the deal as an affiliation to start, officially named Highmark-West Penn. Highmark-West Penn plans to compensate physicians with salaries and is giving variable compensation (bonuses) based on attaining quality and operational efficiency measures. This could be considered a private Shared Savings Program, similar to the Medicare Shared Savings program.
There is plenty of skepticism, and a myriad of questions, associated with this deal. Questions such as: how will a payor compensate a delivery system that they own? Will this create better coordination of care within this community? What effect will this model have on population health in terms of reducing re-admissions, diabetic episodes, adverse drug effects and overall wellness?
Regardless of regulatory approval, Highmark-West Penn is sending a message in the industry. It’s the shot that should be heard around the health care delivery world, aiming at a target of reducing costs, providing better quality and using a technological gun. Let’s just hope other employers, payors, hospitals and physicians are loading their pistols!
June 13, 2011 3:06 PM
Posted by: AllinHIT
, Health information exchange
, Physician adoption
I have been truly amazed at life’s recent events. I was born and raised in Springfield, Massachusetts, the New England town recently on national news for getting one of the worst tornado’s in Massachusetts’ history. This uncommon event that happened in my hometown, in Joplin, Missouri, and elsewhere in the south, have recently reinforced to me the need for EHRs, PHRs, and the need for disaster recovery systems. However, when it comes to adoption of those systems, I can’t help but be reminded about a recent biography on television, Temple Grandin.
Temple Grandin is the one of the most accomplished autistic adults in the US. Known as the “women who thinks like a cow”, she has redefined the process of moving cows throughout the slaughtering process. Before having this impact though, slaughterhouses and ranches ridiculed her ideas and balked at their expense, with the “cattlemen” having trouble switching from the old process to the new. Then the new process eventually gave them a path to efficiency, reduced cost due to errors and stoppages, and created a more humane process. The humanity and efficiency was created by moving and “dipping” the cows in a steady, calm manner, lowering incidents of loss limbs and having zero stoppages. The cows’ path to our table is now based upon on animal science researched by Ms. Grandin, and the positive results are crystal clear!
After watching this HBO movie, I thought about the efficiencies possible with the adoption of PHRs, EHRs, HIEs, ACOs, and the like. I thought about how we must move the physician to EHRs in a steady manner, reducing their work stoppages, while helping them adapt to the new process. Just like the “cattlemen”, physicians must be open to change. Adoption balking should be replaced by exuberance, curiosity, and the desire to improve processes and outcomes. Lastly, all must recognize that the adoption of health IT is truly the most humane process, giving physicians the information to improve outcomes and expand the continuum of care, which is something we all deserve.
So, I want to say “thank you,” Temple Grandin — your story has inspired me to continue preaching the use of health IT for improving processes, increasing efficiencies, and last by not least, in saving lives and improving outcomes.
May 14, 2011 8:58 AM
Posted by: AllinHIT
Once in awhile you see a product that is just so cool, you want to share it with those who can benefit. Such was the case when Joseph Cafazzo, senior director of eHealth innovation at the University of Toronto, gave a presentation on their mHealth app for diabetic teens. This app, called Bant, can be used with an iPhone and Blackberry, and is one of the first where a glucometer connects to a phone and uploads PHI (Cafazzo notes that this took a lot of work with Apple). Bant is also the first mobile app for teens that has a social media aspect to it offering blogs and forums where teens can share their experiences. Lastly there is a reward system giving iTunes credits for using it to monitor glucose, weight and other things based on their care plan (yes, this is bribing them to use the application, and it works!).
A famous couple, Ray & Shannon Allen, who I happen to personally know, are national spokespersons for Juvenile Diabetes, as their son, Walker has Type 1. Ray’s mother, Flo, also works tirelessly raising money and educating herself on this chronic disease. She brings attention to it each year by running the Boston marathon on Walkers behalf. Hence, when I saw this application, I thought of my friends and the thousands of kids that need these tools through-out their lives. Although Walker , is not quite a teen, I hope this app, and many more, are available for him when he is.
I look forward to sharing this information with Ray, Shannon, and Flo. Maybe, their fame can “spread the word”, giving more kids a management tool for this life-long disease. Hear about it in this ATA press conference coverage (starting at 23:00), then let me know what you think!
May 12, 2011 1:50 PM
Posted by: AllinHIT
I had the pleasure of being invited to the ATA press conference in Tampa, Florida. It was a collection of touting the power and justification of Telemedicine, listening to the “powers to be” in the industry, and real life stories from those that benefitted. There were several things that struck me during the conference, and will probably strike you once you see the video below.
First, ATA President, Dale Alverson has contagious passion for telemedicine and is optimistic about its growth. At the same time, he understands the challenges, and what it will take to get Telemedicine more widely used in the medical facilities. Secondly, there are some great human stories reflecting the prowless of Telemedicine in rural america. Listen to Sandra’s story full of skepticism and irony. Last, as a Floridian I realized that the Tele-Trauma program at the University of Miami, has grown and is worthy of more support from our community. I was glad to hear from Dr. Marttos of University of Miami, that the cuts in State funding will have minimal effect on the program, in his opinion. Dr. Marttos description of their service, to areas like in the Florida Keys, was an eye-opener for me being familiar with the geography. A car accident taking place in the Florida Keys, resulting in a head injury, poses a real problem to access a neurosurgeon, and his tele-trauma program addresses the problem and saves lives. Those lives can be my friends, relatives, and even can happen to me, as I’m a frequent visitor to the area.
Yes, the ATA Press conference did make me think. I thought about the technology, the challenges, but most of all, I thought about how it gives people access to care, and it saves lives. Its this latter thought that gives me utopian ideas, like regardless of cost, its something that we all deserve.
May 11, 2011 1:39 PM
Posted by: AllinHIT
Alaska could be called a perfect test bed for telehealth and remote monitoring services. Let’s consider the facts; 70% of Alaska can not be accessed by roads, limiting access to care. The terrain — complete with glaciers, mountains, and extreme cold — contributes to the high cost of transportation, and limits access to medical specialists. The summer/winter rotation of days and nights, the cultural diversity and logistics considereations of rural Indian villages, and the most staggering statistic that 70% of the population will die from chronic diseases. Yes, these are dismal statistics; however, a silver lining does exist, and it does so in the form of the “tele-efforts” of the Alaska Federal Health Care Partnership (AFHCP).
At the recent 2011 ATA conference in Tampa, I had the pleasure meeting David T. Peters, senior program manager of AFHCP’s home telehealth monitoring program. Our happenstance meeting resulted in the following interview on the partnership, telehealth initiatives, the high delivery cost and sustaining strategies, and the positive medical outcomes from their “tele-efforts”.