Going electronic in six painless steps

Forget the rumours — the switch from paper to computer records doesn’t have to be a nightmare

By Sam Solomon, National Review of Medicine April 30, 2007

“I’d like to…” laments Dr Kalyani Srinivasan, a GP in Fredricton, NB, about the thought of switching from paper records to a computerized system. “But the cost — in time, money and effort — is tremendous and I don’t have any of the above to meet the challenge.”

It’s a familiar refrain. Ask almost any Canadian physician if they’re planning to adopt an electronic medical record (EMR) system and the answer invariably begins, “Sounds great, but….”

In fact, Canadian docs came dead last in EMR use compared to other industrialized nations’ physicians in a survey last year by prestigious US-based healthcare charity the Commonwealth Fund. Just 23% of Canadian primary care physicians have computerized their patient files, in stark contrast to Holland’s sparkling 98% mark. If those were MCAT scores, the Dutch would walk away with all the big grants and the cushy fellowships — and Canada wouldn’t even get into med school. EMR systems have been shown to help reduce adverse events, improve communication between health providers and keep a tighter lid on health record privacy.

Sure, the prospect of going electronic can be intimidating, but it doesn’t have to paralyze you. Follow these six simple steps to guide you through the research and implementation of an EMR software system.

1 LEARN WHAT’S OUT THERE
Research, research, research. And then do some more research. That’s the advice from Dr Alan Brookstone, a Vancouver GP and the creator of Canadian EMR, an industry-funded project designed to help Canadian doctors choose EMR software.

Your most important source should be your fellow physicians, he says. (But don’t forget to make sure they aren’t shareholders or board members of the company they recommend.)

Vendors may offer demonstrations of their products to help you get a better look at them. Or you could go to a nearby clinic to check out their system first-hand.

Don’t rely on the internet too heavily; just sifting through the software company’s website and separating the gibberish from the gems could take longer than it took to earn your MD.

It’s important to include all of your practice’s physicians and staff in the decision process to ensure everyone is on the same page, adds Dr Brookstone.

More research sources will soon be available, including a full version of Dr Brookstone’s Canadian EMR project, which will feature a comparison tool to allow physicians to look at other physicians’ ratings of EMR software based on a number of criteria. (The site, which is not yet fully operational, has a physician-only blog located at emruser.typepad.com.) Canada Health Infoway is also developing a set of standards that it intends to use to certify EMR software.

 

Full article here: http://www.nationalreviewofmedicine.com

 

House Bill To Help Small Practices Adopt Health IT

April 23, 2007

Reps. Charles Gonzalez (D-Texas) and Phil Gingrey (R-Ga.) on Thursday introduced a bill that would give grants, loans and tax incentives to small physician-practices to help offset the costs of health IT systems, Health IT Strategist reports.

Under the bill, Medicare would provide payment incentives that could be used by physician practices with 10 or fewer full-time employees to purchase health IT infrastructure tools, such as electronic health record systems, evidence-based clinical decision support tools and secure e-mail.

HHS also could include additional incentives for evaluation and care management services, payments for structured e-mail consultations and any other necessary communication methods, Health IT Strategist reports.

The amount of reimbursement would be based on certain factors, including the type and price of equipment and how it will be used, according to the bill. Grants and loans also would be subject to the discretion of the HHS secretary.

The bill also would change the tax code to increase deductions for purchasing qualified health IT tools for physician practices qualifying under the IRS’ broad definition of a small business. Physicians also could use the deduction for equipment that they started using at the beginning of 2007, Health IT Strategist reports (DoBias, Health IT Strategist, 4/20).

Source: http://www.ihealthbeat.org/

VA Takes the Lead in Paperless Care

Computerized Medical Records Promise Lower Costs and Better Treatment

By David Brown

Washington Post Staff Writer
Tuesday, April 10, 2007; Page HE01

Divya Shroff, a staff physician at the Veterans Affairs Medical Center in Northwest Washington, stops what she’s doing to answer her phone: It’s a doctor down the hall who needs help with a man struggling to breathe.

She calls up the patient’s medical record on the computer at her desk and scrolls through lab reports, doctors’ notes, X-rays and EKGs, thinking out loud with the medical resident, who is at the man’s bedside.

Strep pneumo in the blood. Chest film looks like he’s accumulating fluid. Supposed to get a chest tube. Hard to wake up. No new meds that would be sedating him. Looks like he needs the ICU.

Over the next 10 minutes, Shroff visits the patient’s room and the ICU, and in both places summons his medical record on other computers while she talks with a half-dozen people about what needs to be done. She spends no time looking for the patient’s chart, riffling through paper or decoding handwriting. Nor does she ask anyone to take her word for things. She just lets the evidence — all of it right there for everyone to see — make the case that the patient needs to be moved as soon as possible.

It turns out to be the right decision. Soon after he gets to the ICU, he stops breathing. Doctors resuscitate him and put him on a ventilator.

Did the electronic medical record save this 71-year-old man? It’s impossible to say

But this much is clear: Never again will a VA patient’s chart be an excuse for things not happening efficiently. Never again will information that is lost, hard to read or impossible to move from one place to another be a factor in the complicated calculus of what makes good medical care — and, on occasion, saves lives.

The electronic medical record is the most important single development helping to usher in the Era of No Excuses in modern medicine.

Continued at: http://www.washingtonpost.com/wp-dyn/content/article/2007/04/06/AR2007040601911.html

Survey: E-health records don’t have to jeopardize privacy

Harris Poll also finds most adults comfortable with existing state and federal health privacy laws

Heather Havenstein March 26, 2007 (ComputerWorld) — Electronic health records can be recorded and shared without jeopardizing privacy, according to a Harris Interactive Inc. survey of 2,337 adults that was released today.

In the survey, 63% of respondents said that a move to electronic health records could be done without endangering their privacy, while 25% disagreed. In addition, 60% of those surveyed said that existing state and federal health privacy laws provide a “reasonable level” of privacy.

The survey, which was done in January, was designed with Alan Westin, a professor of public law and government at Columbia University who studies electronic health records.

The survey showed “about a two-thirds majority are ready to accept the potential benefits of electronic health records systems if solid privacy and security rules are applied,” Westin said. “However, about one quarter of the public remains skeptical and worried about such systemic computerization, and it will take highly robust and transparent new privacy and security programs to overcome these fears.”

The survey also found that seven in 10 U.S. adults are generally satisfied with the way doctors and hospitals handle and protect personal health information. However, 50% noted that they believe patients have lost control over how organizations like insurance companies, employers and government health agencies use their personal health data.

The survey comes at a time when privacy concerns are at the forefront of federal government and health care providers’ efforts to help spur the adoption of electronic medical records and the creation of nationwide networks to share them.

Last month, the U.S. Government Accountability Office released a report  that said the federal government has not yet come up with a way to tie together the various ongoing initiatives it has to tackle privacy concerns associated with electronic medical records.

In addition, one of the country’s oldest regional health information organizations was shuttered  late last year, citing privacy as one of the challenges to continuing its operations.

Find article here:  www.computerworld.com

Hospital celebrates going paper lite

03/03/2007 Ruth Campbell Staff Writer Midland Reporter-Telegram

Scanned medical charts, patient histories and barcoded medications are now part of the landscape at Midland Memorial Hospital.

The electronic medical records system is called EDITH (Electronic Data Information for Team Healthcare). It is now the main source for patient care information for all caregivers throughout the hospital, including physicians, nursing staff and other patient care workers.

Work on the system began a year and a half ago and involved everyone in the hospital on the main and west campuses, Senior Clinical Analyst Sharon Nash said.

Medical electronic records, barcoded medication so patients are given the right medicine at the right time and computerized physician order entry have all gone live, Nash said.

“The biggest advantage is retrieval. Doctors can access it from their home or office. A hundred people can get into that one record at once,” she said. However, only one person can place orders.

By 2010, registered nurse Kirk Brogdon said, the government has mandated that all hospitals in the country have electronic medical records. For medication, the U.S. Food and Drug Administration also wants every medication barcoded.

“It’s made the documentation more efficient. The thing about electronic medical records is you’ve got an exact record … of a chart,” he said. “In the paper world, things can easily get misplaced. With this, they don’t.”

“EDITH is a birth to death record,” he said, meaning its a continuous patient record, so every time a patient comes to the hospital, a nurse or physician can review the patient’s medical history.

The system was adapted from VistA, used by the Veterans Administration. The hospital allocated $7 million and was awarded a $250,000 grant from the Voluntary Hospitals of America (VHA) Foundation to make the electronic system a reality.

Part of the $7 million paid for a consulting firm, Aliso Viejo, Calif.-based Medsphere Systems Corp., for training and implementation, hardware and a wireless network on both campuses.

Read article here: www.mywesttexas.com

Psychiatric center reaps EHR benefits

By Bernie Monegain, Editor Healthcare IT News 02/26/07

HOUSTON – The University of Texas-Harris County Psychiatric Center, is reaping the benefits – and savings – of automating its medical records.

The gains are coming after three years of implementation and tweaking to get it to work just right. Psychiatric facilities present a unique set of challenges for turning paper-based records to digital ones, said Richard Montanye, director of medical information systems at the center

Now that that the electronic health record system is up and running, Montanye and his 14-member IT team are ready to tackle other work: Improving registration with photo capability; automating more forms on the Web and making it possible to capture patient electronic signatures on consent forms. They will also upgrade the electronic health record system – Eclipsys Sunrise – to include progress notes and more alerts for clinicians.

The center also is streamlining IT desktop support by centralizing all nursing unit computers in the server room using blade technology

Over the past three years, the psychiatric center partnered with the University of Texas-Health Science Center to introduce document imaging, share bandwidth for telehealth, helpdesk support and a common e-mail system. It also improved its infrastructure to support its electronic health record, wireless access, carts and telehealth with various organizations within and outside of Houston,

The center “is the only hospital along with the VA that has complete documentation for all disciplines,” Montayne said, including computerized physician order entry, medication administration record, initial physician exam and master treatment plan.

Montanye calls the center “small, but modern.”

The 250-bed public psychiatric hospital delivers psychiatric services to children, adolescents and adults with mental illness. It serves more than 6,000 inpatients and 3,000 outpatients annually. It has 25 on-staff physicians and more than 170 nurses.

The repeated visits, and the at times long, unstructured notes physicians enter at each visit don’t fit into an ordinary template, so some adjustments to the EHR system had to be made.

“While implementing an EHR system in a psychiatric setting presented a unique challenges, said Jay Deady, executive vice president, customer solutions, at Eclipsys, “the solution’s flexibility and the team at University of Texas-Harris County Psychiatric Center’s domain expertise made the project a success.

“The ultimate reward for all the hard work is the improved patient outcomes UTHCPC documented following the activation, in particular a reduction in both medication errors and adverse drug events.

In less than three months after implementing the electronic health record system, the pilot unit reported it had eliminated nursing transcription errors and had reduced medication errors by 89%, Montanye said.

Hospital-wide, the number of adverse drug errors reported decreased each quarter by as much as 51 percent after the implementation of CPOE.

Sheppard Pratt, a psychiatric hospital in Baltimore, is at the start of its implementation and customizing of its Eclipsys system. John Baronow, MD, said Eclipsys Sunrise is highly customizable. The down side, he said, is every installation is custom.

Psychiatric hospitals present a unique challenge for automating records, he said. “The kinds of clinical data are not things that med-surg software have been designed to define and capture.”

“All we really want is to record how often the patient is yelling, is he being reclusive? They can do it, but they don’t have a template for doing it.”

Find article here: www.healthcareitnews.com

CMC record system goes electronic

Wed Feb 21 2007 By Jon Tatting

Patients may be noticing a new and improved approach in how they’re receiving care at Cambridge Medical Center.

The approach: an electronic medical record system — a computerized version of the paper system — designed to enhance the safety and quality of a patient’s care.

Allina Hospitals and Clinics and CMC have been busy loading patient charts into the electronic system, which includes medical history relating to allergies, medications, test results as well as contact and insurance information.

While the medical center this month has gone “live” in transitioning its clinic or outpatient areas, CMC is expected to be up to speed with the emergency department and overall hospital by the end of 2008.

“We’ve loaded 10,000 charts (out of 137,000) in the past few months,” said Dr. David Pearson, noting the learning process takes hours of intensive training.

Under the new electronic system, patients will have one record that will follow their care from one clinic to any other Allina clinic, hospital or outpatient facility, which has transitioned to the new system.

The system is also designed to improve the safety and efficiency of a patient’s care as caregivers will have faster access to test results, medical history, medications and prior health conditions. It automatically cross-checks any new prescriptions a caregiver is considering to avoid negative interactions with allergies and current medications.

“This is the biggest change in practicing medicine since medical school, residency,” shared Dr. Pearson of his journey with the new system.

Allina is implementing the biggest integrated electronic system in the country, noted CMC President Dennis Doran.

“It’s a big expense for the betterment of patient care and efficiency. It will be really appreciated by patients,” he added.

Impacts on patients

The new system can retrieve medication information that may be hard for a patient to remember.

Blood orders can be sent electronically without the hassle of paperwork.

Meanwhile, the system will offer a better sense of communication from receptionist to physician.

In light of scheduling, it’s a learning process at Cambridge Medical Center where 400 employees will be impacted by learning the new system. At first, doctors may see less patients in a given day so they can learn as they go.

How it works

During an initial visit, patients will provide their medical history, insurance and contact information so they can be entered into their new electronic medical record. This will save time for future visits as patients will simply verify and update any information.

Information contained in a patient’s medical record may be transferred to another facility outside of Allina or to an Allina facility that has not yet transitioned to the new system.

Doran and CMC staff noted this technology was not available to the medical profession until three years ago, due to security and confidentiality measures.

Privacy held to high standard

Allina and CMC emphasize the privacy of medical information will be more secure than ever, internally and externally, through the new system.

Only medical providers and personnel involved in a patient’s care will have access to his or her record. Another feature monitors who has accessed a patient’s medical information.

‘My Chart’

In about six months, patients will have access to My Chart, a secure Internet tool designed for individual medical records.

Through My Chart, patients can log onto their medical record via a personalized code and password from their home computer. They can view their medications, diagnosis, lab reports and any background information on various health issues or diseases.

Patients can also make doctor appointments online.

With patient permission, instant health-related updates can be shared with other institutions via My Chart. It features a patient’s chart review, progress notes, test results, flowsheets and even graphs showing one’s progress over a certain amount of time.

Article Source: www.isanticountynews.com