electronic health record
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Electronic Health Record. What is in it for you?. “ For 8 minutes the computer and I were both functional today ” Randy Glasbergen. Worried?. Dr. Sattenspiel: - PowerPoint PPT PresentationTRANSCRIPT
Electronic Health RecordWhat is in it for you?
“For 8 minutes the computer and I were both functional today
”Randy Glasbergen
Porter S; American Academy of Family Physicians Pilot project studies EHR implementation issues. Ann Fam Med. 2004 Jul-Aug;2(4):377-8.
Worried?
• Dr. Sattenspiel:• "If we go to a system like this and begin to
implement it, we may not be drowning in paper every day, but if we can’t get enough work done—if we can’t see enough patients in a reasonable amount of time to be able to generate the revenues that will support our office—then that could be a disaster."
Central Concerns
• “More effort same output”
• “Interferes with patient time”– Reduces quality of care
Other Concerns
• Pay for performance
• Anti-trust legal barriers
• Privacy and security obligations
• Liability exposure
• Lack of interoperability
Other Concerns
• Pay for performance
• Anti-trust legal barriers
• Privacy and security obligations
• Liability exposure
• Lack of interoperability Lets focus on central problems that physicians
express
Worried about Effort
• What if we have to maintain both paper and computer records?
“We back up our data on sticky notes because they do not crash”
Randy Glasbergen
Edsall RL, Adler KG. An EHR user-satisfaction survey: advice from 408 family physicians. Fam Pract Manag. 2005 Oct;12(9):29-35
Worried about Effort
• Will it let me do what I am doing?
• Do I have to spend more time at it?– I am not a typist– Will I have to redo
• Is it fast? Time saved because records are available on
demand or remotely
Edsall RL, Adler KG. An EHR user-satisfaction survey: advice from 408 family physicians. Fam Pract Manag. 2005 Oct;12(9):29-35
Worried about Effort
• Will it let me do what I am doing?
• Do I have to spend more time at it?– I am not a typist– Will I have to redo
• Is it fast?How much more time will it take?
More Hype than Reality
• 1994: “Twice as long”
• 2001: “5% more time”
• 2006: “No difference”
Bates DW, Boyle DL, Teich JM. Impact of computerized physician order entry on physician time. Proc Annu Symp Comput Appl Med Care. 1994;:996. Shu K, Boyle D, Spurr C, Horsky J, Heiman H, O'Connor P, Lepore J, Bates DW. Comparison of time spent writing orders on paper with computerized physician order entry. Medinfo.
2001;10(Pt 2):1207-11. Lo H, Newmark LP, Yoon C, Volk LA, Carlson V, Kittler A, Lippincott M, Wang T, Bates DW. The electronic health record in specialty care: A Time motion study. AMIA Annu Symp Proc. 2006 Nov 11;2006(CD):1014.
Time Motion Studies of House Staff & Physician
Offices
Laschober M, Maxfield M, Lee M, K hober Kovac M, P ovac Potter F otter F, F , Felt- elt-Lisk S. Hospital ospital
The Entire Industry is Changing• The 2005 CMS / Mathematica Hospital
survey– 83% used electronic lab results; – 59% used electronic clinical notes; – 50% had electronic images and lab orders; – 24% used electronic reminders – 21% used e-prescribing
What about CPOE?
Studies cited in Health Information Technology in the United States: The Information Base for Progress
Use of Computerized Physician Order Entry in Hospitals
0
20
40
60
80
100
2002 2004 2006 2008 2010 2012 2014
Year
% H
os
pit
als
wit
h C
PO
E
Goal
Ward MM, Jaana M, Bahensky JA, Vartak S, Wakefield DS. Clinical information system availability and use in urban and rural hospitals. J Med Syst. 2006 Dec;30(6):429-38.
Use of Computerized Physician Order Entry in Hospitals
0
20
40
60
80
100
2002 2004 2006 2008 2010 2012 2014
Year
% H
os
pit
als
wit
h C
PO
E
In some areas,80% of Urban Hospitals
Use CPOE
Murff HJ, Kannry J. Physician satisfaction with two order entry systems. J Am Med Inform Assoc. 2001 Sep-Oct;8(5):499-509.
Satisfaction with Order EntryEarlier
systemsCurrentsystems
Impact on QualityMuch more complex than first imagined
Long Term Impact Expected
• Reduced medication errors
• Reduced adverse sentinel events
• Reduced liability & better reliance on guidelines
• Reduced waste and duplicate testing
Kljakovic M, Abernethy D, de Ruiter I. Quality of diagnostic coding and information flow from hospital to general practice. Inform Prim Care. 2004;12(4):227-34.
Reduced Duplicate Test
• “There is delay in information flow from hospital to general practice”
• Remote access could reduce the delay
Bates DW, Teich JM, Lee J, Seger D, Kuperman GJ, Ma'Luf N, Boyle D, Leape L. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc. 1999 Jul-Aug;6(4):313-21.
Less Medication Errors• Improves fidelity of exchanges among
physicians, pharmacists and nurses
Bates DW, Teich JM, Lee J, Seger D, Kuperman GJ, Ma'Luf N, Boyle D, Leape L. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc. 1999 Jul-Aug;6(4):313-21.
Quality: Less Errors• Improves fidelity of exchanges among
physicians, pharmacists and nurses5 months
after CPOE
Before CPOE
Bates DW, Teich JM, Lee J, Seger D, Kuperman GJ, Ma'Luf N, Boyle D, Leape L. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc. 1999 Jul-Aug;6(4):313-21.
Less Medication Errors• Improves fidelity of exchanges among
physicians, pharmacists and nurses5 months
after CPOE
Allergy Warning System
Bates DW, Teich JM, Lee J, Seger D, Kuperman GJ, Ma'Luf N, Boyle D, Leape L. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc. 1999 Jul-Aug;6(4):313-21.
Less Medication Errors• Improves fidelity of exchanges among
physicians, pharmacists and nurses
Drug-Drug Interaction
System
Allergy Warning System
Bates DW, Teich JM, Lee J, Seger D, Kuperman GJ, Ma'Luf N, Boyle D, Leape L. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc. 1999 Jul-Aug;6(4):313-21.
Less Medication Errors• Improves fidelity of exchanges among
physicians, pharmacists and nurses
Just storing and retrieving data is not
much of a benefit. To get more out of your
investment, you need to analyze and use the
stored data.
Shulman R, Singer M, Goldstone J, Bellingan G. Medication errors: a prospective cohort study of hand-written and computerised physician order entry in the intensive care unit. Crit Care. 2005 Oct 5;9(5):R516-21. Epub 2005 Aug 8.
Less Medication Errors• Improves fidelity of
exchanges among physicians, pharmacists and nurses
Shulman R, Singer M, Goldstone J, Bellingan G. Medication errors: a prospective cohort study of hand-written and computerised physician order entry in the intensive care unit. Crit Care. 2005 Oct 5;9(5):R516-21. Epub 2005 Aug 8.
Less Medication Errors• Improves fidelity of
exchanges among physicians, pharmacists and nurses
Why should errors go down?
WOLF, DEBRA M. MSN, RN; GREENHOUSE, PAMELA K. MBA; DIAMOND, JOEL N. MD, FAAFP; FERA, WILLIAM MD; McCORMICK, DONNA L. BS Community Hospital Successfully Implements eRecord and CPOE. Computers, Informatics, Nursing. 24(6):307-316, November/December 200
Before EHR
WOLF, DEBRA M. MSN, RN; GREENHOUSE, PAMELA K. MBA; DIAMOND, JOEL N. MD, FAAFP; FERA, WILLIAM MD; McCORMICK, DONNA L. BS Community Hospital Successfully Implements eRecord and CPOE. Computers, Informatics, Nursing. 24(6):307-316, November/December 200
WOLF, DEBRA M. MSN, RN; GREENHOUSE, PAMELA K. MBA; DIAMOND, JOEL N. MD, FAAFP; FERA, WILLIAM MD; McCORMICK, DONNA L. BS Community Hospital Successfully Implements eRecord and CPOE. Computers, Informatics, Nursing. 24(6):307-316, November/December 200
EHR streamlines the
process & reduces
sources of error
WOLF, DEBRA M. MSN, RN; GREENHOUSE, PAMELA K. MBA; DIAMOND, JOEL N. MD, FAAFP; FERA, WILLIAM MD; McCORMICK, DONNA L. BS Community Hospital Successfully Implements eRecord and CPOE. Computers, Informatics, Nursing. 24(6):307-316, November/December 200
Simple and straight forward
After EHR
WOLF, DEBRA M. MSN, RN; GREENHOUSE, PAMELA K. MBA; DIAMOND, JOEL N. MD, FAAFP; FERA, WILLIAM MD; McCORMICK, DONNA L. BS Community Hospital Successfully Implements eRecord and CPOE. CIN: Computers, Informatics, Nursing. 24(6):307-316, November/December 200
Timetable at a Community Hospital
How fast willall of this happen?
WOLF, DEBRA M. MSN, RN; GREENHOUSE, PAMELA K. MBA; DIAMOND, JOEL N. MD, FAAFP; FERA, WILLIAM MD; McCORMICK, DONNA L. BS Community Hospital Successfully Implements eRecord and CPOE. CIN: Computers, Informatics, Nursing. 24(6):307-316, November/December 200
Timetable at a Community Hospital
Process improvement takes a lot
longer
What next?
• You get what you put in– The sooner the better
• Success is more likely if you are involved– Quality of systems– Components included– Configuration decisions
This is a quality improvement projectand not an IT project
What do you want it to be?The Likely Impact Depends on the Details