Health InformaticsHealth InformaticsIT PerspectiveIT Perspective

Aaron Samson

CIS 615-301

Spring 2010

Electronic Medical Record Electronic Medical Record (EMR)(EMR)

• Helps reduce medical errors through:

1. Computerized prescription entry

2. Predicting drug interactions

3. Medical reconciliation• Number of visits lower, shorter• Greater patient interaction• Charts can be routed easily

Sources: (9), (5), (6)

EMR-How is it Done?EMR-How is it Done?

• Info sent to provider’s EMR inbox• Cleveland Clinic training on EMR• Physician training for patient interaction• Results/appts. acquired by patients• Reminders for disease management, annual screenings or

required immunizations• Monitoring systems for patient accounts: which ones and

how long

Sources: (9), (5), (6)

EMR-Organizational ConcernsEMR-Organizational Concerns

• Crashes, security breaches, and off-site data storage

• Non-personal attitude from physicians (need for “triangle”)

• Initial decrease in productivity due to implementation and training

Sources: (9), (5), (6)

Electronic BillingElectronic Billing

• Primary benefit-speedier payment• Prevention of “dirty claims”-mistakes or improper

forms• $2,500 to $20,000 cost for implementation so

some unwilling to pay amount up-front if future uncertain

• Monetary incentives (Blue Cross California)

Sources: (10)

E-Billing (Cont.)E-Billing (Cont.)

• E-submissions improved accuracy:1. Reduce paperwork

2. Lower postage

3. No lost claims

4. Instant status reports

5. No poor handwriting

Total………………… $15,481

Claim forms………… $1,300

Postage…………….. $1,031

Telephone calls……. $600

Additional overhead $400

Envelopes…………. $150

Salaries……………. $12,000

* Based on one-physician practice processing 15,000 claims per yearUROLOGY TIMES/SOURCE: CIGNA HEALTHCARE, CHATTANOOGA, TN

Sources: (10)

Physician Order EntryPhysician Order Entry(aka CPOE)(aka CPOE)

Benefits include: legible orders, transcription reduction, rapid routing or orders

Challenges:

1.Physician and org. resistance

2.High cost (measured benefits difficult to calculate)

3.Vendor/product immaturity

Sources: (3), (8)

CPOE-CPOE-Introduction of Introduction of evidence-based medicine evidence-based medicine

quicklyquickly• Enhances data flow:

Physicians focus Error-checkingAlerts and reminders

Reengineering of work flow and “clinical leaders” also important

Sources: (3), (8)

Physician Order Entry- Physician Order Entry- Justifying the CostsJustifying the Costs

• Overcoming costs include focusing on patient safety (no complaints)

• Cost-worthy benefits:

1. Reduced callbacks from other providers

2. Increase in important info in patient files

3. Ordering alerts for duplicate or error testing

Sources: (3), (8)

Health Management SystemsHealth Management Systems• Benefits both patients and staff:

1. Keeps patient info in one place

2. Simplifies among organizations and gives context for patient

3. Motivate patients to make better decisions and employees to improve efficiency, reduce costs

EKG Results

MRI Results

Blood Test Results

Patient-Centered Solutions

Sources: (7)

Health Management SystemsHealth Management Systems

• Overall focus: “Information liquidity”• Training/preparation involve:

Involve clinicians in, “What’s in it for me?”Patients have more control of information“Self-service” bank approach

*Overall affects affordability, availability, quality and effectiveness*

Sources: (7)

Order/Result EntryOrder/Result Entry

• Limited as order entry exposes human-computer interaction problems:

1. Separate logins for different portals

2. Workspace outdate for new hardware

3. Non-physician staff receiving non-essential information

4. Reduced Situational Awareness

Sources: (2), (4)

Order/Result Entry: ExampleOrder/Result Entry: Example Unet: Online network for United Network for Organ Sharing

Waitlisting information for nurse coordinators

Real-time information for donor HLA typing/crossmatching

Validation Sources: (2), (4)

HIPAAHIPAA

• Health Insurance Portability and Accountability Act of 1996

• Safeguards medical records and established security standards

• Employees required to:

1. Establish security officer

2. Proper information training

3. Use minimal information

Sources: (1)

HIPAA- Good or Bad?HIPAA- Good or Bad?

• Laboratory information limited due to receiving orders and sending results only to physicians

• Protects information but along with other laws (CLIA ‘88), prevents widespread use of EMRs

“The dream of a nationwide patient-accessible and patient-controlled EHR seems far-off…” -Gary Burkhartsmeier

Sources: (1)

Flexibility-Virtue for ChangeFlexibility-Virtue for Change

• Needs for a successful change:

1. Good attitude- “buzz-i-tude”

2. Keep an open mind

3. Imagine perfection

4. Focus on goals

5. Provide feedback on successes/issues

Sources: (11)

ReferencesReferences1. Burkhartsmeier, G. (2007, June). HIPAA: Where are we now?. MLO: Medical Laboratory Observer, p. 28. Retrieved from Academic Search Premier database.

2. Campbell, E., Guappone, K., Sittig, D., Dykstra, R., & Ash, J. (2009). Computerized Provider Order Entry Adoption: Implications for Clinical Workflow. JGIM: Journal of General Internal Medicine, 24(1), 21-26. doi:10.1007/s11606-008-0857-9.

3. Chaiken, B. (2001). Enhancing Patient Safety with Clinically Intelligent Physician Order Entry. Nursing Economic$, 19(3), 119-120. Retrieved from Academic Search Premier database.

4. Dickinson, D., Bryant, P., Williams, C., Levine, G., Shiqian, L., Welch, J., et al. (2004). Transplant data: sources, collection, and caveats. American Journal of Transplantation, 413-26. doi:10.1111/j.1600-6135.2004.00395.x.

5. Garg, A. X., Adhikari, N. K., McDonald, H., Rosas-Arellano, M. P., Devereaux, P. J., Beyene, J., et al. (2005). Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: A systematic review. Journal of the American Medical Association, 293, 1223–1238.

6. Harrison, J. P., & Palacio, C. (2006). The role of clinical information systems in health care quality improvement. The Health Care Manager, 25, 206–212.

7. Neupert, P., & Mundie, C. (2009). Personal Health Management Systems: Applying The Full Power Of Software To Improve The Quality And Efficiency Of Care. Health Affairs, 28(2), 390-392. doi:10.1377/hlthaff.28.2.390.

8. Poon, E., Blumenthal, D., Jaggi, T., Honour, M., Bates, D., & Kaushal, R. (2004). Overcoming Barriers To Adopting And Implementing Computerized Physician Order Entry Systems In U.S. Hospitals. Health Affairs, 23(4), 184-190. doi:10.1377/hlrhaff.23.4.184.

9. Richards, M. (2009). Electronic Medical Records: Confidentiality Issues in the Time of HIPAA. Professional Psychology: Research & Practice, 40(6), 550-556. doi:10.1037/a0016853.

10. Wynn, P. (1999). Electronic billing cuts costs, speeds reimbursement. Urology Times, 27(6), 32. Retrieved from Academic Search Premier database.

11. (2010). CHANGE MANAGEMENT. (cover story). Health Management Technology, 31(3), 14. Retrieved from MasterFILE Premier database.