Technology: The Good, the Bad and the UglyPresentation Transcript
The Good, The Bad, And The UglyJason Morneau RT(T)Chief Therapist Boston VAMC http://geofflivingston.com/2011/02/21/the-good-the- bad-and-the-ugly-of-online-cause-marketing/
Briefly discuss technological advances in treatmentEMR vs. EHRThe positive and negative outcomes of technologyOverview of human errorPublicized treatment errors/incidencesDiscuss the use of online incident reporting services.
EMR vs. EHR Electronic Medical Record Electronic Version of a Paper Chart Record and Verify Systems ARIA/Varian MOSAIC/ELEKTA Electronic Health Record What is it? HL7 Developed in the start of 1970’s 1971 tested at Brunswick Naval Air Station 1978 launched at 20 VA’s 1981 named DHCP and put into law Finland Hospital first outside US www.wikipedia.com www.healthit.gov/buzz-blog/electronic-health-and-medical-records/emr-vs-ehr-difference/ www.elekta.com www.varian.com http://www.uwlax.edu/md/studentresources/Documents/Heath%20Revised%20Manuscript.pdf
• Recovery and Reinvestment Act of 2009 Health Information Technology for Economic and Clinical Health Act or HITECH Act President Obama wanted all hospitals paperless by 2014 $17 Billion of funds available in incentives Medicare and Medicaid want it by 2015 What is Meaningful Use? http://www.elekta.com/healthcare-professionals
1. Use of CPOE (computerized provider order entry) formedication orders;2. Drug to drug and drug allergy interaction checks;3. E-Prescribing (eligible professionals only);4. Recordation of demographics and smoking status, andchanges in vital signs;5. An up-to-date problem list;6. Active medication list and medication allergy lists;7. One clinical decision support rule;8. CQM as specified by the Secretary;9. Providing patients with an electronic copy of theirhealth information (eligible professionals and hospitals)and discharge instructions (hospitals only);10. Providing clinical summaries for patients for eachoffice visit (eligible professionals only); and Protectingelectronic health information.
• Medicaid- – Physicians whose caseloads include at least 30% Medicaid patients are eligible to receive up to $63,750 over the course of 6 years• Medicare – – Physicians seeing Medicare patients can receive up to $44K over the course of 5 years• Eligible professionals who cannot demonstrate that they are meaningful – January 1, 2015, will receive an adjustment to their Medicare fee schedule of 99% for 2015, 98% for 2016, and 97% for 2017 and each subsequent year. www.gfrlaw.com
Eligible professionals who cannot demonstrate that they are meaningful users of certified EHR by January 1, 2015, will receive an adjustment to their Medicare fee schedule of 99% for 2015, 98% for 2016, and 97% for 2017 and each subsequent year.
Technology Positives and Negatives“WITH GREAT POWER THERE MUST ALSO COME - -GREAT RESPONSIBILITY! “-Stan Lee Amazing Fantasy #15(August 1962)
Better patient care Share patient information securely Dose distribution and escalation Decrease side effects Living longer Improved QA Treating the untreatable Decrease in treatment time
More organized and timely Thank you computer No more missing charts Neat charts/save room Faster Turn around time MD approval of films
The computer Slow or stuck computers Server issues Trusting the computer is always right. Outdated procedures, QA
Education and Training Under staffed departments New generation of students Clinical based vs. Technical based knowledge Dirty Word “Competency” Proper QA/Commissioning of the machines
New grads are experiencing a whole new world of learning. Education has come into the digital age The need to teach things from the past as well pastThe veterans are trying to keep up with a whole new world. AHHHH you want me to what? Getting left behind
New York Times articles A series of articles “The Radiation Boom.” by Walt Bogdanich Cases looked at in Radiation Therapy IMRT plan missing for 3 treatments Missing filter for 27 treatments Field Size issue Cases in other modalities.
• Release of statements – ASTRO • Letter to the New York Times January 25, 2010 Tim R. Williams MD. • Radiation therapy 99.99 percent safe and effective • The White Papers – ASRT • ASRT Responds to New York Times Article Jan. 27, 2010, Diane Mayo, R.T.(R)CT) – NESRT • We must look to and support our regional representation www.asrt.org www.astro.org
Definition:Human error, the propensity forcertain common mistakes bypeople; the making of an error as anatural result of being human(www.dictionary.com)
30 patient=150 treatments per week = 600 treatments a month and 3600 in 6 months.1 incident occurs1/3600=0.003% probability of an error or 99.997% reliability factor.(Swain, 1963)
IHE-RO was established in 2004 www.wiki.ihe.net Vendor equipment connectivity issuesPatient Safety Organizations GE PSORadiation Oncology reporting systems Hospital based AHFMR/HTA ROSIS www.ihe.ca/documents/HTA-FR22.pdf www.astro.org/Practice-Management/IHE-RO/In/www.rosis.infodex.aspx
What do we as therapists need to doThe development of the reporting cultureThe trail of the incidence reportIncidence vs. Reportable medical event DPH 105 CMR Section 120.435
Voluntary incident reporting systemDiscussed last year at the VA Radiation Oncology Meetingswww.rosis.info