Healthcare Networks

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  • Our “experimental” practice, from where all data will be collected.
  • - Communication- not necessarily literal face-to-face (referrals are “communication”)
  • Additional edges: relationships determined by looking up which practice each referred physician is a part of (same practice, there must be a connection, edge), also based on the OBGYNs’ (of WCHA) knowledge of which other physician’s collaborate with each other. In graph: color of nodes = specialization, length (distance) of edges = frequency of referrals (interpreted as weaker or stronger relationships, as opposed to just weak vs. strong with dotted vs. solid lines), thickness of edges = thick signifies the physicians are part of the same practice.
  • Interpretation of Cartoon: working individually, it’s like physicians have on a blindfold, they can only rely on their own knowledge. Physician networks are crucial to thorough treatments and diagnoses, or even just patient assurance. Other factors may include: type of insurance
  • First bullet: mostly helpful because patient’s lose them and it’s convenient to keep them all in one spot (referral is taken note of in the individual patient’s chart as well) Second: Oftentimes, once a patient is referred somewhere, medical records need to be shared, in the case of the practice we looked at, faxed (b/c use PMRs)
  • Overview: have survey in hand and mention what kind of questions there were
  • Q2 – Question of relativity, those who are satisfied with PMRs, might be MORE satisfied with EMRs, but wouldn’t know because they’ve only dealt with one type. Those who use EMRs, have a better sense of “real world” implementation of EMRs, and can compare that with what they had in the past.
  • Significant advantage of EMRs – organization
  • PMR: major issue is space, illegibility EMR: system failure
  • Pros of PMRs:Pros of EMRs: Chart accessibility and retrieval-often MR can be retrieved from any location, locally or remotely, 24/7. Allows for multi-user use.Organized-can search for specific information such as medication changes, allergies, bp over the course of visits
  • Cons of PRMs:Continuity of care-inability to pass on complete set of information from one health care entity to the next ex. From hospital physician to hospice careCons of EMRs:Inability to integrate information from other sources-cannot link information such as clinical laboratory data to EMR unless within same practice. Goes down over time with practice with system.Initial costs-can be upwards of $30,000-$50,000 per physician
  • Annual Per-Physician Costs of Paper Charting for Three Physicians
  • Basic Medicare offering for office-based physicians: range from $20,000 to $44,000Higher amounts go to physicians who meaningfully use EHRs early Penalties through lower reimbursements for those who don’t use a system by 2015 (ex. 2015 would be ~1%)
  • Informationfrom hospitals, private physicians, nursing homes etc. can all access information about a patient.Benefits: Referrals do not have to continue to fax over all related information/ results of lab tests arrive in an “inbox”Medication lists from many physicians are shared which can prevent prescribing drugs with detrimental interactions.
  • Healthcare Networks

    1. 1. Strengthening the bonds of healthcare networks <br />Natalia Hajnas & Michelle Busching<br />Loyola Univeristy Chicago <br />HONR 204, Fall 2010<br />George K. Thiruvathukal, Course Professor<br />
    2. 2. Part one: <br />Establishing the Network of Study <br />
    3. 3. The Practice We Observed<br />
    4. 4. The individual practice as a network within itself<br />Visual: organic chemistry molecular model analogy<br />Molecule represents the “network within the greater healthcare network” <br />Cyclopropane = the 3 family physicians<br />Acetylene = the 2 OB/GYN physicians <br />Connecting double bond = links the separate specializations (family medicine & gynecologic oncology)<br />Communication & referrals to the family doctors from the OB/GYNs occurs on a daily basis <br />
    5. 5. The bigger picture <br />Visual: poster (drawn network graph)<br /><ul><li>Colors
    6. 6. Distance matters
    7. 7. Thickness </li></ul>What constitutes a relationship between 2 physicians? (in other words, how are the edges of the graph created?) <br />Incoming and outgoing referrals <br /><ul><li>Recommending a patient go see a particular physician (“unwritten referral”)</li></ul>Our data: composed of records of outgoing referrals<br />….from the 2 OB/GYNs <br />Qualitative & Quantitative <br />Additional edges – are there any relationships between the referred physician’s? <br />Qualitative <br />
    8. 8. Reasons for referrals <br />From our data (written referrals): <br />Consultation <br />Treatment<br />Evaluation <br />Pre-op testing<br />Ultrasound<br />Colposcopy<br />Colonoscopy <br />
    9. 9. Efficiency of referrals <br />Folder where copies of all written referrals are kept to reference if need be<br />How could there be improvement in communication between physician’s offices? <br />Referral system – works fine <br />Effectiveness of sharing patients’ medical records between medical offices – could be better….. HOW? <br />
    10. 10. Part two: <br />A proposal for change<br />(electronic medical records)<br />
    11. 11. Our Proposal<br />Adoption of EMRs in all healthcare settings<br />Specifically, to the practice we collected network data from<br />
    12. 12. First hand comparison of EMRs vs. PMRs<br />Survey distributed to medical offices within the same hospital as the practice of focus <br />Originally 20 handed out, then ~15 more because of poor return from the 1st distribution<br />Final sample size = 16<br />Overview of the questions asked <br />
    13. 13. Results of the survey <br />Average satisfaction: EMRs = 4.44, PMRs = 4<br />In general those surveyed were satisfied with their current record keeping system despite what they wrote pros and cons of each. <br />0 physicians/ physician reps. who use PMRs have used EMRs in the past. <br />All those who use EMRs, prefer EMRs to PMRs (one respondent who currently uses PMRs prefers EMRs…)<br />
    14. 14. Results (cont.)<br />Advantages <br />A- Ease of use<br />B- Organization<br />C- Time efficient<br />D- Thorough documentation<br />E- Nothing<br />F- Accustomed to it <br />G- Tangibility <br />H- Legibility<br />
    15. 15. Results (cont.)<br />Disadvantages <br />A- Space <br />B- Time <br />C- Poor organization<br />D- Illegibility<br />E- Nothing<br />F- Everything<br />G- System Failure<br />H- Cost <br />I- Poor interoperability<br />J- Error prone <br />
    16. 16. EMRs vs. PMRs <br />Decreased risk of clerical errors<br />Tangible<br />Ability to integrate information from other sources<br />Chart accessibility and retrieval<br />Accurate and legible<br />Organized<br />Security features<br />Pros of PMRs <br />Pros of EMRs <br />
    17. 17. EMRs vs. PMRs <br />Expenses of storage<br />Unorganized<br />Illegible<br />Continuity of care<br />Increased amount of time spent charting<br />Inability to integrate information from other sources<br />Continuity of care<br />System failures<br />Initial costs<br />Cons of PMRs <br />Cons of EMRs<br />
    18. 18.
    19. 19. Government push: input from president Obama<br />http://www.youtube.com/watch?v=qEb6FrSuUJs&NR=1<br />
    20. 20. Government push: Incentives for emr adoption<br /><ul><li>Medicare physicians who implement electronic medical records receive reimbursements
    21. 21. Penalties for those who do not do so begin in 2015 </li></li></ul><li>Universal medical records <br />Our requirements: <br />One record-keeping program with: <br />Medical history <br />Scheduling system<br />Billing system <br />Prescription writing<br />Referrals <br />Reliable system<br />With back-up<br />Supercomputer<br />
    22. 22. VITL<br />Vermont Information Technology Leaders<br />Non-for profit<br />Aids in the transition from PMR to EMR<br />Health Information Exchange<br />EMRs can be exchanged between different healthcare entities throughout the entire state<br />Consolidate medical history to one location<br />
    23. 23. One step further<br />Genealogies of Medical Records<br />A thorough family history of disease, health related traits, and responses to treatments and medications<br />Used for research<br />Could be used as a diagnostic and treatment guide <br />
    24. 24. Electronic medical records<br />V<br />E<br />R<br />S<br />A<br />T<br />I<br />L<br />I<br />T<br />Y <br />
    25. 25. Sources<br />http://pn.psychiatryonline.org/content/38/9/34.full<br />http://www.edocscan.com/reducing-costs-for-scanning-medical-records<br />http://en.wikipedia.org/wiki/Medical_records<br />http://miwww.acog.org/departments/dept_notice.cfm?recno=47&bulletin=4882<br />http://www.compete-study.com/documents/Measuring_the_Success_of_Electronic_Medical_Record_Implementation_Using_Electronic_and_Survey_Data.pdf<br />http://www.chcf.org/~/media/Files/PDF/E/PDF%20EMRLessonsSmallPhyscianPractices.pdf<br />http://www.youtube.com/watch?v=1Nv4Q5-Iij4&feature=related<br />http://www.vitl.net/about-us<br />http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1839727/<br />http://www.openehr.org/specifications/spec_strategy.html<br />http://www.e-mds.com/solutions/chart/chart.html<br />http://www.hemidata.com/emr.html<br />http://www.bcbs.com/blueresources/mcrg/2007/chap3/pay-for-performance/slide5.html<br />http://www.aafp.org/online/en/home/publications/journals/fpm.html<br />http://www.openclinical.org/emr.html<br />Information packet from EMR seminar at Alexian Brothers Hospital in Elk Grove Village, IL hosted by Conomikes Associates, Inc. <br />

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