Samson Health Informatics


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  • Electronic medical records are no longer a glimpse into the future. Hospitals world-wide are using electronic medical records (EMRs) to better serve patients. Several of the advantages of EMRs are listed above. Most importantly, EMRs aid in the reduction of medical errors through prescription entry, drug interaction predictions, and medical reconciliation (Richards, 2009). In reference to emergency room visits, it has been found to decrease the number of visits as well as the length of stay (Garg et. al. 2005, Harrison and Palacio, 2006). Patients can now interact with their own healthcare by entering social, medical, or psychological information into a computer, then link to a physician (Richards, 2009). From the viewpoint of the healthcare provider, EMRs are also very beneficial. Physical, bulky charts no longer need to be stored on-site, but in a remote location. Several important security features are available, such as those used at Cleveland Clinic. Blocked treatment notes diverts information flow only to those with express permission. Aaron Samson
  • Information flow throughout an organization greatly benefits from the implementation of EMRs. For example, specialty providers send copies of their documentation to the primary providers’ inbox, without hassle of folders or mailings (Richards, 2009). There are many possibilities with EMRs, so hospitals such as the Cleveland Clinic require employees to complete EMR training. This is mainly due to the depth of information that is included in an EMR. Training is also important for physicians and other providers. Helping a patient to understand what an EMR is and what type of information will be included in the EMR is important to patient cooperation and interest in their health. EMR enhances employee cooperation through the acquisition of results or appointments by patients, at the ease of physicians (Richards, 2009). EMRs are also able to act as somewhat of a calendar, alerting patients and providers to disease management checkpoints, annual screenings or required immunizations (Richards, 2009). With access to this type of personal information, safeguards are important to establishing healthcare trust. Several auditing systems are in use in a typical EMR system which specify which records have been open and for how long. Aaron Samson
  • In addition to monitored access of EMRs, other concerns exist for organizations. Crashes, security breaches, and off-site data storage are all issues that need to be addressed when EMRs are in use (Richards, 2009). These concerns can be addressed through use of username/password protected workstations and encryption. Additionally, healthcare providers must be trained to use the “triangle” form as seen above to include patients in their treatment and facilitate interaction (Richards, 2009). Healthcare technology often involves focus on lab testing and numerical indicators on a computer monitor, but use of the “triangle” form helps to encourage personal attitudes between provider and patient when visiting face-to-face. Many may be asking if EMRs are immediately profitable after they are enacted. Due to their large up-front cost of implementation and training, productivity often declines at first. Their costs are often off-set in the future when training is complete and staff become more acquainted with the new technology. Aaron Samson
  • From an organizational standpoint, electronic billing is an important factor in the success of the business. Simply put, the faster and more efficiently bills are sent out, the faster payment is received. Dr. Gee of Commonwealth Urology claims that the primary benefit of e-billing is speedier payment (Wynn, 1999). Billing is often slowed by incorrect or faulty information on forms. E-billing helps to alleviate mistakes or improper forms, also called “dirty claims”. So what costs are associated with e-billing implementation? The cost of such a system ranges anywhere between $2,500 and $20,000. Sheldon Schoen of Livingston, NY says, “Without knowing if I'm going to be around 5 years from now, the idea of making such a capital investment doesn't make sense for me.” This is often the sentiment about e-billing and the fear that users may not be around to see the benefit of such technology. Some companies such as Blue Cross California offer monetary incentives as much as $1,000 to switch to e-billing (Wynn, 1999). Aaron Samson
  • In general, physicians are paid more quickly with electronic billing compared to e-billing. E-submissions improved the accuracy of claims for the above reasons. Reducing paperwork, lowered postage, no lost claims, and no poor handwriting are all great benefits (Wynn,1999). However, users now know exactly where and when information is processed with instant status reports. If a claim is in question, users no longer have to wonder if it became lost or refused. An organization’s business nature can no doubt be changed in an example like the one above. One physician processing 15,000 claims per year saved over $15,000 in just savings from e-billing. Not only are these resources no longer being used for paper billing, but they can be used more effectively in other parts of the business. Aaron Samson
  • Physician order entry and EMRs work hand-in-hand. CPOE benefits include eliminating illegible orders, reducing transcription, rapid routing of orders, and a wide knowledge base. (Poon et. al., 2004). A wide knowledge base provides decision support for the checking of orders against other sources (Chaiken, 2001). All of these benefits help to eliminate the non value-added steps in the order entry process. Instead of trying to read illegible orders, rewriting orders, or trying to find requisitions, physicians are able to focus on patient care. One challenge to CPOE is physician and organizational resistance. In one particular hospital where CPOE was implemented, physicians thought traditional entry was faster. The process was also hampered because of low computer literacy levels (Poon et. al., 2004). In response to low cooperation and interest, the hospital was able to identify physician or clinician “champions” who were very instrumental in the process. These “champions” were well-respected in their field and helped to remind others of the down-stream benefits of CPOE. The high cost of CPOE can be overcome by focusing on CPOE as an area of patient safety (Poon et. al., 2004). Noone really will complain if patient safety is a top priority of CPOE. Other benefits of CPOE are difficult to measure. Finally, some organizations never see their products come to life. Some vendors promise “vaporware” that was promised but never delivered. Often, these products fail to perform to expectations due to immature design. Aaron Samson
  • Overall, CPOE enhances data flow through the focus of physicians, error-checking, and alerts and reminders. Instead of focusing on routine, memory tasks, clinicians focus on collecting and synthesizing patient info (Chaiken, 2001). With the ever-increasing volume of information in a medical record, computers now assist in double-checking for possible errors in orders. When events occur, clinicians are notified in real time due to alerts and reminders. Information also flows more freely horizontally through the medical practice. Before CPOE, medical knowledge often took 17 years to trickle through a community. Evidence-based medicine changes more quickly with CPOE due to its technological advantage. As mentioned before, a key to success of CPOE is identification of clinical leaders to serve as conduits between their own clinical groups and administration as they enact the system (Chaiken, 2001). Reengineering the work flow before implementation of the system also helps to prevent bottlenecking that can occur once the system is enacted. If problems are identified before implementation, they can be addressed with less stress and pressure prior to any changes in work flow. Aaron Samson
  • As mentioned before with the high costs of implementation, focusing on patient safety is a top priority and best reason for using CPOE. Other benefits include reduced callback from other providers, increase in important info in patient files, and ordering alerts for duplicate or error testing. Aaron Samson
  • Health Management systems are an IT-aided comprehensive view of managing patient information. The benefits of HMS affects both patients and staff using the system. Patients’ info is kept in one place, where it is optimized for their own goals and needs. Patients no longer need to carry X-rays from one specialist to another. HMS simplifies the treatment process, reducing friction among organizations and gives patients context in order to make better decisions about their health (Neupert, 2009). HMS is used to focus the treatment for each patient on certain goals because all information is in a central location and information is flowing freely. Instead of focusing on each part of a patient’s visit, the integration of information allows a focus on patient-centered solutions, as the above graphic shows. For example, HMS makes easier the communication between pathologist and oncologist concerning test results and future treatment of a suspected leukemia. Ultimately, HMS incorporates information and allows clinicians to come together with patients to focus on a common goal in the patient’s treatment. Aaron Samson
  • From the viewpoint of a business perspective, HMS focuses on “information liquidity”. This involves the free flow of data and putting consumers (patients and clinicians) in control and eliminating walls between data sources (Neupert, 2009). With so much availability, such a system requires training in order to understand how to effectively use the system for both the clinician’s and patient’s benefit. Even before clinicians buy into such a system, they have to understand why they will benefit- “Whats in it for me?” Unless clinicians are able to see the possibilities with HMS, they may continue to use traditional systems. So, in this case, the end users of HMS must come before the patient in understanding every day use of HMS. After clinicians understand their role in HMS, patients are placed in greater control of their information. This serves two purposes: patients are involved in their own treatment processes and have greater trust in clinicians and their sharing of information (Neupert, 2009). The comparison of HMS to a “self-service” bank is testament to patients’ ability to control their own information and trust the decisions made by clinicians. Overall, healthcare affordability, availability, quality, and effectiveness is improved. Aaron Samson
  • Organization-wide, order entry has become an area in need of improvement. As has already been said concerning physician order entry, many benefits are available such as error-checking and alerts, among other things. Order/result entry has continued to change and also brought with it other limitations because of the need for human-computer interaction. For example, separate logins may be required for different portals (Campbell et. al., 2009). The UK medical center uses over thirty portals for order/result entry, many of which have different logins. This can become very cumbersome when working between multiple portals at the same time. Additionally, organizations may update their hardware more quickly than the workspace. Order entry may require a separate computer be set up for particular requisitioning, but there may be a lack of space due to work flow. Also, non-physician staff may receive non-essential information (Campbell et. al., 2009). For instance, a nurse may not need cell counts for a patient on muromonab-CD3 therapy, but a pharmacist may know that more or less drug needs to be administered. This type of routing of information to the appropriate personnel is a continuing struggle for hospitals. Finally, situational awareness is reduced with increased use of order/result entry. This can be alleviated through training of clinicians and staff to recognize and alert proper personnel when results are aberrant or critical. Aaron Samson
  • The above is one particular example of a result entry system. Unet is the network for the United Network for Organ Sharing program in the United States. Their system is aimed at managing information for patients as well as living and deceased donors. Unet is the primary instrument for data collection and verification. The program manages the transplant center’s waiting list for candidates, donor information, and validation of data currently and previously submitted data (Campbell et. al., 2009). New features of this system allow posting of donor information in an electronic file format. This allows a decision to accept or reject an organ offer quickly and effectively. Unet’s employment of real-time data collection technology and reporting facilitates record validation and overall quality of care. The training involved with such a system includes interface training as well as HIPAA-required guideline acceptance. Aaron Samson
  • HIPAA is known as the Health Insurance Portability and Accountability Act of 1996. HIPAA established basic federal safeguards to protect medical record confidentiality and established uniformity and security standards for electronic communication of medical records (Burkhartsmeier, 2007). It was intended to serve as a tool for patients to have greater control of their health information. HIPAA has changed many organizations into becoming more aware of their data transactions and security of personal information. Under HIPAA, employees are required to identify a responsible security officer and train on the importance of HIPAA and how to properly manage information. Employees are also limited to the least amount of information needed in order to perform their jobs effectively (Burkhartsmeier, 2007). Aaron Samson
  • For all the proper safeguards brought on by the enactment of HIPAA, may believe that organizations may be unable to properly serve patients due to the limitations. Data flow has sometimes been seen as limited because orders are received from and results sent directly back to the patient’s physician. State laws also protect patient access to own test data. The direct flow of lab test information, the largest producer of medical record data, has not thrived due to limitations of electronic medical records (Burkhartsmeier, 2007). According to Gary Burkhartsmeier, “the dream of a nationwide patient-accessible and patient-controlled EHR seems far-off…” The capabilities of electronic health records can never be seen as long as these stringent laws exist. Patients should have proper access to their own information. The control over that information comes not from data restrictions, but from greater education. Aaron Samson
  • How will employees and staff have to adapt and be flexible for the changes ahead? Above all, the most important requirement is attitude. Cathy Dougherty, an assistant vice president of revenue management, used the character Buzz Lightyear from The Toy Story, to illustrate the need for a positive attitude. She says, “I wanted all the leaders and staff to see the difference between fearing change and embracing it…” The first step in the implementation process involves product review sessions, in which the project team is educated about the new system (Change Management, 2010). Many possibilities are examined, and particular products are rarely ruled out as possibilities. The next step is to conduct a business-process analysis where implementation leaders are encouraged to think of how new processes should work when there are no limitations due to inefficient systems. This is often a difficult process, as many times companies have “settled” for long periods of time and have found ways to compensate for inefficient systems. Nevertheless, it is an important key in examining the process needs. Next, the implementation team configures the system based on the goals of the hospital (Change Management, 2010). During the “go-live” period of the implementation, it is also important to remain patient and focused on the goals, as the project may require multiple parts to implement. Implementation in parts may be more appropriate as to avoid strain on resources and staff. Finally, the providing of feedback from end-users is an important aspect to the continual improvement of the new system. It should be noted that staff do not always use a system as it was intended. “Instead, they find their own ways of doing things and, in the process, often teach us ways to maximize use of the system,” says Dougherty. Staff must be flexible and ready to adapt, helping to improve the system through constructive feedback that will benefit everyone involved. Aaron Samson
  • Samson Health Informatics

    1. 1. Health Informatics IT Perspective Aaron Samson CIS 615-301 Spring 2010
    2. 2. Electronic Medical Record (EMR) <ul><li>Helps reduce medical errors through: </li></ul><ul><ul><li>Computerized prescription entry </li></ul></ul><ul><ul><li>Predicting drug interactions </li></ul></ul><ul><ul><li>Medical reconciliation </li></ul></ul><ul><li>Number of visits lower, shorter </li></ul><ul><li>Greater patient interaction </li></ul><ul><li>Charts can be routed easily </li></ul>Sources: (9), (5), (6)
    3. 3. EMR-How is it Done? <ul><li>Info sent to provider’s EMR inbox </li></ul><ul><li>Cleveland Clinic training on EMR </li></ul><ul><li>Physician training for patient interaction </li></ul><ul><li>Results/appts. acquired by patients </li></ul><ul><li>Reminders for disease management, annual screenings or required immunizations </li></ul><ul><li>Monitoring systems for patient accounts: which ones and how long </li></ul>Sources: (9), (5), (6)
    4. 4. EMR-Organizational Concerns <ul><li>Crashes, security breaches, and off-site data storage </li></ul><ul><li>Non-personal attitude from physicians (need for “triangle”) </li></ul><ul><li>Initial decrease in productivity due to implementation and training </li></ul>Sources: (9), (5), (6)
    5. 5. Electronic Billing <ul><li>Primary benefit-speedier payment </li></ul><ul><li>Prevention of “dirty claims”-mistakes or improper forms </li></ul><ul><li>$2,500 to $20,000 cost for implementation so some unwilling to pay amount up-front if future uncertain </li></ul><ul><li>Monetary incentives (Blue Cross California) </li></ul>Sources: (10)
    6. 6. E-Billing (Cont.) <ul><li>E-submissions improved accuracy: </li></ul><ul><ul><li>Reduce paperwork </li></ul></ul><ul><ul><li>Lower postage </li></ul></ul><ul><ul><li>No lost claims </li></ul></ul><ul><ul><li>Instant status reports </li></ul></ul><ul><ul><li>No poor handwriting </li></ul></ul>Sources: (10) 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 year UROLOGY TIMES/SOURCE: CIGNA HEALTHCARE, CHATTANOOGA, TN
    7. 7. Physician Order Entry (aka CPOE) <ul><li>Benefits include: legible orders, transcription reduction, rapid routing or orders </li></ul><ul><li>Challenges: </li></ul><ul><li>Physician and org. resistance </li></ul><ul><li>High cost (measured benefits difficult to calculate) </li></ul><ul><li>Vendor/product immaturity </li></ul>Sources: (3), (8)
    8. 8. CPOE- Introduction of evidence-based medicine quickly <ul><li>Enhances data flow: </li></ul><ul><ul><li>Physicians focus </li></ul></ul><ul><ul><li>Error-checking </li></ul></ul><ul><ul><li>Alerts and reminders </li></ul></ul><ul><li>Reengineering of work flow and “clinical leaders” also important </li></ul>Sources: (3), (8)
    9. 9. Physician Order Entry- Justifying the Costs <ul><li>Overcoming costs include focusing on patient safety (no complaints) </li></ul><ul><li>Cost-worthy benefits: </li></ul><ul><ul><li>Reduced callbacks from other providers </li></ul></ul><ul><ul><li>Increase in important info in patient files </li></ul></ul><ul><ul><li>Ordering alerts for duplicate or error testing </li></ul></ul>Sources: (3), (8)
    10. 10. Health Management Systems <ul><li>Benefits both patients and staff: </li></ul><ul><ul><li>Keeps patient info in one place </li></ul></ul><ul><ul><li>Simplifies among organizations and gives context for patient </li></ul></ul><ul><ul><li>Motivate patients to make better decisions and employees to improve efficiency, reduce costs </li></ul></ul>EKG Results MRI Results Blood Test Results Patient-Centered Solutions Sources: (7)
    11. 11. Health Management Systems <ul><li>Overall focus: “Information liquidity” </li></ul><ul><li>Training/preparation involve: </li></ul><ul><ul><li>Involve clinicians in, “What’s in it for me?” </li></ul></ul><ul><ul><li>Patients have more control of information </li></ul></ul><ul><ul><li>“ Self-service” bank approach </li></ul></ul><ul><ul><li>*Overall affects affordability , availability , quality and effectiveness * </li></ul></ul>Sources: (7)
    12. 12. Order/Result Entry <ul><li>Limited as order entry exposes human-computer interaction problems: </li></ul><ul><ul><li>Separate logins for different portals </li></ul></ul><ul><ul><li>Workspace outdate for new hardware </li></ul></ul><ul><ul><li>Non-physician staff receiving non-essential information </li></ul></ul><ul><ul><li>Reduced Situational Awareness </li></ul></ul>Sources: (2), (4)
    13. 13. Order/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)
    14. 14. HIPAA <ul><li>Health Insurance Portability and Accountability Act of 1996 </li></ul><ul><li>Safeguards medical records and established security standards </li></ul><ul><li>Employees required to: </li></ul><ul><ul><li>Establish security officer </li></ul></ul><ul><ul><li>Proper information training </li></ul></ul><ul><ul><li>Use minimal information </li></ul></ul>Sources: (1)
    15. 15. HIPAA- Good or Bad? <ul><li>Laboratory information limited due to receiving orders and sending results only to physicians </li></ul><ul><li>Protects information but along with other laws (CLIA ‘88), prevents widespread use of EMRs </li></ul><ul><li>“ The dream of a nationwide patient-accessible and patient-controlled EHR seems far-off…” -Gary Burkhartsmeier </li></ul>Sources: (1)
    16. 16. Flexibility-Virtue for Change <ul><li>Needs for a successful change: </li></ul><ul><ul><li>Good attitude- “buzz-i-tude” </li></ul></ul><ul><ul><li>Keep an open mind </li></ul></ul><ul><ul><li>Imagine perfection </li></ul></ul><ul><ul><li>Focus on goals </li></ul></ul><ul><ul><li>Provide feedback on successes/issues </li></ul></ul>Sources: (11)
    17. 17. References <ul><li>Burkhartsmeier, G. (2007, June). HIPAA: Where are we now?. MLO: Medical Laboratory Observer , p. 28. Retrieved from Academic Search Premier database. </li></ul><ul><li>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. </li></ul><ul><li>Chaiken, B. (2001). Enhancing Patient Safety with Clinically Intelligent Physician Order Entry. Nursing Economic$ , 19 (3), 119-120. Retrieved from Academic Search Premier database. </li></ul><ul><li>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 , 4 13-26. doi:10.1111/j.1600-6135.2004.00395.x. </li></ul><ul><li>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. </li></ul><ul><li>Harrison, J. P., & Palacio, C. (2006). The role of clinical information systems in health care quality improvement. The Health Care Manager, 25, 206–212. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>Wynn, P. (1999). Electronic billing cuts costs, speeds reimbursement. Urology Times , 27 (6), 32. Retrieved from Academic Search Premier database. </li></ul><ul><li>(2010). CHANGE MANAGEMENT. (cover story). Health Management Technology , 31 (3), 14. Retrieved from MasterFILE Premier database. </li></ul><ul><li>  </li></ul><ul><li>  </li></ul>