July 1st, 2010

Electronic Health Records: A snapshot of ephemeral chaos

Last month I wrote about how electronic health records (EHRs) are not all about the machine with perspectives from others combined with my own and the launch of the OpenNotes study.

The ADL Librarian continues with EHRs and Librarians part 2, giving us a snapshot of the rush to figure out how medical librarians can be involved as part of EHR implementation initiatives. He identified 3 core librar* (I like to think both libraries as institutions and librarians as people have places here) roles of Information Retrieval, Information Organization, and Information Access and includes

This is an ideal time to offer to help organize the piles of forms and documentation. We mustn’t assume that the librarians role in EHR implementation is obvious to the professionals handling the implementation.

Indeed, not much regarding EHR implementation is clearly obvious at this point in time when the final 53 page PDF Temporary Certification Rule was just published (and summarized well at Life as a Healthcare CIO) and applications to be an Authorized Testing and Certification Body (ATCB) are open beginning today. Final Temporary Certification Rule. A Final Permanent Certification Rule by this fall, the permanent certification program in place by fall 2012.

My mind boggles thinking about the amount of time and energy involved in that process alone, and when it comes to implementing the ‘meaningful use’ requirements of EHRs 80% of hospital chief information officers (CIOs) don’t think they’ll be ready to meet the 2015 deadline as covered by the Wall Street Journal Health Blog.

Specifically, they’re worried about the requirements that will actually mean changing how care is delivered — such as using computerized evidence-based guidelines when ordering tests or procedures — says Bruce Henderson, leader of the electronic health records practice at PwC. “There’s lots of focus on the technology, but this is really about standardizing care processes at the highest level of quality with an eye towards the reduction of costs,” he tells the Health Blog. That means changing how doctors, nurses and other personnel work — and changing how anyone does his or her job is not easy.

Very true. In my previous entry I wrote about an experience with one doctor who was clearly very familiar with the electronic workflow; I also had an experience with another doctor last month who clearly was not and vocalized frustration in not being able to locate what she was seeking from the order set.

E-Patient Dave came to the realization that we are human (I reject his claim that he’s not as observant as he thought) and do not recall everything from doctor’s appointments a week later, and found out how helpful access to visit notes are. Read about his first experience as a result of participating in OpenNotes to see what he did.

This is how it should be: everything about our healthcare information accessible in one place, without having to wage a war in the process. Despite what sounds like a long stretch of oppressive heat and humidity in the other Washington, I wish I could be there for Regina Holliday’s e-Patient Ephemera: 73 Cents meets the world of data capture art exhibition on July 29th in Georgetown. She writes:

For too many years the medical record has been viewed as only a billing document and a piece of daily medical ephemera. Hundreds of pages of vitals, imaging results, medical reconciliation and surgeries are distilled into the few pages that form a transfer summary. At each facility this process continues; each set of daily records entering the ether of a payment structure. A daily accumulation of data that will remain untouched by many, if a lawyer and a potential lawsuit is not involved.

How did a document originally intended to facilitate communication and the medical history of a patient become a piece of billing ephemera? How dare institutions consign this living document a role as nothing more than a receipt of services rendered? With the advent of health information technology, the electronic medical record has the potential to leave its old role of medical ephemera and enter the virtual eternity of cloud based computing. Ah, the ability to create a lifetime electronic medical record consisting of transferable and actionable data is within our grasp. Or does this really matter?

I pointed to a picture of my then 7, now 8 year old son on my laptop when I met Regina in May.

All of his healthcare information since the day he was born (my prenatal care is in mine) to now are contained within an electronic medical record.

It really matters to me. I appreciate the struggle and chaos of the work being done now so that one day almost everyone can have them as well. Edit: Let’s hope that soon information about EHRs is in a format as easy to understand as the new HealthCare.gov site is!

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One Response to “Electronic Health Records: A snapshot of ephemeral chaos”

  1. mustang lover says:

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