Posts Tagged ‘EHR’

Electronic Health Records: A snapshot of ephemeral chaos

Thursday, July 1st, 2010

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 site is!

Electronic Health Records: Not All About the Machine

Thursday, June 10th, 2010

Coverage from the recent Medical Library Association meeting included a lot about electronic health records (EHRs) such as the EBSCO Sunrise Seminar, my coverage of the Linking E-Resources to Clinical Information Systems (CIS) session and a panel on Wednesday.

I am sorry I missed Dr. John Halamka’s (Life as a Healthcare CIO) presentation of the Leiter Lecture at the National Library of Medicine and am looking forward to finally having a chance to catch up with his video and slides this weekend. One does not mess with the timing of the only nonstop flight from Washington DC to Seattle though, there were cancellations of connecting flights through Chicago that stranded some of my Seattle colleagues!

Other perspectives that have my attention are The ADL Librarian who started a series about The Role of Libraries in EHR Implementation beginning with Challenges, especially from the perspective of primary care who may not already have relationships with medical librarians, and Dr. Jeff Belden featured the recent AHRQ white paper addressing EMR usability: Vendor Practices & Perspectives which cannot be overlooked.

Of particular interest to me was when Dr. Edward Pullen wrote about How to talk to patients with an EMR in the room on KevinMD though. I recently had the opportunity to see a new doctor who followed these six recommendations extremely well. He maintained a near constant verbal contact with me as he explained what notes he was entering in the EMR, why, and which parts of the notes would integrate with a standard template patient after-visit printout which resulted in it being the best one I’ve received and I’ve had an EMR through this HMO since 2001.

It is due to a combination of this experience and Harborview Medical Center being local that I’ll be following the progress of the recently announced OpenNotes study of over 100 physicians and 25,000 patients funded by the Robert Wood Johnson Foundation to evaluate the impact on both patients and physicians of sharing, through online medical record portals, the comments and observations made by physicians after each patient encounter with great interest. From the press release,

“Doctors have strong differences of opinion about giving patients access to their notes. However, the debate is largely uninformed by evidence,” says Stephen Downs, assistant vice president at RWJF and member of the Foundation’s Pioneer Portfolio. “In the context of a physician’s day-to-day work, opening up notes is a subtle change—but it could reposition notes to be for the patient instead of about the patient, which might have a powerful impact on the doctor-patient relationship and, in the long run, lead to better care.”

They’ve got that one right if I as a medical librarian with both an interest in health informatics and 9 years of experience having an EMR was impressed with the inclusion of personalized notes in my after-visit patient handout.

NLM Theater at MLA

Tuesday, May 18th, 2010

Has it really been 2 years since my MLA 2008 post about the NLM Theater presentations I attended about PubMed (when the automatic term mapping change was the only big deal) & the Drug Information Portal that I later broke down into sections to highlight?

The truth of the matter is that in my short career as a medical librarian, I have been to to the MLA meeting once and then only for one day. Seriously. DC will be my first full MLA conference experience and I’ll also be an official conference blogger, session Twitter jockey (really!) and moderator of another session there. I would love to meet everyone! I’ll be the tall (5’10” in flats) somewhat lanky one usually wearing some shade of black and probably looking slightly overwhelmed by the whole scene.

I finally got a chance to look over the schedule for the NLM Theater presentations this year (get the PDF, it has more detail) and two things jumped out at me that I wasn’t expecting. Keep in mind my standard disclaimer: I’m not speaking on behalf of my employer here, I’m speaking as a medical librarian with an eye on the horizon.

Introduction to NCBI Molecular Databases .… In particular, pre-computed associations between data now promoted in the Discovery initiative expose useful and hypothesis generation relationships that further scientific investigation.

Whoa, hello Discovery initiative in the brochure! Given the level of integration we now see of the 29 databases in PubMed search results, getting a better understanding of what they are about straight from NCBI staff is probably a really good idea.

MedlinePlus Update … Come hear about our recent developments including Mobile MedlinePlus, MedlinePlus email updates and connecting MedlinePlus to EHRs/PHRs. Also be one of the first to get a glimpse of the forthcoming MedlinePlus site redesign.

I definitely want to know more about these connections and what’s up with the site redesign.

I will be covering at least two sessions a day as a conference blogger (my strategy is here), and I’ll write some compilation posts here at my home blog linking to my entries on the conference blog in addition to pictures and additional insights. See you there at MLA, or if not please let me know what questions you have that I can try to find answers for! Comments here or @eagledawg on Twitter will be the best way to make sure I see them in the days ahead.