Cooperating for better care.

EHR

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MU3 and transitions of care

The Centers for Medicare & Medicaid Services’ recently released new rules for Meaningful Use Stage 3 (MU3)  define transitions of care and include elements that directly affect transitions of care.

As MedCity News reported: “For hospitals, the definition includes all inpatient discharges and emergency room admissions where follow-up care is ordered by an authorized provider, regardless of how much information is available to the receiving provider.”

Further, the news service reported, “The Summary of Care … is still sent and required, because it is tailored to the needs of the clinicians at the next level of care, and accessing the EHR does not support the workflow of those clinicians. This last point about workflow addresses challenges observed in the market around portal access to patient records that do not support the critical workflow needs of the receiving provider.”


‘The real cues come from the patient,’ not the EHR

 

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Here’s a look at nurse practitioners’ attitudes to electronic health records.

Tim G. Bartol,  N.P., the author, concludes:

“EHRs can track such easily measured tasks as diabetic foot screening, urine microalbumin measurement, or the patient’s smoking status. However, no research has shown that documenting these measures makes a difference in long-term patient outcomes. The EHR does not effectively measure other things that may have important implications for patient care, such as relationship, empathy, support, and caring between clinician and patient. It does not measure the value of the information produced on continuity of care for a patient over time.

“Rather than complaining about the EHR, I believe that we should use our energy and efforts to find ways to work around the challenges by talking with colleagues, sharing ideas, and trying to maintain high-value continuity of care. My perception of the effect of the EHR on clinical practice is that it has brought new challenges to providing high-value, patient-focused healthcare. There are many benefits, including legibility and easier access (for clinicians using the same system).

“But we also face challenges with integration of this technology. We must strive to maintain a personal, caring relationship with our patients and develop useful notes for continuity of patient care. We must resist being more focused on the device than on the person in front of us. What might seem to be quality care—documenting all of the recommended care and checking all of the boxes—can distract us from what the patient actually wants or needs at that particular visit.

“The real cues or reminders for quality care should come not from the EHR but from the patient.”

 


U.K. health system shaken by Epic costs

 

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At Cambridge University.

The CEO and CFO of Cambridge University Hospitals NHS Foundation Trust, in the United Kingdom, resigned  as the health system faced financial troubles, in part connected with  the hospital’s implementation of Epic System Corp.’s electronic health record system.

A Sept. 21 financial report from private-equity firm Baird says, “This is the first Epic EMR implementation in the U.K. and the resignations come amid increasing scrutiny of Cambridge’s deteriorating financial condition.”

Cambridge University Hospitals went live on its new Epic platform Oct. 23, 2014. Part of the implementation included a hardware upgrade led by Hewlett-Packard.

ComputerWeekly reported HP’s upgrade cost about the equivalent of $212 million, and the Epic software  $45 million, with an additional $30 million in other EHR-related expenses

Will there be transatlantic effects of these Epic issues.


Peril to patients seen in EHR firms’ ‘gag clauses’

 

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Politico reports that that some of the biggest electronic health record companies have inserted “gag clauses” in their taxpayer-subsidized contracts. These clauses effectively bar healthcare providers from “talking about glitches that slow their work and potentially jeopardize patients.”

The news service reports that “Vendors say such restrictions target only breaches of intellectual property and are invoked rarely. But doctors, researchers and members of Congress contend they stifle important discussions, including disclosures that problems exist. In some cases, they say, the software’s faults can have lethal results, misleading doctors and nurses who rely upon it for critical information in life-or-death situations.”

The article says that the  Office of the National Coordinator for Health IT (ONC) and the Centers for Medicare and Medicaid Services, which are responsible for the EHR subsidy program, have ”done little about the clauses, though providers and researchers have been grumbling about them since the 2011 Institute of Medicine report warning that ‘[t]hese types of contractual restrictions limit transparency, which significantly contributes to the gaps in knowledge of health IT–related patient safety risks.”’

 


From the EHR to the EHP

John Glaser writes in Hospitals & Health Networks about how that the electronic health record is evolving to become the electronic health plan. Among this comments:

“Provider organizations will not thrive in an era of health reform simply because they have a superb and interoperable electronic health record. They will thrive because the care they deliver consistently follows a plan designed to ensure desired outcomes. The EHR must evolve so that it focuses on an individual patient’s care plans — the steps required to maintain or create health.”

And,

“Every patient’s EHR should clearly display the master care plan — a long-term care plan to maintain health integrated with short-term plans for transient conditions. The EHR should be organized according to this master plan: It should highlight the steps needed to recover or maintain health, list the expectations of every caregiver with whom the patient interacts, and include tools such as decision support and a library of standard care plans. Interoperability is a necessity, as various providers must be able to use the plan-based EHR. ”

And,

“The shift is underway. The electronic health record does not disappear as a result of this shift, but the strategic emphasis will move to technologies and applications that assist the care team (including the patient) in developing and managing the longitudinal, cross-venue health plan and assessing the outcomes of that plan.”


Wide range of EHR experiences

 

Surveys show   a wide range of happiness and misery among physicians about their electronic health record  (EHR) systems. Some of it depends on whether the system is server- or cloud-based.

Because they have more administrative support and can afford better and more expensive systems, physicians in large-group practices are having better EHR experiences.

Satisfaction rises over time as physicians learn how to better use the systems regardless of the size of the practice.

Still,  many small practices  don’t have the  money, time and other resources to use  EHR systems beyond the basic demands of Meaningful Use, especially regarding inter-operability, whose lack can be one of the great frustrations of EHR.

 

 

 


Benefits and limits of data analytics in population health

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“Because communities and patient populations are simultaneously diverse and interconnected, providers must take an integrated, interdisciplinary approach to care delivery to make the population health model work,” says this piece from MedPage Today.

It reported on a spirit of cross-professional collaboration as more than two dozen invited healthcare leaders gathered June 17-19 at the 2015 HealthLeaders Media Population Health Exchange at The Park Hyatt Aviara, in Carlsbad, Calif.

One of the speakers, Andrew L. Masica, M.D., noted:  “We’ve had a fair amount of success using analytics to help with readmission reduction work.” He is vice president and chief clinical effectiveness officer at Baylor Scott and White, in Dallas.

“The tool in use classifies patients as having certain risk levels.Those who are categorized as high-risk for readmission during their hospital stay get a comprehensive care coordination intervention and, in many patients greater than age 65, home visits from a nurse practitioner to help with the transitional period following discharge. Medium- and lower-risk patients receive lesser degrees of intervention, for example, phone follow-up, tailored to meet any specific identified needs.”

Data analytics has also helped to provide fiscally responsible care, Dr. Masica said.

“That’s been a very efficient way to manage resources. The nurse practitioner model for transitional care has been shown to be effective but can be resource-intensive from a hospital operational standpoint.”

While there is value in numbers, however, Masica explains that the benefits of analytics can only be had if the numbers are strong. “Too much information, particularly if delivered in the wrong fashion, isn’t helpful and can sometimes be harmful.”

“When you talk about population health and you limit the conversation to data analytics — that’s just the tiniest sliver of that solution,” says Alan Pitt, M.D., professor of neuroradiology at Dignity Healthcare in Phoenix. “I think there’s a big role for the objective EHR data, but also [for] the subjective data … that would be more relevant to something of a solution.”

 

 


Trying to address hospitals’ perilous ‘weekend effect’

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Chuck Lauer, a former Modern Healthcare publisher, writes about how to combat “weekend effect” in hospitals.

“Simply put, there are fewer physicians and nurses {on weekends} to treat patients, and fewer technicians to operate life-saving equipment on the weekend. However, people don’t have fewer medical problems on the weekend. They still have heart attacks, accidents and other emergencies, and there are plenty of patients admitted for elective procedures over the weekend.

“So it doesn’t surprise me that there’s a markedly higher death rate for patients admitted on the weekend ….”

“In an industry like healthcare, where you are dealing with life and death issues, is it permissible to reduce the availability of services and use second-string staffing for two days of every week?”

“Examining policies at 117 Florida hospitals and their outcomes for 126,666 patients, researchers concluded that by boosting specific services, hospitals could lower the rate of complications on the weekend.

“These strategies involved raising the nurse-to-bed ratio, fully adopting EHRs and improving inpatient physical rehabilitation, home health and pain management.

“Interestingly, simply hiring more staff — increasing the nurse-to-bed ratio — was not the most effective of these strategies. While hospitals that raised the nurse-to-bed ratio were 1.44 times more likely to overcome the weekend effect, the likelihood rose to 2.37 times for hospitals that had home health programs and 4.74 times for hospitals that fully adopted EHR.”

 


Study: Using scribes to query HIEs makes great sense

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A new study of more than 2,000 emergency department visits in Upstate New York suggests that querying a health information exchange could significantly reduce laboratory tests and radiologic exams.

Use of the HIE was associated with a 52 percent cut  in the expected total number of laboratory tests and a 36 drop  in radiology examinations ordered per patient.
Also significant was that the study was another boost to the idea that medical scribes can be very important in improving healthcare by freeing up clinicians to more directly and for a longer time concentrate on their patients.

The study’s principal researcher, Brookings  Institution fellow Niam Yaraghi, scribes ensured that 100 percent of the patients in the study cohort had queries run through the exchange, as opposed to only 6-7 percent of patient encounters without them. Most physicians don’t have the time to deal with an HIE in the stress and busyness of an emergency room.
“The mere existence of them (scribes) point to the user unfriendliness of our EHR systems,” Yaraghi told Modern Healthcare.

Physicians like to use scribes because doctors find EHRs slow and clunky to use, and interfere with their interactions with patients.


Work-arounds for dealing with EHR headaches

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A look at good and not-so-good work-arounds for clinicians in dealing with electronic health records, including cutting and pasting and the use of medical scribes — all while facing the deluge of data that can overwhelm everyone.


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