November 29th, 2010 by DrWes in Better Health Network, Health Policy, News, Opinion
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From the official White House statement yesterday regarding WikiLeaks disclosure of diplomatic cables:
“By releasing stolen and classified documents, WikiLeaks has put at risk not only the cause of human rights, but also the lives and work of the individuals. We condemn in strongest terms, the unauthorized disclosure of classified documents and sensitive national security information.”
No matter what people think of WikiLeaks disclosure of approximately 250,000 classified diplomatic cables to the Internet yesterday with the help of the New York Times, The Guardian, Der Spiegel, and Le Monde, the implications to electronic healthcare information security are significant.
Day in and day out, I type huge volumes of information on my patients on a computer and my fellow physicians do the same. As a result, vast healthcare information warehouses are at the disposal of the government, insurers, and major healthcare institutions eager to become more efficient, strategic, or competitive. We are promised the information is private, confidential, and even stripped of its identifiers for group analysis. It is even protected to remain so by law. Read more »
*This blog post was originally published at Dr. Wes*
November 16th, 2010 by DavedeBronkart in Better Health Network, Health Policy, News, Opinion
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Last Friday the board of the American Medical Informatics Association (AMIA) published a position paper in its journal saying that the “hold harmless” clause is unethical. One of the paper’s authors is Dr. Danny Sands, currently President of the Society for Participatory Medicine. I hope to write more about it this week, after attending the AMIA conference in DC, but here’s the basic issue:
— For ages, makers of electronic medical record systems (EMR) have insisted on a “hold harmless” clause in the contracts a system buyer must sign. It says, in essence, that if any harm comes to anyone because of a system problem, the buyer (the hospital) will hold the manufacturer harmless.
— In other words, if anything goes wrong with the system and someone gets hurt, it’s not the manufacturer’s fault. The reasoning has been: “Hey, you doctors are smart. If our system displays a wrong value, you’re supposed to notice it.”
I’m told this policy has been one big impediment to adoption of EMR systems, because it removes all motivation for vendors to fix things that make their product hard to use: If there’s a bug or the system slows someone down, and a patient gets hurt, the hospital gets sued, not the vendor.
If you were a hospital, wouldn’t that make you eager to buy? What would that do to your trust of the vendor? Patients, how do you feel about that? Providers? Read more »
*This blog post was originally published at e-Patients.net*
November 5th, 2010 by Lucy Hornstein, M.D. in Better Health Network, Opinion, True Stories
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I’ve had a longstanding policy in my office that routine prescription refills will only be addressed during regular office hours. No evenings; no weekends; if you need a refill of your long-term chronic medications, you need to call during regularly scheduled office hours, five days a week. You can leave a message if you like, but you should not expect us to call in the medication until the office is open.
The main reason for this policy has always been medical: prescription medication requires appropriate monitoring. From the moment I hung out my shingle, I’ve made it my habit always to write enough refills on your medication to last until the next time I need to see you. In all likelihood if you need a refill, what you really need is a visit.
The logical reason for the policy is the need to consult the medical record before authorizing refills. And when those records are contained on bits of dead trees on shelves in the office, there’s no way I can access them if I’m not physically there. I’ve been known to drive out to the office at decidedly odd hours for the express purpose of consulting those records so that I can provide appropriate care to my patients. That has always been the bottom line for me, and always will. Read more »
*This blog post was originally published at Musings of a Dinosaur*
October 27th, 2010 by JessicaBerthold in Better Health Network, Health Policy, News
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Dr. Jay Anders, the CMIO of EHR vendor MED3000, offered a few tips during a Medical Group Management Association (MGMA) session on implementing an EHR successfully:
1. Make a clear communication pathway. Everyone needs to know what’s going on, from the physicians to the receptionist.
2. Clearly identify the needs of every physician who is going to use the EHR. The needs of an internal medicine doctor aren’t the same as a dermatologist. Make sure the EHR meets those needs.
3. Get a physician champion for the EHR who will be responsible for talking about the project to peers and answering questions, and be the first person to implement it. Pay that person for his or her time spent in championing duties.
4. Some people need more time than others. Don’t let a resistant doctor stop the implementation. Develop a plan for dealing with resisters that includes how you’ll respond to negative comments, how to implement other colleagues despite the resister, and how to sell the benefits of the EHR to the resister.
5. Expect the EHR implementation to be time-neutral. Most EHRs don’t save time; their value is in improved patient care and documentation, which leads to better reimbursement.
*This blog post was originally published at ACP Internist*
October 12th, 2010 by KevinMD in Better Health Network, Health Policy, News, Opinion, Research
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One of the supposed strengths of electronic medical records is better tracking of test data. In theory, when using more sophisticated digital systems, doctors can better follow the mountains of test results that they encounter daily.
But a recent study, as written in the WSJ Health Blog, says otherwise. Apparently, a study performed in 2007 found:
VA doctors failed to acknowledge receipt of 368 electronically transmitted alerts about abnormal imaging tests, or one third of the total, during the study period. In 4% of the cases, imaging-test results hadn’t been followed up on four weeks after the test was done. Another study, published in March in the American Journal of Medicine, showed only 10.2% of abnormal lab test results were unacknowledged, but timely follow-up was lacking in 6.8% of cases.
Consider that the VA has what is considered the pinnacle of electronic systems — their unified, VistA program that permeates all their hospitals and clinics. Apparently the problem is one of alert overload:
Hardeep Singh, chief of the health policy and quality program at the Houston VA’s health and policy research center, led both studies. He tells the Health Blog that doctors now receive so many electronic alerts and reminders — as many as 50 each day — that the important ones can get lost in the shuffle.
This is not unlike the alarm fatigue issue that I recently wrote about. Too much data — whether it is written or on the screen — can overwhelm physicians and potentially place patients at harm. Curating test results by prioritizing abnormals will really be the true power of electronic test reporting.
*This blog post was originally published at KevinMD.com*
