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Electronic Health Record

Electronic Health Record. What is in it for you?. “ For 8 minutes the computer and I were both functional today ” Randy Glasbergen. Worried?. Dr. Sattenspiel:

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Electronic Health Record

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  1. Electronic Health Record What is in it for you?

  2. “For 8 minutes the computer and I were both functional today” Randy Glasbergen

  3. Worried? • Dr. Sattenspiel: • "If we go to a system like this and begin to implement it, we may not be drowning in paper every day, but if we can’t get enough work done—if we can’t see enough patients in a reasonable amount of time to be able to generate the revenues that will support our office—then that could be a disaster." Porter S; American Academy of Family Physicians Pilot project studies EHR implementation issues. Ann Fam Med. 2004 Jul-Aug;2(4):377-8.

  4. Central Concerns • “More effort same output” • “Interferes with patient time” • Reduces quality of care

  5. Other Concerns • Pay for performance • Anti-trust legal barriers • Privacy and security obligations • Liability exposure • Lack of interoperability

  6. Other Concerns • Pay for performance • Anti-trust legal barriers • Privacy and security obligations • Liability exposure • Lack of interoperability Lets focus on central problems that physicians express

  7. Worried about Effort • What if we have to maintain both paper and computer records?

  8. “We back up our data on sticky notes because they do not crash” Randy Glasbergen

  9. Worried about Effort • Will it let me do what I am doing? • Do I have to spend more time at it? • I am not a typist • Will I have to redo • Is it fast? Time saved because records are available on demand or remotely Edsall RL, Adler KG. An EHR user-satisfaction survey: advice from 408 family physicians. Fam Pract Manag. 2005 Oct;12(9):29-35

  10. Worried about Effort • Will it let me do what I am doing? • Do I have to spend more time at it? • I am not a typist • Will I have to redo • Is it fast? How much more time will it take? Edsall RL, Adler KG. An EHR user-satisfaction survey: advice from 408 family physicians. Fam Pract Manag. 2005 Oct;12(9):29-35

  11. More Hype than Reality • 1994: “Twice as long” • 2001: “5% more time” • 2006: “No difference” Time Motion Studies of House Staff & Physician Offices Bates DW, Boyle DL, Teich JM. Impact of computerized physician order entry on physician time. Proc Annu Symp Comput Appl Med Care. 1994;:996. Shu K, Boyle D, Spurr C, Horsky J, Heiman H, O'Connor P, Lepore J, Bates DW. Comparison of time spent writing orders on paper with computerized physician order entry. Medinfo. 2001;10(Pt 2):1207-11. Lo H, Newmark LP, Yoon C, Volk LA, Carlson V, Kittler A, Lippincott M, Wang T, Bates DW. The electronic health record in specialty care: A Time motion study. AMIA Annu Symp Proc. 2006 Nov 11;2006(CD):1014.

  12. The Entire Industry is Changing • The 2005 CMS / Mathematica Hospital survey • 83% used electronic lab results; • 59% used electronic clinical notes; • 50% had electronic images and lab orders; • 24% used electronic reminders • 21% used e-prescribing What about CPOE? Laschober M, Maxfield M, Lee M, K hober Kovac M, P ovac Potter F otter F, F , Felt- elt-Lisk S. Hospital ospital

  13. Use of Computerized Physician Order Entry in Hospitals Goal Studies cited in Health Information Technology in the United States: The Information Base for Progress

  14. Use of Computerized Physician Order Entry in Hospitals In some areas,80% of Urban Hospitals Use CPOE Ward MM, Jaana M, Bahensky JA, Vartak S, Wakefield DS. Clinical information system availability and use in urban and rural hospitals. J Med Syst. 2006 Dec;30(6):429-38.

  15. Earlier systems Currentsystems Satisfaction with Order Entry Murff HJ, Kannry J. Physician satisfaction with two order entry systems. J Am Med Inform Assoc. 2001 Sep-Oct;8(5):499-509.

  16. Impact on Quality Much more complex than first imagined

  17. Long Term Impact Expected • Reduced medication errors • Reduced adverse sentinel events • Reduced liability & better reliance on guidelines • Reduced waste and duplicate testing

  18. Reduced Duplicate Test • “There is delay in information flow from hospital to general practice” • Remote access could reduce the delay Kljakovic M, Abernethy D, de Ruiter I. Quality of diagnostic coding and information flow from hospital to general practice. Inform Prim Care. 2004;12(4):227-34.

  19. Less Medication Errors • Improves fidelity of exchanges among physicians, pharmacists and nurses Bates DW, Teich JM, Lee J, Seger D, Kuperman GJ, Ma'Luf N, Boyle D, Leape L. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc. 1999 Jul-Aug;6(4):313-21.

  20. Quality: Less Errors • Improves fidelity of exchanges among physicians, pharmacists and nurses 5 months after CPOE Before CPOE Bates DW, Teich JM, Lee J, Seger D, Kuperman GJ, Ma'Luf N, Boyle D, Leape L. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc. 1999 Jul-Aug;6(4):313-21.

  21. Less Medication Errors • Improves fidelity of exchanges among physicians, pharmacists and nurses 5 months after CPOE Allergy Warning System Bates DW, Teich JM, Lee J, Seger D, Kuperman GJ, Ma'Luf N, Boyle D, Leape L. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc. 1999 Jul-Aug;6(4):313-21.

  22. Less Medication Errors • Improves fidelity of exchanges among physicians, pharmacists and nurses Allergy Warning System Drug-Drug Interaction System Bates DW, Teich JM, Lee J, Seger D, Kuperman GJ, Ma'Luf N, Boyle D, Leape L. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc. 1999 Jul-Aug;6(4):313-21.

  23. Less Medication Errors Just storing and retrieving data is not much of a benefit. To get more out of your investment, you need to analyze and use the stored data. • Improves fidelity of exchanges among physicians, pharmacists and nurses Bates DW, Teich JM, Lee J, Seger D, Kuperman GJ, Ma'Luf N, Boyle D, Leape L. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc. 1999 Jul-Aug;6(4):313-21.

  24. Less Medication Errors • Improves fidelity of exchanges among physicians, pharmacists and nurses Shulman R, Singer M, Goldstone J, Bellingan G. Medication errors: a prospective cohort study of hand-written and computerised physician order entry in the intensive care unit. Crit Care. 2005 Oct 5;9(5):R516-21. Epub 2005 Aug 8.

  25. Less Medication Errors • Improves fidelity of exchanges among physicians, pharmacists and nurses Why should errors go down? Shulman R, Singer M, Goldstone J, Bellingan G. Medication errors: a prospective cohort study of hand-written and computerised physician order entry in the intensive care unit. Crit Care. 2005 Oct 5;9(5):R516-21. Epub 2005 Aug 8.

  26. Before EHR WOLF, DEBRA M. MSN, RN; GREENHOUSE, PAMELA K. MBA; DIAMOND, JOEL N. MD, FAAFP; FERA, WILLIAM MD; McCORMICK, DONNA L. BS Community Hospital Successfully Implements eRecord and CPOE. Computers, Informatics, Nursing. 24(6):307-316, November/December 200

  27. WOLF, DEBRA M. MSN, RN; GREENHOUSE, PAMELA K. MBA; DIAMOND, JOEL N. MD, FAAFP; FERA, WILLIAM MD; McCORMICK, DONNA L. BS Community Hospital Successfully Implements eRecord and CPOE. Computers, Informatics, Nursing. 24(6):307-316, November/December 200

  28. EHR streamlines the process & reduces sources of error WOLF, DEBRA M. MSN, RN; GREENHOUSE, PAMELA K. MBA; DIAMOND, JOEL N. MD, FAAFP; FERA, WILLIAM MD; McCORMICK, DONNA L. BS Community Hospital Successfully Implements eRecord and CPOE. Computers, Informatics, Nursing. 24(6):307-316, November/December 200

  29. After EHR Simple and straight forward WOLF, DEBRA M. MSN, RN; GREENHOUSE, PAMELA K. MBA; DIAMOND, JOEL N. MD, FAAFP; FERA, WILLIAM MD; McCORMICK, DONNA L. BS Community Hospital Successfully Implements eRecord and CPOE. Computers, Informatics, Nursing. 24(6):307-316, November/December 200

  30. Timetable at a Community Hospital How fast will all of this happen? WOLF, DEBRA M. MSN, RN; GREENHOUSE, PAMELA K. MBA; DIAMOND, JOEL N. MD, FAAFP; FERA, WILLIAM MD; McCORMICK, DONNA L. BS Community Hospital Successfully Implements eRecord and CPOE. CIN: Computers, Informatics, Nursing. 24(6):307-316, November/December 200

  31. Timetable at a Community Hospital Process improvement takes a lot longer WOLF, DEBRA M. MSN, RN; GREENHOUSE, PAMELA K. MBA; DIAMOND, JOEL N. MD, FAAFP; FERA, WILLIAM MD; McCORMICK, DONNA L. BS Community Hospital Successfully Implements eRecord and CPOE. CIN: Computers, Informatics, Nursing. 24(6):307-316, November/December 200

  32. What next? • You get what you put in • The sooner the better • Success is more likely if you are involved • Quality of systems • Components included • Configuration decisions This is a quality improvement project and not an IT project

  33. What do you want it to be? The Likely Impact Depends on the Details

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