Not unlike US seems that the Gillard government in Australia also recognises need to provide support to GPs as they initially create EHRs for patients.
GPs win e-health concession provides summary of current situation in Australia
Interesting to see how phase II of meaningful use will succeed with patients in the US.
This requires significant change in practice and in attitudes. Without doubt it will make sense to make patient data available electronically for sharing between a patient and his/her carers. But all parties must see value in the proposition and commit to working in a different way. Temporary, artificial, financial incentives will neither change attitudes not drive sustainable change.
This paper by PwC provides an interesting analysis of some of the attitudes and some of the challenges.
Across the population there are still challenges around access to technology (25% of US people do not have internet access from home), awareness of electronic patient records, trust in technology, willingness to question medical personnel, difficulties defining the roles of patient and medical professional.
In Ireland The Health Service Executive (‘HSE’) recently issued a tender for a four-year national integrated services IT project using electronic health records to underpin its integrated service delivery plan. This project aims to define a platform for integrated service delivery. However it will be interesting to see how the challenges outlined in the PwC report are anticipated and addressed.
Missed the write up of this study at the time.
Very interesting – providing patients with direct access to the notes made at their visit to the doctor. Would seem that, in general, patients favour this development, doctors have a number of concerns (many of these relating to concern for the patient).
I can understand a range of concerns:
However I do not see any way forward without moving to having access to doctors’ notes – in the context of individuals seeking to maintain long term health records – combining info from dentist, GP, specialists, physio, dietician, etc.
Obviously further systems investment and training required – before notes can be available more generally, in secure way. But all part of the EPR/ EMR trend.
Just read this discussion paper.
Difficult to argue with the credentials of the organisations behind the paper (Cleveland Clinic, Cincinnati Children’s Hospital Medical Center, Kaiser Permanente, etc.)
And the content of the paper makes lots of sense.
The checklist is as follows:
Foundational elements
• Governance priority—visible and determined leadership by CEO and Board
• Culture of continuous improvement—commitment to ongoing,
real-time learning
Infrastructure fundamentals
• IT best practices—automated, reliable information to and from the point of
care
• Evidence protocols—effective, efficient, and consistent care
• Resource utilization—optimized use of personnel, physical space, and
other resources
Care delivery priorities
• Integrated care—right care, right setting, right providers, right teamwork
• Shared decision making—patient–clinician collaboration on care plans
• Targeted services—tailored community and clinic interventions for
resource-intensive patients
Reliability and feedback
• Embedded safeguards—supports and prompts to reduce injury and infection
• Internal transparency—visible progress in performance, outcomes, and costs
For those of us interested in health informatics much of this speaks to streamlined and managed processes, information technology embedded in everything that happens, use of information technology to improve patient outcomes. And the importance of an effective EHR is very much to the fore.
Well worth a read – would be interesting to see the views of healthcare provider CEOs.
Liked this piece by Rosemarie Nelson dealing with the potential for Physicians to deploy EHR solutions in the cloud.
When you think about it you would think it must make a lot of sense. A doctor running a busy practice does not want to be worrying about capacity planning, firewalls, patch management, backups, etc. Yet her/his EHR solution is critical to the practice.
Naturally there will be the usual concerns re security/ confidentiality of patient data. But why would a Physician be better at this that a specialist cloud operator?
Rosemarie Nelson, in the context of the US, provides some indicative pricing. And there are obvious attractions in the opex v. capex model for any Physician running a practice.
As we follow the determined efforts in the US to push EHR/EMR interesting to read that they have many of the problems that we see in our own marketplace. What do we do for medics who do not type or do not type quickly & accurately?
Interesting piece about the resistance to having doctors spend their time typing in the US. This in particular relates of use of CPOE – if you don’t enter the data then you don’t get the warning (then and there) about what you are ordering. Abd, in the US, Meaningful Use has been set up to incentivise medics to use EHR – including CPOE.
This is nothing new. Keyboard skills have been a challenge in banking & finance, retail, engineering & construction. Having experience of pushing out ERP solutions across multinationals have seen lots of these challenges. We need to keep the eye on the end game – capture the data once and leverage the data. Can definitely apply also in healthcare.
Obviously application design/ interface and relevant devices all have a role to play in making all of this a lot easier. We want consultants, nurses, pharmacists, doctors all updating the EHR. So we need to design smartly, support users and provide relevant and customised training. Lastly, those inputting the data, must see the end benefit – safer experience for patients, less mistakes by professionals, streamlined processes. All of this has to pay for the effort expended in inputting the data.
Two NHS hospitals, Cambridge University Hospitals NHS and Papworth Hospital NHS, have jointly selected Epic for their Electronic Patient Record solution. Epic won out over Cerner and AllScripts. Both NHS hospitals are migrating from legacy iSoft PAS.
Source: eHi eHealth insider
Seems to me that the observations about a patient, made by a doctor, nurse, consultant or physio should be captured. They represent the professional’s assessment, judgement, advice, direction. This data should be available and accessible for other professionals responsible for caring for the patient. And, I would argue, this information should be available to the patient.
We have to move on from hand written notes – which are not easily shared, stored, searched against.
And I do not buy the concerns of professionals that entering such data into a computer interferes with patient care. In fact it creates records likely to improve patient care.
Bringing medicine into the age of computers is an excellent blog posting on the subject.
The game should have moved on by now. And the players need to start playing the new game.
And we do need to ensure that software and devices are configured to facilitate electronic health records.
Interesting piece by a CFO looking to putting his Board straight on likely payback on investment in systems to support EMR.
CFO argues that the payback is not obvious, is not in the short term. The investment may yet make sense in the longer term - enabling healthcare to go where it needs.
These are very real challenges for all CFOs in healthcare – being pushed to support investment originating with clinicians – but under pressure to demonstrate payback to Boards and/or investors.
IT projects in hospitals are no different to IT projects in other industries – in terms of requiring planning, resourcing and support for change management.
This report on roll out of IT systems at Department of Veterans’ Affairs (VA) hospitals in the US speaks to this issue.
If people are working in busy day jobs and you want to implement change (to improve patient safety, operational efficiency), then you must plan for interruption to day to day operations – be that for testing, training, adjusting to new processes. The business case for such change needs to recognise, inter alia, the costs of the change effort itsself.