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EHR Interoperability Benefits Not Related to Physician Data Sharing

I always love when someone can take a subject and expand my thinking on that subject. Whenever I thought about EHR interoperability I always thought about it from the perspective of a physician sharing that data with another physician. In this case it would be one EHR sharing with another EHR (possibly with an HIE in the middle). In a recent post, Dr. Doug Fridsma from ONC, (I love that ONC blogs) expanded my thinking when it comes to the possible benefits associated with data standards and EHR data sharing when he shared the following list:

  • Patient safety advocates may want to use EHR systems to collect patient safety information, leveraging existing standards like the AHRQ “common format” for patient safety reporting
  • Providers and researchers may want to use the EHR systems to collect data for clinical research, including patient-centered outcomes research, and to identify patients who could benefit from participating in a research study
  • Providers may want to give referrals to their patients for community services, like smoking cessation or weight management programs, after discussing these topics with them during an office visit
  • Providers working with disease surveillance case report forms may wish to collect additional information about reportable conditions, such as infectious diseases
  • Provider’s office staff can use EHR’s to gain pre-authorization of certain kinds of medical devices where health payers may want to leverage clinical information collected in EHRs to support additional review of expensive medical equipment.

After just publishing my recent post about The Coming Physician EHR Revolt, I can’t help but ask what any of the above items do to help a doctor. The last one could help a physician’s workflow, but the rest of them have limited specific value to a physician. This is one of the challenges with EHR data sharing. Doctors don’t buy and implement an EHR because they want to give better referrals to their patients for community services. There’s a mismatch between providers’ needs and healthcare data exchange desires.

February 5, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

ONC Plan Focuses On Health IT Safety

The ONC has decided that it’s time to move health IT safety up to the next level, proposing a plan that would standardize the way health IT safety incidents are reported and make it easier to report straight from an EMR. And brace yourselves, vendors: this could include changing the EMR certification process to include the ability to make such reports easily.

The agency’s Health IT Patient Safety Action and Surveillance Plan is designed to strengthen patient safety efforts, including patients, providers, technology companies and healthcare safety oversight bodies in the mix. The idea, not surprisingly, is to use health IT to make care safer.

The ONC’s key objectives include the following:

*  Making it easier for clinicians to report patient safety events and risks using EMRs

Right now, it’s not exactly easy for clinicians to create a safety event report when something goes wrong in their use of an EMR, and the data they do sometimes produce isn’t easy to work with or compile.  ONC is proposing using certification criteria to make sure that whenever possible, EMRs make it easy to report safety events using the Agency for Healthcare Research and Quality’s standardized Common Formats.

*  Getting health IT developers to support patient safety and safety reporting

Within 12 months, the ONC plans to create a code of conduct — working with professional groups and health IT developers — which will hold developers accountable for:

– Creating usable, safe designs for products and adverse event reporting
– Working with a Patient Safety Organization to report, aggregate and analyze health IT related safety events
–  Scrapping practices that discourage provider reporting of safety events, such as limits in nondisclosure clauses and intellectual property protections
–  Participating in efforts to compare user experiences across different EMR systems

There’s plenty more to consider in this report, but I’ll leave you with these details in the hope that you’ll read it yourself.  As you’ll see in the introduction, you have until February 4th to comment on ONC’s plans. I hope plenty of readers do — this is important stuff.

January 2, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

e-Prescribing: Some Considerations

I’m always in the mood for stories, which is why I love the Cases and Commentaries section on the AHRQ WebM&M site. There’re a bunch of February posts up there but the one that caught my eye was one titled E-prescribing: E for Error?

The case involved a 63 year old man who went in to see his primary care physician. He was receiving psychotherapy, but was still prone to anxiety. The PCP prescribed him alprazolam for the anxiety. Since the clinic had just implemented a new e-prescribing system, the doctor assured the patient that he didn’t need a paper prescription and just needed to show up at pharmacy and pick up his order.

So far so good.

Back at the doctor’s office, a nurse entered the presribed medication into the practice’s shiny new system, except that she inadvertently added an order of atenolol, intended for a different patient, to this patient’s order. She soon realized her mistake and deleted the atenolol order.

When the patient went to the pharmacy, he was given both the alprazolam and the atenolol, which he thought was odd, since he had been prescribed only one medication. However, he just went ahead with taking both medications per the directions handed to him by the pharmacist, and it was only a few days later, during an appointment with a cardiologist that the mistaken atenolol addition was finally identified.

Fortunately, the patient lived to tell the tale, which we all know is not the outcome in some sad cases. Elisa W. Ashton, the author of this Cases and Commentaries piece, has some great points listed as her takeaways from this case. Here are mine:

- It’s too soon to say goodbye to paper. I worry about trees more than the average Jane, but if there’s a ever a case to be made for a paper prescription, here it is. A paper prescription would’ve shown up the double prescription both to the nurse, as well as the patient, making it less likely to make it to the pharmacy.

- It’s not clear who/what failed. Did the nurse realize delete the wrong entry only after she transmitted the patient’s prescription? Did the prescription software trule delete the medication or simply mark it as flagged for deletion?

- This accident happened on a newish system, perhaps users were not as familiar with it as they should have been.

- If you think something’s odd about your prescription, speak up. As patients many of us tend to assume that doctors know best. However, doctors are as human as everyone else, no matter how many initials tag along before or after their names. You don’t have to be obnoxious about it, it’s perfectly fine to verify politely with your doctor’s office if the additional (or missing) medications are necessary.

- Bravo to the eagle-eyed cardiologist! It was great someone caught this error in time, though I would much prefer that some kind of check system be built into the e-prescription system to prevent errors of this sort.

Go check out the post on AHRQ.

February 13, 2012 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.