Healthcare IT News - August 2008 - (Page 11)

www.HealthcareITNews.com August 2008 ■ Healthcare IT News 11 O M M N T R y IN THEIR APRIL, 2008 New England Journal of Medicine article, “Off the Record — Avoiding the Pitfalls of Going Electronic,” Hartzband and Groopman expound on significant pitfalls and shortcomings currently common to the use of electronic health records (EHRs). Write for each other of clear communication if we can ever hope to tell the patient’s story in an electronic fashion. Check-box templates can no more serve as communication vehicles than curriculum vitae can substitute for eulogies. Clinicians should take responsibility for this habitual omission. Insurers have been meticulous about requiring our documentation for years. CMS quality standards rely on our entry of selected data elements for reporting. But only we clinicians can hold each other accountable for writing notes that accurately tell the patient’s story. Similarly, health information leaders must provide systems that facilitate clear communication. If physicians and health systems NeWsmaker iNtervieW What is the next and biggest healthcare “leap” Leapfrog can initiate or influence? Making the money talk – using financing incentives to reward good performance and not reward bad performance. We are rolling out a new version of our Leapfrog Hospital Rewards Program, which will give health plans a system for paying hospitals that perform well or show improvements on Leapfrog. We are also supportive of regional approaches to financial incentives. One of the boldest is in Maine, where the Maine Health Management Coalition changes the deductible when employees use high performing hospitals. The article has been widely referenced as another indicator that the EHR is overrated. The authors accurately identify common errors in use of EHR’s, but fall short in identifying the root cause of these imperfect outcomes Their main criticism is that EHRs encourage the misuse of the standardized computer templates and that physicians over-use copy/paste to speed the documentation of patient encounters, but end up creating expansive notes that do not tell the patient’s story. The authors bemoan expansive data filled notes devoid of useful information. There are fair critiques, but they also applied as well to the paper world, where attending physicians were known to dictate verbatim from a housestaff note, and complex authentic descriptions by the patients were often compartmentalized into buzz terms like “sub-sternal chest pain” and “GERD symptoms.” EHR’s do make certain methods of note creation easier than others, and it will always be easier to copy another’s words than author new information. The fact that the EHR can be used to create poor quality notes does not necessarily reflect poor design. The core issue unaddressed in their essay is the unasked question that the author of every EHR note should be asking, “Whom am I writing this note to?” Clinicians should not expect improvements until they recognize the need to clearly and intentionally write to each other. Templates are wonderful tools to facilitate data input and required documentation but clinicians must add narrative text (via voice recognition, handwriting recognition, typing, or dictation) to the note with the intention Leah Binder CeO, the Leapfrog Group, appointed in march 2008. Formerly vice president of Franklin Community Health Network in Farmington, maine. continue to focus exclusively on documentation and reimbursement when selecting and rolling out a product, then they will end up with EHRs that discourage effective communication and care coordination. Judicious use of voice recognition and dictation to augment template driven documentation is all too frequently viewed as an unnecessary extravagance, but is in fact essential. Visionary EHR companies have not only recognized this need, but actively incorporated work flows allowing focused use of narrative text to augment structured documentation, as they keep close watch on the development of natural language processing products, which hold the promise of extracting discrete data from such narrative descriptions. While some technology companies have created these possibilities, it was up to us to take advantage of them. Our baker see page 10 by r. hal baker, Md Wellspan Health “in the end, only clinicians can drive our EHr’s to our stated destination, and we must give them the tools to succeed.” What role can information technology play in improving the healthcare system? Either positive or negative, it can raised and managed go either way. The key issue is not the more than $8 million in technology itself, though obviously grant funding. that’s important, but how the technology is deployed. Providers are often not served as senior policy adviser to New York City proficient at making mayor rudolph Giuliani. systemwide change, so the most successful IT vendors will know how to guide hospitals and health systems to effectively integrate new technology into their overall operations. Can IT help prevent hospital-acquired infection? yes, but again only if technology is deployed well. Hospitalacquired infection is a classic example of a problem that can only be solved systemically. Every employee, every department, every function in the health system must make change and infections thrive when just one element of the system fails to make that change. So again, properly deployed, with support, IT can be critical to engaging the health system as a whole. bInder see page 10 leTTers Continued from page 10 those who are trying to help them heal, to subject themselves to a widespread uncontrolled experiment like this is really nothing to celebrate. Pe r s o n a l l y, “we are very I’m very grateful to those in the clever, and not healing profesalways wise.” sion who are – Suzie Kidder raising concerns over this trend on behalf of every single one of their patients. We have a tendency in this country to do things because we can and not because we should. We are very clever, and not always wise. And particularly in an environment filled with those who are exceptionally vulnerable, I would have hoped that the Precautionary Principle would have prevailed. I think this is a very useful list of hospitals to which to avoid being admitted. This was a foolish decision on the part of their administrations, and one I believe they will come to regret in the not so very distant future. – Suzie Kidder, San Rafael, Calf. More letters on page 12 Will Microsoft change post Bill Gates? NO “I think they will move more into Apple’s consumer market and even buy a wireless data solution to rival the iPod/iPhone. I’d be very interested in such a device.” – Anonymous “I think most of the Google style Web-based applications are trinkets, and as such, will never really challenge the Microsoft core application market. As such, MS will be fine without Gates.” – Anonymous NEwS mONitOr it should be; it is trying to rule the world, by force, instead of by being a good neighbor. To me, it simply means that Microsoft is now a commodity instead of something special.”ital data into my personal record.” – Thomas Nelson Cox Health Springfield, Mo. HEaltHcarE it NEwSmONitOr Q 80% 60% 40% 20% 0% Will Microsoft chairman Bill Gates’ departure from the company, which he cofounded and has led since 1975, affect Microsoft’s position in the market over the next several years? 276 reader responses “Inertia – the key subordinate leaders who implemented Gates’ strategic direction remain and will keep the fundamental positives and negatives going forward.” – Anonymous “I believe that those at Microsoft will try to produce medical IT software that they will try to sell to all medical facilities and offices. It will probably be very expensive and will not be welcomed by the medical profession as a whole.” – Carol Gacioch McCain Correctional Hospital Raeford, N.C. “Microsoft will eventually get out of the healthcare business primarily because of Gates leaving and of a systemic lack of how healthcare is managed.” – Tim Malloy Malloy Group Boston, Mass. 55% 45% NO YES YES “I think that Microsoft has been losing its focus over the last few years, and with Gates gone, it will flounder even worse than before. Microsoft has lost its vision of what To take future surveys, subscribe to our enewsletter, HealthcareITNewsWeek, or visit us daily on the Web at HealthcareITNews.com. http://www.HealthcareITNews.com http://HealthcareITNews.com

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Healthcare IT News - August 2008 Contents Closer to IT Bill PHIN or RHIOs? Making Leaps After the Flood Tidal Change Denmark Bound Bridging the Divide Robot That Could Mobile Computing Data Everywhere

Healthcare IT News - August 2008

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