RE: EHRs in Surgical Practices

Recently, on his blog “Life as a Healthcare CIO,” Dr. John Halamka gave advice on how to implement EHRs for surgical practices. Dr. Halamka points out many of the issues we’ve found when meeting with surgical practices and ambulatory surgery centers (ASCs). Surgical practices offer a unique set of problems as they have a very specific purpose, are less likely to have many returning patients, and capture a limited amount of information (the rest being captured by referring general practitioners/primary care physicians and their respective facilities). So where is the incentive for these practices to adopt an electronic solution? How can EHRs address these particular needs without being too disruptive to the surgeons’ workflows? Dr. Halamka has some ideas – based on his own experiences – but I think there’s more to add to this discussion.

A Scanner Darkly

The awkward phase. It’s an unpleasant nebulous moment between two well-defined points. That uncomfortable time as people go from childhood and adulthood. Or that fearful moment full of panic as you go from dating to being in a serious relationship with someone else. It’s that interim state where you’re no longer A but you’re not quite B either.

Medical reporting is currently in its own awkward phase.

In the not so distant past lies Paper Based Reporting – filling out forms using pen and pencil, typewriters, printing out reports and having physical copies of every document located somewhere. This is the world of triplicate, of faxes and envelopes, of white-out and paper shredders. Paper charts physically shipped or moved from practice to practice, facility to facility. Paperland, as I like to call it, does have its advantages, though: a physical document that proves that something happened and to which people can refer; an artifact that precisely records how something occurred at that date and time, without any fear of tampering; a collection of data that cannot be wiped out by a virus or any sort of IT snafu.

Meanwhile, in the not so distant future lies Electronic Based Reporting – entering every information via computers. Using synoptic reports to enter structured data, information is culled directly from machines (think of vital signs being automatically recorded and logged), or easily entered using touchscreens, mouse & keyboard or a stylus of some sort. Electronic reports allow for faster sending of information to a wider range of places. Specialized fields ensure consistency in language and information captured. Required fields and “checklist” approaches encourage more completeness in reporting and more pertinent information is readily captured.¹ However, Tronworld, as I’ll refer to it, has its own share of problems. Information can be lost or stolen without any physical backups. There’s ensuring that all systems are speaking the same language when interfacing, so there’s no loss of data or need to reformat the data every time you go from one system to another.

So, between here and there, betwixt Paperland and Tronworld, lies us currently. How are people bridging the divide between the two different modes of reporting? The answer…might surprise you.

Words from Around the Web

Hey Everyone!

Hope people are having a great Friday the 13th. Here is a frightening round-up of some spooktacularly interesting links:

• Andrew Hayek, of the ASC Advocacy Committee, writes about the financial implications that healthcare reform will have on ASCs (Ambulatory Surgery Centers).
• Are you ready for a RAC attack? The Recovery Audit Contractor (RAC) program is looking for inconsistent billing and coding issues existing within health facilities and between those facilities and health professionals. Soon you’ll be able to see exactly what the Contractors are looking for.

A Useful Meaning for Meaningful Use?

Image via HealthITBlog

While the march towards universal EHR adoption continues, some resistance to implementation has emerged, including from inside the medical community. Some of the hesitation is based on safety issues and privacy concerns – people worry that the personal content of health documents could be viewed by anyone or that opportunistic hackers could easily gain access to our most intimate details. I’ve written about this argument before and concluded that, while I agree it’s important to proceed cautiously and intelligently, we must proceed nonetheless.

One of the biggest impediments to electronic health record adoption has been the lack of concrete definition of “meaningful use.” But let’s not get too far ahead of ourselves. In order to receive government funding/aid in the form of incentive payments from Medicare and Medicaid, facilities have to demonstrate that their electronic health record serves or provides “meaningful use” to the practice and physicians. The definition for meaningful use has been murky and vague; a subjective and fleeting characterization that made many physicians and health facilities reluctant to commit to any electronic solutions for fear of not being reimbursed or not qualifying as “meaningful use.” Luckily, this issue has been resolved – mostly – thanks to the definition put forth by the Office of Health and Human Services. So what is the definition and what does this mean for health information technology?