Posts tagged ‘EHR’

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.
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November 17, 2010 at 4:25 pm Leave a comment

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.
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September 13, 2010 at 9:12 am Leave a comment

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:

August 13, 2010 at 3:41 pm Leave a comment

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?
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August 5, 2010 at 4:02 pm Leave a comment

From the Ashes: Ensuring that Your Health IT Data is Secured & Easy to Recover

The Most Popular Recovery Plan Today (Via Leonid Manchenkov's blog)

“Expect the unexpected.”

It’s one of those oxymoronic idioms that have become so ingrained in our culture, it’s hard to determine its origins but it’s taken as a universal truth. Obviously, if you expect the unexpected, then it’s no longer unexpected; but it’s not meant to be a literal set of instructions. As we all know, expect the unexpected means to assume that things will go wrong, or to at least have some contingencies in case your plan doesn’t work out as you intended them. I was reminded of this phrase while reading this list of Top 5 EHR Adoption Barriers and came upon the last one:

Can the Networks Support the Data?
Today’s data explosion is driven by many industries, but healthcare records and imaging are fueling a big part of the growth. Healthcare providers are worried about the complex networking capabilities and their ability to handle the 24×7 influx of massive amounts of data and the disaster recovery plans needed to support that data. VARs play a pivotal role in the networking and disaster recovery markets, so smart VARs will use their knowledge to close the deal.

It was an interesting issue that I hadn’t spent much time thinking about. That’s not to say that we hadn’t taken all of this into account when designing our products, but I personally had never conceived that this would be an obstacle or imposing barrier to health facilities that want to adopt electronic health solutions. And that’s when I decided to look at our products to see how they fare if the unexpected happened and we needed to recover data.
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July 1, 2010 at 2:28 pm Leave a comment

Common Language: The Rise of Standard Formatting for Surgical Reports

Gottfried Wilhelm von Leibniz

Gottfried Leibniz. That name doesn’t mean much to most people, outside of math nerds with a penchant for historical trivia. Leibniz is credited with simultaneously creating calculus at the same time of Sir Isaac Newton. Years of debate ensnared the scientific community as patriotic mathematicians of Germany and Britain argued for their respective countrymen. Each camp tried to prove the independent, solitary insight needed to develop calculus solely rested with one man or the other – but were unable to find definitive proof that Newton or Leibniz had been the one to originally conceive of this new field of mathematics. There are suggestions that Leibniz was inspired by some of Newton’s works but, as there’s still too many gaps in the works of Newton that would have been available for Leibniz to consult in order to develop calculus, there’s no substantial proof that Leibniz plagiarized Newton’s work.

Rob's attempt to innovate calculus was met with much less enthusiasm

So what happened then? Perhaps this is an example of Rupert Sheldrake’s pseudo-scientific theory of “morphic resonance” in which behavior is somehow transported across great geographical distances between similar types of animals or people. And while it is always interesting and neat to consider such a possibility – an example of some innate telepathic or cultural osmosis that seems to exist on a cellular level between people – it’s rather unlikely. How, then, did this rise of a new way of thinking occur at the same time in two different places? How were two men able to discover the same mathematical principles without being in collaboration? And what does any of this have to do with surgical reporting?

To put it simply – great minds think alike. The fact of the matter is that both Newton and Leibniz recognized a need for something in the world – in this case, the lack of a particular mathematics field that could be applied to many facets of our lives and used to explain so much of what we don’t understand. It is this same ability for multiple people, unrelated and independent of one another, to see the writing on the wall in the medical community and recognize the absolute need and demand for standardized and structured surgical reporting.
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June 23, 2010 at 10:22 am Leave a comment

Interview with Dr. Jared Ament: A New Way to Tell an Old Story

Dr. Jared D. Ament recently completed clinical research fellowships at Harvard Medical School’s Massachusetts Eye and Ear Infirmary (MEEI) and at the University of Massachusetts Medical Center (UMass) in surgical outcomes. He has worked with Dr. Dohlman (MEEI) and Dr. Black (Brigham and Women’s Hospital) for 3 years now and with Dr. Richard Moser (UMass) for the last year. His MD is from the Medical School for International Health, a collaborative initiative between Ben-Gurion and Columbia Universities. His MPH is from the Harvard School of Public Health. He is adjunct faculty at Harvard Medical School’s department of Population Health and Epidemiology and has specific interests in cost-effectiveness research, international surgery, surgical outcomes, and medical education. He is currently a surgical resident at UMass.

How did you become interested in medicine?

I was a kid who was fascinated by the workings of the body. I was also very involved in martial arts and interested in the inherent mechanics and physiology. And then, as a teenager interested in culture and public health, I traveled extensively to non-industrialized countries, volunteering in all sorts of public health efforts. I guess I just found a niche where working with people from many cultures, coupled with my fascination for human physiology, struck a cord. The left side of the equation seemed to equal “medicine” on the right.

And how did you decide on being a surgeon, specifically?

Many people just know; for a select minority, however, it’s a struggle between the operating rooms of surgery and the diagnostics and offices of internal medicine (and its specialty fields). I always loved surgery and truly knew that the operating room was where I belonged. Yet, I struggled, as the detective work and thorough understanding of bodily functions was tantalizing. My conclusion, however, was that a good surgeon should, first and foremost, be very strong, clinically. They are, too, diagnosticians, physicians, empathic healers, that have dedicated significant time and training to perfecting a tactile skill in addition to, and very much in parallel with, their medical skills. I am still in training but truly enjoy both the clinic and operating room. I need both. I enjoy the time with my patients; the interaction; the teaching and learning that takes place (bi-directional); collaborating with colleagues (surgical and medical); and hold the operating room, the unconscious patient and the delicate work to be performed with the utmost of respect.
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June 22, 2010 at 1:22 pm 2 comments

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