If all you do is use better tools, and you don't measure all the benefits those tools provide, of course you won't seen improvements. I just finished reading through the Archives of Internal Medicine report on the use of EHR's and Clinical Decision Support to improve quality.
There are some problems with the way this particular study was designed. The intervention "Use of an EMR with Clinical Decision Support" is used to address 20 specific quality of care metrics. However, the intervention as defined is not designed to address any one, let alone all of those quality of care metrics specifically. In fact, provider use of EHRs may be motivated by several factors: Improved use of clinician time, better capture of information used for reimbursement, avoidance of medication errors, use of ePrescribing or electronic billing, as well as support for higher quality of care for specific conditions. The study only address the last as a motivator for use.
In order to obtain quality improvements for the specific measures cited in the report, you need to plan for it when deploying an EMR in your practice. Just because an EMR supports clinical decision support doesn't mean that it provides ALL CDS possibilities all of the time. Different practices have different workflows for which the CDS capabilities of products may need to be configured. For example, some products provide documentation templates that support certain clinical guidelines and have CDS rules enabled. But these guidelines and the templates implementing them must be customized to specific care settings based on population age (e.g., pediatric/geriatric), gender (e.g., ob/gyn), formulary, et cetera. The most commonly enabled CDS feature in EHRs is med/med and med/allergy interaction avoidance. Yet there is not a single quality measure in the study that addresses that issue. Yet, it is the most commonly cited issue I hear about alongside the IOM report "To Err is Human".
The conclusions of the report don't surprise me given its design. Nor should they surprise anyone else who reads it. If the treatment (use of EHR + CDS) is non-specific to the problem (the specific 20 quality measures), the expectation that it would have any effect is a marginal hypothesis to begin with. A better study would be to examine the effects of EHR use with CDS where implementation is designed to improve a specific quality measure. In that case, the intervention would be designed to treat the specific issue and the results would be much more relevant.
The data gathered in the NACMS surveys is insufficient to conclude that decision support doesn't help, but right now, that's all the data the study authors had to work with. I suspect that future studies, which will include EHRs that have had CDS rules enabled to support high priority quality measures will have better results. To better explore those results, it might be useful to start gathering metrics on what quality measures healthcare providers have enabled CDS to support.
Updated at 1/25 3:39 pm
A good analogy to this study would be performing a clinical trial on use of medications to treat a specific set of conditions, where the use of any medication was enough to be considered in the numerator, and measuring the impacts of medication use on disease treatment.
Showing posts with label EMR. Show all posts
Showing posts with label EMR. Show all posts
Tuesday, January 25, 2011
Thursday, January 6, 2011
Definitions Matter
In more than two decades of software development, I've become quite accustomed to having to deal with product builds where the final changes to a product were strictly replacing its name. This is usually because marketing either had a very late brainstorm, or someone higher up decided that we needed something catchier for a name. I'd long been accustomed to using code phrases to identify a release because we never knew what the name was going to be ... sometimes even on purpose. I've also been very wary of believing I understood something just because someone used a name or three word phrase I recognized. I usually ask for definitions.
So, the latest ONC blog post providing definitions for EMR and an EHR shouldn't really bother me. But it does, in part because this office already wasted $100K defining these terms. It was Bush's ONC and not Obama's that wasted the money, but the current office could have at least had the courtesy to reference the previous report rather than ignore it and redefine the terms. But the original report should have been buried anyway ... maybe I would have been happier if ONC had acknowledged the errors in that report and then redefined the terms.
The next part of the post that annoys me is the qualitative judgement applied to the names, that an "EMR" product has certain limits on features (e.g., equivalence to digital paper) and information exchange which an "EHR" solves.
I spent 10 years working on linguistic software. One of the things that I learned during that period of time is how definitions change over time. Today's Electronic Medical Record is a completely different thing that what we had 5 years or a decade ago. Perhaps it is time to change the name, and call it an Electronic Health Record. I guess I'll wind up leaving that issue up to marketing and politicians. What I do know is that changing the name of a thing doesn't change what it IS, just the perceptions of it. I'll just have to remember to use the latest HealthIT Buzz words, but if I happen to use EMR, please remember that I mean EHR. I haven't ever worked on anything as limited as what ONC describes.
So, the latest ONC blog post providing definitions for EMR and an EHR shouldn't really bother me. But it does, in part because this office already wasted $100K defining these terms. It was Bush's ONC and not Obama's that wasted the money, but the current office could have at least had the courtesy to reference the previous report rather than ignore it and redefine the terms. But the original report should have been buried anyway ... maybe I would have been happier if ONC had acknowledged the errors in that report and then redefined the terms.
The next part of the post that annoys me is the qualitative judgement applied to the names, that an "EMR" product has certain limits on features (e.g., equivalence to digital paper) and information exchange which an "EHR" solves.
I spent 10 years working on linguistic software. One of the things that I learned during that period of time is how definitions change over time. Today's Electronic Medical Record is a completely different thing that what we had 5 years or a decade ago. Perhaps it is time to change the name, and call it an Electronic Health Record. I guess I'll wind up leaving that issue up to marketing and politicians. What I do know is that changing the name of a thing doesn't change what it IS, just the perceptions of it. I'll just have to remember to use the latest HealthIT Buzz words, but if I happen to use EMR, please remember that I mean EHR. I haven't ever worked on anything as limited as what ONC describes.
Tuesday, December 21, 2010
More than half of US ambulatory physicians use an EMR in 2010
W00T! My glass is more than half full today.
Early results from the National Ambulatory Medical Care Survey (NACMS) done every year by the CDC project that more than 50% of office based physicians have some form of EMR or EHR according to recent publication by the National Center for Health Statistics. Three states have better than 75% penetration according to the data:
The report goes on to say that more than 10% of providers on average have a fully functional EHR (as defined by a 2008 RWJ report). The NAMCS definition of a fully functional EHR differs significantly from what would qualify an elligible provider for Meaningful Use, but are pretty close. A table included in the report shows some of the differences, and you can also download the survey instrument (see question 18).
As a final caveat, this report is based on preliminary survey returns. Even so, its a good way to end the year.
P.S. I'll have to reread the RWJ report. It needs to be added to my history of meaningful use with regard to defining a fully functional EHR.
Early results from the National Ambulatory Medical Care Survey (NACMS) done every year by the CDC project that more than 50% of office based physicians have some form of EMR or EHR according to recent publication by the National Center for Health Statistics. Three states have better than 75% penetration according to the data:
- Minnesota at 80.2%
- Massachussets at 77.3% (I live here)
- Wisconsin at 75.4%
- Kentucky at 38.1%
- Lousiana at 39.1%
- Florida at 39.4% (I used to live here)
The report goes on to say that more than 10% of providers on average have a fully functional EHR (as defined by a 2008 RWJ report). The NAMCS definition of a fully functional EHR differs significantly from what would qualify an elligible provider for Meaningful Use, but are pretty close. A table included in the report shows some of the differences, and you can also download the survey instrument (see question 18).
As a final caveat, this report is based on preliminary survey returns. Even so, its a good way to end the year.
P.S. I'll have to reread the RWJ report. It needs to be added to my history of meaningful use with regard to defining a fully functional EHR.
Tuesday, September 14, 2010
Electronic Medical Records: The Healthcare Information Experts Weigh In
Crossed my desk this morning while giving the CDA/CCD presentation for HL7. This was a really good discussion two weeks ago, which lead to the creation of the ePatient Rap. I'm glad to be continuing it...
Thursday 9/16: We heard from these four healthcare information professionals two weeks ago at a breakfast meeting and thought you would enjoy hearing their perspectives on what is happening with medical records adoption. They will share professional and personal experiences that will underscore the challenges. Larry Chait will moderate and the audience will be encouraged to join in with questions. The focus is on what it will take to encourage personal participation in electronic medical records management. We all have a stake in the outcome!
Electronic Medical Records: The Healthcare Information Experts Weigh In
Thursday, September 16, 2010, 4:00 - 6:00 p.m., Microsoft, 201 Jones Rd., Sixth Floor, Waltham, MA 02451. Directions.
Panelists: Elaine Alligood (VA Technology Assessment), Dan Bogaty (Partners Healthcare), Keith Boone (GE Healthcare), and Janice McCallum (Health Content Advisors)
Details: http://kmforum.org/blog/?p=792
Registration Form for Thursday: http://s94896443.onlinehome.us/tinc?key=t0p0UHsg&formname=reg_thursday
Registration Comments (Cost, time, meeting format): http://kmforum.org/blog/?page_id=22
Thursday 9/16: We heard from these four healthcare information professionals two weeks ago at a breakfast meeting and thought you would enjoy hearing their perspectives on what is happening with medical records adoption. They will share professional and personal experiences that will underscore the challenges. Larry Chait will moderate and the audience will be encouraged to join in with questions. The focus is on what it will take to encourage personal participation in electronic medical records management. We all have a stake in the outcome!
Electronic Medical Records: The Healthcare Information Experts Weigh In
Thursday, September 16, 2010, 4:00 - 6:00 p.m., Microsoft, 201 Jones Rd., Sixth Floor, Waltham, MA 02451. Directions.
Panelists: Elaine Alligood (VA Technology Assessment), Dan Bogaty (Partners Healthcare), Keith Boone (GE Healthcare), and Janice McCallum (Health Content Advisors)
Details: http://kmforum.org/blog/?p=792
Registration Form for Thursday: http://s94896443.onlinehome.us/tinc?key=t0p0UHsg&formname=reg_thursday
Registration Comments (Cost, time, meeting format): http://kmforum.org/blog/?page_id=22
Subscribe to:
Posts (Atom)