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ED Information Systems and Patient Safety

ED Information Systems and Patient Safety

Throughout the United States, emergency department information systems (EDISs) have been developed in an effort to reduce medical errors. These systems are becoming a significant focus of both federal legislation and healthcare reform. “EDISs are an important component of the movement toward improving quality and outcomes with electronic health records,” explains Kevin M. Baumlin, MD, FACEP. Many types of electronic systems perform various functions for EDs throughout the country, but variations in EDISs can impact physician decision making, clinician workflow, communication, and the overall quality of care and patient safety. The common perception is that EDISs may ultimately improve the quality of medical care delivered in hospitals. Unfortunately, as they are currently configured, these systems also present important threats to healthcare quality and patient safety. The Pros & Cons The purpose of EDISs is to decrease practice variability and improve system reliability. “These systems are designed to enhance communication among healthcare providers, facilitate the retrieval of past information, and assist in clinical decision-making,” Dr. Baumlin says. They can help make medical references easily accessible, assist with important calculations, and monitor for potential adverse events. Some have the potential to share medical information across health systems and may help identify epidemics early. The perceived advantages of EDISs are so significant that Congress allocated nearly $30 billion to build incentives for EDs to universally adopt them through the American Recovery and Reinvestment Act. The rush to capitalize on the government’s investment for EDISs, however, led to some unfortunate and unintended consequences. Vendors for EDISs are making efforts to meet new demands by clinicians, healthcare administrators, and government, but the uniqueness of...

10 Ways to Make EMR Meaningful and Useful

OK, I am an EMR geek who isn’t so thrilled with the direction of EMR.  So what, I have been asked, would make EMR something that is really meaningful?  What would be the things that would truly help, and not just make more hoops for me to jump through?  A lot of this is not in the hands of the gods of MU, but in the realm of the demons of reimbursement, but I will give it a try anyhow. Here’s my list: 1. Require all visits to have a simple summary. One of the biggest problems I have with EMR is the “data diarrhea” it creates, throwing piles of words into notes that are not useful for anything but assuring compliance with billing codes. I waste a huge amount of time trying to figure out the specialists, colleagues, and even what my own assessment and plan was for any given visit. Each note should have an easily accessible visit summary (but not at the bottom of 5 pages of droll historical data I already know because I sent them the patient in the first place!). 2. Allow coding gibberish to be hidden. Related to #1 would be the ability to hide as much “fluff” in notes as possible.  I only care about the review of systems and a repetition of past histories 1 out of 100 times. Most of the time I am only interested in the history of the present illness, pertinent physical findings, and the plan generated from any given encounter. The rest of the note (which is about 75% of the words used) should be hidden,...

Information Technology as Communication

Much of health information technology (IT) focuses on patient documentation, compliance, and coding. While this is clearly a valuable service, there is still much more that can be garnered from health IT. Medicine needs to take a lesson from mainstream pop culture, be it texting, Twitter, Facebook, or other social networking platforms. The power of communication and connectivity is stronger than ever before, and healthcare providers should capitalize on the technological opportunities that exist today. Communication between physicians and between doctors and patients is suboptimal. Some studies have suggested that concerns over privacy and HIPAA compliance hinder the adoption of web communication, but other factors can play a role, including: Medical liability concerns. Difficulty in explaining nuances of medical information. Lack of websites where safe communication can occur. Fear of information going “viral.” Age of physicians. Time constraints in the office. Increasing Physician-to-Physician Communication While much research has been directed at exploring patterns and trends in doctor–patient communication, an equally important area that warrants study is physician-to-physician communication. The value of doctors collaborating on patient care is immeasurable. Unfortunately, several barriers to online communication between physicians are prevalent. For example, many EMR systems are unable to communicate information with other platforms due to technical issues. Some of these systems also do not allow for customized summaries of evaluations that can be sent easily to referral doctors. There is also no “national” secure health messaging system available to physicians. Lastly, the median age of doctors is still tending toward an older, less computer-literate group. Stepping Forward: Specialist Referral In order to improve communication between physicians, both short- and long-term strategies...
U.S. Docs Lag Behind Foreign Colleagues in Embracing Healthcare IT

U.S. Docs Lag Behind Foreign Colleagues in Embracing Healthcare IT

U.S. physicians are not nearly as sold on the benefits of healthcare IT as are their international counterparts, according to an Accenture survey of more than 3,700 doctors across eight countries. However, the majority of doctors in all the countries surveyed said they believed that healthcare IT provided some common benefits, including: Increased access to quality data for clinical research (70.9%) Improved coordination of care (69.1%) Reduced medical errors (66%) But U.S. physicians rated the benefits of electronic medical records (EMR) — and health information exchange (HIE) specifically — lower than did their international colleagues: 45% believed that healthcare IT will improve diagnostic decisions (vs 61% globally) 45% believed that technology leads to improved health outcomes for patients (vs 59% globally) 47% believed that healthcare technology has improved the quality of treatment decisions (vs 61 % globally) A generational divide also exists: Physicians over age 50 who are not actively using healthcare IT rate benefits even lower. The Accenture study found that 65% of these doctors  think EMR and HIE will improve care coordination, and 68% thought that they would offer better access to quality data for clinical research, compared with 72% and 73%, respectively, for doctors under 50. As the U.S. government strives to increase the adoption of meaningful use standards, it will need to consider physician perceptions of healthcare IT...
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