Making Swifter Sense of EHR Data

Thanks to Laura Polas @HITComm who shared this post and allowed Wildflower International to publish it on our blog. She also blogs at HIT Community:  https://www.thehitcommunity.org/2011/12/making-swifter-sense-of-ehr-data/

All that data being aggregated in Electronic Health Records (EHR) may seem like a virtual haystack, where finding the right needle requires advanced software development and data analysis. While that may be true, the upside is dramatically faster research findings and treatment recommendations, ultimately lowering health care costs while improving quality.

Traditionally, medical scientists have conducted random treatment trials and prepared results for peer review and publication—a process that can take six years, according to Philip R.O. Payne, PhD, Associate Professor & Chair, Biomedical Informatics at Ohio State University and Executive Director of the Center for IT Innovation in Healthcare. Review the slides here.

By contrast, Payne used the case of “Sergey Brin’s Search for a Parkinson’s Cure” (Wired, July 2010) to demonstrate that running database queries on aggregated databases in a warehouse can produce similar clinical results, backed up by the data, in a fraction of the time, like eight months.
Biomedical informatics will accelerate medical knowledge as well as medical practice. The Nov. 10 2011 New England Journal of Medicine described a case where Stanford pediatricians were presented with a 13-year-old lupus patient who they thought should be given anticoagulants, but were reluctant because of it being a rare treatment for young people, even when critically ill.
The doctors did a retrospective study of similar patients in the hospital’s data warehouse, called the Stanford Translational Research Integrated Database Environment (STRIDE). Based on the results from 98 pediatric lupus patients between 2004 and 2009, they administered the anticoagulant, and the patient responded well.

Results at bioinformatic speed
The Center for Biomedical Informatics at Harvard Medical School recently entered into a research agreement with health insurer Aetna of Hartford Ct. to analyze medical data with the aim of improving quality while lowering costs. The research will be supervised by Dr. Isaac (Zak) Kohane, M.D., Ph.D., Henderson Professor of Pediatrics and Health Sciences and Technology at Harvard Medical School (HMS) and co-director of the Harvard Medical School Center for Biomedical Informatics.

“If our health care system is going to become a ‘learning’ health care system, we need to better use the enormous amount of information we derive from health care to develop tools to understand what is happening today —such as which drugs are not working as safely as we thought, which therapies have unexpected benefits, what are the predictors of effective diabetes management and which genetic tests are likely to usefully guide therapy,” said Dr. Kohane.
Members of the Center for Biomedical Informatics will work with Aetna clinicians and informatics specialists:

• Evaluate outcomes of various treatments for specific conditions based on quality and cost;
• Determine factors that predict adherence to medical and drug treatments for chronic diseases;
• Study how claims data and clinical data available through electronic health records can best be used to predict disease and follow outcomes; and
• Improve the ability to predict adverse events through the proactive study of claims and clinical data.

On a related topic, we’ll be looking soon at the sudden increase in data due to EHR and how health care organizations of all sizes can not only deal with it, but use it to their advantage. Have a success story to share? Email Laura at lpolas@thehitcommunity.org.

Tagged with: EHR Systems • Health Data • Quality

My First EHR Experience

Written By: One pleasantly surprised patient

I had been hearing mixed reviews about Electronic Health Records ("EHR") in the news and online a lot this year.  It seemed to me that all the opinions were from physicians and I couldn't find info from the patient’s perspective. I certainly wanted to know more.

I recently received a mailing from my doctor's office here in Santa Fe, NM letting me know that they had just converted to “EHR” and are "fully operational." I am a relatively young, healthy guy, but wanting to see what all the EHR buzz was about, I made an appointment for a checkup since it had been awhile. Dad always used to say, "you're your own best advocate son," and I figured I should probably take a little more interest in the management of my health and well-being. 

I hadn't been to my doctor in over a year, hadn't been to any hospital or ER in even longer. The doctor's office was much more alive than I remembered. In the waiting room, they had installed a digital screen which relayed basic health information, waiting times and even had trivia which kept me entertained. When I approached the admin desk to check in, the receptionist politely pointed behind me to a kiosk where I was able to check in virtually. I had never done this before so I needed some help to get going. Once I got used to the format, the prompts were easy to follow. My check in took less than 10 minutes and was a lot more user-friendly than filling out those boring repetitious forms on a clipboard.

I didn't have a stopwatch running, but my wait time seemed to be shorter. It could have been because I was passing time with the trivia and health facts, nonetheless when I was called in I was surprised how easy that first hurdle was. Ah, but now comes the real waiting time. This is where I wait to see the nurse, he/she asks me questions those of which I would've already answered when I called to make the appointment also when I checked in earlier, and then takes some vitals and leaves me to I sit in the exam room forever until the doctor arrives… but that was not to be the case. 

The nurse entered the room with an iPad2 in hand (!?) and instantly brought up my file and confirmed what I had told the receptionist a few weeks prior when I made the appointment. I was there for a basic checkup but also had some other symptoms I wanted to address while I was there. What information I did add to make clarifications, she directly input to the iPad2 (this aspect shows importance later) and more importantly, all the information from my last visit, some random time I was in the ER in New Mexico for strep throat and the info I input at the check-in kiosk was right there, it was like she was psychic. 

That rather cool experience passed and shortly thereafter my doctor arrived with an iPad2 in had as well. As we discussed my visit I noticed much more eye contact and interaction since he was able to more leisurely enter information via point and click on the iPad as opposed to hurriedly scribbling down notes. And that little tidbit I mentioned would be important earlier-was that the small clarifications I mentioned to the nurse were automatically updated and directly sent to my doctor so he was already armed with that info when he entered the room. Being a basic checkup, my visit went smoothly. They noticed I was behind on some treatments I had been avoiding and gave me some options to schedule them online. With the EHR they could directly email and set up contact for the each specialist in different locations I needed to see and include me on the correspondence, the specialist actually emailed me times and dates available and that I could retrieve on my smart phone. So I did not have to do all the calling around myself.  I really liked the E-prescribing option as well that can save me loads of time in the future. 

At the end of the appointment the doctor shook my hand and let me know that my bill would be emailed and I could set up payment online. Wow! I talked to the office manager about my concerns regarding security. She gave me a handout on HIPPA regulations and how their certified EHR system is totally compliant. Overall this experience was top-notch. Seeing all these capabilities, I am going to make sure all my future healthcare providers use at least some form of EHR. If they can make a routine checkup this easy, I’m imagining visits to the dentist might even be less stressful and visits to the ER more accommodating. It leaves me to wonder why more doctors do not convert to EHR and why more people don't demand these services from their physicians.  

I’ve heard that some patients have found serious errors in their medical records once they had access to digital copies through their providers’ online EHR interface.  I don’t know if I would feel angry or just relieved to have a chance to correct such mistakes.  I’d love to hear other patients’ experiences with EHR, so please submit your stories in the comment section so I can see how my experience compares.

The Numbers

January 20 2012
New Mexico

42: number of hospitals in New Mexico, 29 of which are located in rural areas

31 of 33 New Mexico counties are either partially or fully designated by the NM Department of Health as Primary Care Professional Shortage Areas

512,000: NM Medicaid Beneficiaries in FY08 (26% of the state population)

316,973: NM Medicare Beneficiaries in FY08 (15% of the state population)


January 19 2012
In 2005 New Mexico Telehealth Commission determined these consequences of not having access to patient information electronically:

44,000 to 98,000 deaths per year are caused by medical errors in hospitals alone

$38 billion: the estimated costs of these errors is abut  per year 

770,000 people are injured each year because of adverse drug events 

8% of medical errors are caused by inadequate availability of patient information 

20% of lab and x-ray tests are ordered because originals cannot be found 


January 18 2012

A January 13th 2012 survey released by the American Hospital Association (AHA) found that:

Four-fifths of U.S. hospitals currently intend to take advantage of federal incentive payments for adoption and meaningful use of certified electronic health records (EHR) technology 

81% of hospitals plan to achieve meaningful use of EHRs and take advantage of incentive payments.

65% of  U.S. hospitals project that they will enroll during Stage 1 of the federal Incentive Programs, in 2011-2012

41% of office-based physicians are currently planning to achieve meaningful use of certified EHR technology and take advantage of the incentive payments.

32.4%  of office-based physicians responded that they will enroll during Stage 1 of the programs.

19.8% of primary care physicians had  adopted a basic EHR system in 2008

20.6% of primary care physicians had  adopted a basic EHR system by 2010- a 50% increase over 2 years

48.3% of office based physicians report using all or partial EMR/EHR systems in their office-based practices

21.8% of office based physicians reported having systems that met the criteria of a basic system, and about 6.9% reported having systems that met the criteria of a fully functional system  

January 13 2012

Counting the Money 

$27 billion - Projected incentive payments to participating hospitals and providers through 2021

$44,000 - amount non-hospital-based physicians and other eligible professionals can obtain in incentive payments under Medicare

$63,750 - amount non-hospital-based physicians and other eligible professionals can obtain in incentive payments under Medicaid

Read more here: http://www.sacbee.com/2012/01/18/4196154/oregon-is-national-leader-in-electronic.html#storylink=cpy