Friday, August 17, 2012

More On Getting a Handle On How Well Or Not EHRs Are Working. And The Australian Approach.

The following editorial appeared a few days ago - showing how the EHR defect issue continues to be top of mind.

Providers need recourse regarding EHR defects

August 8, 2012 | By Marla Durben Hirsch
It's always great to read about the successful implementation of an electronic health record system, like this story published last week in Inside Tucson Business. After all, transitioning to an EHR is expensive and time consuming. If you're going to adopt an EHR--and that is the direction the healthcare industry appears to be moving in--the process should be as smooth as possible.
It's equally disheartening, however, to read the opposite kind of story. Blogger Rich Just posted this week about his practice's struggles with its EHR system: a glitch causes notes to disappear, sometimes to another section of the chart, sometimes into oblivion. According to Just, the practice discovered that the glitch occurred when physicians started the note before entering the vital signs, so now they can avoid the glitch. Still, despite vendor support, it can't be removed. 
It's bad enough that EHRs have design flaws such as usability problems, or backfiring features that impede workflow and functionality. But software glitches that lose data, cause the system to go down regularly and create other havoc really are inexcusable. They're also apparently rather common.
A Google search of "EHR horror stories" came back with a whopping 51,800 results. Granted, not every horror involved "glitches", but that's still a huge number. And those are just the ones reported on the Internet.   
So what's a hospital or physician to do?
There are some precautions that providers can take to avoid buying a problematic EHR system, of course. For instance, they can check out the KLAS rankings on EHR products, conduct research online, confer with colleagues, ask a vendor for a satisfaction and money back guarantee, and the like.
None of those, though, can assure that an EHR will be glitch-free--or that a glitch won't develop, such as during an upgrade; and all EHRs will need to be upgraded to be able to meet the upcoming Stage 2 of Meaningful Use.
So why not resurrect two concepts that have been discussed for years but never implemented?
Read Marla’s suggestions here:
After seeing the US suggestions it is important to recognise that there is some activity on the same area in OZ.

Welcome to the website for the TechWatch Study

We are tracking computer problems that affect the safety of Australian general practice
The TechWatch Study is the world’s first study of critical incidents specifically involving information technology and patient safety in general practice. Information technology has many benefits for clinical medicine. But problems with computer use can introduce new errors that affect the safety and quality of clinical care and may risk patient harm.
General practitioners from across Australia have been invited to join the TechWatch Study and help identify and track safety and quality issues arising from the use of computers in general practice.
Information collected though the TechWatch Study will be used by researchers to gain a better understanding of how to improve the safety of using computers in clinical practice. Our findings will guide the safe design and use of information technology in general practice.
The site with contacts etc. is found here:
For background:
“The TechWatch Study is being jointly led by Farah Magrabi, Michael Kidd, Teng Liaw and Enrico Coiera from the University of New South Wales and Flinders University and is funded by National Health and Medical Research Council (NHMRC) Project Grant 630583.”
I would encourage all GP’s to get involved so we can get a good feel for the situation in Australia.
David.

6 comments:

Anonymous said...

I have had a good deal of experience integrating with some leading GP systems. My concern with the health records here is well beyond stability of systems and general operation. The basic implementation of health records in these systems do not incorporate basic medico-legal auditability - history and authorship not recorded in some areas.
Whilst it is pretty easy to point the finger at the software vendors in reality there needs to be enough money in the supply of these systems to make quality an imperative - there also seems to be basically no value placed on the provision of this quality by the consumers.
It makes me pretty unhappy GP software is a cottage industry - especially when I visit mine.

Anonymous said...

Anon said
"It makes me pretty unhappy GP software is a cottage industry - especially when I visit mine"

IMHO.

It is a small industry that touches every Australian that visits a GP, but it has been manifestly ignored in solving this problem and as a result will probably remain battling as a small industry.

As long as you have the departments in charge rebuffing local companies advice, defining some solution they "can build" as they see it, rather than defining the real need, you will always have the big consulting companies ready to play the game and take the money.

If you bulldoze in a predefined one size fits all solution then look what we you get on the evidence. Low risk, nothing clinical, ordinary system where you can register, great! The logs and interface messaging is confusing to say the least, not fit for purpose and I just can't imagine any of the local medical software companies confusing NIL with NULL, let alone have the nerve to deliver what has been delivered for $100m.

Meanwhile, in the background, carrying on are the local medical software industry. Continuing to deliver despite it all. The local medical software industry would be a great place to do some good work defining the needs of the industry however I believe this has been a major opportunity gone begging!







Anonymous said...

Oracle fined over multi-million dollar Indian slush fund, From: AFP, August 17, 2012 8:06AM

SOFTWARE and systems giant Oracle has been fined $US2 million ($A1.90m) for allowing an Indian subsidiary to operate a multi-million dollar off-books slush fund.

The US Securities and Exchange Commission said it filed charges in San Francisco District Court accusing Oracle of violating the US Foreign Corrupt Practices Act by not preventing the subsidiary from setting up the $US2.2 million fund.

The money, which came out of the receipts from sales to Indian government agencies from 2005-2007, "was eventually used to make unauthorized payments to phony vendors in India", the SEC said in a statement.

The SEC did not allege that bribery had taken place, but suggested it was the possible purpose for payments to these ostensible vendors.

"In fact, none of these storefront-only third parties provided any services or were included on Oracle's approved vendor list," it said.


"The third-party payments created the risk that the funds could be used for illicit purposes such as bribery or embezzlement."

Oracle neither admitted nor denied the allegations, but the SEC said it voluntarily disclosed the problem, had cooperated with the investigation and had fired employees involved in the misconduct.

But the company was fined for poor internal controls and poor supervision of is India subsidiary.

"Through its subsidiary's use of secret cash cushions, Oracle exposed itself to the risk that these hidden funds would be put to illegal use," said SEC San Francisco official Marc Fagel.

"It is important for US companies to proactively establish policies and procedures to minimize the potential for payments to foreign officials or other unauthorized uses of company funds."

http://www.theaustralian.com.au/australian-it/oracle-fined-over-multi-million-dollar-indian-slush-fund/story-e6frgakx-1226452274421

Anonymous said...

Oracle confirms paying a blogger but Google names no-one

Google's lawyers said they needed more guidance before they could release any names

Oracle has disclosed two names after it and Google were ordered to reveal finciancial ties to people who might have influenced coverage of a trial.
The instruction had been given by a US judge following a copyright and patent lawsuit fought by the two tech firms.

Oracle said it had relationships with blogger Florian Mueller and Stanford University's Prof Paul Goldstein.

Google said it did not pay any "journalists, bloggers, or other commentators to write about this case".

However, the search giant added that it needed further guidance before being able to disclose others it had financial ties to.

The judge had said he was "concerned" that financial relationships might have influenced analysis published in newspapers and on the net.

MORE: http://www.bbc.co.uk/news/technology-19303290

Anonymous said...

Oracle and Google are ordered to reveal paid bloggers
8 August 2012 Last updated at 14:59

http://www.bbc.co.uk/news/technology-19181172

B said...

Just in case there is any implied accusation that there are paid commenters on this blog, I'd like to assure readers that I, for one, only speak for myself.

The reason I did not use my real name was because at the time, I was working for AGIMO and I did not want to give any impression that I was speaking for them.

I am Dr Bernard Robertson-Dunn my website is www.drbrd.com.

While I'm at it, I'll take the opportunity for some blatant self promotion, although I'll claim it is totally relevant to the topic of this blog.

I've just had a paper published by the IBM Journal of Research and Development - "Beyond Zachman: Problem-oriented System Architecture"

It explains the limitations of a solution/requirements approach to system development.

It can be obtained via this page on my website:
http://www.drbrd.com/problem_oriented_architecture/problem_oriented_architecture.html

or directly here
http://www.drbrd.com/docs/Probem-orientedSystemArchitecture.pdf