Wednesday, May 07, 2014

An Interesting Set Of Requirements For Quality And Effective Use Of EHRs. Great Summary That Show Just How Far The Present PCEHR Falls Short.

This appeared a little while ago:

Case for dropping MU Stages 2 and 3

Posted on Apr 28, 2014
By Dale Sanders
Federal meaningful use requirements are well intentioned, but like a teacher who “teaches to the test,” the federal meaningful use program created a very complicated system that might pass the test of meaningful use stages, but is not producing meaningful results for patients and clinicians.
As reported on April 14, 2014 in MedScape (free log-in required), a formal study published in the April 2014 issue ofJAMA Internal Medicine shows no correlation between quality of care and meaningful use adherence. This study validates what common sense has told many of us for the last few years.
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Below are the simple but effective Core Principles of EMR Utilization that we developed. These principles played a huge part in the progressive value of Cerner and Epic on the Northwestern campus and laid the foundation for a relatively easy qualification of Northwestern under the federal meaningful use program.
Core Principles of EMR Utilization
Encounters
·         All patient appointments/visits are to be documented in the EHR as an encounter.
·         Visit encounters should be closed by the attending physician within 48 hours of the patient visit.
Medications
·         All medication prescriptions and refills must be documented in the EHR, including those ordered in a telephone encounter.
·         Medications are to be reviewed at every patient encounter, in accordance with the individual specialty’s standard of care.
·         Every effort should be made to maintain a valid and complete list of patients’ current medications in the EHR, including end dates, discontinuing medications no longer being taken, and removing duplicate medication entries.
Problem Lists
·         All chronic, persistent patient diagnoses or complaints should be documented on the Problem List in the EHR, with the exception of highly sensitive diagnoses such as those associated with mental health care.
·         Problems should be documented using the most specific term applicable to the problem, ex: mild intermittent asthma vs. asthma.
·         The Problem List should be reviewed and updated at every patient encounter, in accordance with the individual specialty’s standard of care, and problems not currently clinically relevant should be filed to history and marked as resolved.
Allergies
·         Allergy lists must be actively maintained for validity and completeness for all patients, including marking as reviewed when no new allergies are reported. The allergy list must be reviewed during any encounter in which a medication is ordered.
Orders
·         All patient orders must be documented in the EHR.
Progress Notes
·         All patient encounters should have an accompanied progress note that appropriately documents the history, physical, and decision-making in a way that is succinct and minimizes redundant content.
·         If dictating, notes must include the patient’s name and medical record number, the date of the encounter, and the attending physician’s name to ensure timely documentation.
In Basket
·         Patient results and messages should be reviewed within 72 hours of receipt, and In Basket coverage should be assigned when clinicians are unable to respond within that time frame.
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The full article is found here:
While the purpose of this article was rather US orientated in terms of the US Meaningful Use program we keep hearing Australians using the term around the PCEHR etc.
My point is that as a summary set of requirements for a useful EHR this is the minimum needed for a useful EHR (for the clinicians and the care and safety of their patients) and that the PCEHR gets nowhere near it. Minister Dutton said recently that the EHR he wants needs to be useful for clinicians - so here is a good spot to start!
Meet this list with the new design and you might just get somewhere Minister. It is the minimum that needs to be in place for an EHR to actually be useful  to clinicians.
David.

1 comment:

Anonymous said...

I presumed that we had some ‘business rules’ around how and what sort of information is sent to a patient’s PCEHR from a clinical system. That would inspire confidence and credibility for clinicians who view a PCEHR, and also allow clinical systems developers to build their integration with the PCEHR to meet these requirements. For example, if a patient has a PCEHR and the GP is recording a new allergy/problem/medication in their local system, then the GP desktop software could recognise the need to add this information to the PCEHR, and process accordingly.
Does anyone know if these business rules have been defined and agreed for the PCEHR? If not, then it is probably one of the key things that needs to happen now to give it ‘meaningful use’, and it needs to happen in close consultation and governance by the clinical community, and the clinical system vendors.