Another Two Examples Of Just How Thoroughness and Care Is Required To Get E-Health Implementation Right!

I came across this abstract a few days ago.

Meaningful Use of Electronic Prescribing in 5 Exemplar Primary Care Practices

• by
• Jesse C. Crosson,
• Rebecca S. Etz,
• Shinyi Wu,
• Susan G. Straus,
• David Eisenman,
• Douglas S. Bell

Published In:

Annals of Family Medicine, v. 9, no. 5, Sept./Oct. 2011, p. 392-397

Abstract

PURPOSE: Successful use of electronic prescribing (e-prescribing) is a key requirement for demonstrating meaningful use of electronic health records to qualify for federal incentives. Currently, many physicians who implement e-prescribing fail to make substantial use of these systems, and little is known about factors contributing to successful e-prescribing use. The objective of this study was to identify successful implementation and use techniques.

METHODS: We conducted a multimethod qualitative case study of 5 ambulatory primary care practices identified as exemplars of effective e-prescribing. The practices were identified by a group of e-prescribing experts. Field researchers conducted in-depth interviews and observed prescription-related workflow in these practices.

RESULTS: In these exemplar practices, successful use of e-prescribing required practice transformation. Practice members reported extensive efforts to redesign work processes to take advantage of e-prescribing capabilities and to create specific e-prescribing protocols to distribute prescription-related work among practice team members. These practices had substantial resources to support e-prescribing use, including local physician champions, ongoing training for practice members, and continuous on-site technical support. Practices faced considerable challenges during use of e-prescribing, however, deriving from problems coordinating new work processes with pharmacies and ineffective health information exchange that required workarounds to ensure the completeness of patient medical records.

CONCLUSIONS: More widespread implementation and effective use of e-prescribing in ambulatory care settings will require practice transformation efforts that focus on work process redesign while being attentive to effects on patient and pharmacy involvement in prescribing. Improved health information exchange is required to fully realize expected quality, safety, and efficiency gains of e-prescribing.

More here:

http://www.rand.org/pubs/external_publications/EP201100178.html

This editorial below also led me to a second abstract from the same issue of the journal:

A Diabetes Dashboard and Physician Efficiency and Accuracy in Accessing Data Needed for High-Quality Diabetes Care

1. Richelle J. Koopman, MD, MS1⇓,
2. Karl M. Kochendorfer, MD1,2,
3. Joi L. Moore, PhD3,
4. David R. Mehr, MD, MS1,
5. Douglas S. Wakefield, PhD2,4,
6. Borchuluun Yadamsuren, PhD3,
7. Jared S. Coberly, BS1,
8. Robin L. Kruse, PhD, MSPH1,
9. Bonnie J. Wakefield, PhD, RN5 and
10. Jeffery L. Belden, MD1,3

CORRESPONDING AUTHOR: Richelle J. Koopman, MD, MS, Curtis W. and Ann H. Long Department of Family and Community Medicine, University of Missouri, MA306N Medical Sciences Building, DC032.00, Columbia, MO 65212, koopmanr@health.missouri.edu

Abstract

PURPOSE We compared use of a new diabetes dashboard screen with use of a conventional approach of viewing multiple electronic health record (EHR) screens to find data needed for ambulatory diabetes care.

METHODS We performed a usability study, including a quantitative time study and qualitative analysis of information-seeking behaviors. While being recorded with Morae Recorder software and “think-aloud” interview methods, 10 primary care physicians first searched their EHR for 10 diabetes data elements using a conventional approach for a simulated patient, and then using a new diabetes dashboard for another. We measured time, number of mouse clicks, and accuracy. Two coders analyzed think-aloud and interview data using grounded theory methodology.

RESULTS The mean time needed to find all data elements was 5.5 minutes using the conventional approach vs 1.3 minutes using the diabetes dashboard (P <.001). Physicians correctly identified 94% of the data requested using the conventional method, vs 100% with the dashboard (P <.01). The mean number of mouse clicks was 60 for conventional searching vs 3 clicks with the diabetes dashboard (P <.001). A common theme was that in everyday practice, if physicians had to spend too much time searching for data, they would either continue without it or order a test again.

CONCLUSIONS Using a patient-specific diabetes dashboard improves both the efficiency and accuracy of acquiring data needed for high-quality diabetes care. Usability analysis tools can provide important insights into the value of optimizing physician use of health information technologies.

http://www.annfammed.org/content/9/5/398.abstract

Full text also available from the site (free).

These article is accompanied by an excellent editorial. Here are the first few paragraphs:

Successful Health Information Technology Implementation Requires Practice and Health Care System Transformation

Carlos Roberto Jaén, MD, PhD, FAAFP

CORRESPONDING AUTHOR: Carlos Roberto Jaén, MD, PhD, FAAFP, Department of Family & Community Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, Mail Code 7794, San Antonio, TX 78229, jaen@uthscsa.edu

The complexity of primary care is increasingly recognized and documented.¹

The inputs and outputs of primary care encounters require considerable additional time beyond the face-to-face time of patient encounters.²

The promises of health information technology (HIT), meaningful use, electronic prescribing, and other policy approaches are thwarted by current incentives built into primary care reimbursement, particularly the fee-for-service–only structure and its practical implementation in most practices.

Most electronic health records (EHRs) are not built to support clinical operations, particularly higher-level primary care functions that involve integrating, personalizing, and prioritizing care across a broad spectrum of opportunities that range from patients’ acute concerns, management of (often multiple) chronic illnesses, prevention, mental health, family care, and often undifferentiated problems of daily living.^3,4

Plug and play is not an option.⁵ A system that grafts on the current paper-based operations of primary care is a fantasy.

Management of chronic diseases requires timely and accurate information to guide action. Most EHRs are designed to optimize documentation of the current encounter and improve billing efficiency, not the integrated, personalized, longitudinal care of chronic illnesses or clinical operations in general. Having discrete disease data available in an EHR is necessary but not sufficient to improve care of chronic diseases. Trolling for important data necessary to optimize delivery of care is often a major barrier to delivery of quality of care. The data need to be converted to useful information.

The full text (free) is here:

http://www.annfammed.org/content/9/5/388.full

There are tips about workflow impact and modification and clinician efficiency here that simply can’t be ignored if we are to get the levels of use and interaction with EHR systems we seek.

Two very valuable and interesting studies I reckon.

David.