Friday, June 23, 2017

A Few Ideas Are Starting To Emerge To Assist With EHR Frustrations. A Good Thing.

This appeared a few days ago:

Why doctors hate electronic records — and what could change that


June 12, 2017 Updated: June 12, 2017 3:19pm

The health care industrial complex has spent billions of dollars and untold amounts of time trying to make medical records as flexible, invisible and unobtrusive as possible for patients and clinicians alike.

The results will be well worth the expense, the thinking goes, if the records — tracking patients in the vast and complicated health care system — could help clinicians spend more time caring for people and less on paperwork.

But after nearly two decades of concerted innovation, amid a push to do away with paper records, many physicians say they’re still hamstrung by issues that have dogged them for years. We’ve replaced the medical chart with a patchwork of systems that impose on doctors’ precious time and have yet to deliver clear improvements.

In a report last year by Medscape, a trade publication, 57 percent of more than 15,000 physicians surveyed said that having to grapple with electronic records was reducing the amount of face-to-face time they were able to spend with patients.

“We’re not at the promised land,” said Dr. R. Adams Dudley, a pulmonologist and the director of the Center for HealthCare Value at UCSF.

Change may be coming. Beyond improving documentation for doctors, large health systems are taking advantage of the troves of patient data to make better decisions in critical situations.

For hospital patients, Kaiser Permanente of Oakland has developed an algorithm that factors in a combination of vital-sign monitoring with data pulled from electronic medical records to predict the risk of rapid deterioration.

If the algorithm deems a patient to be at risk, hospital staffers are sent an alert.

“If we can identify some, many or all of those patients before they experience that (negative) event, and can help avoid that event, then the view is one can reduce complications and reduce morbidity and mortality,” said Dr. Pat Conolly, a Kaiser executive who oversees information technology efforts. The early alert system, she said, will be implemented across all Kaiser hospitals.

At UCSF, Dudley’s team is developing a similar predictive modeling program that will be used to determine if a patient needs to be put on a breathing machine, as well as the patient’s probability for surviving in an intensive care unit. That matters, he said, because families must decide how much they want their loved ones to endure.

Lots more here:

http://www.sfchronicle.com/business/article/Why-doctors-hate-electronic-records-and-what-11206986.php

Well worth a browse for a few interesting ideas.

David.

18 comments:

Anonymous said...

Very interesting ideas and refreshing to see organisations fostering thinking, something our national entity seems to have lost. It is great to see efforts of this sort at the point of care where it matters and perhaps another example of the MyHR being a ship to late to save a drowning witch. I also wonder if the problem is simply that technology just is not ready for healthcare in many areas, noting some areas it is simply a marvel to behold.

Dr Ian Colclough said...

@7:15 PM "I also wonder if the problem is simply that technology just is not ready for healthcare in many areas".

I don't think that's the problem. It may have been over a decade ago but not today. The problem is more that the barriers to progress are due not to the state of technology but to health system politics and competing cultures, to the diversity of complex application functionality requirements across many quite unique domains, to the limited understanding of many overly enthusiastic bureaucrats, politicians and health care administrators, of what is and is not practicable to achieve in the short term, and to their reluctance to entertain new and innovative ways of thinking to overcome the barriers.

Anonymous said...

I agree with Ian. Such a perceptively intelligent comment. It's a great pity our eHealth leaders don't understand.

Bernard Robertson-Dunn said...

I also agree.

"Nobody Knew Health Care Could Be So Complicated" (D Trump) is only true when "nobody" is code for politicians and bureaucrats. Many of us already knew - decades ago.

tygrus said...

The problem is the nobodies become political/bureaucratic somebodies and the "somebodies that know" remain nobodies in the view of politics & bureaucrats.

Anonymous said...


My Health Record already provides a data platform that can foster and support digital
innovation, delivering economic growth and leading to the development of digital health solutions with greater clinical utility, such as mobile health applications. Early app developers are already taking advantage of new interfaces on top of the My Health Record system, which allow people to see the medications they have taken, or to view clinical documents on their mobile devices. It is anticipated that the development of digital health solutions and mobile health apps will attract signi cant investment.
My Health Record has the potential to provide a variety of bene ts to individuals, healthcare providers, the health system, and the economy as a whole. However, the bene ts of the system will only be achieved when there is wide-scale use by not only individuals, but also healthcare providers. Healthcare providers have repeatedly articulated that they would engage with the system when the majority of their patients are registered, which will occur on implementation of the opt-out model in 2018.
The frequency of use of My Health Record services will also likely increase as the platform and associated services better meet health clinician needs. Improving clinical content within the My Health Record will support better health literacy for patients and enhance its use in healthcare. Already, people living in New South Wales and their healthcare providers can view pathology results through the My Health Record consumer portal and mobile applications.
Adopting a user-centric approach to usability, mobility and functionality enhancements, which give patients and providers contextually relevant services, will encourage ongoing use. Greater utility will be realised through pushing information (e.g. noti cations for patients) and pulling information (e.g. quickly accessing patient medical histories).

The opportunity to better understand population-level health needs and support the planning of future health services will build on Australia’s track record in the evaluation of new medicines and treatments.
The bene ts of the My Health Record system will be realised through the delivery of three strategic objectives:
- Increase consumer participation through the delivery of national opt-out arrangements coupled with coordinated awareness activities.
- Increase core clinical content of the My Health Record system through improved system functionality and integration with existing clinical work ows.
- Achieve extensive adoption by healthcare providers across the industry, through national education and support, national peak body engagement and local education and support primarily using primary health networks (PHNs) as delivery partners.

How Will Australia Benefit?
National opt-out will provide a transformative opportunity to support healthcare integration and deliver significant cant improvements in both the quality and efficiency of healthcare.
Lives and money will be saved, with safer medicines management, better coordinated care and informed treatment decisions.
There will be a more efficient health system (e.g. less time searching for patient data, reduced avoidable hospitalisations and tests).
Patients will be put at the centre of their healthcare, so they can take greater responsibility for their own health.
Data analytics will enable innovation and health service planning that will lead to more sustainable resourcing and new evidence based clinical approaches

Dr David More MB PhD FACHI said...

And your published, rather than speculative, evidence for all these claimed benefits is found where? (2-3 good links will help)

David.

Anonymous said...

Looks like it's lifted from screen shots David, benefits is consistently missing a letter. Wonder what this is from?

Anonymous said...

1:46 pm
Wow, that sounds like something that would be in the National Digital Health Strategy? Are you able to provide the full document? Does it have a picture of a unicorn on the cover?

Bernard Robertson-Dunn said...

re: "... new interfaces on top of the My Health Record system, which allow people to see the medications they have taken..."

As I've tried to explain, MyHR doesn't contain medication information it contains prescription and dispensing information - completely different things.

And why would anyone want to log onto a government website to see things they should already know or can find out by looking at the tablet packs in their medicine cabinet?

MyHR does not, was never intended to and cannot contain meaningful, accurate, up-to-date clinical data. At best it's an historical view of various patient treatments.

Question: A patient's BMI (i.e. height and weight) is a significant health indicator - where in MyHR is it stored? Preferably as a time series, not at some arbitrary point of time in the recent past. A health record without such basic data is not much of a health record.

Anonymous said...

That sales guff for MyHR is probably from the business case for proceeding with MyHR. Written by people who are blind to the realities of healthcare informatics (with help from one or more management consultants with vested interests but little else) and read by people with even less understanding of the world of healthcare.

Anonymous said...

I do not necessarily disagree with you you Bernard and others, rather I am somewhat puzzled. On the face of it we are told that medical professionals are at the heart of the GovHR. I need very public and well known GP and others throw their names behind this as do the peak bodies, so why is it that there are these questionable claims made in their name?

Bernard Robertson-Dunn said...

Because nobody has ever demonstrated that MyHR has been or could be of any benefit, either clinically (i.e. it has been used in health care) or to reduce health care costs.

Or, to be very blunt - what's the ROI of $2billion?

Anonymous said...

The government has learnt to massage egos and call people with very little it knowledge "Opinion Leaders" and they will say anything, if only to hide the fact that they don't have a clue. The ADHA doesn't like talking to people that have real experience, it makes them uncomfortable and those people don't buy the BS.

Trevor3130 said...

Here's another doozy. Plan to combat childhood obesity by introducing mandatory growth assessments.
How far has that been thought through, in terms of inclusion of measurements in MyHR?

Bernard Robertson-Dunn said...

"Health Minister Brad Hazzard said early intervention was vital to combatting health problems later in life."

"Early intervention", now there's an un-qualified statement. Intervention by whom? Government? Which government?

In fact, should any Australian government "intervene" in anyone's health? I suppose they have set precedents - seat belts, crash helmets for motor bike and cycle riders, but how about government intervenes in a few other areas:

High sugar drinks with no nutritional value
High fat foods
Alcohol advertising and consumption
Carbon dioxide emissions

It all seems so much easier (but less effective) to pick on the individual rather than the cause.

The assumption that letting people know a few isolated facts about their health (e.g. MyHR and mandatory growth assessments) will result in better behavious seems too much like wishful thinking to me.

tygrus said...

Last time I checked the BEACH data, no significant change in child overweight/obesity over the last 10 to 15 years. Is this a major problem or over-reaction ? How are they going to measure the baseline, future changes and benefits ???

https://ses.library.usyd.edu.au/bitstream/2123/15482/5/9781743325162_ONLINE.pdf
Page 125
"
Children
The prevalence of overweight and obesity among sampled children aged 2–17 years remained
effectively static for the 10 years from 2006–07 to 2015–16 (around 18% and 10% respectively)
(Table 13.1a). Similar patterns were present among both male and female children (Tables 13.2a and 13.3a).
"

Anonymous said...

Makes for a great levy though, families with short kids have been getting away with it to long