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Quote Of The Year - Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

Tuesday, February 13, 2018

It Has Been One Of Those Good and Bad News Weeks For The Digital Health Proponents.

First the good news:

Health IT adoption has positive effect on medical outcomes

Published February 07 2018, 7:29am EST
There is a positive association between the adoption of health information technology and its effect on medical outcomes in terms of efficiency or effectiveness.
That’s the conclusion of a new study published this week in the Journal of Medical Internet Research that analyzed the current literature on the subject over the last five years.
Researchers queried the Cumulative Index of Nursing and Allied Health Literature and Medical Literature Analysis and Retrieval System Online by PubMed databases for peer-reviewed publications. Studies from CINAHL and PubMed that defined an HIT intervention and a corresponding effect on medical outcomes stated in terms of efficiency or effectiveness were eligible for selection. Ultimately, 37 studies were chosen out of 3,636 papers for the review.
At least one improved medical outcome as a result of HIT adoption was identified in 81 percent of the research studies, while no statistical difference in outcomes was identified as a result of HIT in 19 percent of included studies.
“Healthcare providers will continue to be incentivized to adopt HIT as policy makers respond to quality, and safety concerns and reimbursement methods transition toward value-based purchasing,” according to researchers. “Providers, consumers and policy makers alike stand to benefit from the further proliferation of HIT. Our research aligns with previous work that identified improvements achieved as the result of the adoption of HIT.”
“A strong majority of the literature shows positive effects of HIT on the effectiveness of medical outcomes, which positively supports efforts that prepare for Stage 3 of Meaningful Use,” concludes the study.
And now the bad news:

Electronic Health Records: a “Quadruple Win,” a “Quadruple Failure,” or Simply Time for a Reboot?

Editorial
First Online: 05 February 2018
Michael  Hochman
Download article PDF
Just a decade ago, when paper charts were commonplace in the USA, it seemed that electronic health records (EHRs) were destined to transform the quality and efficiency of healthcare delivery, as well as the care experience for patients and clinicians. Few would deny that old fashion paper charts can be awkward to navigate, burdensome to read, poorly amenable for health information exchange, and inadequate for supporting systematic quality improvement. The sentiment that EHRs could solve these problems was pervasive, and many experts predicted that widespread EHR implementation would save billions.1
The reality over the ensuring years has, to put it mildly, not met expectations. According to a 2014 analysis led by the Office of the National Coordinator for Health Information,2 over 80% of US doctors now use EHRs. Yet, many of the predictions about the benefits of EHRs have yet to materialize to the extent predicted. Though EHRs have facilitated some substantial improvements—the ability for clinicians to access charts from any wired location, electronic transmission of prescriptions, and enhanced tracking of population health measures, to name just a few—they have also resulted in numerous unintended consequences. Noteworthy concerns include egregious medical errors resulting from design glitches3, charting templates filled extensively with meaningless boilerplate, the common practice of pasting old notes4 that makes it difficult to know which documentation is “real,” “alert fatigue”5 due to excessive EHR warnings, and even reduced communication among clinical team members.6
Moreover, contrary to expectations, EHRs may also hamper clinician productivity—the so-called IT productivity paradox.7 As Robert Wachter, MD, explains in his incisive 2015 book The Digital DoctorHopeHypeand Harm at the Dawn of Medicines Computer Age,8 many simple tasks like ordering a medication that took seconds using pen and paper can take much longer with computers. EHRs also substantially increase the time it takes for clinicians to document patient encounters,9 and as a result, many health systems report that clinicians see fewer patients per day than they did with paper charts. Furthermore, expectations that EHRs would eliminate wasteful, duplicative services by facilitating health information exchange have, to date, proven illusory in most settings.10 Initial predictions that EHRs would save the healthcare system billions now seem fanciful.
Because of these shortcomings, EHRs represent one of the key drivers of dissatisfaction among clinicians. A frequently cited 2013 RAND survey of physicians concluded: “physicians approved of EHRs in concept and appreciated having better ability to remotely access patient information and improvements in quality of care; however, for many physicians, the current state of EHR technology significantly worsened professional satisfaction [particularly as a result of] poor usability, time-consuming data entry, interference with face-to-face patient care, inefficient and less fulfilling work content, inability to exchange health information, and degradation of clinical documentation.”11
In short, despite some undeniable benefits, the EHR revolution has failed to advance the “quadruple aim”12—improved quality, patient experience, efficiency, and clinician satisfaction—to the extent many had anticipated. While it is unfair to label the EHR era a “quadruple failure”—particularly since there are many different EHR products, some better than others—I believe it is time for a reboot of our approach.
Lots more here:
What are we to conclude?
I would suggest that both the enthusiastic proponents and the noisy knockers both have it wrong!
What is really needed is careful evidence based progress where the successes are being built on and the problems are actually faced squarely.
If that approach were adopted the ADHA would be quick to make a decision that there are positive futures for Digital Health but almost certainly not relying the myHR. There are better approaches to Digital Health than those based on the myHR! And guess what? They are likely to be both cheaper and attract more certain political and public support.
David.

1 comment:

Bernard Robertson-Dunn said...

re:"Health IT adoption has positive effect on medical outcomes"

Before everyone goes gaga about how good HIT is, these are the categories of HIT used in the study, sorted by frequency, with web-based interventions (whatever that means) being 8:

Web-based interventions
Telemedicine
Software
CDSS
mHealth
Telemonitoring
Electronic ordering
HIT
HIE
Robot assist
Videoconferencing
Remote screening

With the health outcomes grouped into:
Physical
Psychological
Continuity of care

I wouldn't put this study into the scientifically rigorous category, especially when the list of specific categories of HIT includes HIT.