This appeared last week:
How much do EHRs impact heart failure patient care?
Post
a comment / Apr 2, 2018 at 12:40 PM
A
new study from the Journal
of the American Heart Association found there was not an
association between a hospital’s degree of EHR implementation and improved
quality of care and outcomes for heart failure patients.
The
research examined participants in the Get with the
Guidelines—Heart Failure program who were admitted to the hospital with
heart failure in 2008. Get With the Guidelines is a national registry of
hospitalized patients with heart failure.
The
hospitals involved had differing degrees of EHR implementation, categorized as
“no EHR, partial EHR and full EHR.”
A
total of 21,222 patients were eligible for the study. Approximately 1,484
individuals went to a hospital with no EHR; 13,473 were admitted to a hospital
with a partial EHR; and 6,265 went to a hospital with a full EHR.
Many
of the patients had comorbidities, such as hypertension, diabetes mellitus and
hyperlipidemia. The majority of hospitals involved — 76 percent —
were teaching hospitals.
Overall,
the results show there isn’t an association between degrees of EHR
implementation and better care quality, 30-day post-discharge death or
readmission. The study only showed improvement in one area related to EHR use:
beta blocker at discharge.
More here:
The full article is available freely
on-line. Here is the Abstract:
Association of Electronic Health Record Use With Quality of Care and Outcomes in Heart Failure: An Analysis of Get With The Guidelines—Heart Failure
Abstract
Background Adoption of electronic health
record (EHR) systems has increased
significantly across the nation. Whether EHR
use has translated into improved quality of care and outcomes in heart failure
(HF) is not well studied.
Methods and Results We examined participants
from the Get With The Guidelines—HF registry
who were admitted with HF in 2008
(N=21 222), using various degrees of EHR
implementation (no EHR, partial EHR, and full EHR).
We performed multivariable logistic regression to determine the relation
between EHR status and several in‐hospital
quality metrics and outcomes. In a substudy of Medicare participants (N=8421),
we assessed the relation between EHR status
and rates of 30‐day mortality, readmission, and a composite outcome. In the
cohort, the mean age was 71±15 years, 49% were women, and 64% were white.
The mean ejection fraction was 39±17%. Participants were admitted to hospitals
with no EHR (N=1484), partial EHR (N=13 473), and full EHR (N=6265). There was no association between EHR status and several quality metrics (aside from
β blocker at discharge) or in‐hospital outcomes on multivariable adjusted
logistic regression (P>0.05 for all comparisons). In the Medicare
cohort, there was no association between EHR
status and 30‐day mortality, readmission, or the combined outcome.
Conclusions In a large registry of
hospitalized patients with HF, there was no association between degrees of EHR implementation and several quality metrics and
30‐day postdischarge death or readmission. Our results suggest that EHR may not be sufficient to improve HF quality or related outcomes.
---- End Abstract.
While the study happened a few years
the Hospitals that were in the active arm of the study where advanced EHR users
by our present standards so the implication that there is more work needed to
achieve clear beneficial outcomes is almost certainly valid.
I do which the Digital Health
spruikers would listen to incoming evidence more and maybe work to improve
things and design real world studies that show the technology is making a real
positive difference rather than just wishing it were so.
David.
15 comments:
Unfortunately David when they (ADHA) do publish a research and evidence website you can guarantee content available through it will have been carefully selected to suit their needs.
Would the launch something that would be overseen by the community with relevance and usefulness of the information avalaible, determined by the community without interference?
The benefits are quite clear, as are the blocking cohort. The Government will soon deal with those healthcare workers stopping progress
From the public ally available online news services:
The My Health Record will hold useful clinical content and have comprehensive coverage of the patient population by the end of this year, fulfilling two of the key requirements for clinicians to begin using the system in earnest, Australian Digital Health Agency Tim Kelsey says.
Mr Kelsey told the Australian Telehealth Conference (ATC 2018) in Sydney this morning that by the end of the year, about 85 per cent of private pathology reports, 75-80 per cent of dispensed medicines information and a significant volume of radiology reports will be uploading to the system by the end of 2018, roughly coinciding with the time that the opt-out system is fully in place.
He said public communication with the community at large about people's rights to opt out and the benefits of not doing so would begin “very shortly”, but he did admit that the system, now in its sixth year of operation, had been dogged by the fact that it hadn't worked will for clinical practice.
“It hasn't really clinically proven its value, and a big part of that was that it wasn't comprehensive,” he said. “Opt out was widely asked for by the clinical community, but equally the other cause of it not delivering value in the way it should have done was a relative absence of useful clinical content.”
8:05 that would indicate the Minister has signed off opt out. Nice of the minister to tell the public. As for clinically useful I guess time will tell. With opt out in place the ADHA no longer has anything to chase or use as a funding request. My guess is by end of 2018 we will witness a massive security breech
Facebook has a Download Your Information capability. Instagram is about to get one.
https://techcrunch.com/2018/04/11/download-your-instagram-photos/
"... an Instagram spokesperson tells me “We are building a new data portability tool. You’ll soon be able to download a copy of what you’ve shared on Instagram, including your photos, videos and messages.”
This tool could make it much easier for users to leave Instagram and go to a competing image social network. And as long as it launches before May 25th, it will help Instagram to comply with upcoming European GDPR privacy law that requires data portability."
Can you download your myhr data? AFAIK, No. Can you download the audit log? AFAIK, No.
Is your health data portable? No. Even if you go to a new GP and they download myhr data into their clinical system, your original GP still has most of your data.
Is it in the interest of your GP to make it easy to go to another GP, taking all your data with you? Depends on the GP.
Does/could myhr comply with GDPR? No. Could it? No. Apart from the portability fail, one of the other requirements for GDPR is that you should be able to ask that all your data be deleted. myhr keeps it until well after you have died, even if you delete any of the documents or deactivate your registration.
Tell me again how myhr is "my" data.
"...He said public communication with the community at large about people's rights to opt out ..."
I do hope that when they start communicating with the public they are fully transparent about MADIP, i.e. linking myhr data with that from Australian Bureau of Statistics, Australian Taxation Office, Department of Education and Training, Department of Human Services and Department of Social Services.
All in the protection of public revenue and improving "the effectiveness of government policies, programs, and services. and "...how combining existing public data can help target services (such as healthcare) to the people and communities who need them."
I'm sure someone will bring it up on social media.
It's nice that Tim Kelsey is working hard to include clinically useful data in myhr, but is he addressing the reliability issue:
"My Health Record will not replace existing medical records. It is an additional tool that brings together a summary of an individual’s significant health information that is important to their ongoing care."
and
"It is safest to assume the information in a patient’s My Health Record is not a complete record of a patient’s clinical history, so information should be verified from other sources and ideally, with the patient."
https://myhealthrecord.gov.au/internet/mhr/publishing.nsf/Content/healthcare-providers-faqs
And then there is this, also on that page:
"Healthcare providers will continue to take and review clinical notes. It is important to remember that the My Health Record system is not intended to be a communication tool – it will not replace the need to communicate important health information directly to individuals or other healthcare providers treating them."
which rather negates ADHA's claim that when you are traveling or visiting a different GP, your myhr will be of some use.
While the GovHR central database may be locked down, the numerous (known and unknown) access points are widespread. User education will be essential to ensure health records aren’t leaked from the over 9,000 connected healthcare entities now using the system, including GPs, hospitals, pharmacies pathology and residential services for the elderly.
The Jurisdictional strategy trend has online medical records at their heart, and integration with the MyHealth national system.
For cyber criminals it’s a veritable treasure trove of data – with medical records reportedly selling for as much as A$1,000 each on the dark web.
A fully populated medical record is a more lucrative grab than credit card data, which can command as little as A$1, a single cell organism good grasp why health businesses are now being targeted.
While the concept of having digital medical records or health records, which could streamline the delivery of health services to patients, is arguably attractive, the fact that health-related data might be accessible from PCs or tablets in an unencrypted format should and must be a concern.
The Government has demonstrated it is careless with population data, the MyHR is headed by two imports that were behind the care.data fiasco. The CEO has shown no signs of changing his spots. There is cause through joining the dots to suggest there are some very questionable dealing going on and the ADHA seems rife with conflicts of interest and seemingly a ship without a rudder.
So yes I think a massive breech will occurs before year end, one that will surpass current records for out governments
What an extraordinary set of circumstances the Government has created - a health record which, according to the government's official publicity, cannot be relied upon, is an innacurate summary of the patient's medical record, is incomplete, and is not intended to be used for exchanging information between a person's health service providers.
Even more extraordinary is that the RACGP and the AMA are silent, so too most medical software developers.
Why is it so?
Why is it so? Money?
As for the ADHA desire to progress based on research and evidence. I was fortunate to attend ATC. From an online journal this morning.
In her research Prof Lupton also asked questions about My Health Record. “I was interested in what women knew or understood about My Health Record, whether they'd heard about it, whether they'd signed up. “I found a profound lack of interest in My Health Record or even knowledge about My Health Record. A lot of women said 'I don't even know what it is,' I don't know if I've signed up to it', or they said 'yes I've signed up to it but my doctor never uses it so I don't know what has happened to it, I certainly never use it'. “There was no one who actually said they had signed up and actively did anything with it.”
Perhaps the Minister for Agriculture could assist the Health Minister in recognising a lemon
8:21 AM I think you will find that is the wrong sort of evidence, not what they are looking for.
7:56 AM with so much change in the narrative and repositioning of the MyHR and target user group. Why have the department not altered those statements?
"Why have the department not altered those statements? "
Becaause those statements reflect the implementation of the system.
Unfortunately for ADHA/DoH, the most basic and fundamental characteristic of the system - all the data exists elsewhere, myhr just takes copies.
The original design was intended to link conformant repositories, with very little held in a central database.
This is from the PCEHR Concept of Operations (ConOp), upon which everything else is base but is now not available on the ADHA website, although we were promised regular updates.
" ...the PCEHR System will provide the necessary national infrastructure, standards and specifications to enable secure access to an individual’s health information drawn from multiple sources. Suppliers of eHealth systems will be able to enhance their products and services to become conformant with the relevant standards and specifications and support healthcare organisations in accessing the PCEHR System.
Clinical documents, such as Shared Health Summaries, Discharge Summaries, Event Summaries, Pathology Result Reports and Specialist Letters will be collected from a range of participating organisations, and stored within a number of secure repositories in the PCEHR System."
The DHS was supposed to operate a conformant repository "The Department of Human Services will also operate a conformant repository enabling access to Medicare information, such as the MBS, PBS, ACIR and organ donor information, and provide a proof of record ownership service to assist with identifying and authenticating individuals during registration." i.e. apart from data they already own (MBS/PBS) no clinical documents.
A number of failings including the inability to solve the interoperability problem (see my earlier comment) meant that they had to implement a kluge - take copies.
If they had further developed the conformant repositories approach they could have ended up with a decentralised system that would have been much more flexible, extensible, and reliable. Rather like the state-of-the-art systems in the UK and Sweden.
As it is, they have built themselves a new dinosaur. But it is useful from a health economic perspective. See earlier comments on MADIP.
As it is, they have removed the ConOp and gone down a completely different path trying to make up for a) their failure to implement they system as designed and b) make it into something it was never intended to be - a government owned database of health data suitable for linking to other government owned data.
What they will not be able to do is make it relevant. Even if they do get away with opt-out, patients and their GPs are most unlikely to populate it with summary information. If that happens, it will just sit there, vainly and forlornly wondering why nobody wants to play the government's sneaky little game.
@7:56 AM Ian, the Facebook & Mark Zuckerberg revelations confirm why I will ONLY share my medical information with my health practitioner. I do not want Government involved, I do not trust the Government, I do trust my GP. As for the AMA and RACGP I cannot believe they are supportive of something that is clearly destructive in so many ways.
@10:01 AM You are not Robinson Crusoe
Why Facebook privacy concerns should impact HIT’s future
https://www.healthdatamanagement.com/opinion/why-facebook-privacy-concerns-should-impact-hit-future
The recent exposure of Cambridge Analytica’s deceptive and invasive use of Americans’ Facebook information during the 2016 election is causing widespread outrage, and more concern is emerging as the company’s top executive has testified before Congress the past two days.
However, government regulations for healthcare information also could be called into question, and many wonder if a similar incident could happen with data from Americans’ medical records. The Facebook situation provides important lessons around needed safeguards in healthcare IT regulation.
The foregoing comments suggest there is an urgent need for a thorough independent forensic enquiry to be conducted by the ANAO (National Audit Office)in the national interest.
This person could probably get a job at ADHA when they graduate. A good cultural fit.
https://i.imgur.com/QIO6a1n.png?1
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