Quote Of The Year

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

Friday, August 24, 2018

Another Study That Shows The myHR Is Not Going To Make The Difference We Need.

This study appeared last week:

CDS alerts in hospital EHR reduce costs, improve outcomes

Published August 17 2018, 7:33am EDT
A new study finds that clinical decision support alerts embedded into a hospital records system have improved patient health and financial outcomes.
Researchers at Cedars-Sinai Medical Center say the results show the positive effects of leveraging Choosing Wisely recommendations. An article on the study was published this week in the American Journal of Managed Care.
For the study, Cedars-Sinai evaluated the 18 highest-volume Choosing Wisely alerts integrated into its Epic EHR. The observational study of 26,424 inpatient encounters examined the associations between adherence to Choosing Wisely recommendations embedded into CDS alerts and four measures of resource use and quality.
“Encounters in which providers adhered to all alerts had significantly lower total costs, shorter lengths of stay, a lower probability of 30-day readmissions, and a lower probability of complications compared with non-adherent encounters,” according to the study’s authors.
When it comes to financial outcomes, the authors noted that adherence to Choosing Wisely alerts was associated with savings of $944 from a median encounter cost of $12,940.
 “Inpatient alerts selected for study were those deemed the most technically feasible to deploy accurately and with a sufficient number of relevant orders that would trigger an alert, thus providing a sufficient volume of alerted encounters to evaluate,” state the authors. “When initiating a potentially inappropriate order, a provider received real-time notification of deviation from a CW recommendation. That provider then had the option to cancel, change, or justify the order, if he or she agreed with the alert’s recommendation in the context of the individual patient.”
Here is the link:
And here is come commentary.

HIT Think How providers can benefit from more study of CDS benefits

Published August 17 2018, 5:49pm EDT
Amid healthcare’s complexities, many providers are trying to streamline their core business, delivering quality patient care at sustainable margins. The objective sounds deceptively simple: Serve the organizational mission by reducing services that provide little value to patients—and can occasionally cause harm. But providers have long sought effective strategies for reaching that elusive goal and continue to do so.
A new study shows how technology can help. Pop-up alerts can aid physicians in treating patients so they experience fewer complications and lower costs, leave the hospital sooner and are less likely to be readmitted. Patients realize these benefits when physicians adhere to alerts in EHRs with care instructions based on evidence-based guidelines, according to the study that was a collaboration between Cedars-Sinai and Optum.
Specifically, the study showed that when physicians follow all clinical decision support (CDS) alerts, their care correlated to significantly better outcomes than for physicians who did not follow all alerts:
  • Costs of care reduced by $944 from a median-cost hospital encounter—an improvement of more than 7 percent, after adjusting for differences in patient illness severity and case complexity.
  • Patients’ average length of hospital stay decreased by 6.2 percent.
  • The odds of complications improved by 29 percent.
  • The odds of hospital readmissions within 30 days of the patients’ original visits shrank by 14 percent.
The American Journal of Managed Care, a peer-reviewed journal, first published the observational study and noted in an editorial, “This study adds to promising evidence that [clinical decision support] assists clinicians in making value-based clinical decisions and reducing the use of care that is not clinically indicated.”
The study examined data from 26,424 inpatient visits at Cedars-Sinai Medical Center from October 2013 to July 2016 in which one or more of the 18 most frequent alerts was triggered.
Here is the link:
So there you have it! A capability that the secondary myHR can never have is the one that will help reduce the low value and wasteful care the Government so hates. So why don’t they follow the evidence and improve the primary and hospital systems and stop building a largely useless database in the sky (cloud)?
Heavens knows.
David.

6 comments:

Anonymous said...

The MyHR champions position/excuse is that others just need to change and all will be fine. Ironic then that as everyone and everything around them changes, they fail to change and keep up.

Anonymous said...

@4:25 PM - ADOHA have a hard time changing what they do, as it creates relevance and enables a belief in them. Even after new ideas and practices are shown to be effective. The MyHR (the concept of it) is being hamstrung, not by adoption but rather through, deadoption. Sadly deadoption may be even slower that adoption. As hard as it seems to get people to adopt new practices, a pervasive asymmetry in human psychology makes it even harder for them to give up old practices that they have come to believe in, even when new evidence reveals that those practices offer little value.

Anonymous said...

What's even harder is to adopt/adapt to something that is obviously of no use and which has significant downsides/costs/risks.

Anonymous said...

August 24 @4:35. I very good observation. Just who is unwilling to adopt and change. When I look at my care team today from Ten years ago they have adopted and adapted technology well and without the cost to care or the human touch. Perhaps government is to slow or too unwilling to change.

Anonymous said...

https://www.theage.com.au/national/victoria/it-was-creepy-the-parents-opting-out-of-technology-in-the-classroom-20180825-p4zzqf.html

There needs to be a lot more thought into how information technology is introduced. The ability to be an end user does not map directly to one “understanding” information technology.

Take a look at ADHA, masters of retweeting but have any other the top three layers have a PHD and career in conputire science? How many have a true health informatics legacy?

Bernard Robertson-Dunn said...

A study that demonstrates just how much of a problem Health Records create and why adding another is only likely to make it far worse:

Learning to Write Notes in Electronic Health Records
https://arxiv.org/pdf/1808.02622.pdf

The article is proposing to use AI to write clinical notes but of more interest is a description of the problems health records create:

"According to a study (Sinsky et al., 2016), physicians spend nearly 2 hours doing administrative work for every hour of face-time with patients. The most time-consuming aspect of the administrative work is inputting clinical notes into the electronic health record (EHR) software documenting information about the patient including health history, assessment (e.g. diagnoses) and treatment plan.

Much of the documentation requirements are viewed as drudgery and is a major contributor to career dissatisfaction and burnout among clinicians. Furthermore, patient satisfaction is affected by the intrusion of this work into time spent with patients.

The severity of the problem is such that documentation support industries have arisen as work-arounds, ranging from dictation services, where clinicians speak notes to be transcribed by a human or machine backend, to scribes, human-assistants whose primary job is to write the notes.

We take a similar opinion as Gellert et al. (2015) and view this as a sign that EHR software usability should be improved."

And remember, the purpose of, and data in, myhr is significantly different from that of a clinical system.

Here is an analysis of the paper
https://www.emrandehr.com/2018/08/27/ai-based-tech-could-speed-patient-documentation-process/

the last para is worth reading:

"I am left with at least one question, though. If the Google Brain technology can predict physician notes with great fidelity, how does that differ than having the physician cut-and-paste previous notes on their own? I may be missing something here, because I’m not a software engineer, but I’d still like to know how these predictions improve on existing workarounds."

IMHO, technologists are trying to solve the wrong problem. They should be looking at ways of replacing document management activities by better acquisition and use of point of care information.