As we are seeing more health systems gradually ramp up their levels of automation the benefits case for Health IT is rapidly firming. The following is a really fabulous example of how useful clinically decisive information can be derived from EHRs. This is followed by a few more, equally interesting write-ups of things that are being done.
Electronic Medical Records Strengthen Vaccine Safety Monitoring In Seizure Study
Cheryl Clark, for HealthLeaders Media, June 28, 2010
Intelligent use of electronic health records—even those collected from multiple health systems—can alert providers to harmful medical practices.
That's how Kaiser Permanente's analysis of 459,000 pediatric health records revealed that young children who received the combo MMRV (measles, mumps, rubella, varicella) vaccine experienced twice the rate of febrile seizures as did children who received two separate shots—one for measles, mumps, rubella and the other just for varicella.
"This study shows the tremendous power of electronic medical records to improve vaccine safety monitoring," says Nicola P. Klein, MD, co-director of the Kaiser Permanente Vaccine Study Center.
She adds that with either type of vaccine, the risk of a child having a seizure and a high fever as a result is very low, but it's important that parents know that risk so they can have informed discussions with their doctors about whether the combination vaccine is worth the risk.
For every 10,000 children given MMRV instead of MMR +V, there was an additional 4.3 seizures during the seven to 10 days following vaccination.
The finding, published in today's edition of the journal Pediatrics, prompted the Centers for Disease Control and Prevention last month to change its vaccine guidance to one that favored the MMRV over MMR plus V.
Much more here:
It is worth noting that the lack of nationwide systems in Australia made more difficult than it might have been the sorting out of similar issues with the seasonal flu vaccine and young children here. We could have both noticed and responded to the issue better with better real—time surveillance systems.
That said there are also these recent reports along similar lines.
See here:
Clinical Studies Fueled by EMR Data
Gienna Shaw, for HealthLeaders Media, June 29, 2010
At Montefiore Medical Center in Bronx, NY, researchers are harnessing the power of more than a decade's worth of electronic medical record data using a software program called Clinical Looking Glass (CLG). Developed by the academic medical center, the program interprets de-indentified data for entire patient populations and can be used to gauge the effectiveness of patient safety measures, identify and track public health threats, and provide data for professional articles and published studies.
Researchers, physicians, and other clinicians run as many as 2,800 queries every month using the software. Three examples: They used the program to measure the impact of Medicare regulations on rehabilitation patients, quantify the reduction in radiation exposure for emergency department patients, and track the care and progress of diabetes patients over time.
Measuring Medicare Policy
The Centers for Medicare and Medicaid (CMS) announced in 2005 a new rule that said a large percentage of rehabilitation hospitals' patients must have one of 13 specific diagnoses or the organizations could lose reimbursement. Concerned about the rule's potential impact on patients, a group of physicians at Montefiore, using CLG, performed a retrospective study of discharges from the hospital the year before the rules were implemented and discharges the year after the rules. They found that, in general, "restricting access to inpatient rehabilitation on the basis of diagnosis alone" resulted in patients being readmitted sooner and dying sooner. Their study called for broader, evidence-based guidelines to allocate rehabilitation services.
The Centers for Medicare and Medicaid (CMS) announced in 2005 a new rule that said a large percentage of rehabilitation hospitals' patients must have one of 13 specific diagnoses or the organizations could lose reimbursement. Concerned about the rule's potential impact on patients, a group of physicians at Montefiore, using CLG, performed a retrospective study of discharges from the hospital the year before the rules were implemented and discharges the year after the rules. They found that, in general, "restricting access to inpatient rehabilitation on the basis of diagnosis alone" resulted in patients being readmitted sooner and dying sooner. Their study called for broader, evidence-based guidelines to allocate rehabilitation services.
Reducing Radiation
To reduce unnecessary radiation exposure to patients admitted to the ED with a suspected pulmonary embolism, a group of radiology and nuclear medicine physicians conducted educational seminars for ED physicians. They showed the ED physicians that for certain embolism patients, a high-radiation CT pulmonary angiography (CTPA) was not necessary and that the lower-radiation ventilation-perfusion scan was just as effective. Using CLG, they showed that the number of CTPA scans performed decreased from 1,473 before the educational seminars to 920 after the seminars for an average reduction in radiation exposure of 23% percent per patient.
To reduce unnecessary radiation exposure to patients admitted to the ED with a suspected pulmonary embolism, a group of radiology and nuclear medicine physicians conducted educational seminars for ED physicians. They showed the ED physicians that for certain embolism patients, a high-radiation CT pulmonary angiography (CTPA) was not necessary and that the lower-radiation ventilation-perfusion scan was just as effective. Using CLG, they showed that the number of CTPA scans performed decreased from 1,473 before the educational seminars to 920 after the seminars for an average reduction in radiation exposure of 23% percent per patient.
Much more here:
and here:
A Data Gold Mine
Gienna Shaw, for HealthLeaders Magazine, June 9, 2010
Tech-savvy hospitals are using EMR data to conduct clinical research, improve quality, and inform business decisions.
Clinical studies can take years to conduct. Just one example: A study of the widely used antibiotic gatifloxacin showed it could cause dangerous fluctuations in blood sugar levels among diabetic patients. After further research showed that all patients were at risk for the dangerous side effect, the drug was pulled from the market.
At Montefiore Medical Center in Bronx, NY, an analyst was curious whether a new clinical research tool the system had developed could duplicate the results of the gatifloxacin studies. The analyst isolated a cohort of the four-hospital system's patients who had been on the antibiotic and compared them to a group that was on a different antibiotic. Sure enough, the query showed that the patients on gatifloxacin were six times more likely to have high or low blood sugar than those who were not.
But the analyst didn't have to study the drug for months or years, go in front of a committee of physicians and data experts for research review, nor wait for the results to be published in a peer-reviewed journal. The analyst performed the query on his lunch break using a software program called Clinical Looking Glass that taps into more than a decade's worth of electronic medical record data.
The program interprets de-indentified data for entire patient populations and can be used to gauge the effectiveness of patient safety measures, identify and track public health threats, and provide data for professional articles and published studies. CLG has been used to measure the impact of Medicare regulations on rehabilitation patients, quantify the reduction in radiation exposure for emergency department patients, and track the care and progress of diabetes patients over time.
It also helped the system react quickly to a surprise FDA hospitalwide study during the heparin scare to check if patients using the blood-thinning drug had a longer hospitalization or died. Montefiore analysts quickly tracked all the patients who were given the drug from December 2007 through January 2008 and compared length of stay and mortality against those who were given the drug during the same period 12 months earlier, before the quality concerns were raised. The query found no increase in either measure—and no cause for alarm for Montefiore patients.
"The goal of these analytics is to gather information and conduct studies that lead to better clinical decision-making," says Eran Bellin, MD, vice president for clinical IT research and development at Montefiore, who was instrumental in designing CLG. "The queries have provided the quantitative evidence for dozens of peer-review journal articles, presentations at professional meetings, institutionwide patient quality improvement initiatives and programs that benefit entire populations."
"We believe it offers a glimpse into how healthcare informatics is shaping the future of medicine," says Montefiore's president and CEO Steven Safyer, MD.
Heaps more here
Also here is more even:
HIT That Enables Quality, Efficiency, and Value
June 2010
In the rush to implement healthcare information technology, providers might miss crucial steps to get the most from their systems and best reengineer care processes to provide higher quality and better value.
In this HealthLeaders Media Breakthroughs report, leading hospital systems—Bon Secours Virginia Health System, Denver Health, Trinity Health, and Hackensack University Medical Center—share insights and the lessons learned that will help you:
- Understand the value of data warehousing and analysis
- Use HIT as a transformational quality improvement tool
- Communicate and align with physicians
- Define what meaningful use means to your organization’s goals and objectives
See here:
And finally for some future work:
HealthPartners Research Foundation team to study role of electronic health records in reducing heart disease risk
BLOOMINGTON, Minn. --(Business Wire)--
A HealthPartners Research Foundation team has received a National Institutes of Health research grant to develop and implement an electronic health record (EHR)-based clinical decision support system to help reduce patients' risk of heart attack or stroke. The team, led by Patrick O'Connor, MD, MPH, senior clinical investigator, HealthPartners Research Foundation, received $3.7 million to conduct the five-year study, 'Prioritized Clinical Decision Support to Reduce Cardiovascular Risk.'
"This is the next generation of personalizing care with decision support that's meaningful to care providers and patients," said O'Connor who is also an assistant medical director at HealthPartners Medical Group. "HealthPartners Medical Group physicians and clinics have been pioneers in this area and this new project will likely lead to further improvements in care for thousands of patients," he said.
The team, in collaboration with the University of Minnesota's Carlson School of Management, will engineer a point-of-care system that identifies and prioritizes evidence-based treatment options for patients at moderate to high risk for a heart attack or stroke within 10 years. With HealthPartners physicians, they will test its effect on risk in a randomizedtrial that includes 18 primary care clinics, 60 primary care physicians and 18,000 patients.
If successful, this approach will reduce the risk of heart attack or stroke for about 35 percent of adults in the United States and maximize the clinical return on investment for electronic health record systems. It could also be a model for using electronic health record technology to deliver personalized medicine in primary care settings.
Full release here:
All in all we live in very exciting times. Sadly most of this will NOT be enabled by the Roxon proposed Personally Controlled EHRs without about a decade of work putting in the systems for providers that are needed first.
David.
