Nurses Using An EMR And Also Being Consulted On EHRs Seems To Be A Good Thing For Everyone.

This appeared a little while ago.

Why nurses must be involved in developing new health IT

November 22, 2013 | By Ashley Gold

Nurses are an essential part of the medical system and patient care--so why shouldn't they be more involved in developing new healthcare IT?
This question is explored in an article in Nursing Times, along with discussion on how attitudes toward nurses differ in the U.K. and the U.S., and how nurses can use technology to improve practice. Five key points made in the article include:

1.       In the U.K. and the U.S., nurse leaders must justify their requests for resources.

2.       The value of technology is determined by how it is used and whether it helps or hinders care.

3.       There is a general belief that nurses are "reluctant to accept change and "resent new technology."

4.       The U.S. and U.K. share similar goals for technology innovation, but differ when it comes to economics and delivery.

5.       Frontline staff often is not involved in the planning and implementation of health IT.

One example of how the perception that nurses are slow to adapt to technology is proved wrong is in nurses' work in neonatal or intensive care units, the article argues. Such a belief keeps technology system suppliers from understanding the practicalities of nursing care and how they can support innovation in everyday practice.

More here with references.

http://www.fiercehealthit.com/story/why-nurses-must-be-involved-developing-new-health-it/2013-11-22

I also spotted this summary a while ago,

Study: EHRs improve hospital nursing care

January 11, 2012 — 4:13pm ET | By Marla Durben Hirsch - Contributing Editor

Electronic health records do more than improve care rendered by physicians. They also improve care provided by nurses.

That's the scoop in a study of more than 16,000 nurses published in the Journal of Nursing Administration. According to the study, which covers 316 hospitals in four states, poor patient safety and other quality outcomes occurred less frequently when nurses used an EHR system.  

The study suggests that the implementation of a basic EHR may result in improved and more efficient nursing care, better care coordination and patient safety. 

"EHRs are rapidly becoming part of the daily practice of the bedside nurse," lead researcher Ann Kutney-Lee, a health outcomes researcher with the University of Pennsylvania School of Nursing, said in a statement. "Nursing administrators should be fully engaged in the process of EHR adoption and implementation to ensure effective use and success in creating seamless transitions for patients throughout the healthcare continuum." 

More here:

http://www.fierceemr.com/story/study-ehrs-improve-hospital-nursing-care/2012-01-11

Here are the detailed links:

To learn more:
- read the study's abstract
- check out this article from the University of Pennsylvania's Nursing School
- read this UPI piece
- read the abstract of the nurse EHR training study
- here's the abstract of the ICU nurse study

The two studies reported here are useful in showing the possible impacts of Health IT when used by clinicians - and especially when used by the most numerous clinicians - the nurses.

So this is an important reminder of the importance of nurses in most aspects of Health IT.

Pity there were so few involved in the PCEHR over the years.

David.

What A Fantastically Interesting Outcome From A Major Implementation. Real Lessons For NEHTA and DoH.

This appeared a little while ago.

December 11, 2013, 5:18 PM ET

Avon’s Failed SAP Implementation Reflects Rise of Usability

The failure of Avon Products Inc.’s $125 million implementation of SAP AG software is the latest – and perhaps most dramatic – example of how usability has become a critical issue in the workplace. People who are accustomed to using simple, well-designed applications in their personal lives have no patience for disappointing technology at work.

As the WSJ’s Drew Fitzgerald reported earlier today, Avon is pulling the plug on a $125 million software system rollout that has been in the works for four years after a test of the system in Canada drove away representatives the door-to-door beauty product company relies on to drive sales.

Avon began testing the new order management software system in Canada in the second quarter. While the new system based on software supplied by SAP AG worked as planned, it was so burdensome and disruptive to the representatives’ daily routine that they left in meaningful numbers. Avon relies on a direct sales model where its representatives aren’t employees, which makes it difficult to add new tasks associated with the software system.

…..

“Basically, users will accept less crap today, when it comes to software,” says Michael Krigsman, an independent industry analyst. “That is because the world of consumer software has become easy and simple to use and has trained users to expect that business software will follow a similar model. And if it doesn’t, people are much less patient than they were in the past.”

…..

UPDATE–This story has been updated to add comment from SAP.

More here:

http://blogs.wsj.com/cio/2013/12/11/avons-failed-sap-implementation-reflects-rise-of-usability/?mod=djemCIO_h

This line says it all:

“Basically, users will accept less crap today, when it comes to software,”

Surely this is another reason for the debacle of the PCEHR? Users who use iPads, iPhones, late Windows etc. simply will not put up with hopeless, slow, inconsistent and unstable user interfaces.

Maybe someone should point out the basic truth to the powers that be (and shouldn’t be!).

David.

After Developing The PCEHR For Two Years and Having It Live for 18 Months NEHTA Notices It Does Not Work Very Well!

This appeared a little while ago on the NEHTA Web Site:

Usability Feedback

PCEHR Viewing

Software vendors have implemented the ability to draw down a list of documents available from the PCEHR for a given patient. Each vendor has implemented a process for sorting and filtering these documents. Feedback received from primary care clinicians suggests a common method of presenting this information (called a Health Record Overview or HRO) would be valuable.  The PCEHR infrastructure will be modified to support the HRO. Subsequent to that, primary care software vendors will build the HRO into their software products. This work is underway, with the first software able to display the HRO expected to be available in mid-2014.

Positive feedback has been received from clinicians regarding the prescription and dispense “smart” view available in the PCEHR (and some software products). This functionality allows the user to filter and sort medication, prescription and dispense records within a patient’s PCEHR in a variety of ways. Where software does not include this function, clinicians can still see the records in a static list together with all other clinical documents based on the date of submission of the document to the PCEHR.

Shared Health Summary Uploading

Feedback has been received about the process for populating and uploading a Shared Health Summary, and the way in which some information is handled within the document. NEHTA has worked with representatives from the peak health bodies to provide further guidance for software vendors on these issues. Primary care software vendors can now start incorporating this guidance within their respective products and release the enhanced software to their users. NEHTA will publish a list of software vendors that have released products addressing this usability guidance.

Accessing PCEHR Functionality within Software

Feedback has been received about the way primary care software systems access the PCEHR, where the PCEHR functions are located, and whether or not a patient has a PCEHR. This guidance has now been released to software vendors.

Event Summary

Feedback has been received from primary care clinicians that they are unclear about what information to include in an Event Summary, and in which situations they would use one. NEHTA intends to produce guidance material relating to this in early 2014.

This information is found here:

http://www.nehta.gov.au/for-providers/usability-feedback

How astonishingly incompetent are these guys? For years, at least, I have warned about how clumsy and inaccessible these PCEHR is and how much worse that will become as you add more records. Anyone who has a PCEHR record and is on any regular medications would have been aware of the issue ages ago. Because this obvious flaw was not addressed ages ago the vendors have tried to patch an obvious gap, done it in different ways and we have wound up with systems which work different ways.

This and the other issues would have been spotted ages ago had there been proper development,  testing and acceptance processes and some well planned initial implementations to ensure the system was useable.

To have taken 18 months to come up with these obvious flaws is a testament to just how out of touch with clinical reality NEHTA and DoH are.

As far as not having defined and been clear as to what should be in Event Summaries is just a horrible joke!

Again we see the issues that flow from poor communication, leadership and governance as well as implementing to a political time-table rather than a properly planned and tested time-table.

If there is any plan to attempt to fix the PCEHR then we must ensure none of all the guilty parties have anything to do with it.

David.

Medicare Local Review Announced - Very Short Response Deadline - Commments Welcome

This popped up very recently.

Medicare Locals review

Australia’s former Chief Medical Officer Prof John Horvath AO will oversee the Australian Government’s review of Medicare Locals.

Page last updated: 16 December 2013

PDF Printable version of Medicare Locals review (PDF 30 KB)

16 December 2013

Australia’s former Chief Medical Officer Prof John Horvath AO will oversee the Australian Government’s review of Medicare Locals.

Prof Horvath is a distinguished doctor, researcher and health adviser and served as the nation’s CMO from 2003 to 2009.

Health Minister Peter Dutton has announced details of the review which was a Coalition election commitment.

It will begin immediately with Professor Horvath providing his independent advice to the Government by March next year.

The 61 Medicare Locals established by the former Labor Governments were allocated flexible federal funding of more than $1.8 billion over five years as well as additional funding for specific programs.

Health Minister Peter Dutton said the government’s priority from the program was to ensure that Commonwealth health funding was used as productively as possible.

“We are committed to reducing waste and spending on administration and bureaucracy, so that greater investment can be made in services that directly benefit patients and support health professionals who deliver those services to patients,” he said.

Stakeholders have been invited to comment on various aspects of Medicare Locals’ functions including:

• The role of MLs and their performance against stated objectives
• The performance of MLs in administering existing programmes, including after-hours GP services
• Recognising general practice as the cornerstone of primary care in the ML functions and governance structures
• Ensuring Commonwealth funding supports clinical services, rather than administration
• Processes for ensuring that existing clinical services are not disrupted or discouraged by ML programs
• Interaction between MLs and Local Hospital Networks and other health services, including boundaries
• Tendering and contracting arrangements
• Other related matters.

Here is the link:

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2013-dutton025.htm

The deadline for those asked to respond is 23rd December, 2013 I am told.

Anyone who has comments that might be fed back on all these issues and MLs effectiveness feel free. Will pass them on if I can.

Most will know I see them as a rather nebulous set of entities whose purpose and actual performance is pretty unclear - given their cost.

David.

Mr David Gonski To Become ANZ Chairman From Next Year. Will He Leave NEHTA?

To quote the Aust Financial Review from today.

“Following the announcement today by the Australia and New Zealand Banking Group Limited that I will be joining the ANZ Board in February 2014 and succeeding John Morschel as Chairman in May 2014, I confirm I will be relinquishing some of my current commitments,” Mr Gonski said.

“I intend to step down as chairman of the guardians of the Future Fund during January 2014 so as to avoid any possible conflict of interest with my new position and allowing sufficient time for a smooth transition and handover to my successor, who will be appointed by the Federal Government.”

The full article is here.

http://www.afr.com/p/business/companies/gonski_appointed_anz_chairman_rhH86b5ksrMIhqNznWADsK

No mention of NEHTA of which he is also Chair. Might be a good time to leave this as well. I am sure ANZ shareholders would like this outcome as the more focus he has on the ANZ the better!

David.

Disclosure: I have a few ANZ shares.

Recent Comments Widget Replaced With A Much Better One!

Enjoy!

David.

You Have To Think The MYEFO Budget Problem Will Stop E-Health Spending Big Time!

Given the mess the Federal Budget seems to be  in - what chance further spending on E-Heath?

Curious to know what others think.

My feeling - this will be the excuse to cancel the PCEHR Program.

What do you think? About this and the apparent budget mess in general if you wish.

David.

For The Record - Mr Dutton’s Second Whack At The Labor PCEHR. Is He Trying To Saying Something?

From early last week - we have in Hansard the following.

Monday, 9 December 2013

Hospitals (and the PCEHR)

Mr LAUNDY (Reid) (15:09): My question is to the Minister for Health and, given today's sitting arrangements, I am looking forward to hearing the answer. Will the minister inform the House of how many patients are treated in private hospitals across Australia every year? What percentage of the estimated 95,000 people who have private health insurance in Reid can expect to have important information in their electronic records accessed and updated if they present at a private hospital for treatment?

Mr DUTTON (Dickson—Minister for Health and Minister for Sport) (15:10): I very much thank the member for Reid for his question. He is particularly interested in getting better services for the people of Reid. I have been able to detail some of the achievements of the former health minister—or, rather, the Acting Leader of the Opposition, with all the qualities of Julia Gillard sitting in that chair. She is fully behind the leader She is fully behind Bill Shorten—just like Julia Gillard was behind Kevin Rudd! Remember him?

Ms King: Madam Speaker, I raise a point of order on relevance: he was asked specifically about the electronic health record, and I ask you to draw him back to that question.

The SPEAKER: Thank you. The member can resume her seat.

Mr DUTTON: A fair point of order, Madam Speaker. The member rightly points out that in his electorate he has 95,000 people who hold private health insurance. Bear in mind that the member for Sydney, the former health minister, claimed that it was a great day for the country—the rollout of the personally controlled electronic health record, referred to affectionately as the PCEHR.

When you consider that 95,000 people within just the electorate of Reid have private health insurance, you would have thought that one of the achievements of the member for Sydney would have been that private health insurance patients, when they went into a hospital, could have had their record accessed and updated in that private hospital. We know that around 40 per cent of hospital patients are treated in private hospitals. And yet I explained to the House last week that, in the formation of the personally controlled electronic health record, the previous government forgot to speak to doctors and public hospitals about this record. But now it turns out that they forgot to speak to private hospitals. I will ask for the help of my colleagues here: you would have thought that, of 95,000 people, what—50,000?

Mr Hockey: Forty thousand!

Mr DUTTON: No! Let us say 20,000 of the 95,000—

Government members: No!

Mr DUTTON: Do you think 20,000?

Government members: No!

Mr DUTTON: No! They are too generous; not even 10,000, not even a thousand, not a hundred, not one—not one patient! Unbelievable! Do you know that this former government, this former minister who wants to be the Leader of the Opposition, spent $1 billion on the personally controlled electronic health record. About 10,000 Australians had a record uploaded by their doctor. But we know that people who go into emergency departments and people who go into private hospitals cannot have their record accessed, in many cases, except in, out of the 150 electorates, just one electorate—

Government members: Which one?

Mr DUTTON: Now my colleagues ask, 'Which electorate?' It was one electorate: the electorate of Sydney. But they did not get around to the other 149.

Mr Truss: I move that further questions be placed on the Notice Paper.

Here is the link.

http://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;db=CHAMBER;id=chamber%2Fhansardr%2F5f0f5c44-95ba-4857-8d00-f969c7b99627%2F0096;query=Id%3A%22chamber%2Fhansardr%2F5f0f5c44-95ba-4857-8d00-f969c7b99627%2F0000%22

Here is the official info on Mr Laundy.

Biography for LAUNDY, Craig Arthur Samuel

Member for Reid (NSW)

Liberal Party of Australia

Parliamentary Service

Elected to the House of Representatives for Reid, New South Wales, 2013.

Personal

Born 16.2.1971, Sydney, NSW.

Married.

Qualifications and Occupation before entering Federal Parliament

BEcon&Fin (UNSW).

Hotelier.

-----

Link here:

http://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;query=Id%3A%22handbook%2Fallmps%2F247130%22;querytype=;rec=0

Clearly a Dorothy Dixer followed by a choreographed effort to attack the Opposition at the expense of the failure, so far, of the PCEHR.

What is going on here?  My guess we are being softened up for either:

1. Shutting down the PCEHR.

2. A major revamp of the PCEHR.

The level of this attack does not seem to suggest a small tweak or two. To say both have risks is an understatement!

What do others make of these comments?

David.