Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Saturday, June 29, 2019

Weekly Overseas Health IT Links – 29th June, 2019.

Here are a few I came across last week.
Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.
-----

Calls for BMA to oppose Hancock’s ‘ill-conceived’ ban on outdated tech

Setting “arbitrary dates” to stop using outdated technology puts patients “at risk”, regional medical councils have said as they called on the BMA to oppose blanket policies.
Andrea Downey – 18 June 2019
Several motions are expected to be discussed at the British Medical Association’s annual representatives meeting (ARM), calling on NHS England, NHS Digital and individual trusts to collate the advantages and disadvantages of all communication methods currently used in the health service.
East Midlands Regional Council proposed a motion labelling secretary of state for health and social care, Matt Hancock’s, flagship Axe the Fax and Purge the Pager campaigns “premature and ill-conceived”.
The region is calling on the BMA to oppose the blanket policies until “feasible alternatives” are determined.
-----

Morale among some Ottawa Hospital doctors low amid 'chaos' of new records system rollout

Elizabeth Payne
Updated: June 19, 2019
Anxiety levels are high among some physicians at The Ottawa Hospital as it transitions to a new electronic health record system.
One doctor, who contacted this newspaper, said some physicians feel they were not adequately trained before the June 1 launch and are not receiving the support they need.
“We feel abandoned.”
In a statement, the hospital’s director of communications and engagement, Kate Eggins, said that 98 per cent of physicians had training. Additional training and support were also provided.
-----

Data breach forces medical debt collector AMCA to file for bankruptcy protection

The aftermath of the data breach seems to be too much for AMCA to bear.
By for Zero Day | | Topic: Security
US medical bill and debt collector American Medical Collection Agency (AMCA) has filed for bankruptcy protection in the aftermath of a disastrous data breach.
AMCA was hacked last year in a time period estimated to be from August 1, 2018, to March 30, 2019, resulting in the theft of information from corporate clients including Quest Diagnostics, LabCorp, BioReference Laboratories, Carecentrix, and Sunrise Laboratories.
The companies in question used AMCA's payment portal to bill their medical customers.
-----

DirectTrust Urges ONC to Build on Existing Interoperability Networks

DirectTrust suggested ONC adopt a lightweight approach to its developing TEFCA draft that builds on existing successes in the HIE marketplace.
June 20, 2019 - DirectTrust recommended ONC build on networks and frameworks within the health information exchange (HIE) marketplace that have already proven successful in the federal agency’s Trusted Exchange Framework and Common Agreement (TEFCA) in a recent comment letter.
The non-profit healthcare industry alliance urged ONC to adopt a lightweight approach to the framework, and suggested the federal agency establish the minimum conditions necessary for efficient health data exchange to occur rather than imposing strict requirements.
“While we applaud the goals of TEFCA Draft 2 to advance nationwide healthcare interoperability between existing networks,” said DirectTrust President and CEO Scott Stuewe, “we advocate for a more agile and iterative approach, which would, appropriately, tie back to the goals of Congress in the 21st Century Cures Act.”

Friday, June 28, 2019

So Much For The Idea Electronic Medical Records Improve Care Co-Ordination. Not Really Suited For That Role!

This report appeared last week:

Inquest into the death of Melissa King

Australia June 20 2019
On 14 June 2019, the Coroner's Court of New South Wales released its findings into the death of Melissa King. The circumstances of her death highlight the risks associated with the use of electronic progress notes as a means of communicating concerns about the treatment decisions made in respect of patients.
Background
Ms King was 33 years old at the time of her death at Blacktown Hospital. On Wednesday 10 August 2016, she had called the National Home Doctor Service on account of having vomiting and diarrhoea for two to three days. The service referred her to Mount Druitt Hospital from which she was transferred to Blacktown Hospital. She had a history of chronic alcohol use and malnutrition, weighing 40kg upon her admission to hospital.
At Blacktown Hospital, she was treated with fluid and electrolyte replacement and was admitted to the ICU. She was ultimately diagnosed with urinary tract sepsis, severe malnutrition with electrolyte metabolic derangements, notable low sodium and a number of other micronutrients, deranged liver function and ascites, pulmonary effusions and obstructive renal calculus diagnosed by CT. Further investigations into the cause of her symptoms were arranged. A CT scan showed bowel wall thickening which suggested inflammatory bowel disease.
In replenishing her depleted micronutrients, one consideration for her treating team was the risk of ‘re-feeding syndrome' whereby a malnourished person who starts receiving artificial refeeding is at risk of a potentially fatal shift in fluids and electrolytes. That risk was identified in the records. There was fluctuation in her response to refeeding and also in relation to her overall condition. She had periods of lucidity, deterioration, confusion and agitation. On 15 August she began complaining of ongoing abdominal discomfort. An endocrinology registrar noted that her abdomen was distended and bowel sounds were difficult to hear.
The intensive care specialist decided to transfer her to the ward. Ms King had been tachycardic for most of her admission and the endocrinology and gastroenterology teams felt that it was not safe for her to be transferred while this remained unexplained, recording their opposition to this decision in the progress notes. The specialist also altered Ms King’s calling criteria so that a review would only be triggered upon her heart rate exceeding 130 bpm. The endocrinology and gastroenterology teams were not informed of the ultimate transfer, nor of the alteration to the calling criteria.
It was intended that Ms King would have an endoscopy on 17 August. Upon admission to the ward, she began her preparation, which required her to consume a glycoprep solution. She was also reviewed by an anaesthetist trainee. The trainee identified a wheeze for which Ms King required a bronchodilator. Her oxygen saturation also dropped, and a nurse was advised to increase her oxygen supply, 3L/min via nasal prongs.
Later in the evening, Ms King told a nurse than she felt hot and cold. She was still short of breath. The nurse asked a doctor to review Ms King and that doctor asked the nurse write a note requesting the after-hours doctor to review the patient. No review followed.
Before midnight, Ms King called for a bedpan and continued drinking the grycoprep solution. At 11:58 she was found unresponsive. Cardiopulmonary resuscitation was commenced and a tracheostomy was inserted,. On 13 September at a family conference it was decided that the tracheostomy be removed and palliative care provided. Ms King passed away on 16 September.
An autopsy showed that Ms King’s cause of death was hypoxic ischaemic encephalopathy with an antecedent cause of in-hospital cardiopulmonary arrest and resuscitation. Chronic alcoholism with liver disease and malnutrition with refeeding syndrome were also seen as significant conditions contributing to the death.
Much more of the summary is here:
There is a full Coroner’s document found here:
The core paragraph is this one:
“The coroner accepted one expert’s observation that 'the electronic record is a valuable repository of information but a poor and dangerous communication tool'. In was inappropriate that the notes citing opposition to transfer were not seen and that relevant teams were not notified of the decision to transfer the patient.”
If an internal hospital system with its currency and completeness – but without special modes and tweaks to optimise communication – failed, it is easy to see just how useless the #myHR would be in a similar role. (This internal one has now been improved greatly with extra functionality added and improved usage protocols.)
You have to make sure then intended audience of any communication actually gets the message and rhe #myHR is a million miles away from being that sort of tool. Don’t believe anything the ADHA says about how great the #myHR is for care-coordination – it simply is not designed for, or suited to, that function!
David.
Postscript: It is amusing to note that the line 'the electronic record is a valuable repository of information but a poor and dangerous communication tool' came from Prof. Malcolm Fisher who, in another life, was the ICU Director and fellow ICU Specialist, with yours truly, at RNSH! Small world.
D.