The RAND Corporation Offers A View Of the Future Of Health IT. We Need To Work At It.

This appeared a little while ago.

The Delayed Promise of Health-Care IT

• by
• Arthur L. Kellermann,
• Spencer S. Jones

February 26, 2013

Because information technology (IT) has so quickly transformed people's daily lives, we tend to forget how much things have changed from the not-so-distant past. Today, millions of people around the world regularly shop online; download entire movies, books, and other media onto wireless devices; bank at ATMs wherever they choose; and self-book entire trips and check themselves in at airports electronically.

But there is one sector of our lives where adoption of information technology has lagged conspicuously: health care.

Some parts of the world are doing better than others in this respect. Researchers from the Commonwealth Fund recently reported that some high-income countries, including the United Kingdom, Australia, and New Zealand, have made great strides in encouraging the use of electronic medical records (EMR) among primary-care physicians. Indeed, in those countries, the practice is now nearly universal. Yet some other high-income countries, such as the United States and Canada, are not keeping up. EMR usage in America, the home of Apple and Google, stands at only 69%.

The situation in the US is particularly glaring, given that health care accounts for a bigger share of GDP than manufacturing, retail, finance, or insurance. Moreover, most health IT systems in use in America today are designed primarily to facilitate efficient billing, rather than efficient care, putting the business interests of hospitals and clinics ahead of the needs of doctors and patients. That is why many Americans can easily go online and check the health of their bank account, but cannot check the results of their most recent lab work.

Another difference between IT in US health care and in other industries is the former's lack of interoperability. In other words, a hospital's IT system often cannot “talk” to others. Even hospitals that are part of the same system sometimes struggle to share patient information.

As a result, today's health IT systems act more like a “frequent flyer card” designed to enforce customer loyalty to a particular hospital, rather than an “ATM card” that enables you and your doctor to access your health information whenever and wherever needed. Ordinarily, lack of interoperability is an irritating inconvenience. In a medical emergency, it can impose life-threatening delays in care.

A third way that health IT in America differs from consumer IT is usability. The design of most consumer Web sites is so obvious that one needs no instructions to use them. Within minutes, a seven year old can teach herself to play a complex game on an iPad.

But a newly hired neurosurgeon with 27 years of education may have to read a thick user manual, attend tedious classes, and accept periodic tutoring from a “change champion” to master the various steps required to use his hospital's IT system. Not surprisingly, despite its theoretical benefits, health IT has few fans among health-care providers. In fact, many complain that it slows them down.

Lots more here:

http://www.rand.org/blog/2013/02/the-delayed-promise-of-health-care-it.html

Especially as we consider what the next Health IT Strategy should look like we need to consider both the scale of the problem and the urgent need to address it for all our sakes.

A good summary of the problem.

David.

The Issue Of Health IT Safety Seems To Be Getting More and More Coverage. A Good Thing I Think.

This appeared a little while ago.

Ways EHRs can lead to unintended safety problems

Wrong records and failures in data transfer impede physicians and harm patients, according to an analysis of health technology incidents.

By Kevin B. O'Reilly, amednews staff. Posted Feb. 25, 2013.

In spring 2012, a surgeon tried to electronically access a patient’s radiology study in the operating room but the computer would show only a blue screen. The patient’s time under anesthesia was extended while OR staff struggled to get the display to function properly.

That is just one example of 171 health information technology-related problems reported during a nine-week period to the ECRI Institute PSO, a patient safety organization in Plymouth Meeting, Pa., that works with health systems and hospital associations in Kentucky, Michigan, Ohio, Tennessee and elsewhere to analyze and prevent adverse events.

Eight of the incidents reported involved patient harm, and three may have contributed to patient deaths, said the institute’s 48-page report, first made privately available to the PSO’s members and partners in December 2012. The report, shared with American Medical News in February, highlights how the health IT systems meant to make care safer and more efficient can sometimes expose patients to harm.

The institute’s report did not rate whether electronic systems were any less safe than the paper records they replaced. The report is intended to alert hospitals and health systems to the unintended consequences of electronic health records.

The leading cause of problems was general malfunctions, responsible for 29% of incidents. For example, following a consultation about a patient’s wounds, a nurse at one hospital tried to enter instructions in the electronic record, but the system would not allow the nurse to type more than five characters in the comment field. Other times, medication label scanning functions failed, or an error message was incorrectly displayed every time a particular drug was ordered. One system failed to issue an alert when a pregnancy test was ordered for a male patient.

A quarter of incidents were related to data output problems, such as retrieving the wrong patient record because the system does not ask the user to validate the patient identity before proceeding. This kind of problem led to incorrect medication orders and in one case an unnecessary chest x-ray. Twenty-four percent of incidents were linked to data-input mistakes. For example, one nurse recorded blood glucose results for the wrong patient due to typing the incorrect patient identification number to access the record.

Most of remaining event reports were related to data-transfer failures, such as a case where a physician’s order to stop anticoagulant medication did not properly transfer to the pharmacy system. The patient received eight extra doses of the medication before it was stopped.

It is not enough for physicians and other health care leaders to shop carefully for IT systems, the report said. Ensuring that systems such as computerized physician order entry and electronic health records work safely has to be a continuing concern, said Karen P. Zimmer, MD, MPH, medical director of the ECRI Institute PSO.

“Minimizing the unintended consequences of health IT systems and maximizing the poten­tial of health IT to improve patient safety should be an ongoing focus of every health care organization,” she said.

The report recommends that hospitals and clinics conduct extensive tests before using a new electronic system in patient care. They also should incorporate interfaces designed to prevent errors. For example, an interface should not allow alphabetic characters in numeric entry fields. To prevent wrong-record retrievals, systems should require validation of a patient’s identity, such as the patient’s initials, gender and age, before the electronic record is opened.

Rise in EHR safety reports

The institute’s findings are just the latest to draw attention to the safety problems posed by health IT systems, such as EHRs. A December 2012 Pennsylvania Patient Safety Authority study found that the number of EHR-related adverse events reported to the authority doubled in just one year, from 555 in 2010 to 1,142 in 2011. A study in February’s Critical Care Medicine showed that three-quarters of physicians’ progress notes for intensive care patients were copy-and-pasted, a practice dubbed “sloppy and paste” that experts say can lead to mistakes in care.

Lots more here:

http://www.ama-assn.org/amednews/2013/02/25/prsa0225.htm

This article reports a very important study that reveals that when considering the overall Health IT cost/benefit framework we need to consider both the safety of the technology as well as considering whether the Health IT actually works.

Another take on all this can be found here:

http://hcrenewal.blogspot.com.au/2013/03/jamia-reduction-in-medication-errors-in.html

This post review the good claimed from CPOE as well as the potential harm that may be noticed.

Well worth a read. All this is making it quite difficult to find clarity - with a firm evidence base - anywhere. More work and better studies are clearly needed.

To quote the end of the blog from Scot Silverstein:

“Thus, I agree with the author's conclusion (especially in view of the recent and direct-reporting ECRI PSO study) that "future research in this area will be critically important to inform policy and funding decisions regarding the development and implementation of CPOE in care delivery."

From a clinical perspective, "primum non nocere" and the avoidance of gambling billions of dollars applies, at least until a better understanding of the technology's risk/benefit ratio and how to improve it occurs.

A fraction of those billions would pay for more robust, current studies on the scale needed to get closer to the truth.”

David.

Now This Is Getting Really Silly. I Think Someone Is Rather Out Of Their Depth.

This appeared yesterday.

Guy Sebastian caught out by stalled patent probe

• by: Fran Foo
• From: The Australian
• March 12, 2013 12:00AM

SINGER Guy Sebastian has weighed in on allegations of patent infringement by the Gillard government's National E-Health Transition Authority.

MMRGlobal, the US firm investigating NEHTA for alleged patent infringements, was in talks with Sebastian's management team to fund his planned charitable foundation.

However, discussions have hit a roadblock pending the outcome of the probe, which has been delayed by NEHTA's silence.

"As a recording artist I understand the importance of being able to protect my intellectual property from being pirated around the world," Sebastian said.

In reference to the number of patents under MMR's belt, he added: "What kind of example do we set when our own government ignores intellectual property, including a company's patents already on file in 13 other countries?"

Early last month, MyMedicalRecords.com, a subsidiary of MMRGlobal, claimed that "both state and federal governments in Australia, through NEHTA, appear to be infringing on patents and other intellectual property issued to MyMedicalRecords.com".

As reported on March 5 in The Australian, MMR's investigation into the matter has been stymied by NEHTA's lack of follow-up communication.

Lots more here:

http://www.theaustralian.com.au/australian-it/government/guy-sebastian-caught-out-by-stalled-patent-probe/story-fn4htb9o-1226594987626

To me the issue here is that none of these claims have been tested in any Australian tribunal or court and until they are frankly no one is really sure just what rights - if any - the two Australian Patents claimed by MMRGlobal.

Claiming IP ownership on a broad concept such as the Personal Health Record it very different to claiming IP ownership on an original song I believe.

I think intervention in this case by a popular entertainer is really rather sad and ill-informed.

However I do also think that the Government, DoHA and NEHTA need to promptly address these claims. Just letting it all drift on with no public comment seems to indicate they are concerned about these claims. I hope that is not true and believe that our concerns should be promptly and officially allayed.

David.