EHR and Health IT Consulting
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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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Is EHR Optimization Possible? | Hospital EMR and EHR

Is EHR Optimization Possible? | Hospital EMR and EHR | EHR and Health IT Consulting |

At the Healthcare Forum Heather Haugen, PhD posited that the Promise of an Electronic Health Record (EHR) is that it “has the potential to transform healthcare by providing clinicians access to comprehensive medical information that is secure, standardized and shared.”  She then proceeded to remind us how far we have come on the journey of adoption, but that we still haven’t gotten where we need to be.  EHR is indeed a lofty goal, but we haven’t gotten there yet.

Plus, Dr. Haugen suggested that far too many people are focused on the EHR implementation and yet that’s only one milestone along the EHR journey.  In fact, she compared looking at EHR implementation numbers to talking about the number of weddings as opposed to the success of those weddings.  EHR implementations are just an event, but we continue to talk about the wedding instead of the marriage.

When you start to look at EHR as a journey, the first steps of Selecting, Building, and Installing are relatively short parts of the journey.  However, the EHR journey also includes: leadership engagement, speed to proficiency, performance metrics, and adoption sustainment.  Each of these are crucial to EHR adoption, but are much longer journeys than the initial implementation steps.

The journey of adoption is challenging, messy and dynamic and we may never actually arrive at “EHR Adoption.”   EHR adoption has a lifecycle that’s influenced by many factors including staff turnover and software upgrades.  So every organization must be prepared for ongoing education, training and engagement with their end-users to keep the EHR journey moving forward.

When considering this challenge, Dr. Haugen asked the question: Can data help us? And then she offered the following suggestions on how data can help an organization.

  • Data saves time and resources by focusing on the right patients
  • Data incents actions
  • Data removes subjectivity

As Dr. Haugen said, “Measurement has impact.”  She then offered five key measurement areas where healthcare leaders can evaluate their EHR project.  Have users:

  • Understood how the application impacts their job?
  • Understood why the application was implemented?
  • Felt that the leadership team is committed to the success of the project?
  • Felt that the organization’s leadership helped them understand what they need to do to adopt the new system?
  • Felt that communication from the leadership team helped make them feel more comfortable about the change?

Each of the above measurements is really focused on making sure an organization has user buy in for the EHR journey.  After you get past the EHR implementation stage, Dr. Haugen offered a series of other important questions you should understand and measure in order to optimize your EHR:

  • How is the application being used?
  • How are upgrades being adopted?
  • How do we overcome workarounds?
  • Who is struggling to use the new system?
  • What areas of the application are confusing and could lead to clinical errors?
  • How can we gain increased productivity?
  • Inefficient workflows – what are they and how do we change them?

Each of these questions and measurements can help an organization realize where end users could use more or better EHR education.  Dr. Haugen suggested that the best way to close any learning gaps is to offer scenario-based learning that helps end users become more knowledgeable and confident in their work.

Dr. Haugen also offered a number of other early findings from their research on the EHR journey.  First, only a small percentage of users need one on one help.  Second, software upgrades erode adoption over time and so with every upgrade you need a commensurate effort to retrain adoption.  Third, optimization is the responsibility of clinical leaders.  Fourth, users want education delivered at the time of need.  Fifth, data still lives on paper.  Sixth, there is a lot of opportunity to improve productivity through more efficient workflows.

Dr. Haugen concluded that “Feet on the street are probably not going to be how we solve the optimization challenges.  The right data could help us solve the optimization challenges.”  The right data with fast, effective and sustainable training will take us a long way on the EHR journey to a secure, standardized, and shared medical record.

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Health Data Outside the Doctor’s Office | The Health Care Blog

Health Data Outside the Doctor’s Office | The Health Care Blog | EHR and Health IT Consulting |

Health primarily happens outside the doctor’s office—playing out in the arenas where we live, learn, work and play. In fact, a minority of our overall health is the result of the health care we receive.  If we’re to have an accurate picture of health, we need more than what is currently captured in the electronic health record.

That’s why the U.S. Department of Health and Human Services (HHS) asked the distinguished JASON group to bring its considerable analytical power to bear on this problem: how to create a health information system that focuses on the health of individuals, not just the care they receive. JASON is an independent group of scientists and academics that has been advising the Federal government on matters of science and technology for over 50 years.

Why is it important to pursue this ambitious goal? There has been an explosion of data that could help with all kinds of decisions about health. Right now, though, we do not have the capability to capture and share that data with those who make decisions that impact health—including individuals, health care providers and communities.

The new report, called Data for Individual Health, builds upon the 2013 JASON report, A Robust Health Data Infrastructure.  It lays out recommendations for an infrastructure that could not only achieve interoperability among electronic health records (EHRs), but could also integrate data from all walks of life—including data from personal health devices, patient collaborative networks, social media, environmental and demographic data and genomic and other “omics” data.

This report, done in partnership with the Agency for Healthcare Research and Quality (AHRQ) and the Office of the National Coordinator for Health Information Technology (ONC) with support from the Robert Wood Johnson Foundation, comes at a pivotal time: ONC is in the process of developing a federal health IT strategic plan and a shared, nationwide interoperability roadmap, which will ensure that information can be securely shared across an emerging health IT infrastructure.

Data sharing is a critical piece of this equation. While we need infrastructure to capture and organize this data, we also need to ensure that individuals, health care professionals and community leaders can access and exchange this data, and use it to make decisions that improve health.

Initiatives like Blue Button and OpenNotes are already empowering patients and allowing them to take a more active role in their care. But giving individuals access to integrated streams of data from inside and outside the doctor’s office can increase the ways in which people engage directly in their own health and wellness.

Broadening data beyond the four walls of the doctors’ office will give health care professionals a more holistic view of their patient’s health. Sharing that data among members of the health care team will also lead to greater care coordination. Ensuring this data is used in meaningful ways will of course require training our health care workforce to a higher level of quantitative literacy.

Efforts now underway like County Health Rankings guide community leaders in setting priorities for improving health. With access to more data, communities can make faster, smarter decisions that support health—creating healthier homes, schools, workplaces and neighborhoods. For example, if a city wants to plan bike infrastructure, they could invest millions in conducting studies into where bike lanes should go, or they instead could quickly access information generated by bikers, such as Map My Ride or Strava, to see where people are actually riding.

While there are an enormous number of uses for the data that we can imagine and many more we cannot yet anticipate, it will be vitally important that we all make every effort to protect the privacy and security of these data. The report highlights numerous ways to protect the data in ways that benefit health and wellness, while also prompting accelerated innovation.

We’re excited by the potential to take this emerging data and turn it into useable information to build a Culture of Health—a nation where everyone has the opportunity to live longer, healthier lives.

Institute for Critical Infrastructure Technology's curator insight, December 8, 2014 10:13 AM

for more news on critical infrastructure see the Institute for Critical Infrastructure Technology blog