Readers Write 12/11/08

Submit your article of up to 500 words in length, subject to editing for clarity and brevity. I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

Low Cost IT Hospital Improvement Project
By Downin Katmandu, CIO

Our Information Services Department is working with our hospital’s Infection Control (IC) Department to create a system that sends a real-time, proactive notification of patients that present at hospital with chief complaints that might trigger operational or policy processes.

Due to the nature of our data collection process, specific diagnosis codes are rarely available during the admission/registration process. That being the case, we use the chief complaint as our primary data field for attempting to notify the IC department of patients that might benefit from more timely intervention by the IC staff.

The basis of our pilot study is to evaluate appropriate HL7 records and segments for keywords (keyphrases) defined by the IC department. If we find one of these words/phrases we will:

1. Send the IC department an email containing a message that does not contain patient identifiable information (PHI, re: HIPAA), but it will contain the chief compliant. The IC department can use this field to prioritize their processes.
2. Send a more descriptive file to a secure folder on the network
3. The file we send will contain the following fields:

Patient Information

Message Information: A04
Patient MRN                 
Patient Account Number        
Patient Name                
Patient DOB                
Patient Sex                 

Admission Information

Admit Source                
Chief Complaint       
Admit Date Time       
Admitting Doctor      
Attending Doctor      
Current Location            
Patient Class               

A04: Patient Registration
A01: Patient Admission

The file naming convention that we are using to store the detailed reports is Lastname-AccountNumber-ccyymmdd-hhmmss.txt.

This same system is used by the Admitting Department to receive real-time notification of incomplete registrations. Our hospital information system does not require a chief complaint during admission and registration processes, but our hospital policy states that it must be entered. We use this system to help audit compliance.

Software: MIRTH Interface Engine (www.mirthproject.org – Open Source)
Hardware: Low end PC or server
HL7 Feed: Clone from ADT Feed from HIS to Laboratory System

Keyword examples: influenza, tuberculosis, lice, pertussis, diarrhea, chlamydia, strep, pinworms, measles, blood in sputum, bloody sputum.

You Can’t Give It Away
By Catherine Huddle, VP Market Development, Sevocity

While the Big Three automakers extend their tin cups on Capitol Hill, we hear that at least one of the first four communities designated by HHS to receive Electronic Health Record (EHR) funding, Louisiana, submitted only half the applications of the 100 available $58,000 grants. So, you can’t even give EHR away?

I believe that part of the problem is that most physicians didn’t know about or understand the HHS program. Our company saw the first four community initiatives as an opportunity to get in front of physicians at the most opportune time. We sent multiple mailers and made calls to hundreds of physicians in the first four communities. What we learned:

• Mail that is not payment- or insurance-related may be ignored or lost. Less than 5% of our mail was returned, but over 80% of practice managers said they never received our mailing or couldn’t find it.
• Nearly all the office managers and physicians we talked to were unaware of the HHS program. Those who had heard about it were confused and didn’t understand the difference between the EHR program and the national HHS ePrescribing initiative.
• Trying to explain the available funding and the timing was difficult. If you review HHS’s Web site, this problem is clear — the process to obtain the funding is long and convoluted and the dollars to be expected is difficult to predict.
• Physicians do not believe they will see any material funding from HHS.

So, if physicians had a clear program that helped them fund purchase of an EHR would it make a difference? I think the answer is yes — sometimes.

Just like a tax incentive encourages a would-be home owner to become a home buyer, I believe that clear, timely payments for EHR adoption would incent the physicians interested in EHR to go ahead buy EHR. Funding is such a clear motivator for the group already interested that I think it helps explain why our company is achieving record sales in a very weak economy.

The new customers I talk with tell me they purchased after months or years of looking because our solution is CCHIT-certified/complete, but only requires a small down payment and ongoing monthly payments. Their risk is minimized because their personal investment is minimized.

While there is a segment of physicians that is already motivated to buy EHR and will do so with some clear achievable financial assistance, I believe there is another segment that wouldn’t implement EHR if you gave it to them – right now. This is the segment that is downright terrified of implementing EHR. They have read and heard the horror stories of six-figure EHRs that sit unused. They are concerned the EHR will slow them down, knowing their productivity is the lifeblood of their income.

As EHRs evolve, physicians experience the benefits, and EHR vendors improve, I believe this will gradually change. As vendors, it is up to us to make this happen. We must listen to our potential customers and design affordable and easy-to-use systems.

Low Cost IT Hospital Improvement Project
By Julie

Having worked in healthcare for 20+ years in both the hospital and vendor settings, I see many opportunities for low cost IT projects. Many in the hospital setting are not utilizing the power of the Intranet to provide Web-based access to policy and procedure manuals, the automation of manual calculations (e.g. heparin protocols), and the use of paging/text messaging. Many other types of info (links to emedicine, Medline, etc) could be of great help if provided at the clinicians desktop in an easy to use format.

CEO-Express provides a desktop application that I’ve used for years both personally and in business. The generic MD-Express has potential as well, if taken private label and customized. I have no financial ties to the company, but have found it extremely useful.

Access to well-written, searchable policies and procedures is critical, with staff members (both nursing and ancillary) frequently being forced to float due to variations in patient populations and workloads. Also, with the diversity among providers today, communication can be hampered by regional and international accents and dialects. Text-based paging/messaging can be a non-obtrusive method of improving communication.

Having worked for Cerner and seeing real and planned “bleeding edge” technology only to return to a severely challenged community hospital has been extremely frustrating. Financial limitations and the staff’s lack of exposure to or fear of even 20th century technology are disturbing. And to think this organization is not that physically distant from both Partners and BIDMC is amazing! While expert rules firing off text messages to communicate critical values to providers is technology available to some, there have to be workarounds for financially challenged organizations.

Some things to think about: while most people choose a hospital perceived or documented to be the best, most progressive, well-staffed, or well-funded, the reality is that if you or a loved one is involved in an accident or suddenly falls ill, you may not have the choice of where you go for care. The nearest hospital becomes your best or only chance for survival. If that hospital is severely challenged in any way, you or your loved one may not make it. Transport to another hospital depends upon the patient’s stability. For those without the clinical knowledge and understanding to evaluate the limitations of a facility and where the best care would be for a particular condition, you are at the mercy of whoever is providing care.