Giving a patient medications in the ER, having them pop positive on a test, and then withholding further medications because…
Readers Write 5/10/10
Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!
Thoughts About athenahealth
By Deborah Peel, MD
Another misguided, uninformed EHR vendor will discount the price of EHR software for doctors willing to sell their patients’ data!
How is it possible to be so unaware of what the public wants? The public doesn’t want anything new or earth-shattering, just the restoration of the right to control who can see and use their medical records in electronic systems.
Not only is the practice of selling your patient’s data illegal and unethical, but the new protections in the stimulus bill require that patients give informed consent before their protected health information can be sold. So selling patient data without consent is now a federal crime.
Quotes from the story:
- athena’s EHR customers who opt to share their patients’ data with other providers would pay a discounted rate to use athena’s health record software.
- athena would be able to make money with the patient data by charging, say, a hospital a small fee to access a patient’s insurance and medical information from athena’s network.
- Caritas Christi [Health Care] initially launched athena’s billing software and service in October and then revealed in January that it decided to offer the company’s EHR to physicians.
- How many patients would agree to sell their health records to help their doctor’s bottom line AND at the same time put their jobs, credit, and insurability at risk?
Health information is an extremely valuable commodity, so people are always thinking of new ways to use it.
What will athena’s informed consent for the sale of health patients health data looks like? Will athena lay out all the risks of harm? Will athena lay out the fact that once the personal health data is sold, the buyer can resell it endless to even more users? Will athena caution patients that once privacy is lost or SOLD, it can never be restored?
I guess some people are so out of it they do not realize what a barrier the lack of privacy and lack of trust is to healthcare. HHS reports 600,000 people a year refuse to get early diagnosis and treatment for cancer because they know the information won’t stay private. Another 2,000,000 refuse early diagnosis and treatment for mental illness for the same reasons.
Check out slides from a recent conference at the UT McCombs Business School on the subject of patient expectations, privacy and consent.
Deborah C. Peel, MD is a practicing physician and the founder of Patient Privacy Rights.
Thoughts About athenahealth
By Truth Seeker
Um, I think we need to settle down here, folks. I may be wrong, but I believe when athena refers to athenaCommunity and the exchange of information, they are referring to the following hypothetical scenario:
A patient whose primary physician is an athena customer needs to be admitted to the hospital. athena delivers to that hospital a clean, clinically accurate, and up-to-date record of that patient’s medical history and charges the hospital a few bucks. athena is able to charge the primary care physician a lower fee for their EMR service because they are shifting some of the financial burden to the hospital. And intuitively, this make sense for a couple reasons:
The push towards electronic medical records is to enable greater exchange of information and better coordination of care, etc So when athena talks about athenaCommunity, I’m fairly certain that they’re not talking about a sinister plot to share info with hospitals so they can refuse to admit high-risk or expensive patients. (Seriously, the conclusions people draw from articles like this without doing their homework can be completely ridiculous, but I suppose that casting baseless aspersions is just the nature of informed discussion in the Internet era.)
They’re just talking about handing the patient over to another provider and making sure that the new provider has a completely accurate and up-to-date record of that patient’s medical history, and of shifting the financial burden from the handover away from the primary care physician. What a "privacy disaster" … a sheer outrage!
And second, I’m no healthcare economist, but I’m pretty sure that a) the hospital really wants and needs that patient’s medical history and that athena is probably better positioned to deliver it in a more useful format than a lot of their competitors; and b) it’s probably worth a lot more to the hospital than a few bucks.
I’m not an athena employee or other stakeholder, but I do think that they continue to think of innovative new solutions to problems, bottlenecks, and inefficiencies in the healthcare system. Unfortunately, they seem to have a bulls eye on their backs right now. I for one am happy that we have smart people like Jonathan Bush out there coming up with creative new solutions.
Why Emergency Physicians Prefer Best-of-Breed IT Systems
By John Fontanetta, MD, FACEP
According to a recent report from KLAS, some hospitals are replacing standalone, best-of-breed (BoB) emergency department information systems (EDIS) with enterprise solutions that are leaving ED clinicians — and often their patients — unsatisfied. Why unsatisfied? Because the clinical functionality in enterprise solutions is both less comprehensive and less efficient for the ED environment and they are just so hard to use.
This report has re-energized the debate over the benefits of the two kinds of systems. IT professionals prefer the seamless interoperability supposedly offered by single systems, but the fact is that many large vendors have simply bought and shoehorned in a separate ED system. The resulting systems have their own interface issues.
Like many of my fellow ED physicians, I have found that a first-class BoB system tailored specifically to the needs of the ED, in our case EDIMS, offers a number of advantages. For example:
- Workflow in the ED is measured in seconds and minutes rather than hours or days. The fewer clicks required, the faster the care. At Clara Maass Medical Center, we can issue complete sets of orders in as few as three clicks, enabling our physicians to be more productive.
- Trying to retrofit an inpatient IT system to the ED is difficult because the ED is just so different from the floors. Customized ED order sets with a linked charge capture system means less delay between treatment and billing, not to mention a more accurate capture of charges, which has dramatically increased our per-patient revenue.
- In the same way, customized alerts that tell the ED staff what they’re forgetting to document cuts back on the number of claims denied due to missing or inaccurate information. At Clara Maass, we have slashed such denials by 75%.
One of the most important things about a good ED system vendor is responsiveness. The vendor should be able to quickly accommodate the ongoing changes in standards and regulations. For example, at Clara Maass, when the H1N1 virus first appeared in 2009, we had templates for recommended care and discharge instructions built into our system by our BoB vendor within 24 hours. And when we decided to create an observation area, they promptly responded with observation-specific templates and order sets and created a secondary note option for the observation physicians.
The EMR system has enabled us to make a number of other improvements in our ED. For example, we have reduced the average patient turnaround time by over 30%. We have boosted the number of EKGs we perform within five minutes of a patient coming through the door from 46% to more than 90%.
Overall, my specialty has been slow to adopt EHRs, not because we don’t see their importance, but because they have a reputation for being unwieldy and unresponsive to the requirements of the ED. With more and more EDs adopting BoB systems that are designed to support ED clinicians’ intricate and demanding workflows, physicians are starting to realize that an EHR can actually be an advantage in our fast-paced environment, rather than a burden.
CIOs are finding that these BoB systems can offer the same, if not better, integration capabilities than a single, enterprise solution. While many of the HIS vendors are inflexible when it comes to working with other systems, BoB systems have always had to offer integration solutions and many pride themselves on their ability to integrate with almost any system.
John Fontanetta MD, FACEP, is chairman of the department of emergency medicine at Clara Maass Medical Center, Belleville, NJ and chief medical officer of EDIMS.
Digging for Gold in your HIT Applications
By Ron Olsen
Over the past few years, hospitals have focused IT budgets and resources on purchasing applications to enhance their HIS. Many facilities have spent tens or hundreds of thousands — millions for the larger hospitals — on licensing, maintenance, and ongoing professional services.
In the feeding frenzy to continually acquire and implement the latest healthcare information technology, most IT/IS teams are neglecting to ask basic but important questions about their existing applications, such as:
- Are we using the software to its fullest extent?
- Have we turned on every feature we’re currently licensed for?
- Are HIT products meeting the needs we identified when planning the deployment?
- Have we asked users what they’d like to see added to the product, and if so, has that been communicated to the vendor so they can include it in a future version?
Asking questions does not cost anything and end users are usually very vocal about what they’d really like to see software do for them. Their invaluable real-world input is useless if there’s no feedback mechanism, or if your team refuses to incorporate it into product roadmap discussions with vendors.
In a time in which hospitals’ funds are tighter and IT budgets frozen or cut, it’s time to double back and review what products you have purchased and their capabilities. Maybe re-present the product to different areas of the facility explaining existing functionality again, and introducing new features that have been added since the initial implementation. Now that the users have gotten a refresher, they may identify functionality that was not implemented initially and would now prove useful.
Healthcare technology vendors are always eager to showcase new features and theoretical uses for these at sales presentations, but IT/IS admins often overlook “hidden gems” in the software that other hospitals are actually using. If the vendor has a user group, listservs, or an online forum, these are great places to start, not to mention that they cost nothing and consume very little time.
These collaborative tools may enable your team to discover other use cases that even your vendors have not thought of. There are a lot of people in the healthcare IT trenches creating workarounds every day. There may be capabilities within current products to join with other systems within your tool bag to create a new or improved process that is, again, a freebie.
One of the most over-used buzz words in healthcare IT is “interoperability,” a is really a big word that self-important people use to describe data transfer. When thinking about data transfer at a basic level, almost every HIT product can output to a printer. A printer can be easily set up to print to a file. So now you have data in a file format.
Scripting tools can manipulate those files, turning them into almost any format imaginable. With the correct format, data can be transferred to disparate systems, individually or concurrently, via a data stream. This could be a raw text file, compressed zip file, encrypted e-mail file, FTP, or an HL7 file.
This method is easily applied to an enterprise forms management system. If it has a decision engine, you could print a form set from it and then have the engine input the data to a database for audit trails (you should be able to choose the data points). Next, the engine sends the data to a file and launches an application to text the ordering physician that the patient just presented, based on the data in the text file.
If you’re a budget-conscious healthcare IT professional who wants to better meet the needs of your user community, I implore you to take another look at the systems you’re already working with. In my many years as a system admin at a community hospital, getting more out of the tools available to me (instead of just relying on new purchases) helped me deliver more effective tech solutions to my users, positively impact patient service, and keep decision makers happy by saving money.
You, too, have gold nuggets hidden in your existing software. It’s up to you to find and use them.
Ron Olsen is a product specialist with Access.
What a great juxtaposition of views on athenahealth (and yes, I actually use words like juxtaposition naturally; it’s the part of me that double-majored in English). While the online community certainly has a tendency to leap onto details and blow them up, I’m not quite as convinced as the anonymous Truth Seeker that the concerns over this program are much ado about nothing; rather, I think many want to ensure that unlike King Lear, we can weigh the good from the bad in the world of HIT.
Privacy is a very real concern, as evidenced by Dr. Peel’s and many other’s anecdotal evidence of people attempting in destructive ways to protect their sensitive information. Finding the balance between these concerns and the need for greater data transfer (as Ron Olsen would call it) is part of the reason the various HHS work groups are still trying to hash out meaningful use.
Speaking of Mr. Olsen, thank you so much for this refreshing bit of common sense. I’m continually learning new features of software I use every day, ones that maybe I didn’t need before or simply overlooked. Innovation does not necessarily mean reinventing the wheel, but instead saying, “Hmm, that’s a cool wheel; maybe if it wasn’t stone, maybe if it had rubber, what if I attached it to something else and rode it?” Finding the best path is often a matter of honestly asking the right questions, whose answers may not necessarily be where we think they will.
I find Dr.Fontanetta’s comments very self serving since he is a corporate officer of a best of breed ED vendor. There are many single vendor solution vendors that have excellent ED clinical modules that do the same thing as EDIMS. The benefit of a good single vendor approach is the integration. The inpatient nursing unit or ICU will have instant and complete access to the ED record before the patient arrives on the floor. No more incomplete records, no more redundant data entry. This is very important when more and more inpatient admissions are generated from the ED.
Thoughts About Athenahealth
Every conversation about HIE or any other health care information exchange starts and ends with privacy. What many including Dr Peel fail to realize is that every person in the discussion is concerned about the privacy dilemma. Everyone involved agrees that we have to solve the privacy problem. Physicians and providers do not have a monopoly the concern for privacy. After all we will all ultimately be patients at some point in our lives.
What is concerning about the Athenaheath scenario is not the actual sharing of data but that it is an insurance company that is doing the sharing.
Why Emergency Physicians Prefer Best-of-Breed IT Systems
Every clinical environment things that their process is so special that they have to have their own system and can not possibly use the “enterprise systems.” This leads to silo-ed data, incomplete medical information, and in the worst cases medical errors. Until all vendors implement standards based non-proprietary databases and give customers full access to their data organizations a with best of breed philosophy are going to have increasing problems duplicate data entry, data reconciliation, and out of sync data.
The title of this article should be ” Why All Physicians Prefer their Own IT Systems.”
Both articles written by physicians are myopically focus on their world and have little or no regard for the continuum of care. Dr Peel article has little regard for the physician in the ED, ICU, or Pre-Operative Nurse. Similarly Dr Fontanetta fails to appropriate the needs of the clinicians in PreOp or ICU. Both exhibit what I call the pull up the ladder I’m aboard attitude toward Heathcare Information Systems.
Good comments Marc, but I have to go along with Dr Fontanetta on this one. A single vendor simply does not have enough resources to have the best, good or sometimes even adequate solution for all clinical areas. That is why most of them have acquired companies with focused solutions with better functionality to fill out their portfolio offering. If an EMR vendor does this type of acquisition then they have the same integration challenges as standalone vendors. Case in point would be McKesson, GE, Cerner, etc.
BoB solutions must have robust integration capabilities or they will not survive. They rely on being able to capture data and pass it to and accept it from other apps such as LIS, Pharmacy, Billing, Scheduling, EMR, etc. typically via the HL7 standard (it’s the best we have). Areas such as the ED and the OR, particularly anesthesia, are considered the “last mile” of electronic documentation and those areas are driven by BoB vendors that focused solely on that workflow.
My experience has been that if you want to see the best workflow and most complete documentation for acute care then look at the BoB vendors. Their products will force the large EMR vendors to say “we can do that too”. The problem is that it may take them a couple of years to focus resources to develop it and by then the BoB vendors has solved another problem or added another feature. Always playing catch up until the EMR vendor buys the BoB vendor, destroys the culture, looses the inventive staff and looks for the next acquisition target.
The circle of entrepreneurial life…
EDIS or EIS?
Single vendor versus Best of Breed….now there’s a debate that is as old as the Rockies.
Here’s another view. Several years ago there was a very good article in CIO magazine that asked what is the role of the CIO these days since many IT shops (almost all in healthcare) do not develop systems, they purchase them. Since the CIO’s role has morphed into a high powered purchasing agent, or contract administrator where should his/her primary focus be?
The thrust of the article was that the primary role for the CIO is to focus on integration, buying the best systems they could find and making sure they work together. And as we all know that is not an easy task. Getting multiple vendors to play nice together is a real challenge. So to make his /her life easier and avoid all the integration hassles the CIO (with backing usually from the CFO) goes for the ‘less work for Mother’ solution – single vendor.
When the CIO takes that position they ignore the fact that the only reason there is an IT department is to serve our customers – the operating departments. Yet, they are willing to sacrifice department capability for less integration hassles.
Unfortunately the ‘C’ level folks prefer it that way, and more importantly, the BoBs and their end users do not know how to make their case to upper management. Simply arguing the SV is not as good as the BoB is a empty argument easily brushed off.
A key point is that often times, the IT department doesn’t listen to the clinical end users. The institution has spent tens of millions of dollars on a single vendor who supposedly has “included” this specific functionality but it just hasn’t been a priority to build out yet. So the institution requires the clinical departments to wait until we get to that piece when in fact it doesn’t exist.
The clinicians have limited input and hence no buy in so they are not committed to success.
The single vendors have created such a fear of integration that IT staffs and leaders are petrified to even approach the effort. The IT staffs should force vendors to play nice. It is their $$ that vendors are vying for. They should realize that “they have the power!” just as Jim Carey did in Bruce Almighty.
“A key point is that often times, the IT department doesn’t listen to the clinical end users”
IMHO – it doesn’t matter that IT does not listen to clinical users – the users need to get the CEO/COO to listen. That’s who the CIO listens to. How do you get the department users to get the attention of the CEO/COO? Stop talking about functions and features, and talk about impact on ROI, and regs, and liability…
If department users can’t do that, the CIO will win every time.
I assume that the aethenaHealth debate was ignited from some recent article? Some links would have been helpful to let me count hyperboles.
(I’m an engineer and avoided English classes. I never use the word hyperbole, my computer suggested it).
Neo, Let’s agree to disagree. But, I think it would be safe to assume that most non-Level 1 trauma or academic medical center EDs could exist very nicely on a single vendor solution that is seamlessly integrated into the EMR. The incremental clinical/operational benefit that a BOB would potentially provide could not be justified by the additional license or ongoing maintenance fees that would be incurred when compared to a good single vendor ED solution–emphasis on good.
Community hospitals do not have the IT staff to burn on figuring out interface engines and HL7 connections. HL7 was supposed to be the great leveler, a vanilla solution. Yeah sure, in what universe? If HL7 is so easy, why do hospitals and vendors have so many interface issues? How many different variations are there on vanilla? A lot.
Maybe we should ask Dr. Fontanetta how many interfaces (let alone integrations) between his system and the EMR has he developed for EDIMS? Does EDIMS pass ED generated drug orders, allergy information or physician documentation to an EMR. I will bet you a buck that they don’t offer that.
Re: Juxtaposing Hyperbole — Michelle W and Jedi Knight shore talks real purdy with them big, fancy words.
So do Deborah Peel and Jonathan Bush. I’ve had the pleasure of talking with and/or hearing them speak publicly on numerous occasions. Both are extremely articulate and exquisitely passionate. Both seem bent upon “doing the right thing” for the healthcare world. Both are intellectual heavyweights.
Maybe a little boxing match…er…healthy debate would help the Privacy vs. Data Sharing conversation. Maybe Mr. H would consider stepping into the ring…er…forum as referee…er…moderator. Bet it’d be a great fight…er…discussion.
Marc, good question regarding ED interfaces for Dr. Fontanetta. Hopefully he is reading.
Although other industries seem to have been able to incorporate workable solutions for data transfer exchanges (banking ATMs come to mind) it continues to be a struggle for healthcare. The fear of problematic integrations, finger pointing (who’s problem is is?) and the IT Vendor’s strength and control over their customers are all aspects adding to the chanllenge.
ED is the department that has spawned this discussion but as I mentioned earlier, anesthesia documentation is right on ED’s heels. With only 10% of the market penetrated there is going to be big push to move anesthesia care to an electronic charting solution. Some vendors (Meditech) have told their customers that they do not have a solution and there is not one on their roadmap so that creates an integration opportunity for single vendors, their clients and BoBs.
HIT – as you mentioned earlier – if you have a good solution, word will get out and you have the opportunity to be succesful. But then you have to deliver…
RE: HL7… stating that HL7 solves interoperability issues is like declaring that off-shore drilling is perfectly safe; How’s THAT working for you?? Until we have data normalization resolved (e.g. with SNOMED, Drug Data banks, Med Reconcilliation, etc), we will just be sending “blobs” of data across the wires, instead of discrete data. I work in an organization with 3 EHRs, 3 Practice Management systems, and multiple BoBs (ED, OR, Transplant, Endoscopy, etc.) Trust me, our biggest nightmare has been interoperability (and believe me, every Physician knows that word). Try telling your EHR vendors that they should send OUT normalized data… they all believe that they are the “truth” and should only be receiving data, not sending it…
I realize that Data Warehouses and BI will help us normalize our data, but for most of us, Clinical data warehouses are not much more than a pipe dream. The emphasis for years has only been on financial data warehouses.
I’m just sayin’