Electronic Health Records chicken soup or rotten egg?

Daniel J. Vreeman, PT, DPT, MSc Assistant Research Professor, Indiana University School of Medicine

Research Scientist, Regenstrief Institute, Inc

Continuing Education Course for Gentiva Home Health

03.29.2012 © 2012 dvreeman@regenstrief.org

Overview

1.  Welcome to the future 2.  Convergence of forces 3.  Computer + Human > Human

photo via Vernio77

Objectives When it’s all said and done, you’ll be able to…

1.  Explain the current forces promoting adoption of information technology

2.  Appreciate the kinds of problems that can be improved with more judicious use of health information technology

3.  Discuss the key factors for success, as well as important barriers to implementing electronic health record systems in rehabilitation

4.  Articulate at least one way that you could use health information technology to improve care

The Future Great Scott!

Complete, longitudinal information that follows the consumer

Care that is value-based and coordinated across settings

photos via meddygarnet and brykmantra

Health decisions made with information tools that assist and guide

Have you considered…

Results Fewer errors, waste, variations Consumer-centered care Lower spending

Meanwhile, back on planet Earth…

Patients move faster and further than their health information

Growing Recognition

1960’s •  1st studies of

computers in healthcare

1991 •  IOM says

EHR’s are essential

2003 • HHS promotes

widespread use of HIT

2004 •  Pres. Bush

makes HIT a top national priority

2004+ •  Flurry of

federal activity

2009 •  ARRA has $20

billion for HIT adoption

e "rst priority in realizing the bene"ts of health IT is to achieve nationwide adoption of EHRs and widespread information exchange.

“

CMS EHR Incentive Program

a.k.a. “Meaningful Use”

EHR “Meaningful Use” Reimbursement incentives for eligible providers who become “meaningful users” of certified EHR technology

EHR “Meaningful Use” OTs, PTs, SLPs are NOT eligible providers

“Meaningful Use” drug-drug checks structured lab results in your EHR clinical decision support exchange key clinical info report on quality measures

Electronic Health Records Opportunities and Challenges

Show me the data!

8 Core EHR Functions

Results Orders

Decision Support

Communication Patient support

Administrative

Population Health

An EHR is a suite of applications. WAY more than just electronic documentation.

photo via nosha McDonald et al. Canopy Computing: using the Web in Clinical Practice. JAMA. 1998;280(15):1325-1329.

Only way to corral the infinite indiosyncracies

is with standards.

photo via pfarrell95

Data standards are like telephones. They require a critical mass of users before they become useful.

photo via iboy_daniel

- Clem McDonald, MD 1998

A Unified Patient Record

41% of ED visits are for patients with

data at another institution

Finnell JT, Overhage JM, Grannis SJ. All Health Care is Not Local: An Evaluation of the Distribution of Emergency Department Care Delivered in Indiana. AMIA Annu Symp Proc. 2011;:409-416.

Connectedness among IN EDs

Finnell JT, Overhage JM, Grannis SJ. All Health Care is Not Local: An Evaluation of the Distribution of Emergency Department Care Delivered in Indiana. AMIA Annu Symp Proc. 2011;:409-416.

Nearly every ED in IN shares

patients with every other ED

in the state.

photo via Rob Pongsajapan

Do therapists today really use

EHRs? good question…

APTA 2010 Member Survey

28%

33%

38%

1%

Got EHR?

Yes, all electronic Yes, part paper, part electronic No

Don't know

ASHA SLP Health Care Survey 2011 Private Practice Owners and Independent Contractors Report

21%

24% 55%

Use an EHR?

Always Sometimes Never

APTA 2010 Member Survey

Very dissatisfied

Dissatisfied

Neither satisfied nor dissatisfied

Satisfied

Very satisfied

0 10 20 30 40 50 60

EHR Satisfaction

Most common complaint?

anecdotal

4 Ways EHRs can Help Accelerate that Vision Seamless web of data Data reuse Cost savings Decision support

photo via OiMax

practice management, quality reporting, accreditation, public health, research…

Collect once. Use many.

Healthcare is an information business. e quality, effectiveness, and efficiency of care depend on our ability to manage information. You just can't do it without EHRs.

Bill Tierney, AMIA 2011 Keynote

“

photo via Refracted Moments™

Cost

Healthcare spending as % of GDP

U.S.

graph via incidentaleconomist.com

The Great American

Rip-Off

graph via andrew sullivan at the atlantic

EHRs = lower cost

Really???

Cost Savings

$78 billion net savings at national level1

$3 billion net gain at the VA2

$4.5 billion annual net value in New York state3

1.  Walker J, Pan E, Johnston D, Adler-Milstein J, Bates DW, Middleton B. The value of health care information exchange and interoperability. Health Aff (Millwood). 2005 Jan-Jun;Suppl Web Exclusives:W5-10-W5-18. PMID: 15659453

2.  Byrne CM, Mercincavage LM, Pan EC, Vincent AG, Johnston DS, Middleton B. The value from investments in health information technology at the U.S. Department of Veterans Affairs. Health Aff (Millwood). 2010 Apr;29(4):629-38. PMID: 20368592

3.  Hook JM, Pan E, Adler-Milstein J, Bu D, Walker J. The value of healthcare information exchange and interoperability in New York state. AMIA Annu Symp Proc. 2006:953. PMID: 1723857

Clinical Decision Making Right info. Right time. Right format.

Evidence-based Practice

Everyone wants it. Nobody has time.

(so they say)

patients + evidence + clinical expertise

Jette DU, Bacon K, et al. Evidence-based practice: beliefs, attitudes, knowledge, and behaviors of physical therapists. Phys Ther. 2003;83(9):786-805.

How can EHRs help? Tools to help implement EBP at the point of care.

myEBP

EHR Decision Support A computer-generated suggestion about care for an individual patient

me

photo via IdS Kho AN, Dexter PR, Warvel JS, et al. An effective computerized reminder for contact isolation of patients colonized or infected with resistant organisms. Int J Med Inform. 2008;77:194-198.

REMINDER Isolate this patient infected with a resistant organism!

photo via IdS

Improved isolation rate from 33% to 89%

Kho AN, Dexter PR, Warvel JS, et al. An effective computerized reminder for contact isolation of patients colonized or infected with resistant organisms. Int J Med Inform. 2008;77:194-198.

REMINDER Isolate this patient infected with a resistant organism!

photo via IdS

Decreased median time for isolation orders written from 16.6 to 0.0 hours

Kho AN, Dexter PR, Warvel JS, et al. An effective computerized reminder for contact isolation of patients colonized or infected with resistant organisms. Int J Med Inform. 2008;77:194-198.

REMINDER Isolate this patient infected with a resistant organism!

photo via IdS

Even better when data is shared across institutions.

Kho AN, Lemmon L, Dexter PR, Doebbeling B. An operational citywide electronic infection control network: Results from the first year. AMIA Annu Symp Proc. 2008:1222.

Kho AN, Lemmon L, Commiskey M, Wilson SJ, McDonald CJ. Use of a regional health information exchange to detect crossover of patients with MRSA between urban hospitals. J Am Med Inform Assoc. 2008;15:212-216.

REMINDER Isolate this patient infected with a resistant organism!

Where’s the evidence?

photo via paskukaru76

Evidence for Computerized Reminders

Evidence for Health IT

Why are there no reminder studies in rehabilitation?

ACTIVITY

Examples from practice What would be suggested? What data would be needed?

No Exercise!

Evidence for EHRs in Rehabilitation

Benefits of EHRs

0

2

4

6

8

10

12

Improved Reporting

Improved Operational

Efficiency

Improved Communication

Improved Data Accuracy

Barriers to Implementing EHRs

0

1

2

3

4

5

6

Behavior or Workflow

Modification

Software or Hardware Inadequacy

Staff Training

Success Factors in Implementing EHRs

0

1

2

3

4

5

6

7

8

9

End-user Participation in Development

Data Standardization

Adequate Staff Training

Incorporating Workflow Analysis

Getting from Here to There

photo via janeandd

A journey. Not a destination.

Frances Westley Brenda Zimmerman

Michael Patton

Get in the game.

photo via the U.S. Army

Adopt interoperable Electronic Health Records (EHRs) but be mindful of the complexity

apta.org/EHR

Although most health professionals use IT daily in their work, few know how to adapt their roles and work processes to incorporate IT for the greatest bene"t.

Stead WW, Searle JR, Fessler HE, Smith JW, Shortliffe EH. Biomedical informatics: changing what physicians need to know and how they learn. Acad Med. 2011 Apr;86(4):429-34. PMID: 20711055

“

Silverman H, Cohen T, Fridsma D. The evolution of a novel biomedical informatics curriculum for medical students. Acad Med. 2012 Jan;87(1):84-90. PubMed PMID: 22104049

We have frequently heard the opinion from both faculty and students that medical students already possess all the basic skills necessary to function effectively in an information-rich environment. is is similar to assuming that a student pro"cient in the use of a word processing program knows how to write an award-winning novel.

“

We are not alone

We are not alone.

Physical therapist education programs should partner with

health informatics professionals in evaluating the efficacy of informatics interventions in physical therapist practice,

education, and research.

Key Lessons for Today

photo via IMLS DCC

or

photo via Robert Couse-Baker and Nina Matthews Photography

Computer +

Human Human

Interoperable EHRs can improve clinical decisions

and

support data re-use (for lots of purposes)

closing thought

photo via scragz

photo via milos milosevic