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A brief history of the EHR

A brief history of the EHR | Health, Digital Health, mHealth, Digital Pharma, hcsm latest trends and news (in English) | Scoop.it

So far, 2015 has been a busy year for reflecting on the use of electronic health records (EHRs). CMS just released its proposed rules for meaningful use stage 3. One might say that “MU 3” supports the belief that the sequel is never as good as the original (though the original might not have been that good either). Earlier, the Office of the National Coordinator for Health Information Technology (ONC) issued its “interoperability roadmap.”


While I welcome ONC’s highlighting the importance of interoperability, I thought that waiting until now to create a roadmap is like getting your TripTik two days into your cross country road trip (after discovering that you are 500 miles off course). Dr. Bob Wachter’s book and its behind-the-scenes look at the digitization of medicine is also getting people talking. (It’s on my iPad but I haven’t started it yet.)


In February, the Annals of Internal Medicine published Clinical Documentation in the 21st Century: Executive Summary of a Policy Position Paper From the American College of Physicians, which summarizes many of the problems with documenting care using EHRs. The paper includes proposed solutions for addressing many of the deficiencies in the electronic clinical record.


All of this activity and many conversations with colleagues and patients got me thinking more about what went wrong and what went right with EHRs. I started using an EHR in 2006 BE (Before Everything) and led my practice’s selection committee, which started its search a couple of years earlier. “Before Everything” means before the CMS EHR incentive, PCMH, Meaningful Use, PQRS, ACOs, and many of the other programs, initiatives, and acronyms that we now associate with EHRs. In fact, in 2006 BE, the government was minimally involved in EHR adoption. Much of it was driven by small private practices.


So if we had to pay for it ourselves and didn’t need it for reporting or earning bonuses, why did we go electronic in 2006 BE? We thought it would help us take better care of patients through improved access to legible and complete records, allow us to start measuring how we delivered care (in a basic way, but anticipating what was coming), make us more efficient, and improve the bottom line. I’ve addressed many of these goals and how things turned out in my earlier “report card” columns (2012 and 2014).


We wanted an EHR that let us enter data however we wanted — check lists, templates, typing text, dictating, with keyboard, with handwriting recognition, or various combinations — and could meet future needs such as integrating outside data and communicating with other EHRs. And while today’s critics call it out as unimportant and even corrupting, the ability to document in a way that would support the level of coding mattered to us because we believed  that many of us were being overcautious and undercoding in our paper records.


That is what we were looking for. That is pretty much what we got.

Then the world started to change, rather rapidly when you think about it. In 2009, HITECH and its incentive payments expanded the market and introduced requirements for “certified EHR technology.” More entities needed things tracked and counted for a long list of quality activities and “pay for performance” programs. Interoperability, which people thought was a “nice thing to have” in 2006 BE, was all of a sudden a “must have.”


Vendors responded by adapting their products to meet these new needs, and not surprisingly, it got messy at times (and expensive). Upgrades to add new “features” that would meet the latest requirements often broke the “old” new features added in the previous upgrade. Sometimes the upgrade process itself disrupted the work of the practice. With each “enhancement,” the code got bloated, the number of threads, pings, and server hits grew, and the EHR slowed down. It was no longer enough to have the information in the record. It had to be in the right place, in a “structured” field, all too often entered manually with a box click, so the physician slowed down along with the EHR.


It’s as if one bought a compact car to drive to work and take an occasional highway trip out of town but was now forced to use it for off-road driving and to tow large trailers into the mountains. It could be done, but very slowly and with frequent breakdowns. The Feds’ “hands off, let the marketplace take care of it” approach sounded very American and was politically easier than the alternative, but assumed that vendors would listen to their customers, and if not, that changing EHRs was as easy as switching from a compact car to a four-wheel  drive SUV. The difference, of course, is that the compact car has trade-in value that offsets some of the cost of the SUV, one doesn’t have to take driving lessons all over again to change vehicles, and you don’t have to pay thousands of dollars to move your belongings from the glove compartment and trunk of your old car to the new one.

Despite my cynicism, I do not think that all is lost. The collective discontent is getting louder. More practices and health care organizations are replacing or considering changing EHRs. The pressure is mounting on vendors to think less about their proprietary interests and more about the needs of their customers.


The ACP position paper has good recommendations for EHR system design. In a future post, I will discuss my “wish list” for the EHR of the near future. I invite you to share your ideas as well.



Via Technical Dr. Inc.
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HIMSS Launches EHR/HIE Interoperability Testing & Certification Program

HIMSS Launches EHR/HIE Interoperability Testing & Certification Program | Health, Digital Health, mHealth, Digital Pharma, hcsm latest trends and news (in English) | Scoop.it
HIMSS has announced the launch of a new testing and certification program called ConCert by HIMSS designed to streamline the certification of interoperability.
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Drug Companies Could Use EHR Systems for Targeted Marketing #pharma

Drug Companies Could Use EHR Systems for Targeted Marketing #pharma | Health, Digital Health, mHealth, Digital Pharma, hcsm latest trends and news (in English) | Scoop.it

Pharmaceutical companies increasingly are using electronic health records to analyze patient data and market their products to consumers and physicians through advertisements and email campaigns.

 

Electronic health record systems could be used by pharmaceutical companies to market their products to physicians and consumers,Reuters reports.

 

Pharmaceutical companies historically have gathered patients' de-identified data from insurers, pharmacies and public records to improve their marketing strategies.

 

However, drug companies can collect and analyze data through EHR systems and use that information to reach out to consumers and doctors.

 
Via nrip, Lionel Reichardt / le Pharmageek
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Report: Healthcare Interoperability Gets Failing Grade

Report: Healthcare Interoperability Gets Failing Grade | Health, Digital Health, mHealth, Digital Pharma, hcsm latest trends and news (in English) | Scoop.it
61% of physicians gave the health care industry a failing grade (D or F) for achieving healthcare interoperability, according recent athenahealth study.
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EHRs Detect Depression When Many PCPs Can’t

EHRs Detect Depression When Many PCPs Can’t | Health, Digital Health, mHealth, Digital Pharma, hcsm latest trends and news (in English) | Scoop.it

Depression is one of the hardest disorders to diagnose, yet it affects 14 percent of the world’s population. Researchers have found factors in EHRs may be key to predicting a diagnosis of depression.


While depression comes at a high cost to those who suffer from it, the actual price tag in the United States reaches over $44 billion annually. This takes into account, among other things, lost productivity and direct expenses. Depression is a diagnosis that is often missed by primary care physicians, despite the fact that it is the second most common chronic disorder they treat.


According to EHR Intelligence, researchers from Stanford University have worked to use EHR systems as a tool to help predict depression diagnoses. In the study, published by the Journal of the American Medical Informatics Association, researchers say valuable information already stored in the EHR can be used to predict depression up to a year in advance.


“Depression is a prevalent disorder difficult to diagnose and treat. In particular, depressed patients exhibit largely unpredictable responses to treatment,” explain researchers. “Many depressed patients are not even diagnosed … primary care physicians, who deliver the majority of care for depression, only identify about 50 percent of true depression cases.”


The Stanford team used EHR data including demographic data, ICD-9, RxNorm, CPT codes, progress notes, and pathology, radiology, and transcription reports. From these, they used a model which factored in three criteria: the ICD-9 code, the presence of a depression disorder term in the clinical text, and the presence of an anti-depressive drug ingredient term in the clinical text.


These factors were then compared to predict a diagnosis of depression, response to treatment, and determine the severity of the condition.


more at http://www.healthitoutcomes.com/doc/ehrs-detect-depression-when-many-pcps-can-t-0001



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