2015 02 10 - Why Using EHRs Might Save Lives but Steal your Sunshine

8/9/2019 2015 02 10 - Why Using EHRs Might Save Lives but Steal your Sunshine

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Daniel J. Vreeman, PT, DPT, MScAssociate Research Professor

, Indiana University School of Medicine

Associate Director for Terminology Services, Regenstrief Institute, Inc

© 2015

Why Using EHRs Might Save Lives

but Steal your Sunshine

T558. OT Management in Today’s Health and Community Systems


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photo via [credit]

photo via Sadie Hernandez

http://www.flickr.com/photos/sadiediane/


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For as long as I havewanted to be a clinician,

I have also wanted to bea scientist and an

information technology specialist .


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No magical thinking!


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Objectives

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

1. Explain the current forces driving adoption of information

technology

2. Appreciate the kinds of problems that can be improved withmore 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

rehabilitation4. Articulate at least one way that you could use health

information technology to improve care

photo via Vernio77

http://www.flickr.com/photos/verino77/


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First, someintroductions…


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McDonald CJ, Callaghan FM, Weissman A, Goodwin RM, Mundkur M, Kuhn T. Use of internist's free time by ambulatory care Electronic Medical Record systems. JAMA

Intern Med. 2014 Nov;174(11):1860-3. PubMed PMID: 25200944.

The EHR steals 60 minutes a day from me!

photo via lara604

48 mins/day

mean time loss per

clinic day for attendingphysicians

http://www.flickr.com/photos/lara604/4689353343/sizes/o/in/photostream/


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Were MC, Nyandiko WM, Huang KT, et al. Computer-generated reminders and quality of pediatric HIV care in a resource-limited setting. Pediatrics. 2013 Mar;

131(3):e789-96. Epub 2013 Feb 25. PubMed PMID: 23439898.

4xincrease in completion

of overdue clinicaltasks!

(68% vs 18%)


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Saving lives orstealing sunshine?


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The FutureGreat Scott!

photo via JD Hancock

http://www.flickr.com/photos/jdhancock/4100030094/


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Complete,

longitudinalinformation that

follows the consumer


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Care that is

value-based and coordinated

across settings

photos via meddygarnet and brykmantra

http://www.flickr.com/photos/brykmantra/http://www.flickr.com/photos/meddygarnet/


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photo via proimos

Someday, care will be

Comprehensive

Patient-centered

CoordinatedAccessible

SafeHigh quality

http://www.flickr.com/photos/proimos/7015509987/in/photostream/


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Meanwhile,back on planet Earth…


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Forrey AW, McDonald CJ, et al. Logical observation identifier names and codes (LOINC) database: a public use set of codes and names for electronicreporting of clinical laboratory test results. Clin Chem. 1996 Jan;42(1):81-90. PubMed PMID: 8565239.


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Fundamental challenges: Local systems have different ways of

identifying the same concept .

Things that look alike aren’t the same.


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Patients move faster

and further than theirhealth information


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In USA, major driver ofeHealth standards adoption is

EHR Incentive Program

a.k.a. “Meaningful Use”

Blumenthal D, Tavenner M. The "meaningful use" regulation for electronic health records. N Engl J Med. 2010 Aug 5;363(6) :501-4. Epub 2010 Jul 13. PubMed PMID: 20647183.


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Electronic Health RecordsOpportunities and Challenges


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4 Ways EHRs can

Accelerate that VisionSeamless web of dataData reuse

Cost savings

Decision support

photo via OiMax

http://www.flickr.com/photos/oimax/1966934332/


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

http://www.flickr.com/photos/nosha/


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photo via [credit]

A U ifi d P ti t R d


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A Unified Patient Record


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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.

41% of ED visits are for patients withdata at another institution

Connectedness among Indiana EDs


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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 Indiana EDs


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Nearly every ED inIndiana shares

patients with

every other ED inthe state


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photo via pagedooley

Collect once. Use many.

Clinical care, public health reporting, quality

management, clinical and epidemiological research, etc…

http://www.flickr.com/photos/pagedooley/8435953365/sizes/o/in/photostream/


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photo via [credit]photo via Rob Pongsajapan

http://www.apple.com/


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Cost Savings

photo via Refracted Moments™

http://www.flickr.com/photos/refractedmoments/


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EHRs = Lower Cost

Only crazy people would say that!


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Clinical Decision MakingRight info. Right time. Right format.


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Everyone wants it.

Nobody has time.

Evidence-based Practice

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

patients + evidence + clinical expertise

(So they say)


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


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


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The secret sauce of theEHR chicken soup

photo via liberphoto via liber

http://www.flickr.com/photos/liberhttp://www.flickr.com/photos/liber


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Where’s the evidence?

photo via paskukaru76

http://www.flickr.com/photos/pasukaru76/


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92%of 154 studies

July 2007

to Feb 2010


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Odds Ratio = 1.7995% CI 1.56, 2.05


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Evidence in Rehabilitation


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Your Turn…What would be suggested?

What data would be needed?

1968!


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1968!


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Benefits of EHRs

Improved reporting

Improved operational efficiency

Improved communication

Improved data accuracy

Vreeman DJ, Taggard SL, Rhine MD, Worrell TW. Evidence for electronic health record systems in physical therapy. Phys Ther. 2006 Mar;86(3):434-46; discussion 4 46-9. Review.

PubMed PMID: 16506879.


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Barriers to Implementing EHRs

Behavior or workflow modificationSoftware/hardware inadequacy

Staff training




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Success Factors in Implementing EHRs

End-user participation i n

developmentData standardization

Adequate staff training

Incorporating workflow analysis




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Do therapists todayreally use EHRs?good question…


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The Tide is Rising

Office of the National Coordinator for Health IT. Update on the adoption of health information technology and related efforts to facilitate the electronic use and exchange of health

information. Report to Congress.

Had “Basic” EHR 2008 2013

Hospitals 19% 59%Physicians 22% 48%

APTA 2010 Member Survey


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Yes, all electronic Yes, paper and electronicNo

Don’t know

Got EMR?

ASHA SLP Healthcare Survey 2011


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Always SometimesNever

Use an EHR?


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Most commoncomplaint? anecdotal


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Getting from here


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Getting from here…

to therephoto via janeandd

http://www.flickr.com/photos/jayneandd/


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photo via Justin Ornellas

What are we waiting for?Let’s jump in.

http://www.flickr.com/photos/ornellas/


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Adopt interoperable

EHRs.

Be mindful of thecomplexity.


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Physical therapisteducation programs

should incorporate coreinformatics competencies

into their curricula.

Alth gh t h lth“


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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

Although most health

professionals use IT dailyin their work, few know

how to adapt their rolesand work processes to

incorporate IT for thegreatest benefit.

“

“We have frequently heard the


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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 theopinion from both faculty and

students that medical studentsalready possess all the basic skillsnecessary to function effectively inan information-rich environment.

This is similar to assuming that a

student proficient in the use of a word processing program knows how

to write an award-winning novel.


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photo via JOPHIELsmiles

Rehabilitation education

programs should partner withhealth informatics professionals

in evaluating the efficacy ofinformatics interventions in

rehabilitation practice,education, and research.

http://www.flickr.com/photos/26015375@N06/3715306069/


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Key Lessonsfor Today

photo via IMLS DCC

http://www.flickr.com/photos/imlsdcc/5637868432/sizes/o/in/photostream/


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Human

+Computer

Human


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Interoperable EHRs canimprove clinical decisions

and support data re-use

(for lots of purposes)


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Closing Thought


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Tone is in your fingers

Th h W t ' b


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photo via [credit]photo via scragz

Though Wooten's basses

receive much attention, hismost frequent and consistent

response when asked by hisfans about his equipment isthat "the instrument doesn't

make the music ... you do".

http://www.flickr.com/photos/scragz/109426798/


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2015 02 10 - Why Using EHRs Might Save Lives but Steal your Sunshine

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