Patient data errors force VA to close EMR system
Nextgov’s Bob Brewin reports that errors in patient data have forced the Department of Veterans Affairs to close access to the Bidirectional Health Information Exchange, the Defense Department’s vast electronic medical record system. The bug first surfaced in February when a physician noticed that the system claimed one of his female patients had been prescribed an erectile dysfunction drug. The errors have been blamed on old code in the six-year-old system which could not handle peak usage rates.
The glitch did not cause harm to any patient, but “the potential exists for decisions regarding patient care to be made using incorrect or incomplete data,” said Jean Scott, director of the Veterans Health Administration’s Information Technology Patient Safety Office, in the alert issued on Wednesday.
… The VA clinician may see the patient’s data during one session, but another session may not display the data previously seen,” the alert noted. “This problem occurs intermittently and has been reported when querying DoD laboratory, pharmacy and radiology reports.”
The system is expected to go back online March 9. Until then, Brewin writes, “VA doctors will have to obtain a patients’ health information from their paper medical files, faxes or PDF attachments that are e-mailed to the physicians.”
According to its tagline, Nextgov focuses on “Technology and the Business of Government.”
FDA to regulate health information technology?
Fred Schulte and Emma Schwartz, the Huffington Post Investigative Fund duo who have made it their business to stay in front of all stories related to the federal push for the adoption of health information technology, now look at the possibility of federal regulation of health IT.
Schulte and Schwartz write that “In the past two years, the agency has received reports of six patient deaths and several dozen injuries linked to malfunctions in the systems,” and officials say those voluntary reports represent just the tip of the iceberg. In case you’re interested, here are the transcripts from the relevant government hearing.
… digital medical systems are not risk-free. Over the past two years, the FDA’s voluntary notification system logged a total of 260 reports of “malfunctions with the potential for patient harm,” including 44 injuries and the six deaths. Among other things the systems have mixed up patients, put test results in the wrong person’s file and lost vital medical information.
Schulte and Scwartz summarize the three possible regulatory approaches outlined by officials:
- Option 1: FDA requires HIT makers to register, submit safety reports and correct problems.
- Option 2: FDA requires HIT makers to report safety concerns and sets minimum quality guidelines.
- Option 3: FDA makes HIT “subject to the broader regulatory actions that new medical products must face before they ever reach the market.”
Many manufacturers argue that such regulation could be counterproductive.
The manufacturers of the systems generally have opposed regulation by the FDA, arguing in part that imposing strict controls would slow down the government’s campaign to spur widespread adoption of the technology.
Regulation will not necessarily create a “safer” electronic medical record “and might actually limit innovation and responsiveness when it is needed most,” Carl Dvorak, executive vice president of Epic Systems Corporation, a Wisconsin-based company that builds the systems mainly for hospitals and large medical practices, said in his prepared testimony for Thursday’s hearing. The hearing is being held by an advisory group created by the stimulus law.
Government Health IT also is following the issue and points to some problems the Veterans Health Administration has run into and how it dealt with the lapses.
FCC’s broadband plan includes wireless health tech
The Federal Communications Commission will release a report next month outlining a national broadband plan that is expected to include measures for promoting and facilitating the use of mobile devices in health care, Mary Mosquera of Goverment Health IT reports. The plan was mandated as part of the stimulus package.
The FCC plan will describe “where government has a role to reduce some of the hurdles to these technologies both in connectivity and to promote innovation in applications,” said Dr. Mohit Kaushal, digital healthcare director of the FCC’s Omnibus Broadband Initiative.
The American Recovery and Reinvestment Act called for the FCC to develop a plan for establishing broadband connections to the Internet as a way to spur business development, job creation and improvements in healthcare.
To demonstrate a few possible uses of such technology, Mosquera also talks to organizations, hospitals and doctors who are taking advantage of current resources.
Gawande, Google and health systems analysis
Filed under: Government, Health data, Health policy, Hospitals
Earlier this month, New Yorker writer and surgeon Atul Gawande brought his checklist gospel (video) to the President’s Council of Advisors on Science and Technology. Writing for AAAS’ science-policy blog ScienceInsider, Jeffrey Mervis chronicled the encounter, paying special attention to the observations of council member and Google CEO Eric Schmidt.
Google CEO Eric Schmidt. Photo by World Economic Forum via FlickrTo Schmidt, the challenge of creating a system that synthesizes patient history and creates a list of standardized recommendations boils down to a simple “platform database problem,” something he says computer scientists are very good at.
Gawande’s take is that programmers don’t quite understand the vagaries of a typical clinical encounter. The technological capability may exist, but it’s going to be hard to make an information system that is able to generate recommendations brief and practical enough to be of use to a typical super-busy physician who has to suss out six different problems in one 15-minute visit.
In the course of the discussion, Gawande and the council also bemoaned the relatively low status of the health systems analyst and brainstormed ways to raise the profile and effectiveness of the specialization.
Grassley questions hospitals for HIT investigation
Filed under: Health policy, Hospitals, Hot Health Headline
Fred Schulte and Emma Schwartz continue to stay on top of the stimulus/health information technology/Sen. Charles Grassley investigation story for the Huffington Post Investigative Fund, this time explaining how and why the Grassley-driven inquiry into plans to spend an estimated $19 billion in stimulus money on HIT is now asking leading hospitals for input on their experiences with EMRs. The reporters also posted a copy of Grassley’s Jan. 19 letter.
Sen. Charles Grassley
Grassley sent the 11-question letter to 31 hospital organizations and requested that they respond by Feb. 16.
At this point, Grassley seems focused on technical issues that threaten patient safety, as well as potential conflicts of interest. Here are some of his more prominent lines of inquiry:
- How hospitals make purchasing HIT decisions.
- Potential financial or incentive-based relationships between HIT vendors and hospitals.
- Whether or not hospitals rely on outside contractors for HIT implementation.
- Procedures for and costs of training staff on new technology.
- Quality control and bug/problem-reporting procedures.
- Communication with tech vendors, peers and government officials.
- The relative liability of vendors and hospitals for HIT-related problems.
Grassley also asked hospitals to “provide a list of HIT problems or complaints that have been identified by or reported to your facility since January 2008 that directly or indirectly impacted patient safety or the delivery of care, including any complications or adverse events that have occurred as a result of HIT product design and/or usability.” He also requested that they “provide examples of contracts with HIT vendors that include non-disclosure clauses” and list any payments or discounts the hospitals received from those vendors.
Related: Fla. docs, vendors battle over EMR headaches
Sammy Mack’s piece for Health News Florida is a lively recounting of the complete meltdown that occurred between a group of Florida doctors and an EMR vendor, one rich in scandalous details like cease and desist letters and collection agencies. Mack’s work highlights the cultural divide between tech-savvy IT specialists and medical professionals and points out that the number of such conflicts is likely to increase as EMR adoption rises. Here’s Mack’s description of one such conflict, a dispute which happens to have a unique connection to journalism, medicine and ethics:
In another complaint against [EMR vendor Joe] Castranova, Dr. Linda Kaplan said she too was surprised by charges on her invoice. When they first met, Castranova recognized her as a former medical editor at the local NBC television affiliate. She said he offered to waive her software and training fees if she would endorse the product.
Kaplan agreed, but she said she was unimpressed with the system once it was installed in her Hallandale Beach office. She was reluctant to drum up business when she wasn’t a satisfied customer.
Kaplan said Castranova was displeased with her lackluster endorsement and locked her out of some 600 patient records on his server. He billed for the software system anyway.
Castranova said he gave her four months’ notice before locking her out – plenty of time to retrieve patient files.
Denmark sees results from electronic records
In The New York Times, Sindya Bhanoo examines Denmark, a country which has adopted health information technology to a high degree. Bhanoo finds that, while Denmark is in some ways an exceptional case, it can also provide a few principles to guide America’s proposed adoption of the same technology, chief among those being patience, persistence and a gradual pace.
Photo by juhansonin via Flickr
While Denmark does not have a standardized electronic medical records system, it does have a national patient registry and a wealth of examples of hospitals adopting innovations such as telemedicine (including remote monitoring and diagnosis), paperless prescriptions and electronic modeling. “Virtually all” Danish primary care physicians use electronic records, Bhanhoo writes, and nearly half of Danish hospitals have adopted them as well. To put those numbers in perspective, Bhanoo mentions that “about 10 percent of American hospitals and about 17 percent of American doctors use electronic records.”
Bhanoo writes that while the decade-long Danish push into HIT has not been perfect – it’s fragmented and hampered by budget constraints – it has achieved measurable success.
Several studies, including one to be published later this month by the Commonwealth Fund, conclude that the Danish information system is the most efficient in the world, saving doctors an average of 50 minutes a day in administrative work. And a 2008 report from the Healthcare Information and Management Systems Society estimated that electronic record keeping saved Denmark’s health system as much as $120 million a year.
In the end, Bhanoo concludes that while these same successes will be harder to achieve in the significantly larger and more complex American system, experts believe that a modified Danish roadmap should be able to produce results in the United States.
Visiting some health care blogs you might not know
FierceHealthcare, a site that says it’s geared toward health executives, spotlighted nine health care bloggers and, once they realized all nine were male, five female health bloggers. We thought we’d point out some blogs that our readers might not have on their radar.
Tip: To navigate those slide shows, just click on the tiny mug shot hiding in the bottom right corner well beyond the point where you assume the post has already ended.
Worth a visit
Health Populi: Jane Sarasohn-Kahn’s strategy seems to be to take something interesting and current, illustrate it with a chart or graphic and then riff on that idea, bringing in other sources as needed. The upshot is that her site’s updated almost daily with something you usually haven’t already heard somewhere else.
Dr. Greiver’s EMR: While the list included a number of wonky HIT blogs, I found that I learned the most from Canadian physician Michelle Greiver’s running updates on her transition to electronic medical records. I recommend taking a few minutes to start from the beginning and scan Greiver’s journey. You’re sure to come across a heap of fascinating anecdotes, from how EMRs make flu shot clinics more efficient to how much she dislikes insurance companies.
HealthBlawg: Health attorney and consultant David Harlow’s Blawg (shorthand for Law-Blog) often touches on topics of interest to health journalists, including electronic medical records, privacy and, of course, HIPAA.
Case studies show how health IT fits in today
Filed under: Health care reform, Health data, Hospitals, Hot Health Headline
Writing for content, document and knowledge management publication KMWorld, David Raths evaluates applications of health information technology, or HIT, in a set of case studies which he wraps up into a handy overview of the utility and potential of HIT and electronic medical records. Raths breaks HIT up into specific applications because, he writes, the very thing that loads HIT with so much potential – the byzantine complexity and built-in inefficiency of the American health care system – also serves as its biggest obstacle.
“The sheer complexity of the healthcare setting is off-putting,” says Alan Pelz-Sharpe, a principal at CMS Watch covering enterprise content management technologies. “Joining up the clinical and administrative, not to mention the insurance part, is a spectacular challenge.”
A hospital has many small departments and people don’t tend to think outside their department, he says. Deploying enterprise content management solutions is difficult when there are so many interlinking elements in the healthcare chain, and nobody really owns the overall process from beginning to end. “There is usually not one unifying solution,” Pelz-Sharpe says, “but lots of departmental solutions.”
A few of the solutions Raths explores:
- Systems to integrate the paper, which will inevitably be part of any system, with EMR systems. Other systems will help integrate existing paper archives with EMRs.
- Systems that speed up the decision-making process and collaboration between physicians while better recording exactly why decisions were made.
- Administrative-side systems used by hospitals to navigate through health care’s financial maze.
- Cloud-based systems that envision health IT as a service.
Government a ‘game changer’ in health IT
In the knowledge management magazine KM World, Nancy Davis Kho evaluates the Obama administration’s push for health information technology, focusing on the impact this new market will have on information technology businesses.
The stimulus package signed by Obama during his first month in office includes $19.2 billion for HIT and established the Office of the National Coordinator for Health Information Technology within the Health and Human Services Department. The government involvement is a “total game changer,” said the president and CEO of the country’s largest health care association focused on information technology.
Veteran and new businesses alike are looking at how to use technology to improve health care delivery outcomes and lower costs.
Kho’s report takes stock of the HIT industry and specifically how the major players, from GE Healthcare to Google, are positioning themselves to take advantage of the billions in stimulus money poised to flow into the industry. It discusses electronic health records, social media tools, the use of mobile devices to deliver information to doctors and decision support tools.
Doc praises, explains benefits of electronic records
Calling the typical paper-based health record system “a primitive, fragmented and unreliable way to do business,” Rahul Parikh, M.D., writing for the Los Angeles Times, shows how electronic medical records have improved his practice.
Parikh’s piece starts from a foundation of a few electronic interactions with patients and builds a thesis from there:
In the past, these parents would have left a phone message and we probably would have spent the better part of a day or two playing phone tag. Or they would have had to make an appointment, strap their children into car seats, pack diaper bags and snacks and sit in a waiting room full of sick children — only to spend 5 to 10 minutes with me while I told them everything was fine. Instead, we fixed the issues by e-mail, allowing parents to stay in their lives at home and at work.
Parikh says that while EMRs do increase his workload – data entry is far more of a hassle than just scribbling something on a scrap of paper and shoving it into a file – they also allow him to shift between work and home when needed, giving his schedule a flexibility it lacked when he was permanently tied to the office by mountains of paper. While EMRs are “far from perfect,” he writes, they are still a significant improvement over the status quo.
Parikh acknowledges some criticisms of electronic medical records, such as a study that concluded using hand-held PDAs led to an increase in wrong and redudanct diagnoses. He says those errors can be remedied by “holding doctors and others accountable for the accuracy of their documentation.” As far as the security issues surrounding electronic records, he says they are legitimate concerns but no different from those in other industires, such as finance.
Past news about EMRs
- Kaiser’s switch to electronic records hits snags
- Failure to use digital record system hurts soldiers’ care
- Strides in efficiency don’t necessarily benefit doctors or patients
- Military resists new health records system
- Issues remain before personal health records go mainstream
- Health IT reforms move slowly in Calif. prisons
- Weigh risks, benefits of electronic personal health records
Tip Sheet
- Improving patient safety through health information technology: Presentation by Rainu Kaushal, M.D., M.P.H., assistant professor of public health, Weill Medical College of Cornell University
Reports/Studies
On the Web
- The American Health Information Community recommends specific actions to achieve a common interoperability framework for health information technology. (May 2007)
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Health Journalism 2010, AHCJ's annual conference, features a world-class program with story ideas, sources, stronger reporting skills, chances to meet newsmakers and network with other journalists.
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- Aging in the 21st Century: Presentations and tip sheets
- AHCJ calls for better information from Joint Commission Web site
