Dear Healthcare Professional,
Welcome to the March issue of the Indidge Advantage newsletter.
The Indidge Advantage is produced by Indidge Systems , a healthcare software solutions company specializing in Compliance and Risk Management solutions.
Last month we discussed Electronic Medical Records. This month our focus is on improving healthcare quality through standardizing patient care and as a result virtually eliminating treatment errors. This is music to a risk manager's ears.
Our first article blows in with an understanding of using IT versus having IT. The second article treats you to a surprise regarding the efficacy of highly touted EMR systems.
Finally, our last article addresses a very serious issue regarding hand writing errors. Register for the FREE educational webinar following this article to learn what can be done about it.
by George Lauer, iHealthBeat Features Editor
If Congress or the American public needed more convincing about the potential of health IT, it arrived with uncanny timing last week in a study showing the use of health IT systems was associated with lower mortality rates, fewer complications and lower costs in 41 urban hospitals in Texas.
The key phrase in that sentence -- and in the study -- is "use of."
Researchers intentionally set out to measure and analyze how electronic systems were actually used as opposed to which hospitals had them.
Funded by the Commonwealth Fund and published in the Archives of Internal Medicine, the study arrives as Congress is considering two kinds of legislation that could have great impact on the future of health IT - the economic stimulus package and health care reform proposals.
"I wish we could say that was intentional, but it's not," Ruben Amarasingham, a physician and lead researcher of the study, said, adding, "This data [were] first presented at the Academy of Health conference in June and then the paper was accepted for publication in July. The fact that it's coming out now in the middle of all this is nothing but good luck."
Using vs. Having Health IT
Researchers surveyed physicians from 41 hospitals in Texas treating a diverse group of patients with a variety of conditions, including heart attack, heart failure, and pneumonia.
Physicians were asked about their use of several different types of health IT, including electronic notes and records, order entry, and clinical decision support.
Researchers found that relatively modest increases in technology use produced changes in outcome.
For instance, a 10-point increase in the use of electronic notes and medical records was associated with a 15% reduction in the likelihood of patient death. When physicians electronically entered their instructions for patient care, the likelihood of death for some procedures was reduced by 55%.
Increased use of health IT also was linked to lower costs. Hospitals where physicians used automated test results, order entry and decision support experienced lower costs for all hospital admissions.
Researchers from the University of Texas Southwestern Medical Center, Johns Hopkins School of Medicine and the University of Maryland adjusted results to account for the seriousness of conditions and whether a hospital was an academic center or a "safety-net" facility for the indigent. The results held up after adjustments, researchers said.
"We know that a lot of hospitals still do not have comprehensive IT systems and we know there is a big financial commitment involved in making that leap," said Anne-Marie Audet, a physician and vice president at the Commonwealth Fund who worked on the study.
"We hope the results of this study will help show there is a return on investment for health IT, but it won't come just because you buy the tool," Audet added.
"One of the most important points the results of this study makes I think is that it's not enough just investing in the tools of health information technology. You also have to invest in changing your operation of care in the hospital," Audet said, adding, "You have to change the way you do things to make the best use of technology. Just buying a tool and putting it on a desk is not sufficient."
'A Different Approach'
Amarasingham -- associate chief of medicine at Parkland Health & Hospital System in Dallas and assistant professor of medicine at UT Southwestern Medical School -- said the survey is the first to comprehensively measure and compare IT use at several hospitals.
"There have been great computer interface studies but none have been able to assess more than one or two hospitals at a time or to compare them to any great extent," Amarasingham said.
The fact that researchers are beginning to measure and analyze how health IT is used rather than simply determining whether it exists could signal something of an evolutionary advance in the relatively young age of health IT.
"I think that's a very good possibility," Amarasingham said, agreeing that the study could be a sign of a maturing health IT industry. "There's still a long way to go in this country -- most hospitals don't even have a lot of the technology we're talking about yet. But where it does exist we are starting to look beyond the basics and looking at how to measure its effectiveness," Amarasingham said.
In a 2005 report, the RAND Corporation estimated that fewer than 25% of U.S. hospitals had digital electronic information systems. Four years later, that number is higher, but not much higher, according to industry experts. Cost is one of the major impediments.
"It's possible that hospitals could put a huge sum of money into technology and if they don't spend extra time, diligence and sometimes money -- you could actually set things back," Amarasingham said, adding, "There needs to be lot of diligence and follow through to make sure the system becomes part of how the hospital handles everything it does."
What's Next in Measuring Health IT?
This research project, "Clinical Information Technologies and Inpatient Outcomes: A Multiple Hospital Study," dealt only with physicians' use of health IT. No other health care providers -- nurses, therapists, technicians or other allied health workers -- were part of the survey.
"That's a limitation of this study, certainly," Amarasingham said, adding, "We chose to survey physicians because we're physicians ourselves and we know that part of the system best. But definitely, in a hospital setting, nurses' interaction with technology and the patient are perhaps the most critical in making systems work."
Amarasingham said more research is needed to explore how the use of health IT is experienced -- and influenced -- from several perspectives in the health care system, including nurses, physician assistants and others.
"One could envision at some point a survey looking at it from the patient's perspective," Amarasingham said.
from www.fiercehealthfinance.com
Most of the talk around electronic medical records to date has come with the assumption that such systems would not only improve care, they'd also save money. Well, one health plan has decided that this just isn't so. Based on its review of available research , BlueCross BlueShield of Massachusetts has concluded that it won't make physicians install an EMR to take part in its pay-for-performance program. Among the research it reviewed was an American Medical Association study that estimated that doctors see only 11 cents of every dollars saved through health IT use. Along the way, meanwhile, the health plan concluded that computerized physician order entry programs actually do make financial sense within hospitals, and will require health systems to install CPOE systems by 2012 to participate in its P4P program.
A recent study by the Massachusetts Technology Collaborative and the New England Healthcare Institute found that CPOE systems could prevent 55,000 medication errors in Massachusetts and save $170 million statewide per year ($2.7 million per hospital). Given an estimated cost of $2.1 million to implement a CPOE system, and a cost of $435,000 to maintain it , hospitals will still see payback within 26 months through reducing hospitalizations generated by errors, researchers said.
A mechanic was removing a cylinder-head from the motor of a motorcycle when he spotted a well-known cardiologist in his shop. The cardiologist was there waiting for the service manager to come take a look at his bike when the mechanic shouted across the garage, 'Hey Doc, want to take a look at this?'
The cardiologist, a bit surprised, walked over to where the mechanic was working on the motorcycle. The mechanic straightened up, wiped his hands on a rag and asked, "So Doc, look at this engine. I open its heart, take the valves out, repair any damage, and then put them back in, and when I finish, it works just like new. So how come I make $39,675 a year and you get the really big bucks ($1,695,759) when you and I are doing basically the same work?"
The cardiologist paused, smiled and leaned over, then whispered to the mechanic...
"Try doing it with the engine running"
BY Kit EatonTue Jan 27, 2009
Medical doctors get lumbered with the traditional "bad handwriting joke" for a reason--I haven't yet met one that writes legibly. But these scribbles are no joke: Doctors' bad handwriting may be the source of up to 7,000 deaths in the US each year. That's why President Obama's economic recovery package is expected to contain around $20 billion for computerized medical notes.
By connecting hospitals and doctors over the net, the speed and ease of sharing information will increase. Prescription fraud and abuse may decline as well, along with the potential for misunderstanding another medical expert's notes.
A recent piece of research from hospitals in Texas highlights exactly these benefits. The study found that patients who were treated in "paperless" hospitals--specifically those that ranked highest in the use of health IT to manage patient details--were 15% less likely to die than patients in hospitals ranked at the lowest end. And when it comes to life-or-death situations, a 15% margin is enormous.
The IT-heavy hospitals were 9% less likely to lose a heart-attack patient and 55% less likely to lose a bypass patient than those hospitals who have only light use of health IT.
And the benefits of using digital medical records extend beyond patient deaths into having fewer patients with medical complications, and reduced operating costs. According to Dr. Neil Poe of Johns Hopkins, "If these results were to hold for all hospitals in the United States, computerizing notes and records might have the potential to save 100,000 lives annually."
I have just one hope about Obama's plans for modernizing the medical notes system: It must include typing training for medical doctors, nurses and technicians. Not only is that going to be a vital safety issue, but it's frankly awful to watch my already-computerized family doctor painfully hunt-and-peck type at his PC keyboard when it'd take him a tenth of the time to write by hand.