L. Blair Heath--HIM

Wired for Success

2006-11-09T09:09:00.000-08:00

John Glaser

The key elements in good healthcare information technology include: a healthy organizational foundation, a sound link between organizational strategies and the IT plan, and strong project management skills. In order to build a healthy foundation for IT success there must be talented leadership. This involves exceptional performance, which requires leadership. This requires many a team of different roles including: CEOs, CFOs, CIOs, IT department staff, and middle managers. The leaders must have a good understanding of the organization’s vision for the project and be able to communicate with team members. The leaders must also be able to recruit and motivate team members. The team must be strong by having effective relationships. There must be a well-developed technical architecture and a high performance infrastructure. This involves have a stable network (no virus attacks). Strong IT organization and management is also important. If the IT department’s talent and skills are mediocre, excellence is difficult to achieve.

The Links between organizational strategy and the IT plan is important concerning information technology. In order to be successful, the IT plan must support and enable the hospital’s goals. In order to develop a strong IT strategy there are four major ways that Dr. Glaser listed:
· Deriving IT initiatives from organizational strategies
· Basing IT strategy on continuous improvement of core operational process and information management needs.
· Examining the role of new technologies in health care.
· Basing IT strategy on the organization’s vision.
There are also three key points to remember when developing IT strategy. 1. IT planning is not a separate process. It should occur as an integral part of the organizational strategy planning process. 2. IT planning should be a continuous process. This should reflect the continuous change in the healthcare environment. 3. IT planning should involve shared decision-making and shared learning between IT and the organization. There should be a relationship between the IT leaders and organizational leaders that ensure both groups understand technologies, business plans, strategies, and constraints.

Project management is a set of management practices that will help achieve success. The objectives of project management include : Describing the scope and intended results of the project. Identifying accountability for the successful completion of the project and associated project tasks. Defining the processes for making project-related decisions. Identifying the project’s tasks, task sequence, and interdependencies. Determining the resource and time requirements of the project. Ensuring appropriate communication with relevant stakeholders regarding project status and issues. Achieving IT project success is a difficult task, but it requires effective organizational leadership.

I believe that out of the four attributes that Dr. Glaser listed as the health foundation for IT success, having talented leadership is the most important. Although each attribute Dr. Glaser named is critical for success, the people in charge demonstrating good leadership qualities is the most important. I think excellence radiates from top to bottom. There is very little chance for a team to excel without great leadership. The three elements that are important in developing a successful IT strategy are a healthy organizational foundation, links between organizational strategy and the IT plan, and also strong project management skills. Each area is very important for IT success. If I were to investigate an IT failure, I would approach the situation by first examining the leadership and the healthcare environment. This is the basis for a successful IT strategy.

Health Care CIOs

2006-11-01T15:57:00.000-08:00

Burke, Menachemi, Brooks

Currently there is very little known about CIOs (Chief Information Officers). The purpose of this study is to understand the background about CIOs, their organizational status, and their influence in hospital health care information technology adoption. The survey demonstrates that CIO position varies greatly depending on the profit status of the hospital. There have been increases in health information technology (HIT). This brings about gains in computing power, electronic integration of information, and Internet and wireless applications provide many applications to choose from. The downside of adoption of health information technology is a major commitment of resources. The CIO is responsible for “the challenging task of guiding hospital operations related to HIT.” In the past CIOs have been referred to as “Data Processing Managers” where now they are referred to as “business futurists, strategic thinkers, and executives with many organizational responsibilities and roles.” Governance is a term used to describe the decision authority and reporting structure of the CIO.
Although an estimated 26-29% of CIOs report directly to the chief executive officer (CEO), little is known about the background of a CIO.
The purpose of the study by Burke, Menachemi, and Brooks was to determine the trends in the CIO position in hospitals. They hope to find out the information by looking at demographic factors (such as educational background, experience, and reporting structure). They will also focus on the relationship between CIO demographic factors and organizational factors (such as hospital profit status, membership in a hospital system, and hospital size). The authors will also use a predictive model to test the relationship between HIT adoption and CIO and organizational factors. One method used in this study is survey. The CIO (or equivalent) of each acute care facility was responsible for the survey completion. The authors used a measure of adoption which captured to develop 3 scales: administrative, clinical, strategic. They also used regression models.
The most common reporting structure (43.9%) was reporting directly to the CFO. 27% showed that they reported directly to the CEO. Other reporting structures involved reporting to the COO or a dual reporting structure to the CEO, CFO, COO, or CCO (chief clinical officer). One trend that was shown was that for-profit hospitals CIOs were more likely to report to the CFO than not-for-profit hospitals. Demographic factor did play a part in the results. In not-for-profit hospitals CIOs were more likely to have more IT experience than for-profit hospitals. CIOs reported having terminal academic degrees ranging from high school diploma to Master’s degree. The highest degree most frequently awarded was a Bachelors degree. 35.7% had a Master’s degree. The study showed that a majority of hospital CIOs have an estimated 18 years IT experience. This demonstrates that they have witnessed a great deal of change in the information technology world. Demographic factors have a large impact on this profession. It is important to examine many variables when doing a study such as this. These variables should include the different capabilities of someone holding a high school diploma compared with someone who has a Master’s degree. It should be examined if these variables affect patient safety or administrative functions.

Privacy, Information, Technology, and Health Care

2006-10-25T08:45:00.000-07:00

By: Thomas C. Rindfleisch

Privacy is a very important issue in health care. A controversial issue is whether the use of technology threatens patient privacy. Currently the electronic patient record (EPR) is becoming more accepted. Thomas C. Rindfleisch states that there are many reasons that influence the acceptance of the EPR such as: “the desire to improve health care through timely access to information and decision-support aids; the need for simultaneous access to record by doctors, nurses and administrators in modern, integrated provider and referral systems; meeting the needs of highly mobile patients; the push toward improved cost effectiveness based on analyses of outcomes and utilization information; the need for better support of clinical research; and the growing use of medicine and telecare.” Deloitte and Touche show that 24% of US hospitals use an integrated delivery system (IDS) and 56% of hospitals are pursuing an EPR.

Medical Records contain a great deal of information. Information ranges from episodes of flu, broken bones, blood pressure readings, to fertility and abortions, sexual behavior, substance abuse, emotional problems, and genetic predispositions to diseases. It is important to protect patient privacy because of the sensitive information involved. Disclosure of patient information can cause social embarrassment, affect our insurability, and cause job limitations. Damage can occur by having medical records in paper or electronic form. Patients expect their medical information to be kept confidential and only used in the context of providing care. These expectations stem from many principles such as: the Hippocratic Oath, Code of ethics, and the Federal Privacy Act of 1974. Physicians and other providers expect and need complete access to patient records in order to provide quality care and to not duplicate tests and procedures.

Medical Records serve a variety of functions: sent to insurers to justify payment for medical serviced rendered, and to detect fraud, used for quality reviews, administrative reviews, and utilization studies to manage the business aspects of health care. They are also use for medical research and public health management. There are many threats to patient information confidentiality including: accidental disclosure, insider curiosity, insider subornation, uncontrolled secondary usage, and unauthorized access. There are many advantages of the electronic paper record such as 1. availability and integrity 2.accountability 3. perimeter definition 4. Role/need limited access 5.comprehensibility and control.

There are three general classes of technological interventions to improve security—deterrents, obstacles, and system management precautions. Deterrents depend on ethical behavior of people and provide reminds to reinforce those standards. Obstacles directly control the ability of a user to get information. System management precautions involve proactively surveying an information system to ensure that known sources of vulnerability are eliminated. Integration of an EPR system is crucial for effective delivery of health care. There are significant advantages that include: enhanced research, improved medical care, and more cost-effective management of medical institutions. The risks are privacy issues; however, there are still privacy risks even with paper-based records. The benefits outweigh the risks.

Privacy is the right and desire of a person to control the disclosure of personal health information.
Confidentiality is the controlled release of personal health information to a care provider or information custodian under an agreement that limits the extent and conditions under which that information may be used or released further.

Security is a collection of policies, procedures, and safeguards that help maintain the integrity and availability of information systems and control access to their contents.

An important method that helps reduce unauthorized disclosure is education. This greatly reduces unethical behavior such as “insider curiosity, and insider subornation”. Other measures to help ensure confidentiality are alerts and reminders. Serious consequences for unauthorized disclosure of patient information should be in place. Practices should have the rights management tools and system management precautions.

Security between paper based and EHR is a controversial issue. Paper based records are all utilized manually. There is more room for error and there is no password or authorized user authentication when it comes to paper based records. I feel that the electronic record is just as secure or more secure than the paper based record. In the electronic record there are many technologies that help protect patient information. These include: firewalls, pass codes, authentication, authorized access, etc. I feel the EHR record would limit “insider curiosity and insider subornation” by keeping a track record of what records were accessed and for what reasons; whereas paper based records there could be no effective tracking method.

There are many information technology means of ensuring patient information confidentiality such as firewalls, authorization, authentication, passwords, encryption, rights management tools, and system management precautions.

With the reality of the National Health Information Network, there will of course be challenges. There will be issues dealing with protection of patient privacy. The challenge will be that the patient information will be on a national network. There will be advantages and disadvantages, but hopefully all the problems will be resolved for the advantages to outweigh the disadvantages.

Article by Hammond

2006-10-20T09:31:00.000-07:00

Creating a better health care system requires a complete and comprehensive electronic health record. This involves using data which must be built upon common words, structures, and organization--interoperability. Interoperability requires standards. Department systems were stand-alone applications. For example at Duke Medical Center, lab results came back in paper form and had to be entered manually into TMR (the medical record)—this lead to an increase of data, excessive use of human resources, and high error rates. Steps to create a standard begin with the need for a standard. The expertise is likely to come from a vendor; however, the ideal standard is “vendor-neutral”. The standard must be marketed for adoption and then implemented. Standards may created by my methods such as 1. a group of interested parties can come together to create an ad hoc standard; 2. the government can mandate a standard; 3. marketplace competition and technology adoption can introduce a de facto standard; or 4. a formal consensus process, such as ANSI (the American National Standards Institute) can be followed.
Developing health data standards began in the 1980s. There are other important standard-making organizations that contribute to standards use in healthcare which include : the World Wide Web Consortium (W3C), Internet Engineering Task Force (IETF), the Object Management Group (OMG), and the Organization for the Advancement of Structured Information Standards (OASIS) bur business standards. ANSI coordinates the U.S. voluntary standards activities. Interoperability means that all necessary standards must be defined, adopted, and implemented. There are several concerns dealing with health data standards. There has been no clear set of definitions or instructions. No one has defined all the standards required to support interoperability for a NHIN. This is an important issue that is not being resolved because there has not been any effort to create a set of guidelines for health data standards. There needs to be “just-in-time” standards. These standards have the ability to produce effective standards quickly. Creating “just-in-time” standards will help implementers make progress toward interoperability.
Competition among SDOs have led to further issues in adoption health data standards. The competition forces implementers to choose between the competing SDOs. There is also overlapping in some areas. For example, the scripting standard created by the NCPDP (National Council for Prescription Drug Programs and the medication messaging standards defined by HL7. This causes conflict. Many users and vendors will use this particular conflict as a reason not to implement any standard until the situation is resolved. ANSI defines a process (including balloting rules) that support the creation of American National Standards. The ANSI process is governed by a set of rules and procedures for reaching consensus on technical decisions. Ninety percent of those voting must approve a ballot for it to advance to the level of a national standard. The ANSI balloting process can be accelerated by initial ballots for a Draft Standard for Trial Use (DSTU). Standards are very important in the health IT industry. Vendors want a standard that is favorable to their products because they are concerned that their products might not conform with standards. For this reason, almost all vendor participants in the standard-making process take part to protect their proprietary interest.
Standards within health information management are constantly changing. Hammond states, “New versions of standards are coming out even before older versions reach the final ballot stage. This process results in confusion and instability and creates a moving target for standardization.” He also suggest that the balloting rules need to be reevaluated and definitely shortened. HIPAA (The Health Insurance Portability and Accountability Act of 1996 was the first large-scale mandate of standards related to IT. There were major problems including the expense of processing claims, lack of data standards and identifiers, and the frequent changes in reimbursement rules. There are also several issues that must be dealt with concerning health data standards. These include : competition among SDOs, efforts to identify and create required standards are poor or do not exist, effective integration of clinical expertise into the process of making standards, a more effective approval process, a method to “fill the gaps”, balanced involvement of vendors, and many more. Hammond shows that these must be dealt with first before attempting to create a successful data standard. In order to deal with the above issues he recommends the creation of a neutral, nonprofit organization in the private sector with the authority to manage all aspects of health data standards. The work would be coordinated at that level and standards would be developed as single integrated efforts governed by process rules. Hammond suggests creating an environment where interested parties work together as one to produce a single set of standards.

There has been no effort to create a set of guidelines or instructions concerning health data standards. There are many gaps that have not been identified and will only be identified as progress is made toward a NHIN. There is also competition among the SDOs which further complicates the standard process. This causes implementers to choose among multiple operations and requires an additional step of mapping between standards using an interface engine for interoperability. Data Standards have also become an ever-changing process which makes them difficult to adopt and implement.
Each area in healthcare needs a set of standards. There needs to be a common language for all areas so that communication about a patient is efficient.
Interoperability means using data that is built upon common words, structures, and organization. It is imperative to use this so that multiple organizations can share and use data. Using interoperability can support for a national health information network (NHIN). In order to create a NHIN, there must be a set of common rules/structure which is called interoperability.
Standards for the content of EHR include functional requirements, HER models, continuity of care records (CCR), patient summary record, and personal health record.
SDO is standards-development organizations. Every standard does not necessarily need its own SDO. SDOs were created for general topics. General Standards were created by the SDOs—W3C, IETF, IEEE, OMG, HL7.

L. Blair Heath--HIM: L. Blair Heath--HIM: L. Blair Heath--HIM

2006-10-03T09:08:00.000-07:00

L. Blair Heath--HIM: L. Blair Heath--HIM: L. Blair Heath--HIM
IT Doesn’t Matter
By Nicholas G. Carr

Certainly information technology (IT) has spread over the past few decades. Since Ted Hoff created the microprocessor by putting the circuits necessary for processing on a tiny piece of silicon, many other technologies have come about. These include desktops, local and wide area networks, and the Internet. In the 1980s, only 15% of capital expenditures went to information technology. Now this expenditure has reached almost 50%. Not only has the expenditures on IT changed, but so has the view toward technology. In the past, computers were viewed as something for only secretaries to use, and CEO’s would not dare touch them. This has definitely changed. Now CEO’s use IT in their strategic thinking and how to gain a competitive edge. There is a problem with this view however, because IT is now viewed as a necessary resource rather than something extra that no one else has. Since availability increased and cost decreased, IT has become a commodity.

There are two different types of technology: proprietary technology and infrastructural technologies. Proprietary technology can be owned by a single company. An example of this would be an industrial manufacturer discovering a way to employ a process that other competitors cannot replicate or a company with consumer goods discovers a new packaging material that gives its product a longer shelf life. Infrastructural technologies offer more value when shared than when isolated such as the railroad. Although efficient for one company to have, it would be much more beneficial to everyone for an open rail network connecting many companies and buyers. In order to gain a competitive edge in infrastructural technologies, industries must be able to look ahead to see the advantage because there is only a small window of opportunity. Soon after the technology becomes known and appreciated, the cost drops and it becomes available/affordable to everyone, thus taking away the competitive edge. On the other side, when a technology comes out and a company lags behind implementing the new technology; this can seriously affect and damage their business.

IT is a transport mechanism, it is far more valuable when shared than when used in isolation (just as infrastructural technology). It would be almost silly to write your own application for word processing or e-mail, when you can buy it for a fraction of the cost. In order to keep up with information technology, many businesses now purchase “web services” provided by third parties. The author states, “The rapidly increasing affordability of IT functionality has not only democratized the computer, it has destroyed one of the most important potential barriers to competitors. Even the most cutting-edge IT capabilities quickly become available to all.” The best opportunities for gaining information technology based advantages are already dwindling. New technologies are easily replicated and are quickly built into software.

The most important statement the author made was “When a resource becomes essential to competition but inconsequential to strategy, the risks it creates become more important than the advantages it provides.” Since the advantage of having IT is decreasing, there are 3 important rules to remember. 1) Spend less—the penalties for wasteful IT spending will grow stronger 2) Follow, don’t lead—if you wait longer to make an IT purchase, you’ll get more for your money 3) Focus on vulnerabilities, not opportunities—companies need to prepare themselves for technical glitches, outages, and security breaches. Information technology has become imperative in all aspects of business. IT can be very beneficial in health information systems. Our world is moving more and more into technology, and healthcare should not lag behind. Health Information Systems should, however, be on the defense rather than the offense. This means, health information systems should not do large amount of IT spending, but rather stay on the lookout for risks and breaches. IT can be very beneficial if implemented into health information systems, but they should proceed with caution. Carr made a good discussion about information technology. This article points out IT is now available and affordable for everyone; therefore, taking away a competitive edge.

L. Blair Heath--HIM: L. Blair Heath--HIM

2006-09-26T08:42:00.000-07:00

Herding Cats
The story is about a certain medical center selecting an electronic medical record (EMR) vendor and all the challenges that are involved.

Fletcher Allen Health Care (FAHC) has interfaces to current technology systems such as IDX-Rad in radiology and SunQuest in the laboratory. They are both highly interfaced and poorly integrated. The system is highly manual and very redundant. There is no computer-based clinical documentation system for outpatient care. There is only a semi-automated system for inpatient care.

The first goal is to select an appropriate vendor that will provide the core clinical systems necessary for FAHC to achieve : supporting the work of FAHC clinicians and non-clinicians, supporting the Vermont community with a statewide patient healthcare record. The second goal was to create an enterprise clinical patient record. The third goal was to initiate a change management process within the clinical arena. The medical center does “not want to simply replicate the existing paper processes on the computer.”

They both established a team/committee. They both take a step of defining or selecting criteria, and then they both set goals or developed a strategy. The steps in chapter 6 involve exploring other options, conducting cost-benefit analysis, and contract negotiations—which the author did not include in his system acquisition. Both Chapter 6 and the authors of the article include distributing request for RFP, evaluating vendor proposals, and recommendations in their steps of system acquisition.

The 5 significant lessons that were learned include:
1. The initiative was established as a project, it was actually a discovery and a learning process.
2. “Although there was acceptance of the evaluation criteria at the beginning of the project, it would have been beneficial to have formal corporate buy-in of the criteria right from the start.”
3. “Consensus may not occur.”
4. “The initial goal was to discriminate the best vendor from the others. Eventually the goal was expanded to identify the vendor that was least risky…”
5. “Begin the contract development and negotiation during the sales process. This is when the vendor is willing to make commitments to gain new business.”

L. Blair Heath--HIM: L. Blair Heath--HIM

2006-09-26T08:00:00.000-07:00

Herding Cats

The story is about a certain medical center selecting an electronic medical record (EMR) vendor and all the challenges that are involved.

Fletcher Allen Health Care (FAHC) has interfaces to current technology systems such as IDX-Rad in radiology and SunQuest in the laboratory. They are both highly interfaced and poorly integrated. The system is highly manual and very redundant. There is no computer-based clinical documentation system for outpatient care. There is only a semi-automated system for inpatient care.

The first goal is to select an appropriate vendor that will provide the core clinical systems necessary for FAHC to achieve : supporting the work of FAHC clinicians and non-clinicians, supporting the Vermont community with a statewide patient healthcare record. The second goal was to create an enterprise clinical patient record. The third goal was to initiate a change management process within the clinical arena. The medical center does “not want to simply replicate the existing paper processes on the computer.”

They both established a team/committee. They both take a step of defining or selecting criteria, and then they both developed a strategy. The steps in chapter 6 involve exploring other options, conducting cost-benefit analysis, and contract negotiations—which the author did not include in his system acquisition. Both Chapter 6 and the authors of the article include distributing request for RFP, evaluating vendor proposals, and recommendations in their steps of system acquisition.

The 5 significant lessons that were learned include:
1.The initiative was established as a project, it was actually a discovery and a learning process.
2.“Although there was acceptance of the evaluation criteria at the beginning of the project, it would have been beneficial to have formal corporate buy-in of the criteria right from the start.”
3.“Consensus may not occur.”
4.“The initial goal was to discriminate the best vendor from the others. Eventually the goal was expanded to identify the vendor that was least risky…”
5.“Begin the contract development and negotiation during the sales process. This is when the vendor is willing to make commitments to gain new business.”

L. Blair Heath--HIM: L. Blair Heath--HIM

2006-09-26T07:55:00.000-07:00

Herding Cats

The story is about a certain medical center selecting an electronic medical record (EMR) vendor and all the challenges that are involved.

Fletcher Allen Health Care (FAHC) has interfaces to current technology systems such as IDX-Rad in radiology and SunQuest in the laboratory. They are both highly interfaced and poorly integrated. The system is highly manual and very redundant. There is no computer-based clinical documentation system for outpatient care. There is only a semi-automated system for inpatient care.

The first goal is to select an appropriate vendor that will provide the core clinical systems necessary for FAHC to achieve : supporting the work of FAHC clinicians and non-clinicians, supporting the Vermont community with a statewide patient healthcare record. The second goal was to create an enterprise clinical patient record. The third goal was to initiate a change management process within the clinical arena. The medical center does “not want to simply replicate the existing paper processes on the computer.”

They both established a team/committee. They both take a step of defining or selecting criteria, and then they both set goals or developed a strategy. The steps in chapter 6 involve exploring other options, conducting cost-benefit analysis, and contract negotiations—which the author did not include in his system acquisition. Both Chapter 6 and the authors of the article include distributing request for RFP, evaluating vendor proposals, and recommendations in their steps of system acquisition.

The 5 significant lessons that were learned include:
1. The initiative was established as a project, it was actually a discovery and a learning process.
2. “Although there was acceptance of the evaluation criteria at the beginning of the project, it would have been beneficial to have formal corporate buy-in of the criteria right from the start.”
3. “Consensus may not occur.”
4. “The initial goal was to discriminate the best vendor from the others. Eventually the goal was expanded to identify the vendor that was least risky…”
5. “Begin the contract development and negotiation during the sales process. This is when the vendor is willing to make commitments to gain new business.”

L. Blair Heath--HIM

2006-09-20T12:59:00.000-07:00

L. Blair Heath--HIM

Dr. Fineberg talks about ways to enhance the quality and safety of health care.

He speaks about better ways to do what we already know should be done for patients.

Dr. Fineberg feels that the quality of health care in the United States could be improved. He speaks about the article “To Err is Human” which documents the frequency of errors in the United States. Tens of thousands of patients lost their life because of medical errors. Dr. Fineberg also speaks of “Crossing the Quality Chasm” which lays out an agenda of improving the safety and quality of health care in the United States.

Health care should be safe, effective, patient-centered, timely, efficient, and equitable. Dr. Fineberg proposes a few approaches to solve the quality of health care. The Moral Actor model says, providers have an ethical and moral responsibility to their patients. This would eliminate many errors. Rational Actor Model’s theory is to reward quality and to punish the errors in care. Psychological Actor Model states that people are overworked and exhausted, and decision support systems would help organize the information. This would help overcome many deficiencies. Educated Actor would involve improvement of education systems would greatly improve quality. Information technology is very important in health care. It is, however, underused in the United States.

Information Technology is key in improving health care. Mothers who receive computer-generated reminders, had a 25% higher rate of on time immunizations for their infants. Adverse drug affects have been reduced from 28-95% before computerized systems. This is where many medical errors occur. 9% of redundant lab tests could be eliminated by using a computerized system. Information Technology is very important and has the potential to greatly improve the quality of health care in the United States. I don’t think anything will improve the quality of health care overnight, but I do believe that implementing more information technology will help make great progress.

L. Blair Heath--HIM: Electronic Health Records

2006-09-15T07:04:00.000-07:00

L. Blair Heath--HIM: L. Blair Heath--HIM

Electronic Health Records
The author discusses electronic health records. His purpose is to show the statistics of how many physician practices are actually using electronics on a regular basis. The author is surprised to find out the low amount of physicians that have actually made the change to electronic health records. He also wants to demonstrate the reasons that physicians are not embracing EHR. The author wants to show the positives of the technology and the results of making the necessary changes. The results are an increase of productivity and revenue. EHR is also much more efficient.

The author arrived at the conclusion that physicians are not jumping on board to the technology of today. According to the statistics, there is a small percent of physicians using electronics on a routine basis.

There is still a long way to go to have EHR adopted near universally. The eight core capabilities for EHR are very efficient and helpful. The capabilities of EHR are wonderful—decision support, patient support, order management, result management. All of these combined would greatly impact the healthcare of an individual. It only makes sense that in this technological society, that our healthcare would be also technologically advanced. Although the capabilities “seem” wonderful, physicians still do not seem to be willing to make the time-consuming change.

The biggest factor is cost. A large investment is required and it takes 18-24 months to recover the efficiencies gained. Embracing EHR would change the workload within the physicians office.

Change itself is scary. It is also time-consuming. Even if the end result pays off, it is switching over to EHR is the hard part. It is not just an investment of money, it is an investment of themselves. The physicians and staff have to be willing to make the necessary changes and implement electronic health records. There are also so many choices concerning electronic health records. Physicians have a hard time making a decision of which one to choose. After implementing electronic health records, a physician practice can expect to see 25% less patients for a period of 3 months. This is another negative factor that many physicians do not wish to deal with. It is a sacrifice worth making. After the system is up and running efficiently, the physician practice will be able to see more patients than before.

L. Blair Heath--HIM

2006-09-09T08:51:00.000-07:00

L. Blair Heath--HIM

HIPAA, TB, and Me
The story is about a woman who’s daughter lives with a roommate that received a positive TB test. The college did not take the preventive course of action in order to protect the girl from also receiving TB. The student with the positive TB test did not want to take an x-ray because of radiation from an x-ray.

What is the author's major points? She is trying to show how a law with good intentions can actually hinder the health of some patients in certain situations. The goal of HIPAA is to protect patient information. The goal of health care providers should also incorporate preventing health problems if possible. I agree with the mother in this particular situation. It was the college’s responsibility to make sure the proper course of action was taken. They knew that the girl contracted TB within the past year, and it was only fair to those around her for her to have an x-ray.

The mom definitely had a much better understanding of HIPAA regulation. It was the Health Services Center Administrator’s duty to disclose personal information in order to avert threats to the health and safety of others. She could have also answered the mom’s questions without disclosing patient information.

Everyone was putting patients privacy over everything else. Protecting patients and preventive care was not above of protecting patient privacy. The administrator thought that she was following the law by protecting one patient’s privacy, when she was in fact preventing the care of another.

The goal of HIPAA is to protect patient privacy. Many health care providers understand that it is their job to protect patient privacy. There is some discrepancy. Sometimes it is more hassle than help. They protect information from people that it does not need to be protected from. The HIPAA law has good intentions but it is a difficult law.

The author’s point is that although HIPAA attempts to do something good, sometimes it does not always turn out that way. She is showing how HIPAA grants information to police, employers, court officials—but not mom, dad, son, daughter. I agree with the mom in some aspects. It is a controversial issue. In some situations it seems that patient privacy should be protected, but in many situations this is not the case—yet it is still protected. Many health care providers know that they can receive jail time for violating the HIPAA law, so they obviously do not want to break HIPAA rules even if it means putting someone else in harm's way.

L. Blair Heath--HIM

2006-08-31T08:34:00.000-07:00

L. Blair Heath--HIM

August 31, 2006

Computerization Can Create Safety Hazards: A Bar-Coding Near Miss

The article by Clement McDonald, MD discusses the positives and negatives of computer-based physician order entry (CPOE). The CPOE uses a bar-coding system. The author describes a few cases in which there were serious mistakes using the bar-coding system. The misidentification of patients led to serious problems and misdiagnoses after admission.
The author attempts to point out that although computerized systems can be beneficial, we need to continue to closely monitor a patient and “double check” everything in order to ensure patient safety. The author is trying to show that this bar-coding system can be a positive thing, but we do not need to rely on it 100%. There is always room for error. McDonald also states that the best defense against error is a doctor who knows his/her patient well. I agree with the author. I think there is a good description of both the pros and cons of the CPOE. The author goes into details of several different errors that can occur during patient care. In the first case the author described, there was the error of switching the 2 bracelets during admission. The nurse did not notice that Mr. D’s 2 wristbands differed. Results were downloaded onto the wrong record because of the switched identification. The clerk, after noticing the error, did not personally confirm that the error had been resolved before further damage.
The patients name, admission date, birthday, doctor’s name, and patient number are all listed on the patient wristband. The quality of the data on the wristband is very good. It is accurate, current, and comprehensive which are comparable to the AHIMA characteristics.
The author promotes redundancy as a way to prevent errors. The tradeoff is that there is less time for direct patient care, but the safety of the patient is maintained. It is important to reduce the risk of misidentification as much as possible. Redundancy is a good way to reduce the risk of errors. I think for the most part the errors that occurred were systemic. Most of the time there was no “double checking”. The error that the clerk did not follow through after she realized the mistake was a random error.
The article goes into detail the continual need for humans to double check things. We put too much “faith” into computers. Although computers are very beneficial to the medical world, we do not need to lose sight that there is room for error. This article was very interesting to me. I am sure it would be a wake-up call to many professionals that are involved in hospital care.

HIM

2006-08-28T13:20:00.000-07:00

Just checking this thing out