Measuring Improvements in Patient Safety

Measuring Improvements in Patient Safety as a Result of Using the Electronic Medical

In 2007, it has become regular practice to use a laptop to display a patient's medical history as well as giving the health care provider an opportunity to add notes regarding the patient's current health, or results from previous examinations. Medical staff now have software that allows them to use shorthand and have their words automatically transcribed, this allows medical staff to maintain eye contact with patients; while forwarding vital records and other pertinent information worldwide. However, technology is not without its faults. Lazar (2006), reports on how simple it is to have information misinterpreted when using software and working with patient information electronically. The writer further reports on how the information of a 63-year-old patient was misinterpreted due to mistyping, the word movies was seen as remove from the software. This forced the staff to endure difficult menu screens to fix the problems.

Switching from paper charts to electronic health records is like any conversion experience-it takes a little faith. However, patient data stored on a filing shelf doesn't miraculously move into a computer by itself. You've got to lend a hand.(Lowes, 2007)

In the age of electronic patient records, there are a number of concerns that arise; these consist of the security, and the quality of information in hospitals as well as efficiency. These concerns are primary reasons why companies akin to Allscripts exist. Lager (2007), discusses that Allscripts exists to smooth out the wrinkles by providing electronic medical records software and information solutions for the healthcare industry. However, as a growing industry, the sheer volume of data combined with the relative scarcity of capable people and solutions left Allscripts scrambling to remain reliable for its clients. A solution became necessary, and was in immediate need. Information technology came into play; therefore, a Virtual Support Engineer was created. Virtual Support Engineers are available either on-demand or installed, performs all the routine maintenance that would normally fall to technology personnel, and alerts service engineers when a Problem is developing that's beyond the software's scope, so that it can be resolved before anybody notices a difficulty.

Schmit (2005), reports on an interview that stated; more than 85% of U.S. doctors rely on paper records. That slows the flow of information between doctors, labs, and hospitals. The health care industry, encompassing more than 700,000 doctors and thousands of hospitals, has been slow to adopt information technology in part because the industry is so big and fragmented.

Cavolo (2007), reports that the first step toward implementing an electronic medical record EMR system is to establish ones facility's "technology baseline" by evaluating its current technology, including PCs, servers, network hardware, application licensing agreements, network wiring, electrical wiring, and current Information Technology (it) support operations. This technology must be documented, reviewed, and assessed to ensure that the current technology environment can support an EMR system. One will need to know which infrastructure components will require an upgrade -- and the price of upgrading these-before purchasing an EMR system.

Often administrators start the EMR vendor selection process by inviting vendors into their facilities to demonstrate their software systems. Software demos should never be the first step of selecting any technology vendor, especially for EMR. Vendors will often tell you the total cost of the software only, and facilities may take this number to be the bottom-line cost of the project. The price of the software is not the bottom line; administrators must also determine the hardware, network, infrastructure, electrical, and other expenses specific to their facilities. On average, the software outlay for an EMR system represents less than 50% of the total cost of an EMR projects first year of operation. (Cavolo, 2007) national survey reveals that the majority of Americans would prefer physicians and insurance companies that use electronic medical records over those that do not. Healthcare giant Kaiser Permanente commissioned the telephone survey of 1,000 U.S. adults conducted by an independent research firm. Seventy-two percent of respondents view a computer system as more efficient than a paper system when it comes to managing medical records. Although Americans are clearly interested in electronic medical records, 57% of respondents said they did not recall seeing, hearing, or reading about electronic records before being surveyed. (Swartz, 2007)

Rosenbloom (2007), refers to the complications with previous manual approaches to data collection and maintenance. She further reports that difficulties with paper systems have led perceptive healthcare providers to consider revamping this paper-based process. Providers are aggressively assessing all aspects of the revenue cycle, with a focus on improving labor-intensive, high-cost operations. Perhaps the most obvious result stemming from implementation of electronic charge capture is the eradication of encounter forms. With the elimination of paper comes increased efficiency for the provider. If providers are unsure of the status of specific charges, rather than speaking with the operations manager or billing department, they can simply access an online reconciliation screen, which clearly identifies missing charges. Providers would never have had such transparency with a paper-based process.

Quality continues to be an issue with electronic data, as well as a means of testing that system to see how efficiently it functions. Robeznieks (2007), reported data on a study that was conducted in 2003 thru 2004; the published report indicated that an Electronic Health Record (EHR) did not insure an increase in the quality of care provided to patients. This caught the attention of healthcare providers and vendors. The study examined records of 50,374 patient visits collected as part of the National Ambulatory Medical Care Survey, and compared how physicians with and without EHRs did on 17 quality measures. What the study shows is that with the way EHRs are being used they are not much more than a replacement for the paper chart. The two measures that the EHR-using physicians scored significantly better involved avoiding prescribing benzodiazepine to patients with depression and avoiding unwarranted urinalysis testing. The authors were surprised to report that EHRs were associated with worse quality when it came to prescribing medication to treat high cholesterol.

There is concern that vendors, in an effort to keep up with demand, will rush to incorporate quality measures before they are fully vetted by the field. This can be problematic considering most of the current quality initiatives rely on administrative and billing data rather than clinical data to ensure that providers who do not have an EHR system are able to participate. (McKinney, 2007)

The move toward all EHRs is gathering momentum and support just over 38% of U.S. hospitals now use EHRs, according to surveys conducted. Open-source software originally developed at Veterans Affairs is pulling EHR pricing down from stratospheric levels. In Midland, TX, Midland Memorial Hospital is spending $7.1 million to convert its 371-bed hospital, three-campus system to Open Vista, an open-source EHR from California-based Medsphere. Like most serious EHR systems, OpenVista combines patient charting, electronic order entry pharmacy, labs, nursing, admitting, billing, and other hospital functions into a single interoperable system. The EHR is the basis for driving significant improvements in health care.(Gebhart, 2007)

In addition to not offering a ringing endorsement of EHRs, the report also commented on the low level of quality in healthcare in general, and stated, "It is worth noting that the performance on most indicators was suboptimal regardless of whether an EHR was used." (Robeznieks, 2007)

Swift and widespread use of electronic health records and networks to connect clinics, hospitals, pharmacies and public health agencies outpoll other strategies to boost U.S. healthcare's uneven quality of care in the latest Commonwealth Fund / Modern Healthcare Opinion Leaders Survey. Slightly more than two thirds of the 214 respondents in the online poll of industry executives and healthcare delivery, finance and policy experts agree that information technology could improve quality, compared with 59% who express the same confidence in public reporting of performance measures. (Evans, 2007)

Terry (2007), discusses the second article in a series concerning implementation of an EHR system. Three small and medium-sized practices reported on the unexpected and frustrating problems they encountered when they turned on their new EHR and practice management systems. To varying extents, their plans for the "go-live" phase of implementation were inadequate to cope with the reality.

Lowes (2007), reported on one of the methods used to increase the efficiency of using EHRs thru the utilization of two flat-panel monitors, which allow healthcare staff the ability to view the electronic health record program on one, and hospital records on the other. He further reports that several studies claim that dual monitors boost a person's workstation productivity by 10% to 40% as well as reduce errors. Faster computing frees up time for other tasks, like seeing patients. These efficiencies extend to staffers too. Many new computers come with dual-head video cards, meaning that they have two monitor sockets. If your machine has just one socket, you can add a second single-head video card or else a dual-head card.

Researches have expressed what a critical component personal health records are in the fight to improving the quality of health care, but thorough consent and security policies regarding access and transmission of electronic health information are an equally important matter. Gonzalez (2007), discusses the company WellPoint Inc. that provides its members with the capability to develop their own personal health records, an option to receive test results online, provide a limited set of records to their providers and to allow other family members access to the information. In terms of security safeguards, WellPoint tracks who accesses information and has staff members to monitor the systems for potential breaches. This in turn offers users a certain level of security and quality in services rendered.

As pay-for-performance programs flourish, there is a fear that many EHRs cannot accurately capture the data that is required to participate. The biggest obstacles for software makers are the sheer volume of performance measures and the lack of standardization among them. One pressing issue is that some EHR systems are still text-based and are therefore not as powerful for reporting and extracting information. (McKinney, 2007)

Wilson (2007), explains that since Michael Murphy became the top executive at San Diego-based Sharp Healthcare in June 1996, he has utilized a consensus-building style that continually led seven hospitals (four acute-care facilities and three specialized operations) and 2,600 affiliated physicians to leverage information systems to improve patient care. In addition to the physician-practice EMR, Murphy supported a difficult decision to deploy a single-product, inpatient EMR, severing decades-old relationships with a number of other vendors. Murphy says it is an important tool of a program he launched six years ago called "The Sharp Experience," which strives to improve patient, employee and physician satisfaction with the health system using Six Sigma, a systematic, data-driven approach to continuous quality improvement originally developed at Motorola.

Burda (2007), explains that many hospitals have been using the legal uncertainty over it subsidies to physicians as a reason not to provide practitioner with the funds to digitize their practices, clinics, and outpatient surgery and diagnostic centers. Under the federal tax code, the charitable assets of tax-exempt organizations such as not-for-profit hospitals cannot be used to benefit private individuals, including physicians. Hospitals that violate that code could face special excise taxes or even risk losing their tax-exempt status. This is a strong enough reason to not give funding so freely that would allow practitioners to acquire, install, and implement it in order to connect their practices to the hospitals where they admit and treat patients.

Leaders of both the hospital and physician communities as well as it advocates reported that such a connection is essential to improving patient care. Better coordination of data will in return bring about better coordination of care, safer patient care, and better clinical outcomes. However, until now, it was up to each side-hospitals and physicians-to buy their own it systems and hope they work together. Most often, it is the capital-deep hospital or hospital system with the state-of-the-art it system cajoling the capital-shallow physician or group practice to buy a similarly fancy it system. Study after study over the past few years has quantified the low penetration of various it systems in the physician sector.(Burda, 2007)

Burda (2007), concludes that there was a shift in the paradigm when it was reported that not-for-profits could give money to doctors to buy electronic health records systems without jeopardizing the hospitals' tax-exempt status. The IRS said such subsidies are permissible as long as the hospital-physician it arrangements do not violate any other federal laws. To avoid violating any other federal regulations like the anti-kickback statutes, which bar any form of remuneration to induce Medicare or Medicaid patient referrals, hospitals, must make the same it goods and services and the same level of subsidy available to all physicians on staff.

As healthcare stakeholders advance toward the President's vision of providing every American with an electronic medical record by the year 2014, a growing number are taking the intermediary step of creating personal health records (PHR). PHRs maintained by health plans are based on aggregated claims data. Plan-sponsored PHRs provide a broad range of information and enable patients to track their medical encounters across multiple providers. (Reese, 2007)

Use of it in health care is intensifying rapidly, with President George W. Bush calling for widespread adoption of electronic medical records (EMRs) within the next ten years. In addition to digitizing the information that providers use to care for their patients within organizations, clinicians, patients, and policymakers are looking ahead to sharing appropriate information electronically among organizations. To explore the qualitative and economic implications of health care information exchange and interoperability (HIEI), the researchers studied the value of electronic data flow between providers (hospitals and medical group practices) and other providers, and between providers and five stakeholders with which they exchange information most commonly: independent laboratories, radiology centers, pharmacies, payers, and public health departments. Results indicated that a fully standardized HIEI could yield a net value of $77.8 billion per year once fully implemented. Non-standardized HIEI offers smaller positive financial returns. (Walker, Pan, Johnston, Adler-Milstein, & et al., 2005)