Beyond Medical Informatics

I found a great online resource: IT Execs Release Guidebook on E-Health Records Implementation – CIO.com.

The College of Healthcare Information Management Executives released a guidebook for CIOs and other IT managers with tips and first-hand experiences in implementing electronic health records in order to meet government “meaningful use” standards.

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The publication, The CIO’s Guide to Implementing EHRs in the HITECH Era, includes best practices and steps health-care organizations should take to successfully implement EMRs, from the initial planning through the final documentation of results.

The guidebook is free for the public and can be downloaded here.

Here’s the first bit of news:

Electronic medical orders may save lives

Doctors at a California children’s hospital have found the first evidence that using an electronic system to communicate their orders may save lives.

After the system was introduced in 2007, the hospital witnessed a 20-percent drop in mortality rate, the equivalent of 36 fewer deaths over a year and a half.

CPOE implementations are challenging projects–and are prone to failure. But this shows the risk is worth taking.

About Telehealth:

Telehealth takes off as evidence grows that it can improve care, save money – FierceHealthIT

Telehealth is helping to expand the reach of dermatologists, neurologists, radiologists, critical care physicians and mental health professionals, among other specialties, and to reduce the need to transport the sickest of patients.

This news bit refers to an InformationWeek Article, which expounds on the points made about the activities and benefits of Telemedicine.

In the Philippines, the gap between what is and what should be when it comes to the delivery of basic health services is still wide. Undoubtedly, telemedicine plays an important role in bridging that gap. News like these can help in the cause.

I recently stumbled upon good news about CHITS:

First Region-wide CHITS-EMR Conference a Success

CHITS stands for Community Health Information Tracking System. More info about it here.

Last Nov. 16 to 21, 2009, we visited three US hospitals: Stanford University Medical Center in Palo Alto, CA, Children’s Hospital Boston in Boston, MA and Brigham and Women’s Hospital also in Boston, MA. We chose to visit these organizations because they are Stage 6 Hospitals in the HIMSS EMR Adoption Model.

This was our schedule:

Nov. 16: Arrive San Francisco from Manila
Nov. 17: Stanford University Medical Center
Nov. 18: Flight to Boston
Nov. 19: Children’s Hospital Boston
Nov. 20: Brigham and Women’s Hospital
Nov. 21: Flight to Manila via Boston-Detroit-Nagoya

I know, the trip was undeniably tiring. I had to fight jet lag, mental fatigue and body aches (mostly from the economy airline seats) all throughout the site visits. But overall it was one great learning experience.

Below is a summary of the recurring lessons we gathered from all the hospitals.  Items in bold are lessons that I feel are not so common and therefore need more emphasis.

Don’ts

• Don’t think of Healthcare IT projects as IT projects. They are, at the core, clinical process improvement projects aimed at improving clinical quality and patient safety.
• Don’t expect to achieve anything substantial:
  • in 1 year or less. Successful hospital IT projects take time.
  • without a governance structure.
  • without engaging users at the RIGHT level and RIGHT context.
• Don’t do too many IT projects at the same time. It taxes hospital resources and might cause ‘project fatigue’ among users and staff.
• Don’t force compliance. Forced compliance is not buy-in.
• Don’t be afraid of failure or risks.
• Don’t expect a perfectly-executed and problem-free implementation.

Do’s

• Align IT projects with organizational strategic initiatives. This helps ensure executive sponsorship.
• Create a well-thought out governance structure. Get the right people responsible for decision-making.
• Manage project and resource priorities through the governance structures. Avoid bypassing the decision-making process.
• Build the right teams around project champions. Identify project leaders.
• Make sure users are represented in the governance and decision-making process.
• Engage users at the RIGHT level. Let MDs talk to MDs. Nurses talk to nurses.
• Engage users at the RIGHT context. Understand how the systems interact with their organizational structures, processes and teams. IT systems in hospitals do not ‘work alone’.
• Plan properly. Planning takes time and involves many stakeholders.
• Manage user expectations all throughout the implementation. Involve the project leaders/champions in managing user expectations.
• Do include a ‘stabilization’ stage after implementation. This gives the hospital staff ‘breathing space’ to adopt (and adapt to) the new processes brought by the IT changes.
• Consider staged or phased implementations. This lessens the risk of ‘big bang’ failures, requires lesser implementation resources and avoids ‘project fatigue’ among hospital staff.
• Consider IT projects as collaborative endeavors between IT and users.
• Expect problems. Be ready for them.

My biggest take away from all of these is the importance of governance in hospital IT projects. For these hospitals, the responsibility for project prioritization has moved from the hospital administration and operations to the clinical staff. The clinical staff, therefore, had to work with hospital leadership and IT to create governance structures for their needs.

All three had different governance structures, which means that there is NO silver bullet for the right one. But having a hospital IT governance structure that aligns projects with key strategic initiatives, focuses on patient safety and allows user representation in decision-making increases the chances of success.

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Do you have other Health IT lessons worth mentioning? What lessons did you learn from your own implementations? Please share them below. Thanks!

Here’s a list of news, links and articles about Medical Informatics, Healthcare and IT that I found interesting this past 3 weeks.

Medpedia
A new online resource for health professionals and patients. It is an online Wiki for medical knowledge. It adopts Web 2.0 concepts of open platforms, collaborative efforts and fostering communities to build an online repository of user-contributed, peer-reviewed health information.

Healthcare’s Most Wired Magazine
Website of a magazine that does annual benchmarking studies on US hospitals “to promote the effective use of information technology in achieving clinical and operational excellence”. Good resource for hospital managers and IT departments for possible projects.

Plain Language For Health Care Professionals To Improve Communication With Patients
Understanding what language to use based on the audience is important in effective communications. This article highlights the communication gap between doctors and patients and recommends a readibility toolkit to help bridge it. Consider this concept when understanding the differences in implementation, content and usability features of EMRs and PHRs.

Paperless health care? A hospital’s long journey
A short overview of one hospital’s effort to computerize its clinical processes. The article even describes pitfalls and provides tips to those who want to start on their own EMR efforts. Here’s my favorite line: “Building an EMR doesn’t just mean buying software and flipping a switch. It physically changes how doctors and nurses work…”

And some quick links to interesting articles:

• Saving the healthcare industry: EMRs are the ‘beginning, not the end’
• Text messaging promises cheap, effective delivery of health information–in Africa

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Is there an interesting Healthcare IT-related link you’d like to share? Please post them below. Thanks!

When I have time to get my mind out of my hospital work, I sometimes wonder about national Healthcare IT initiatives. Where are we as a country in terms of Healthcare IT adoption and implementation?

First off, I don’t have the answer. Second, it is not a rhetorical question.

Health IT is now a ‘hit topic’ in US headlines, mainly because of the Health IT component of the US Stimulus Package. In my HIT List for June 20, I posted an article about Sweden launching a national electronic health record. According to Wikipedia, there are other nationwide projects in the UK and Canada.

Well, what about the Philippines?

The National Telehealth Center (NThC) is at the forefront of national telemedicine projects. And it is doing a very good job. But what about Hospital Information Systems (HIS) and Electronic Medical Records (EMR) adoption?

HIS and EMR adoption may be still be very low among Philippine hospitals, both public and private. Administrative, financial and inventory systems might exist but clinically-relevant applications might be sparse. I hear there are several pockets of successful clinical databank implementations, but data integration and interoperability are still monumental challenges.

Beyond a formal study of national EMR adoption, we can start doing benchmark exercises in our own organizations to see how we compare against US standards. It gives management valuable insight into what still needs to be done.

Benchmarking

Here are 2 good online resources to start benchmarking:

1) CDW Healthcare IT Checkup

The site is basically an online questionnaire. It guides the user to answer several questions about the organizational implementation of client technologies, IT infrastructure and clinical applications. Once completed, a conclusion and graph is shown to compare your hospital against CDW’s data on US hospital IT standards.

2) EMR Adoption Model from HIMSS Analytics

From the site: “HIMSS Analytics, the authoritative source on EMR Adoption trends, devised the EMR Adoption Model to track EMR progress at hospitals and health systems. The EMRAM scores hospitals in the HIMSS Analytics Database on their progress in completing the 8 stages to creating a paperless patient record environment.”

The EMR Adoption Model (PDF) and the EMR Adoption Model Descriptions can also be seen accessed, downloaded and studied for uses beyond benchmarking. It gives a rough draft of what is possible, what applications build on each other and what activities need to be done at a certain stage.

The 1st site is relatively new, but the 2nd one provides US benchmark data from as early as 2006.

National Discussion

I think we should start a national discussion on HIS and EMR adoption and implementation. The HIT advocacy by different groups and people are still ongoing, but it may be time to step it up a notch.

Benchmark data allows us to compare against other countries and establish a baseline. But we are not in a race with other countries. We are in a race with ourselves. So, the point of the exercise is not about catching up. It is about imagining possibilities, proposing local and national initiatives, and coming up with ways to improve delivery of care with the help of information technology.

Knowing where we are is NOT as important as knowing where we want to go.

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Do you have your own online resources (or maybe offline articles and studies) to benchmark your HIT activities?

Do you know of national initiatives to promote HIS and EMR adoption? How do we jumpstart one? How do we improve efforts in HIT advocacy?

Here’s a list of news, links and articles about Medical Informatics, Healthcare and IT that I found interesting this past week (May 17 – 23, 2009) .

AMIA Podcasts and Media
Podcasts and materials may not be so new but I just found out about this online resource this past week. It’s from the American Medical Informatics Association Website.

 Quest, Microsoft platform allows shared lab results
The 2 companies “created an infrastructure allowing patients and doctors to share diagnostic lab test results online”. I know some local laboratories have been doing this for some time now. They allow patients to create user profiles so they can access their results online. In the US, they have to adhere to HIPAA laws. Here in the Philippines, we don’t have any local HIPAA counterpart. Should there be one? I personally have my hesitations.

VA plans EMR-based project to study treatment effectiveness
The real value of electronic medical records is in improving clinical outcomes. However, the process of getting clinical outcomes involves comprehensive data capture, storage and analysis that only computerization can provide. Sometimes it can be a chicken-and-egg thing. That’s why buy-in from hospital management can be difficult if computerization is still in its early stages. Good thing there are studies—done and ongoing—that can help provide evidence. I’m excited to see the results of this one.

Patients willing to forgo some health IT privacy for availability
It’s always give-and-take. Here in the Philippines, unless one is a public figure, patients are not so concerned about privacy issues. I guess in a country where the basic delivery of primary care is still an ongoing challenge, healthcare IT privacy is the least of our concerns.

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Is there an interesting Healthcare IT-related link you’d like to share? Please post them below. Thanks!

Here’s a list of news, links and articles about Medical Informatics, Healthcare and IT that I found interesting this past week.

I found 2 new online resources for Healthcare IT :

• FierceMobileHealthcare (c/o a post from Neil Versel’s Healthcare IT Blog)
• FierceHealthIT (after following the link above)

Other interesting links:

• Health Technology Watch List for 2009: A list by ECRI, ‘electronic medical records’ still remain at No. 1. Interestingly, in the light of the Swine Flu Pandemic, No. 10 is ‘rapid tests for deadly infections’.
• GE plans new health care initiative: Still another technology vendor going into the Electronic Medical Record space. There’s plenty of room, including room for improvement! Here’s another article on GE’s plan: GE to Invest $6B in Health Care Initiatives.
• AHIMA Identifies Measures for Widespread EHR Adoption: A list of items to consider for EHR adoption. Will have to comment on each item in succeeding posts.
• Philippines urged to adopt int’l telehealth standards: An InfoWorld/ComputerWorld article on the potential action items after the eHealth 2009 conference.

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Is there an interesting Healthcare IT-related link you’d like to share? Please post them below. Thanks!

Here’s a short list of Healthcare IT news and articles that I found interesting this week (April 24, 2009).

• Obama names first-ever CTO to oversee health IT: The US names a National Chief Technology Officer (CTO). And he’s first task is to oversee EMR adoption and Healthcare IT initiatives. Interesting.
• Robots are Rx to reduce errors: This hospital applied several technologies and clinical informatics concepts to help reduce errors; these include automation, barcodes, electronic medical records and robots!
• Defining the medical subspecialty of clinical informatics: The American Medical Informatics Association (AMIA) is putting in a lot of effort to make Medical Informatics a legitimate Medical Subspecialty in the US. If this pushes through, other countries are sure to follow. This is something I’m keeping an eye on.

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Is there an interesting Healthcare IT-related link you’d like to share? Please post them below. Thanks!

Here’s a short list of Healthcare IT news and articles that caught my attention this week (April 17, 2009).

• CMIO Magazine is a new magazine targeted for Chief Medical Information Officers (or similar positions, e.g. Medical Informatics Consultant). It’s still on its first issue. I hope it’s good. I look forward to an information resource that’s more focused on issues, topics and applications for hospital enterprises and healthcare institutions.

Many software and technology vendors are riding the Healthcare IT wave.

• Sun Software Key to Electronic Medical Records Network: Sun is working with US Federal agencies to work on the National Healthcare Information Network (NHIN).
• Intel, GE Invest $250 Million in Health IT Partnership: Two big powers joining forces to tackle Healthcare IT challenges.

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Is there an interesting Healthcare IT-related link you’d like to share? Please post them below. Thanks!