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8/9/2019 2015 02 10 - Why Using EHRs Might Save Lives but Steal your Sunshine
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Daniel J. Vreeman, PT, DPT, MScAssociate Research Professor
, Indiana University School of Medicine
Associate Director for Terminology Services, Regenstrief Institute, Inc
© 2015
Why Using EHRs Might Save Lives
but Steal your Sunshine
T558. OT Management in Today’s Health and Community Systems
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photo via [credit]
photo via Sadie Hernandez
http://www.flickr.com/photos/sadiediane/
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For as long as I havewanted to be a clinician,
I have also wanted to bea scientist and an
information technology specialist .
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No magical thinking!
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Objectives
When it’s all said and done, you’ll be able to…
1. Explain the current forces driving adoption of information
technology
2. Appreciate the kinds of problems that can be improved withmore judicious use of health information technology
3. Discuss the key factors for success, as well as important
barriers to implementing electronic health record systems in
rehabilitation4. Articulate at least one way that you could use health
information technology to improve care
photo via Vernio77
http://www.flickr.com/photos/verino77/
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First, someintroductions…
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McDonald CJ, Callaghan FM, Weissman A, Goodwin RM, Mundkur M, Kuhn T. Use of internist's free time by ambulatory care Electronic Medical Record systems. JAMA
Intern Med. 2014 Nov;174(11):1860-3. PubMed PMID: 25200944.
The EHR steals 60 minutes a day from me!
photo via lara604
48 mins/day
mean time loss per
clinic day for attendingphysicians
http://www.flickr.com/photos/lara604/4689353343/sizes/o/in/photostream/
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Were MC, Nyandiko WM, Huang KT, et al. Computer-generated reminders and quality of pediatric HIV care in a resource-limited setting. Pediatrics. 2013 Mar;
131(3):e789-96. Epub 2013 Feb 25. PubMed PMID: 23439898.
4xincrease in completion
of overdue clinicaltasks!
(68% vs 18%)
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Saving lives orstealing sunshine?
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The FutureGreat Scott!
photo via JD Hancock
http://www.flickr.com/photos/jdhancock/4100030094/
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Complete,
longitudinalinformation that
follows the consumer
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Care that is
value-based and coordinated
across settings
photos via meddygarnet and brykmantra
http://www.flickr.com/photos/brykmantra/http://www.flickr.com/photos/meddygarnet/
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photo via proimos
Someday, care will be
Comprehensive
Patient-centered
CoordinatedAccessible
SafeHigh quality
http://www.flickr.com/photos/proimos/7015509987/in/photostream/
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Meanwhile,back on planet Earth…
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Forrey AW, McDonald CJ, et al. Logical observation identifier names and codes (LOINC) database: a public use set of codes and names for electronicreporting of clinical laboratory test results. Clin Chem. 1996 Jan;42(1):81-90. PubMed PMID: 8565239.
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Fundamental challenges: Local systems have different ways of
identifying the same concept .
Things that look alike aren’t the same.
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Patients move faster
and further than theirhealth information
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In USA, major driver ofeHealth standards adoption is
EHR Incentive Program
a.k.a. “Meaningful Use”
Blumenthal D, Tavenner M. The "meaningful use" regulation for electronic health records. N Engl J Med. 2010 Aug 5;363(6) :501-4. Epub 2010 Jul 13. PubMed PMID: 20647183.
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Electronic Health RecordsOpportunities and Challenges
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4 Ways EHRs can
Accelerate that VisionSeamless web of dataData reuse
Cost savings
Decision support
photo via OiMax
http://www.flickr.com/photos/oimax/1966934332/
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photo via noshaMcDonald et al. Canopy Computing: using the Web in Clinical Practice. JAMA. 1998;280(15):1325-1329.
http://www.flickr.com/photos/nosha/
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photo via [credit]
A U ifi d P ti t R d
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A Unified Patient Record
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Finnell JT, Overhage JM, Grannis SJ. All Health Care is Not Local: An Evaluation of the Distribution of Emergency Department Care Delivered in Indiana. AMIA Annu
Symp Proc. 2011;:409-416.
41% of ED visits are for patients withdata at another institution
Connectedness among Indiana EDs
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Finnell JT, Overhage JM, Grannis SJ. All Health Care is Not Local: An Evaluation of the Distribution of Emergency Department Care Delivered in Indiana. AMIA Annu
Symp Proc. 2011;:409-416.
Connectedness among Indiana EDs
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Nearly every ED inIndiana shares
patients with
every other ED inthe state
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photo via pagedooley
Collect once. Use many.
Clinical care, public health reporting, quality
management, clinical and epidemiological research, etc…
http://www.flickr.com/photos/pagedooley/8435953365/sizes/o/in/photostream/
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photo via [credit]photo via Rob Pongsajapan
http://www.apple.com/
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Cost Savings
photo via Refracted Moments™
http://www.flickr.com/photos/refractedmoments/
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EHRs = Lower Cost
Only crazy people would say that!
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Clinical Decision MakingRight info. Right time. Right format.
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Everyone wants it.
Nobody has time.
Evidence-based Practice
Jette DU, Bacon K, et al. Evidence-based practice: beliefs, attitudes, knowledge, and behaviors of physical therapists. Phys Ther. 2003;83(9):786-805.
patients + evidence + clinical expertise
(So they say)
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How can EHRs help?Tools to implement EBP at the point of care.
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EHR Decision Support A computer-generated suggestion aboutcare for an individual patient
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The secret sauce of theEHR chicken soup
photo via liberphoto via liber
http://www.flickr.com/photos/liberhttp://www.flickr.com/photos/liber
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Where’s the evidence?
photo via paskukaru76
http://www.flickr.com/photos/pasukaru76/
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92%of 154 studies
July 2007
to Feb 2010
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Odds Ratio = 1.7995% CI 1.56, 2.05
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Evidence in Rehabilitation
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Your Turn…What would be suggested?
What data would be needed?
1968!
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1968!
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Benefits of EHRs
Improved reporting
Improved operational efficiency
Improved communication
Improved data accuracy
Vreeman DJ, Taggard SL, Rhine MD, Worrell TW. Evidence for electronic health record systems in physical therapy. Phys Ther. 2006 Mar;86(3):434-46; discussion 4 46-9. Review.
PubMed PMID: 16506879.
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Barriers to Implementing EHRs
Behavior or workflow modificationSoftware/hardware inadequacy
Staff training
Vreeman DJ, Taggard SL, Rhine MD, Worrell TW. Evidence for electronic health record systems in physical therapy. Phys Ther. 2006 Mar;86(3):434-46; discussion 4 46-9. Review.
PubMed PMID: 16506879.
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Success Factors in Implementing EHRs
End-user participation i n
developmentData standardization
Adequate staff training
Incorporating workflow analysis
Vreeman DJ, Taggard SL, Rhine MD, Worrell TW. Evidence for electronic health record systems in physical therapy. Phys Ther. 2006 Mar;86(3):434-46; discussion 4 46-9. Review.
PubMed PMID: 16506879.
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Do therapists todayreally use EHRs?good question…
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The Tide is Rising
Office of the National Coordinator for Health IT. Update on the adoption of health information technology and related efforts to facilitate the electronic use and exchange of health
information. Report to Congress.
Had “Basic” EHR 2008 2013
Hospitals 19% 59%Physicians 22% 48%
APTA 2010 Member Survey
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Yes, all electronic Yes, paper and electronicNo
Don’t know
Got EMR?
ASHA SLP Healthcare Survey 2011
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Always SometimesNever
Use an EHR?
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Most commoncomplaint? anecdotal
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Getting from here
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Getting from here…
to therephoto via janeandd
http://www.flickr.com/photos/jayneandd/
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photo via Justin Ornellas
What are we waiting for?Let’s jump in.
http://www.flickr.com/photos/ornellas/
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Adopt interoperable
EHRs.
Be mindful of thecomplexity.
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Physical therapisteducation programs
should incorporate coreinformatics competencies
into their curricula.
Alth gh t h lth“
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Stead WW, Searle JR, Fessler HE, Smith JW, Shortliffe EH. Biomedical informatics: changing what physicians need to know and how they learn. Acad Med. 2011 Apr;86(4):429-34.PMID: 20711055
Although most health
professionals use IT dailyin their work, few know
how to adapt their rolesand work processes to
incorporate IT for thegreatest benefit.
“
“We have frequently heard the
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Silverman H, Cohen T, Fridsma D. The evolution of a novel biomedical informatics curriculum for medical students. Acad Med. 2012 Jan;87 (1):84-90. PubMed PMID: 22104049
“We have frequently heard theopinion from both faculty and
students that medical studentsalready possess all the basic skillsnecessary to function effectively inan information-rich environment.
This is similar to assuming that a
student proficient in the use of a word processing program knows how
to write an award-winning novel.
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photo via JOPHIELsmiles
Rehabilitation education
programs should partner withhealth informatics professionals
in evaluating the efficacy ofinformatics interventions in
rehabilitation practice,education, and research.
http://www.flickr.com/photos/26015375@N06/3715306069/
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Key Lessonsfor Today
photo via IMLS DCC
http://www.flickr.com/photos/imlsdcc/5637868432/sizes/o/in/photostream/
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Human
+Computer
Human
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Interoperable EHRs canimprove clinical decisions
and support data re-use
(for lots of purposes)
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Closing Thought
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Tone is in your fingers
Th h W t ' b
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photo via [credit]photo via scragz
Though Wooten's basses
receive much attention, hismost frequent and consistent
response when asked by hisfans about his equipment isthat "the instrument doesn't
make the music ... you do".
http://www.flickr.com/photos/scragz/109426798/
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