The issue of Patient Safety with EHRs

Optimal use of Electronic Health Records is expected to bring in fundamental and revolutionary changes in the healthcare industry. Its adaptation has already resulted in enhanced patient care and coordination. Things are only expected to get better moving forward. However, it is very important to understand that Health IT is like a tool which needs to be used properly to derive the real benefits – that there are also possibilities of negative unintended consequences also, leading at times to adverse events if not used in the right way. Keeping this in perspective, guidance has been issued to enable healthcare personnel recognize clinical mishaps or unsafe conditions arising out of an electronic health records as and when they occur. Most of such incidents don’t otherwise get reported since the concerned clinicians and risk managers don't see the role of health IT in those adverse events. Some of the common causes of such adverse events related to EHR or Health IT, in broad terms, are because of

• system interface issues
• wrong data input
• wrong record retrieval
• software functionality
• configuration issues

To conclude that the adverse results are specific to EHRs only and will not occur otherwise will not be apt. Even if one were using papers, the likelihood of such occurrences still exists. Identifying the source is critical here as with EHRs, errors can have a cascading effect very fast with erroneous data getting auto populated into related fields.

It has been widely accepted that if health IT errors are unaddressed; they will act as huge lag factors in improving the overall patient care. Hence, efforts are being put at various levels to combat it. Since EHRs have fundamentally altered how physicians interact with patients, its adoption amongst the existing group of physicians has not been a smooth one. Inadequate technical support and changing regulations have only added to the woes, so much so that time and again there are questions raised in the physician fraternity on its effectiveness. To ensure that the next generations of physicians do not join their predecessor in holding such prejudices, medical school curriculums are being changed so as to include the required training on EHR usage. The aim is to maximize the understanding and acceptance of EHRs right from the beginning. As long as they consider it as part and parcel of their job, there will always be an intent to find solutions to issues arising out of them and not question their existence at the first place. There are many ways to guard against IT-related incidents in healthcare setups. For e.g. some of steps which can be taken could be to

• have a good monitoring system
• support a culture where such incidents get reported the moment they are identified
• establish a Health IT patient safety priority list

Among EHRs, it has been noted that the ones used in emergency departments seem to be more prone to errors. Research done in this field has suggested that such a trend could be a fall-out of the unique characteristics prevalent in these departments. Some of those would be rapid turn overs, frequent care transitions, interruptions and variance in patient volumes. EHRs have not been robust enough in handling so many factors.

The governing bodies realized that in order to find a solution to this issue, it will have to finally boil down to clinicians having the ability to share their insights with system developers. Since it is they who observe problems first-hand, they are best placed to share inputs related to making the required improvements. Also, it was concluded that just encouraging the clinician fraternity to work without subsequent actions from the IT side will lead to no positive developments whatsoever. Taking this into account a set of principles was shared with the EHR vendor industry to act as guidelines, the focus of which are on the following:

• Patient safety
• Privacy and security
• Patient engagement
• General business practices
• Clinical and billing documentation
• Interoperability and data portability

Besides the above, there are also implementation guidelines which have been shared with the vendor community. They have also been quite receptive to the guidelines and view this as a very important step taken so as to knit together stakeholders determined to improve the healthcare delivery system.

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Measures to handle Health IT hazards

Implementation of the Medicare and Medicaid EHR incentive programs has led to widespread adoption of EHRs everywhere. The trigger to all this was with the Obama government encouraging the adoption of Health IT by passing the Recovery Act in 2009. In the year 2011, the Medicare and Medicaid EHR incentive programs made it possible for physicians, hospitals, and other eligible providers to draw incentives for adopting and meaningfully using certified electronic health records. Health IT, besides all the benefits that it is supposed to bring forth, also needs to ensure safety of patients. Understanding the relevance of this area, the federal government has established a communications infrastructure to capture data about IT-related patient safety events. This is expected to hugely benefit the providers since it will result in the right intervention to handle issues when they arise. Thus new systems, when they get implemented, should without fail take into account the safety of patients. Two things hold the key to achieve this; more engagement from the Patient’s end and provision for exchange of patient information among providers. Surveys conducted have indicated some common occurrences of problems which can broadly be categorized to fall under the following heads:

• Information that is very coarse : generic statements
• Information that's too fine : being very specific reduces chances of considering alternatives
• Missing reality : only reports and numbers do not necessarily indicate the actual situation
• Multiplicity : results / analysis from various sources suggesting conflicting information

These are problems which physicians encounter when they deal with Information systems in real time. What needs to be done here is to have a provision for giving feedback to system developers on a regular basis to close the loopholes. Physicians need to be empowered to suggest improvements when they observe problems. Not providing feedback and being operationally efficient in following what the systems prompt can in the long run prove to be a big pitfall for the industry.

Health IT is expected to bring about tremendous benefits to patients care. However since it involves complex technologies, there are high chances of mistakes occurring in its roll out. Information errors comprise a major chunk of the potential hazards of Health IT. From data mismatches to interoperability failures between devices and systems to distractions caused by smartphones and devices, all these have the potential to undo or spoil a lot of the positives of health IT implementation. If we take the last point into account, the event does not seem to be as fatal as the effect it ends up having. In today’s world of BYOD culture, physicians carry their own smartphones and tablets to work. It is quite obvious to have a lot of apps available in these devices in addition to the ones which are required to work with. Since a lot of these apps have live updates etc. it is quite normal to get distracted by them if one were using the device during patient visits with the apps switched on. Apart from the fact that it may lead to mistakes and missing out on relevant information, focusing more on the device might lead to not noticing vital clues in patients affecting the quality of care. The medical schools are trying to address the matted by devising special courses to help the future physicians learn about ways to integrate technology into their workflow without getting distracted or affected in ways which might prove to be detrimental.

Experts in the industry are suggesting ways by which the concern of safety in Health IT can be addressed. One such recommendations is to device a framework which can be rolled out in three phases and get combined with EHR implementation and related Meaningful Use requirements. The important thing to keep in mind is to incorporate safety into training of Healthcare providers and also into certification of software products. The software developers involved in developing these complex systems also need to be involved and explained their need to share responsibility for the safety. Finally measures should be taken to ensure that physicians find it easy and convenient to share their feedback and concerns whenever they want to. Nothing can be more vital than their feedback. Healthcare software development teams can help you build clinical and EHR/EMR software projects within allocated budgets and time schedules.

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Can Big Data live upto Healthcare expectations?

Based on the analysis made so far on the effect Big data on restraining healthcare cost, it is being suggested that the industry stands to save an approximate amount to the tune of $450 bn. Further improvements and suggestions which are bound to come by as more research is done in this field will only result in more savings. Important suggestions made so far include doing away with the fee-for –service as a method of payment and change in the mindset of the providers and patients to accept the benefits of making use of data. The second point is highly critical. Unless there is a change in the approach on the part of the stakeholders in terms of their willingness to use the recommendations suggested by the analysis which comes with the sue of data , it will be next to impossible to actually start realizing the benefits of the approach. A case in point could be as simple as the following. No matter how much of investment and research is done in the field of fitness and exercise, the true benefit can never be passed on to people if they continue with the sedentary lifestyles as they have been for all this while . What big data analysis might provide as an input is the importance of exercising and some metrics to prove how it can possibly help people with a better lifestyle. But no matter how many new exercising techniques are suggested, the benefits can never be realized unless people actually start devoting time to fitness. Experiments done in controlled conditions have indicated that even if simple interventions were made successfully, on the large the results will lead to huge savings. This however will require physicians to combine their treatment methodologies with bog data. Although one of the major factors to distinguish one physician from another is their ability of judgment for treatment decisions, there is no harm if they were to combine it with big data usage and multiply the benefits. This however requires a paradigm shift in their openness to this field and a willingness to apply the recommendations.

Various developments over the last two decades in healthcare have resulted in the industry reaching this juncture at which the benefits of harvesting on the data available seem to have a lot of potential. Providers and Payers have digitized their medical records, Pharmaceutical companies have been supplying huge amount of information related to research and development into medical databases. Information from clinical trials and insurance programs are available and most importantly it is possible now to collect and analyze data from multiple sources. However the major factor which is responsible for driving up the demand is that of rising fiscal costs. There is now a huge need among healthcare stakeholders to compile and exchange information. This has been the result of a shift in healthcare delivery approach which is taking place. The tradition method of delivery where the payment was based on treatment volume resulted in high cost escalation which has compelled adoption of models where payment is related to the outcome and just not on the delivery of service. Since it is now the outcome which is of importance the stakeholders have started realizing that the costs can be brought down and results better achieved if there is more cohesion in their approaches and there is avoidance of repetition of processes. For this to happen it is imperative that they have access to common data and systems which make it possible to exchange information. Thus the need for availability of data and its harvesting has never been more.

Physicians who till now have relied on their judgment to take treatment related decisions have also started noticing the benefits of more evidence-based decision making. The process is based on taking inputs from systematic reviewing of clinical data and letting the best available information impact treatment decision. The important point here is that, surveys have indicated that the early adopters of this new approach have already started drawing the benefits. This is not only encouraging but could mean the beginning of a new era in the healthcare industry which till now has not been banking on use of big data compared to others like the retail and banking. There are bound to be roadblocks ahead but the journey nevertheless seems to have started already. Healthcare software development teams can help you build clinical and EHR/EMR software projects within allocated budgets and time schedules.

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Top trends driving Healthcare IT in 2013

Going by what some of the stalwarts of the industry feel, healthcare like the education industry is more than a decade behind where it should be in terms of adoption of technology. To say that it has had a tremendous impact on the manner in which the industry goes about offering its services would be an understatement. There is huge amount of scope available for improvement in this field. However, the irony lies in the fact that for real development to actually start taking shape the current landscape needs to undergo a complete change. The Healthcare industry now has too many players, of smaller size, trying to grab a market which seems limited in terms of innovations. Hence the expectations from these players is to deliver high levels of services for less, which kind of in turn is bound to put a lot of financial burden on them . As these vendors keep jostling amongst themselves for a higher share of hospital market which is kind of limited, the later on the contrary want less number of vendors to deal with. This is simply because they want to be more efficient in their operations and not run into a state where the burden of handling multiple vendors takes a toll on their core job. Thus the industry as it grows, which it must, will see a lot of changes happening in the near future culminating in the presence of fewer and efficient vendors offering a better ROI than what they do now. A lot of mergers and acquisitions are not far away as we proceed into the future.

What Health IT systems do is that they equip doctors, hospitals, and other providers to provide better coordinated care. They also ensure reduction of errors and readmissions all of which result in costing more money and leaving patients less healthy .The year 2012 proved to be a windfall year for Healthcare IT with a record $1.2 billion pumped into the sector through venture funding. While the major chuck of the deals were in health information management, significant investments seem to have been made in companies which focused on consumers e.g. Mobile health, Telehealth, Personal Health etc.

The first quarter of 2013 has also seen record investment in this field. The trigger to all this was with the Obama government encouraging the adoption of Health IT by passing the Recovery Act in 2009. In the year 2011, the Medicare and Medicaid EHR incentive programs made it possible for Doctors, hospitals, and other eligible providers to incentives for adopting and meaningfully use certified electronic health records. This move, as part of the Recovery Act, kind of incentivized early adoption of EHRs which is critical for broader healthcare Quality and efficiency improvement. It results in better care coordination, reduction of duplicate tests and procedures and finally rewarding hospitals for keeping patients healthier. The results till date prove to be highly encouraging with more than half of eligible professionals and 80 percent of eligible hospitals having meaningfully adopted EHRs and received the incentive payout. This trend is expected to up and lead to complete adoption by 2015 post which the government has plans of penalizing the ones who fail to comply with the mandate.

There is however another concern which is quite grave that is showing along with the wider adoption of EHR and it involves protection of patient data contained in its electronic health record system. By rule, to become eligible for the incentive payout, only those EHRs which are certified need to be used meaningfully. But one also needs to take into account the fact that finally the usage of the system has a human element involved and that is where adequate training needs to be given to the staff as well as monitor their access. There have been a few instances were law suits have been filed by patients where their data has been found to be compromised. This becomes a matter of grave concern and requires all concerned stakeholders to take all the requisite steps to ensure that such discrepancies are removed completely. According to the U.S. Department of Health & Human Services, 40 percent of large data breaches have involved laptop or storage devices that have been lost or stolen. Healthcare software development teams can help you build clinical and EHR/EMR software projects within allocated budgets and time schedules.

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Adoption of Health IT

Going by the projections being made by various surveys in this field, the global market for healthcare IT will expand at a compound annual growth rate of 7.0 percent by 2017. The market which was at a net value of $40 billion in 2012 is expected to expand to 56.7 billion by 2017. This is going to be triggered by the need for effective administrative solutions and an increasing demand for clinical data technology. Empirical data seems to suggest that physicians, hospitals, and other providers develop the ability to better reduce errors and better coordinate care with the help of Healthcare systems. It also reduces the overall cost of operations and makes patients more healthy and satisfied. There are some major drivers of the growth in the adoption of Healthcare IT - starting from a growing demand for interoperable systems to the rise in aging population.

There are also financial incentives from the U.S. government providing for adoption of technology in Healthcare. The systems also seem to provide a high rate of return on investment to its users. From the time the Obama administration has started encouraging providers to adopt electronic health records; usage seems to have increased dramatically. This has been proved by the fact that EHR usage by physicians, which stood at about 17 percent in the year 2008 has risen to 50 percent by 2012 which has enabled them to receive the meaningful use incentive payment.  The adoption of HER by hospitals which stood at a dismal rate of just 9 percent in 2008 is currently more than 80 percent. Health IT has helped them provide better coordinate care, which has in turn improved their patients’ health and helped them save money at the same time.

As much as the momentum for Health IT is gaining ground there are also a lot of detractors. They do not necessarily agree that these advances will further doctors' knowledge about patients and help them care for people in a better, more efficient way. ON the contrary they feel that it will drain their time and financial resources. As examples they quote that EHRs actually take more time entering patient information than it takes to see patients. They also feel that the compulsion to adopt ICD-10 by October 1, 2014 is also not going to be of much help as it greatly increases the specificity of diagnostic codes physicians must use when billing payers, which is a way is going to create a major  headache for some to learn the new codes.  Various Researchers have also indicated that  high initial costs to implement these healthcare IT applications systems is acting as a deterrent to the adoption . Further to this the maintenance expenses are also quite high which ultimately ends up slowing the pace of further growth. Also, it has been noticed that inspite of most physicians expressing their  interest in the prospect of using mobile health tools for clinical purposes, the mHealth market within the provider setting remains untapped. Research shows nearly 60 percent of physicians as non-users of mobile health tools.  

In many surveys done by leading companies to gauge the acceptance of healthcare IT amongst Physicians have elicited information which indicate that quite a reasonable percentage, although they are going ahead with the process of adoption, think that use of health IT tools ultimately will cost more and not less. They also felt that the promise of reduced costs due to increased use is probably inflated.  There seems ot be a belief amongst some of the respondents that hospital-physician relationships will become less stable as hospitals continue to comply with Meaningful Use.

Inspite of a lack of complete support for the process the government seems quite convinced about the supposed benefits of adopting healthcare IT and is leaving no stone unturned to hasten its implementation. Infact, there seems to be a belief that the adoptions is likely to be accelerated  likely if the local insurers, employers and consumers ensure that they tie their provider to those using HIT effectively in clinical care coordination and administrative paperwork reduction. Healthcare software development teams can help you build clinical and EHR/EMR software projects within allocated budgets and time schedules.

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