Tag Archives: EHR

VA head opts for no-bid approach to EHR upgrade

Rebecca Vesely

About Rebecca Vesely

Rebecca Vesely is AHCJ's topic leader on health information technology and a freelance writer. She has written about health IT since the late 1990s for a variety of publications.

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Last week’s announcement that the Department of Veterans Affairs would replace its homegrown electronic health record system VistA with a Cerner product came ahead of the expected July 1 deadline for a decision on the matter.

The move made waves in the health IT sector for several reasons. Most notably, Secretary of Veterans Affairs David Shulkin, M.D., chose to invoke a “public interest exception” in the Cerner pick, bypassing the usual competitive bidding process for government contracts. Continue reading

CEO’s predictions about health IT offers some guidance for reporters

Rebecca Vesely

About Rebecca Vesely

Rebecca Vesely is AHCJ's topic leader on health information technology and a freelance writer. She has written about health IT since the late 1990s for a variety of publications.

Photo: Army Medicine via Flickr

Photo: Army Medicine via Flickr

Can technology save us? It’s among several questions on a lot of people’s minds these days. Can technology save us from rising health costs? Can technology save Medicare by reducing costs to the program? Can technology help our veterans gain better access to care? Can technology help people take control of their health decisions?

At the same time, criticism of technology has grown in the aftermath of a presidential election that shocked many. Continue reading

Better diagnostic codes for better dentistry

Mary Otto

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health and the author of "Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America." She can be reached at mary@healthjournalism.org.

Here’s a question to ask dental leaders in your state or community:

Does dentistry need a uniform, commonly accepted system of diagnostic codes?

I had the chance to listen in on a daylong conference that focused on the topic and to write about it for DrBicuspid.com, an online publication that serves the dental profession. The question is one more way to think about the gap between dentistry and medicine.

Photo by TheKarenD on Flickr.com.

Dentists have long used procedure or treatment codes for billing and for keeping patient records. But, in terms of diagnostic terminology, “we’re behind medicine by a lot,” said Joel White D.D.S., M.S., at the conference.

“Back in the days of the bubonic plague, medicine captured why people die. We don’t capture why teeth die. We’re centuries behind,” said White, a professor at the University of California, San Francisco, School of Dentistry and a member of an international academic workgroup focused upon developing a useful vocabulary of dental diagnostic terms.

To that end, the team has come up with the EZCodes Dental Diagnostic Terminology, a system of 1,358 terms organized into 91 subcategories under 15 major headings.

Team members said their system, being tested in 17 dental schools and institutions in America and in Europe, will help dentists in providing care for patients and in tracking clinical outcomes as well as assist in mapping disease patterns, monitoring community oral health status and identifying best practices.

Mary OttoMary Otto, AHCJ’s topic leader on oral health is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover oral health care.

If you have questions or suggestions for future resources on the topic, please send them to mary@healthjournalism.org.

The use of diagnostic terms represents “a move from treatment-centric to diagnostic-centric,” dentistry according to EZCodes lead developer Elsbeth Kalenderian, D.D.S., M.P.H., chair of oral health policy and epidemiology at the Harvard School of Dental Medicine. With the growing importance of electronic health records (EHRs), diagnostic coding will become increasingly important, many at the conference pointed out. Developers of the EZCode system say they set to work on the diagnostic vocabulary because other efforts to standardize dental diagnostic terms have failed to gain wide usage. The World Health Organization’s International Classification of Disease coding system, or ICD, includes some oral and dental diagnoses, but lacks sufficient specificity in its dental terminology, they said. They criticized as too cumbersome a second system of more than 7,000 terms called SNODENT which is contained within the Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT.)

For its part, the American Dental Association, developer of SNODENT says EZCodes is an “interface terminology” that is useful for capturing health problems but which is not a replacement for SNODENT in terms of storing information in electronic health records.

The Nov. 28 conference at the Harvard School of Dental Medicine did not end the discussion, as Dental Informatics blogger Titus Schleyer, D.M.D., Ph.D., pointed out in ”Does Dentistry Need More than One Diagnostic Vocabulary?

Baby’s death illustrates how health IT can introduce complexity, error to system

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Chicago Tribune reporters Judith Graham and Cynthia Dizikes explore the pitfalls of health information technology through the story of an infant boy who survived despite being born months early and weighing just 1.5 pounds, only to be killed by a sodium chloride overdose when a pharmacy tech entered information into the wrong field of his electronic medical record.

health-it

Photo by Christiana Care via Flickr

The tech’s fatal clerical error was compounded by disabled alarms on a compounding machine, incorrect labeling on an IV bag and an ignored lab test. The heart of the errors, the reporters write, seems to be that all the different systems involved don’t communicate.

Almost all medication requests at Advocate are transmitted by a doctor’s keystroke to the hospital pharmacy’s drug-dispensing system. But in this case, there was no electronic connection with the automated compounding system that prepared the IV bag for baby Burkett, a specialized device that handles low-volume, highly individualized orders.

So a technician transcribed the order by hand, and an error was introduced.

Electronic communication gaps are common at large hospitals, which typically use upward of 50 to 100 different information systems at their facilities, with different technologies used in emergency rooms, labs, pharmacies and other medical departments, said Ross Koppel, a sociologist at the University of Pennsylvania who studies health information technologies.

“To some degree these systems talk to each other, but mostly they don’t, so hospitals have to design custom-made software ‘bridges’ to make this happen,” Koppel said. With each jury-rigged software solution comes the potential for new software bugs, transcription errors and other problems.

Explain elements of health reform through the eyes, stories of doctors

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org. Follow her on Facebook.

In these posts about covering health reform, I usually don’t point to the big national dailies because a lot of people have already read those stories  but a recent New York Times piece, “As Physicians’ Job Change, So Do Their Politics” is a story that may be able to help reporters think about a good local or regional  jumping off point  for telling aspects of the health reform story in a more narrative, accessible manner, through the eyes and experiences of doctors.

What questions do you have about health reform and how to cover it?

Joanne KenenJoanne Kenen is AHCJ’s health reform topic leader. She is writing blog posts, tip sheets, articles and gathering resources to help our members cover the complex implementation of health reform. If you have questions or suggestions for future resources on the topic, please send them to joanne@healthjournalism.org.

The Times story, by Gardiner Harris, described a shift leftward (or at least less rightward) among physicians. He cited several reasons: younger doctors, more female doctors, and above all more doctors who are salaried employees of hospitals instead of basically being small businessmen (or women) running a practice.

Because so many doctors are no longer in business for themselves, many of the issues that were once priorities for doctors’ groups, like insurance reimbursement, have been displaced by public health and safety concerns, including mandatory seat belt use and chemicals in baby products.

Even the issue of liability, while still important to the A.M.A. and many of its state affiliates, is losing some of its unifying power because malpractice insurance is generally provided when doctors join hospital staffs.

He wrote mostly about Maine, but had a few observations about other states, including Texas. Last year Texas physicians opposed the national health reform law by a three to one margin. But doctors who did not have their own practices were twice as likely to support the law. The same goes for female doctors.

How does a story about physician politics translate into a narrative about health reform?

The shift to salaried positions has many causes (including work-balance for doctors who want more time with their families) but the move toward more clinical integration  and the formation of accountable care organizations or ACO-like entities will hasten this trend.   It is really, really, really hard to explain ACOS clearly and concisely (when an editor of mine recently asked me to give him a nice, tight two-graf description, I began it something like, “One of the challenges of ACO is that they defy simple explanation.”)

But doctors who are joining hospital staffs or whose practices are being bought up by hospitals or who are entering different contractual relationships and affiliations with hospitals have stories to tell.  You can also talk about quality measures and “never events” and how that affects physicians and the practice of medicine, particularly in states mandating more public reporting. Through their stories, you can illustrate what an ACO is or isn’t, or how a medical home works, or  what “clinical integration” means.

I interviewed a physician in South Carolina the other day, Dr. Angelo Sinopoli, who told me about  how the team approach and the use of electronic medical record with clinical decision support was giving him more real-time feedback on his own performance – and he welcomed it.

“You think you are doing something and you might not be, or think you might not be, but you are,” he said. “Seeing real data in as real time as possible made a difference in how we think.” That made me understand an aspect of the electronic medical record that I hadn’t understood before, and readers can grasp that too.

You can explore the changing attitudes and politics along with that – in some states that may be more significant than others, depending on what your state is doing with health exchanges, malpractice legislation, quality reporting etc.

Editor’s note:

Learn more about how electronic health records could mean new opportunities to improve clinical care and public health, according to David Blumenthal, M.D., the former national coordinator for health information technology. Blumenthal spoke at Health Journalism 2011 as he was leaving his federal position.