Tag Archives: EHR

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

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.

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

About Joanne Kenen

Contributing editor to Politico Magazine and former health care editor-at-large, Politico, Commonwealth Fund journalist in residence and assistant lecturer at Johns Hopkins Bloomberg School of Public Health.

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.

Audit: UK’s health IT program falls short of expectations

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.

After a damning report from the U.K.’s national audit office indicating that the National Health Service’s massive health IT program has essentially been a black hole which vacuums up far more money than its lack of progress would justify, politicians are now calling for what amounts to the program’s termination.

Physicians support a national system of health records, but there seems to be a consensus that, in the current climate of British austerity, it may be time to amputate the program to stop the bleeding. After all, the audit indicated that despite a seven-year extension, it looks like the program has no chance of meeting its 2014-15 deadlines, or even of producing meaningful results. Here’s Polly Curtis in The Guardian.

The original aim of the £11.4bn NHS IT programme – to install a patient record database accessible from any point in the NHS in England by 2015 – will fail, the National Audit Office (NAO) warned.

The £2.7bn spent so far on the system has not been value for money, the watchdog said, adding it had no confidence that the remaining £4.3bn would be any better spent.

The nine-year-old project – the biggest civilian IT scheme attempted – has been in disarray since it missed its first deadlines in 2007. While its ambitions have been downgraded in recent years, the bill from the suppliers has remained largely unchanged, the report said.

ER scribes handle EMRs, free up doctors

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.

St. Louis Post-Dispatch reporter Michele Munz has found that some emergency rooms are easing the transition to electronic medical records by hiring “scribes” to enter information into the system, thus freeing up the doctor to focus on the actual patient.

emr-scribes

Photo by MC4 Army via Flickr

Munz reports that scribes are often young, well-trained, tech-savvy pre-med types who get $8 to $10 an hour and plenty of real-world clinical observation for their trouble. The use of one California-based company’s scribes has grown sevenfold in the past two years, expansion its CEO called “exponential.”

Munz’ story shows that the growth is driven by the desire to ameliorate productivity hits that many hospitals have faced in the wake of EMR adoption.

After the switch to computer records, emergency departments have reported a loss in productivity. At DePaul, patient wait times initially increased 28 percent and patient satisfaction declined 40 percent despite additional staffing, said Dr. Stephen Larson, director of the hospital’s emergency department. St. John’s Mercy also reported a peak in wait times.

While both hospitals have seen wait times drop as doctors get past the learning curve, the emergency physicians group at DePaul decided to begin the scribe program in December “to allow us to continue to add to our gains,” Larson said.

New EHR error-reporting system to keep data confidential

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.

EHRevent.org, a service that will allow health workers to report and track errors associated with electronic health records, has launched with broad support and no small amount of fanfare. In cooperation with the federal government, the new system will be run by the iHealth Alliance and the PDR network. The iHealth Alliance already runs the Health Care Notification Network, while the PDR Network, perhaps best known for their Physicians Desk Reference, already distributes FDA warnings and drug labeling information.

It shows promise, of course, but that promise comes with one hefty caveat for health journalists: The resulting data will be kept under wraps. Wall Street Journal health blogger Katherine Hobson has the details:

The aggregated data will be available to medical societies, liability carriers and agencies such as the FDA, but will remain confidential — and won’t be subject to legal discovery. (The mechanism for this type of information sharing is the patient safety organization, federally sanctioned groups formed by providers, nonprofit groups and other interested parties to analyze data about medical errors. Groups can get aggregated data if they agree to keep it out of the public domain.)