Electronic medical records improve quality of care in resource-limited countries, study suggests

Electronic medical records improve quality of care in resource-limited countries, study suggests

From the March 18 2011 Science Daily news item

ScienceDaily (Mar. 18, 2011) — A new study [Abstract***], conducted by researchers from the Regenstrief Institute and the schools of medicine at Indiana University and Moi University, is one of the first to explore and demonstrate the impact of electronic record systems on quality of medical care in a developing country….

…This work is particularly significant because of the many medical errors that occur in settings where too few skilled health-care providers deal with a large patient population with critical illnesses. In developed countries, patients with HIV are often seen by infectious disease specialists for their HIV care. In contrast, a large number of HIV-positive patients in resource-limited countries like Kenya are taken care of by clinical officers whose level of training is similar to that of nurse practitioners. The combination of overworked staff with limited training, increasingly busy clinics, the challenges of providing chronic disease management, and the difficulty of keeping up-to-date often results in suboptimal patient care.

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Related articles

Towards electronic healthcare centred on the patient (Science Daily)

A vast computer based glossary of healthcare terms culled from so-called e-health tools, medical news sites, telemedicine applications, home care-management systems, internet-based public health records, and even health-oriented and medical blogs could help improve the relationship between patients and healthcare workers, according to new research.

Abstract is here

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Health Information Technology Resources from NN/LM

The National Network of Libraries of Medicine (NN/LM), Greater Midwest Region has a Web page devoted to health information technology resources. It includes links to pdf files of the presentations at the December 2010 meeting – “EHRs and Librarians: A Symposium”.

From the web page

Health information technology (Health IT or HIT) describes the management and secure exchange of health information among consumers, providers, government entities, and insurance agencies. Electronic Health Records (EHRs) are a special focus of HIT. EHR’s can assist in maintaining an accurate picture of a patient’s health and to more securely share information between doctors. Using an EHR can replace paper medical records to maintain your health information.

Electronic Health Records (EHRs) and Personal Health Records (PHRs)

In December 2010, the GMR held a meeting called “EHRs and Librarians: A Symposium” before the fall RAC meeting in December 2010. Below are pdf files of the presentations.

Regional Extension Centers – David Sweet

Summary: Overview about what Regional Extension Centers (RECs) are doing to assist health professionals with implementation of electronic health records; what AHIMA is doing related to RECs, and possible roles for librarians.

Using New Digital Resources to Promote and Understand PHRs – Allison Vance

Summary: Learn about AHIMA’s consumer education campaign, my Personal Health Record (myPHR), and the various digital resources available to librarians interested in assisting patients and community members with learning more about PHRs and larger health literacy issues.

Implementation of a Patient Portal and MedlinePlus Connect in a Low-Income Population – Maxine Rockoff, Ph.D.

Summary: The Institute for Family Health, a network of Federally Qualified Health Centers in Manhattan, the Bronx, and the Mid-Hudson Valley, has had an electronic medical record (EMR) since 2002. In 2008, the Institute implemented the patient portal for its EMR. This talk will present research findings to date from focus groups, a Health IT Readiness Survey, usability studies, a survey of providers & staff, and a statistical analysis of patients who received access codes and those who didn’t. The talk will also describe the process of developing MedlinePlus Connect with the National Library of Medicine, as well as some preliminary information on the classes developed for patients to teach them how to use these tools.

MedlinePlus Connect: Linking Patients to Health Information – Joyce Backus

Summary: Overview and background for developing MedlinePlus Connect, a new service from the National Library of Medicine that allows electronic health records (EHR) systems to link users to information in MedlinePlus. MedlinePlus Connect delivers information about conditions and disorders, health and wellness, and prescription and over-the-counter medications to patients, families, and health care providers when it is needed. MedlinePlus Connect accepts requests for information on diagnoses (problem codes) and medications. For problem codes, MedlinePlus accepts ICD-9-CM and SNOMED CT CORE. For medications, MedlinePlus Connect accepts RXCUIs and NDCs. The API for this service conforms to the HL7 Context-Aware Knowledge Retrieval (Infobutton) Knowledge Request URL-Based Implementation specification.

The GMR has set up a listserv to continue the conversation about EHRs and PHRs. To subscribe to EMR-GMR, send the command SUBSCRIBE EMR-GMR BARACK OBAMA to listserv at uic.edu, replacing “Barack Obama” with your first and last name. Make sure the subject line is left blank.

HIT Resources

AHRQ

AHRQ National Registry Center for Health IT

AHIMA

American Health Information Management Association

Beacon Community Program

Beacon Communities will focus on specific and measureable improvement goals in the three vital areas for health systems improvement: quality, cost-efficiency, and population health.

MyPHR

MyPHR – Resources for seniors, parents, the chronically ill and more.

Health and Data Standards

Health Information Technology and Data Standards at NLM

HealthIT

The Office of the National Coordinator for Health Information Technology

HRSA Health Information Technology

U.S. Department of Health and Human Services, Health Resources and Services Administration

Overview EHR Incentive Programs

Centers for Medicaare and Medicaid Services

Regional Extension Centers (RECs)

Explanation of the the Regional Extension Center Program

Electronic medical records not always linked to better care in hospitals, study finds

From the December 23, 2010 Eureka News Alert

Use of electronic health records by hospitals across the United States has had only a limited effect on improving the quality of medical care, according to a new RAND Corporation study.

Studying a wide mix of hospitals nationally, researchers found that hospitals with basic electronic health records demonstrated a significantly higher increase in quality of care for patients being treated for heart failure.

However, similar gains were not noted among hospitals that upgraded to advanced electronic health records, and hospitals with electronic health records did not have higher quality care among patients treated for heart attack or pneumonia.

The findings, published online by the American Journal of Managed Care, are part of a growing body of evidence suggesting that new methods should be developed to measure the impact of health information technology on the quality of hospital care…..

 

 

Electronic Medical Records: Privacy, Accuracy, and the Digital Age

 

An October 20, 2010 blog item from  Free Government Information – Because Information Wants to be Free

My brother is a surgical resident. A few weeks ago he was complaining about the difficult Electronic Medical Record (EMR) software his hospital is using, particularly the unintuitive user interface. Then I read
an article in the New York Times about the business opportunities that are growing in the world of electronic health records.
According to this article, two brothers, who have already developed a software EMR package for small-practice doctors’ offices, are waiting for the Obama stimulus package to essentially kick in, as the medical community will eventually have to migrate to digital patient records, or pay the penalties for failure to do so.

To me, there are two primary issues: privacy and accuracy. In extolling the benefits of the EMR (Saves lives! Lowers costs! No more pesky paper!), what will prevent the doctors’ offices, hospitals, and health insurers from abdicating responsibility over the care and quality control of those records? I realize that the e-document movement is permeating all levels of our lives, from the personal to the professional, but I cannot help but feel that an attorney’s e-discovery litigation case papers are better protected than patient information in a hospital.

Further, not everyone knows that HIPAA entitles you to your entire medical record, doctor’s notes and all (which is why, from what I understand in talking to several medical residents, doctors are usually instructed to take care in how they write about the patient in the medical record, for subpoena purposes and patient record requests; it probably is not a good idea to write “this patient is an idiot”). But in the same DHHS website, HIPAA privacy rules seem to have a series of caveats. A Washington, DC public interest research center has the same concern: Apparently, the DHHS proposed rules required that privacy breaches need not be reported to patients unless the provider or insurer felt that there was a “significant
risk” of harm. So then the discretion for the standard of “significant risk” is left to a large impersonal corporation or a doctor who does not have the time to return phone calls? Not good. DHHS is currently reconsidering that medical breach notification rule, but this caveat that the covered entities determine whether “significant risk” exists, does not appear on the DHHS’s website summary pages.

Accuracy is another issue, and I believe it will be a growing concern as records are increasingly kept in digital format. With the health care companies pushing the doctors and hospitals to get patients in and out of the hospitals as quickly as possible, the quality of time spent with the patient will inevitably be reflected in the patient EMR. Case in point: I visited the ophthalmologist a couple years ago for a routine check-up. I advised the technician that I had scar tissue on my left cornea from an old boxing injury. The technician then inserted the eye pressure gauge into my left eye and the instrument tore into my cornea. The doctor treated me for this second injury but my medical record has no indication of this new injury from the doctor’s office. How do I know? When I mentioned the injury to my GP in a routine checkup, he had no idea what I was talking about. I obtained the medical record myself and added notes for my own records, indicating the date and type of this new injury; I may need this information for future eye care.

Another example: my GP’s EMR for me does not include the list of drugs to which I am allergic (it also does not include any reference to the eye injury from above). I have called his office, but I have yet to see that information added to the EMR. This information is in his paper record on me (I know because I filled out the “patient information form” upon my first visit years ago), but the problem with the EMR is that it can be replicated to any doctor in the country with one phone call, and the information will be inaccurate – even though (or because?) it is digital.

So the government will monitor the transition to EMRs, a “cost-saving” and “patient care” measure, but just who benefits here?

Johanna Blakely-Bourgeois, Pratt SILS

Some Electronic Medical Records Links

• MedlinePlus Health Topic : Personal Health Records includes links to information about basic information, myths, organizations, privacy, ethics, and more
• What Is a PHR (Personal Health Record)?(American Health Information Management Association)
• Learn More about Personal Health Records(Centers for Medicare & Medicaid Services)
• How to Create a Personal Health Record(American Health Information Management Association)
• [Video] Creating a Personal Medical Record(Agency for Healthcare Research and Quality)
• Your Health Information Privacy Rights(Dept. of Health and Human Services, Office for Civil Rights) – PDF

 

Bar Codes Help Reduce Medication Administration Errors

Bar codes used with electronic health records greatly reduce the administrating of the “wrong drugs” which can harm patients.

When bar codes are used with eMAR (electronic medical administration records), it is greatly ensured that the correct medication is administered in the correct dose at the correct time to the correct patient. ” The study is published in the May 6 issue of the New England Journal of Medicine.

 This study (press release here) was partially funded by the US Agency for Healthcare Research and Quality (AHRQ).

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AHRQ is the lead federal agency mission in improving the quality, safety, efficiency, and effectiveness of health care for all Americans. Information from AHRQ’s research helps people make more informed decisions and improve the quality of health care services.

Information for Consumers and Patients  includes publications, videos, and podcasts in the following areas:
**Staying Healthy
**Choosing Quality Care
**Getting Safer Care
**Understanding Diseases and Conditions
**Comparing Medical Treatments

Other broad topics include:
**Clinical Information areas as Evidence Based Practice, Technology Assessment, and National Guideline Clearinghouse™. 
**Quality and Patient Safety areas as Health Information Technology, National Quality Measures Clearinghouse™ , and WebM&M: Morbidity & Mortality Rounds.

**Data & Surveys areas as Available Data Sources from AHRQ, and Health Care Costs and Utilization Project.