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Emergency Department Information Systems Market Fueled By Growing Patient Flow

Posted on March 20, 2017 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A new research report has concluded that the size of the emergency department information systems market is expanding, driven by increasing patient flows. This dovetails with a report focused on 2016 data which also sees EDIS upgrades underway, though it points out that some hospital buyers don’t have the management support or a large enough budget to support the upgrade.

The more recent report, by Transparency Market Research, notes that ED traffic is being boosted by increases in the geriatric population, an increasing rate of accidents and overall population growth. In part to cope with this increase in patient flow, emergency departments are beginning to choose specialized, best-of-breed EDISs rather than less-differentiated electronic medical records systems, Transparency concludes.

Its analysis is supported by Black Book Research, whose 2016 report found that 69% of hospitals upgrading their existing EDIS are moving from enterprise EMR emergency models to freestanding platforms. Meanwhile, growing spending on healthcare and healthcare infrastructure is making the funds available to purchase EDIS platforms.

These factors are helping to fuel the emergence of robust EDIS market growth, according to Black Book. Its 2016 research, predicted that 35% of hospitals over 150 beds would replace their EDIS that year. Spurred by this spending, the US EDIS market should hit $420M, Black Book projects.

The most-popular EDIS features identified by Black Book include ease of use, reporting improvements, interoperability, physician productivity improvements, diagnosis enhancements and patient satisfaction, its research concluded.

All that being said, not all hospital leaders are well-informed about EDIS implementation and usability, which is holding growth back in some sectors. Also, high costs pose a barrier to adoption of these systems, according to Transparency.

Not only that, some hospital leaders don’t feel that it’s necessary to invest in an EDIS in addition to their enterprise EMR,. Black Book found. Thirty-nine percent of respondents to the 2016 study said that they were moderately or highly dissatisfied with their current EDIS, but 90% of the dissatisfied said they were being forced to rely on generic hospital-wide EMRs.

While all of this is interesting, it’s worth noting that EDIS investment is far from the biggest concern for hospital IT departments. According to a HIMSS survey on 2017 hospitals’ IT plans, top investment priorities include pharmacy technologies and EMR components.

Still, it appears that considering EDIS enhancements may be worth the trouble. For example, seventy-six percent of Black Book respondents implementing a replacement EDIS in Q2 2014 to Q1 2015 saw improved customer service outcomes attributed to the platform.

Also, 44% of hospitals over 200 beds implementing a replacement EDIS over the same period said that it reduced visit costs between 4% and 12%, the research firm found.

Paris Hospitals Use Big Data To Predict Admissions

Posted on December 19, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Here’s a fascinating story in from Paris (or par-ee, if you’re a Francophile), courtesy of Forbes. The article details how a group of top hospitals there are running a trial of big data and machine learning tech designed to predict admission rates. The hospitals’ predictive model, which is being tested at four of the hospitals which make up the Assistance Publiq-Hopitaux de Paris (AP-HP), is designed to predict admission rates as much as 15 days in advance.

The four hospitals participating in the project have pulled together a massive trove of data from both internal and external sources, including 10 years’ worth of hospital admission records. The goal is to forecast admissions by the day and even by the hour for the four facilities participating in the test.

According to Forbes contributor Bernard Marr, the project involves using time series analysis techniques which can detect patterns in the data useful for predicting admission rates at different times.  The hospitals are also using machine learning to determine which algorithms are likely to make good predictions from old hospital data.

The system the hospitals are using is built on the open source Trusted Analytics Platform. According to Marr, the partners felt that the platform offered a particularly strong capacity for ingesting and crunching large amounts of data. They also built on TAP because it was geared towards open, collaborative development environments.

The pilot system is accessible via a browser-based interface, designed to be simple enough that data science novices like doctors, nurses and hospital administration staff could use the tool to forecast visit and admission rates. Armed with this knowledge, hospital leaders can then pull in extra staffers when increased levels of traffic are expected.

Being able to work in a distributed environment will be key if AP-HP decides to roll the pilot out to all of its 44 hospitals, so developers built with that in mind. To be prepared for the future, which might call for adding a great deal of storage and processing power, they designed distributed, cloud-based system.

“There are many analytical solutions for these type of problems, [but] none of them have been implemented in a distributed fashion,” said Kyle Ambert, an Intel data scientist and TAP contributor who spoke with Marr. “Because we’re interested in scalability, we wanted to make sure we could implement these well-understood algorithms in such a way that they work over distributed systems.”

To make this happen, however, Ambert and the development team have had to build their own tools, an effort which resulted in the first contribution to an open-source framework of code designed to carry out analysis over scalable, distributed framework, one which is already being deployed in other healthcare environments, Marr reports.

My feeling is that there’s no reason American hospitals can’t experiment with this approach. In fact, maybe they already are. Readers, are you aware of any US facilities which are doing something similar? (Or are most still focused on “skinny” data?)

Access To Electronic Health Data Saves Money In Emergency Department

Posted on October 24, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A new research study has found that emergency department patients benefit from having their electronic health records available when they’re being treated. Researchers found that when health information was available electronically, the patient’s care was speeded up, and that it also generated substantial cost savings.

Researchers with the University of Michigan School of Public Health reviewed the emergency department summaries from 4,451 adult and pediatric ED visits for about one year, examining how different forms of health data accessibility affected patients.

In 80% of the cases, the emergency department had to have all or part of the patient’s medical records faxed to the hospital where they were being treated. In the other 20% of the cases, however, where the ED staff had access to a patient’s complete electronic health record, they were seen much more quickly and treatment was often more efficient.

Specifically, the researchers found that when information requests from outside organizations were returned electronically instead of by fax, doctors saw that information an hour faster, which cut a patient’s time in the ED by almost 53 minutes.

This, in turn, seems to have reduced physicians’ use of MRIs, x-rays and CT scans by 1.6% to 2.5%, as well as lowering the likelihood of hospital admission by 2.4%. The researchers also found that average cost for care were $1,187 lower when information was delivered electronically.

An interesting side note to the study is that when information was made available electronically on patients, it was supplied through Epic’s Care Everywhere platform, which is reportedly used in about 20% of healthcare systems nationwide. Apparently, the University of Michigan Health System (which hosted the study) doesn’t belong to an HIE.

While I’m not saying that there’s anything untoward about this, I wasn’t surprised to find principal author Jordan Everson, a doctoral candidate in health services at the school, is a former Epic employee. He would know better than most how Epic’s health data sharing technology works.

From direct experience, I can state that Care Everywhere isn’t necessarily used or even understood by employees of some major health systems in my geographic location, and perhaps not configured right even when health systems attempt to use it. This continues to frustrate leaders at Epic, who emphasize time and again that this platform exists, and that is used quite actively by many of its customers.

But the implications of the study go well beyond the information sharing tools U-M Health System uses. The more important takeaway from the study is that this is quantitative evidence that having electronic data immediately available makes clinical and financial sense (at least from the patient perspective). If that premise was ever in question, this study does a lot to support it. Clearly, making it quick and easy for ED doctors to get up to speed makes a concrete difference in patient care.

HHS OIG Says Unplanned Hospital EMR Outages Are Fairly Common

Posted on August 24, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

More than half of U.S. hospitals responding to a new survey reported having unplanned EMR outages, according to a new report issued by the HHS Office of the Inspector General, due to a variety of common but difficult-to-predict technical problems. Some of these outages have merely been inconveniences, but some resulted in patient care problems, the OIG report said.

The agency said that it conducted this study as a follow up to its prior research, which found that both natural disasters and cyberattacks were having a major impact on EMR availability. For example, it noted, hospitals faced substantial health IT availability challenges in the wake of Superstorm Sandy, include damage to HIT systems and problems with access to patient records.

According to the survey, 59% of the hospitals reported having unplanned EMR outages. One-quarter said that the outages created delays in patient care and 15% said that the outage lead to rerouted patient care. Only 1 percent of outages were caused by hacking or breaches.

The most common causes, in order, were topped by hardware malfunctions, followed by Internet connectivity problems, power failures and natural disasters. (For more detail on the root causes of outages, see this great post by my colleague John Lynn.)

It’s worth noting that these hospitals were selected for having their act together to some degree. To conduct the study, researchers spoke with 400 hospitals which were getting Meaningful Use incentive payments for using a certified EMR system in place as of September 2014.

Nearly all of these hospitals reported having a HIPAA-required EMR contingency plan in place. Also, two thirds of the hospitals addressed the four HIPAA requirements reviewed by OIG researchers. Eighty-three percent of surveyed hospitals reported having a data backup plan, 95% had an emergency mode operations mode plan, 95% said they had a disaster recovery plan and 73% said they had testing and revision procedures in place.

Not only that, most of the hospitals contacted by the study were implementing many ONC and NIST-recommended practices for creating EMR contingency plans. Nearly all had implemented practices such as using paper records for backup and putting alternative power sources like generators in place.

Also, most hospitals said that they reviewed their EMR contingency plans regularly to stay current with system or organizational changes, and 88% said they’d reviewed such plans within the previous two years. Most responding hospitals said they regularly trained their staff on EMR outage contingency plans, though just 45% reported training staff through recommended drills on how to address EMR system downtime. And 40% of hospitals that activated contingency plans in the wake of an outage reported that they saw no disruption to patient care or adverse events.

Still, the OIG’s take on this data is that it’s time to better monitor hospitals’ ability to address EMR outages. Now more than ever, the agency would like to see the HHS Office for Civil Rights fully implement a permanent HIPAA compliance program, particularly given the mounting level of cyberattacks endured by the industry. The OIG admitted that HIPAA standards aren’t crafted specifically to address these types of outages, so it’s not clear such monitoring can solve the problem, but the agency would prefer to forge ahead with existing standards given the risks that are emerging.

Managing Health Information to Ensure Patient Safety

Posted on August 17, 2016 I Written By

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin's latest HIM Scene posts here.

This post is part of the HIM Series of blog posts. If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.

Electronic Medical Records (EMRs) have been a great addition to healthcare organizations and I know many would agree that some tasks have been significantly improved from paper to electronic. Others may still be cautious with EMRs due to the potential patient safety concerns that EMRs bring to light.

The Joint Commission expects healthcare organizations to engage in the latest health information technologies but we must do so safely and appropriately. In 2008, The Joint Commission released Sentinel Event Alert Issue 42 which advised organizations to be mindful of the patient safety risks that can result from “converging technologies”.

The electronic technologies we use to gather patient data could pose potential threats and adverse events. Some of these threats include the use of computerized physician order entry (CPOE), information security, incorrect documentation, and clinical decision support (CDS).  Sentinel Event Alert Issue 54 in 2015 again addressed the safety risks of EMRs and the expectation that healthcare organizations will safely implement health information technology.

Having incorrect data in the EMR poses serious patient safety risks that are preventable which is why The Joint Commission has put this emphasis on safely using the technology. We will not be able to blame patient safety errors on the EMR when questioned by surveyors, especially when they could have been prevented.

Ensuring medical record integrity has always been the objective of HIM departments. HIM professionals’ role in preventing errors and adverse events has been apparent from the start of EMR implementations. HIM professionals should monitor and develop methods to prevent issues in the following areas, to name a few:

Copy and paste

Ensure policies are in place to address copy and paste. Records can contain repeated documentation from day to day which could have been documented in error or is no longer current. Preventing and governing the use of copy and paste will prevent many adverse issues with conflicting or erroneous documentation.

Dictation/Transcription errors

Dictation software tools are becoming more intelligent and many organizations are utilizing front end speech recognition to complete EMR documentation. With traditional transcription, we have seen anomalies remaining in the record due to poor dictation quality and uncorrected errors. With front end speech recognition, providers are expected to review and correct their own dictations which presents similar issues if incorrect documentation is left in the record.

Information Security

The data that is captured in the EMR must be kept secure and available when needed. We must ensure the data remains functional and accessible to the correct users and not accessible by those without the need to know. Cybersecurity breaches are a serious threat to electronic data including those within the EMR and surrounding applications.

Downtime

Organizations must be ready to function if there is a planned or unexpected downtime of systems. Proper planning includes maintaining a master list of forms and order-sets that will be called upon in the case of a downtime to ensure documentation is captured appropriately. Historical information should be maintained in a format that will allow access during a downtime making sure users are able to provide uninterrupted care for patients.

Ongoing EMR maintenance

As we continue to enhance and optimize EMRs, we must take into consideration all of the potential downstream effects of each change and how these changes will affect the integrity of the record. HIM professionals need prior notification of upcoming changes and adequate time to test the new functionality. No changes should be made to an EMR without all of the key stakeholders reviewing and approving the changes downstream implications. The Joint Commission claims, “as health IT adoption becomes more widespread, the potential for health IT-related patient harm may increase.”

If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.

Value Based Reimbursement: Another Challenge for HIM Professionals

Posted on August 3, 2016 I Written By

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin's latest HIM Scene posts here.

How many times have you heard something along these lines: “HIM professionals must stay relevant and current with the continuous healthcare changes.” I must sound like a broken record to my team but it is absolutely true! HIM professionals provide the bridge between clinical data and reimbursement methodologies through CDI, coding, documentation integrity, and health data analytics to name a few. It has been proven time and time again that these HIM skills are vital to healthcare organizations but these skills must also be adapted and be put to good use each time a new guideline or rule is introduced.

Value-Based Reimbursement is an area that continues to grow with the push for quality patient outcomes and healthcare savings with potential penalties for excessive costs and poor quality of care. Reimbursement incentives that are tied to quality of care make perfect sense and HIM professionals need to take the plunge into these initiatives. By marrying departments and cross-functioning teams, we are able to generate proactive data and improve performance.

At my facility, I oversee the HIM department as well as the Quality department because we work closely together and will continue to have an even closer relationship throughout healthcare reform. This is becoming very common in the industry.

In this roundtable article for the Journal of AHIMA, we each outlined how we are bringing HIM to the table for Value Based Reimbursement initiatives and maximizing the tried and true skills of HIM professionals.

I have said it before and I will continue to say it: Always keep your finger on the pulse of healthcare and stay relevant by taking on these new challenges!

If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.

E-Patient Update: If Hospitals Were Like Airports

Posted on June 6, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Almost everyone reading this blog has spent some time in an airport. And though not much of it is visible on the surface, airlines do an amazing job of managing people and things seamlessly while you sit reading the New York Times and drinking your latte. People are ushered on and off of flights, baggage is dispatched around the world and airplanes maintained and fueled at a miraculous pace. Although, you probably forget about that when it’s your flight that has delays or issues.

The hospitals many of us work for also do an amazing job of managing people and things, typically in a way that patients never need notice. While the carefully orchestrated dance of care plays out, patients simply eat their meals, sleep, visit with their friends and family and provide whatever bodily fluids are necessary to diagnose them. Meanwhile, multi-million dollar IT systems help see to it that the process works.

In some ways, however, the two industries are quite different in how they work with the people they serve. And in my opinion, the healthcare system would work better if it borrowed from the airlines when it comes to using IT to simplify the customer experience.

Status updates

One thing airlines do well is keep passengers informed about the status of their flight, or the flights of those for whom they might be waiting. Airlines began posting real-time schedules and allowing passengers to preregister for flights from early in the emergence of the commercial Internet.

In more recent times, the airlines have added a mobile dimension to their customer experience, offering small but valuable services like reminder texts and mobile-only information. While being able to check on your flight from your home desktop is great, it’s even better to know what’s up as you head for the airport, and mobile apps make this possible.

Traffic information

Unlike hospitals, airlines post scrolling information on key progress indicators — i.e. arrivals and departures. While you, as a consumer, typically only need to know the status of your own flight, having a comprehensive information source sometimes allows you to better understand delays, orient yourself to time and place and even make a mental note as to which destinations your chosen airline travels.

Such displays don’t disclose any personal information about passengers, but they still offer some value to individuals, if for no other reason than that having this information available helps to put airline staff and consumers on the same page.

Kiosks

These days, many airlines allow passengers to check in for their flights and print tickets without ever speaking to a human clerk. The process not only saves time, but also personal aggravation, as waiting in long airline ticketing queues can be quite tiring.

Checking in at a kiosk also offers passengers additional reassurance that they are indeed booked on the fight of their choice, allows them to confirm their seating choice and in some cases, even add additional flight options.

Transparency is key

I could go on, but I’m sure you get the idea. By exposing what might otherwise have been internal systems to consumers, airlines have substantially improved aspects of their customers’ experience. And they’ve done so without exposing individualized data or subjecting themselves to increased risk of hacking episodes. On the other hand, while health systems and hospitals have dabbled in these areas — for example, by posting ED waiting times on the web — it’s still something of a rarity for them to share live patient information.

Admittedly, hospitals may be leery of giving the patient too much visibility into the process they undergo. After all, their interaction with consumers is a good deal more complex than that of the airline industry, and they don’t have time to explain what they’re doing and why beyond a certain degree.

Still, as a patient who wants to know what the heck is going on with my care, a little transparency would go a long way. If you want patients to be prepared to care for themselves, treat them like adults and include them in what you’re doing.

Can HIM Professionals Become Clinical Documentation Improvement Specialists?

Posted on April 21, 2016 I Written By

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin's latest HIM Scene posts here.

Most acute care hospitals have implemented a clinical documentation improvement (CDI) program to drive appropriate reimbursement and clarification of documentation. These roles typically live (and should live) within the HIM department. Clinical Documentation Specialists (CDS) work closely with the medical staff and coders to ensure proper documentation and must have an understanding of coding and reimbursement methodologies along with clinical knowledge.

Certain aspects of the CDI or CDS role require in-depth clinical knowledge and experience to read and understand what documentation is already in the chart and find what is missing. Some diagnoses may be hiding in ambiguous documentation and it is up to the CDS to gather consensus from the medical staff to clarify through front-end queries. There are many tools available to assist in this process by creating worklists and documentation suggestions based on diagnosis criteria and best practices. The focus of CDI is not entirely on reimbursement, although it is a nice reward to receive appropriate reimbursement for the treatment provided while obtaining compliant documentation for regulatory purposes.

Determining or changing the potential DRG prior to discharging a patient provides a secondary data source for many healthcare functions such as case management, the plan of care, decision support, and alternative payment models. For these reasons, a CDS must know the coding guidelines for selecting a principal diagnosis that will ultimately determine the DRG.

Inpatient coders also have the foundational skills to perform this role. Coders and HIM professionals are required to have advanced knowledge of anatomy and physiology, pharmacology, and clinical documentation. Therefore, to answer my original question “Can HIM professionals become Clinical Documentation Improvement Specialists?”, the answer is absolutely. But I will say that it depends on the organization as to whether nursing licensure and clinical experience is required in the job description.

Some organizations have mixed CDI teams consisting of coders and nurses while others may allow only nurses to qualify for this role. The impact of who performs the CDS role in the CDI program all lies in the understanding of the documentation, knowledge of coding guidelines, and detective work to remedy missing or conflicting documentation.

If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.

Making the Case for a Unique Patient Identifier – #MyHealthID

Posted on April 13, 2016 I Written By

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin's latest HIM Scene posts here.

Healthcare is a high priority for the US Government and as HIM professionals, we know the importance of keeping our fingers on the pulse of issues facing our nation. We must stay current with proposed regulatory changes and those that address the needs of the US healthcare system as they relate to HIM, privacy and security, and Health IT. One issue our nation has struggled with is secure universal identification for citizens. Social security numbers were not originally meant to be secure identifiers yet they have controversially been used as unique identifiers by Centers for Medicare and Medicaid Services (CMS) for many years.

In our line of work, we see all of the potential negative implications and the important role that patient identification plays in patient safety, HIPAA compliance, and health record accuracy. When patients are not appropriately identified throughout the continuum of care, many issues arise that can lead to misdiagnosing, incomplete information, unnecessary testing, and fraud to name a few. Duplicates and overlays are far too common due to issues matching patient names and dates of birth versus using a universal secure identifier. Sharing information through health information exchange is nearly impossible when patients are registered in multiple systems with different spellings or misidentification.

The HITECH act of 2009 laid the ground work for the Department of Health and Human Services (HHS) to standardize unique health identifiers among other tasks but we have yet to see any real progress on this subject due to federal budget barriers. In response to this, AHIMA sees this as a critical need and has started a petition to the White House to:

“Remove the federal budget ban that prohibits the U.S. Department of Health and Human Services (HHS) from participating in efforts to find a patient identification solution. We support a voluntary patient safety identifier. Accurate patient identification is critical in providing safe care, but the sharing of electronic health information is being compromised because of patient identification issues. Let’s start the conversation and find a solution.”

The campaign is called MyHealthID and looks to have 100,000 signatures on the petition to garner the attention of the US Government. HIM professionals recently took to Washington, DC to visit with Congressmen and Senators from each state to advocate for MyHealthID. The message that “there’s only one you,” hopes to resonate with politicians and make the case that a unique patient identifier is necessary and important to healthcare.

I encourage all healthcare professionals to sign this petition and assist the advocacy efforts toward a unique patient identifier. MyHealthID will not only help with HIM and Health IT initiatives; it will be in the best interest of healthcare consumers nationwide.

If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.

Tablets Star In My Fantasy ED Visit

Posted on April 1, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

As some readers may know, in addition to being your HIT hostess, I cope with some unruly chronic conditions which have landed me in the ED several times of late.

During the hours I recently spent being examined and treated at these hospitals, I found myself fantasizing about how the process of my care would change for the better if the right technologies were involved. Specifically, these technologies would give me a voice, better information and a higher comfort level.

So here, below, is my step-by-step vision of how I would like to have participated in my care, using a tablet as a fulcrum. These steps assume the patient is ambulatory and fundamentally functional; I realize that things would need to be much different if the person comes in by ambulance or isn’t capable of participating in their care.

My Dream (Tablet-Enabled) ED Care Process

  1. I walk through the front door of the hospital and approach the registration desk. Near the desk, there’s a smaller tablet station where I enter my basic identity data, and verify that identity with a fingerprint scan. The fingerprint scan verification also connects me to my health insurance data, assuming it’s on file. (If not I can scan my insurance card and ID, and create a system-wide identity status by logging a corresponding fingerprint record.)
  2. The same terminal poses a series of screening questions about my reasons for walking into the ED, and the responses are routed to the hospital EMR. It also asks me to verify and update my current medications. The data is made available not only to the triage nurse but also to whatever physician and nurse attend me in my ED bed.
  3. When I approach the main registration desk, all the clerks have to do is put the hospital bracelet on my wrist to do a human verification that the bracelet a) contains the right patient identity and b) includes the correct date of birth for the person to which it is attached. If the clerks have any additional questions to pose — such as queries related to the patient’s need for disability accommodations  — these are addressed by another integrated app the clerk has on their desk.
  4. At that point, rather than walking back to an uncomfortable waiting room, I’m “on deck” in a comfortable triage area where every patient sits in a custom chair that automatically takes vital signs, be it by sensor, cuff or other means. In some cases, the patient’s specific malady can be addressed, by technologies such as AliveCor’s mobile cardiac monitoring tool.
  5. When the triage nurses interview me, they already have my vitals and answers to a bunch of routine clinical questions via my original tablet interaction, allowing them to focus on other issues specific to my case. In some instances this may allow the staff to move me straight to the bed and ask questions there, saving initial triage time for more complex and confusing cases.
  6. As I leave the triage area I am handed a patient tablet which I will have throughout my visit. As part of assigning me to this tablet my fingerprint will again be scanned, assuring that the information I get is intended for me.
  7. When I am settled in a patient bed in the ED, I’m given the option of either holding the tablet or placing on a swing-over bed desk which can include a Bluetooth keyboard and mouse for those that find touchscreen typing to be awkward.
  8. Not long after I am placed in the bed, the hospital system pushes a browser to the tablet screen. In the browser window are the names of the doctor assigned by case, the nurse and tech who will assist, and whenever possible, photos of the staff involved. In the case of the doctor or NP, the presentation will include a link to their professional bio. This display will also offer a summary of what the staff considers to be my problem. (The system will allow me to add to this summary if I feel the triage team has missed something important.)
  9. As the doctor, nurse and tech enter the room, an RFID chip in their badges will alert the hospital system that they have done so. Then, a related alert will be pushed to the patient tablet – and maybe to the family members’ tablet which might be part of this process — giving everyone a heads up as to how they’re going to interact with me. For example, if a tech has entered to draw blood, the system will not only identify the staff member but also the fact that they plan a blood draw, as well as what tests are being performed.
  10. If I have had in interaction with any of the staff members before, the system will note the condition the patient was diagnosed with previously when working with the clinician or tech. (For example, beside Doctor Smith’s profile I’d see that she had previously treated me for stroke-like symptoms one time, and a cardiac arrhythmia before that.)
  11. As the doctor or NP orders laboratory tests or imaging, those orders would appear on a patient progress area on the main patient ED encounter page. Patients could then click on the order for say, an MRI, and find out what the term means and how the test will work. (If a hospital wanted to be really clever, they could customize further. For example, given that many patients are frightened of MRIs, the encounter page would offer the patient a chance to click a button allowing them to request a modest dose of anti-anxiety medication.)
  12. As results from the tests roll in, the news is pushed to the patient encounter home page, scrolling links to results down like a Twitter feed. As with Twitter, all readers — including patients, clinicians and staff — should have the ability to comment on the material.
  13. When the staff is ready to discharge the patient — or the doctor has made a firm decision to admit — this news, too, will be pushed to the patient encounter homepage. This announcement will come with a button patients can click to produce a text box, in which I can type out or dictate any concerns I have about this decision.
  14. When I am discharged from the hospital, the patient encounter homepage will offer me the choice of emailing myself the discharge summary or being texted a link to the summary. (Meanwhile, if I’m being admitted, the tablet stays with me, but that’s a whole other discussion.)

OK, I’ll admit that this rather long description caters to my prejudices and personal needs, and also, that I’ve left some ideas out (especially some thoughts related to improving my interaction with on-call specialists). So tell me – does this vision make sense to you? What would you add, and what would you subtract?

P.S.  Some high-profile hospitals have put a lot of work into integrating EMRs with tablets, at least, but not in the manner I’ve described, to my knowledge.

P.S.S. No this is not an April Fool’s joke. I’d really like for someone to implement these workflows.