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ED Alerts Help Health Plans Cut Costs

Posted on February 4, 2014 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 readers of this publication know, many hospitals are interested in participating in HIEs, but are buried in projects already and not so sure the investment will pay off.  But here’s an instance where a very modest HIE application helped a health plan save real money in just six months without having to do an expensive buildout.

According to iHealthBeat, a new study by the Agency for Healthcare Research and Quality has found that simply sending near real-time alerts to health plans when a member is admitted to the hospital ED could help the health plan save money and get patients into primary care.

To do the study, Indiana Health Information Exchange programmers developed an application which sent daily alerts about health plan members who visited EDs at nine Central Indiana hospitals. As part of the pilot, the alerts were sent to the participating health plan within 24 hours. The health plan then used this data to replace non-urgent ED visits with primary care visits, iHealthBeat reports.

During the six-month pilot, the health plan was able to reduce nonemergency ED visits at participating hospitals by 53 percent; the same time primary care visits among plan members jumped to 68 percent during the pilot period.

The bottom line in all of this was that after using the daily updates to guide patient behavior, the health plan was able to save $2 million to $4 million over six months. While I could be wrong, I don’t believe there are many test cases out there that can demonstrate the effectiveness of hospital to plan communication and brag of this much success.  While this isn’t exactly an argument for all hospitals to have HIEs, this does suggest that shared, timely information on important patient behaviors can be extremely valuable.

Inappropriate EMR Use Causes At Least Two ED Patients At VA To Die

Posted on November 4, 2013 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.

Problems using the EMR in the emergency department at the Memphis Veterans Affairs facility led to the deaths of two people — and possibly more — according to the VA’s Office of the Inspector General,  iHealthBeat reports.

In one case, a nurse had entered into an EMR that a patient was allergic to aspirin. But the physician bypassed the EMR and instead wrote out a prescription for ketorolac, an anti-inflammatory drug contraindicated for patients with aspirin allergies. The patient went into respiratory and cardiac arrest and died, according to iHealthBeat.

The report also identified another case in which a patient died after doctors failed to treat a patient’s high blood pressure in a timely basis due to incomplete and conflicting progress notes.

In a third case, still under investigation, a patient became comatose and died after being given three separate drugs for back  pain and not being properly monitored for oxygen saturation.  According to the OIG, it’s not yet clear whether the EMR contributed to the patient’s death.

This is not the first time that the OIG has called attention to possible problems in this facility’s ED. The OIG previously reviewed operations in the facility’s ED in 2012, after a complaint alleged that conditions in the ED were putting patients at risk. The facility is still in the process of responding to those recommendations, the agency notes.

Now, it’s entirely possible that this VA facility has problems that go well beyond technology, especially if two separate OIG investigations found problems there.

But it’s also possible that the staff simply needs better training on the EMR, something that is quite fixable if the leadership decides to  move forward.

That being said, if the DoD and VA do move once again toward a joint EMR, the odds of bugs in the system emerging is great. Let’s hope that the movement toward building the iEHR, patient harm doesn’t increase.

ED Docs Spend More Time With EMRs Than Patients

Posted on October 2, 2013 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.

Emergency department doctors spend substantially more time entering data into EMRs than they do interacting with patients, according to an American Journal of Emergency Medicine study reported by FierceEMR.

According to FierceEMR, the study found that the average percentage of time ED docs spend on data entry was 43 percent. During a 10-hour shift, researchers concluded, total mouse clicks neared 4,000.

In contrast, the amount of time emergency department doctors spent interacting directly with patients during the AJEM study was 28 percent, the researchers found.  Meanwhile, reviewing tests and records accounted for an average of 12 percent of the doctors’ time, and talking to colleagues consumed 13 percent.

It’s hardly surprising that doctors would rack up nearly 4,000 clicks during a shift. Mouse clicks for common charting functions and patient encounters range from a low of six clicks for ordering an aspirin to a high of 227 for completing a record for patients with abdominal pain through the point of discharge, according to an article in Medscape Medical News cited by FierceEMR.

These results are consistent with those of a similar study published earlier this year in the Journal of General Internal MedicineiHealthBeat reports. According to iHealthBeat‘s story,  researchers who observed 29 medical interns at Johns Hopkins Hospital in the University of Maryland Medical College found that the interns spent 40 percent of their time on computer related tasks, and 12 percent of the time talking with and examining patients.

Such reliance on EMRs in the ED may have some benefits, but there are also risks involved,  according to a recent study appearing in the Annals of Emergency Medicine. According to the study, the design of EMRs for emergency departments varies widely, with some having problems which can compromise clinician workflow, communication and ultimately, quality and safety of care.

The Annals research suggests that hospitals ought to be auditing the performance of their EDISs regularly,  given how central these tools are to emergency medicine these days.  If doctors are going to click nearly 4,000 times during a single shift, it’s best if the EDIS in question doesn’t foster communication failures, alert fatigue or wrong order/wrong patient mistakes, all problems which emerge when the EDIS doesn’t function well, researchers concluded.

Hospital Data Exchange Climbs Over Four Years

Posted on August 12, 2013 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 study appearing in Health Affairs concludes that health data exchanges between hospitals and other healthcare providers have climbed 41 percent between 2008 to 2012, according to a report in iHealthBeat.

The study, which was led by soon-to-be-ex ONCHIT head Farzad Mostashari, analyzed data sharing outputs and the type of information exchanged by more than 2,800 hospitals over the four-year period, iHealthBeat said.

According to iHealthBeat, the study found that in 2012, 58 percent of hospitals routinely exchanged health data with providers and health systems outside their organization, and that data exchange with outside hospitals actually doubled.

It also found that 84 percent of hospitals adopting a basic EMR and participating  in a RHIO shared information with providers outside of their organization during the period studied.

In addition, the proportion of hospitals adopting at least a basic EMR and participated in an  HIE shot up more than 500 percent during the four years studied.   And hospitals with a basic EHR participating in an HIEs had the highest rates of hospital data exchange, iHealthBeat reports.

Along with tracking the growth of health information exchange, the study tracked specific kinds of data exchanged.  It found that there were large increases in the percentage of hospitals sharing clinical care summaries, lab results, medication lists and radiology reports.

This data should be music to the ears of groups coming together into large HIEs, as it suggests that hospitals are becoming engaged users of networked data. Any sign that health information exchange is becoming a mission-critical activity is a good omen.

That being said, the study doesn’t seem to get into the issue of who will sustain and pay for the HIEs in question. It could be that the hospitals are perfectly happy to take advantage of a service supported by grant money — as is very frequently the case — but won’t be up for ponying up real money when the grants expire.  We’ll just have to see how deeply HIEs become ingrained into the hospitals’ workflow to see whether active HIEs are worth real money to them.

Many Hospital Executives Expect Big Health IT Investments This Year

Posted on May 8, 2013 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.

Surprise, surprise.  A new report from the Premier healthcare alliance finds that many hospital executives will make their largest capital investments in IT this year.

To prepare the report, known as the spring 2013 Economic Outlook, Premier spoke with 530 survey respondents, most of whom were hospital leaders.  Survey respondents also included materials and practice area managers, reports iHealthBeat.

Roughly 43 percent of respondents said that their health organization’s biggest capital investment over the next year would be in health IT, a jump of 21 percent from two years ago.  Offering a hint on where the money may be going, the report also found that 32 percent of respondents can’t currently share data across the continuum of care.

Other clues as to where the spending is going come from the study’s topline finding, which predicts a big shift from inpatient to outpatient care.

According to Premier, only 35 percent of respondents are expecting to see an increase in inpatient spending this year as compared to 2012, down 30 percent from predictions made last year. Meanwhile, 69 percent of respondents said they expect to see an increase in 2013 outpatient volume compared to last year.

Some additional intelligence from the report:

* 22 percent of respondents are in an ACO, and 55 percent plan to be by the end of next year

* 27 percent don’t have plans to pursue the ACO model, and may look to bundled payment, care management fees or pay for  performance options

*  29 percent said overutilization of products and services and 22 percent said lack of clinical coordination were the biggest drivers of healthcare costs

* 48 percent said reimbursement cuts had the biggest impact on their health systems

* 40 percent said capital spending would increase over the next 12 months as compared with the previous year

* Almost 37 percent project a capital spending decrease

Making Devices Interoperable Offers $30B Savings Opportunity

Posted on March 25, 2013 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.

Right now, it’s a hit and miss thing whether hospital medical devices can talk to each other or connect with the facility’s EMR. A lack of standards — and money for next-gen devices — has made such interoperability a very tough job. But getting the job done is worth the trouble, a new story in iHealthBeat suggests.

At present, patients in hospitals are treated with six to 12 medical devices in a typical intensive care unit, including defibrillators, electrocardiographs, vital sign monitors, ventilators and infusion pumps, typically from a mix of manufacturers, notes West Health Institute.  Because these devices aren’t inherently interoperable, hospitals spend big on IT infrastructure to connect them.

There’s plenty of reason to make them connect, however. A study by West Health has concluded that if the industry could improve medical device interoperability and adhere to interoperability standards,  it could shave $30 billion off of U.S. healthcare costs.  According to the report, the U.S. spends $36 billion each year on “addressable waste” resulting from a lack of medical device interoperability.  Savings the U.S. could realize breaks down as follows, iHealthBeat reports:

  • $17.8 billion from higher treatment capacity that would result from shorter hospital stays
  • $12.3 billion from increased clinician productivity
  • $3 billion from reducing the cost of providing care
  • $2 billion from reducing adverse events
  • $1.2 billion from wider adoption of interoperability standards

But getting to the point where interoperability is common could take a long time, according to West Health’s Joseph Smith, who recently testified on the Hill on this subject. Right now, only one-third of hospitals using six or more medical devices that can be integrated with EMRs have actually done the integration work, Smith told a House subcommittee.

What’s more, vendors will need to invest in R&D to turn out next-gen interoperable devices, a cost that will be at least partly absorbed rather than passed on to the buyer, Smith noted.

Hospitals Beware: EMR Copy And Paste Common

Posted on January 16, 2013 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.

EMR templates are both a curse and a blessing. On the one hand, they systematize clinical data in a way that makes it far easier to share, aggregate and study trends. But the down side, and it’s a big one, is that EMR templates tempt clinicians to save time by cutting and pasting old data from patient’s record into current visit notes.  The following study gives us a look at just how easily copy-and-paste can become a (bad) habit for clinicians in a hospital.

To study template use, an assistant professor at Case Western Reserve University School of Medicine brought together a group of colleagues to examine EMR-based progress reports. The group looked at 2,068 electronic progress reports created by 62 residents and 11 attending physicians, all of whom were working in the intensive care unit of a Cleveland hospital.

To determine how common cut-and-paste content was in the notes, the researchers reviewed notes for 135 patients over a five-month period using plagiarism-detection software, iHealthBeat reports. The results?  They found that 82 percent of progress notes created by residents contained 20 percent or more of copied and pasted material from patient records.  Meanwhile, 74 percent of progress notes created by attending physicians contained 20 percent or more of material cut-and-pasted from patient EMR records.

I’m not writing this to beat up on doctors, who certainly have their hands full simply coping with the new systems. Cut-and-paste is a natural instinct when you’ve spent your life doing so successfully in Word docs and spreadsheets. But as the iHealthBeat piece points out, courtesy of EHR Intelligence, there are reasons to be concerned when this much copying is going on, including outdated records, incorrect billing requests and worst of all, mistakes in documentation which could harm vulnerable ICU patients.

Seems that cutting and pasting within EMR documentation is a problem that’s not going to go away on its own.