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EMR Med Reconciliation Works, But Doesn’t Come Easy

Medication reconciliation is a complex process which could always stand to be improved — so how about leveraging your EMR?

Editor Maria Durben Hirsch of FierceEMR recently talked with a handful of health IT execs about how it’s working out to use EMRs as part of their med reconciliation process, and learned that while health leaders are enthusiastic about med reconciliation in the EMR, they’re still working out kinks in the process.

Health IT leaders do seem enthusiastic about the possibilities for using EMR med functions.

For example, Texas Health Resources, a 25-hospital health system in the Dallas/Fort Worth area, has found that using EMRs improves the accuracy of the process by providing tools to capture the patient’s previous med history, better managing new med orders and generating instructions for patients, CMIO Ferdinand Velasco, MD, told FEMR.

And at Naperville, Ill.-based Edward Hospital,  staff are happily using a “pretty robust” functionality for med reconciliation, CIO Bobbie Byrne told Durben Hirsch. Their EMR offers several useful features , including a home medication list, tools to convert meds to inpatient orders or provide substitutions, and features to continue meds after discharge and generate prescriptions.

But there are still issues with using this technology, Byrne told FEMR.  For one thing, she notes, a transaction that takes no time at all in a physician’s mind takes longer, and is more complicated. What’s more, med reconciliation itself is more difficult these days, given that many patients have chronic diseases and are on 10 to 15 meds before coming to the hospital.

And Mary Beth Mitchell, chief nursing information officer at Texas Health Resources, points out that the EMR-based med reconciliation process requires patience and thoroughness: “This process is dependent on the nurse or physician going to the medication reconciliation activity and identifying the current status of each med, every time the patient moves throughout the system,” she told Durben Hirsch.

The bottom line seems to be that while EMRs have made a lot of progress in the med reconciliation arena, few if any EMRs offer the simple process we all know it should be. Getting medication reconciliation right is critical, though. Let’s hope vendors get the kinks out soon.

August 19, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Remote Patient Monitoring Going Mainstream

This week I read a piece of news which suggests to me that we’re seeing a turning point in the use of remote monitoring technology to manage patients.  It looks like AT&T is taking a major public position in support of remote monitoring via the cloud, via a partnership with a  hot new startup that just raised funding, according to a report in mobihealthews.

According to the mobile health news publication, cloud-based patient monitoring company Intuitive Health just got a $3.4 million investment in what appears to be the company’s first public round of investment.

Intuitive, which completed a pilot with health system Texas Health Resources and AT&T last year, offers cloud-based remote monitoring software which can interface with any device.

The pilot involved monitoring CHF patients remotely for 90 days using wireless pulse oximeters, blood pressure cuffs and weight scales, plus tablets and apps feeding the data to the  patients’ EMR records. During the pilot, THR reduced hospital readmissions for chronic heart failure patients by 27 percent, mobihealthnews reports.

According to a press release from AT&T, Intuitive’s software has since become a key component in the telecom giant’s own SaaS patient monitoring product.

Remote monitoring has been a hot topic of discussion and an emerging approach for several years, but hasn’t found an established place in day-to-day care for most institutions.  With AT&T and Intuitive offering a device-agnostic model, however, I believe they will give a boost to the use of remote monitoring generally.

Personally, I’ve been cheering for remote monitoring to succeed for some time; after all, given how mobile-device-oriented people are anyway, it just makes sense to leverage those capabilities to improve their health.  I hope this represents a turning point for this type of technology and that we see news of more successful pilots this year.

January 31, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

New Hospital Rockets To Top Of HIMSS EMR Adoption Scale

Here’s a story of what can happen when a hospital starts out from scratch with the latest in EMR knowledge, rather than having to integrate its system bit by bit.

Texas Health Alliance, a 50-bed acute-care hospital based in north Fort Worth, has been named as achieving the rarely-seen Stage 7 in HIMSS Analytics EMR Adoption Model. At present, only 103 U.S. hospitals, or 1.9 percent, are currently at Stage 7.

Some of the outstanding features of the rollout include:

* Over 95 percent utilization of CPOE (driven predominately by well-designed order set content, HIMSS says)
* Advanced clinical decision support alerts that support best practice protocols
* Smart use of an enterprise data warehouse used to monitor best practice alerts and core measures
* Closed-loop medication administration environment

This award is interesting given that small hospitals have been well behind the curve in Meaningful Use and meeting the HIMSS standards.  But there’s some obvious reasons why it’s been so successful.

For one thing, THA has been open only since September. I’ll bet many readers would kill for the clean slate that offers the IT people there. No need for expensive integration projects to bring the new EMR on board; no having to switch staffers from one technology to another; no major transition from paper to digital; and the list of benefits goes on.

Another major factor working in its favor is that THA is part of nonprofit hospital system Texas Health Resources.

A tiny hospital backed by a sizeable IDN is in a different position entirely than an independent critical access hospital, so it’s not exactly astonishing that it zoomed ahead. And when the parent chain already has its own (Epic) install well under way — and an engaged community of users — that knowledge goes a long way.

Too bad most hospitals can’t start out fresh the way THA did. Innovation always comes easier if it isn’t competing with the stuff you’ve already got.

December 26, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Driven by EMRs, Hospital Mobile Use Gains Ground

For most U.S hospitals, giving staff mobile access to key apps is more a vision than a reality. But here and there, hospitals are adopting cutting-edge mobile applications – and their doctors seem pretty happy with the arrangement, according to a piece in the Green Bay Press-Gazette.

Despite the security and support issues that come with supporting mobile devices, hospitals have more reason than ever to get on board. After all, doctors are increasingly demanding mobile access to their EHRs, a trend that’s only likely to heat up in coming years.

At Texas Health Resources of Arlington, Tx., mobile devices have changed the way physician Ignacio Nunez handles emergencies.  Though Nunez, an OB/GYN, may make his rounds in the morning, he can still take phone calls at 2PM from the field and remain connected. For example, he can check an expectant  mother’s medical records or even watch the fetus’s heartbeat on his iPhone.

THR’s goal, according to associate CMIO Luis Saldana, goes well be yond just to expanding the reach of his EMR, the paper reports. Ultimately, he hopes to “extend the physician beyond the hospital.” (I love his turn of phrase, don’t you?)

Meanwhile, other hospitals are beginning to stick their toe in the water as clinicians begin to demand mobile access to their systems, the newspaper reports. Aurora Healthcare, for example, is getting a flood of requests for it to support iPads, handheld devices and smartphones, says Russ Hinz, who manages the system’s EHR.

To get more examples of hospitals’ mobile progress, I encourage you to check out the newspaper piece, which captured more case studies than most trade journals.  I didn’t want to summarize them all here, but you’ll find a lot to consider there.

If there’s any single theme I took away from the varied anecdotes, it’s that doctors aren’t just interested in mobile technology, they’re ready to stage a revolt if they don’t get it.  Given that hospitals have a desperate need to keep up with physicians, it seems like a win-win proposition.

That being said, doctors, there may be a flip side to all of this. Anyone want to guess how long it will be before hospitals insist that their physician use mobile technology?

August 22, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.