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Roche, GE Project Brings New Spin To Clinical Decision Support

Posted on January 10, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

The clinical decision support market is certainly crowded, and what’s more, CDS solutions vary in some important ways. On the other hand, one could be forgiven for feeling like they all look the same. Sorting out these technologies is not a job for the faint of heart.

That being said, it’s possible that the following partnership might offer something distinctive. Pharmaceutical giant Roche has signed a long-term partnership deal with GE Healthcare to jointly develop and market clinical decision support technology.

In a prepared statement, the two companies said they were developing a digital platform with a difference. The platform will use analytics to fuel workflow tools and apps and support clinical decisions. The platform will integrate a wide range of data, including patient records, medical best practices and recent research outcomes.

At least at the outset of their project, Roche and GE Healthcare are targeting oncology and critical care. With a pharmaceutical company and healthcare technology firm working together, providing tools for oncology specialists in particular makes a lot of sense.

The partners say that their product will give oncology care teams with multiple specialists a common data dashboard to review, which should help them collaborate on treatment decisions. Meanwhile, they plan to offer critical care physicians a dashboard integrating data from patient’ hospital monitoring equipment with their biomarker, genomic and sequencing data.

The idea of integrating new and possibly relevant information to the CDS platform is intriguing. It’s particularly interesting to imagine physicians leveraging genetic information to make real-time decisions. I think it’s safe to say that we’d all like it if CDS systems could bring the rudiments of precision medicine to thorny day-to-day clinical problems.

But the truth is, if my interactions with doctors mean anything, that few of them like CDS systems. Some have told me flat out that they end up overriding many CDS prompts, which arguably makes these very expensive systems almost irrelevant to hospital-based clinical practice. It’s hard to tell whether they would be willing to trust a new approach.

However, if GE and Roche can pull off what they’re pitching, it might just provide enough value it might convince them. Certainly, creating a more flexible dashboard which integrates data and office workflows is a large step in the right direction. And it’s probably fair to say that nothing like this exists in the market right now (as they claim).

Again, while there’s no guaranteed way to build out useful technology, bringing a pharma giant and a health IT giant might give both sides a leg up. I wonder how many users and patients they have involved in their design process. Let’s see if they can back up their promises.

When It Comes To Meaningful Use, Some Vendors May Have An Edge

Posted on December 1, 2017 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A new article appearing in the Journal of the American Medical Informatics Association has concluded that while EHRs certified under the meaningful use program should perform more or less equally, they don’t.

After conducting an analysis, researchers found that there were significant associations between specific vendors and level of hospital performance for all six meaningful use criteria they were using as a yardstick. Epic came out on top by this measure, demonstrating significantly higher performance on five of the six criteria.

However, it’s also worth noting that EHR vendor choice by hospitals accounted for anywhere between 7% and 34% of performance variation across the six meaningful use criteria. In other words, researchers found that at least in some cases, EHR performance was influenced as much by the fit between platform and hospital as the platform itself.

To conduct the study, researchers used recent national data on certified EHR vendors hospitals and implemented, along with hospital performance on six meaningful use criteria. They sought to find out:

  • Whether certain vendors were found more frequently among the highest performing hospitals, as measured by performance on Stage 2 meaningful use criteria;
  • Whether the relationship between vendor and hospital performance was consistent across the meaningful use criteria, or whether vendors specialized in certain areas; and
  • What proportion of variation in performance across hospitals could be explained by the vendor characteristics

To measure the performance of various vendors, the researchers chose six core stage two meaningful use criteria, including 60% of medication orders entered using CPOE;  providing 50% of patients with the ability to view/download/transmit their health information; for 50% of patients received from another setting or care provider, medication reconciliation is performed; for 50% of patient transitions to another setting or care provider, a summary of care record is provided; and for 10% of patient transitions to another setting or care provider, a summary of care record is electronically transmitted.

After completing their analysis, researchers found that three hospitals were in the top performance quartile for all meaningful use criteria, and all used Epic. Of the 17 hospitals in the top performance quartile for five criteria, 15 used Epic, one used MEDITECH and one another smaller vendor. Among the 68 hospitals in the top quartile for four criteria, 64.7% used Epic, 11.8% used Cerner and 8.8% used MEDITECH.

When it came to hospitals that were not in the top quartile for any of the criteria, there was no overwhelming connection between vendor and results. For the 355 hospitals in this category, 28.7% used MEDITECH, 25.1% used McKesson, 20.3% used Cerner, 14.4% used MEDHOST and 6.8% used Epic.

All of this being said, the researchers noted that news the hospital characteristics nor the vendor choice explained were then a small amount of the performance variation they saw. This won’t surprise anybody who’s seen firsthand how much other issues, notably human factors, can change the outcome of processes like these.

It’s also worth noting that there might be other causes for these differences. For example, if you can afford the notably expensive Epic systems, then your hospital and health system could likely afford to invest in meaningful use compliance as well. This added investment could explain hospitals meaningful use performance as much as EHR choice.

Half of Medication Errors Found In PA Study Involve HIT Issues

Posted on March 29, 2017 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A new study by a Pennsylvania healthcare organization has found that computerized order entry systems and pharmacy systems were the most commonly reported factors contributing to medication errors in the state.

The Pennsylvania Patient Safety Authority, an independent agency tasked with finding and reducing the rate of medical errors in the state, recently released a report on medication errors reported to the agency during the first six months of last year. Under state law, Pennsylvania-based providers cutting across several categories, including hospitals, ambulatory surgical facilities and birthing centers, are required to disclose adverse events and “near misses” to the agency.

Between January 1 and June 30, 2016, the state’s healthcare facilities reported 889 medication-error events which cited health IT as a factor in the event(s). The errors most often reported were dose omission, wrong dose or overdosage and extra dosages, while CPOE and pharmacy systems-related problems were the most commonly reported health IT issues. (High-alert medications such as opioids, insulin and anticoagulants – which pose a higher risk of harm if misused – occupied three of the top five drug categories involved in most events.)

When they analyzed the data, agency analysts found that health IT-related errors took place during every step of the medication use process, and worse, most of those errors affected the patient directly, the data suggested.  And things may get worse before they improve. To hear agency officials tell it, HIT-related medication problems have become more common as health IT infrastructures have matured.

“As more healthcare organizations adopted EHRs and such systems became increasingly interoperable, the Authority observed an increase in reports of HIT-related events, particularly in relationship to medication errors,” said agency executive director Regina Hoffman in a prepared statement.

The Authority’s data doesn’t gibe completely with other research. For example, a report by the Leapfrog Group and Castlight Health notes that CPOE use has been very effective at reducing medication error rates. The report specifically refers to a CPOE study led by David Bates, MD, chief of general medicine at Brigham & Women’s Hospital, in which rates of serious medication errors fell by 88 percent during the period studied. Elsewhere, Leapfrog has cited studies in which CPOE use seems to have cut hospital lengths of stay, as well as major reductions in pharmacy, radiology and lab turnaround times.

On the other hand, the same report notes that CPOE systems still have a long way to go before they realize their potential. According to the 2015 Leapfrog Hospital Survey, hospitals’ CPOE systems failed to flag 39 percent of all potentially harmful drug orders, as well as 13 percent of potentially fatal orders. So it’s not a huge stretch to imagine that CPOE-using Pennsylvania hospitals are still having medication errors fall through the cracks.

It’s also worth pointing out that doctors don’t necessarily see CPOE systems as their best friend either. A study published last year in the Mayo Clinic Proceedings found that physicians who use EMRs and CPOE had lower satisfaction with time spent on clerical tasks and higher rates of burnout. Of course, given that the study lumps CPOE use in with EMR use, the results are somewhat skewed, but it’s still a data point worth considering.

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.

CPOE Alerts Still Vex Doctors

Posted on April 20, 2016 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A new study by Castlight Health has found that while nearly all hospitals have implemented CPOE systems, those systems are far from perfect. And that may be because too many clinicians find system alerts to be a distracting annoyance.

The research, based on an analysis of data collected by The Leapfrog Group, found that 96% of hospitals reported use of a CPOE system, up from 33% in 2010 in a scant 2% in 2001.  This data is drawn from the 2015 Leapfrog Hospital Survey of 1,750 U.S. hospitals.

But while the high adoption rate might be good news, it comes with bad news as well. The Castlight analysis found that even where hospitals had CPOE systems in place, 39% of possibly harmful drug orders and 13% of potentially fatal orders weren’t flagged by the system in place.

The most common errors that didn’t get flagged included when clinicians prescribed the wrong meds for the patient’s condition, or the wrong dose or meds entirely inappropriate for kidney function, and the failure to display a reminder to test drug levels after issuing medication.

These errors are occurring despite the fact that many of the hospitals studied by Leapfrog (64%) met its CPOE standard. To do so, the hospitals had to alert physicians about a minimum of 50% of common, serious prescribing errors. Also, physicians had to order at least 75% of inpatient medication orders through a CPOE system.

So if the CPOE system is being used actively, and performing as it should in most cases, why would nearly 40 percent of potentially harmful drug errors slip by? The answer may be that fairly or not, CPOE alerting is still seen as a hindrance rather than a help by many physicians.

While I don’t have hard statistical evidence to this effect, the anecdotes doctors share suggest that some click through alerts as quickly as possible. One physician blogger shared that he was quite frustrated by the alert generated when he wanted to prescribe 81mg baby aspirin tablets, which patients can buy over the counter. I understand his frustration (and even what seems like wounded pride).  And if it took several clicks to dismiss the related prompts, I’m sure it was indeed annoying.

On the other hand, as my colleague John Lynn rightfully notes, doctors aren’t going to blog or tweet about the time the CPOE system alert saved them from making a major prescribing error. So there is a bias to comments and blog postings since they only cover the negative side of CPOE and not the positive side. Perhaps the doctors who are working with these alerts successfully are simply going about their business and feel no need to vent. (Please note: I’m not suggesting that those who do vent are out of line in some way.)

Still, it seems quite clear that there’s considerable work to do in improving the workflow around physician alerting. If hospitals with CPOE in place are still seeing this level of potentially harmful or fatal prescribing, after many years to adapt to alerts, they need to do more to accommodate physicians.

P.S. They might want to start with a look at how Montefiore Medical Center succeeded with its CPOE rollout.

EMR Change Cuts Cardiac Telemetry Use Substantially

Posted on September 25, 2014 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Changing styles of medical practice can be really tough, even if major trade organization sticks its oar in to encourage new behavior from docs.

Such is the situation with cardiac telemetry, which is listed by the American Board of Internal Medicine Foundation as either unnecessary or overused in most cases. But a recent piece of research demonstrated that configuring an EMR to help doctors comply with the guideline can help hospitals lower needless cardiac monitoring substantially.

Often, it takes a very long time to get doctors to embrace new guidelines like these, despite pressure from payers, employers and even peers. (Physicians may turn on a dime and try out a new drug when the right pharmaceutical rep shows up, but that’s another story.) Doctors say they stick to their habits because of patient, institutional or personal preferences, as well as fear of lawsuits.

But according to a recent study appearing in JAMA Internal Medicine, reprogramming its Centricity EMR did the trick for Wilmington, Del.-based Christiana Care Health System.

To curb the use of cardiac telemetry that was unnecessary, Christiana Care removed the standard option for doctors to order cardiac monitoring outside of AHA guidelines, and required them to take an extra step to order this type of test.

Meanwhile, when the cardiac monitoring order did fall within AHA guidelines, Christiana Care added an AHA-recommended time frame for the monitoring. After that time passed, the EMR notified nurses to stop the monitoring or ask physicians if they believed it would be unsafe to stop.

The results were striking. After implementing the changes in the EMR, the health systems average daily not intensive care unit patients with cardiac monitoring fell by 70%. What’s more, Christiana Care’s average daily cost of administering  non-ICU cardiac monitoring held by 70%, from $18,971 to $5,772.

Christiana Care’s health IT presence is already well ahead of many hospitals — it’s reached Stage 6 of the HIMSS EMRAM scale — so it’s not surprising to see it leading the way in shaping physician behavior.

The question now is how the system builds on what it’s learned. Having survived a politically-sensitive transition without creating a revolution in its ranks, I’d argue the time is now to jump in and work on compliance with other clinical guidelines. With pressure mounting to deliver efficient care, it’d be smart to keep the ball rolling.

Physician Coaches Can Increase EMR Engagement

Posted on July 24, 2013 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Today I read an interesting piece in HealthSystemCIO.com about the approach Naples, FL-based NCH Health System has taken to help its physicians ease into using its EMR.  According to Helen Thompson, VP & CIO, NCH has created a corps of physician coaches to help doctors get and stay comfortable with EMR use.

As she not too surprisingly notes, physicians are her toughest customers, rightfully demanding that the EMR helps them to deliver better care and supports their process. However, getting physicians situated is a very difficult challenge, given that they’re having to learn new processes and a new language.

To address this challenge, NCH has developed a new model for training, involving physician coaches in pre-conversion, implementation and post-conversion support for doctors. While these coaches don’t necessarily have direct clinical experience, they are very knowledgeable about both the EMR and physician workflow issues, Thompson says

The process of using the coaches works as follows:

* Preconversion:  The coaches work on programs for teaching and behavior change management plus develop an online education component.  As the teaching and behavior change takes place, they monitor progress and report as milestones are reached. To make themselves accessible, the coaches provide “concierge-like” services including making rounds with doctors or offices.

* During conversion: Coaches are available for dedicated “at the elbow” support to physicians as needed.

* Post-conversion:  The coaches offer refresher courses and change management support, as well as continuing to be available for at the elbow coaching to physicians as needed.

The coaches seem to be quite a success. NCH has seen a significant improvement in CPOE and electronic documentation measures, with adoption and engagement increased by roughly 5 percent to 10 percent. What’s more, the coaches share physician feedback with hospital leaders, allowing for ongoing improvement. (Thompson also hired a CMIO to further boost the process, which drove up e-documentation and CPOE use by a total of 25 percent.)

From my vantage point, the coaching program sounds like a very good idea. My only question is whether hospital IT departments will typically have the resources to build up a team of coaches, given that they’re generally short on time and staff as it is.  But it does seem to me that it’s a no-brainer for hospitals that can manage it to give this idea a try; after all, getting physicians on board with your EMR is worth just about any effort you put into it.

CA Hospital Adds CPOE To VistA Implementation

Posted on July 1, 2013 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

It’s still rare these days to see a private hospital roll out open source EMR VistA, despite VistA’s excellent reputation. But one such hospital has not only implemented VistA, it’s added CPOE to its VistA rollout.

The facility in question is Oroville (CA) Hospital, which spent three years self-implementing the VA platform. Oroville has spent seven years developing a paper-based order set system, and has now converted its order sets from paper to electronic.

For a year the medical staff at Oroville had been using paper order sets and the VistA EMR, but that arrangement was getting old, so the transition was a happy one, according to Dr. Matthew Fine, the hospital’s chief medical officer, who’s quoted in a press statement.

“After a whole year of using paper and electronic charts the staff was chomping at the bit to go live and the anticipation outweighed the fear… so turning on CPOE was almost a welcomed event. The inadvertent strategy of having hybrid charts seems to have been a good way to make full conversion to EHR/CPOE more palatable,” Dr. Fine said.

To make the CPOE transition, the Oroville staff created a mechanism for systematically converting order sets to an electronic format, the press release notes. Each order set, once transformed, was reviewed by a relevant group of physicians along with 20-odd additional staff including department/section heads, nurses, pharmacists, nutritionists, lab staff and anyone else who might be carrying out the orders in the order sets.

Since go-live in October of last year, electronic order volume has mounted, and now 80 percent of orders are electronic. The hospital’s goal is for 100 percent of orders to be electronic, but it has hit a stumbling block in that it has been unable to adapt VistA’s original CP Flowsheet module.

For that reason, Oroville will have to create its own CPOE solution for several areas of the hospital, including outpatient surgery and the PACU.

Structuring for the Future of Clinical Decision Support (CDS)

Posted on May 10, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest post by Adam Lokeh, M.D., vice president of clinical development and informatics with Wolters Kluwer Health.

Clinical decision support tools (CDS) play an increasingly critical role in a healthcare organization’s overarching strategy to comply with federal incentive programs and succeed within the quality- and performance-based reimbursement landscape currently unfolding. When effectively aligned with physician documentation practices at the point of care, these tools can have a powerful impact on error reduction, the standardization of evidence-based practices, quality of care and ultimately saving lives.

Research reveals that a combination of advanced CDS technology working in tandem with computerized physician order entry (CPOE) solutions will be needed to successfully navigate the coming healthcare landscape. A number of CDS elements will need to be considered and integrated into existing systems to create this powerful collaboration including evidence-based order sets, alerting systems for medication management, ECA rules (event, condition, action), referential information including guidelines and care plans, smart documentation and surveillance technology to name a few. To fully leverage the advantages of these tools, it’s important to understand the different approaches to data and content and the inherent advantages and disadvantage of each.

Currently, there are two approaches to content when designing point-of-care IT infrastructures—structured and unstructured. While both have the potential to standardize care and improve decision-making, industry preference leans toward greater integration and use of structured content for its ability to lay a foundation of improved accuracy, efficiency and ability to drive clinical decision support and analytics.

Because structured content is tagged or coded data that resides in a fixed field, it can be easily located, identified and understood, simplifying the process of integrating content into existing systems and sharing between disparate systems. In contrast, unstructured content, such as free text, often results in irregularities and ambiguities that make it harder to interpret.

Unstructured data makes it more difficult for health IT systems to recognize shared data, requiring complex and largely manual conversion processes that are prone to errors, resulting in inaccurate data. When inaccurate patient information is then shared between systems, the potential for adverse events or care issues is only compounded.

While the premise of this discussion as it relates to the benefits of structured content would seem clear, it’s not that simple. Physicians want the ability to express themselves freely when documenting, and there is concern within the physician community that the full patient picture could get lost if the narrative is too highly structured. As a practicing physician, I understand the delicate balance that exists between the need for a technological foundation that promotes accurate information sharing and the desire to protect the individual patient story.

The truth is that there can be risk without allowing for flexibility in creation of narrative content.  Poorly-designed interfaces have clearly existed with some structured content frameworks historically—and still do today within some CDS and CPOE applications—that can cause pieces of the patient narrative to get lost. The use of applications lacking in flexible design and without trustworthy content that is thorough and exhaustive in nature has led to poor physician perception and even fear that the technology will marginalize patient care. Ultimately, the end result is poor physician adoption.

That is why it is so critical that vendors work with physicians to identify all essential elements as well as the factors that can hinder adoption.  The solution is new, thoughtful clinician-designed systems that are more intuitive and flexible, allowing some limited unstructured content to help flesh out the narrative.

When CDS technology is developed through this kind of high-level partnership and designed to accommodate the use of structured content where it is needed most, content can be indexed at a granular level, easing the process of mapping within systems.  It also lays a foundation for automated updating of content as industry evidence changes and provides a framework for more robust reporting due to extensive filtering capabilities.

The end result is more accurate and efficient integration of the best industry evidence at the point of care, delivering a framework for decision support that truly impacts care without compromising the patient narrative. It’s this kind of far-reaching potential—currently offered through some of the more advanced CDS and CPOE applications in the industry—that physicians need to witness to truly understand what can be accomplished. Unfortunately, the industry has not done a very good job of educating them to date.

Some are looking to the potential of natural language processing (NLP) to address the needs for mapping in free-text environments through data mining. While this path offers an alternative, it is not as powerful a foundation as structured content for improving decision making at the point of care. In fact, it’s retroactive. If data mining occurs after the patient narrative has already been input, decision support can, by definition, only be offered “after the fact.”

In essence, physician documentation that is completed in a structured-content environment —as opposed to a traditional dictation method—is, in itself, a form of CDS. Because documentation can be structured to guide and remind physicians to document important medical elements, it assures that nothing is overlooked.

Many industry initiatives point to greater incorporation of structured content into the design of IT applications for information exchange. Industry movements and organizations such as Meaningful Use, HL7, the Standards and Interoperability (S&I) Framework Health eDecisions Project and the CDS Consortium are working towards industry standards that will require use of more structured content.

The simple fact is that when data is shared, it has to be recognized across and between systems. Structured content within CDS applications allows data to be mapped to a standardized vocabulary to ensure accuracy.

That said, clinicians prefer free text. Until the industry properly educates physicians regarding the power inherent in structured content, the best approach will be a hybrid that includes avenues for both models. For maximum adoption, IT vendors should consider that critical components will need to be structured to drive CDS, reporting and quality metrics, but allowing for some amount of free text to smooth out the edges for more widespread adoption.

New Hospital Rockets To Top Of HIMSS EMR Adoption Scale

Posted on December 26, 2012 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

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.