Electronic health records: underused in the ICU?
|
|
|
- Barbra James
- 10 years ago
- Views:
Transcription
1 Electronic health records: underused in the ICU? Christopher W. Seymour, MD MSc Assistant Professor of Critical Care Medicine Core Faculty Member, CRISMA Center University of Pittsburgh School of Medicine
2 Disclosures Research funding: NIH / NIGMS K23 award Surgical Infection Society Consulting fees from Beckman Coulter on sepsis biomarkers No tobacco relationships
3 Caveats My clinical translational research focuses on sepsis I spend more time thinking about biomarkers than bioinformatics And yet EHR
4
5 But I m not alone Google trends search: EHR
6 Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009 Goal to promote the adoption and meaningful use of health information technology $6.5 billion investment in adoption of EHRs
7 No other industry, to our knowledge, has been under a universal mandate to adopt a new technology before its effects are fully understood, and before the technology has reached a level of usability that is acceptable to its core users. RAND, Friedberg et al., Health Affairs, 2014
8 But there are redeeming features? Integration of EHR data in prediction tools Clinical decision support and minimizing errors Royal College of Physicians, accessed 2015
9 Objectives Briefly address epidemiology if EHRs Explore the tension of EHR adoption in the ICU Potential benefit Perceived threats to care Illustrative case studies
10 Adoption and spending is increasing Office of the Auditor General Canada, 2013 ONC Data Brief No. 23 April 2015, accessed HealthIT.gov
11 Perceived benefits of the EHR Overcome bad hand writing Provide platform for quality care and clinical decision support Promotes billing practice Gather and trend patient, unit, hospital data Interoperability of patient data Improve efficiencies Secure private patient information Thakker et al., 2006 Perspect Health Inf Manag
12 Perceived barriers EHR usability that did not match clinical workflows Time-consuming data entry Interference with face-to-face patient care Overwhelming numbers of electronic messages and alerts A deisgn to optimize billing through quality Only as good as the quality metrics the measure RAND, Friedberg et al., Health Affairs, 2014
13 Lack of data? 17% of all RCTs with benefit Rahurkar et al., Health Affairs, 2014
14 Propotion of time (%) Example of workflow changes Patient care Clinical review and documentation Rural 400-bed tertiary-care medical center 3 ICUs 26 Attending physicians 0 Pre Post 2 Carayon et al., Int J Med Informatics, 2015
15 Meaningful use? Quality of care Clinical decision support Alerts for sick patients Medication errors Interoperable patient data Reduce costs Accuracy of orders (CPOE) Smart alerts Enrollment in randomized trials
16 Can EHR help with RCTs? Screening for eligible patients Nest interventions in the computerized order sets Record compliance with interventions Ease of platform trials Follow up / outcomes already tracked as part of clinical care Angus DC, JAMA, 2015
17 Case study: POC trial of insulin Fiore et al, Clin Trials, 2011
18 Case study: smart alerts To Err is Human Current ability to detect unusual patient management are knowledge based rely on prior knowledge input into the system EHR could learn typical care of ICU patients Leverage updating statistics on anomalies in care Create alerts for clinical care outliers, conditional on usual practice patterns
19 Case study: smart alerts for outlier care
20 Case study: smart alerts for outlier care Require balance Low frequency High quality Low override rate Independent and self learning Don t require outside expert input Directly informed by concurrent and past practice in the EHR
21 ICU care helps these people
22 Case study: smart alerts for ICU triage Admissions related to illness severity Admissions unrelated to illness severity Chen et al., N Engl J Med, 2013
23 Case study: smart alerts for ICU triage Mutiple prognostic tools exist (e.g. LAPS2 from Kaiser, among others) Deploy real time, use admission and physiologic data in the EHR Appropriately target the sick for ICU admission Need RCTs
24
25 Conclusions Adoption of the EHR is rapidly expanding in the US and Canada We spend A LOT of time with it Despite absence of controlled trials, the use of EHR will increase in the ICU Think creatively about efficient uses in the ICU not just for QI or billing agendas Promote trial enrollment (research) Smart alerts (adjuncts to our clinical practice)
26 Visit us at
Providence- OHSU Informatics Course
Providence- OHSU Course Logistics, Detailed Curriculum, Learning Objectives, and Other Information William Hersh, M.D. Department of Medical & Clinical Epidemiology Oregon Health & Science University Course
How To Be A Guinea Pig
Fusing RCTs with EHR Big Data Derek C. Angus, MD, MPH, FRCP CRISMA Center, Department of Critical Care Medicine Department of Health Policy and Management McGowan Institute for Regenerative Medicine Clinical
Implementation of the ABCDE Bundle: Results from a Real-World, Pragmatic Study Design. Andrew Masica, MD, MSCI Chief Clinical Effectiveness Officer
Implementation of the ABCDE Bundle: Results from a Real-World, Pragmatic Study Design Andrew Masica, MD, MSCI Chief Clinical Effectiveness Officer 0 Gap Between Knowledge and Delivery Translational Roadmap
Dr. Peters has declared no conflicts of interest related to the content of his presentation.
Dr. Peters has declared no conflicts of interest related to the content of his presentation. Steve G. Peters MD NAMDRC 2013 No financial conflicts No off-label usages If specific vendors are named, will
3/9/2011 ELECTRONIC HEALTH RECORDS: A NATIONAL PRIORITY. Mandate for electronic health records is tied to:
To lower health care cost, cut medical errors, And improve care, we ll computerize the nation s health records in five years, saving billions of dollars in health care costs and countless lives. ELECTRONIC
TOWARD A FRAMEWORK FOR DATA QUALITY IN ELECTRONIC HEALTH RECORD
TOWARD A FRAMEWORK FOR DATA QUALITY IN ELECTRONIC HEALTH RECORD Omar Almutiry, Gary Wills and Richard Crowder School of Electronics and Computer Science, University of Southampton, Southampton, UK. {osa1a11,gbw,rmc}@ecs.soton.ac.uk
Using Predictive Analytics to Improve Sepsis Outcomes 4/23/2014
Using Predictive Analytics to Improve Sepsis Outcomes 4/23/2014 Ryan Arnold, MD Department of Emergency Medicine and Value Institute Christiana Care Health System, Newark, DE Susan Niemeier, RN Chief Nursing
1/16/2015 HOW CLINICAL EDUCATORS CAN DISCLOSURE LEARNING OBJECTIVES MAKE MEANINGFUL USE MEANINGFUL. We have no financial disclosures
HOW CLINICAL EDUCATORS CAN MAKE MEANINGFUL USE MEANINGFUL Daryl Wieland, MD Tammy Gruenberg, MD Michelle Giannone, MD Albert Einstein College of Medicine, Bronx, NY DISCLOSURE We have no financial disclosures
Health Information Technology and the National Quality Agenda. Daphne Ayn Bascom, MD PhD Chief Clinical Systems Officer Medical Operations
Health Information Technology and the National Quality Agenda Daphne Ayn Bascom, MD PhD Chief Clinical Systems Officer Medical Operations Institute of Medicine Definition of Quality "The degree to which
An Update in Electronic Health Records
An Update in Electronic Health Records Mark Seigel, MD, FACOG Assistant Professor, Obstetrics and Gynecology, George Washington University School of Medicine Disclosure I have no financial interests or
Electronic Medical Records
Electronic Medical Records Milisa K Rizer, MD, MPH Clinical Director, Integrated Healthcare Information System Associate Professor, Clinical Family Medicine The Ohio State University Medical Center 2011
OF MEANINGFUL USE THE HIDDEN REQUIREMENTS HOSPITAL QUALITY REPORTING: Introduction. Authors: Jane Metzger, Melissa Ames and Jared Rhoads
HOSPITAL QUALITY REPORTING: THE HIDDEN REQUIREMENTS OF MEANINGFUL USE Authors: Jane Metzger, Melissa Ames and Jared Rhoads Hospitals must report on 15 required quality measures for Stage 1, using the certified
Health Management Information Systems: Clinical Decision Support Systems
Health Management Information Systems: Clinical Decision Support Systems Lecture 5 Audio Transcript Slide 1 Welcome to Health Management Information Systems, Clinical Decision Support Systems. The component,
Patient Centered Medical Homes and Meaningful EHR Use: Competing for Scarce Resources or Dynamic Synergy?
Patient Centered Medical Homes and Meaningful EHR Use: Competing for Scarce Resources or Dynamic Synergy? Jeff Hummel, MD, MPH Medical Director, Washington & Idaho Regional Extension Center March 31, 2010
Technology Mediated Translation Clinical Decision Support. Marisa L. Wilson, DNSc, MHSc, CPHIMS, RN-BC. January 23, 2015.
Technology Mediated Translation Clinical Decision Support Marisa L. Wilson, DNSc, MHSc, CPHIMS, RN-BC January 23, 2015 Background Presidents Bush, President Obama American Recovery and Reinvestment Act
Physician Motivations for Adoption of Electronic Health Records Dawn Heisey-Grove, MPH; Vaishali Patel, PhD
ONC Data Brief No. 21 December 2014 Physician Motivations for Adoption of Electronic Health Records Dawn Heisey-Grove, MPH; Vaishali Patel, PhD In 2009, Congress committed to supporting the adoption and
The HITECH Act and Meaningful Use Implications for Population and Public Health
The HITECH Act and Meaningful Use Implications for Population and Public Health Bill Brand, MPH Public Health Informatics Institute Meaningful Use for Public Health Professionals: Basic Training May 16,
Electronic Health Record Use: Health Care Providers Perception at a Community Health Center. Gina Robinson CentroMed San Antonio, TX
Electronic Health Record Use: Health Care Providers Perception at a Community Health Center Gina Robinson CentroMed San Antonio, TX Introduction The Health Information Technology for Economic and Clinical
Post-Implementation EMR Evaluation for the Beta Ambulatory Care Clinic Proposed Plan Jul 6/2012, Version 2.0
1. Purpose and Scope Post-Implementation EMR Evaluation for the Beta Ambulatory Care Clinic Proposed Plan Jul 6/2012, Version 2.0 This document describes our proposed plan to conduct a formative evaluation
Meaningful Use. Goals and Principles
Meaningful Use Goals and Principles 1 HISTORY OF MEANINGFUL USE American Recovery and Reinvestment Act, 2009 Two Programs Medicare Medicaid 3 Stages 2 ULTIMATE GOAL Enhance the quality of patient care
Meaningful Use: Driving Physicians to eprescribing/emr and Pharma Marketing Opportunities
Meaningful Use: Driving Physicians to eprescribing/emr and Pharma Marketing Opportunities Devin Paullin EVP, New Business Development Physicians Interactive Dan Pucci Director, Informatics Solutions Allscripts
Hospital Performance Management: From Strategy to Operations
Hospital Performance Management: From Strategy to Operations Every hospital wants to be on top in terms of revenue and quality of care. It is tough enough to get to the top, but tougher still to stay there.
Applied Health Informatics Through the Lens of an Integrated Care Delivery System
Applied Health Informatics Through the Lens of an Integrated Care Delivery System Andrew Masica, MD, MSCI VP, Chief Clinical Effectiveness Officer Baylor Scott & White Health [email protected]
Shared Governance Models Optimize Outcomes, Adoption and User Perception
Shared Governance Models Optimize Outcomes, Adoption and User Perception Nicole Martinez BSN, RN DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily
Improving Outcomes and Saving Lives in Real Time: How Hospitals Can Use Predictive Analytics Across the Care Continuum Essential Hospitals Engagement
Improving Outcomes and Saving Lives in Real Time: How Hospitals Can Use Predictive Analytics Across the Care Continuum Essential Hospitals Engagement Network February 18, 2015 CHAT FEATURE The chat tool
Implementing an Evidence Based Hospital Discharge Process
Implementing an Evidence Based Hospital Discharge Process Learning from the experience of Project Re-Engineered Discharge (RED) Webinar January 14, 2013 Chris Manasseh, MD Director, Boston HealthNet Inpatient
Conflict of Interest Disclosure
Leveraging Clinical Decision Support for Optimal Medication Management Anne M Bobb, BS Pharm., Director Quality Informatics Children s Memorial Hospital, Chicago IL, February 20, 2012 DISCLAIMER: The views
Health Information Technology (IT) Simplified
Health Information Technology (IT) Simplified A glossary of all things Health IT Accountable Care Organizations (ACO) - A group of health care providers who give coordinated care, chronic disease management,
Ergonomics in Healthcare Delivery
http://www2.fpm.wisc.edu/seips/ Ergonomics in Healthcare Delivery Pascale Carayon, Ph.D. Center for Quality and Productivity Improvement Department of Industrial and Systems Engineering University of Wisconsin-Madison
Nurses at the Forefront: Care Delivery and Transformation through Health IT
Nurses at the Forefront: Care Delivery and Transformation through Health IT Ann OBrien RN MSN CPHIMS National Senior Director of Clinical Informatics Kaiser Permanente Robert Wood Johnson Executive Nurse
Practice Workflow & Information Management Redesign Specialist Program Application Packet
12800 Abrams Road Dallas, Texas 75243-2199 972.238.6950 www.richlandcollege.edu/hit Health Professions Division Practice Workflow & Information Management Redesign Specialist Program Application Packet
Meaningfully Incorporating Social Determinants into EHRs. Paul Tang, MD Palo Alto Medical Foundation
Meaningfully Incorporating Social Determinants into EHRs Paul Tang, MD Palo Alto Medical Foundation Agenda The Meaningful Use context Not all data are the same The makings of good EHR data Example social
Meaningful Use: What is the Good and How Do We Leverage It?
Meaningful Use: What is the Good and How Do We Leverage It? Harris R. Stutman, MD CMIO, MemorialCare Health System Charles S. Sawyer, MD, FACP CHIO, Geisinger Health System Michael Zaroukian, MD, PhD,
HIT Workflow & Redesign Specialist: Curriculum Overview
HIT Workflow & Redesign Specialist: Curriculum Overview Component - Description Units - Description Appx. Time 1: Introduction to Health Care and Public Health in the U.S. Survey of how healthcare and
Clinical Decision Support (CDS) to improve colorectal cancer screening
Clinical Decision Support (CDS) to improve colorectal cancer screening NIH Collaboratory Grand Rounds Sept 26, 2014 Presented by: Tim Burdick MD MSc OCHIN Chief Medical Informatics Officer Adjunct Associate
Len Bowes, MD, MS, Intermountain Healthcare Medical Informatics Jan 2010. *ARRA = American Recovery and Reinvestment Act
Len Bowes, MD, MS, Intermountain Healthcare Medical Informatics Jan 2010 *ARRA = American Recovery and Reinvestment Act What are HITECH and ARRA? The Health Information Technology for Economic and Clinical
Engaging Physicians from the Inside Resident Informatics Program
Engaging Physicians from the Inside Resident Informatics Program Kevin Baldwin, MPH CPHIMS Strategic IT Engagement Manager, UCLA Health Program Administrator 4 hospitals 952 Inpatient beds ~60,000 hospital
Creating a Checklist Culture Chris George, RN MS [email protected]
Creating a Checklist Culture Chris George, RN MS [email protected] Objectives Benefits of using checklists What makes a good checklist Creating a culture that supports checklists Why do we need checklists?
Meaningful Use of EHRs:
Meaningful Use of EHRs: First Steps To Improved Patient Outcomes www.ciscohealthpath.com Jointly sponsored by Postgraduate Institute for Medicine. Learn How to Achieve Meaningful Use In Your Practice With
THE 2009 HEALTH INFORMATION TECHNOLOGY FOR ECONOMIC AND CLINICAL HEALTH ACT
July 2009 THE 2009 HEALTH INFORMATION TECHNOLOGY FOR ECONOMIC AND CLINICAL HEALTH ACT SUMMARY The Health Information Technology for Economic and Clinical Health Act (HITECH) is an important component of
Computer Provider Order Entry (CPOE) in Hospital Systems to reduce post surgical adverse outcomes. October 27, 2010
Computer Provider Order Entry (CPOE) in Hospital Systems to reduce post surgical adverse outcomes October 27, 2010 1 Christopher Jackson, DO, PhD, MBA, FACOEP Certified Physician Informaticist Residency
Toward Meaningful Use of HIT
Toward Meaningful Use of HIT Fred D Rachman, MD Health and Medicine Policy Research Group HIE Forum March 24, 2010 Why are we talking about technology? To improve the quality of the care we provide and
Inpatient EHR. Solution Snapshot. The right choice for your patients, your practitioners, and your bottom line SOLUTIONS DESIGNED TO FIT
Inpatient EHR The right choice for your patients, your practitioners, and your bottom line SOLUTIONS DESIGNED TO FIT Our customers do more than save lives. They re helping their communities to thrive.
Journal of Business & Economics Research July 2008 Volume 6, Number 7
Accounting And Economic Implications Of Healthcare Information Technology Paul J. Carruth, Southeastern Louisiana University Ann K. Carruth, Southeastern Louisiana University ABSTRACT There is a growing
How To Use An Ehr
Use of Electronic Health Records by Nurse Practitioners and Nurse Midwives Prepared for: The California Medicaid Research Institute for the California Department of Health Care Services Office of Health
TORCH Meaningful Use Assessment Program
TORCH Meaningful Use Assessment Program TORCH Meaningful Use Assessment Program Introduction & Background This is a significant and challenging time for the healthcare industry. With the unprecedented
Healthcare Terminologies and Classifications:
Healthcare Essential Keys to Interoperability Healthcare Classification: Essential Keys to Interoperability The Stakes The language of medicine and health is as complex and vast as the concepts it represents
Case Study: Using Predictive Analytics to Reduce Sepsis Mortality
Case Study: Using Predictive Analytics to Reduce Sepsis Mortality 1 Learning Objectives 1. Understand how an automated, real time IT intervention can help care teams recognize and intervene on critical,
The recently enacted Health Information Technology for Economic
Investments in Health Information Technology Driven by HITECH Act Marcy Wilder, Donna A. Boswell, and BarBara Bennett The authors review provisions of the new stimulus package that authorize billions of
Patient Management Systems. Terrence Adam, BS Pharm,, MD, PhD Assistant Professor, PCHS University of Minnesota College of Pharmacy
Patient Management Systems Terrence Adam, BS Pharm,, MD, PhD Assistant Professor, PCHS University of Minnesota College of Pharmacy Background Interests Interest in clinical informatics with training in
Introduction to Nursing Informatics & Health Information Technology for Student Nurses
Course Overview In this 8 hour course, ADN nursing students will be introduced to health information systems and informatics concepts that they will most likely experience in a clinical setting. Course
Agenda. Government s Role in Promoting EMR Technology. EMR Trends in Health Care. What We Hear as Reasons to Not Implement and EMR
Agenda A 360-Degree Approach to EMR Implementation Environmental Overview Information on the HITECH Stimulus Opportunities Hospitals, Physicians and Interoperability Preparing for an EMR Implementation
Overnight ICU Physician Coverage: Do We Need to Stay in Hospital 24-7?
Overnight ICU Physician Coverage: Do We Need to Stay in Hospital 24-7? Allan Garland, MD, MA Associate Professor of Medicine and Community Health Sciences University of Manitoba Introduction There are
Summary of the Proposed Rule for the Medicare and Medicaid Electronic Health Records (EHR) Incentive Program (Eligible Professionals only)
Summary of the Proposed Rule for the Medicare and Medicaid Electronic Health Records (EHR) Incentive Program (Eligible Professionals only) Background Enacted on February 17, 2009, the American Recovery
Custom Report Data Elements: IT Database Fields. Source: American Hospital Association IT Survey
Custom Report Data Elements: IT Database Fields Source: American Hospital Association IT Survey TABLE OF CONTENTS COMPUTERIZED SYSTEM IMPLEMENTATION... 4 Bar Coding... 4 Computerized Provider Order Entry...
How does your EHR tie into Patient Safety?
How does your EHR tie into Patient Safety? 2 nd Annual Wyoming Patient Safety Summit Casper, Wyoming November 15, 2013 David S Hanekom, M.D., F.A.C.P., C.M.P.E Chief Medical Officer MDdatacor, Inc. The