clinical decision support
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Bingo Medicine: Are EHRs Oppressive Straightjackets?
For several decades, software builders have tried to help doctors practice medicine more efficiently and more effectively. As is often the case with good intentions, the results turned out to be a mixed bag of goods, with paternalistic overtones from the helpers and mostly resentment and frustration from those supposedly being helped. Whether we want to admit it or not, the facts of the matter are that health IT and EHRs in particular have turned from humble tools of the trade to oppressive straightjackets for the practice of medicine. Somewhere along the way, the roles were reversed, and clinicians of all stripes are increasingly becoming the tools used by technology to practice medicine.
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EHRs, Clinical Decision Support Top 2017 Patient Safety Hazard List
Information management errors in electronic health records, incorrect use of clinical decision support, and poor prescribing habits are among the most dangerous health IT hazards for 2017, according to ECRI Institute’s annual patient safety list. The repeat offenders are joined by a number of workflow and process shortfalls that can leave hospitalized patients without sufficient monitoring, lead to costly and deadly hospital-acquired infections, and open up serious behavioral health risks...
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Halamka on MU3 Regs: The Good, The Bad, and the Ugly
On Friday March 20, CMS released the Electronic Health Record Incentive Program-Stage 3 and ONC released the 2015 Edition Health Information Technology (Health IT) Certification Criteria, 2015 Edition Base Electronic Health Record (EHR) Definition, and ONC Health IT Certification Program Modifications. Perhaps the most important statement in the entire 700+ pages is the following from the CMS rule: "Stage 3 of meaningful use is expected to be the final stage and would incorporate portions of the prior stages into its requirements."
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Halamka Says We Can and Must Improve Healthcare Management
As a physician and CIO, I’m quick to spot inefficiencies in healthcare workflow. More importantly, as the care navigator for my family, I have extensive firsthand experience with patient facing processes. My wife’s cancer treatment, my father’s end of life care, and my own recent primary hypertension diagnosis taught me how we can do better. Last week, when my wife received a rejection in coverage letter from Harvard Pilgrim/Caremark, it highlighted the imperative we have to improve care management workflow in the US. Since completing her estrogen positive, progesterone positive, HER2 negative breast cancer treatment in 2012 (chemotherapy, surgery, radiation), she’s been maintained on depot lupron and tamoxifen to suppress estrogen...
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HHS Releases Landmark Report: Reforming America's Healthcare System
On December 3, 2018, the Department of Health and Human Services (HHS) released an extensive, 120-page report on the administration's proposals to reform the healthcare system. The report, titled Reforming America's Healthcare System Through Choice and Competition, is divided into four major sections. The report that government policy of the last few years has suppressed competition, increased prices for healthcare, and limited choices for consumers. Though rich in detail as it tries to prove each of these points, the more than fifty recommendations are often broad and aspirational rather than practical. Since I am not a health economist, I will leave the market issues to others to discuss (many of the ideas in this report have been vetted and discussed by others previously). But there are two sections of the report which make direct mention of Health IT.
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New To-Do Lists Loom For 'Post-EHR Era'
As the electronic health record becomes "just another app," more and more providers are setting their sights on an array of complex future needs. IDC Health Insights' latest report sees big changes coming for care delivery in 2014 and beyond. Read More »
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Open ImmuCast: An 'Open Source' Immunization Forecasting Web Service
STC is thrilled to introduce Open ImmuCast™, a free and open source immunization forecasting web service now available to public health entities in the U.S. STC’s over twenty years of experience in developing immunization evaluation and forecasting solutions and the implementation success of the forecasting algorithm combine to make Open ImmuCast™ a reliable and proven product. Read More »
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Open Source EHR Generator Delivers Healthcare Big Data with FHIR
Healthcare data analysts frustrated by the lack of access to large volumes of clean, trusted, and complete patient data can now take advantage of an open source EHR data generator platform called Synthea. One million synthetic patient records are currently available within the free online system, which uses HL7 FHIR to allow access to standardized datasets that mimic real electronic health records...
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openEHR: A Game Changer Comes of Age
I’ve been watching openEHR over more than fifteen years and have always been impressed by its potential to enable us to do things differently, but it’s been a slow burn, with limited take up, particularly in the United Kingdom (UK) where it was invented. However, recent developments mean that I think this is about to change and that openEHR is going to take off in a big way which is going to revolutionize how we think about and do digital health and increase the speed at which we can do it by at least two orders of magnitude. Why do I say this and what evidence is there to support my assertion?
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OpenEMR Community Responds to HRSA Call for Advanced EHR Solutions for Community Health Centers
The Health Resources and Services Administration (HRSA) is taking major steps to help Community Health Centers across the US tackle the devastating opioid epidemic by providing funding for substance abuse services and modern EHRs. OpenEMR, a modern, customizable, open-source and ONC Certified EHR is the best solution for high impact and cost-effective information technology solutions for Community Health Centers
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Scenarios for Health Care Reform (Part 1 of 2)
All reformers in health care know what the field needs to do; I laid out four years ago the consensus about patient-supplied data, widespread analytics, mHealth, and transparency. Our frustration comes in when trying to crack the current hide-bound system open and create change. Recent interventions by US Republicans to repeal the Affordable Care Act, whatever their effects on costs and insurance coverage, offer no promise to affect workflows or treatment. So this article suggests three potential scenarios where reform could succeed, along with a vision of what will happen if none of them take hold...
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The EHR Debacle: Has Organized Medicine Failed Us?
By now, it should be no secret that physicians in the United States, although largely receptive to the idea of electronic health records (EHRs), are widely dissatisfied with the current state of the art, and with the way that EHR adoption is being implemented.[1] Indeed, Congress[2] has shown continuing – but sometimes seemingly perfunctory – interest in the concerns of physicians and other health care providers, and I am at this point pessimistic about seeing any results of its efforts in the near future unless a more fundamental change is made in our approach. As Einstein noted, “We cannot solve our problems with the same thinking that created them.”
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The Next Generation of EHRs Will Be Fundamentally Different
Electronic Health Records (EHRs) have come a long way. Over 80 percent of physicians use them in their offices, and nearly all hospitals have implemented EHRs as well. Spurred by the HITECH portion of the 2009 Recovery act, Meaningful Use has put money on the table for physicians and hospitals to adopt and use EHRs. It also defined what kinds of features an EHR must have in order to be Certified. Legacy systems took on these new requirements by adding to their offerings (sometimes referred to as “bolt-on solutions”)...
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The ONC 10 Year Vision
On June 5th 2014, ONC released “Connecting Health and Care for the Nation: a 10-Year Vision to Achieve an Interoperable Health IT Infrastructure." The plan is divided in 3 year goals, 6 year goals, and 10 year goals. Five specific tactics support the strategies. Below is a summary of the report and a few comments from my Massachusetts experience that support the reasonableness of the ONC goals.
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