EHR

Follow-up visits conducted via a secure Web site may result in similar clinical outcomes as in-person visits among patients with acne, according to a report in the April issue of Archives of Dermatology, one of the JAMA/Archives journals.

'Ensuring timely access to high-quality care is currently a challenge for the stressed U.S. health care system. Many specialities, including internal medicine, psychiatry and dermatology, are struggling to accommodate a growing demand for appointments owing to a critical shortage of health care providers,' the authors write as background information in the article. Dermatology, in particular, faces challenges such as an increase in skin cancer and a work force that is not equally distributed geographically. 'One potential solution to these issues may be the adoption of innovative, technology-enabled models of care delivery.'

'In this trial, delivering follow-up care to subjects with mild to moderate acne via office and online visits produced equivalent clinical outcomes by several different metrics,' the authors conclude. 'These findings suggest that dermatologists obtain sufficient information from digital images and survey responses to make appropriate management decisions in the treatment of acne. In addition, this model of care delivery was popular with both physicians and patients, likely owing to the convenience and/or time savings associated with e-visits.'

Although this article discusses follow-up care for a fairly benign condition - mild to moderate acne - it highlights the growing need for, and benefits of, telemedicine.

Recent passage of the American Reinvestment and Recovery Act (ARRA) increases pressure on health care practitioners and organizations to implement currently available electronic health records (EHRs). Research and experience gained to date show that such implementation efforts are difficult, costly, time-consuming, and fraught with many unintended consequences.¹ Evaluation of these systems after implementation suggests that they do not routinely meet safety standards of other safety-critical industries.² The aggressive timeline proposed in the ARRA bill means that a large number of practitioners and health care organizations will soon be attempting a monumental feat without the time or ability to customize these systems to their local workflows.³

Pfizer announced today results of a survey the company recently sponsored that shows physicians are more likely to report side effects through an electronic health records (EHR) system, as compared to traditional paper methods. Nearly 60 percent of physicians who responded to the survey also agreed that adverse event reporting through an EHR system would improve patient care.

“Patient safety continues to be a top priority at Pfizer,” said Freda Lewis-Hall, MD, Pfizer’s chief medical officer. “This survey furthers our understanding about how we can best use electronic health records systems to collect critical information about the safe and appropriate use of our products so that we can improve patient safety.”

Of the 300 physicians surveyed, two-thirds utilized some form of an EHR system and one-third used a paper-based system. Half of all respondents and 60 percent of fully-functional EHR users reported that they would be much more likely to submit information about adverse events using an EHR system. Of those still using paper-based systems, 80 percent cited cost as a deterrent to investing in an EHR system.

Ipsos conducted the survey online among primary care physicians in the United States who were categorized as basic electronic health record users, fully functional electronic health record users or paper health record users. The research was conducted during September and October 2009.

The Department of Health and Human Services (HHS) expects to award in March $60 million to universities and research centers to support the adoption and meaningful use of health information technology (IT). The Strategic Health IT Advanced Research Projects (SHARP) program is designed to address existing barriers in the following four areas:

• Security and risk mitigation policies and the technologies deemed necessary to build and preserve the public trust as health IT systems become ubiquitous.

• Patient-centered cognitive support to harness the power of health IT in a patient-focused manner and align the technology with the day-to-day practice of medicine to support clinicians as they care for patients.

• New and improved architectures necessary to achieve electronic exchange and use of health information in a secure, private, and accurate manner.

• Strategies to enhance the use of health IT in improving the overall quality of healthcare, population health, and clinical research while protecting patient privacy.

10. Usability - products are hard to use and not well engineered for clinician workflow.

9. Politics/naysayers - every organization has a powerful clinician or administrator who is convinced that EHRs will cause harm, disruption, and budget disasters.

8. Fear of lost productivity - clinicians are concerned they will lose 25% of their productivity for 3 months after implementation. Administrators are worried that the clinicians are right.

7. Computer Illiteracy/training - many clinicians are not comfortable with technology. They are often reluctant to attend training sessions.

6. Interoperability - applications do not seamlessly exchange data for coordination of care, performance reporting, and public health.

5. Privacy - there is significant local variation in privacy policy and consent management strategies/

4. Infrastructure/IT reliability - many IT departments cannot provide reliable computing and storage support, leading to EHR downtime.

3. Vendor product selection/suitability - it's hard to know what product to choose, particularly for specialists who have unique workflow needs

2. Cost - the stimulus money does not flow until meaningful use is achieved. Who will pay in the meantime?

1. People - its's hard to get sponsorship from senior leaders, find clinician champions, and hire the trained workers to get the EHR rollout done. (this was the #1 concern by far)

Great post from Dr. Halamka; a nice succinct "cheat sheet" for the [predictable] implementation barriers.

To test the EHR-savvy of nearly 190 fourth-year medical students who haven't participated in a formal class, the school set up a mock patient encounter in the summer and fall of 2009.

In addition to grading individual students' performances, the results provide baseline data on how well students, on average, handle the EHR during a patient encounter

Not surprising conclusion considering the state of healthcare informatics education in medical, pharmacy or nursing curriculum. The study will be interesting to review once it is published in a peer-reviewed journal.