Perspectives on the Acute Care Continuum

The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions. 

A Plug for EMR Standardization

9/10/2012 5:27:47 PM | 0 comments

The potential is almost endless right now for data collection and aggregation to push efficiency and cost savings forward across the Acute Care Continuum.  The process of analyzing large data sets has reached buzzword status with the term “big data”, and the McKinsey Global Institute (MGI) recently listed healthcare as one of the five domains they studied when calling big data the “next frontier for innovation.”  MGI estimates the sector could create $300 billion in savings per year. Dr. Nigram Shah of Stanford agrees with this, arguing, “biomedical informatics stands ready to revolutionize human health and healthcare using large-scale measurements on a large number of individuals.”

With such promise for the future, the state of data collection today could be at a similar point in medicine as when electricity was first entering the mainstream; and one means to harness this power is through Electronic Medical Records (EMR).  Yet a lack of standardization is preventing the type of data enlightenment that could be taking place.

When electricity was introduced to households in the late 19th century there were different outlets for different appliances. The maker of an appliance dictated what kind of electrical outlet you had to have in your home. You couldn’t plug a lamp into just any socket and expect to get electricity out. This new technology was in its infancy, with one-off appliances finding new applications regularly.

Today, there is exponentially more healthcare data available and it’s more accessible than ever, thanks to electronic data collection, new kinds of imaging and testing, and electronic health records. There are opportunities to revolutionize treatments and outcomes with better data analysis, and also to lower costs by making treatments more efficient, aligning incentives and outcomes, and identifying operational inefficiencies.

EMR is the gateway to accessing and utilizing this data. Dr. Mike Aratow describes some of the usability challenges of EMR systems, showing how challenging it can be to do conscientious documentation with various EMR systems.

I work in healthcare data analysis, and when I ask an emergency department why patient wait times to see a provider have doubled since last month, 4 times out of 5 the answer is, “Implementation of a new EMR system.”  Inconsistency in usability is a huge pain point for physicians, and I often wonder why some of the best minds of my generation are currently employed by Facebook studying ad placement theory rather than working toward improved usability for EMR systems.

As part of my graduate thesis in 2008 I interviewed doctors about information management and at one public hospital they estimated that they had access to patient records at only about 50% of visits. For the other half of visits, doctors had to trust patient self-reports of histories and medications. Their charts were paper based, often photocopied and just as often unavailable during the patient visit. Clinical notes were also done on paper, unless a doctor preferred to walk over to telephones to dictate notes to medical transcriptionists. As a sign of how little attention was being paid to providing cutting edge technology in the hospital setting, as a graduate student I had access to many technologies unavailable to the physicians in their hospital environment; speech recognition, collaborative tools on the internet, and social media.

Now, with the greater reporting requirements for CMS, not only must doctors and staff use the EMR correctly for data collection, but hospital IT staff have the immensely challenging task of extracting it for reporting purposes. Getting data out generally means writing custom reports that are as useful to other hospitals as a lamp with its own custom-shaped plug is useful for lighting my home.

Electronic health care usability and data need to evolve standards that are adopted across the healthcare field, because having to build a different plug for every outlet just keeps us in the dark.

Topics: Health IT

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