February 3, 2014

Can The Medical Community Re-engineer Health Care?

Health care technology of today lacks common sense. The needed ability for different pieces of equipment to work and communicate with other equipment is absent and manufacturers will not work with other manufacturers. This proprietary attitude is doing harm to patients. This blog by Peter Pronovost of the Armstrong Institute division of Johns Hopkins in Baltimore covers what is starting to happen at a few hospitals across the nation.

Changing this will require unprecedented collaboration between health care’s many stakeholders. Will this work to end the problems presently built into the medical equipment? Only time will tell if the hospitals will work together to make this happen. Johns Hopkins has a project in place at the Johns Hopkins Baltimore hospital. The project, 'Project Emerge' is supported by a 9.4 million grant from the Gordon and Betty Moore Foundation.

Combining the wisdom of engineers, nurses, doctors, bioethicists, and patients and family members, or 18 disciplines from across Johns Hopkins University to design safer care in intensive care units (ICUs). This is desperately needed because patients treated in ICUs often need up to 200 therapies a day, and there is not a system that has automated this list of therapies. It is expected that by integrating medical devices that this would eliminate human error and save $8 billion annually.

For this to become a reality, device manufacturers must be willing to their systems and share their data. Providers need to say they will no longer purchase equipment from vendors that won't agree to that standard and policy makers need to revise pre-EHR regulations to allow electronic double checks.

To accomplish this, hospital systems will need to work together to help integrate health care information technology systems to optimize them for helping health care providers to work more efficiently. This could solve healthcare's cost problem once we are past the cost of integrating all the pieces. This would reduce waste, but also reduce preventable patient harm. We could then improve patient outcome and experiences.

Now for a piece of news on the diabetes front and what a help this will be for those using a certain insulin pump. Finally, some integration in diabetes equipment and this is welcome news. You can read about it here on the DiabetesMine blog.

Now for the last piece of interesting information on electronic health records and this is alarming. Michael Chen, MD is exposing a giant flaw in many EHRs. He is a practicing physician and well as a software coder. Dr. Chen declares that health care IT is still in its infancy despite the number of years computers have been around and the legislation behind the use of computers in healthcare. He is concerned about the poor user interfaces that affect not just workflow and user happiness, but patient safety.

One patient safety design element he points out in the EHR he is working with and can greatly affect patient safety is the medication list. Dr. Chen says that this on one problem most physicians may not be able to identify until safety problems become known. He states that as a physician, you would assume the current medication list is current and up to date. He continues that with the EHR system he is using, this is not the case and medication lists are often not current because the EHR automatically removes a medication from the list when it is determined to be expired.

Patient safety is therefore compromised because not all patients take their medications regularly and no physician assumes this to be true. Programmers failed to take this into account and therefore the EHR makes an unverified assumption. Also troublesome is treatments sometimes are to be taken only as needed. The EHR cannot even account for this variance.

I urge everyone to read his blog. Then always keep your own medication list up to date and if when you are allowed a patient portal to the EHR, check your medication list. I have found several mistakes on mine and I am having trouble getting corrections done by the people that work in the doctor's office. So far, they make one correction and another error shows up. This is why when I was admitted to the hospital, a couple of my medications were not given to me. If I had not taken my own medications, I would have missed taking two of them, plus the supplements.

So do not rely on the medication list in your EHR being correct at anytime.

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