Interesting Review of Health Informatics by Institute Of Medicine

I read the summary. It is very interesting and it does make some good points.

To encourage further discuss Precious_P

What exactly did you find "interesting" and what were the points that you found "good" or what was good about the "points"?

I really liked the review - didn't get to the full book yet.

What strikes me as true is that we use our clinical systems not as we would hope - to drive better patient care - but to standardize charting and ease billing, bottom line.

We are also driven a lot by government mandates and then not given the money to implement their requirements.

Smaller facilities are locked into less-than-acceptable systems because they don't have to money to start from scratch, or to afford a better system anyway.

And meanwhile, the clinicians have been burned because if the board doesn't buy into IT expenditures one has to first prove that the hardware is inadequate by using the outmoded, inadequate stuff until it seriously impedes patient care and then and only then will upgrades be approved.

In short, the clinicians get bitten on the butt by what we promise will help them.

YMMV and IM (not so H) O.

Angela, what's your experience been with obstacles and problems? You're the only one here who's been doing it for very long and I'd love to hear your anecdotal experiences. I feel very alone in what I do, sometimes. My IT co-workers (not boss) sort of resent that I'm not more technical (as in sysadmin stuff and dropping cable) and the clinical folks view me with the stink-eye.

Thanks for asking Sue! I think you may be asking me to speak to two things" #1 the problems within the larger arena of HIT and #2 the more subtle issue of clinician vs techie. Here goes.

#1
I agree that the majority of systems are over designed or designed and implemented without a true eye to how clinicians practice or without knowledge of the process flow of a patient through the healthcare systems. Just automation, for automations sake, and not true redesign occurs too often. We then have automated the same bad processes.
What’s up with that?
The healthcare system unlike the banking and aviation systems have not utilized technology to decrease costs and improve safety ...........instead we in healthcare think if one CT scan is good then spending money for 2 is even better! We in the USA think: well if we have the technology then lets use it or too often we think that access to the very best and cutting edge is our right. No matter the waste of resources or inappropriate use. Such as spending money on giving an alcoholic a liver transplant.... but I've digressed into the social ramifications of non socialized medicine and I need to stay on point related to HIT.

Is a poorly organized and inefficient healthcare system also to blame? Yep!
Could interoperability and true systems integration have been achieved way before now by all vendors? Yep!
Could healthcare costs, duplication of services, costly redundancies, pure waste, and poor management be avoided if we mandated such changes? Yep. Do we as clinicians, payers, and healthcare organizations tell the vendors we want better systems and standardization but then in the same breath tell them "but we also want different things per specialty, healthcare organization, type of clinician, and when the moon is in the seventh house, with the second planet of Pluto rising?" Yep and yep again!

Although not true related to a balanced diet, exercise and healthy living the saying "No pain, No gain" is true in HIT.
If we want standards and interoperability we will have to let go of best of breed systems. If we want all vendor systems to be able to communicate with each other vendor's have to let go of some of their proprietary crap and realize that the buyer will purchase the best system(s) or the systems that work best for them instead of being locked into contractual deals that they stay in because it would be too costly to uninstall and re-install a different system. If we have a true EHR/EMR (that any hospital the patient goes to can access) it would (as one example) decrease maybe even eliminate 90% of duplication in cost related to lab tests alone. But maybe the providers have thought of the loss in their individual revenues and that’s why the true EHR has not happened???


#2
Perspective is an amazing thing. I don’t think there is a good clinician, professional, leader or human being who has not at some point in their career asked themselves: "And why am I doing this? For what?" "Why am I fighting so hard to get this or that initiative/project/change, etc pushed through? When those who I am doing it for don’t seem to care or want it?" Again, I'll say "Perspective" ..........

and don’t take yourself too seriously all the time! Keep your perspective and sense of humor and you may keep your sanity

Related to how one group does or does not view the value of your skill set - who cares? Don't let others distract you from doing the very best job you can.
I try to remember to treat everyone with the same respect that I want. That means I try not to lord it over clinicians that I know how to defrag a hard drive and they don’t. I also try not to embarrass technicians with the fact that they would not know the different between an 18 and a 20 gage angiocath.
In short don’t sweat the small stuff.

I don’t know all the answers and admit to being frustrated more than once in my own informatics practice with clinicians who resist change, a government that sometimes over legislates this but under mandates that; and vendors who frequently seem to purposefully frustrate efforts to improve their systems.

I do consider myself an optimist. There are a great many issues and challenges within HIT and our specialty. I do believe there are fixes and that eventually the problems will get solved if enough people continue to work at the solutions. We have spent a great deal of time talking about the "problems". The majority of us are very familiar with what the "problems" are. We need to focus on the solutions and get to work!

Just my anecdotal opinion. If I bored you to death, blame Sue................she asked

I didn't read the report -- but will be watching the discussion as a very interested "bystander" if there is such a thing. Many years ago, I focused my doctoral work on the fledgling nursing informatics field. The more I got into it, the more I saw that the "powers that be" were heading in a lot of directions that infuriated me -- and were not open to incorporating much input from those in clinical practice. So, I left the field.

The real eye-opener for me was when 1 leader in the field of nursing informatics told me that I needed to stop thinking like a nurse -- and start just doing what the computer and informatics experts told me to do!

Well, you sure didn't bore me. That was a great response, Angela. Thanks for taking the time to write it. It's good to know that what I've been observing is endemic and not just my imagination.

In the same vein as our discussion


On the subject of how can make EMR's a reality. The article quotes one of the implementers of a project in NY that was successful. “Our experience here is that it’s just hard,” Dr. Mostashari said. “It’s not impossible.”

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From CCHIT 3/3/09

NYT offers ideas on how to make EHR work
Posted: 02 Mar 2009 12:22 PM PST

An article in The New York Times over the weekend—How to Make Electronic Medical Records a Reality—discusses how recent legislation is trying to stimulate EHR adoption:
A main feature of the legislation calls for incentive payments of more than $40,000 spread over a few years for a physician who buys and uses electronic health records. But the technology is just a tool, one that needs to be used properly to improve health care.
So the legislation states that physicians will be paid only for the “meaningful use” of digital records. The government has not yet defined that term precisely. While the long-term goal is better health for patients, that can take years to measure. Consequently, many health experts predict that the meaningful use will be a requirement to collect and report measurements that can be closely correlated with improved health. Examples would be data for blood glucose, cholesterol and blood pressure levels for diabetes patients.
The article also highlights Primary Care Information Project in New York City as an example of EHR implementation done right.
To learn more, read the article in The New York Times.
http://www.nytimes.com/2009/03/01/bu...nbox.html?_r=1

The article was very interesting and really did provide some great points!