Archive November 2009

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A Personal Experience with Electronic Health Records

As I lay on a gurney in the recovery area, I heard a nurse say “I have to call the doctor, I can’t read his handwriting.” It took me a few scary seconds to realize she was talking about the doctor of the patient in the bed next to me.
 
When my uncle’s primary care physician returned from vacation,
he said that my uncle’s health records had information that
would have provided the other doctor with information
that would have made the tests unnecessary.
 
I was recovering from my first cataract surgery at the Kaiser Permanente Hospital, located east of Los Angeles. I had the distinction of being a patient in a hospital that had recently implemented electronic health records while employed as a contractor training Kaiser health care professionals at other hospitals on how to use that electronic health record system.
 
During a four year period, I had three cataract surgeries at two locations, along with the accompanying exams, follow-ups, and visits to pharmacies for prescriptions. The EHR status of the various health care facilities I utilized ran the gamut from completely wired through my having to hand-carry a copy of my records so an ophthalmologist would get them in time for an exam.
 
As a patient, let me simply state that electronic health records work! I quickly became spoiled and would be frustrated when a facility wasn’t “wired” with access to my records. It annoyed me to have to undergo an examination because the facility or the doctor didn’t have my records or the results of exams done at other facilities within the Kaiser system. I didn’t like having to drop off a prescription at an un-wired pharmacy, especially when I wasn’t feeling well, and would have to return to pick-up the medication some time later.
 
Coincidentally, a month after my second cataract surgery, my uncle died. While at his funeral, I talked with his daughters about his health care. They told me that a few weeks before my uncle died, he had some health issues, but his primary care physician was on vacation. The medical facilities involved all used paper health records. The replacement doctor submitted my uncle to a series of painful, invasive tests that were inconclusive. When my uncle’s primary care physician returned from vacation, he said that my uncle’s health records had information that would have provided the other doctor with information that would have made the tests unnecessary. Unfortunately, the replacement doctor did not have access to all my uncle’s paper health records.
 
While writing this article, I mentioned my topic to a colleague. She said a recent scheduled medical procedure was postponed for two days because her paper health records couldn’t be found.
 
As a training consultant with more than three decades of experience, I have a pragmatic view of EHRs. They require the right software installed with the right training given to the right people at the right time.
 
Thomas Lenzo is a Pasadena, California based consultant with more than 35 years experience specializing in corporate training, technology, and security. He is active in ASTD-LA and LA-ISPI. Tom is a member of the FBI's InfraGard program and a volunteer identity theft investigator with the Pasadena Police Department. He has written for and spoken to local, national and international audiences. He can be reached at tlenzo@att.net .

HIT and its Impact on Workforce Development

This evening I am in a writing mood and just couldn’t resist commenting on their post. One of the things a blog does is allow me to post my thoughts where friends and colleagues will see them rather than scattering them on fence posts, at the base of trees, and fireplugs around the neighborhood. Comments that would have been scattered at the end of other peoples’ posts just a year ago now go here on my blog.

The three authors of part one, Katz, Saran, and Wool have done a nice job of capturing the current uncertainty surrounding EMRs and the much broader topic of healthcare information technology. Today’s market is badly fractured and still poorly defined. Having said that, I thought it would be fun to take a stand today and look back next week or two years from now and just see how much progress we have made and the direction we have taken.
For what it is worth, my best estimate is that connectivity will be via the Internet with significantly more security at all levels. The primary new employment market will probably be security because is it so critical and the threats will shift as the defenses improve. Block the bad guys here and they will move over there and we have to develop new blocking mechanisms. Then they move again. Security is always more of a process than a project.

Data will be stored using existing technology, both software such as SQL and evolving storage media including virtualized systems and clouds. More people will be needed but the skills will be extension of current skills. At lot of today’s designers, programmers, data base administrators, etc., will use the skills they have to move up. There will probably be a big market back-filling jobs in other industries were incumbents have left to go into healthcare. These will be real jobs, just not in healthcare and they may not qualify for government assistance.

Data acquisition – how the data is captured – will be the place where we see the greatest change. The work-load impact of capturing the information is one of the biggest complaints about most EMRs. There will be new technologies and significant improvement in existing data acquisition technologies. And perhaps equally important, larger markets for these new and improved technologies will bring down costs. Almost all of this will happen in industries outside of healthcare. Healthcare will be buyers, not participants.

There appear to be huge training needs to help almost everyone involved in healthcare learn to use the new tools. Fortunately there a lot of people who are already familiar with computers, office applications, and the Internet. We are not starting from square one. Flip side, most of them know very little about security, the place where I began these comments.

Bill Crounse, MD,  Microsoft’s worldwide health senior director addressed this broader training need in a blog post dated October 7, 2009. “Dr. David Blumenthal (National Coordinator for Health Information Technology) has announced a ‘workforce training initiative’ to educate more health information management professionals with expertise in electronic health records and related technologies.  He says at least 50,000 new jobs are needed in the field.  I would add, based on what I’ve experienced, that we will also need training for perhaps ten or twenty times that number of people; i.e. most of the physicians, nurses and other clinicians who are currently practicing in offices, clinics and hospitals all over America.

“It’s not that these folks have their heads in the sand. Most of them are working so hard day to day in patient care, trying to stay afloat and keep their practices from going under, that they literally don’t have time to come up for air.  So what happens when we expect them to use all of this technology and also give 45 million more people access to their services?  That is going to call for one hell of a training program!
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Hal is a management consultant with business process improvement experience in a number of industries including health care. From March 2001 to July 2003 he was the publisher of the HIPAA Implementation Newsletter
 
·         My Recent Blog posts
 
·         Useful links
Summary of HITECH act by House Ways and Means Committee
American Recovery and Reinvestment Act of 2009 HITECH Act pages 112 through 165 Large: 1.08 MB
Meaningful Use:
- PowerPoint - Matrix - Preamble
- Interoperabilty Capabilities
EMR+ Glossary