Monthly Archives: December 2010

EMRs as Part of Larger Networks

Electronic medical records provide an alternative to paper based records. They are also a source of information that can be used as part of other processes to address a wide range of healthcare issues. Here’s one example:

Congress has passed a bill requiring food processors to implement systems to track cases of food that may be related to outbreaks of food-borne illness.

An estimated 76 million people contract food-borne illnesses in the U.S. each year, with 325,000 hospitalizations and 5,000 deaths, according to the Centers for Disease Control and Prevention in Atlanta. Those illnesses cost the U.S. economy $152 billion a year in health care and related expenses. Rapid identification of the source of these illnesses and their removal from the market is critical.

Under the required tracking system, farmers would scan individual cases of produce, keeping records of where they are shipped. If a recall is ordered by the FDA, the records would be quickly disseminated to trace the current location of the recalled produce.

Once specific cases have been identified as carrying a food-borne illness, the new system will allow those cases to be removed from the market; however this is only part of a complete system. How can the illness be linked to specific cases of food? Here’s where an EMR system can help.

Most EMR systems provide for reporting of food-borne illnesses. By adding a few additional elements of information, the search for the source can be narrowed very quickly. When a doctor enters a diagnosis of food-borne illness, the system can ask for the type of food that is suspect, i.e., eggs, fish, spinach, etc., and the name of the market where the suspected food was purchased. The EMR can track doctors’ reports and when a target number of similar reports is reached an analysis can be launched. A single answer will not be helpful, but if the answers from several cases list the same food and the same market or chain, that provides a place to start. Appropriate information can be forwarded to a public agency.

Samples can be acquired, tests run, and the investigation focused on just a few likely sources. Once a case of food carrying an illness is found, the food processors’ system can be used to find all of the cases from a specific producer and they can be remove from the market.

There is one other piece to the complete solution and that is rapid access to a large enough number of records to find what may be an isolated set of incidents. There are a number of organizations including the VA, Kaiser, and vendors of hospital systems that have large databases and could report to public health agencies or the FDA. There are also physician office systems like Practice Fusion that are database driven and can quickly draw information from more than five million patient records today.

The tracking process from identification of a problem to a solution would look like this:

A Food Illness Tracking Process

This provides an illustration of the way an EMR can also be linked to other tracking systems to identify and facilitate the search for health issues such as some common types of sports injuries or automobile accident injuries. EMRs are clearly more than just systems to replace doctors’ paper records.

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EMRs: More, Better and Quicker Data

Electronic medical records provide value at several levels. The most basic level is a specific doctor/patient relationship. Above that is care by a doctor team and a patient dealing with a complex medical issue such as cancer. Above that is a database derived from those records from multiple doctors and teams.

Large databases already exist. The Veterans Administration has one and so does Kaiser. Just three vendors—Meditech, McKesson, and Cerner—serve more than half of the acute care hospitals that have vendor systems. Practice Fusion is the dominant service in doctors’ offices with more than five million patient records.

We are already beginning to see more and better data quicker.

A large database—more data–has a number of advantages. First, you can look at issues that affect only a very small percent of the total population and still have enough cases to draw reasonable conclusions. Second, you can define “control groups” with very similar characteristics who are not affected by whatever you are studying so you can begin to look for potential causes.

Data collected by professionally trained doctors and nurses in the normal course of their medical practice using structured formats is more reliable and easier to analyze—better data–than most of today’s studies that rely on interviews and limited records. Practice-derived data will be adequate for some studies and will provide the starting point for others. One possibility is to use practice data to find patients of interest and then work with them and their doctors to obtain additional information. The Web site PatientsLikeMe.com has already demonstrated the willingness of people to share treatment and symptom information when they see value to themselves and others.

The processes of most of today’s research require a significant period of time between data collection and publication. Large databases support near real-time analysis of data and reporting—better data quicker. Two illustrations are provided by Practice Fusion’s response to the N1H1 flu using the guidelines published by the CDC and their posting of data on Microsoft’s Azure MarketPlace.

What can happen if we get better data quicker? Here is some of what we can expect:

  • Widespread use of standardized quantifiable measures of service, effectiveness and safety; healthcare is not totally quantifiable, but much of it is and the quantifiable part can provide guidance about what works best under what circumstances.
  • Identification of significant risks and steps to reduce them such as the risks associated with center line catheter infection.
  • New ways to identify, manage, and respond to the potential risks associated with new medications and new uses for existing medications.
  • Significant impacts on medical litigation including reductions in the actual harm done to patients with subsequent reductions in compensatory damages plus better standards of care and records to reduce, and in some cases eliminate, punitive damages.

More and better data quicker from EHRs will be one of the major medical breakthroughs in the next few years.

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