E.H.R Standards for India : GOI Report

Electronic health records are a summary of the various electronic medical records that get generated during any clinical encounter. Without standards, a lifelong summary is not possible as different records from different sources spread across ~80+ years will potentially need to be brought into one summary. To achieve this, a set of pre-defined standards for information exchange that includes images, clinical codes and a minimum data set is imperative.

Foreword to ‘ E.H.R Standards for India ’ by the GOI.

The Government of India, as it goes for the unveiling of National Health Portal, comes out with a definitive guidelines for E.H.R standards in India. The document takes a look at E.H.R standards to be followed throughout different medical provider institutions in India, so that medical data becomes portable and easily transferable. Its amazing to see how many ehealth companies have been stumped because of lack of such a document earlier. This might be good news for a number of companies which foolishly wait for standards to be finalized, instead of simply building the most Flexible, Secure, Doctor & Patient-friendly E.H.R they can.

More importantly , It takes a look at Data ownership.

It says “The health data is owned by the patient while the actual records are owned by the care providers who act as the custodians of the data. Adequate safeguards to ensure data privacy and security must strictly be adhered to at all times. Patients must have the privilege to verify the accuracy of their health data and gain access whenever they wish to do so.

Thankfully, Patients have earned their spot in our policy making. We know that products which do not have the patient interactions in mind will just not succeed. Now that we have a roadmap ahead, It’s a race to the finish for the nascent ehealth industry in our country.

You can download a copy of the document here.

Top 10 Health Technology Hazards For 2013

The evolution of healthcare information technology systems such as electronic health records (EHRs) has definitely helped improve quality and efficiency in healthcare. At the same time, there’s a growing level of complexity and opportunity for error. With increasing use of technology in healthcare, healthcare providers need to be wary of the associated risks with its use.

Now in its sixth year, ECRI Institute publishes an annual list of top hazards of technology in healthcare. The Top 10 Health Technology Hazards list is updated each year based upon the prevalence and severity of incidents reported to ECRI Institute by healthcare facilities nationwide; information found in the Institute’s medical device problem reporting databases; and the judgment, analysis, and expertise of the organization’s multidisciplinary staff. Here are the group’s estimation of the most probable hazards which might crop up in 2013 because of use of technology in healthcare.

1.  Alarm hazards

2.  Medication administration errors using infusion pump

3.  Unnecessary radiation exposures and radiation burns during diagnostic radiology procedures

4.  Patient/data mismatches in EHRs and other health IT (HIT) systems

5.  Interoperability failures with medical devices and health IT systems

6. Air embolism hazards

7. Inattention to the needs of pediatric patients when using “adult” technologies

8. Inadequate reprocessing of endoscopic devices and surgical instruments

9. Caregiver distractions from smartphones and other mobile devices

10. Surgical fires

You can download the original report by registering here.

Here are the lists of Top hazards for 2010. for 2011 and for 2012

Photo credit: @Jacobsons on Flickr (CC BY-NC-SA 2.0)

Why Doctors Love To Hate Electronic Health Records

Doctors love to hate electronic health records. Over the years, many surveys have tried to pinpoint the physicians who are more likely to be satisfied by their EHRs. Surveys have found that those in primary care or Internal medicine are generally more satisfied with their EHRs than their colleagues in Oncology or Ophthalmology. Also, solo physicians were the most satisfied and that satisfaction decreased as the practice size grew to 50 physicians. Physicians in 100% productivity-based practices were more satisfied than salaried physicians. 

So what are the top reasons doctors love electronic health records?

1) An electronic record forces documentation of many steps which might be otherwise missed. More thorough documentation of clinical visits leads to less leakage of revenue.

2) In medicine, patient data is the source of all decisions. EHRs make data retrieval easier and thus quality of patient service is enhanced

3) Doctors are no longer tied to their desks and can work from anywhere anytime.

As many doctors will be quick to point out, EHR adoption also comes with a lot of pain-points.

1) There is no guaranteed improvement in productivity. In fact, there could be a loss of productivity in the short term.

2) Some EHRs are badly designed and require too many steps/ clicks for relatively simple documentation procedure, for eg. CPOE.. Sometimes, important data maybe difficult to find.

3) The omnipresent computer monitor and keyboard is not a very likeable third party in the examination room. It is an obstacle to one-to-one relationship building between doctors and patients.

Nevertheless, electronic health records are used widely and are here to stay. Insights into the reasons some EHRs are preferred over others can be an important advantage for many companies in this multi-billion-dollar industry.
You can read the original AMA article here.

Also see:
-How Poor Health IT Implementation Can Hurt Patients : Electronic health records can improve care, but doctors should also be mindful of some health IT obstacles that can be detrimental to patients.
-How To Ease EHR Frustration : EHRs can slow physicians' practices to a crawl, but evidence suggests they ultimately pay off.

Doing More With EMRs: What Are The Top Reasons For Failure?

Electronic Medical Records hold a lot of promise. When used well, EMRs decrease drug errors, streamline work flow, assist in clinical decisions and allow efficient accounting. At the same time, EMRs chosen without proper thought and assessment can cause long term pains. The really restrictive EMRs won't even let you shift medical data elsewhere and healthcare providers maybe stuck with outdated EMRs soon after buying them.

EMR failures are most often a cause of one or more of the following four reasons

• Technical EMR implementation failures, because of issues with hardware/ software combination or wireless connectivity issues;
• Financial failures, where the expected EMR ROI wasn’t realized, or the costs were significantly more than expected;
• Software incompatibility issues, where the EMR system didn’t interface with an existing medical practice management system; and
• People-related issues, where some physicians or staff members avoid training or simply refuse to use the EMR system. 

Making an EMR work for a healthcare provider needs work before, during and after installation of an EMR system. When choosing an EMR system, Ignore the bells and whistles and Look at the nuts and bolts.

Demystifying HL7

HL7 was founded in 1987 to produce a standard for hospital information systems.It was accredited in 1994 by the American National Standards Institute (ANSI). HL7 standards specify a number of flexible standards, guidelines, and methodologies by which various healthcare systems can communicate with each other. Such guidelines or data standards are a set of rules that allow information to be shared and processed in a uniform and consistent manner. These data standards are meant to allow healthcare organizations to easily share clinical information.

This is a simple explanation using fun animation explaining how HL7 works.

Related article

• New HL7 Standard for EHRs and Clinical Research (tissuepathology.typepad.com)