Government mandate on the use of exchange data

One of the main reasons the adoption of standards has been slow and uneven is due to the fact that Vendors don’t see much in return on investment (ROI). Majority of the Vendors are in the business of health information technology system to maximize profit and therefore see the adoption of standards for data exchange as weakening their competitive edge. I believe that government intervention in the use of exchange standards is what will drag the industry to accelerate and even the adoption.

Looking at the pharmaceutical companies and the adoption of safety standards, this would not have been possible without the “Big brother” – Food and Drug Administration (FDA). Even though some of the standards developed so far have been by Ad Hoc, De Facto and Consensus, but the wide use or increase in usage has been fueled by the government. Example: Centers for Medicare and Medicaid on e-prescribing, Healthcare Information Technology Standard Panel established by the Office of the National Coordinator for the Health Information Technology which is an arm of the government.

The fact is that it has been recognized that adoption will be delayed without the active involvement of the government. Within the last few years, the government has been playing a bigger role in the establishing of standards – HIPAA, Nationwide Health Information Network and the likes and Vendors who want to remain relevant in the market have become reluctant participants.

Government mandates on standards to facilitate adoption will be unavoidable like the involvement of FDA with pharmaceutical companies on safety standards. FDA now requires some smart phones with clinical applications to go through them for review and approval within certain standards before it goes to circulation as they now consider them to be medical device. Again the concern here is safety for the population and the government involvement will establish standard for wide adoption.

Health Information Exchange

As a doctor in solo practice, considering the benefit of the Regional Health Information Exchange (HIE) – reducing health care cost, improving quality of patient care and saving time. I will be more incline to hook up to the HIE if funding is easily available. Since the benefits are well documented, my goal will be to pursue the meaningful use funding and if able to secure that money, the transition will be smooth. If not, I will still attempt to connect through personal funding knowing that successful implementation will Improve quality of my practice, save time spent on seeing patients and I may be able to reduce my administrative cost.

Achieving these will enable me attract more  patients as the quality of my practice will be an advertisement to increase my patients volume while saving time will help my patients flow management and savings in administrative cost will increase my income. This will free up money for things like equipment or practice expansion. It is clear that the benefits in connecting to the HIE outweigh the risk. Therefore, I will pursue public or private funding to be connected.

Knowledge at the point of care

The verse amount of information in circulation has dwarfed the human mind in the acquisition of knowledge to effectively deliver care at the point of service. I support the use of clinical decision support systems to assist clinicians in delivering knowledge in a convenient way.

The use of portable devices like smart phones, I Pad and mounted units in patients rooms that are linked with the organization EMR. These convenient or portable products could be set up to alert clinicians, look up drugs information, assist with treatment critical pathways, test inputs and results look up, reminders and currently available information on best practices.

Dr. Yellowlees in his lecture talks about the “Principle of Complementarity”. Computer does best what human do poorly and Human does best what computer do poorly. Clinicians with the creative , analytical mind can supplement their knowledge with the remembering and retaining skill of the computer system.

The knowledge at the point of care for the clinicians will be enhanced if the computer products has features for things like drug look up, alerts, clinical algorithms, monitoring applications that can interface with the organization EMR and portable and convenient enough for the clinician to use at the point of care.

Epic-Care EMR

After reviewing the discussed lesson and checking other systems on-line, I decided that Epic-Care EMR will be the right system for the Blue Sky Clinic. Epic-Care EMR is a commercial off the shelf system (COTS) that can be configured to meet the Blue Sky Clinic information systems need.

Blue Sky Clinic is a small practice management group with limited funds and depends heavily on government reimbursement (Medicare/Medicaid) for the care it provide to patients. The clinic in it requirements is looking for a system that can qualify for government aid by complying with certification commission for health information technology (CCHT) requirements. This primary care focused clinic has a large geriatrics patients and practice personalized care in the management of chronic diseases.

Epic-Care EMR is a perfect system for the Blue Sky Clinic based on my finding of the functionality and the software architecture. The system is rated # 1 in its category by the KLAS Enterprises and has been for the last 10 years straight. It is stated that the system makes physicians more productive by simplifying the important facing elements of care delivery. In this case, it is capable of improving services by enhancing physician’s performance, providing more information to better trend care and fight competition. It has the potentials to reduce the cost of operations.

Epic-Care EMR is design to be a physician friendly system and it is used by providers of more than 100 specialties. It has prebuilt models that can be configured to meet specific work flow requirements. This will be of great benefit to the Blue Sky Clinic operational feasibility since it will require minimal support, encourage workflow reduction, ease the training of users and reduce adverse effect of care delivery.

This system has wide range of users and has been able to build on the content from successful customers including decision support, order sets, reports and documentation tools. If Blue Sky Clinic adopts this system, it will be capable of resulting in faster path to effective chronic care management and measurable quality gains. It will also aid the clinic better manage chronic diseases in personalized mode.

This system also meets the technical feasibility requirements of the Blue Sky Clinic in the sense that it has a record of brining physicians up the speed on time, on budget and with high performance tools – from orders and results to integrated voice recognition and other documentation shortcuts to meet the meaningful use. The system is compliant and has been certified by the certification commission for health information technology (CCHIT). It should be noted that this was one of the requirements for the Blue Sky Clinic.

Since the system is designed to have a single shared record, community physicians and the patients will be able to share record with Blue Sky Clinic at a reduced cost. It will also enable the continuity of care, enhanced quality of care and contributes to safer care because of the completeness of records. The system will be economically feasible because of the obvious tangible and intangible benefits. It brings IT staff and the users closer and also has the potential to reduce the cost of hardware and other equipments.

This system will aid Blue Sky Clinic in providing a framework for interoperability where, when the patients goes between health organizations, the physicians providing care will be able to view all of patient information. The design of the Epic-Care EMR makes it possible to interface with other Epic systems or non Epic system EMR that complies with industry standards.

Clinical Decision Support System (CDS) versus the Art of Medicine

The design and implementation of clinical decision support systems is not intended to take the place of human decision making. The intent is to complement the human decision making process. I believe that is called the principle of complementarity. Computers do well what humans do poorly. Computers are good at remembering and humans are good at analysis.

 CDS is design to combine patient data with knowledge based on certain rules to produce patient specific options or recommendations for diagnosis and treatment.

Human beings by composition are analytical and judgmental. These are values that are developed over time through upbringing, training, and life journey experiences which collectively transform into what we can call wisdom.  

CDS is cut and dry – things are either white or black and it lacks the ability to read between the lines. It is unable to take the individuality of a human into consideration. On the other hand, humans are able to come to a decision by evaluating factors as in the individuality of the patients drawn from the wisdom acquired over the years.

Does using CDS eliminate the “Art of Medicine”?

I consider the art of medicine as the human factor in the provision of care. If this explanation is accepted, I will conclude that at the current state of CDS development, it does eliminate the art of medicine because of the impersonal nature of the machine. It lacks empathy and cannot share with a patient any similar observation or personal experience close to what the patient may be going through.

The advances in machine learning as we fast forward into the future will create the ability of new generation CDS to acquire the skill set to practice the art of medicine. Recently, it was announced in one of the TV news channel that an Avatar competed in the show – Jeopardy against the best players and won. But in health care, the current generation of CDS is deficient in the “Art of Medicine.”

    

 

Review of Mayo Clinic Website

I spend time on the Internet but I truly had not spent time reviewing websites until now. I decided to review Mayo Clinic website. I was particularly impressed at its richness and organization for easy navigation. The categorization of topics and the layout really make it easy for consumers of health and professionals to search for desired information.

At the top bar and left side of the website topics were broken down into categories as follows;

Diseases and Conditions

Symptoms

Drugs and Supplements

Test and Procedures

Healthy lifestyle

First Aid

In my opinion, this type of arrangement makes the site user friendly even to the uninitiated to the digital age. The targeted audience includes those who are not just looking for hard science in search of whatever resolution they may be looking for. It was very interesting for me to read about the historical information on green tea. I like Mayo Clinic’s disclaimer that states, “This monograph is intended for informational purposes only and not an attempt to give medical advice.” They did suggest that for advice, a qualified health care provider should be consulted.

The website is credible. Mayo Clinic is a well-known establishment in health related innovation worldwide, it also claims to have more than 3,000 physicians, scientist, and researchers from the clinic who share their experience to empower the people to better manage their health. It is truly this empowerment that is leading to the explosion of Internet websites today. I also see that as the reason for the birth of Dr. Yellowlees book.

For the health Junky, the site has a monthly health newsletter that addresses common disease conditions, like arthritis, high blood pressure, heart diseases, nutrition and more for a monthly subscription rate of $1.97.

As you check on any desired topic, it gives you sub topics that further explain that issue to give you a complete awareness of whatever someone is reviewing. It truly becomes a great empowerment tool when reviewed thoroughly.

The website is very current as the last update was July 2010 and some of the blog postings were as recent as 24 hours ago. The contributors to the website have impressive biography which enhances the site’s creditability.

The site carries some advertisements but they are presented responsibly. It does not create any major distraction and they are tastefully done. In conclusion, this website is an excellent site for professionals and consumers of health. It covers disease management, healthy lifestyle (prevention), healthy cooking. It is truly a one stop shop to great health and consumer’s empowerment.