Electronic Health Records (EHR, EMR)

Action items to help make the most of whichever electronic health record platform you’ve chosen.

Could distributed ledger technology offer the promise of real-time EHR updates, seamless interoperability and protection from ransomware?

The number of people seeking health information online across EU countries nearly doubled last year, compared to figures from 2008, according to research cited in a new report from the European Commission and the Organisation for Economic Co-operation and Development (OECD). The Health at a Glance: Europe analysis, published in November, looks at the state of health of EU citizens and the performance of health systems in the 28 EU member states, along with five candidate countries and three from the European Free Trade Association. Figures from an annual European Information and Communication Technologies survey mentioned in the report, including the responses from around 150,000 households and 200,000 individuals aged between 16-74, found that half of all EU residents sought health information online in 2017, with the number going up to around 70 per cent in the Netherlands and Finland. But the 2016 version of the survey found that only 13 per cent of EU residents made a medical appointment online, although the number went up by five per cent compared to figures from 2012. Looking at individual countries, nearly half of all Danish residents reportedly made an appointment with a health care practitioner online in 2016. Use of EHRs and ePrescribing  The Commission and the OECD’s new report also shows that the use of electronic health records has been increasing across the EU.  A 2016 survey of OECD countries, which included 15 EU member states, revealed that all or nearly all primary care practices in Estonia, Finland, Greece and the UK had implemented such a system. The situation was different in Poland and Croatia, however, where it was reported to be “much more limited”. Meanwhile, a 2018 survey from the Pharmaceutical Group of the EU found variation in the implementation of ePrescribing systems across EU countries. Although 90 per cent of prescriptions were transmitted to community pharmacies electronically in Denmark or Sweden, figures indicated that ePrescribing had not yet been implemented in Bulgaria, Malta or Poland. According to the Commission, these countries expressed an intention to implement ePrescribing at either regional or national levels during the coming years. “Digital technology offers great opportunities to deliver health services more efficiently, and the European Commission supports a digital transformation of health systems to empower citizens to have access to their health data and to promote exchange of health data among health care providers across the EU,” the report reads. "Every European citizen should have an electronic health record" In a mid-term review on the implementation of the digital single market strategy, the Commission said it would take further action in three areas: ensuring citizens’ secure access to and sharing of health data beyond borders, connecting data to drive advancements in “research, disease prevention and personalised health care”, and empowering citizens to take control of their care through digital tools. Until 20 December, the EU institution is accepting feedback on an initiative to create a recommendation for the establishment of a European EHR exchange format. "Every European citizen should have an electronic health record - and this record should be easily exchangeable across Europe. We will soon publish a recommendation on how this should happen,” Roberto Viola, Director General of DG Connect, European Commission, recently said at the EU Health Summit. Source: Health at a Glance: Europe report, published in November 2018. Twitter: @1Leontina Contact the author: lpostelnicu@himss.org

With 11 hospitals validated at Stage 7 on the EMRAM, China has made great inroads with digitizing healthcare. Yu Quan, CIO at China Medical University's Shengjing Hospital, which achieved Stage 7, talks about the next steps in the country's efforts.

Black Book survey shows that some were wooed by brand names, instead of seeking core functionalities that give ROI – and wish they'd gotten more bang for their buck.

Sinai AppLab at Mount Sinai Health System in New York and UPMC Enterprises at UPMC in Pittsburgh offer tips for commercialization success.

St. Mary Medical Center brought in a consulting team to reduce length of stay and the left-without-being-seen rate in its emergency department – and it worked.

New York City-based Hospital for Special Surgery, the first specialty hospital to win a HIMSS Davies Award for Excellence. has found a way to use teamwork and health IT to improve processes and care outcomes. With nearly 19,000 annual inpatient surgeries, requiring close bed utilization monitoring, HSS leadership used to receive operational reports four times a day using manual data collection, but this posed significant operational challenges, and length of stay adherence was also lacking. To remedy the situation, HSS instituted clinical pathways – procedure-specific, post-op order sets. These pathways established best practices, by coordinating and standardizing care, according to HSS. The pathways are made up of time-based goals and milestones for the interdisciplinary care of defined patient groups, ensuring standardized care across these groups. The pathways also include LOS adherence as part of the performance goals. WHY IT MATTERS Many healthcare organizations wrestle with patient volume challenges on a regular basis, requiring close monitoring of bed utilization. Once HSS began to address bed management and LOS through a multipronged approach that included EHR enhancements and new reporting capabilities – including a capacity management dashboard – capacity improved significantly, hospital officials say. THE LARGER TREND There are a variety of care coordination technologies on the health IT marketplace. Vendors include Cipherhealth, eQHealth, GSI Health, Imprivata, Microsoft, Optum and pMD. We reported last month, for instance, that Penn Medicine used care coordination tech, TrekIT, to reduce LOS and readmissions. According to preliminary findings by TrekIT, the company’s care coordination technology helped Penn Medicine achieve a 50 percent reduction in pneumonia readmissions, a 7 percent reduction in risk-adjusted length of stay, and a 9 percent improvement in HCAHPS scores. Groups using the technology during clinical rounds were able to access real-time data on their patients 50 percent more often than teams that didn't, while spending 25 percent less time logging into their devices. Another success story, is Cedar View Rehabilitation and Healthcare Center, a skilled nursing facility in Methuen, Massachusetts, that shifted from piecing together a patient’s encounter history from discharge records and verbal summaries from patients and their families to PatientPing, a technology which provides real-time alerts from hospitals, emergency departments and post-acute care providers every time a patient goes through a transition of care. The vendor also supplies key clinical data that is valuable for placing a patient’s situation in context, as well as contact information for their healthcare providers. The technology allowed Cedar View to trim LOS for the average Medicare Advantage patient by three to five days. Diana Manos is a Washington, D.C.-area freelance writer specializing in healthcare, wellness and technology.  Twitter: @Diana_Manos Email the writer: dnewsprovider@gmail.com  Healthcare IT News is a HIMSS Media publication. 

A national group is being formed to start work on linking the country’s four regional clinical portals, with approval from the district health boards’ (DHBs) chief information officers. The group is being led by Stella Ward, chief digital officer at Canterbury DHB. If successful, the project would allow any clinician involved in a patient’s care to view that person’s computerised health data from anywhere across New Zealand. Waitemata DHB clinical adviser digital innovations Lara Hopley is a key driver of the project and says clinicians are very keen to be able to see patients’ data from other regions as they often move around the country. An information paper, Connecting the Regional Clinical Portal to improve patient safety and quality of care, went to the National DHB IS Leadership Forum in November and was noted. The idea was also raised at a recent meeting of clinical IT leads from around the country, who were supportive. The paper says, “safety and clinical care would be improved if the clinician was aware of the other records, and could seamlessly view, from within their local Clinical Portal, all the available nationally stored computer information about their patient”. New Zealand’s 20 DHBs are grouped into four regions that each have a shared view of their region’s patient information via Clinical Portal 8 from Orion Health. Of the 20 DHBs, three are not yet using their regional shared portal, but all have imminent plans to move on to one. The southern region has all five South Island DHBs using Health Connect South and the Midlands region has five DHBs using the e-space Midland Clinical Portal. The central North Island has five DHBs already using the Regional Health Informatics Programme portal and Capital and Coast DHB has plans to join. Two Northern DHBs are using the Northern Regional Shared Clinical Portal and Auckland and Northland are due to join in 2020. Hopley says the details of exactly what data will be shared and how to technically achieve the sharing still need to be worked out but she would like it to start as a read-only “portal into other portals”, meaning they would have a tab to access one of the other three portals and land on their dynamic patient summary screen. “Access to the latest documents is likely to give 80–90 per cent of the information you need while assessing a patient,” she added. “It’s a rich data set and we don’t want information overload, but we are skilled clinicians at filtering out the signal from the noise.” Ultimately, the aim would be to have more integrated sharing of all the data with documents and results from other areas, and the end clinicians not needing to tab into a different portal, she says. Issues around auditing also need to be agreed, but Hopley says DHBs already have robust internal auditing processes in place and could extend these to monitor staff looking at other portals. She suggests starting with a proof of concept to prove the value, allowing paediatricians in the Midlands area to access the Northern Regional portal, as a lot of children go up to Starship Hospital for treatment. “As we are already supplying them with access via CareConnect’s TestSafe portal, we are not really changing what they can see, we are just making it easier,” explains Hopley. “This would prove the value and allow a blueprint for how we can do this as a minimum viable product, allowing each region to then understand the cost and prioritise accordingly.” Auckland DHB chief digital officer Shayne Tong says, “in Auckland metro a big number of our population come from outside the region so linking up the portals nationally would be beneficial”. ADHB recently approved a business case to move on to the Northern Regional Clinical Portal. The project is underway and ADHB has an estimated go-live date of February 2020, followed closely by Northland DHB. “Our doctors and clinicians move around DHBs so to have that one-stop-shop for the region is pretty incredible and being able to link nationally too is a real benefit,” says Tong.   This article first appeared on eHealthNews.nz. 

The MasterCare EMR solution will be used by Bass Coast Health clinicians to govern the assessment and management plans of clients, along with the monitoring and measuring of on-going outcomes. It comprises of a complete EMR and Practice Management solution, with software supporting Minimum Data Set (MDS) collection required for funding, including: Commonwealth Home Support Program (CHSP); Home and Community Care (HACC); Community Health (CH) MDS; Victorian Alcohol and Drug Collection (VADC) and Victorian Integrated Non-Admitted Health (VINAH) data sets. MasterCare EMR Product Manager Kye Cherian told HITNA that the decision behind using EMR was to have an integrated clinical and administrative system with a collection of reporting data built into administrative and clinical workflows. “The solution is integrated with a number of other Australian funding and billing types. Many other Victorian services are either using paper-based records and administrative systems with stand-alone applications to collect their reporting data,” he said. According to Cherian, more Federal and State funded programs becoming available resulted in Bass Coast Health requiring an efficient data collection software solution, in addition to fundamental features in an EMR. Having initially used PBJ Software Australia technology, Cherian said the move to MasterCare EMR’s intelligent commissioning framework allowed much of the new program data capture and reporting requirements to be supported through software configuration rather than new development. The three-month implementation involved interfacing MasterCare EMR to the existing DXC iPM Patient Management System, currently used in acute services around Victoria. “Global Health… brought a deep understanding of Victorian program workflow and data capture requirements. It resulted in a project where both parties took the time to understand the product framework, business needs and data capture requirements,” he said. “The outcome was a solution that utilises the product’s configurability to support new programs and streamline workflows with minimal software enhancements required. “A big challenge was migrating five core and high volume programs and their reporting requirements into the new application. With that being said, items such as data migration, integration and change management had to be amplified resulting in the solution having great end-user acceptance and adoption.”  Cherian said the increased efficiency of data collection in MasterCare EMR has resulted in “a wide range of benefits” including ease of reporting and a decreased duplication of work. “It future-proofs Bass Coast Health on a number of levels. The system has framework to support a number of anticipated program structure changes and being integrated with core e-health foundation services has improved processes.” Moving forward, Bass Coast Health has planned subsequent phases of the project to enhance the applications’ use as an EMR within the service and to integrate additional features within the application. Cherian said there is also potential for some planned product improvements to strengthen the product’s support for certain programs and services. “This will enhance MasterCare EMR’s credentials around the state. Both parties remain committed to working collaboratively in order to become a luminary site for Victorian outpatients and community health organisations.” This article first appeared on Healthcare IT News Australia.