Archive for the ‘EHR’ Category
Monday, December 2nd, 2013
Health care is undergoing a virtual information revolution, fueled by the American Recovery and Reinvestment Act of 2009, which permits reimbursement incentives for eligible professionals and hospitals that meet criteria for becoming “meaningful users” of certified electronic health record (EHR) technology.
“Meaningful use” is defined, in part, as using EHRs to improve and demonstrate the quality of care, such as e-prescribing, electronic exchange of health information, and submission of quality measures to Centers for Medicare and Medicaid Services (CMS). CMS has set standards to meaningful use that are to be met in stages. According to a post by American Medical News, organizations are currently working on Stage 1 implementation; Stage 2 implementation starts in 2014.
MedlinePlus Connect is a free service that supports health professionals’ ability to provide health information to their patients, which they will be expected to do (and document) in Stage 2 of implementation. Designed by the National Library of Medicine (NLM), the service links EHR systems to MedlinePlus.gov, an authoritative up-to-date health information resource for patients, families, and health care providers.
The National Network of Libraries of Medicine (NN/LM) is assisting the NLM with promoting MedlinePlus Connect. An NN/LM task force conducted interviews with 17 key informants representing the broad spectrum of organizations that are involved with EHR implementation.
The interviews included discussion with some innovative hospital librarians who are taking advantage of the dynamic EHR environment and finding ways to be involved with meaningful use at their organizations.
Key informants provided insight into the aspects of MedlinePlus Connect that are major advantages of the service from their perspective:
- The material is evidence-based and updated regularly.
- MedlinePlus links to primary literature, which is becoming increasingly popular among patients as they become more sophisticated in locating health information.
- Patient information is provided in varying reading levels, multi-media formats, and different languages, with an extensive database of Spanish-language materials.
- Health IT professionals will find easy instructions for integrating MedlinePlus Connect into EHRs.
- MedlinePlus Connect allows health organizations to maintain their identifying information when MedlinePlus information is sought.
The fact that MedlinePlus Connect can be added to EHRs at no cost to users was a definite advantage, but key informants cautioned against calling it a “free resource,” a term that has a negative connotation among health professionals. It would be more effective to call it a “non-commercial service paid for by the National Library of Medicine with no cost to users.”
The time to promote MedlinePlus Connect is now. Key informants said that patient portals were the emerging issue of the year as organizations focus on Stage 2 criteria.
Monday, November 4th, 2013
Last week, the National Library of Medicine (NLM) released an enhancement to MedlinePlus Connect.
With the enhancement, MedlinePlus Connect will respond to SNOMED CT codes with information from both MedlinePlus and NLM’s Genetics Home Reference (GHR) web site. GHR is the NLM’s web site for consumer information about genetic conditions and the genes or chromosomes related to those conditions. This feature is available exclusively for English SNOMED CT requests. The GHR information will be available using either the MedlinePlus Connect web application or web service.
Additional details are now available in the MedlinePlus Connect technical documentation.
Friday, September 27th, 2013
Guest Author: Lisa Huang, Central Park Campus Library, Collin College, McKinney, TX
I am grateful to the National Network of Libraries of Medicine South Central Region (NN/LM SCR) for providing the Professional Development Award, which enabled me to attend the all day workshop “The Evolving Librarian: Responding to Changes in the Workplace and Healthcare” held at the OU-Tulsa Schusterman Library, in Tulsa, OK on April 18, 2013. The workshop was taught by one of the leaders in medical librarianship, Michelle Kraft, senior medical librarian at the Cleveland Clinic and current candidate for MLA President-elect. Kraft is also renowned for her Krafty Librarian blog http://kraftylibrarian.com/.
Kraft discussed current and emerging forces shaping the healthcare landscape such as the Affordable Care Act (ACA), electronic health record (EHR), local community benefit, new tax laws, numerous technological changes and evolving expectations of administrators and library clients. The Great Recession has accelerated these issues as hospitals are being funded differently now. Non-profit hospitals must turn a profit to stay afloat due to increasing technological costs of the EHR implementation. Kraft’s lecture was immensely informative and explained why the local hospitals have accelerated their community engagement efforts to maintain their tax exemption.
I was struck by the similarities of funding between Collin College, a community college district, and hospitals. Collin is no longer being funded by student enrollment numbers; funding is dependent on graduation, completion, and retention rates of students. For hospitals, funding is dependent on patient satisfaction and success rate of providing health care services instead of the number of services performed or provided to patients. Compounding these changes is the shrinking number of personnel as institutions have their reduced staffing. Kraft encouraged the attendees to re-evaluate traditional time honored activities such as cataloging books for hospital libraries with a small print collection. Libraries must evolve with society and its nomadic client expectations of on demand services and resources.
An issue addressed repeatedly at the workshop is that librarians need to demonstrate value to their home administration because libraries are expensive or as someone calls them, a “black hole.” Administrators are not sure about the value of libraries because they do not bring in money; librarians need to change the perception of the library as an asset. Amid fiscally challenging times, the notion of libraries as time honored institutions is antiquated; libraries are up for staff reduction or closure. Kraft argued that librarians need to re-align library operations and goals with the administration’s goals, regardless if you work for a hospital, academic health sciences center, or a community college. Libraries need to conduct qualitative research that measures their return on investment and the impact of all their services such as literature reviews, library instruction; or, the value of their books to the clients. ROI calculators and library narratives should be common knowledge for librarians. Librarians tend to shy away from research or simply don’t have the time to conduct research, but they need to conduct mini-research projects to demonstrate value and track impact. Possible projects include literature searches that lead to improved patient care or decreased length of stay.
Other takeaways from the workshop:
- The need to be aware of healthcare legislation changes from the local to national level.
- Staying abreast of new roles for librarians such as data management, emerging roles with the EHR, patient education, and embedded librarianship. The profession is evolving and new identities of librarians are being written.
- Be flexible as change is constant and inevitable.
- Understanding when technology is disruptive or you’ve allowed it to be disruptive in your library?
I appreciated the opportunity to attend this workshop and much appreciation goes to Stewart Brower and the OU-Tulsa Schusterman Library staff for their gracious hospitality.
Thursday, August 1st, 2013
The Robert Wood Johnson Foundation recently released the Health Information Technology in the United States 2013: Better Information Systems for Better Care Report.
According to the report “since 2010, the proportion of hospitals having a basic electronic health record (EHR) has tripled.” With “more than 38 percent of physicians reporting having adopted basic EHRs in 2012.” With incentive programs for health information technology (HIT) adoption, such as the Health Information Technology for Economic and Clinical Health (HITECH) Incentive Program many hospitals were able to take steps and move toward EHR system adoption. The report shows that while adoption in hospitals was large, the increase in adoption of EHR systems by physicians in private practice was not as large. Small practices continue to lag behind in EHR adoption and will likely need continued support from agencies such as Regional Extension Centers (RAC).
In a positive finding the report shows that “physicians and hospitals alike appear to be adopting EHRs with more sophisticated capabilities that enable improvements in the delivery of care and management of patient populations.” The report also suggests that many hospitals are adopting at least as basic EHR system (44 percent) while only 16.7 percent of hospitals have already adopted a comprehensive EHR system.
According to the report four areas where most organizations which have adopted EHRs lag behind are related to patient clinic summaries and include the ability for the patient to view quality data, receive guideline reminders, receive patient e-copy of health information, and provide patient clinical summaries.
The report goes on to compare HIT implementation in the US to HIT implementation in other countries as well as provide additional insights into the development of Health Information Exchanges and their role in healthcare.
The final chapter of the report deals specifically with “Improving Patient Education with EHRs” an area many hospital and consumer health librarians are familiar with. According to the report “little is known about best approaches for using EHRs to provide patients with materials that are understandable and actionable for patients, especially those with limited health literacy and English proficiency.” The report provides a good study of vendors in the EHR industry and specifically looks at patient health information portals and delivery.
The report suggests that “U.S. providers could do more using HIT to engage patients with educational materials tailored to an individual’s diagnosis and health literacy level.”
Overall, this is a valuable report for those involved in HIT and EHR implementation. Using the data provided in this report librarians can demonstrate the value of consumer health information resources such as MedlinePlus and MedlinePlus Connect in meeting Meaningful Use objectives.
Monday, July 8th, 2013
This is the second part in a short series about Electronic Health Records (EHRs), meaningful use, and the connection between EHRs and librarians.
As mentioned in the previous post in this series, the rate of adoption of EHRs by healthcare practitioners has been slow. As a result, the Health Information Technology for Economic and Clinical Health (HITECH) Act was created as part of the American Recovery and Reinvestment Act (ARRA) of 2009. The HITECH Act authorized the Centers for Medicare & Medicaid Services (CMS) to provide incentive payments to eligible professionals, eligible hospitals, and critical access hospitals (CAHs) that implement EHRs and are able to demonstrate meaningful use. Under the ARRA and HITECH Act, meaningful encompasses the following three components:
- The use of a certified EHR in a meaningful manner.
- The electronic exchange of health information to improve quality of health care.
- The use of certified EHR technology to submit clinical quality and other measure.
In 2010, the CMS published a final rule that established three stages for supporting eligible professionals, eligible hospitals, and CAHs that plan to implementing EHRs in a way that will meet meaningful use criteria and objectives (to see a detailed timetable of the three stages visit HealthIT.gov’s page on meaningful use). Currently, only Stage 1 has been put into effect, with Stage 2 to begin sometime in 2014.
Each stage requires eligible professionals, eligible hospitals, and CAHs to meet a number of core and menu set objectives in order to achieve meaningful use. For example, in Stage 1, eligible professionals are required to meet 15 core objectives and 5 out of 10 menu set objectives found here. Also as part of the meaningful use core objectives, eligible professionals and hospitals are required to report on clinical quality measures (CQMs) which are tools that “help measure and track the quality of healthcare services provided by eligible professionals, eligible hospitals and critical access hospitals within our health care system” (CMS.gov, Clinical Quality Measures http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/EP-MU-TOC.pdf)
To find more information on how meaningful use and EHRs are being utilized, search PubMed using the Structured Evidence Query for HealthyPeople2020 Objective HC/HIT-11.
Centers for Medicare & Medicaid Services: EHR Incentive Program Final Rule
Centers for Medicare & Medicaid Services : Meaningful Use
HRSA Meaningful Use Stage 1 Clinical Quality Measures for the Safety Net Community
Wednesday, June 12th, 2013
This is part one in a short series about Electronic Health Records (EHRs), meaningful use, and the connection between EHRs and librarians.
Electronic Health Records, or EHRs, as defined by HealthIT.gov are “digital (computerized) versions of patients’ paper charts” that combine past and present patient information into a single record. They contain a patient’s demographic and health information history including diagnoses, prescribed medications, as well as lab data and results. EHRs have the potential to streamline the amount of health information concerning a single patient, and therefore provide improved management of patient records by providers. In addition, most EHRs also have the ability to support evidence-based tools and software that assist in clinical decision-making and are able to integrate health information for patients (such as MedlinePlus Connect).
The term EMR (Electronic Medical Record) is often used interchangeably with EHR but the two are very different. The most important distinction to mention however is that EMRs, unlike EHRs, are not able to be modified across different provider offices or healthcare organizations. Another term often used is PHR, or Personal Health Record. A PHR is different from both an EMR and EHR in that it is a record of medical health information and history kept by the patient, rather than the providers.
Despite President George W. Bush’s 2004 initiative for all Americans to have EHRs, the rate of adoption has been slow. In 2009, the American Recovery and Reinvestment Act authorized the Centers for Medicare & Medicaid Services (CMS) to provide incentive payments to providers and hospitals who implement EHRs and are able to demonstrate meaningful use. More about meaningful use will be covered in the next EHR blog post.
Amatayakul, M.K. Electronic Health Records: A Practical Guide for Professionals and Organizations. 5th ed. Illinois: AHIMA Press; 2012
NLM. Personal Health Records. MedlinePlus. http://www.nlm.nih.gov/medlineplus/personalhealthrecords.html Last updated May 13, 2013. Accessed June 10, 2013.