Electronic health records are still waiting to be transformed

In 2018, a Stanford Medicine/Harris Poll found that nearly half of U.S. primary care physicians said that electronic health records actually detract from their effectiveness as clinicians, and 44% said they believed that the primary value of these systems is data storage. Far from being a transformative health care tool to support clinical decision-making, a large portion of physicians feel they have traded physical filing cabinets for digital ones.

Electronic health records still have the potential to make health care more predictive, preventive, and precise — but only if we can achieve sustained collaboration among health care providers, technology companies, and health insurers to address their shortcomings. One step in that direction took place on Stanford’s campus last June, where we convened leaders in patient care, technology, design thinking, and policy to discuss a path forward for electronic health records. In principle, the group agreed on three points:

1. First, electronic health record systems must become interoperable.
2. Electronic health records must be redesigned to better respond to physicians’ needs. 
3. Building a more clinically relevant electronic health record system should incorporate artificial intelligence that can synthesize anonymized patient records; combine them with the medical literature; and provide insights at the point of care. 

The full STAT article can be viewed at this link.  

Death by a Thousand Clicks: Where Electronic Health Records Went Wrong

The U.S. government claimed that turning American medical charts into electronic records would make health care better, safer, and cheaper. Ten years and $36 billion later, the system is an unholy mess: Inside a digital revolution gone wrong. A joint investigation by Fortune and Kaiser Health News.

The full Fortune article can be read at this link.  

In 2018, eHealth Initiative Foundation (eHI) and Manatt, Phelps & Phillips hosted two executive advisory board meetings on privacy and security in the age of wearable technologies. The risky business of sharing data In and Outside of the healthcare system is becoming more complicated, especially as consumer use of health applications and the desire to share health data increases exponentially. The roundtables convened experts in healthcare privacy and security, explored data sharing within and between organizations (including the relationships healthcare providers have with business associates and application (app) developers), and tackled data sharing implications for the bio-economy and the state, federal, and international policies and rules that aim to guide organizations through the murky terrain. The brief examines the significant amount of health data being generated from apps and consumer devices that are ungoverned by HIPAA and aims to clear up some of the confusion, offering tangible examples of what constitutes a covered and non-covered HIPAA entity, how to determine business associates in relation to HIPAA, provides an examination of federal guidance and regulations for covered entities and app developers, and discusses the nuances of the California Consumer Privacy Act (CCPA) and the General Data Protection Regulation (GDPR).

Electronic Health Records: A Promising New Way To Fight the Opioid Epidemic

From the injured athlete who underwent ACL surgery to the mother recovering from a broken ankle, the nation’s opioid epidemic selects its victims indiscriminately and at an alarming rate, with 8% to 12% of patients prescribed painkillers eventually developing a use disorder. As of 2017 – the most recent full year for which data is available – prescribing rates still hover around 60 prescriptions per 100 persons.  Addiction disorders disproportionately affect young adults, with opioid overdoses accounting forone in every five deaths of Americans between the ages of 25 and 34. This is the grim face of the epidemic today.

While the Attorney General and U.S. courts fight to determine the role pharmaceutical companies such as Purdue Pharma had in precipitating our nation’s drug crisis – as well as their prior knowledge of the addictiveness of drugs like OxyContin – patients, physicians and local communities continue to battle the epidemic on the front lines. From controversial measures like safe injection sites, to collection programs for unused pills as well as new medical policies designed to reduce overprescribing, communities across the country are developing and implementing innovative ways to address the epidemic.

One of the strategies outlined in recent months comes from the Centers for Medicare & Medicaid Services (CMS), which describes a three-pronged approach to fighting the epidemic: opioid use disorder (OUD) prevention, treatment and improved data utilization in electronic health records (EHRs). The cornerstone of this strategy – to equip health workers on the front lines with access to real-time data about patient prescribing patterns – is a key aspect of CMS’s roadmap that health technology leaders are still exploring today. And, while much of the necessary data is already being collected through various means, getting it in front of prescribers when and where they need it – and in a useable format – is another matter.

The full Forbes article can be viewed at this link.  

Interoperability Progress and Remaining Data Quality Barriers of Certified Health Information Technologies

The Consolidated Clinical Document Architecture (C-CDA) is the primary standard for clinical document exchange in the United States. While document exchange is prevalent today, prior research has documented challenges to high quality, effective interoperability using this standard. Many electronic health records (EHRs) have recently been certified to a new version of the C-CDA standard as part of federal programs for EHR adoption. This renewed certification generated example documents from 52 health information technologies that have been made publicly available. This research applies automated tooling and manual inspection to evaluate conformance and data quality of these testing artifacts. It catalogs interoperability progress as well as remaining barriers to effective data exchange. Its findings underscore the importance of programs that evaluate data quality beyond schematron conformance to enable the high quality and safe exchange of clinical data.

The full article can be downloaded below.

ScriptNumerate: A Data-to-Advice Pipeline using Compound Digital Objects to Increase the Interoperability of Computable Biomedical Knowledge

Many obstacles must be overcome to generate new biomedical knowledge from real-world data and then directly apply the newly generated knowledge for decision support. Attempts to bridge the processes of data analysis and technical implementation of analytic results reveal a number of gaps. As one example, the knowledge format used to communicate results from data analysis often differs from the knowledge format required by systems to compute advice. We asked whether a shared format could be used by both processes. To address this question, we developed a data-to-advice pipeline called ScriptNumerate. ScriptNumerate analyzes historical e-prescription data and communicates its results in a compound digital object format. ScriptNumerate then uses these same compound digital objects to compute its advice about whether new e-prescriptions have common, rare, or unprecedented instructions. ScriptNumerate demonstrates that data-to-advice pipelines are feasible. In the future, data-to-advice pipelines similar to ScriptNumerate may help support Learning Health Systems.

The full article can be downloaded below.  

Impediments to the Implementation of Healthcare Information Technology: A Systematic Literature Review 

The healthcare industry has seen a splurge in information technology investments largely due to the incentives offered by the government for its adoption as well as the penalties imposed under the HITECH Act of 2009. This has resulted in extensive research on Healthcare Information Technology (HIT) in recent years. In this study, we follow a systematic literature review across diverse disciplines ranging from management, information systems, and healthcare, and find that successful implementation of HIT follows three inter-related stages - adoption stage, integration stage, and sustenance stage. Given the uniqueness of healthcare industry with respect to knowledge-intensity and power hierarchy within job positions, we ascertain impediments that impact HIT implementation. Major impediments we identified include limited user buy-in, lack of risk assessment and safety measure during the adoption stage, physician resistance, spillover effect, standardized training, negative viewpoint in the integration stage, and lack of interoperability in the sustenance stage. Identifying and classifying impediments through a systematic literature review is the first step towards operationalizing these impediments and creating effective interventions to minimize their effect on HIT performance.

The full article can be downloaded below.  

How Banner Health Network is managing interoperability with 30-plus EHRs

Banner Health Network, with 5,000 affiliated physicians and 15 hospitals in the Phoenix area, is large and complex. Its accountable care and population health management efforts require lots of high quality data and a keen focus on closing gaps in care. But that's something of a challenge when those physicians are using more than 30 different electronic health records.

"Thirty-two, I think is the number," said David Coe, vice president of data management, analytics and population health technology at Banner Health. "So you could imagine doing point to point interfaces to each one of those individual EHR systems."

So BHN has recently tried a new approach to interoperability, partnering with Atlanta-based Holon for its CollaborNet platform, which Coe said connects physicians across the organization with necessary data to improve care coordination and pop health, enabling the jointly owned Banner|Aetna organization to make good on the the promise of value-based care, officials said.

The full Healthcare IT News article can be viewed at this link.