Most of the EMR's are starting to recognise Diversity in creating patient Demographics.
One of the fastest growing demographic groups in our society are bi/multi racial category.Traditionally language defines us more than the ethnicity.It is true even in America for the new immigrants.As the immigrants become more English language proficient. Ethnicity start taking priority over language, suddenly Colombians who themselves identify as the people of that nation start seeing themselves as black ,white or native people.In a strange way we find that as Moroccans and french speaking Quebec people loose their french they are lumped away from each other with Germans and may be with blacks.
The main reason for this strange mix of data is US Census which has been taken every ten years from the inception of our nation.This flawed census ethnic data is least useful for Meaningful use in creation of EMR and its mandate.We recognise that Irish whites from Boston may have least in common with Hasidic Jew from southern Spain. This need to collect a detailed ancestry record is an effort to find our unique health traits and help the patient(us).
I was told by a very reputed heart Surgeon of Indian descent that natives of India in US should lower their Cholesterol below 160 as we have narrower arteries .This type of information while not currently available could be norm if we collected ethnicity specific data for the patients.
An anomaly has been found the Hispanics Live five years longer than Whites in America even while the health care availability and Obesity is worse in their population.It is also an opportunity for us to study what factors make it possible for them to live longer and could we duplicate those conditions.It has been speculated that diet though high in meat and fat content may play some role as well as involvement in the society.
For Diversity organizations it is a challenge as well as opportunity to be part of the Discussion of EMR software for better outcome.
LET US NOT MISS THIS OPPORTUNITY.
Showing posts with label EMR. Show all posts
Showing posts with label EMR. Show all posts
Wednesday, February 23, 2011
Wednesday, December 15, 2010
How to implement the patient mandate equitably
Final rule 170,302(m)wants the mandate to create patient education resources,problem lists,medication lists,and to make the test results available to patients.
I add in a medium most accesible to patient(Cell phone app,written in varoius languages,or interactive Web content).This is how many of the people in the field are interpretting it.
One of the goals of the EMR is to remove the inequities in delivery of the medical services because of other inequities.
Uninsured ,underinsured and medically underserved amd minority communities need to be benefitted by it. We have seen that in massachussetts where only 2.6 % are uninsured in general population in the hispanics the rate is 7.2 %.
Race based health inequities exist across .Blacks live five years less than whites and their is an anomaly that Hispanics outlive whites by two years even when they have lower level of health coverage than populations in general.
We will have to work extra hard so that our underrepresented population opt in the health exchanges to get the benefits to be derived from the new EMR mandate.
Better management of critical diseases will help us effect better health outcome for our people.Five or so are critical fields where we can make a major difference.
Hypertension
Diabeties
obesity
Mal nutrition in mothers and children
respiratory problems
smoking
We think by focusing on nutrition,smoking cessation,and physical activity we can improve health outcomes of many people.We will have to identify at risk populations and then educate them and provide resources.An ounce of prevention is always better than a pound of cure.
When we look at the risk groups we may find that it is a moving target.Now they include large number of:
Hispanics
blakcs
hmongs
Glbstg
unemployed
children
foreign born populaion
and now home less and even vetrans
We will have to make sure that they remain healthy mentally and physically for society to do well.
I add in a medium most accesible to patient(Cell phone app,written in varoius languages,or interactive Web content).This is how many of the people in the field are interpretting it.
One of the goals of the EMR is to remove the inequities in delivery of the medical services because of other inequities.
Uninsured ,underinsured and medically underserved amd minority communities need to be benefitted by it. We have seen that in massachussetts where only 2.6 % are uninsured in general population in the hispanics the rate is 7.2 %.
Race based health inequities exist across .Blacks live five years less than whites and their is an anomaly that Hispanics outlive whites by two years even when they have lower level of health coverage than populations in general.
We will have to work extra hard so that our underrepresented population opt in the health exchanges to get the benefits to be derived from the new EMR mandate.
Better management of critical diseases will help us effect better health outcome for our people.Five or so are critical fields where we can make a major difference.
Hypertension
Diabeties
obesity
Mal nutrition in mothers and children
respiratory problems
smoking
We think by focusing on nutrition,smoking cessation,and physical activity we can improve health outcomes of many people.We will have to identify at risk populations and then educate them and provide resources.An ounce of prevention is always better than a pound of cure.
When we look at the risk groups we may find that it is a moving target.Now they include large number of:
Hispanics
blakcs
hmongs
Glbstg
unemployed
children
foreign born populaion
and now home less and even vetrans
We will have to make sure that they remain healthy mentally and physically for society to do well.
Tuesday, December 14, 2010
NY times article onEHR 12/13/2010
Panel Set to Study Safety of Electronic Patient DataBy MILT FREUDENHEIM
Published: December 13, 2010
Almost two years ago, President Obama pledged $19 billion in stimulus incentives to help convert the nation’s doctors and hospitals to using a paperless system of electronic health records intended to improve the quality of care and reduce costs. But the conversion is still a slow work in progress.
A family clinic in Walsenburg, Colo., is part of the Spanish Peaks Regional Health Center, which planned to adopt an electronic health records system. Administrators predicted the cost would be recovered through federal funds.
Only about one in four doctors, mostly in large group practices, is using the electronic record system. A vast majority of physicians in small offices, the doctors who serve most Americans, still track patients’ illnesses and other problems with pen and paper.
The thousands of sometimes deadly medical errors tallied by an Institute of Medicine study in 1999 are still all too common, according to a recent report on North Carolina hospitals in the New England Journal of Medicine. And the electronic record systems are themselves increasingly attracting concerns that computer errors, design flaws and breakdowns in communication sometimes endanger patients.
For example, parts of a patient’s electronic medical records have disappeared or been saved in the wrong patient’s file, according to the Food and Drug Administration. Incorrect entries have sometimes been posted for drug allergies and blood pressure readings, the agency said.
Taking a fresh look at such concerns, the Institute of Medicine created the Committee on Patient Safety and Health Information Technology to run a yearlong study and issue recommendations. The 16-member panel is meeting for the first time on Tuesday in Washington.
In February, the F.D.A. said it had received 260 reports of malfunctions related to health information technology “with the potential for patient harm,” including 44 reported injuries and six reported deaths in 2008 and 2009. The malfunctions were reported voluntarily to the agency, mainly by hospitals.
“Because these reports are purely voluntary, they may represent only the tip of the iceberg,” said Dr. Jeffrey Shuren, a senior F.D.A. policy and enforcement official.
In an indication of interest from Congress, Senator Charles E. Grassley of Iowa, the ranking Republican on the Senate Finance Committee, wrote to the health information industry and to Kathleen Sebelius, the secretary of Health and Human Services, to ask what was being done to make sure the systems were being reviewed and monitored for patient safety concerns and what role the F.D.A. played in regulating health information technology.
Dr. Shuren suggested that F.D.A. regulators could consider a range of new safety requirements under the agency’s authority to assure the safety, effectiveness and quality of medical devices, including software devices.
“All options for assuring safety are on the table,” said Dr. David Blumenthal, the Obama administration’s national coordinator for health information technology. His office gave the Institute of Medicine $989,000 for the patient safety panel, which is led by Gail L. Warden, the former president and chief executive of the Henry Ford Health System in Detroit.
Dr. Blumenthal said health information experts like Dr. Donald M. Berwick, the Medicare and Medicaid administrator, and Dr. Brent James, of Intermountain Healthcare, based in Salt Lake City, “agree that electronic health records will improve the safety of care.”
“At the same time, any time you change the world you create risks,” Dr. Blumenthal said in a telephone interview last weekend. “We want to make sure that implementation is as safe as it can be and all safety benefits are realized.”
He said that if the Institute of Medicine “concludes that regulation is an important part of this fabric of assuring safety, we will want to balance regulation and innovation as we do in every marketplace.”
Manufacturers of the systems have long opposed government regulation of their products.
“The policing of design by a third party or agency, however well intended, will likely stifle innovation and inhibit the growth and development of electronic health records in the future,” said Carl Dvorak, executive vice president of Epic Systems, which has built electronic records systems for Kaiser Permanente and other large health care and hospital groups.
The industry has recently avoided speaking out on a role for the F.D.A. In a statement for this article, the Healthcare Information and Management Systems Society, a Washington-based industry group, said only that it “supports the administration’s decision to ask the Institute of Medicine to study this complex issue and report back over the next 12 months.”
Last month, in protest of one common industry practice, the American Medical Informatics Association said “hold harmless” clauses in many purchasing contracts were unethical. The clauses typically absolve manufacturers of responsibility for any errors or misuse.
“We said we value innovation, but we don’t value it more than safety,” said Kenneth W. Goodman, a University of Miami bioethicist who headed an association advisory group on patient safety.
“We just do not have good data on medical errors, whatever the cause,” said Arthur A. Levin, a member of the new Institute of Medicine commission. Mr. Levin, director of Center for Medical Consumers in New York, also was a member of the institute group that warned in a 1999 report, “To Err Is Human,” that there could be 98,000 preventable deaths each year in hospitals.
An article in the New England Journal of Medicine last month pointed to a potential for malpractice liability risks because more information might be available on electronic records that might have gone unnoticed on a paper chart. Health care providers must weigh the substantial upfront costs and possible risks against the potentially sizable, but uncertain long-run benefits, Dr. Sandeep S. Mangalmurti, an internist at New York University’s Langone Medical Center, and his colleagues wrote.
“We probably catch about 2 percent of the errors,” said Ross Koppel, a University of Pennsylvania sociologist and investigator for RAND Corporation, the research organization based in Santa Monica, Calif. “The errors are the 98 percent that got through
Published: December 13, 2010
Almost two years ago, President Obama pledged $19 billion in stimulus incentives to help convert the nation’s doctors and hospitals to using a paperless system of electronic health records intended to improve the quality of care and reduce costs. But the conversion is still a slow work in progress.
A family clinic in Walsenburg, Colo., is part of the Spanish Peaks Regional Health Center, which planned to adopt an electronic health records system. Administrators predicted the cost would be recovered through federal funds.
Only about one in four doctors, mostly in large group practices, is using the electronic record system. A vast majority of physicians in small offices, the doctors who serve most Americans, still track patients’ illnesses and other problems with pen and paper.
The thousands of sometimes deadly medical errors tallied by an Institute of Medicine study in 1999 are still all too common, according to a recent report on North Carolina hospitals in the New England Journal of Medicine. And the electronic record systems are themselves increasingly attracting concerns that computer errors, design flaws and breakdowns in communication sometimes endanger patients.
For example, parts of a patient’s electronic medical records have disappeared or been saved in the wrong patient’s file, according to the Food and Drug Administration. Incorrect entries have sometimes been posted for drug allergies and blood pressure readings, the agency said.
Taking a fresh look at such concerns, the Institute of Medicine created the Committee on Patient Safety and Health Information Technology to run a yearlong study and issue recommendations. The 16-member panel is meeting for the first time on Tuesday in Washington.
In February, the F.D.A. said it had received 260 reports of malfunctions related to health information technology “with the potential for patient harm,” including 44 reported injuries and six reported deaths in 2008 and 2009. The malfunctions were reported voluntarily to the agency, mainly by hospitals.
“Because these reports are purely voluntary, they may represent only the tip of the iceberg,” said Dr. Jeffrey Shuren, a senior F.D.A. policy and enforcement official.
In an indication of interest from Congress, Senator Charles E. Grassley of Iowa, the ranking Republican on the Senate Finance Committee, wrote to the health information industry and to Kathleen Sebelius, the secretary of Health and Human Services, to ask what was being done to make sure the systems were being reviewed and monitored for patient safety concerns and what role the F.D.A. played in regulating health information technology.
Dr. Shuren suggested that F.D.A. regulators could consider a range of new safety requirements under the agency’s authority to assure the safety, effectiveness and quality of medical devices, including software devices.
“All options for assuring safety are on the table,” said Dr. David Blumenthal, the Obama administration’s national coordinator for health information technology. His office gave the Institute of Medicine $989,000 for the patient safety panel, which is led by Gail L. Warden, the former president and chief executive of the Henry Ford Health System in Detroit.
Dr. Blumenthal said health information experts like Dr. Donald M. Berwick, the Medicare and Medicaid administrator, and Dr. Brent James, of Intermountain Healthcare, based in Salt Lake City, “agree that electronic health records will improve the safety of care.”
“At the same time, any time you change the world you create risks,” Dr. Blumenthal said in a telephone interview last weekend. “We want to make sure that implementation is as safe as it can be and all safety benefits are realized.”
He said that if the Institute of Medicine “concludes that regulation is an important part of this fabric of assuring safety, we will want to balance regulation and innovation as we do in every marketplace.”
Manufacturers of the systems have long opposed government regulation of their products.
“The policing of design by a third party or agency, however well intended, will likely stifle innovation and inhibit the growth and development of electronic health records in the future,” said Carl Dvorak, executive vice president of Epic Systems, which has built electronic records systems for Kaiser Permanente and other large health care and hospital groups.
The industry has recently avoided speaking out on a role for the F.D.A. In a statement for this article, the Healthcare Information and Management Systems Society, a Washington-based industry group, said only that it “supports the administration’s decision to ask the Institute of Medicine to study this complex issue and report back over the next 12 months.”
Last month, in protest of one common industry practice, the American Medical Informatics Association said “hold harmless” clauses in many purchasing contracts were unethical. The clauses typically absolve manufacturers of responsibility for any errors or misuse.
“We said we value innovation, but we don’t value it more than safety,” said Kenneth W. Goodman, a University of Miami bioethicist who headed an association advisory group on patient safety.
“We just do not have good data on medical errors, whatever the cause,” said Arthur A. Levin, a member of the new Institute of Medicine commission. Mr. Levin, director of Center for Medical Consumers in New York, also was a member of the institute group that warned in a 1999 report, “To Err Is Human,” that there could be 98,000 preventable deaths each year in hospitals.
An article in the New England Journal of Medicine last month pointed to a potential for malpractice liability risks because more information might be available on electronic records that might have gone unnoticed on a paper chart. Health care providers must weigh the substantial upfront costs and possible risks against the potentially sizable, but uncertain long-run benefits, Dr. Sandeep S. Mangalmurti, an internist at New York University’s Langone Medical Center, and his colleagues wrote.
“We probably catch about 2 percent of the errors,” said Ross Koppel, a University of Pennsylvania sociologist and investigator for RAND Corporation, the research organization based in Santa Monica, Calif. “The errors are the 98 percent that got through
Monday, November 29, 2010
Inefficiency Hurts U.S. In Ranking of Health
Whereas in the U.S. we have a highly inefficient health system that’s taking away financial resources from other lifesaving programs.”
New study has found that our health care cost has increased three fold in last 30 or so years and we have not improved the ranking on the health in the world.This is based on study of many advanced countries of the world.We have most expensive health care system which fails to deliver us the services.
We have reduced smoking in our population .Our ranking remains terrible 49 th in the world.
We will have to improve the health care delivery and efficiency in our system so we may control cost and deliver better care for our patients(that is us).I see it happening with EMR mandate and meaningful use part of it which will benefit us tremendously
New study has found that our health care cost has increased three fold in last 30 or so years and we have not improved the ranking on the health in the world.This is based on study of many advanced countries of the world.We have most expensive health care system which fails to deliver us the services.
We have reduced smoking in our population .Our ranking remains terrible 49 th in the world.
We will have to improve the health care delivery and efficiency in our system so we may control cost and deliver better care for our patients(that is us).I see it happening with EMR mandate and meaningful use part of it which will benefit us tremendously
Friday, November 19, 2010
Why Ipads could become Device of choice for EMR practices.
Here is a detailed article in CIO insider Magazine.
Why One Company is Ditching Sales Laptops for iPads
Take a look at the decision process behind one company's move to replace laptops with iPads and embrace the consumerization of enterprise IT - plus the training and security issues that have popped up.
http://www.cio.com/article/637864/Why_One_Company_is_Ditching_Sales_Laptops_for_iPads?page=2&taxonomyId=3004
This article analyses how Ipad is a better tool than laptop. I am a strong believer that any technology which mimics the current process and improves on it without complicating it will be the final successfully accepted technology.
I can envision all the Medical practices will have a device like Ipad/or other tablet in every examination room.Once a patient is checked in. The person checking in would create and open the records of the patient for the doctor review.Check for all the things they do now and hand it over to attending doctor like they do with paper files now.Doctor reviews and examins the patient, makes recomendations including prescrptions.Patients goes back to the front desk and the attendent reviews required follow up and sends the instructions to required providers and bill for it while updating the records.
While filling prescription software checks and double checks for any allergies and conflicts in prescriptions.In future it may also check for the best cost effective choices for filling the prescrptions.
I KNOW IT MAY PLAY HAVOC IF IT WOULD ALSO CALCULATE COSTS OF THE PROCEDURES TO BE PERFORMED INSTANTLY AND INFORM THE BEST CHOICES ON THE BASIS OF COST AND OUTCOME BASIS.
The company has figured costs for Ipad in the range of 1500 dollars per unit against a laptop 2200 dollars.They think their are issues with support which need attention.
Conceptus is looking at a few apps on the App Store as a temporary fix, but the long-term goal is to implement a Citrix virtual desktop solution sometime next year, whereby documents reside on the server and are accessed via a native iPad app.
"Until we get some level of virtualization on the device for those tasks, we don't have a firm answer," Letasse says. "There's a gap between now and when we can go without a laptop."
In the case of EMR this problem does not exist as IPad will WI Fi connected with the web and a server with in few feets.
Why One Company is Ditching Sales Laptops for iPads
Take a look at the decision process behind one company's move to replace laptops with iPads and embrace the consumerization of enterprise IT - plus the training and security issues that have popped up.
http://www.cio.com/article/637864/Why_One_Company_is_Ditching_Sales_Laptops_for_iPads?page=2&taxonomyId=3004
This article analyses how Ipad is a better tool than laptop. I am a strong believer that any technology which mimics the current process and improves on it without complicating it will be the final successfully accepted technology.
I can envision all the Medical practices will have a device like Ipad/or other tablet in every examination room.Once a patient is checked in. The person checking in would create and open the records of the patient for the doctor review.Check for all the things they do now and hand it over to attending doctor like they do with paper files now.Doctor reviews and examins the patient, makes recomendations including prescrptions.Patients goes back to the front desk and the attendent reviews required follow up and sends the instructions to required providers and bill for it while updating the records.
While filling prescription software checks and double checks for any allergies and conflicts in prescriptions.In future it may also check for the best cost effective choices for filling the prescrptions.
I KNOW IT MAY PLAY HAVOC IF IT WOULD ALSO CALCULATE COSTS OF THE PROCEDURES TO BE PERFORMED INSTANTLY AND INFORM THE BEST CHOICES ON THE BASIS OF COST AND OUTCOME BASIS.
The company has figured costs for Ipad in the range of 1500 dollars per unit against a laptop 2200 dollars.They think their are issues with support which need attention.
Conceptus is looking at a few apps on the App Store as a temporary fix, but the long-term goal is to implement a Citrix virtual desktop solution sometime next year, whereby documents reside on the server and are accessed via a native iPad app.
"Until we get some level of virtualization on the device for those tasks, we don't have a firm answer," Letasse says. "There's a gap between now and when we can go without a laptop."
In the case of EMR this problem does not exist as IPad will WI Fi connected with the web and a server with in few feets.
Wednesday, November 17, 2010
Some ideas on EMR
As a national agenda to control costs and serve our population better Obama administaration has under taken and funded a mandate for EMR. A greate ammount of investment is being made in the IT of the medical delivery services to meat this goal.
With EMR and meaningful mandates the medical care will become more responsive to patients needs and deliver better care . I will be working with you ,to get the maximum benefits out of the process so that minorities and others who are extensive useres of hospital services may benefit from this investment of 100s of billion dollars.Education of patients ( through the effected communities) is integral part of that.representation of minority providers make it urgent for us to educate and train the youth in this field to provide the services .When we want to raise the standard of living in our communities it is important that we provide jobs to the one who do not have and upgrade the skills for all so that upward mobility is the norm not the exception.We need to be reminded that who are given a lotshould lift the one's who are left behind.
One way to uplift our community is to develop our talents locally by using our institutions to their fullest potential. Let us use all the advantages we have including proximity to learning institution of Mass and take advantage of using the experiences of state mandated health
Low cost care and developments in EMRS in that state .
things to study
What are the softwares used by hospital for EMRs
What are the softwares used by insurance companies that is blue cross,aetna,medicaid and medicare
What are the softwares used by providers (doctors,pharmacists,other providers )
Study the massachusset NEHEN software operablity.
Study what dept of health had plans for data and what sytem they were using.
Develop relationship with suppliers of software as agents and sell it to the service providers with ayearly billing to be aupported by federal funding for the project.
With EMR and meaningful mandates the medical care will become more responsive to patients needs and deliver better care . I will be working with you ,to get the maximum benefits out of the process so that minorities and others who are extensive useres of hospital services may benefit from this investment of 100s of billion dollars.Education of patients ( through the effected communities) is integral part of that.representation of minority providers make it urgent for us to educate and train the youth in this field to provide the services .When we want to raise the standard of living in our communities it is important that we provide jobs to the one who do not have and upgrade the skills for all so that upward mobility is the norm not the exception.We need to be reminded that who are given a lotshould lift the one's who are left behind.
One way to uplift our community is to develop our talents locally by using our institutions to their fullest potential. Let us use all the advantages we have including proximity to learning institution of Mass and take advantage of using the experiences of state mandated health
Low cost care and developments in EMRS in that state .
things to study
What are the softwares used by hospital for EMRs
What are the softwares used by insurance companies that is blue cross,aetna,medicaid and medicare
What are the softwares used by providers (doctors,pharmacists,other providers )
Study the massachusset NEHEN software operablity.
Study what dept of health had plans for data and what sytem they were using.
Develop relationship with suppliers of software as agents and sell it to the service providers with ayearly billing to be aupported by federal funding for the project.
This is the first post on Halamaka's bad day
I will be posting articles concerning EMR and my research on the subject.
Here is a nice article,chronicling the events when all systems went down for the hospital in 2002.This showes the travails of best among us.In the end Dr Halamka shares his experience for the benefit of everybody.
Halamka on Beth Israel's Health-Care IT Disaster
By Scott Berinato
Sat, February 15, 2003
http://www.cio.com/article/31701/Halamka_on_Beth_Israel_s_Health_Care_IT_Disaster?page=3&taxonomyId=3071
Here is a nice article,chronicling the events when all systems went down for the hospital in 2002.This showes the travails of best among us.In the end Dr Halamka shares his experience for the benefit of everybody.
Halamka on Beth Israel's Health-Care IT Disaster
By Scott Berinato
Sat, February 15, 2003
http://www.cio.com/article/31701/Halamka_on_Beth_Israel_s_Health_Care_IT_Disaster?page=3&taxonomyId=3071
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