Health IT

Smartphone use by hospitalists and other hospital staff is becoming ubiquitous, with a recent survey showing 72% of physicians using these devices at work.¹ At the same time, concerns are being raised about clinical distractions and threats to patient privacy, even while such benefits as rapid access to colleagues, medical references, and patient records are touted.

In a study published in the Journal of Hospital Medicine, Rachel Katz-Sidlow, MD, of the department of pediatrics at Jacobi Medical Center in Bronx, N.Y., and colleagues surveyed residents’ and attendings’ perceptions of the use of smartphones during inpatient rounds, both their own and observed behaviors of colleagues.² Fifty-seven percent of residents and 28% of faculty reported using smartphones during inpatient rounds, while significantly higher percentages observed other team members doing so.

The most common smartphone uses were for patient care, but doctors also use them to read and reply to personal texts and emails, as well as for non-patient-care-related Web searches. The authors observe that smartphones “introduce another source of interruption, multitasking, and distraction into the hospital environment,” with potential negative consequences.

Nineteen percent of residents believed they had missed important clinical information because of smartphone distraction during rounds. After seeing the survey results, Jacobi Medical Center instituted a smartphone policy in February 2012, essentially requiring personal mobile communication devices to be silenced at the start of rounds, except for patient care communication or urgent family matters, Dr. Katz-Sidlow wrote in an email to the The Hospitalist.

Confirmation of the spread of communication technology in the hospital toward smartphones and away from traditional pagers comes from data presented at the American Academy of Pediatrics conference in New Orleans in October by Stephanie Kuhlmann, MD, pediatric hospitalist at the University of Kansas at Wichita.³ Dr. Kuhlmann conducted an electronic survey of pediatric hospitalists, with 60% reporting that they receive work-related text messages. Twelve percent sent more than 10 text messages per shift, while 40% expressed concern about HIPAA violations. Most text messages are not encrypted, and many hospitals have yet to implement appropriately secure programs and policies, Dr. Kuhlmann says.

“Hospitals need to be aware of this trend and need to find a way to secure these text messages,” she adds.

Another recent survey by the Orem, Utah-based firm KLAS Research found that while 70% of clinicians report using smartphones or tablets to look up electronic patient records, they are less likely to input information into the EHR on these devices because of the difficulty of entering data on their small screens.⁴

References

1. Dolan B. 72 percent of US physicians use smartphones. Mobi Health News website. Available at: http://mobihealthnews.com/7505/72-percent-of-us-physicians-use-smartphones/. Accessed Dec. 8, 2012.
2. Katz-Sidlow RJ, Ludwig A, Millers S, Sidlow R. Smartphone use during inpatient attending rounds: prevalence, patterns and potential for distraction. J Hosp Med. 2012;7(8):595-599.
3. Miller NS. Text messages are a growing trend among pediatric hospitalists. Pediatric News Digital Network website. Available at: http://www.pediatricnews.com/news/top-news/single-article/text-messages-are-a-growing-trend-among-pediatric-hospitalists/3dabf7208c75c44d36f368a83221d320.html. Accessed Nov. 1, 2012.
4. Westerlind E. Mobile healthcare applications: can enterprise vendors keep up? KLAS website. Available at: http://www.klasresearch.com/KLASreports. Accessed Dec. 8, 2012.

Smartphone use by hospitalists and other hospital staff is becoming ubiquitous, with a recent survey showing 72% of physicians using these devices at work.¹ At the same time, concerns are being raised about clinical distractions and threats to patient privacy, even while such benefits as rapid access to colleagues, medical references, and patient records are touted.

In a study published in the Journal of Hospital Medicine, Rachel Katz-Sidlow, MD, of the department of pediatrics at Jacobi Medical Center in Bronx, N.Y., and colleagues surveyed residents’ and attendings’ perceptions of the use of smartphones during inpatient rounds, both their own and observed behaviors of colleagues.² Fifty-seven percent of residents and 28% of faculty reported using smartphones during inpatient rounds, while significantly higher percentages observed other team members doing so.

The most common smartphone uses were for patient care, but doctors also use them to read and reply to personal texts and emails, as well as for non-patient-care-related Web searches. The authors observe that smartphones “introduce another source of interruption, multitasking, and distraction into the hospital environment,” with potential negative consequences.

Nineteen percent of residents believed they had missed important clinical information because of smartphone distraction during rounds. After seeing the survey results, Jacobi Medical Center instituted a smartphone policy in February 2012, essentially requiring personal mobile communication devices to be silenced at the start of rounds, except for patient care communication or urgent family matters, Dr. Katz-Sidlow wrote in an email to the The Hospitalist.

Confirmation of the spread of communication technology in the hospital toward smartphones and away from traditional pagers comes from data presented at the American Academy of Pediatrics conference in New Orleans in October by Stephanie Kuhlmann, MD, pediatric hospitalist at the University of Kansas at Wichita.³ Dr. Kuhlmann conducted an electronic survey of pediatric hospitalists, with 60% reporting that they receive work-related text messages. Twelve percent sent more than 10 text messages per shift, while 40% expressed concern about HIPAA violations. Most text messages are not encrypted, and many hospitals have yet to implement appropriately secure programs and policies, Dr. Kuhlmann says.

“Hospitals need to be aware of this trend and need to find a way to secure these text messages,” she adds.

Another recent survey by the Orem, Utah-based firm KLAS Research found that while 70% of clinicians report using smartphones or tablets to look up electronic patient records, they are less likely to input information into the EHR on these devices because of the difficulty of entering data on their small screens.⁴

References

1. Dolan B. 72 percent of US physicians use smartphones. Mobi Health News website. Available at: http://mobihealthnews.com/7505/72-percent-of-us-physicians-use-smartphones/. Accessed Dec. 8, 2012.
2. Katz-Sidlow RJ, Ludwig A, Millers S, Sidlow R. Smartphone use during inpatient attending rounds: prevalence, patterns and potential for distraction. J Hosp Med. 2012;7(8):595-599.
3. Miller NS. Text messages are a growing trend among pediatric hospitalists. Pediatric News Digital Network website. Available at: http://www.pediatricnews.com/news/top-news/single-article/text-messages-are-a-growing-trend-among-pediatric-hospitalists/3dabf7208c75c44d36f368a83221d320.html. Accessed Nov. 1, 2012.
4. Westerlind E. Mobile healthcare applications: can enterprise vendors keep up? KLAS website. Available at: http://www.klasresearch.com/KLASreports. Accessed Dec. 8, 2012.

Smartphone use by hospitalists and other hospital staff is becoming ubiquitous, with a recent survey showing 72% of physicians using these devices at work.¹ At the same time, concerns are being raised about clinical distractions and threats to patient privacy, even while such benefits as rapid access to colleagues, medical references, and patient records are touted.

In a study published in the Journal of Hospital Medicine, Rachel Katz-Sidlow, MD, of the department of pediatrics at Jacobi Medical Center in Bronx, N.Y., and colleagues surveyed residents’ and attendings’ perceptions of the use of smartphones during inpatient rounds, both their own and observed behaviors of colleagues.² Fifty-seven percent of residents and 28% of faculty reported using smartphones during inpatient rounds, while significantly higher percentages observed other team members doing so.

The most common smartphone uses were for patient care, but doctors also use them to read and reply to personal texts and emails, as well as for non-patient-care-related Web searches. The authors observe that smartphones “introduce another source of interruption, multitasking, and distraction into the hospital environment,” with potential negative consequences.

Nineteen percent of residents believed they had missed important clinical information because of smartphone distraction during rounds. After seeing the survey results, Jacobi Medical Center instituted a smartphone policy in February 2012, essentially requiring personal mobile communication devices to be silenced at the start of rounds, except for patient care communication or urgent family matters, Dr. Katz-Sidlow wrote in an email to the The Hospitalist.

Confirmation of the spread of communication technology in the hospital toward smartphones and away from traditional pagers comes from data presented at the American Academy of Pediatrics conference in New Orleans in October by Stephanie Kuhlmann, MD, pediatric hospitalist at the University of Kansas at Wichita.³ Dr. Kuhlmann conducted an electronic survey of pediatric hospitalists, with 60% reporting that they receive work-related text messages. Twelve percent sent more than 10 text messages per shift, while 40% expressed concern about HIPAA violations. Most text messages are not encrypted, and many hospitals have yet to implement appropriately secure programs and policies, Dr. Kuhlmann says.

“Hospitals need to be aware of this trend and need to find a way to secure these text messages,” she adds.

Another recent survey by the Orem, Utah-based firm KLAS Research found that while 70% of clinicians report using smartphones or tablets to look up electronic patient records, they are less likely to input information into the EHR on these devices because of the difficulty of entering data on their small screens.⁴

References

1. Dolan B. 72 percent of US physicians use smartphones. Mobi Health News website. Available at: http://mobihealthnews.com/7505/72-percent-of-us-physicians-use-smartphones/. Accessed Dec. 8, 2012.
2. Katz-Sidlow RJ, Ludwig A, Millers S, Sidlow R. Smartphone use during inpatient attending rounds: prevalence, patterns and potential for distraction. J Hosp Med. 2012;7(8):595-599.
3. Miller NS. Text messages are a growing trend among pediatric hospitalists. Pediatric News Digital Network website. Available at: http://www.pediatricnews.com/news/top-news/single-article/text-messages-are-a-growing-trend-among-pediatric-hospitalists/3dabf7208c75c44d36f368a83221d320.html. Accessed Nov. 1, 2012.
4. Westerlind E. Mobile healthcare applications: can enterprise vendors keep up? KLAS website. Available at: http://www.klasresearch.com/KLASreports. Accessed Dec. 8, 2012.

Years ago, hospitalists were introduced as new, efficient options for staffing hospitals. Today, they are known as the quarterbacks for patient care and quality improvement (QI) within the hospital.

This year, hospitalists everywhere can help their hospitals resolve to make 2013 a landmark year for QI. And making time for quality improvement need not be a major investment, nor do you have to “reinvent the wheel” and create your own programs.

SHM’s full menu of QI options gives hospitalists and other caregivers the confidence that their program is field-tested as well as the ability to choose the level of involvement that’s right for them.

For more information, visit www.hospitalmedicine.org/qi.

Years ago, hospitalists were introduced as new, efficient options for staffing hospitals. Today, they are known as the quarterbacks for patient care and quality improvement (QI) within the hospital.

This year, hospitalists everywhere can help their hospitals resolve to make 2013 a landmark year for QI. And making time for quality improvement need not be a major investment, nor do you have to “reinvent the wheel” and create your own programs.

SHM’s full menu of QI options gives hospitalists and other caregivers the confidence that their program is field-tested as well as the ability to choose the level of involvement that’s right for them.

For more information, visit www.hospitalmedicine.org/qi.

Years ago, hospitalists were introduced as new, efficient options for staffing hospitals. Today, they are known as the quarterbacks for patient care and quality improvement (QI) within the hospital.

This year, hospitalists everywhere can help their hospitals resolve to make 2013 a landmark year for QI. And making time for quality improvement need not be a major investment, nor do you have to “reinvent the wheel” and create your own programs.

SHM’s full menu of QI options gives hospitalists and other caregivers the confidence that their program is field-tested as well as the ability to choose the level of involvement that’s right for them.

For more information, visit www.hospitalmedicine.org/qi.

It’s great to be a Tennessee Volunteer. I said, It’s great to be a Tennessee Volunteer!

The crowd, a sea of orange, packs into Neyland Stadium in Knoxville, Tenn., brimming with pride, dedicated to the team they call the Vols. Neyland Stadium, built in 1921, comfortably seats more than 100,000 brash fans on most fall weekends during the college football season. These die-hard fans pack the stadium regularly, hoping to catch a glimpse of victory.

Throughout the decades of Tennessee Volunteers football, numerous coaches have spent countless hours thinking about how to realize those victories. And they have also spent a lot time thinking about how to keep their players safe. Each coach has had different styles and tactics, but all had one thing in common: They were clearly invested in keeping their players safe. A safe player is a good player, one who can make the full season without injury. As such, before each practice and each game, the players don the gear required to play the safest game possible.

This gear is expensive, difficult to put on, difficult to keep on, makes them run slower, and makes them sweat heavier. When you think about it, it is a wonder that they wear it at all—unless you consider the fact that each precisely placed article takes them one step closer to surviving the game intact, and making it to the next victory. Just like any other type of protective equipment, football equipment has evolved over the course of time. The helmet, for example, is now custom-fit for each player with calipers, and then subsequent additions are applied to ensure durability, shock resistance, and comfort. Relatively new additions include eye shields (to protect the eyes and reduce glare) and even radio devices (to allow the coach to relay last-minute critical information to the quarterback). These helmets are all customized to the players’ position, to allow for the best balance between protection and visibility.

And the helmet is just the beginning. The remaining bare minimum amount of gear needed for standard player safety includes a mouthpiece, jaw pads, neck roll, shoulder pads, shock pads, rib pads, hip pads, knee pads, and cleats. All told, the weight of all this equipment is between 10 and 25 pounds and takes up to an hour to fully gear up. But nonetheless, it has become such a mainstay, of centralized importance to the game, that each team has a dedicated equipment manager. They are charged with providing, maintaining, and transporting the best gear for every member of the team. The equipment manager is a vital resource for the team and the sport.

Despite the extra weight and inconvenience that their gear can burden them with, you don’t see a single football player “skimp” on it. And it would certainly be obvious to all those around them if they ran onto the field without their helmet. Over the years, the football industry has not abandoned gear that they thought was less than perfect, too heavy, too bulky, or made the player perform with less agility. They just made the gear better, lighter, more comfortable, and more protective.

You Can Do This

In a similar fashion, hospital providers have become increasingly interested in keeping themselves—and the patient—safe. But have we come to consensus on who the coach and equipment managers should be, and what the essential elements of the gear should be? I would argue there are a number of coaches and equipment managers in the hospital setting whose mission is to keep their “players” safe. The players are both patients and providers, as generally a “safe provider” is one who makes and implements solid decisions, and who is housed within a safe, predictable, and highly-reliable system, is also one who can and will keep their patients safe.

We may not think of ourselves as such, but hospitalists can be extremely effective coaches and equipment managers. They can help create and maintain safe and effective gear for themselves and those patients and providers around them. They can be a mentor for displaying how vitally import this gear is and can work to improve it when it proves to be imperfect.

Although we don’t tend to think of these things as “safety gear,” these things do, in fact, keep us and our patients safe. Some of these include:

• Computerized physician order entry (CPOE) with decision support (or order sets without CPOE);
• Checklists;
• Procedural time-outs;
• Protocols;
• Medication dosing guidelines;
• Handheld devices (for quick lookup of medication doses, side effects, predictive scoring systems, medical calculators, etc.); and
• Gowns and gloves.

Additional “gear” for the patients can include:

• Arm bands for identification and medication scanning;
• Telemetry;
• Bed alarms;
• IV pumps with guard rails around dosing;
• Antibiotic impregnated central lines; and
• Early mobilization protocols.

The Next Level

To take the medical industry to the next level of safe reliability, we need all providers to accept and embrace the concept of “safety gear” for themselves and for their patients. We need to make it perfectly obvious when that gear is missing. It should invoke a reaction of ghastly fear when we witness anyone (provider, patient, or family) skimping on their gear: removing an armband for convenience, bypassing a smart pump, or skipping decision support in CPOE. And for the current gear that is imperfect, slows us down, beeps too often, or reduces our agility, the solution should include improving the gear, not ignoring it or discounting its importance.

So before you go to work today (every day?), think about what you need to keep yourself and your patients safe. And get your gear on.

Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at scheured@musc.edu.

It’s great to be a Tennessee Volunteer. I said, It’s great to be a Tennessee Volunteer!

The crowd, a sea of orange, packs into Neyland Stadium in Knoxville, Tenn., brimming with pride, dedicated to the team they call the Vols. Neyland Stadium, built in 1921, comfortably seats more than 100,000 brash fans on most fall weekends during the college football season. These die-hard fans pack the stadium regularly, hoping to catch a glimpse of victory.

Throughout the decades of Tennessee Volunteers football, numerous coaches have spent countless hours thinking about how to realize those victories. And they have also spent a lot time thinking about how to keep their players safe. Each coach has had different styles and tactics, but all had one thing in common: They were clearly invested in keeping their players safe. A safe player is a good player, one who can make the full season without injury. As such, before each practice and each game, the players don the gear required to play the safest game possible.

This gear is expensive, difficult to put on, difficult to keep on, makes them run slower, and makes them sweat heavier. When you think about it, it is a wonder that they wear it at all—unless you consider the fact that each precisely placed article takes them one step closer to surviving the game intact, and making it to the next victory. Just like any other type of protective equipment, football equipment has evolved over the course of time. The helmet, for example, is now custom-fit for each player with calipers, and then subsequent additions are applied to ensure durability, shock resistance, and comfort. Relatively new additions include eye shields (to protect the eyes and reduce glare) and even radio devices (to allow the coach to relay last-minute critical information to the quarterback). These helmets are all customized to the players’ position, to allow for the best balance between protection and visibility.

And the helmet is just the beginning. The remaining bare minimum amount of gear needed for standard player safety includes a mouthpiece, jaw pads, neck roll, shoulder pads, shock pads, rib pads, hip pads, knee pads, and cleats. All told, the weight of all this equipment is between 10 and 25 pounds and takes up to an hour to fully gear up. But nonetheless, it has become such a mainstay, of centralized importance to the game, that each team has a dedicated equipment manager. They are charged with providing, maintaining, and transporting the best gear for every member of the team. The equipment manager is a vital resource for the team and the sport.

Despite the extra weight and inconvenience that their gear can burden them with, you don’t see a single football player “skimp” on it. And it would certainly be obvious to all those around them if they ran onto the field without their helmet. Over the years, the football industry has not abandoned gear that they thought was less than perfect, too heavy, too bulky, or made the player perform with less agility. They just made the gear better, lighter, more comfortable, and more protective.

You Can Do This

In a similar fashion, hospital providers have become increasingly interested in keeping themselves—and the patient—safe. But have we come to consensus on who the coach and equipment managers should be, and what the essential elements of the gear should be? I would argue there are a number of coaches and equipment managers in the hospital setting whose mission is to keep their “players” safe. The players are both patients and providers, as generally a “safe provider” is one who makes and implements solid decisions, and who is housed within a safe, predictable, and highly-reliable system, is also one who can and will keep their patients safe.

We may not think of ourselves as such, but hospitalists can be extremely effective coaches and equipment managers. They can help create and maintain safe and effective gear for themselves and those patients and providers around them. They can be a mentor for displaying how vitally import this gear is and can work to improve it when it proves to be imperfect.

Although we don’t tend to think of these things as “safety gear,” these things do, in fact, keep us and our patients safe. Some of these include:

• Computerized physician order entry (CPOE) with decision support (or order sets without CPOE);
• Checklists;
• Procedural time-outs;
• Protocols;
• Medication dosing guidelines;
• Handheld devices (for quick lookup of medication doses, side effects, predictive scoring systems, medical calculators, etc.); and
• Gowns and gloves.

Additional “gear” for the patients can include:

• Arm bands for identification and medication scanning;
• Telemetry;
• Bed alarms;
• IV pumps with guard rails around dosing;
• Antibiotic impregnated central lines; and
• Early mobilization protocols.

The Next Level

To take the medical industry to the next level of safe reliability, we need all providers to accept and embrace the concept of “safety gear” for themselves and for their patients. We need to make it perfectly obvious when that gear is missing. It should invoke a reaction of ghastly fear when we witness anyone (provider, patient, or family) skimping on their gear: removing an armband for convenience, bypassing a smart pump, or skipping decision support in CPOE. And for the current gear that is imperfect, slows us down, beeps too often, or reduces our agility, the solution should include improving the gear, not ignoring it or discounting its importance.

So before you go to work today (every day?), think about what you need to keep yourself and your patients safe. And get your gear on.

Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at scheured@musc.edu.

It’s great to be a Tennessee Volunteer. I said, It’s great to be a Tennessee Volunteer!

The crowd, a sea of orange, packs into Neyland Stadium in Knoxville, Tenn., brimming with pride, dedicated to the team they call the Vols. Neyland Stadium, built in 1921, comfortably seats more than 100,000 brash fans on most fall weekends during the college football season. These die-hard fans pack the stadium regularly, hoping to catch a glimpse of victory.

Throughout the decades of Tennessee Volunteers football, numerous coaches have spent countless hours thinking about how to realize those victories. And they have also spent a lot time thinking about how to keep their players safe. Each coach has had different styles and tactics, but all had one thing in common: They were clearly invested in keeping their players safe. A safe player is a good player, one who can make the full season without injury. As such, before each practice and each game, the players don the gear required to play the safest game possible.

This gear is expensive, difficult to put on, difficult to keep on, makes them run slower, and makes them sweat heavier. When you think about it, it is a wonder that they wear it at all—unless you consider the fact that each precisely placed article takes them one step closer to surviving the game intact, and making it to the next victory. Just like any other type of protective equipment, football equipment has evolved over the course of time. The helmet, for example, is now custom-fit for each player with calipers, and then subsequent additions are applied to ensure durability, shock resistance, and comfort. Relatively new additions include eye shields (to protect the eyes and reduce glare) and even radio devices (to allow the coach to relay last-minute critical information to the quarterback). These helmets are all customized to the players’ position, to allow for the best balance between protection and visibility.

And the helmet is just the beginning. The remaining bare minimum amount of gear needed for standard player safety includes a mouthpiece, jaw pads, neck roll, shoulder pads, shock pads, rib pads, hip pads, knee pads, and cleats. All told, the weight of all this equipment is between 10 and 25 pounds and takes up to an hour to fully gear up. But nonetheless, it has become such a mainstay, of centralized importance to the game, that each team has a dedicated equipment manager. They are charged with providing, maintaining, and transporting the best gear for every member of the team. The equipment manager is a vital resource for the team and the sport.

Despite the extra weight and inconvenience that their gear can burden them with, you don’t see a single football player “skimp” on it. And it would certainly be obvious to all those around them if they ran onto the field without their helmet. Over the years, the football industry has not abandoned gear that they thought was less than perfect, too heavy, too bulky, or made the player perform with less agility. They just made the gear better, lighter, more comfortable, and more protective.

You Can Do This

In a similar fashion, hospital providers have become increasingly interested in keeping themselves—and the patient—safe. But have we come to consensus on who the coach and equipment managers should be, and what the essential elements of the gear should be? I would argue there are a number of coaches and equipment managers in the hospital setting whose mission is to keep their “players” safe. The players are both patients and providers, as generally a “safe provider” is one who makes and implements solid decisions, and who is housed within a safe, predictable, and highly-reliable system, is also one who can and will keep their patients safe.

We may not think of ourselves as such, but hospitalists can be extremely effective coaches and equipment managers. They can help create and maintain safe and effective gear for themselves and those patients and providers around them. They can be a mentor for displaying how vitally import this gear is and can work to improve it when it proves to be imperfect.

Although we don’t tend to think of these things as “safety gear,” these things do, in fact, keep us and our patients safe. Some of these include:

• Computerized physician order entry (CPOE) with decision support (or order sets without CPOE);
• Checklists;
• Procedural time-outs;
• Protocols;
• Medication dosing guidelines;
• Handheld devices (for quick lookup of medication doses, side effects, predictive scoring systems, medical calculators, etc.); and
• Gowns and gloves.

Additional “gear” for the patients can include:

• Arm bands for identification and medication scanning;
• Telemetry;
• Bed alarms;
• IV pumps with guard rails around dosing;
• Antibiotic impregnated central lines; and
• Early mobilization protocols.

The Next Level

To take the medical industry to the next level of safe reliability, we need all providers to accept and embrace the concept of “safety gear” for themselves and for their patients. We need to make it perfectly obvious when that gear is missing. It should invoke a reaction of ghastly fear when we witness anyone (provider, patient, or family) skimping on their gear: removing an armband for convenience, bypassing a smart pump, or skipping decision support in CPOE. And for the current gear that is imperfect, slows us down, beeps too often, or reduces our agility, the solution should include improving the gear, not ignoring it or discounting its importance.

So before you go to work today (every day?), think about what you need to keep yourself and your patients safe. And get your gear on.

Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at scheured@musc.edu.

Electronic decision support significantly improves VTE prophylaxis and hospital-acquired VTE rates, according to a new study in the Journal of Hospital Medicine.

The report, "Improving Hospital Venous Thromboembolism Prophylaxis With Electronic Decision Report," saw overall medical service prophylaxis rise to 82.1% from 61.9% (P<0.001) and pharmacologic VTE prophylaxis increase to 74.5% from 59% (P<0.001).

"Healthcare leaders talk about information technology (IT) as a means toward effecting improvements in quality and patient safety and, most of the time, they view that and discuss that in terms of the actual IT system being implemented," says lead author Rohit Bhalla, MD, MPH, associate professor of clinical medicine at Albert Einstein College of Medicine in New York City. "What our intervention really got to was once you've implemented an IT system ... how can it be modified, vis-à-vis decision support, so that it provides an even better result than you get with the product that comes out of the box."

Tailoring a health IT system to improve outcomes requires interdisciplinary work that includes quality officers, physicians, IT staff, and programmers. Hospitalist and fellow author Jason Adelman, MD, MS, patient safety officer at Montefiore Medical Center in the Bronx, N.Y., where the study was conducted, says that the research can help generate future buy-in from physicians who don't value electronic decision support tools.

It can "ease the swallowing of the bitter pill to know that it really makes a difference," Dr. Adelman says. "Don't be up in arms when you're forced to do something a little bit extra, because it really works."

Visit our website for more information about health information technology.

Electronic decision support significantly improves VTE prophylaxis and hospital-acquired VTE rates, according to a new study in the Journal of Hospital Medicine.

The report, "Improving Hospital Venous Thromboembolism Prophylaxis With Electronic Decision Report," saw overall medical service prophylaxis rise to 82.1% from 61.9% (P<0.001) and pharmacologic VTE prophylaxis increase to 74.5% from 59% (P<0.001).

"Healthcare leaders talk about information technology (IT) as a means toward effecting improvements in quality and patient safety and, most of the time, they view that and discuss that in terms of the actual IT system being implemented," says lead author Rohit Bhalla, MD, MPH, associate professor of clinical medicine at Albert Einstein College of Medicine in New York City. "What our intervention really got to was once you've implemented an IT system ... how can it be modified, vis-à-vis decision support, so that it provides an even better result than you get with the product that comes out of the box."

Tailoring a health IT system to improve outcomes requires interdisciplinary work that includes quality officers, physicians, IT staff, and programmers. Hospitalist and fellow author Jason Adelman, MD, MS, patient safety officer at Montefiore Medical Center in the Bronx, N.Y., where the study was conducted, says that the research can help generate future buy-in from physicians who don't value electronic decision support tools.

It can "ease the swallowing of the bitter pill to know that it really makes a difference," Dr. Adelman says. "Don't be up in arms when you're forced to do something a little bit extra, because it really works."

Visit our website for more information about health information technology.

Electronic decision support significantly improves VTE prophylaxis and hospital-acquired VTE rates, according to a new study in the Journal of Hospital Medicine.

The report, "Improving Hospital Venous Thromboembolism Prophylaxis With Electronic Decision Report," saw overall medical service prophylaxis rise to 82.1% from 61.9% (P<0.001) and pharmacologic VTE prophylaxis increase to 74.5% from 59% (P<0.001).

"Healthcare leaders talk about information technology (IT) as a means toward effecting improvements in quality and patient safety and, most of the time, they view that and discuss that in terms of the actual IT system being implemented," says lead author Rohit Bhalla, MD, MPH, associate professor of clinical medicine at Albert Einstein College of Medicine in New York City. "What our intervention really got to was once you've implemented an IT system ... how can it be modified, vis-à-vis decision support, so that it provides an even better result than you get with the product that comes out of the box."

Tailoring a health IT system to improve outcomes requires interdisciplinary work that includes quality officers, physicians, IT staff, and programmers. Hospitalist and fellow author Jason Adelman, MD, MS, patient safety officer at Montefiore Medical Center in the Bronx, N.Y., where the study was conducted, says that the research can help generate future buy-in from physicians who don't value electronic decision support tools.

It can "ease the swallowing of the bitter pill to know that it really makes a difference," Dr. Adelman says. "Don't be up in arms when you're forced to do something a little bit extra, because it really works."

Visit our website for more information about health information technology.

Hospital-based eligible professionals do not qualify for the Medicare or Medicaid electronic health record (EHR) incentive program or the impending payment penalties for not being “meaningful users” of EHR technology.

A hospital-based “eligible professional” (EP) is defined by the Centers for Medicare & Medicaid Services (CMS) as an EP who furnishes 90% or more of their covered professional services in either the inpatient or emergency departments of a hospital. This exemption applies to most hospitalists and recognizes they have very little control over whether their respective institutions invest in this technology.

Although this 90% threshold should qualify most hospitalists for the exemption, it does not tell the entire story. A growing number of hospitalists are spending time rounding in skilled nursing or other post-acute facilities, and some are focusing the entirety of their practice in the post-acute setting. Under the current CMS definition, these hospitalists are not hospital-based and will, therefore, be subject to the upcoming penalties for not being meaningful users of EHR technology.

Contrary to the 90% threshold, the reality for post-acute hospitalists is that when it comes to EHRs, they are no different than their hospital-based colleagues. A hospitalist, irrespective of setting, has very little control over what kind of technology, if any, a facility invests in.

For hospitalists who are rounding or spending more of their practice time in post-acute facilities, this mechanical classification based on practice location alone is problematic. A physician-implemented EHR is not practical and does not make sense given the unique practice patterns of hospitalists. Although SHM remains strongly committed to the promise represented by health information technology (HIT), SHM consistently has noted to CMS that hospitalist practice does not always fit the confines of their rulemaking.

Hospitalists should not be penalized for failure to implement their own HIT, because they already use facility EHRs or lack control over the availability of EHR systems. It is for these reasons that SHM has been a strong advocate for an additional exemption that works for hospitalists—an exemption that recognizes lack of control of availability.

In August, CMS released the final rule for Stage 2 of Meaningful Use, and the voice of hospitalists was clearly heard. The rule includes an SHM advanced-hardship exemption acknowledging that EPs who practice in multiple locations, such as nursing homes, could face a significant hardship as they would have no way to control the use of Certified EHR Technology (CEHRT). In promulgating the exemption, CMS specifically states that a “physician merely sees patients at the center or home, and does not have any other interest in the facility; they would exert little to no influence over whether the nursing home, center, or other similar outpatient site adopts and implements CEHRT.” Hospitalists seeking this exemption would need to apply annually for up to five years.

This hardship exemption could apply to hospitalists who work in multiple facilities outside of hospitals, such as nursing homes. Although imperfect due to the time-limited nature, the exemption represents a victory in the effort to differentiate HM from traditional practice patterns. It is precisely this difference that makes HM uniquely positioned to lead changes in the healthcare system.

Josh Boswell is SHM’s interim senior manager of government relations.

Hospital-based eligible professionals do not qualify for the Medicare or Medicaid electronic health record (EHR) incentive program or the impending payment penalties for not being “meaningful users” of EHR technology.

A hospital-based “eligible professional” (EP) is defined by the Centers for Medicare & Medicaid Services (CMS) as an EP who furnishes 90% or more of their covered professional services in either the inpatient or emergency departments of a hospital. This exemption applies to most hospitalists and recognizes they have very little control over whether their respective institutions invest in this technology.

Although this 90% threshold should qualify most hospitalists for the exemption, it does not tell the entire story. A growing number of hospitalists are spending time rounding in skilled nursing or other post-acute facilities, and some are focusing the entirety of their practice in the post-acute setting. Under the current CMS definition, these hospitalists are not hospital-based and will, therefore, be subject to the upcoming penalties for not being meaningful users of EHR technology.

Contrary to the 90% threshold, the reality for post-acute hospitalists is that when it comes to EHRs, they are no different than their hospital-based colleagues. A hospitalist, irrespective of setting, has very little control over what kind of technology, if any, a facility invests in.

For hospitalists who are rounding or spending more of their practice time in post-acute facilities, this mechanical classification based on practice location alone is problematic. A physician-implemented EHR is not practical and does not make sense given the unique practice patterns of hospitalists. Although SHM remains strongly committed to the promise represented by health information technology (HIT), SHM consistently has noted to CMS that hospitalist practice does not always fit the confines of their rulemaking.

Hospitalists should not be penalized for failure to implement their own HIT, because they already use facility EHRs or lack control over the availability of EHR systems. It is for these reasons that SHM has been a strong advocate for an additional exemption that works for hospitalists—an exemption that recognizes lack of control of availability.

In August, CMS released the final rule for Stage 2 of Meaningful Use, and the voice of hospitalists was clearly heard. The rule includes an SHM advanced-hardship exemption acknowledging that EPs who practice in multiple locations, such as nursing homes, could face a significant hardship as they would have no way to control the use of Certified EHR Technology (CEHRT). In promulgating the exemption, CMS specifically states that a “physician merely sees patients at the center or home, and does not have any other interest in the facility; they would exert little to no influence over whether the nursing home, center, or other similar outpatient site adopts and implements CEHRT.” Hospitalists seeking this exemption would need to apply annually for up to five years.

This hardship exemption could apply to hospitalists who work in multiple facilities outside of hospitals, such as nursing homes. Although imperfect due to the time-limited nature, the exemption represents a victory in the effort to differentiate HM from traditional practice patterns. It is precisely this difference that makes HM uniquely positioned to lead changes in the healthcare system.

Josh Boswell is SHM’s interim senior manager of government relations.

Hospital-based eligible professionals do not qualify for the Medicare or Medicaid electronic health record (EHR) incentive program or the impending payment penalties for not being “meaningful users” of EHR technology.

A hospital-based “eligible professional” (EP) is defined by the Centers for Medicare & Medicaid Services (CMS) as an EP who furnishes 90% or more of their covered professional services in either the inpatient or emergency departments of a hospital. This exemption applies to most hospitalists and recognizes they have very little control over whether their respective institutions invest in this technology.

Although this 90% threshold should qualify most hospitalists for the exemption, it does not tell the entire story. A growing number of hospitalists are spending time rounding in skilled nursing or other post-acute facilities, and some are focusing the entirety of their practice in the post-acute setting. Under the current CMS definition, these hospitalists are not hospital-based and will, therefore, be subject to the upcoming penalties for not being meaningful users of EHR technology.

Contrary to the 90% threshold, the reality for post-acute hospitalists is that when it comes to EHRs, they are no different than their hospital-based colleagues. A hospitalist, irrespective of setting, has very little control over what kind of technology, if any, a facility invests in.

For hospitalists who are rounding or spending more of their practice time in post-acute facilities, this mechanical classification based on practice location alone is problematic. A physician-implemented EHR is not practical and does not make sense given the unique practice patterns of hospitalists. Although SHM remains strongly committed to the promise represented by health information technology (HIT), SHM consistently has noted to CMS that hospitalist practice does not always fit the confines of their rulemaking.

Hospitalists should not be penalized for failure to implement their own HIT, because they already use facility EHRs or lack control over the availability of EHR systems. It is for these reasons that SHM has been a strong advocate for an additional exemption that works for hospitalists—an exemption that recognizes lack of control of availability.

In August, CMS released the final rule for Stage 2 of Meaningful Use, and the voice of hospitalists was clearly heard. The rule includes an SHM advanced-hardship exemption acknowledging that EPs who practice in multiple locations, such as nursing homes, could face a significant hardship as they would have no way to control the use of Certified EHR Technology (CEHRT). In promulgating the exemption, CMS specifically states that a “physician merely sees patients at the center or home, and does not have any other interest in the facility; they would exert little to no influence over whether the nursing home, center, or other similar outpatient site adopts and implements CEHRT.” Hospitalists seeking this exemption would need to apply annually for up to five years.

This hardship exemption could apply to hospitalists who work in multiple facilities outside of hospitals, such as nursing homes. Although imperfect due to the time-limited nature, the exemption represents a victory in the effort to differentiate HM from traditional practice patterns. It is precisely this difference that makes HM uniquely positioned to lead changes in the healthcare system.

Josh Boswell is SHM’s interim senior manager of government relations.

Hospitalists join SHM for lots of reasons, but the ability to network with hospitalists across the country is among the top motivators. In an emerging medical specialty, being able to collaborate and connect with peers is critical to career development and improving care.

Now, SHM has made connecting and collaborating easier than ever with Hospital Medicine Exchange (HMX), the first online community exclusively for hospitalists and hot topics in HM. Using HMX, hospitalists can start public discussions, post responses, and share files in one location.

For fast-moving issues, such as healthcare reform and hospitalist program management, HMX enables hospitalists to go straight to the source of some of the most important innovations: other hospitalists.

Using HMX is easy. Hospitalists log in to HMX using their SHM member username and password at HMXchange.org (automated assistance is available for those who don’t know their usernames or passwords). Once logged into HMX, hospitalists can browse communities, check out recent discussion threads, and update their profiles. Members can browse contacts to connect with thousands of other HMX users.

In addition to being the new home for conversations in hospital medicine, communities within HMX are replacing an array of legacy programs (e.g. the email listservs for practice management and SHM’s Leadership Academy alumni). HMX provides new flexibility not available in older systems like the listservs. Users can now opt into communities easily and decide how often they receive updates via email.

Conversation-Starters

Some hospitalists began collaborating with the HMX platform nearly a year ago. At the time, the platform was known as Higher Logic and supported SHM’s CODE-H, an educational program for hospital coding, along with SHM’s Hospital Value-Based Purchasing Toolkit (HVBP), a set of online resources and a community for hospitalists preparing their hospitals for value-based purchasing.

Patrick Torcson, MD, MMM, FACP, SFHM, led the HVBP community and sees the promise that HMX offers hospitalists. “It’s a nice synthesis of both content and resources because of the networking element,” he says. “It has a very real personal element as well.”

The HVBP community used HMX as equal parts educational session, networking, and library. Dr. Torcson and community members presented webinars, then followed up with discussions. Community members also shared resources about value-based purchasing through the discussion threads and the online library.

The immediate online interaction proved to be especially valuable when discussing a topic that was anything but static, he says.

“Because hospital value-based purchasing was unfolding over a timeline from [the Centers for Medicare & Medicaid Services (CMS)], we were able to add content as the program unfolded, including policy papers from Washington, webinars, and other relevant information,” Dr. Torcson explains. “For something like value-based purchasing, there’s no definitive source, so the collaboration was helpful. It’s true for a lot of topics in hospital medicine.

“To have a community tool like this that can accommodate for all the different inputs is really very valuable,” he adds.

HMX is a nice synthesis of both content and resources because of the networking element. It has a very real personal element as well.

—Patrick Torcson, MD, MMM, FACP, SFHM, chair, SHM’s Performance Measuring and Reporting Committee

Something for Every Member

In addition to a community for general issues affecting hospitalists, HMX also features specific communities designed to facilitate conversations on particular issues. As the communities evolve and conversations develop, SHM will add new communities.

Because so many hospitalists access the Internet from mobile devices, HMX is available for iPhones, iPads, and Android platforms through a third-party mobile application. Instructions for downloading and using the app are available at the HMX website.

SHM notified certain listserv users and others about the HMX introduction in August and September. Users quickly took to the new platform. Within a week of introducing HMX, nearly 100 hospitalists logged in for the first time.

The early interest in HMX isn’t surprising to Dr. Torcson, who says he “definitely” will use HMX in the future.

“It’s a great way to share best practices and case studies,” he says. “The personal dimension was really nice to connect so easily with the hospital medicine community. It’s nice to get the perspectives from other colleagues around the country and in different settings.”

Brendon Shank is SHM’s associate vice president of communications.

Hospitalists join SHM for lots of reasons, but the ability to network with hospitalists across the country is among the top motivators. In an emerging medical specialty, being able to collaborate and connect with peers is critical to career development and improving care.

Now, SHM has made connecting and collaborating easier than ever with Hospital Medicine Exchange (HMX), the first online community exclusively for hospitalists and hot topics in HM. Using HMX, hospitalists can start public discussions, post responses, and share files in one location.

For fast-moving issues, such as healthcare reform and hospitalist program management, HMX enables hospitalists to go straight to the source of some of the most important innovations: other hospitalists.

Using HMX is easy. Hospitalists log in to HMX using their SHM member username and password at HMXchange.org (automated assistance is available for those who don’t know their usernames or passwords). Once logged into HMX, hospitalists can browse communities, check out recent discussion threads, and update their profiles. Members can browse contacts to connect with thousands of other HMX users.

In addition to being the new home for conversations in hospital medicine, communities within HMX are replacing an array of legacy programs (e.g. the email listservs for practice management and SHM’s Leadership Academy alumni). HMX provides new flexibility not available in older systems like the listservs. Users can now opt into communities easily and decide how often they receive updates via email.

Conversation-Starters

Some hospitalists began collaborating with the HMX platform nearly a year ago. At the time, the platform was known as Higher Logic and supported SHM’s CODE-H, an educational program for hospital coding, along with SHM’s Hospital Value-Based Purchasing Toolkit (HVBP), a set of online resources and a community for hospitalists preparing their hospitals for value-based purchasing.

Patrick Torcson, MD, MMM, FACP, SFHM, led the HVBP community and sees the promise that HMX offers hospitalists. “It’s a nice synthesis of both content and resources because of the networking element,” he says. “It has a very real personal element as well.”

The HVBP community used HMX as equal parts educational session, networking, and library. Dr. Torcson and community members presented webinars, then followed up with discussions. Community members also shared resources about value-based purchasing through the discussion threads and the online library.

The immediate online interaction proved to be especially valuable when discussing a topic that was anything but static, he says.

“Because hospital value-based purchasing was unfolding over a timeline from [the Centers for Medicare & Medicaid Services (CMS)], we were able to add content as the program unfolded, including policy papers from Washington, webinars, and other relevant information,” Dr. Torcson explains. “For something like value-based purchasing, there’s no definitive source, so the collaboration was helpful. It’s true for a lot of topics in hospital medicine.

“To have a community tool like this that can accommodate for all the different inputs is really very valuable,” he adds.

HMX is a nice synthesis of both content and resources because of the networking element. It has a very real personal element as well.

—Patrick Torcson, MD, MMM, FACP, SFHM, chair, SHM’s Performance Measuring and Reporting Committee

Something for Every Member

In addition to a community for general issues affecting hospitalists, HMX also features specific communities designed to facilitate conversations on particular issues. As the communities evolve and conversations develop, SHM will add new communities.

Because so many hospitalists access the Internet from mobile devices, HMX is available for iPhones, iPads, and Android platforms through a third-party mobile application. Instructions for downloading and using the app are available at the HMX website.

SHM notified certain listserv users and others about the HMX introduction in August and September. Users quickly took to the new platform. Within a week of introducing HMX, nearly 100 hospitalists logged in for the first time.

The early interest in HMX isn’t surprising to Dr. Torcson, who says he “definitely” will use HMX in the future.

“It’s a great way to share best practices and case studies,” he says. “The personal dimension was really nice to connect so easily with the hospital medicine community. It’s nice to get the perspectives from other colleagues around the country and in different settings.”

Brendon Shank is SHM’s associate vice president of communications.

Hospitalists join SHM for lots of reasons, but the ability to network with hospitalists across the country is among the top motivators. In an emerging medical specialty, being able to collaborate and connect with peers is critical to career development and improving care.

Now, SHM has made connecting and collaborating easier than ever with Hospital Medicine Exchange (HMX), the first online community exclusively for hospitalists and hot topics in HM. Using HMX, hospitalists can start public discussions, post responses, and share files in one location.

For fast-moving issues, such as healthcare reform and hospitalist program management, HMX enables hospitalists to go straight to the source of some of the most important innovations: other hospitalists.

Using HMX is easy. Hospitalists log in to HMX using their SHM member username and password at HMXchange.org (automated assistance is available for those who don’t know their usernames or passwords). Once logged into HMX, hospitalists can browse communities, check out recent discussion threads, and update their profiles. Members can browse contacts to connect with thousands of other HMX users.

In addition to being the new home for conversations in hospital medicine, communities within HMX are replacing an array of legacy programs (e.g. the email listservs for practice management and SHM’s Leadership Academy alumni). HMX provides new flexibility not available in older systems like the listservs. Users can now opt into communities easily and decide how often they receive updates via email.

Conversation-Starters

Some hospitalists began collaborating with the HMX platform nearly a year ago. At the time, the platform was known as Higher Logic and supported SHM’s CODE-H, an educational program for hospital coding, along with SHM’s Hospital Value-Based Purchasing Toolkit (HVBP), a set of online resources and a community for hospitalists preparing their hospitals for value-based purchasing.

Patrick Torcson, MD, MMM, FACP, SFHM, led the HVBP community and sees the promise that HMX offers hospitalists. “It’s a nice synthesis of both content and resources because of the networking element,” he says. “It has a very real personal element as well.”

The HVBP community used HMX as equal parts educational session, networking, and library. Dr. Torcson and community members presented webinars, then followed up with discussions. Community members also shared resources about value-based purchasing through the discussion threads and the online library.

The immediate online interaction proved to be especially valuable when discussing a topic that was anything but static, he says.

“Because hospital value-based purchasing was unfolding over a timeline from [the Centers for Medicare & Medicaid Services (CMS)], we were able to add content as the program unfolded, including policy papers from Washington, webinars, and other relevant information,” Dr. Torcson explains. “For something like value-based purchasing, there’s no definitive source, so the collaboration was helpful. It’s true for a lot of topics in hospital medicine.

“To have a community tool like this that can accommodate for all the different inputs is really very valuable,” he adds.

HMX is a nice synthesis of both content and resources because of the networking element. It has a very real personal element as well.

—Patrick Torcson, MD, MMM, FACP, SFHM, chair, SHM’s Performance Measuring and Reporting Committee

Something for Every Member

In addition to a community for general issues affecting hospitalists, HMX also features specific communities designed to facilitate conversations on particular issues. As the communities evolve and conversations develop, SHM will add new communities.

Because so many hospitalists access the Internet from mobile devices, HMX is available for iPhones, iPads, and Android platforms through a third-party mobile application. Instructions for downloading and using the app are available at the HMX website.

SHM notified certain listserv users and others about the HMX introduction in August and September. Users quickly took to the new platform. Within a week of introducing HMX, nearly 100 hospitalists logged in for the first time.

The early interest in HMX isn’t surprising to Dr. Torcson, who says he “definitely” will use HMX in the future.

“It’s a great way to share best practices and case studies,” he says. “The personal dimension was really nice to connect so easily with the hospital medicine community. It’s nice to get the perspectives from other colleagues around the country and in different settings.”

Brendon Shank is SHM’s associate vice president of communications.

The Centers for Medicare & Medicaid Services' (CMS) recently announced final rule [PDF] on Stage 2 compliance for "meaningful use" of electronic health records (EHR) has been met with mixed reactions among most providers and trade groups, including SHM which voiced its concerns back in July.

"It's the classic government mixed bag," says Brenda Pawlak, director of Manatt Health Solutions, a division of New York City law firm Manatt, Phelps & Phillips.

Physician groups, including SHM and the Medical Group Management Association (MGMA), have lauded CMS for pushing back the implementation of Stage 2 meaningful-use requirements to 2014 from 2013. They also praised the agency for halving to 5% the percentage of a practice's patients who interact with an online portal. But for some providers, even the 5% threshold will be difficult to meet. And because physicians have to meet all requirements to qualify for incentive bonuses, the issue could loom large for specific groups.

"I don't think the 10% to 5% is a substantive change," Pawlak says.

Although most hospitalists are not directly subject to "meaningful use" requirements, many are heavily involved with assisting their institutions with implementation. SHM, which voiced its concerns in a July letter to CMS, is following this topic closely.

Some physician groups also lamented that the deadline for Stage 1 compliance remains unchanged at 2015. As physicians and provider groups attempt to comply with myriad rules, Pawlak says, meeting the 5% threshold will emerge as more burdensome as the deadline approaches. Still, CMS and federal officials say, the final rule will help nudge the healthcare system further into the digital age.

"The big message here is the push on standards-based interoperability of information," says Farzad Mostashari, MD, ScM, of the U.S. Department of Health and Human Services' Office of the National Coordinator for Health Information Technology. "We are staying on course with the road map that we set in Stage 1."

The Centers for Medicare & Medicaid Services' (CMS) recently announced final rule [PDF] on Stage 2 compliance for "meaningful use" of electronic health records (EHR) has been met with mixed reactions among most providers and trade groups, including SHM which voiced its concerns back in July.

"It's the classic government mixed bag," says Brenda Pawlak, director of Manatt Health Solutions, a division of New York City law firm Manatt, Phelps & Phillips.

Physician groups, including SHM and the Medical Group Management Association (MGMA), have lauded CMS for pushing back the implementation of Stage 2 meaningful-use requirements to 2014 from 2013. They also praised the agency for halving to 5% the percentage of a practice's patients who interact with an online portal. But for some providers, even the 5% threshold will be difficult to meet. And because physicians have to meet all requirements to qualify for incentive bonuses, the issue could loom large for specific groups.

"I don't think the 10% to 5% is a substantive change," Pawlak says.

Although most hospitalists are not directly subject to "meaningful use" requirements, many are heavily involved with assisting their institutions with implementation. SHM, which voiced its concerns in a July letter to CMS, is following this topic closely.

Some physician groups also lamented that the deadline for Stage 1 compliance remains unchanged at 2015. As physicians and provider groups attempt to comply with myriad rules, Pawlak says, meeting the 5% threshold will emerge as more burdensome as the deadline approaches. Still, CMS and federal officials say, the final rule will help nudge the healthcare system further into the digital age.

"The big message here is the push on standards-based interoperability of information," says Farzad Mostashari, MD, ScM, of the U.S. Department of Health and Human Services' Office of the National Coordinator for Health Information Technology. "We are staying on course with the road map that we set in Stage 1."

The Centers for Medicare & Medicaid Services' (CMS) recently announced final rule [PDF] on Stage 2 compliance for "meaningful use" of electronic health records (EHR) has been met with mixed reactions among most providers and trade groups, including SHM which voiced its concerns back in July.

"It's the classic government mixed bag," says Brenda Pawlak, director of Manatt Health Solutions, a division of New York City law firm Manatt, Phelps & Phillips.

Physician groups, including SHM and the Medical Group Management Association (MGMA), have lauded CMS for pushing back the implementation of Stage 2 meaningful-use requirements to 2014 from 2013. They also praised the agency for halving to 5% the percentage of a practice's patients who interact with an online portal. But for some providers, even the 5% threshold will be difficult to meet. And because physicians have to meet all requirements to qualify for incentive bonuses, the issue could loom large for specific groups.

"I don't think the 10% to 5% is a substantive change," Pawlak says.

Although most hospitalists are not directly subject to "meaningful use" requirements, many are heavily involved with assisting their institutions with implementation. SHM, which voiced its concerns in a July letter to CMS, is following this topic closely.

Some physician groups also lamented that the deadline for Stage 1 compliance remains unchanged at 2015. As physicians and provider groups attempt to comply with myriad rules, Pawlak says, meeting the 5% threshold will emerge as more burdensome as the deadline approaches. Still, CMS and federal officials say, the final rule will help nudge the healthcare system further into the digital age.

"The big message here is the push on standards-based interoperability of information," says Farzad Mostashari, MD, ScM, of the U.S. Department of Health and Human Services' Office of the National Coordinator for Health Information Technology. "We are staying on course with the road map that we set in Stage 1."

The Institute of Medicine (IOM) issued the report Health IT and Patient Safety: Building Safer Systems for Better Care in November 2011. SHM considers this a landmark report that serves as a call to action to improve the health information technology (HIT) systems used daily to deliver on the promise of safer, more efficient care. SHM’s IT Committee and IT Policy Committee carefully reviewed this report and have released a letter in support of its findings. SHM encourages its members to read the IOM report (www.iom.edu) or the summary of the report.

In support of the report, SHM highlighted the following:

• SHM specifically supports a call for safety transparency; a mandatory reporting mechanism for vendors; a voluntary reporting mechanism for providers to report unsafe conditions in electronic health records (EHRs) and adverse events; and the elimination of nondisclosure clauses.
• SHM supports the need for additional research to guide the design and implementation of EHR, computerized physician order entry (CPOE) systems, and clinical-decision-support (CDS) systems, including usability and expanded functionality.
• SHM supports the need for HIT education at all levels of the healthcare system from providers to vendors to include quality/safety science and process improvement.
• SHM echoes the need for interoperability, not only for data exchange, but also for CDS tools and for liquidity of data to allow new product incomers into the market and the ability to move between vendors.
• SHM believes in dual accountability between vendors and providers in HIT products to help motivate the industry to more quickly improve the safety and usability of products.
• SHM is moving ahead on these areas independently and believes that hospitalists are well positioned to be involved in achieving these goals. To assist members in their efforts, the IT Education Committee is working on in-person and online HIT educational venues for SHM members. SHM’s Health IT Quality Committee is organizing collaboratives around CDS and quality innovation sharing. The Health Quality and Patient Safety Committee continues to discuss the safety of IT systems and methods to improve them. SHM’s mentored implementation programs are engaging directly with vendors to try to build products and the functionality needed around glycemic control, care transitions, and VTE prophylaxis.
• SHM believes that its members can be involved in the research to answer many of the important questions that are unresolved in HIT. Please contact SHM to ensure that the organization is representing your needs in this important area. The current situation is a long way from the full potential HIT can provide, and SHM is committed to helping its members and the industry in moving to the next level.

The Institute of Medicine (IOM) issued the report Health IT and Patient Safety: Building Safer Systems for Better Care in November 2011. SHM considers this a landmark report that serves as a call to action to improve the health information technology (HIT) systems used daily to deliver on the promise of safer, more efficient care. SHM’s IT Committee and IT Policy Committee carefully reviewed this report and have released a letter in support of its findings. SHM encourages its members to read the IOM report (www.iom.edu) or the summary of the report.

In support of the report, SHM highlighted the following:

• SHM specifically supports a call for safety transparency; a mandatory reporting mechanism for vendors; a voluntary reporting mechanism for providers to report unsafe conditions in electronic health records (EHRs) and adverse events; and the elimination of nondisclosure clauses.
• SHM supports the need for additional research to guide the design and implementation of EHR, computerized physician order entry (CPOE) systems, and clinical-decision-support (CDS) systems, including usability and expanded functionality.
• SHM supports the need for HIT education at all levels of the healthcare system from providers to vendors to include quality/safety science and process improvement.
• SHM echoes the need for interoperability, not only for data exchange, but also for CDS tools and for liquidity of data to allow new product incomers into the market and the ability to move between vendors.
• SHM believes in dual accountability between vendors and providers in HIT products to help motivate the industry to more quickly improve the safety and usability of products.
• SHM is moving ahead on these areas independently and believes that hospitalists are well positioned to be involved in achieving these goals. To assist members in their efforts, the IT Education Committee is working on in-person and online HIT educational venues for SHM members. SHM’s Health IT Quality Committee is organizing collaboratives around CDS and quality innovation sharing. The Health Quality and Patient Safety Committee continues to discuss the safety of IT systems and methods to improve them. SHM’s mentored implementation programs are engaging directly with vendors to try to build products and the functionality needed around glycemic control, care transitions, and VTE prophylaxis.
• SHM believes that its members can be involved in the research to answer many of the important questions that are unresolved in HIT. Please contact SHM to ensure that the organization is representing your needs in this important area. The current situation is a long way from the full potential HIT can provide, and SHM is committed to helping its members and the industry in moving to the next level.

The Institute of Medicine (IOM) issued the report Health IT and Patient Safety: Building Safer Systems for Better Care in November 2011. SHM considers this a landmark report that serves as a call to action to improve the health information technology (HIT) systems used daily to deliver on the promise of safer, more efficient care. SHM’s IT Committee and IT Policy Committee carefully reviewed this report and have released a letter in support of its findings. SHM encourages its members to read the IOM report (www.iom.edu) or the summary of the report.

In support of the report, SHM highlighted the following:

• SHM specifically supports a call for safety transparency; a mandatory reporting mechanism for vendors; a voluntary reporting mechanism for providers to report unsafe conditions in electronic health records (EHRs) and adverse events; and the elimination of nondisclosure clauses.
• SHM supports the need for additional research to guide the design and implementation of EHR, computerized physician order entry (CPOE) systems, and clinical-decision-support (CDS) systems, including usability and expanded functionality.
• SHM supports the need for HIT education at all levels of the healthcare system from providers to vendors to include quality/safety science and process improvement.
• SHM echoes the need for interoperability, not only for data exchange, but also for CDS tools and for liquidity of data to allow new product incomers into the market and the ability to move between vendors.
• SHM believes in dual accountability between vendors and providers in HIT products to help motivate the industry to more quickly improve the safety and usability of products.
• SHM is moving ahead on these areas independently and believes that hospitalists are well positioned to be involved in achieving these goals. To assist members in their efforts, the IT Education Committee is working on in-person and online HIT educational venues for SHM members. SHM’s Health IT Quality Committee is organizing collaboratives around CDS and quality innovation sharing. The Health Quality and Patient Safety Committee continues to discuss the safety of IT systems and methods to improve them. SHM’s mentored implementation programs are engaging directly with vendors to try to build products and the functionality needed around glycemic control, care transitions, and VTE prophylaxis.
• SHM believes that its members can be involved in the research to answer many of the important questions that are unresolved in HIT. Please contact SHM to ensure that the organization is representing your needs in this important area. The current situation is a long way from the full potential HIT can provide, and SHM is committed to helping its members and the industry in moving to the next level.

Earlier this summer, the Centers for Medicare & Medicaid Services (CMS) announced that more than 100,000 healthcare providers and 48% of all eligible hospitals are using electronic health records (EHRs) that meet federal standards, and they have benefited from federal incentive programs to do so.¹

According to CMS acting administrator Marilyn Tavenner, meeting that provider goal makes 2012 the “Year of Meaningful Use.” She also says healthcare providers have recognized the potential of EHRs to cut down on paperwork, eliminate duplicate screenings and tests, and facilitate better, safer, patient-centered care.²

Belying CMS’ celebratory declarations, however, are concerns among experts that health information technology’s (HIT) actual use falls short of its promise—and might even endanger patients—due to shortcomings in system interoperability, safety, accountability, and other issues.

“Federal funding of IT was a step in the right direction, but it has also created a guaranteed customer base for electronic medical records, so vendors have less incentive to improve their products to meet clinicians needs,” says Kendall M. Rogers, MD, CPE, FACP, SFHM, chair of SHsM’s IT Executive Committee and chief of hospital medicine at the University of New Mexico Health Sciences Center School of Medicine in Albuquerque. “We want systems that help us make better clinical decisions and allow us to work more efficiently. Unfortunately, many hospitalists are frustrated with existing HIT systems, knowing how much better they need to be. It can be a dangerous gamble to push rapid adoption of potentially unsafe systems in hospitals.”

Questioning HIT Safety

Health IT experts affirm that potential danger. Jerry Osheroff, MD, FACP, FACMI, principal and founder of TMIT Consulting LLC and former chief clinical informatics officer for Thomson Reuters Healthcare, says HIT “is most effective when it gets the right information to the right people, through the right channels, in the right format, at the right point in the workflow. The danger comes when it gets one of those five ‘rights’ wrong; that can lead to distraction, confusion, wasted time, missed improvement opportunities, and safety concerns.”

Last November, the Institute of Medicine (IOM) released a scathing critique of HIT’s current ability to ensure patient safety.3 As the federal government invests billions of dollars to encourage hospitals and healthcare providers to adopt HIT, the IOM report said, improvements in care and safety are not yet established, and little evidence exists that quantifies the magnitude of the risk associated with HIT problems—partly because many HIT vendors discourage providers from sharing patient-safety concerns with nondisclosure and “hold harmless” provisions in contracts that shift the liability of unsafe HIT features to care providers.³

The report also cautioned that serious errors involving these technologies—including medication dosing errors, failure to detect fatal illnesses, and treatment delays due to complex data interfaces and poor human-computer interactions or loss of data—have led to several reported patient deaths and injuries. Furthermore, there is no way to publicly track adverse outcomes because there is no systematic regulation or authority to collect, analyze, and disseminate such information.

The report concluded that the current state of safety and health IT is not acceptable and that regulation of the industry might be necessary because the private sector to date has not taken sufficient action on its own to improve HIT safety.

SHM applauds the IOM report as an overdue and direly needed call to action, Dr. Rogers says. SHM sent a letter to the U.S. Department of Health and Human Services underscoring the importance of the IOM report.

“In our practices, we have experienced the threats to patient safety outlined in the report: poor user-interface design, poor workflow, complex data interfaces, lack of system interoperability, and lack of sufficient vendor action to build safer products,” Dr. Rogers says.

“Lack of interoperability—preventing access to patient data from previous physician or other hospital visits—makes a mockery of a coordinated, patient-centered healthcare system,” says HIT researcher Ross Koppel, PhD, faculty member of University of Pennsylvania’s Sociology Department and School of Medicine.

Although Dr. Rogers acknowledges that HIT has the potential to revolutionize healthcare systems, boost quality and safety, and lower cost, he maintains that current HIT products fall short of those ambitious goals. “Vendors typically regard usability of their products as a convenience request by clinicians; any errors are regarded as training issues for physicians,” Dr. Rogers says. “But the way that data is presented on a screen matters—if it is difficult to input or retrieve data and leads to cognitive or process errors, that’s a product redesign issue for which vendors should be held accountable.”

Dr. Koppel says many HIT systems originated from billing system applications “and were not initially designed with the clinical perspective in mind. Hospitalists have to be particularly focused on usability of HIT systems when it comes to patient-safety impacts. They’re not the canary in the coal mine, they’re the miners—often the teachers guiding other clinicians on HIT use.”

Improvement Agenda

SHM fully supports many of the IOM’s recommendations to improve the safety and functionality of HIT systems, including these as stated in an email to its members:

• Remove contractual restrictions, promote public reporting of safety issues, and put a system in place for independent investigations that drive patient-safety improvement.
• Establish standards and a common infrastructure for “interoperable” data exchange across systems.
• Create dual accountability between vendors and providers to address safety concerns that might require
• changes in an IT product’s functionality or design.
• Promote research on usability and human-factors design, safer implementation, and sociotechnical systems associated with HIT.
• Promote education of safety, quality, and reliability principles in design and implementation of HIT among all levels of the workforce, including frontline clinicians and staff, hospital IT, and quality teams—as well as IT vendors themselves.

There also are ongoing efforts in the private sector to improve HIT system functionality. For example, the HIMSS CDS Guidebook Series, of which Dr. Osheroff is lead editor and author and Dr. Rogers is a contributing author, is a respected repository of information synthesizing and vetting critical guidance for the effective implementation of clinical decision support (CDS).

“We’re also working with Greg Maynard [senior vice president of SHM’s Center for Hospital Innovation & Improvement] to use the collaborative’s tools to disseminate clinical-decision-support best practices for improving VTE prophylaxis rates,” Dr. Osheroff notes.

Hospitalists, as central players in quality improvement (QI), standardization, and care coordination, are natural choices as HIT champions, with valuable insight into how HIT systems should be customized to accommodate workflows and order sets in an optimal fashion, Dr. Rogers says.

“As critical as we are about the status of current HIT systems, we believe that systems can be designed more effectively to meet our needs,” he says. “By adopting many of the improvements enumerated in the IOM report, hospitalists are uniquely positioned to advance HIT to help achieve the goals of safer, higher-quality, and more efficient care.”

Christopher Guadagnino is a freelance writer based in Philadelphia.

References

1. Centers for Medicare & Medicaid Services. More than 100,000 health care providers paid for using electronic health records. Centers for Medicare & Medicaid Services website. Available at: http://www.cms.gov/apps/media/press/release.asp?Counter=4383&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&sr. Accessed July 31, 2012.
2. Centers for Medicare & Medicaid Services. 2012: the year of meaningful use. The CMS Blog website. Available at: http://blog.cms.gov/2012/03/23/2012-the-year-of-meaningful-use. Accessed July 18, 2012.
3. Institute of Medicine of the National Academies. Health IT and patient safety: building safer systems for better care. Institute of Medicine of the National Academies website. Available at: http://www.iom.edu/Reports/2011/Health-IT-and-Patient-Safety-Building-Safer-Systems-for-Better-Care.aspx. Accessed July 14, 2012.

Earlier this summer, the Centers for Medicare & Medicaid Services (CMS) announced that more than 100,000 healthcare providers and 48% of all eligible hospitals are using electronic health records (EHRs) that meet federal standards, and they have benefited from federal incentive programs to do so.¹

According to CMS acting administrator Marilyn Tavenner, meeting that provider goal makes 2012 the “Year of Meaningful Use.” She also says healthcare providers have recognized the potential of EHRs to cut down on paperwork, eliminate duplicate screenings and tests, and facilitate better, safer, patient-centered care.²

Belying CMS’ celebratory declarations, however, are concerns among experts that health information technology’s (HIT) actual use falls short of its promise—and might even endanger patients—due to shortcomings in system interoperability, safety, accountability, and other issues.

“Federal funding of IT was a step in the right direction, but it has also created a guaranteed customer base for electronic medical records, so vendors have less incentive to improve their products to meet clinicians needs,” says Kendall M. Rogers, MD, CPE, FACP, SFHM, chair of SHsM’s IT Executive Committee and chief of hospital medicine at the University of New Mexico Health Sciences Center School of Medicine in Albuquerque. “We want systems that help us make better clinical decisions and allow us to work more efficiently. Unfortunately, many hospitalists are frustrated with existing HIT systems, knowing how much better they need to be. It can be a dangerous gamble to push rapid adoption of potentially unsafe systems in hospitals.”

Questioning HIT Safety

Health IT experts affirm that potential danger. Jerry Osheroff, MD, FACP, FACMI, principal and founder of TMIT Consulting LLC and former chief clinical informatics officer for Thomson Reuters Healthcare, says HIT “is most effective when it gets the right information to the right people, through the right channels, in the right format, at the right point in the workflow. The danger comes when it gets one of those five ‘rights’ wrong; that can lead to distraction, confusion, wasted time, missed improvement opportunities, and safety concerns.”

Last November, the Institute of Medicine (IOM) released a scathing critique of HIT’s current ability to ensure patient safety.3 As the federal government invests billions of dollars to encourage hospitals and healthcare providers to adopt HIT, the IOM report said, improvements in care and safety are not yet established, and little evidence exists that quantifies the magnitude of the risk associated with HIT problems—partly because many HIT vendors discourage providers from sharing patient-safety concerns with nondisclosure and “hold harmless” provisions in contracts that shift the liability of unsafe HIT features to care providers.³

The report also cautioned that serious errors involving these technologies—including medication dosing errors, failure to detect fatal illnesses, and treatment delays due to complex data interfaces and poor human-computer interactions or loss of data—have led to several reported patient deaths and injuries. Furthermore, there is no way to publicly track adverse outcomes because there is no systematic regulation or authority to collect, analyze, and disseminate such information.

The report concluded that the current state of safety and health IT is not acceptable and that regulation of the industry might be necessary because the private sector to date has not taken sufficient action on its own to improve HIT safety.

SHM applauds the IOM report as an overdue and direly needed call to action, Dr. Rogers says. SHM sent a letter to the U.S. Department of Health and Human Services underscoring the importance of the IOM report.

“In our practices, we have experienced the threats to patient safety outlined in the report: poor user-interface design, poor workflow, complex data interfaces, lack of system interoperability, and lack of sufficient vendor action to build safer products,” Dr. Rogers says.

“Lack of interoperability—preventing access to patient data from previous physician or other hospital visits—makes a mockery of a coordinated, patient-centered healthcare system,” says HIT researcher Ross Koppel, PhD, faculty member of University of Pennsylvania’s Sociology Department and School of Medicine.

Although Dr. Rogers acknowledges that HIT has the potential to revolutionize healthcare systems, boost quality and safety, and lower cost, he maintains that current HIT products fall short of those ambitious goals. “Vendors typically regard usability of their products as a convenience request by clinicians; any errors are regarded as training issues for physicians,” Dr. Rogers says. “But the way that data is presented on a screen matters—if it is difficult to input or retrieve data and leads to cognitive or process errors, that’s a product redesign issue for which vendors should be held accountable.”

Dr. Koppel says many HIT systems originated from billing system applications “and were not initially designed with the clinical perspective in mind. Hospitalists have to be particularly focused on usability of HIT systems when it comes to patient-safety impacts. They’re not the canary in the coal mine, they’re the miners—often the teachers guiding other clinicians on HIT use.”

Improvement Agenda

SHM fully supports many of the IOM’s recommendations to improve the safety and functionality of HIT systems, including these as stated in an email to its members:

• Remove contractual restrictions, promote public reporting of safety issues, and put a system in place for independent investigations that drive patient-safety improvement.
• Establish standards and a common infrastructure for “interoperable” data exchange across systems.
• Create dual accountability between vendors and providers to address safety concerns that might require
• changes in an IT product’s functionality or design.
• Promote research on usability and human-factors design, safer implementation, and sociotechnical systems associated with HIT.
• Promote education of safety, quality, and reliability principles in design and implementation of HIT among all levels of the workforce, including frontline clinicians and staff, hospital IT, and quality teams—as well as IT vendors themselves.

There also are ongoing efforts in the private sector to improve HIT system functionality. For example, the HIMSS CDS Guidebook Series, of which Dr. Osheroff is lead editor and author and Dr. Rogers is a contributing author, is a respected repository of information synthesizing and vetting critical guidance for the effective implementation of clinical decision support (CDS).

“We’re also working with Greg Maynard [senior vice president of SHM’s Center for Hospital Innovation & Improvement] to use the collaborative’s tools to disseminate clinical-decision-support best practices for improving VTE prophylaxis rates,” Dr. Osheroff notes.

Hospitalists, as central players in quality improvement (QI), standardization, and care coordination, are natural choices as HIT champions, with valuable insight into how HIT systems should be customized to accommodate workflows and order sets in an optimal fashion, Dr. Rogers says.

“As critical as we are about the status of current HIT systems, we believe that systems can be designed more effectively to meet our needs,” he says. “By adopting many of the improvements enumerated in the IOM report, hospitalists are uniquely positioned to advance HIT to help achieve the goals of safer, higher-quality, and more efficient care.”

Christopher Guadagnino is a freelance writer based in Philadelphia.

References

1. Centers for Medicare & Medicaid Services. More than 100,000 health care providers paid for using electronic health records. Centers for Medicare & Medicaid Services website. Available at: http://www.cms.gov/apps/media/press/release.asp?Counter=4383&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&sr. Accessed July 31, 2012.
2. Centers for Medicare & Medicaid Services. 2012: the year of meaningful use. The CMS Blog website. Available at: http://blog.cms.gov/2012/03/23/2012-the-year-of-meaningful-use. Accessed July 18, 2012.
3. Institute of Medicine of the National Academies. Health IT and patient safety: building safer systems for better care. Institute of Medicine of the National Academies website. Available at: http://www.iom.edu/Reports/2011/Health-IT-and-Patient-Safety-Building-Safer-Systems-for-Better-Care.aspx. Accessed July 14, 2012.

Earlier this summer, the Centers for Medicare & Medicaid Services (CMS) announced that more than 100,000 healthcare providers and 48% of all eligible hospitals are using electronic health records (EHRs) that meet federal standards, and they have benefited from federal incentive programs to do so.¹

According to CMS acting administrator Marilyn Tavenner, meeting that provider goal makes 2012 the “Year of Meaningful Use.” She also says healthcare providers have recognized the potential of EHRs to cut down on paperwork, eliminate duplicate screenings and tests, and facilitate better, safer, patient-centered care.²

Belying CMS’ celebratory declarations, however, are concerns among experts that health information technology’s (HIT) actual use falls short of its promise—and might even endanger patients—due to shortcomings in system interoperability, safety, accountability, and other issues.

“Federal funding of IT was a step in the right direction, but it has also created a guaranteed customer base for electronic medical records, so vendors have less incentive to improve their products to meet clinicians needs,” says Kendall M. Rogers, MD, CPE, FACP, SFHM, chair of SHsM’s IT Executive Committee and chief of hospital medicine at the University of New Mexico Health Sciences Center School of Medicine in Albuquerque. “We want systems that help us make better clinical decisions and allow us to work more efficiently. Unfortunately, many hospitalists are frustrated with existing HIT systems, knowing how much better they need to be. It can be a dangerous gamble to push rapid adoption of potentially unsafe systems in hospitals.”

Questioning HIT Safety

Health IT experts affirm that potential danger. Jerry Osheroff, MD, FACP, FACMI, principal and founder of TMIT Consulting LLC and former chief clinical informatics officer for Thomson Reuters Healthcare, says HIT “is most effective when it gets the right information to the right people, through the right channels, in the right format, at the right point in the workflow. The danger comes when it gets one of those five ‘rights’ wrong; that can lead to distraction, confusion, wasted time, missed improvement opportunities, and safety concerns.”

Last November, the Institute of Medicine (IOM) released a scathing critique of HIT’s current ability to ensure patient safety.3 As the federal government invests billions of dollars to encourage hospitals and healthcare providers to adopt HIT, the IOM report said, improvements in care and safety are not yet established, and little evidence exists that quantifies the magnitude of the risk associated with HIT problems—partly because many HIT vendors discourage providers from sharing patient-safety concerns with nondisclosure and “hold harmless” provisions in contracts that shift the liability of unsafe HIT features to care providers.³

The report also cautioned that serious errors involving these technologies—including medication dosing errors, failure to detect fatal illnesses, and treatment delays due to complex data interfaces and poor human-computer interactions or loss of data—have led to several reported patient deaths and injuries. Furthermore, there is no way to publicly track adverse outcomes because there is no systematic regulation or authority to collect, analyze, and disseminate such information.

The report concluded that the current state of safety and health IT is not acceptable and that regulation of the industry might be necessary because the private sector to date has not taken sufficient action on its own to improve HIT safety.

SHM applauds the IOM report as an overdue and direly needed call to action, Dr. Rogers says. SHM sent a letter to the U.S. Department of Health and Human Services underscoring the importance of the IOM report.

“In our practices, we have experienced the threats to patient safety outlined in the report: poor user-interface design, poor workflow, complex data interfaces, lack of system interoperability, and lack of sufficient vendor action to build safer products,” Dr. Rogers says.

“Lack of interoperability—preventing access to patient data from previous physician or other hospital visits—makes a mockery of a coordinated, patient-centered healthcare system,” says HIT researcher Ross Koppel, PhD, faculty member of University of Pennsylvania’s Sociology Department and School of Medicine.

Although Dr. Rogers acknowledges that HIT has the potential to revolutionize healthcare systems, boost quality and safety, and lower cost, he maintains that current HIT products fall short of those ambitious goals. “Vendors typically regard usability of their products as a convenience request by clinicians; any errors are regarded as training issues for physicians,” Dr. Rogers says. “But the way that data is presented on a screen matters—if it is difficult to input or retrieve data and leads to cognitive or process errors, that’s a product redesign issue for which vendors should be held accountable.”

Dr. Koppel says many HIT systems originated from billing system applications “and were not initially designed with the clinical perspective in mind. Hospitalists have to be particularly focused on usability of HIT systems when it comes to patient-safety impacts. They’re not the canary in the coal mine, they’re the miners—often the teachers guiding other clinicians on HIT use.”

Improvement Agenda

SHM fully supports many of the IOM’s recommendations to improve the safety and functionality of HIT systems, including these as stated in an email to its members:

• Remove contractual restrictions, promote public reporting of safety issues, and put a system in place for independent investigations that drive patient-safety improvement.
• Establish standards and a common infrastructure for “interoperable” data exchange across systems.
• Create dual accountability between vendors and providers to address safety concerns that might require
• changes in an IT product’s functionality or design.
• Promote research on usability and human-factors design, safer implementation, and sociotechnical systems associated with HIT.
• Promote education of safety, quality, and reliability principles in design and implementation of HIT among all levels of the workforce, including frontline clinicians and staff, hospital IT, and quality teams—as well as IT vendors themselves.

There also are ongoing efforts in the private sector to improve HIT system functionality. For example, the HIMSS CDS Guidebook Series, of which Dr. Osheroff is lead editor and author and Dr. Rogers is a contributing author, is a respected repository of information synthesizing and vetting critical guidance for the effective implementation of clinical decision support (CDS).

“We’re also working with Greg Maynard [senior vice president of SHM’s Center for Hospital Innovation & Improvement] to use the collaborative’s tools to disseminate clinical-decision-support best practices for improving VTE prophylaxis rates,” Dr. Osheroff notes.

Hospitalists, as central players in quality improvement (QI), standardization, and care coordination, are natural choices as HIT champions, with valuable insight into how HIT systems should be customized to accommodate workflows and order sets in an optimal fashion, Dr. Rogers says.

“As critical as we are about the status of current HIT systems, we believe that systems can be designed more effectively to meet our needs,” he says. “By adopting many of the improvements enumerated in the IOM report, hospitalists are uniquely positioned to advance HIT to help achieve the goals of safer, higher-quality, and more efficient care.”

Christopher Guadagnino is a freelance writer based in Philadelphia.

References

1. Centers for Medicare & Medicaid Services. More than 100,000 health care providers paid for using electronic health records. Centers for Medicare & Medicaid Services website. Available at: http://www.cms.gov/apps/media/press/release.asp?Counter=4383&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&sr. Accessed July 31, 2012.
2. Centers for Medicare & Medicaid Services. 2012: the year of meaningful use. The CMS Blog website. Available at: http://blog.cms.gov/2012/03/23/2012-the-year-of-meaningful-use. Accessed July 18, 2012.
3. Institute of Medicine of the National Academies. Health IT and patient safety: building safer systems for better care. Institute of Medicine of the National Academies website. Available at: http://www.iom.edu/Reports/2011/Health-IT-and-Patient-Safety-Building-Safer-Systems-for-Better-Care.aspx. Accessed July 14, 2012.

In “The Lean Startup,” author Eric Ries notes that in its early stages, his gaming company would routinely issue new versions of their software application several times each day. Continuous deployment—the process Ries’ company used—leveraged such Lean principles as reduced batch size and continuous learning based on end-user feedback to achieve rapid improvements in their product.

Ries says companies that learn the quickest about what the customer wants, and can incorporate that information into products more efficiently, stand the greatest chance of succeeding. A software engineer by trade, Ries uses many examples of companies that have succeeded with this approach, none of which are from healthcare.

In stark relief, the chief technology hospitalists interface with daily is the electronic health record (EHR), widely recognized as a system that fails to consider the end-user experience, that is unable to interoperate with other software, and is incapable of using data for quality improvement (QI). The PDSA (“plan, do, study, act”) cycle is the foundation of QI activities and relies on rapidly incorporating observations made by those performing the work to create novel workflows and processes based on learning. EHRs, by digitizing health information, theoretically provide the ideal tool for supporting QI.

The reality is that EHRs have been a colossal disappointment with regard to QI efforts. The space in and around EHR effectively represents “dead zones” for innovation and improvement. Mandl and Kohane note:

EHR companies have followed a business model whereby they control all data, rather than liberating the data for use in innovative applications in clinical care.

Conducting a Google-style search of an EHR database usually requires involvement of a clinician’s information services department and often the specialized knowledge and cooperation of the vendor’s technical teams.

Greg Maynard, MD, MSc, SFHM, senior vice president of SHM’s Center for Hospital Innovation and Improvement, recently provided testimony to the Office of the National Coordinator for Health Information Technology about the challenges current EHRs present to QI efforts and what features EHRs need to incorporate to better serve the needs of patients and clinicians. Dr. Maynard answered a few questions for The Hospitalist:

Q: What is it about current EHRs that make continuous improvement so difficult?

A: EHRs were built for fiscal and administrative purposes, not for quality improvement and safety. The administrative/fiscal roots of today’s IT systems lead to poor availability of clinical, quality, and safety data. In many medical centers and practices, the great majority of information available is months-old administrative data, which does not lend itself to rapid cycle improvement.

Q: Why is the PDSA cycle endangered in most systems?

A: EHRs often do not facilitate rapid-cycle, PDSA-style improvements on a small pilot scale. Most improvement teams get one shot to get the clinical decision support and data-capture tools correct after months of waiting in queue and development time. Any request for revisions and refinements is treated as a failure of the improvement team, and it is often difficult or impossible to pilot new tools in a limited setting.

Q: What features would you like to see in EHRs that would facilitate QI?

A: We need a user-friendly interface for clinicians and for data analysts/reporters. Other industries have common data formats to allow for sharing of information across disparate systems. We need the same capability for clinical information in healthcare. Also, a change in architecture of EHRs and other health IT tools that allows for not just interoperability but substitutable options is required. In the more “app”-like environment, innovation and flexibility would be the rule. An underlying architecture could have different plug-and-play modules for different functions. Some companies are overcoming the current barriers to provide wonderful, easy-to-generate and useful reports, but most are stymied by proprietary systems.

Reference

1. Mandl KD, Kohane IS. Escaping the EHR trap: the future of health IT. N Engl J Med. 2012;366(24):2240-2242.

Dr. Whitcomb is medical director of healthcare quality at Baystate Medical Center in Springfield, Mass. He is a co-founder and past president of SHM. Email him at wfwhit@comcast.net.

In “The Lean Startup,” author Eric Ries notes that in its early stages, his gaming company would routinely issue new versions of their software application several times each day. Continuous deployment—the process Ries’ company used—leveraged such Lean principles as reduced batch size and continuous learning based on end-user feedback to achieve rapid improvements in their product.

Ries says companies that learn the quickest about what the customer wants, and can incorporate that information into products more efficiently, stand the greatest chance of succeeding. A software engineer by trade, Ries uses many examples of companies that have succeeded with this approach, none of which are from healthcare.

In stark relief, the chief technology hospitalists interface with daily is the electronic health record (EHR), widely recognized as a system that fails to consider the end-user experience, that is unable to interoperate with other software, and is incapable of using data for quality improvement (QI). The PDSA (“plan, do, study, act”) cycle is the foundation of QI activities and relies on rapidly incorporating observations made by those performing the work to create novel workflows and processes based on learning. EHRs, by digitizing health information, theoretically provide the ideal tool for supporting QI.

The reality is that EHRs have been a colossal disappointment with regard to QI efforts. The space in and around EHR effectively represents “dead zones” for innovation and improvement. Mandl and Kohane note:

EHR companies have followed a business model whereby they control all data, rather than liberating the data for use in innovative applications in clinical care.

Conducting a Google-style search of an EHR database usually requires involvement of a clinician’s information services department and often the specialized knowledge and cooperation of the vendor’s technical teams.

Greg Maynard, MD, MSc, SFHM, senior vice president of SHM’s Center for Hospital Innovation and Improvement, recently provided testimony to the Office of the National Coordinator for Health Information Technology about the challenges current EHRs present to QI efforts and what features EHRs need to incorporate to better serve the needs of patients and clinicians. Dr. Maynard answered a few questions for The Hospitalist:

Q: What is it about current EHRs that make continuous improvement so difficult?

A: EHRs were built for fiscal and administrative purposes, not for quality improvement and safety. The administrative/fiscal roots of today’s IT systems lead to poor availability of clinical, quality, and safety data. In many medical centers and practices, the great majority of information available is months-old administrative data, which does not lend itself to rapid cycle improvement.

Q: Why is the PDSA cycle endangered in most systems?

A: EHRs often do not facilitate rapid-cycle, PDSA-style improvements on a small pilot scale. Most improvement teams get one shot to get the clinical decision support and data-capture tools correct after months of waiting in queue and development time. Any request for revisions and refinements is treated as a failure of the improvement team, and it is often difficult or impossible to pilot new tools in a limited setting.

Q: What features would you like to see in EHRs that would facilitate QI?

A: We need a user-friendly interface for clinicians and for data analysts/reporters. Other industries have common data formats to allow for sharing of information across disparate systems. We need the same capability for clinical information in healthcare. Also, a change in architecture of EHRs and other health IT tools that allows for not just interoperability but substitutable options is required. In the more “app”-like environment, innovation and flexibility would be the rule. An underlying architecture could have different plug-and-play modules for different functions. Some companies are overcoming the current barriers to provide wonderful, easy-to-generate and useful reports, but most are stymied by proprietary systems.

Reference

1. Mandl KD, Kohane IS. Escaping the EHR trap: the future of health IT. N Engl J Med. 2012;366(24):2240-2242.

Dr. Whitcomb is medical director of healthcare quality at Baystate Medical Center in Springfield, Mass. He is a co-founder and past president of SHM. Email him at wfwhit@comcast.net.

In “The Lean Startup,” author Eric Ries notes that in its early stages, his gaming company would routinely issue new versions of their software application several times each day. Continuous deployment—the process Ries’ company used—leveraged such Lean principles as reduced batch size and continuous learning based on end-user feedback to achieve rapid improvements in their product.

Ries says companies that learn the quickest about what the customer wants, and can incorporate that information into products more efficiently, stand the greatest chance of succeeding. A software engineer by trade, Ries uses many examples of companies that have succeeded with this approach, none of which are from healthcare.

In stark relief, the chief technology hospitalists interface with daily is the electronic health record (EHR), widely recognized as a system that fails to consider the end-user experience, that is unable to interoperate with other software, and is incapable of using data for quality improvement (QI). The PDSA (“plan, do, study, act”) cycle is the foundation of QI activities and relies on rapidly incorporating observations made by those performing the work to create novel workflows and processes based on learning. EHRs, by digitizing health information, theoretically provide the ideal tool for supporting QI.

The reality is that EHRs have been a colossal disappointment with regard to QI efforts. The space in and around EHR effectively represents “dead zones” for innovation and improvement. Mandl and Kohane note:

EHR companies have followed a business model whereby they control all data, rather than liberating the data for use in innovative applications in clinical care.

Conducting a Google-style search of an EHR database usually requires involvement of a clinician’s information services department and often the specialized knowledge and cooperation of the vendor’s technical teams.

Greg Maynard, MD, MSc, SFHM, senior vice president of SHM’s Center for Hospital Innovation and Improvement, recently provided testimony to the Office of the National Coordinator for Health Information Technology about the challenges current EHRs present to QI efforts and what features EHRs need to incorporate to better serve the needs of patients and clinicians. Dr. Maynard answered a few questions for The Hospitalist:

Q: What is it about current EHRs that make continuous improvement so difficult?

A: EHRs were built for fiscal and administrative purposes, not for quality improvement and safety. The administrative/fiscal roots of today’s IT systems lead to poor availability of clinical, quality, and safety data. In many medical centers and practices, the great majority of information available is months-old administrative data, which does not lend itself to rapid cycle improvement.

Q: Why is the PDSA cycle endangered in most systems?

A: EHRs often do not facilitate rapid-cycle, PDSA-style improvements on a small pilot scale. Most improvement teams get one shot to get the clinical decision support and data-capture tools correct after months of waiting in queue and development time. Any request for revisions and refinements is treated as a failure of the improvement team, and it is often difficult or impossible to pilot new tools in a limited setting.

Q: What features would you like to see in EHRs that would facilitate QI?

A: We need a user-friendly interface for clinicians and for data analysts/reporters. Other industries have common data formats to allow for sharing of information across disparate systems. We need the same capability for clinical information in healthcare. Also, a change in architecture of EHRs and other health IT tools that allows for not just interoperability but substitutable options is required. In the more “app”-like environment, innovation and flexibility would be the rule. An underlying architecture could have different plug-and-play modules for different functions. Some companies are overcoming the current barriers to provide wonderful, easy-to-generate and useful reports, but most are stymied by proprietary systems.

Reference

1. Mandl KD, Kohane IS. Escaping the EHR trap: the future of health IT. N Engl J Med. 2012;366(24):2240-2242.

Dr. Whitcomb is medical director of healthcare quality at Baystate Medical Center in Springfield, Mass. He is a co-founder and past president of SHM. Email him at wfwhit@comcast.net.