COLORADO SPRINGS, CO – For the first time ever, the United States Olympic Committee will use electronic medical records rather than paper charts to manage care for more that 700 athletes at the summer games.

The USOC announced Thursday that it will deploy GE’s Centricity Practice Solution, which integrates EMR with practice management technology, to manage the care of more than 700 American athletes competing in the London 2012 Olympic and Paralympic Games, and for 3,000 additional records maintained by USOC staff.

Once upon a time, the USOC relied on pallets of paper records, shipped around the globe, to the the games' host city. Now, at last, EMRs will offer doctors and caregivers faster access to athletes’ medical records and enable more targeted care.

"It's definitely, for the Olympics, the right time to jump on [EMRs] now," Jan De Witte, chief executive officer of GE Healthcare IT and Performance Solutions tells Healthcare IT News. "The EMR has shown its value for healthcare in driving quality, both with completeness of data and speed of decision-making."

Set to go live in June, the London deployment will "be, for us, a record-speed implementation," says De Witte. "We're doing it in less than 90 days." So far, the process has gone well, he reports, especially with the training for the 100 or so people on the USOC medical staff who'll be using the Centricity technology.

Part of that preparation involves populating the medical records with the "relevant information for 700 athletes and close to 3,000 staff and volunteers" who will be in the system, says De Witte. From June right through the closing ceremonies, all information related to the athletes' health and performance is going "straight into the EMR."

Studies have shown in recent years that the quality of data in many electronic medical records is often not very good. According to Peter Witonsky, president and chief sales officer at iSirona, this is largely due to simple inaccuracies that occur more often than we think.

"A lot of these fall into the same category, in my mind, but it's different ways of getting to that category," said said Witonsky. "That latency of data is terrible. We have customers, prior to us, with eight to 10 hours in latency of data, and that's not uncommon. It's not the end of the world, but there are tons and tons of examples of what latency of data will do to decision making on the other side."

Witonsky highlights five reasons why data inaccuracies occur in EMRs.

1.Simple miskeying. Although it may be easy and "quite common," said Witonsky, the main way data inaccuracies tend to occur is because of simple miskeying. "If you look at any nurse of any floor, there's about 1,000 or over 1,000 data elements a shift that person is responsible for," he said. "So if you're an ICU nurse, and you're taking vitals and other critical information every 15 minutes, or if you're a low acuity nurse and you have for patients to be responsible for, it seems to average out just north of 1,000 data elements." And to expect a nurse to key in those elements with 100 percent accuracy isn't a realistic goal, Witonsky said. "The idea any person [can do that] is ludicrous," he said. 

2.Miscommunication from the patient. Bad information or miscommunication from the patient is another all-too-common way these inaccuracies can occur, said Witonsky. And this can include the patient not telling which drugs they're on, not knowing the name of the drug or the dosage or even the patient lying about his or her weight. "So it's sort of a garbage in, garbage out theory," said Witonsky. "If you don't tell me that you're allergic [to a drug] and I give you Penicillin and it's a bad result, again, that's bad data in the EMR." It's for that reason, he pointed out, that most of today's EMRs have allergies highlighted at the top of every patient screen.

3.Wrong entry or lack of entering device data. Looking back to simple miskeying, said Witonsky, 1,000 data elements, over time, is "an awful lot of work," he said. "So you have something called smoothing, [which is] a long practice of smoothing data where a nurse of physician is expecting to see normal [results], and they put in normal regardless of what the device is telling you." These generic readings tend to bring out inconsistencies in data, he continued, which wouldn't occur if the person inputting data took the actual information from the device. "That's not intended to be a knock," he said. "That's intended to say, in performing the hardest job on the planet, if they knew [a patient] was healthy, they leave all the vitals on the machine and may choose to put [the patient] in as a normal patient, as opposed to the exact answers."

More.

WASHINGTON – The Peace Corps plans to acquire a comprehensive electronic health records system to serve its volunteers stationed in 77 developing countries. The agency wants to develop a proof of concept electronic health record (EHR) and test it in a limited pilot by September and deploy it in fiscal 2013.

Many of the developing regions where volunteers work, primarily in Africa and the Asia Pacific, have low bandwidth and big delays in processing network data because it is difficult to acquire affordable Internet connectivity, according to a recent request for information announcement in Federal Business Opportunities.

“An overall solution must work for all posts, not just the well-connected ones,” the agency said.

Peace Corps staff in country will use a laptop or mobile device to record basic medical information and synchronize it to OpenEMR, a free and open source application that will be used in post countries for practice management and be customized to meet requirements. It is also certified by the Office of the National Coordinator for Health IT to meet meaningful

Among the comprehensive EHR’s functions, the system should supply searchable problem, medication and allergies lists and a record of vaccinations. The EHR will allow for the electronic transfer of information from a pre-service medical screening system.

The EHR system will also provide a billing module for exporting to a claims database a “super bill,” which will include healthcare provider, cost and other information in standard codes to enable an audit trail to track specific expenses, medical costs for specific conditions and medical budgeting from the bottom up.

A clinical notes section will also enable the provider to enter free-form narrative entry for each patient visit. And the system will feature a lab and imaging section and a consultation section, for which results can be scanned and pasted into the record.

The Peace Corps has other related systems underway to better recruit, place and support its volunteers around the world, including a volunteer lifecycle management system and volunteer electronic health system.

SAN DIEGO – Hospitals are usually eager to embrace the latest medical technology, but the road to deploying tablet computers has been bumpy.  

iPads have been available since April 2010, but less than one percent of hospitals have fully functional tablet systems, according to Jonathan Mack, director of clinical research and development at the West Wireless Health Institute, a San Diego-based nonprofit focused on lowering the cost of health care through new technology. 
        
"We're really lagging behind in the U.S. in using electronic medical records on mobile devices like iPads," Mack says.

The federal government is giving hospitals financial incentives to implement electronic records systems, which can cost a health system between $2 million and $16 million, depending on size, says Mack.
The most popular systems don't yet make apps that allow doctors to use electronic medical records on a tablet the way they would on a desktop or laptop. To use a mobile device effectively requires a complete redesign of the way information is presented, Mack says.
 
And that would require hospitals to "cough up a lot more money," he says. "When you look at a health system that has bought into an EMR, they’re not ready to turn the boat around and start over."

UC San Diego Health System's experience with iPads illustrates both the promise and the challenge of using tablet technology at hospitals. Doctors there have been using the iPad since it first came out, but a year and a half later, only 50 to 70 --less than 10 percent of physicians-- are using them. Physician Assistant Kate Franko, who is part of the hospital’s transplant team, has been one of the pioneers.

More.

WASHINGTON – Electronic health records will become the norm, sooner than later, experts said at a summit hosted Friday by the Office of the National Coordinator for Health IT (ONC).

The bottom line, said many of the speakers at ONC's Grantee and Stakeholder Summit, is that consumers are demanding EHRs. The government is helping with adoption, but this is not nearly as influential as the healthcare consumer's pressure on providers.

National Coordinator for Health IT Farzad Mostashari, MD, said the patient is not just "a ticket holder crammed into economy."

"The patient is the copilot" with his or her healthcare provider, Mostashari said. "Increasingly, we'll hear patients, consumers, people expecting more out of their interactions with others. So we're going to see all of the pieces come together for this."

In a keynote speech, Jay Walker, curator for the TEDMED Conference, a forum for healthcare innovation, said "tech speed" is the world we live in. "Med speed" is much slower. Too slow, in fact, for consumer's liking, he said.

In a quick survey of the audience of 1,200 people, Walker asked who does not possess a smart card. Only fifteen people raised their hands. Walker pointed out that would not have been true five years ago. Smart cards are a new phenomenon, and part of the exponentially changing world consumers live in. Paper maps, phone books and rolodexes are now all obsolete. "The consumer is driving all of the change," he said.

"Suddenly the patients are in charge of the future, instead of the healthcare system," Walker added. "You are at the front line when you walk into a doctor's office and say, 'it's time for electronic health records.'"

More.

Poorly designed, hard-to-use computerized health records are a threat to patient safety, and an independent agency should be set up to investigate injuries and deaths linked to health information technology, according to a federal study released Tuesday.

The report by the Institute of Medicine comes as the government is spending billions of dollars in incentive payments to encourage doctors and hospitals to adopt electronic health records. The Department of Health and Human Services requested the study, in response to concerns from some doctors and public health experts that the drive for digital records might bring a wave of technology-induced medical errors.

The goal of moving from paper to computerized patient records is to improve patient care and curb health care costs. The federal report does not assert that the effort to move to electronic health records is misguided, but that safety considerations must be a crucial ingredient.

The proposed investigative agency, the report said, should be modeled after the National Transportation Safety Board, which examines airline safety and accidents. The Institute of Medicine committee also called for tracking the safety performance of electronic health records in use. Results from studies done so far, the report said, are mixed. Success stories are offset by reports of patients harmed.

The advisory group recommended that electronic health record suppliers drop “hold harmless” clauses from their sales contracts. Such language often limits the freedom of doctors and hospitals to publicly raise questions about software errors or defects.

The report was an attempt to balance interests by acknowledging the safety risks and calling for more accountability, without hindering innovation or slowing the adoption of electronic health records, said Dr. Ashish K. Jha, an associate professor at the Harvard School of Public Health and a member of the panel.

Technical standards may seem arcane, but they are often powerful tools of economic development and social welfare. They can be essential building blocks for innovation and new industries. The basic software standards for the Web are striking proof.

Safety is also a potent argument for standards. Today, the matter of standards for electronic health records is raising concerns, prompting heated debate in recent meetings of representatives from medicine, industry, academia and government. The stakes, they say, could scarcely be higher. They agree that, when well designed and wisely used, digital records can deliver the power of better information to medicine, improving care and curbing costs. But computer forms, they add, can also be difficult to use, cluttered and distracting, causing more harm than good in health care.

The controversy points to the delicate balancing of interests involved when creating technical standards that inherently limit some design choices yet try to keep the door open to innovation. It also raises the question of the appropriate role for government in devising such technology requirements.

Read more.

Go here to read AV Systems, Part 1: Planning for Growth—Meeting Your Present Needs
Go here to read AV Systems, Part 2: Identify your Objectives

AV Systems, Part 3: Decision-making: What is the Rationale?
By Michael Young

Choosing an AV system appropriate for your setting is not an easy task.  Whether you are a decision-maker or the person making the recommendation, the end result is that you live with the consequences, whether good or poor. Do you ever wish you could get into the head of someone who has already been through the AV system selection process?  The rationale for any decision process is important. 

There are reasons behind all the choices we make, but when it comes to technology, some people tend to treat the decision process much like a multiple-choice question, and fail to understand the context of the decisions that must be made.  For example, 

1.    Which camera would you recommend for your setting:

a.   Premium, HD quality IP Camera

b.   Off-brand, HD quality Analog Camera

c.    CD quality, USB Web Cam

d.   All of the Above

e.   None of the Above

The answer may seem obvious, but there are hints presented in the question that imply that the decision-maker must understand their setting and the specifications for the heart of the AV system.  Of the three to five leading vendors, choice a, b or c could be true. To not think through the question and discover the rationale for any one answer is a common mistake of the inexperienced; but seasoned professionals tend to repeat this error when making a decision outside of their own expertise.  I am not suggesting that you need to be an AV specialist or a technology guru to make the best decision.  However, good educators know that a well-constructed question on a test can reveal a lot about what anyone may know, while a poorly written question is usually the one that gets thrown out.  While the question is a good question, it is premature, because you need to understand what your AV system is designed to do.

Let’s assume that you don’t have any experience with audio-video systems or with computer technology outside of the Office suite you use daily.  If you don’t have the time to spend on figuring out what the implications (rationale) are of choosing one over the other, then you have a few more decisions to make: Do you rely solely on the vendor to tell you what you need? Or do you rely on your local IT department to tell you what you need?  I guarantee that you will learn a lot from either party, but the reality is that they don’t necessarily know your needs: YOU are the specialist when it comes to your goals.  By clearly outlining what you want to accomplish with your AV system, you can listen to the IT specialists, AV specialists, and the vendors (who also have their specialists) all in concert and then return to your list of stated objectives.

The fact is you can get good, high quality video from any of the three genres of cameras: IP, USB, or analog.  However, you don’t want to tell a vendor whose system is built on an analog system that you want to use IP cameras, because they will likely discourage you from that move, but will “make it work” in your setting. In the end, it may cost you more and create unforeseen problems down the road.  Likewise, you would not want to tell a vendor that you want to use analog cameras when their system is built around IP cameras.

The remaining segments in this series will deal with observations about my own decision making process. I hope that the end result is that it will help you as you move forward in finding the appropriate AV system for your environment. Until next week…

Join me on the blog every week for more on AV Sytems. I welcome your comments. Email me with any questions at hmichaelyoung@live.com.

Go here to read AV Systems, Part 1: Planning for Growth—Meeting Your Present Needs

AV Systems, Part 2: Identify your Objectives
By Michael Young

The purpose of this article is not to tell you which vendor is best, or what you need; rather, its purpose is to introduce concepts that many do not consider. 

“Define your objectives first; it will guide you through the rest of the decisions needed to program the patient scenario.”  I’ve heard that plenty of times, but did you know that it is just as true when making decisions about an AV system?

However, to understand what objectives you need to consider, you need to have a bigger view about the role of technology in the administration of your center/facility.  The greater your need for AV for scenario recording, the more other considerations should be evaluated:

• the number of simulators you have,
• the number of spaces (rooms/stations),
• the number of students and faculty/staff that are involved,
• the number of inventory items that must be tracked,

Although you are primarily concerned with recording, there is so much more to managing simulation than the AV Debriefing system.  Consider also where you are going with your program. 

When you look at the offerings of various vendors, consider what features are available in addition to the AV component.  Consider if each component in that system actually “talks” to the other components.  For example: Does your room scheduling system talk with your camera scheduling?  Does your inventory system update depending on consumables used in a scenario?  Does your EMR integrate with the scenarios that are recorded, allowing each new group to start with a baseline record?  Does your communication system keep scenario participants updated so that everyone can be on the same page?  How do your team members (faculty, lab staff, technicians etc.) coordinate their various tasks?  Several vendors address many of these features, while only a few address most of them.  Your needs vary to some degree depending on what simulators are used and if standardized patients are utilized in the program.

After thinking through your entire program and the role that technology plays in the administration of all aspects of that program, you are ready to scrutinize what is on the market as you review your entire list of objectives.

Join me on the blog every week for more on AV Sytems. I welcome your comments. Email me with any questions at hmichaelyoung@live.com.

AV Systems, Part 1: Planning for Growth—Meeting Your Present Needs
by Michael Young

Chances are, if you have a limited budget of $20-30,000, then you have no choice but to go with a “low-end” system.  However, if you have been using such a system already, you know that there are "gaps" that entry-level systems will never fill.  You may have come to the conclusion that you need a system that enables you to manage not just videos, but the entire learning environment: inventory, communication with students and colleagues, and data collection. If you find yourself using five or six different software packages from different vendors to manage your learning center, then you are frustrated that they don’t “talk” with each other.  If your recording areas do not require more than one or two simultaneous recordings, then there are systems available in the mid to upper $30k range that offer learning center management tools accessible via the web, so their use can be accessed from anywhere (your office, or debriefing area) and not just at the control station.

Don’t have the budget to do better than a basic system?  That is really alright.  Lower-end systems can teach you a lot about what you want and what you really need.   Even if you don’t have the big bucks now, you can save a lot of money and headache in the future by thinking through what your ultimate requirements are.

·         Research the major players in Simulation/SP AV:

o   What type of camera do they use? (network [IP] cameras, or analog cameras) 

o   What camera models are they recommending? 

o   What microphones are they using? 

o   With what simulators do they interface?

Compare each vendor’s offerings and see if your lower-end system will work just as well with the cameras and microphones that the full-feature systems will require; it will be just that much less you will have to buy later.

Join me on the blog every Wednesday for more on AV Sytems. I welcome your comments: hmichaelyoung@live.com.