One Entrepreneur’s Rise, the Future For EHRs/EMRs and of Medicine

Posted on 08/06/2012 by admin

Forbes magazine is one of my favourite reads. Last evening before bedtime, I was catching up on the May 21 issue – (opposite left), my copy now almost 9 days old was lying idle altough I had skimmed through its pages already, when I noticed on page 28 from the Leaderboard pages, a short commentary on computing entrepreneur Neal Patterson, founder and Chief Executive of Cerner, “the world’s largest stand-alone maker of health IT systems – and company number 1,621 on FORBES’ Global 2000 list”.

I remember reading a past issue about this man (the May 7 issue to be exact, as I found out from this page 28 commentary).

I also remembered Patterson’s startup beginnings when I was researching for my other blog I am working on, Internet Start-ups.

This May 7 issue (opposite right) ran a cover story – “Obamacare Billionaires: What One Entrepreneur’s Rise Says about the Future of Medicine”, on this billionaire health information technology personality. I retrieved back this past issue and read this cover story again, as I thought it would make an interesting re-read, make a post to blog out and share, since I am been passionate lately on enhancing this blog, from stories ranging from anything traditional paper records to EHRs/EMRs.

Last night I quickly assembled this post, touched up the post this morning, and its before your eyes now. I don’t wish to write a long post and drown you with all that is in this cover story(you can research it as well if you wish to know more), but what I wish to do with this post is to share with you some reflections from this man who for 33 years “has preached better health through information”, and the future on EHRs particularly in the U.S. along with President Obama’s plan to mandate an EHR for every US citizen by 2014( p. 445 of H.R. 1, Economic Stimulus Bill).

Pals, below I quote his vision and thoughts I picked from my Forbes read which I think are worthy of mention, from the minds of a start-up entrepreneur “growing up on a wheat farm on the Kansas-Oklahoma border”:

Patterson “insists that health care’s moment of digital transformation has arrived. “It is finally happening,” he says. “Without a doubt in my mind, it is happening this decade.”¹
Both Patterson and Bernard Birnbaum, vice dean and chief of operations at NYU Lang one Medical Centre in New York City maintain that they are “off to the races”²
Both Patterson and Bernard Birnbaum are adamant that “health costs are ramping up too fast”, “you need well-implemented electronic health records ………you need to manage the data”, and “the trajectory of health care in America and elsewhere is set”²
Patterson cites “To Err Is Human” report “as the moment when health IT entered the mainstream”³
“Patterson says he isn’t worried at all” what Bates⁴ thinks the day when“Microsoft and Google could finally move into the health care industry, exploding the niche that has protected Cerner and its rivals for so long”, and that “he’s ready for revolution”.
Pattersons claims, “There is going to be fundamental change that’s going to happen,” he says, “but the elements of that change are all here today. And it’s going to be better for almost every participant.”

¹What is really “happening this decade”, is Cerner’s financial gains past 5 years. Patterson is visionary, made many innovations in computing and data storage and this has made him a very rich man. President Barack Obama’s healthcare reform has given him a healthy boost as well.

² There is little likelihood business will be hurt for Cerner and that of its rivals. Cerner’s fortunes and Patterson’s as well, is predicted to continue to grow no matter what happens in the election and regardless of what happens when the Supreme Court rules on the Obamacare plan.

³ When I was managing hospital quality management, the 1999 “To Err Is Human “ report from the prestigious Institute of Medicine, was a favourite report to quote and reference on patient safety. This report “detailed how between 44,000 and 98,000 people die every year in hospitals from preventable mistakes, like getting the wrong medicine or the wrong dose of the right one.” “The report specifically prescribed better computer systems as a way to prevent these deadly mistakes”.

⁴ David Westfall Bates, a Harvard professor was the lead author of the Institute of Medicine report.

I think with the hype surrounding the Obamacare plan blowing through the US amidst all the confusion and concerns over privacy and freedom to choose, health IT and EHRs/EMRs will still get a tremendous boost in the US, and this I believe will have a spiralling effect all over the world(the trajectory effect)², when other nations emulate the US’s strides towards switching to EHRs/EMRs.

What I tried to do here in this post is to bring you excerpts of a visionary’s push for a greater IT enabled industry in the US which would have direct impact for medical records and health information management there and the world, and what’s trending now in health IT.

< Happy weekend as I shall continue posting only next week! >

JCI Standard MCI.19.2 & MCI19.3 – Patient Clinical Record

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Its been 7 days since I last posted on quality standards for patient clinical records.

To continue on JCI hospital accreditation standards, this Thursday morning I am posting away this post drafted over the last 4 days, sharing with you my experiences on the JCI Standard MCI.19.2 and JCI Standard MCI.19.3. These 2 standards relate to the quality of patient clinical records.

JCI Standard MCI.19.2 states that “organization policy identifies those authorized to make entries in the patient clinical record and determines the record’s content and format”.

Thus, the person(s) who have the authority and right to document in a patient clinical record must be as defined by the hospital’s policy. This would mean all writers who document in a patient clinical record – doctors especially, must be trained in and/or briefed and follow their hospital’s standards and policies for documentation.

A hospital policy for patient record documentation must define by job title and function, including students in academic settings as those authorised to make entries in the patient clinical record The policy must determine the format and location of entries, contain a process to ensure that only authorised individuals make entries in patient clinical records, contain a process that addresses how entries in the patient record are corrected or overwritten, provides identities of those authorised to have access to the patient clinical record and thereby have the obligation to keep the information confidential, and also contains a process to ensure that only authorised individuals have access to the patient clinical record and if information is compromised then it also contains a process to be followed when confidentiality and security are violated. If your hospital policy satisfies these provisions, then the MEs of MCI19.2 surely be in full compliance (graphic below gives a summary of the policy, double-click on graphic for a larger view of this graphic in a new tab, of the same window of your browser).

In Malaysia, training and awareness on the right to document in patient clinical records by doctors begins during their internship. “A Guidebook for House Ofﬁcers”, published 23 April 2008 by the Malaysian Medical Council, clearly states that “in Malaysia, pursuant to the Medical Act 1971, internship is only imposed upon after graduation. The two-year internship combines service and training roles. It is formulated in such a way to ensure medical practitioners like you gain appropriate knowledge, skill and experience as well as correct attitude rather than merely employment and provision of services”. This training roles includes that regarding documentation in the patient clinical record as in section 4.4, page 32 of this guidebook.

If the author, the date and the time for each patient clinical record entry especially for timed treatments or medication orders can all be identified successfully, then you patient record satisfies the Standard MCI.19.3 which states that “every patient clinical record entry identifies its author and when the entry was made in the record”.

However the requirement that the author, the date and the time for each patient clinical record entry especially for timed treatments or medication orders, must be stipulated in the hospital policy.

I think it is also wise to include in the policy that the authors should sign with their legal signature (your last name and legal first name or initials), no nicknames should be used, and initials should follow their name indicating their status as a specific caregiver, depending on local statutes and regulations which I think is lacking in Malaysia, but take note that this is not required(no mention) by JCI Standard MCI.19.3

I did not cover in this post about counter-signatures, telephone order (T.O.), voice order (V.O.), Fax Signatures, Electronic Signatures, and Signature Stamps, but of course all these other modes of documentation entries can be included in the policy.

Here I remember the familiar ISO 9001 cliché “say what you do and do what you say”, is to document everything that everyone does. You also must have heard the “wasn’t documented, wasn’t done” motto which is a common one in healthcare settings.

Race to the ICD-10 Finish Line

Posted on 06/06/2012 by admin

In the US, the race is on to comply with ICD-10 by 1 October 2013!

Take a look at this info-graphic from teksystems.com about the race to this finish line. It tells the story about the healthcare system in the US and their partnership with healthcare vendors to implement ICD-10 there.

We in Malaysia, had no such fiery race but a finish line to switch over from ICD-9 to ICD-10 during the transition period from as early as 1998 to our finish line on 31 December 1998, and we started using ICD-10 by 1 January 1999 in our morbidity and mortality reporting systems, some 14 YEARS earlier than in the US!

I think as HIM/MR professionals, we are the ones who need to spearhead the next big thing in ICD, that is ICD-11 when medical records systems in Malaysia would probably be IT driven. Our hospital IT departments are usually with a young and usually inexperienced workforce(my experiences and opinion). I also think it will be wise to take the lead and not make them to struggle with the then implementation of ICD-11 or even ICD-10 if your hospital plans to go the EMR way in the foreseeable years, because they would be lacking the experience, skills and bandwidth to handle ICD systems.

8 Ways You Can Visualise Proportions

Posted on 03/06/2012 by admin

Reviewing student assignments, I come to live with the fact of life that there is much to be desired in terms of creativity, critical thinking, depth, style, understanding of concepts, presentation, grammar and written language.

Looking back at the assignment which included the use and interpretation of graphs to visualise proportions, I suddenly thought I would make a post on graphs and how they can aid visualisation, and share with you the reader of this website-blog, and this post in particular.

In the course of your work as a HIM/MR professional, you must have prepared graphs using the computer. Chances are you prepared pie charts, the stacked bar(either vertical or horizontal bars), and just plain bar graphs and line graphs.

Since I had started posting on JCI Standards, I remember well when I used radar charts to display compliance ratings in medical records review findings report while working with my JCI experiences. I shall talk more on this in my coming post on the JCI Standard MCI.19.4.

A radar chart looks like this one:

Now, let us look at 8 ways to represent data we churn out each day, visually to represent proportions.

Pie charts and stacked bars are two ways used to represent proportions, you have used it!

You used a pie chart(WAY 1), which is a circle which represents the whole, and the size of each wedge represents a percentage of that whole, all wedges add up to 100 percent. For example, you may have presented the 10 leading causes of mortality in a pie chart for a particular year, and used the stacked bar chart (WAY 2) to represent for example proportions of 10 leading causes of morbidity for a number of years in a vertical stacked bar chart.

Likewise these other 6 graph types can also be used to represent proportions.

The donut (WAY 3) is the same idea as the pie, but with a hole cut out in the middle. Here is one example:

The stacked area chart(WAY 4) is used to show changes over time for several variables. You can use it for percentages, where the vertical always adds up to 100 percent, or you can use raw counts if you’re more interested in the peaks and valleys. Here is an example:

The treemap(WAY 5) uses the areas of rectangles to show relative proportions. It works especially well if your data has a hierarchical structure with parent nodes, children, etc. One example is :

A Voronoi diagram(WAY 6) uses polygons to represent area as well to visualize magnitude, except instead of rectangles or wedges. The Voronoi diagram is more flexible over some of the problems when restricted to rectangles to represent areas. One example is:

If you want to focus on a single data point and need to show every individual count within a data point, then consider using the Everything(WAY 7) . It takes up a lot of space, but sometimes puts things in better perspective, like in this way:

The Nightingale rose graph – or the polar area diagram(WAY 8), coined after its creator, Florence Nightingale, is like a combination of the stacked bar and pie chart. The length of radius is used to indicate one thing, usually a count, and polar area represents a portion of the whole. I like to tell you more on the Nightingale rose graph in some future post, and looks like this:

I hope I have not drawn you too deep technically into this blog post, but I wish you can respond and talk about these things in your life and work, by leaving your comments.

The Top 20 Most Popular EMR Software Solutions

Posted on 02/06/2012 by admin

I located this infographic on the most popular EMR solutions out there originally from Randy Krum’s blog at http://www.coolinfographics.com/. I wrote to him to ask permission to link or embed this infographic, and this morning I am delighted to get his reply and advice. Thank You Randy!

I am not going to say anything much on EMRs in this post, as I have already talked about them in earlier posts, I just want to share this infographic in this blog.

However, if an HIM/MR professional is a member of a committee that is charged with developing EMR systems in a hospital, I think this would serve as a good visual for him or her about EMR solutions out there.