Category Archives: EHR

Electronic vs Paper medical records – tracking down John Doe’s medical records

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Many Health Information Management (HIM) / Medical Records (MR) practitioners worldwide are still stuck with the conventional paper-based medical record. The infographic in this post (you can view a larger image by first clicking on the image below which will open in a new tab of your current window and then clicking again on the image in the new tab) is a typical scenario of “missing” medical records, and offsite storage which continues to post many problems from logistics to damaged medical records.

Electronic medical records seem to drive greater efficiency in the storage of medical information, and it seems to me perhaps the best possible path and solution for the betterment of medical records management. HIM / MR practitioners practicing in such an environment will know its impact.

Whither paper-based medical records systems?

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I have this infographic (below) to share which shows how technology has advanced over the last 50 years (from 1960 to today), yet most of us accept that medical records are still kept in paper files, and that’s the way it is. Technology has evolved over those many years and has brought sweeping changes, brought about many changes, whither paper-based medical records systems? Since back in the mid-70s when I started my career in Health Information Management (HIM) / Medical Records (MR) Management there is no way I would ever have dreamt of where we are technologically today. I wonder what our medical records systems will be like in 2020 technologically when Malaysia envisions being a developed nation.

2020 is just under 8 years more to arrive, meanwhile, have we thought about how much time is being wasted on paper activities that could so easily be streamlined?

This is how it looks (below) at a typical medical records department here in Malaysia.

Image credit: A typical scene in a paper-based medical records department in Malaysia, MyTawau, Facebook

Is your life as an HIM / MR practitioner going to become easier – and much more organised if we moved to computer-based medical records, lured by the promise that once you move to a paperless way of organising things?

Talk about getting rid of paper, I hope hospitals everywhere can go from a large file room with tons of paper in files to a large server with high-tech programs, surely we’ve saved thousands of trees and dollars by doing so.

Although access online is available 24/7 for everything from shopping to helping with homework, it is not available for medical records. Patients, doctors, and other caregivers who rely on the medical system may find themselves in a dire situation when data about the most critical information about health and quality of life can’t be accessed in a timely manner that would and should guide future treatment. Yet it ought to be. The cost comes in wasted time, diminished quality of care, duplicate testing, needless expense, unnecessary worry, and, worst of all, lives lost.

Is then the paper-based medical records system not good enough anymore?

The technology applied in ATMs and online banking provides universal access to financial records, and one can access them online, too. The paper-based system of medical information currently in use has no connectivity, no ease of access for either patients or providers and limited security and tracking of access. It is a barrier to improved treatment. This kind of technology could and should be applied to healthcare as it means more than convenience, this technology will definitely save lives. What is needed, is making the connection, and I think the technological answer to the need is within reach.

I hope the day is not far off when we can walk into an HIM/MR department of a hospital and not see any more medical records still kept in paper files!

EHRs – identifying and treating at-risk patients to improve their health

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Diabetes mellitus is a common disease causing significant mortality and morbidity. It is a serious debilitating and deadly disease, but you can control it and you can learn to live with it as once you are a diabetic, it’s very difficult to reverse it.

In Malaysia, the First National Health and Morbidity Survey (NHMS I) conducted in 1986 reported a prevalence of diabetes of 6.3% and in the Second National Health and Morbidity Survey (NHMS II) in 1996, this had risen to 8.3%. The third National Health and Morbidity Survey  (NHMS III) was conducted between April to July 2006 and showed a dramatic increase in the prevalence of diabetes for adults aged 30 years and above to 14.9% – an increase of 80% over a period of just 10 years (8.3% in NHMS II vs 14.9% in NHMS III ) representing an average 8% rise per year.

Can electronic health records (EHRs) serve to help patients manage their health and to provide treatment to patients with chronic diseases, such as diabetics?

EHR systems widely implemented in Wisconsin, USA are improving coordination and making health care more efficient, lowering costs and identifying and treating at-risk patients to improve their health.

Image credit : JSOnline, Milwaukee, Wisconsin, USA.
Eida Berrios, a registered nurse and certified diabetes educator, leads a discussion in early July during a class for patients with insulin pumps at the Sixteenth Street Community Health Center in Milwaukee.

Here is how it works  in diabetes management using EHRs for patients at the Sixteenth Street Community Health Centers in Milwaukee, Wisconsin as reported from the July 16, 2012 JSOnline, the online version of The Milwaukee Journal Sentinel – the primary newspaper  and the largest newspaper in Milwaukee :

  1. patients who may have a three-month average blood sugar level higher than the recommended 7% may be flagged by the systems to receive extra help to manage their chronic disease
  2. doctors can run reports of patients who missed their cholesterol panel check last year and, in that way, focus on patients out of range and get them in for an appointment sooner
  3. graphics generated from data of individual patient history reports received since 2010 allow doctors  compare their patients against national trends and other doctors’ patients
  4. doctors look at treatment plans and the most recent test results, while providers use the data to create intervention plans, to identify which screenings are getting missed and to refer patients to diabetic educators to help them manage their chronic illness
  5. the coordinated care and testing that a patient receives when doctors and diabetic educators monitor their patients using the EHR systems provides a holistic view of care, and it can also be shared by doctors to avoid retesting
  6. doctors become more proactive in providing care by identifying patients who are far away from their health care goals, even if the patient hasn’t been in the clinic for a while, and the patient becomes more informed and they tend not to fall out of care, preventing costly emergency hospitalisations
  7. the EHR systems remind doctors to address certain screenings and lab tests with their patients
  8. the EHR systems sends out reminder calls for example about a missed appointment or a missed flu shot
  9. data in the EHRs system help to document statistics for example, 74% of the 1,895 patients that saw their doctors twice last year have an average blood-sugar level under 8%; it also shows 70% of their diabetic patients have a blood pressure of less than 130/80
  10. providing monthly reports for example of regular neuropathy exams – to see if diabetics had loss of sensation in their feet, could highlight that too many patients weren’t getting a documented foot exam, and remind doctors to keep up with testing
  11. information from in-house reports divided by blood-sugar controls, blood-pressure management, cholesterol level and screenings of neuropathy foot exams and retinal exams allows for specific follow-up to target areas patients are struggling with, such as exercise, nutrition, emotional support and diabetes education classes
  12. researchers use the information from the the EHR systems to identify at-risk groups that live within specific geographic areas by linking clinical information in the EHR system to public health data to identify and map the prevalence of diabetes compared with levels of economic hardships

This is one good example how EHRs serve as a platform to manage health education, to help patients manage their health and to provide treatment.

Abridged by R. Vijayan, from the original article “Diabetes management using electronic medical records” by By Aisha Qidwae of the Journal Sentinel, July 16, 2012.

How safe is safe for the future of Electronic Health Records?

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It’s late sunday afternoon, I was reading news feeds. One feed struck me as worthy of sharing on this blog this instance. I hope you like the Photoshop graphics I swiftly assembled to prepare along for this post.

A Bloomberg report, citing a privacy blog Dissent Doe reported that  hackers were able to access electronic medical records and emails belonging to the Surgeons of Lake County, a medical practice in Libertyville, Illinois, USA.

The hackers holding the data for ransom, demanded the practice to pay ransom money for a password to access the encrypted.The blog reported the practice declined to pay, it shut down the server and notified authorities but was clueless whether the practice was eventually able to access its Electronic Health Records (EHRs), or if it did, how did they do it.

This disturbing new trend emerging serves as a warning that unpredictable things can happen to data once it’s digitized when hackers (criminals) try to exploit the healthcare industry’s shift to digital healthcare information.

Also from this article, it quoted Bloomberg which reported two cases involving pharmaceutical prescription systems in 2009 and 2008, and also several cases prior to 2008 related to outsourcing practices.

In 2009, the Virginia Prescription Monitoring Program was hacked and hackers demanded $10 million from the state of Virginia (USA) after he or she claimed to have stolen and encrypted personal and prescription drugs for 8.3 million patients. Another hacker in 2008  demonstrated he or she had personal information on a few dozen members of the prescription-drug benefits manager Express Scripts and demanded ransom money, but never got the ransom demanded from this company. Four years earlier to 2008, several California hospitals were blackmailed after outsourcing their medical transcriptions overseas.

The Obama Administration is aggressively expanding the use of EHRs that it strongly believes is fundamental to reforming the U.S health care system. Billions of dollars worth of grants have been announced to help hospitals and health care providers implement and use EHRs. Many hospitals around the world have also moved the EHR way.

Criminal activities I am now quoting from this article, may seem one small event or events in an isolated area far away in the U.S and may not seem especially noteworthy, but it may offer the first tangible warning of a larger problem developing as the shift to digital medical records begins in U.S in a big way and even here on Malaysian shores as our hospitals begin to move the EHR way. I think hackers holding healthcare data for ransom may be described as a canary in a coal mine for the future of EHRs.

Abridged by R. Vijayan from the orginal article “Hackers Hold Health Data Hostage” by John Pulley for Nextgov, August 11, 2012

The Five Rights of Data Administration!

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If you read the post Documentation of medication administration in medical records, I am sure you did not miss reading about how clinicians and nurses use the “Five Rights of Medication Administration” to ensure proper patient care.

If you work in an EMR environment, then the following infographic, entitled “The Five Rights of Data Administration,” created by Symantec to help Health IT staff and users like you, Health Information Management(HIM) / Medical Records (MR) practitioners answer important questions about the use, access, and availability of critical patient data. This infographic outlines specific best practices to ensure that patient information is kept secure regardless of where it is. The infograhic also helps you and Health IT staff in organizations like the hospital you work in better understand the administration of patient data

I believe HIM/MR practitioners working in an EMR setting need to adopt similar but modified best practices for ensuring proper security and privacy for patient data based on the specific best practices outlined in this infograhic.

Note: Click on the infograhic above to view a larger image in a new tab of your current window.

From this infograhic, you need to cultivate the following specific best practices with coordination, guidance and help from IT staff of your hospital.

  1. Right Time – data in EMRs should be available to authorised personnel in your department whenever they need it and must be backed up and secure
  2. Right Route – users like clinicians who need access to EMR data regardless of where they and the device they’re using, must have ready access to updated data your are responsible for at your end
  3. Right Person – ensure only the right people have access to certain information though access verification in your department
  4. Right Data – prevent unauthorised tempering or accidental corruption of data with only users entitled or authorised to have access to data in your department and minimising or banning Bring Your Own Device (BYOD) mobile devices
  5. Right Use – ensure only the “minimum necessary” information is provided to external sources who request data that can be extracted from your end of the EMR system, thus assuring confidentiality

Just like medication administration is taken very seriously with the utmost accuracy and attention to detail as they can mean the difference between life and death, the proper administration of patient data should also be taken very seriously as it too can prevent misdiagnoses or mistreatment without accuracy and attention to detail.