EHR Killer App

Great, insightful article on the need for a EHR Killer App:

"...So where is the EHR 'killer app'? Unfortunately, it doesn't yet exist, and instead providers find themselves courted by innumerous EHR vendors, each offering their own, proprietary methods for accomplishing familiar tasks. If providers aren't careful, they might find themselves locked into vendor-specific software systems and siloed IT universes."

HITECH and its effect on HIT

An interesting article on how HITECH has its own set of unintended consequences. In this case, the government can "screw things up" by forcing providers into acquiring HIT systems at a such a fast rate (less than 24 months), that they end up buying " certified" systems by large vendors. The result being they end up with systems that are less innovative with poor usability. This is a sure way to stiffle HIT innovation and destroy entrepreneurship. And then we wonder why HIT systems are so primitive compared with systems in other industries. Remember, Meditech introduced the ability to point-and-click by a mouse only within the last 5-7 years. This article does a great job in explaining this:

Mapping Lab terminologies

There can be anywhere from 5000 to 15,000 labs code at a given institution. The task of mapping these codes to a standard code set to another institutions codes for the purposes of use in Health Information Exchanges, EHRs for trending lab results can be daunting.

This task cannot be done by someone who understands just the bits and bytes. Considerable domain knowledge is required in order to this efficiently as well as accurately. It is common knowledge within this domain that far fewer than the 5000-15,000 codes account for the vast majority of the commonly ordered tests. And among this subset of commonly ordered, a smaller number of codes are actually important for the purposes of trending.

For example, in the in patient setting, each morning during review of patients lab during rounds, the most commonly trended lab observations are the lab elements contained within the "Comprehensive and Basic Metabolic" profiles, and the CBC. The CPK and ESR rates are trended, but usually for a limited time duration within a patients hospital stay. Test such as the Rheumatoid Factor or ANA on the other hand do not typically require a trended analysis for clinical decision making.

This paper by Daniel Vreeman et al (Regenstrief Institute, Inc. and Indiana University, Indianapolis, IN) makes the following conclusion:

"Given limited mapping resources, our findings support the strategy of focusing the effort on the small subset of observations that account for the majority of volume. Mapping the observation codes that cover 99% of the reported results would ensure that all of the results for more than 99% of patients would be mapped. Mapping even the few (49 to 68) observation codes accounting for 80% of reported results would cover all results for 91–98%
of patients."

Also see: Automated Mapping of Observation Codes Using Extensional Definitions

Hospital 30 day Re-Admission Rate now reported by CMS

The CMS website will now report on hospital's 30 day re-admission rates along with mortality data. Read more here. These measures are felt to be an indication of a hospital's quality of care. Hospitals will need to find ways to minimize repadmissions while at the same time, keeping lengths of stay low. This means, the post-hospitalization phase needs to be managed effectively, employing technologies such as telemedicine and remote monitoring.