Johns Hopkins Part 3: Getting the Electronic Health Record (EHR) Right

Today I received a call from Stephanie L. Reel, Vice Provost for Information Technology and Chief Information Officer, The Johns Hopkins University. We discussed the importance of having an EHR system that worked for health care providers and patients. I suggested that she talk to some end users to see what actually works and does not work.

My experiences demonstrated how the EHR system can become a burden for all levels of health care providers and patients. This becomes exacerbated when the productivity of health care providers is measured and calibrated by the inputs and metrics that are captured as part of the EHR. It seems that with all the numbers that are crunched the qualitative aspect of health care interactions are lost. Moreover, the value of the interpersonal dimension of care is diminished if not obliterated by just counting the procedures that are quantitative, i.e., easy to measure. As a result a health care provider ends up spending more time in front of a computer than in front of a patient. This is not what was intended.

All health care providers and patients want an EHR that works. Health care providers need to have an EHR system that helps them input, review, and correct patient information accurately and easily. Patients want information that is accurate so that the precious time with their health care provider is not spent making corrections.

In our case my husband has an excellent physician and I want to make sure that the tools that are at his disposal are useful tools and not impediments. I also want to make certain that during those visits that by their very nature are stressful, that time does not have to be wasted because the EHR failed to do what it was intended to— be a vital tool for patient safety by reducing the likelihood of medical errors.

Johns Hopkins Part 2: Is This Service Excellence?

The initial response to my email (see earlier post) was from a staff person who was supposed to respond to patient issues. I thanked her for her call and emphasized that it would be better if I received a call from a more senior person who could address my concerns with their EHR system and the ease of its use.

Later I received a call from Ms. Becky Zuccarelli, Director of Service Excellence, who informed me that because of HIPPA requirements that she would need a release before she could talk to me about the patient issue. I informed her that this was not a HIPPA issue as it was not about a specific patient but about their system. While she tried to do what she was trained to do, she was unable to understand the broader implications of the failure of their EHR system to either engage physicians or other health care providers or be responsive to the needs of patients. Ms. Zuccarelli's focus on service excellence missed concerns about system adequacy.

Part of the success of any new system is listening to feedback from users and fixing the problem. Handling a situation is not the answer. I emphasized that they need to fix their EHR system before they kill someone and the fatal mistake ends up being chalked up to medical error rather than avoidable system failure.

I am still hoping for a meaningful response and will keep you posted on what happens next.

Johns Hopkins Part 1: The Electronic Health Record (EHR) that Isn't

On Friday, September 16, 2011 I sent the email below to Dr. Edward Miller, Dean and CEO of Johns Hopkins Medicine. Let's see the response I get:

Just to share with you two exchanges I had with your staff which indicates a failure in the design and implementation of your EHR system.

1. When I brought my husband in for his regular visit, once again he noted that he did not take the medicines listed on the printout. The response was that it was too complicated to change what was there as it would take too much time and anyway his medicines were properly listed in the notes.

2. When I reviewed the letter for my husbands scheduled infusion his medicine was incorrectly listed as Rituzan. When I called to get it corrected I was told that it was a mistake in the coding but that he would get the correct medicine..and moreover it has been incorrectly listed in the system since March when he first started to get his infusions.

Having worked on many aspects of getting legislation passed with respect to EHRs I was surprised and disappointed by the responses I received. EHRs are for more than billing; they are essential for patient safety. If someone is brought into the ER do you think the staff in the ER have the time to read through the notes to know the medications that a patient has taken? The responses of your staff reflect the failure of your EHR system to meet the needs of the health care providers at the front line as well as those of the patient.

I hope that you are able to make your system work better before someone gets hurt. I look forward to hearing from you about how you intend to fix a system which is not working as it should.

Sincerely,

Jane L. Delgado, Ph.D., M.S.
President and CEO
National Alliance for Hispanic Health
1501 Sixteenth Street, NW, Washington, DC 20036-1401
(202) 797-4321 Executive Office | (202) 265-8027 FAX
jdelgado@hispanichealth.org | http://www.hispanichealth.org

Public Health and Science

There is an enormous gap between the public health community and the science community. Public health is driven by large data sets and averages. Science is moving into the realm of each person being their own universe of 10 trillion cells and 100 trillion microbes. How do we use the rich data we are able to analyze about the individual with health at the community level? We need to benefit from both.

Public health must become better at measuring multiple factors at the same time while understanding that communities are more than the composite of unique individuals factors. Our analysis of communities and public health needs to keep up with what science is teaching us about individualized health and systems.

For Cinco de Mayo No More Latino Policy Day

When I was invited to a recent gathering for a Latino Health Policy Day I thought I was reading some script from the 1980’s that read, “In order to reach the Hispanic community invite a group of Hispanics to meet with you one day.” Are we so out of touch with each other that we need Latino Day to hear from Hispanics? I wondered if there was an Anglo Day, and only on that day would the effort be made to include Anglos in policy.

In health to make good policy we need to understand the entire community we serve, and it needs to be a part of how we do our work every day. Today about 1 out of every 6 persons in the United States is Hispanic. Also consider that the combined total population of Canada and Australia is 57 million which is about the size of the population of Hispanics in the U.S (54 million*).

Just not on Cinco de Mayo, but everyday our policies need to take everyone into account and make it possible to tailor what we do to meet individual needs. To have good policy it means that every day is Hispanic Policy day, African American Policy Day, Anglo Policy Day, Women’s Policy Day, and so on. If we do not include all communities we make policies that are bound to miss the mark.

*Unlike Census and others when I give the population of Hispanic persons in the United States I include the 4 million citizens who live in Puerto Rico.

New data has surprising results

Today the news is that salt is okay and yesterday it was that BMI was not a good measure of health. The eagerness to make news sometimes gets in the way of being informative. One day’s science news is trumped (does that have new meaning today?) by the next day’s new discovery. Typically the data are described, the findings are made into pronouncements, and the need for further research is discussed. The reader is left wondering which facts were correct. Is it any surprise that consumers are confused by and distrusting of science? When information is presented in a way that is unclear people just keep doing what they are most familiar with and ignore the information generated by the new finding. We need to make science relevant to the people we are trying to reach.