MJ, A Case For EHR

Could EHR have prevented Michael Jackson’s allegedly abuse of prescription drugs? Saying EHR could “prevent” prescription drug abuse may be a bit far reaching, but it definitely makes it more difficult for prescription drugs to be obtained fraudulently. Before you close your browser session, navigate to another web page, or write me off as having drank the “EHR Kool-Aid,” hear me out.

There's basically only one of three ways, or a combination thereof, for a person to easily obtain and abuse prescription drugs. The abuser must either visit several different physicians to obtain several prescriptions, enlist the help of others to obtain unnecessary prescriptions written in their name that eventually gets passed on to the abuser, and/or find a physician that would write fraudulent prescriptions.

The first scenario, one person visiting several doctors, currently physicians depend on the patient to self identify their past medical and medication history. What makes scenario one plausible is that a patient can see several doctors and conveniently forgets to inform the other physician of their current medications. With EHRs, all doctors will have access to the patients’ history as reported by the patient’s providers. Since the overwhelming majority of doctors are honest, this scenario is unlikely to contribute to the abuse of prescription drugs under an EHR system.

The second scenario, multiple people obtaining unneccessary prescriptions to be later passed on the abuser. Under EHR would someone really want to risk getting a prescription for someone else, to later be possibly denied this prescription when actually needed? Or worse yet, run the risk of altering their future treatment plans because of fraudulent prescriptions in their EHR?

The last scenario a dishonest provider writing uneccessary prescriptions. Although EHRs cannot prevent a physician from writing fraudulent scripts, but because EHR captures the patient’s history, and the visibility of EHR records by other providers may deter some from being dishonest. Similarly to home alarms, if a burglar wants to break into your specific house, a home alarm system would not stop it. Just like EHR doesn’t stop a dishonest physician from writing fraudulent scripts. However, a Rutgers University study, using five years of data, scientifically proved that burglars tend to avoid homes with alarm systems. So the fear of physicians being exposed by EHR’s historical prescription data, individuals not wanting to risk their own health and treatment with fraudulent data in their EHR, and physicians would have an accurate picture of a patient’s current and past treatments would inherently would reduce the number of fraudulent scripts written hence reducing the opportunity to abuse prescription drugs.

Maybe I did have a sip, or two, of the “EHR Kool-Aid.”

Read the complete Rutgers press release here.

Click here to see HIMSS definition of HER.

For Everything Else, VistA

I haven’t hid my affinity for open source code, especially as it relates to HITECH’s requirement for providers to implement EMRs. I’ve come across an interesting article from Washington Monthly, "Code Red," that does a nice job articulating my viewpoint. This article contrasts two EMR implementations, one institution uses the much touted open source system initially written for the Veterans Administration hospitals called VistA and the other institution implemented a proprietary solution developed by Cerner Corporation.

In a nutshell, the institution that used the open source system achieved dramatic positive results, i.e. the number of medical errors and deaths decreased drastically. Whereas the institution that installed the proprietary system, experienced disastrous results, i.e. in some cases two doctors were required to attend to a patient whereas previously only one was needed and the mortality rate for certain patient populations more than doubled. Although I’m sure a similar contrast could be made extolling the virtues of using a proprietary system, however, I think this article does a good job of articulating my position overall for open source code EHR.

In addition, this article also shed light on other possible unintended outcomes resulting from HITECH requiring providers to implement EHR a such a fast pace.

Read the complete Washington Monthly article here.

A Healthy Discussion on EHRs

Medscape reported although physicians agree with the potential advantages of electronic medical records (EMRs), they are taking issue at the current administration push for EHR’s on three fronts:

1. the incentive program for providers to implement EHRs;
2. quality of existing EMR systems; and
3. the drive to put EHR on every doctor’s desk.

In the words of President Obama, there’s nothing wrong with a healthy discussion on the issues. Although I don’t agree with all three of the physicians’ reasons (reason number 2 is a valid concern), I do believe this dialogue with physicians, bureaucrats, and the IT community will yield a better solution. However, the question becomes can all of the stakeholders stomach a painstakingly long “healthy discussion?” Or will everyone pick-up their marbles and go home, then in 2012 healthcare reform will be the bat used to beat up those that supported it?

Read the complete Medscape report here.

EMR Usability, Leapfrog or IBM OS/2

I stumbled across an interesting article this afternoon on FierceHealthIT by Anne Zieger, “HIMSS says poor usability cuts EMR adoption.” In her article she basically reports that HIMSS published a paper outlining usability as one of the key reasons that will prevent EMR adoption. In their paper, HIMSS proposed that usability should become a part of the EMR certification process. HIMSS EHR Usability Task Force chair Jeffery Belden, MD stated that if certified EMRs were guaranteed to be user-friendly, decision-makers would feel more confident in selecting such systems.

What concern me are the diverse computer skills among the provider community. Some providers take to technology like a fish to water, and there are others where it’s more like forcing a kid to eat spinach. Usability testing in its purest form is generally done using black-box testing techniques, whereas the aim is to observe a random set of people using the product to discover errors and areas of improvement. If the usability test group is skewed towards the technology adverse providers, the resulting interface could end up resembling a Leapfrog educational gadget. Or if it’s skewed towards the technology favorable providers the interface could end up resembling IBM’s ill-fated OS/2 operating system, a PC operating system that was only appreciated by the most technical savvy of technologists.

Yes, I have over simplified the issue of usability certification. Surely the random collection of usability testers (providers) would be a fair representation of the skill set in the provider community. However, the criticality of assembling a “fair representation” of the provider community does give me reason to pause on the idea of usability certification for EMR applications to "guarantee" user-friendliness.

Read the complete HIMSS paper here.


Read FierceHealth IT article here.

Open Source EHR, Back On Main Street

As I’ve stated many times before in this blog, I’m a proponent of open source software. Unfortunately, the required certification needed from Certification Commission for Health Information Technology (CCHIT) in order for providers to receive EHR stimulus put open source EHR on life support. Much to everyone’s delight, well open source advocates' delight, CCHIT recently announced they were modifying the EHR certification process.

To understand why this recently announced EHR certification modification could possibly put open source EHR back on Main Street, you must first understand why the original CCHIT’s certification process impacted EHR open source. In a nutshell, the impact boiled down to two major reasons. First, the cost for CCHIT certification is significant. By nature of open source software, no one particular entity owns the source code, so the issue is not only the cost, but also who pays for the certification, providers (users) or the developers? If providers are required to pay CCHIT certification is open source EHR really free? In addition, if the provider had to pick up the CCHIT certification fee, it would be easier to justify implementing a certified proprietary EHR package. Secondly, the current certification approach supports the certification the “end-to-end” solution versus integrated solutions that could be implemented to support the “end-to-end” business process. This could force some providers into needlessly retiring previously installed proven software in favor of a CCHIT certified “end-to-end” solution.

CCHIT announced they were replacing the single certification approach with multiple certification paths. One of the new certification paths would have a simplified, low cost site-level certification path. In addition, a path was created to allow for modular certification. This would be welcomed from providers who prefer to integrate technologies from various certified sources.

Once the details are ironed out for the new CCHIT EHR certification, this has the potential of putting open source EHR back in play for smaller providers.

Read the official CCHIT announcement article here.