Post on 24-Feb-2016
description
Kevin S. Hughes, MD, FACSCo-Director, Avon Comprehensive Breast Evaluation Center
Massachusetts General Hospital
Associate Professor of SurgeryHarvard Medical School
SurgeonThe Newton-Wellesley Hospital Breast Center
Electronic Health Records: Are they ready for you?
Using Computers to increase Efficiency in a Breast Oncology Practice
EHR HIT has tremendous promise as a means of decreasing workload, decreasing
cost and improving quality of care
EHR and productivity varies by specialty100 internists, pediatricians and family practitioners
• 25 to 33 percent drop in MD productivity
• Over time
– Internists slightly above original productivity
– Pediatricians /family practitioners never recovered
Hemant Bhargava, UC Davis Graduate School of Management
Quote from a breast surgeon beginning EHR use
• …our productivity is down 28%
• I am the highest paid transcriptionist in the state
• Each cancer patient chart takes me apprx 1 hour
• For the first time in my career, I turned down an add-on patient
“Computerization hasn't saved a dime, nor has it improved administrative
efficiency”• 4,000 hospitals 2003 to 2007 • Computerization –Weak correlation • Quality for MI
– No correlation• Cost savings• Improvements in administrative efficiency• Quality for pneumonia• Quality for heart failure• Overall quality (MI, heart failure, pneumonia)
Himmelstein, The American Journal of Medicine (2010) 123, 40-46
Currently: Paper + memory
Patient completes paper form
Reviews data using memory of guidelines
Orders Genetic Testing
Documents and Orders
EHR: Paper + extra work + memory
Patient completes paper form
Reviews data using memory of guidelines
Staff enters data into the EHR
Documents and Orders
EHR
Generic InterfaceMostly
Filing CabinetOr
Document Management System
SmallDatabase
MedsAllergies
EHR
Generic InterfaceMostly
Filing CabinetOr
Document Management System
SmallDatabase
MedsAllergies
Same interface for every Specialty
CDS
Hereditary Risk Identification
Click open 4 screens
BRCA1+
Hereditary Risk Identification
Hereditary Risk Identification
EHRMammography
Pathology
Generic
Anesthesia
Cardiovascular
EHR
Breast MedOnc Interface
Breast Surgery Interface
RT Interface
HughesRiskAppsBreast Surgery Module
Kshughes@Partners.org
www.HughesRiskApps.net
Reviews Report
Reviews suggestedManagement
Adds clinical information
Documents and Orders
Patient educatio
nal material
sClinical Decision Support
Patient enters data :
Tablet PCiPad
Website
Clinical Decision Support
EHR
EHR
HughesRiskAppsBreast Surgery Module
Kshughes@Partners.org
www.HughesRiskApps.net
HughesRiskAppsBreast Surgery Module
Kshughes@Partners.org
www.HughesRiskApps.net
• Quote from a breast surgeon recently on a new EHR
• …our productivity is down 28%
• I am the highest paid transcriptionist in the state
• Each cancer patient chart takes me apprx 1 hour
• For the first time in my career, I turned down an add-on patient
EHR
Generic InterfaceDatabase
Filing CabinetOr
Document Management System
HughesRiskApps modules follow a simple workflow
Patient data entry
Clinical Decision Support (CDS)
Printout with suggested actions
Clinician editing/enhancing
Clinical Decision Support (CDS)
Generate orders and documents
Repurpose existing
data
•Apply Algorithms/Guidelines to patient data
•Identify best course of action
•Results displayed as intuitive Visualizations
BRCAPRO Mutation Risk 25%
Suggest Genetic Testing
Facilitates best action as part of workflow
Clinical Decision Support
EHR
Breast MedOnc Interface
Breast Surgery Interface
RT Interface
Better workflow
Reviews Report & Pedigree
Reviews suggestedmanagement Documents and
Orders
Patient educatio
nal material
sClinical
Decision Support
Patient enters data Tablet PC
iPadWebsite
Clinical Decision Support
EHR
Current EHR Future EHRDecrease productivity or neutral
Increase productivity
Mostly document repository Database
Mostly free text Structured data
Data entered by staff or provider
Data entered by patient, staff or provider
Generic interface Specialty specific interfaces
Rudimentary CDS/Drug-Drug interactions
Effective CDS for multiple specialties
View isolated transactions View consolidated information about a given problem
Proprietary hidden information
Open access to patient data
Monolithic, barely intraoperable
Interoperable with multiple ‘best of breed’ systems
HughesRiskAppsBreast Surgery Module
Free software available at:
Kshughes@Partners.org
HughesRiskApps.net
EHR
Database
Breast MedOnc Interface
Breast Surgery Interface
Mammography Interface
Pathology Interface
RT Interface
HughesRiskAppsBreast Surgery Module
Kshughes@Partners.org
www.HughesRiskApps.net
Breast Data Overlaps
EHR and productivity varies by specialty100 internists, pediatricians and family practitioners• Initial implementation
– 25 to 33 percent drop in MD productivity
• Over time– Internists
• Slightly above original productivity– Pediatricians and family practitioners
• Remained below original productivity
• Explanations– Internists review data entered by others
• EMRs more efficient– Pediatricians/family practitioners data entry and
documentation • EMR more time-consuming
Hemant Bhargava, UC Davis Graduate School of Management
EHR HIT has tremendous promise as a means of decreasing workload, decreasing
cost and improving quality of care
Kevin S. Hughes, MD, FACSCo-Director, Avon Comprehensive Breast Evaluation Center
Massachusetts General Hospital
Associate Professor of SurgeryHarvard Medical School
SurgeonThe Newton-Wellesley Hospital Breast Center
Electronic Health Records: Are you ready?
Using Computers to increase Efficiency in a Breast Oncology Practice