Kevin S . Hughes , MD, FACS Co-Director, Avon Comprehensive Breast Evaluation Center
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Kevin S. Hughes, MD, FACS Co-Director, Avon Comprehensive Breast Evaluation Center Massachusetts General Hospital Associate Professor of Surgery Harvard Medical school Creating the EHR of the future Using Computers to Decrease Workload and Improve Quality Israeli Association for Medical Informatics
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Creating the EHR of the future Using Computers to Decrease Workload and Improve Quality Israeli Association for Medical Informatics. Kevin S . Hughes , MD, FACS Co-Director, Avon Comprehensive Breast Evaluation Center Massachusetts General Hospital Associate Professor of Surgery - PowerPoint PPT Presentation
Transcript of Kevin S . Hughes , MD, FACS Co-Director, Avon Comprehensive Breast Evaluation Center
Kevin S. Hughes, MD, FACSCo-Director, Avon Comprehensive Breast Evaluation Center
Massachusetts General Hospital
Associate Professor of SurgeryHarvard Medical school
Creating the EHR of the future
Using Computers to Decrease Workload and Improve Quality
Israeli Association for Medical Informatics
The EHR has tremendous promise as a means of decreasing workload, decreasing cost and
improving quality of care
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
“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
Quote from a surgeon beginning an 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 InterfaceMostly
Filing CabinetOr
Document Management System
SmallDatabas
eMeds
Allergies
MinimalGeneric
CDS
EHR
Database
Breast MedOnc Interface
Breast Surgery Interface
Mammography Interface
Pathology Interface
RT Interface
SpecialtySpecific
CDS
SpecialtySpecific
CDS
SpecialtySpecific
CDS
SpecialtySpecific
CDS
SpecialtySpecific
CDS
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
Clinical Decision Support (CDS) •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
CDS
Genetic Testing and Risk
Click open 4 screens
BRCA1+
Genetic Testing and Risk
Genetic Testing and Risk
Programs exist that can fill this gap
• HughesRiskApps• Progeny• Jameslink• CancerGene• BRCAPRO
Current EHR Future EHR
Monolithic Interoperable with multiple ‘Specialty Specific’ systems
Current EHR Future EHR
Monolithic Interoperable with multiple ‘Specialty Specific’ systems
Family History CDS
AlgorithmsKnowledge
Base
Vendor 1Vendor 2
Vendor 3
Family History CDS
AlgorithmsKnowledge
Base
Family History CDS
AlgorithmsKnowledge
Base
Monolithic Approach150 Vendors create 150 different CDS approaches to the same problemCurrent EHR Future EHR
Monolithic Interoperable with multiple ‘Specialty Specific’ systems
Clinical Decision Support
AlgorithmsKnowledge
Base
HL7
Vendor 1
Vendor 2
Vendor 3
Current EHR Future EHRMonolithic Interoperable with multiple
‘Specialty Specific’ systems
Current EHR Future EHR
Mostly free text Structured data
Using free text for CDS will require Natural Language
Processing and is not trivial
Natural Language Processing of breast pathology reportsDiagnosis Phrase
sInvasive Ductal Carcinoma 124Invasive Lobular Carcinoma
95
Ductal Carcinoma in situ 52Lobular Carcinoma in situ 53Atypical Lobular Hyperplasia
17
Atypical Ductal Hyperplasia
14
Natural Language Processing of breast pathology reportsDiagnosis Phrase
sNegate
Total Patterns
Invasive Ductal Carcinoma 124 33 4216Invasive Lobular Carcinoma
95 333230
Ductal Carcinoma in situ 52 33 1768Lobular Carcinoma in situ 53 33 1802Atypical Lobular Hyperplasia
17 33578
Atypical Ductal Hyperplasia
14 33476
21 negations before diagnosis ( No evidence of …)
12 negations after diagnosis ( … was not seen)
Current EHR Future EHRMostly free text Structured data
Specialty Specific Systems ask for specialty specific data and in return
provide specialty specific CDS
Providers will enter Structured Data if they get value in return or if it saves them time
EHR: Paper + extra work + memory
Patient completes paper form
Reviews data using memory of guidelines
Staff enters data into the EHR
Current EHR Future EHR
Data entered by staff or provider Data entered by patient, staff or provider
Documents and Orders
Reviews Report & Pedigree
Reviews suggestedmanagement Documents and
Orders
Patient education
al materials
Clinical Decision Support
Patient enters data Tablet PC
iPadWebsite
Clinical Decision Support
Current EHR Future EHRData entered by staff or provider Data entered by patient, staff or
provider
Breast Cancer PatientPrint 3 Op Reports and 3 Path Reports
Accession Number: Report Status: Updated
Type: Surgical Pathology
Pathology Report:
CASE:
PATIENT:
Date Taken: 12/11/2008 Source Care Unit:
Path Subspecialty Service: Results To:
Signed Out by.
********** Addended Report ***********
Accession Number: Report Status: Updated
Type: Surgical Pathology
Pathology Report:
CASE:
PATIENT:
Date Taken: 12/11/2008 Source Care Unit:
Path Subspecialty Service: Results To:
Signed Out by.
********** Addended Report ***********
CLINICAL DATA:
Accession Number: Report Status: Updated
Type: Surgical Pathology
Pathology Report:
CASE:
PATIENT:
Date Taken: 12/11/2008 Source Care Unit:
Path Subspecialty Service: Results To:
Current EHR Future EHR
View isolated transactions View consolidated information about a given problem
Current EHR Future EHRView isolated transactions View consolidated information
about a given problem
EHR
Specialty Interfaces/CDS
Will allow us to increase quality while decreasing cost
Specialty Interfaces/CDS
Specialty Interfaces/CDS
Specialty Interfaces/CDS
Specialty Interfaces/CDS
Specialty Interfaces/CDS
HughesRiskAppsBreast Surgery Module
Free software available at:
HughesRiskApps.net
Reviews Report & Pedigree
Reviews suggestedmanagement Documents and
Orders
Patient education
al materials
Clinical Decision Support
Patient enters data Tablet PC
iPadWebsite
Clinical Decision Support
EHR
Demo• An explanation of
HughesRiskApps
HughesRiskAppsBreast Surgery Module
Free software available at:
HughesRiskApps.net
