Quality: Are We Far Enough Along to Get There?
OPINION – September 3, 2013 -- Recently I had the privilege of presenting on a panel on the use of social media in healthcare at the MedInfo Conference in Copenhagen, Denmark. Not only was the conference well-attended by colleagues from across the globe, but also it was most interesting to hear about the many advances that were being made in health informatics, including in some unlikely settings, e.g., rural portions of Africa.
The day before the meetings, I was invited to tour a hospital outside of Copenhagen. It was a beautiful public hospital. After a warm welcome, and the opportunity to observe the resection of a kidney with a tumor by a physician operating a surgical robot, I met the head nurse for quality for one of the hospital’s departments. She demonstrated how her department was using electronic health records (EHR), and even had taken the time to place some of the entries in a dummy EHR in English.
The quality nurse discussed how those in the department took care with respect to bar coding the patient, the medications, and certain aspects of the process to ensure quality and safety. She stated how drug interactions might trigger alerts. She also discussed specific quality and safety initiatives.
However, for the most part, she noted that she still had to look through each EHR for each patient to observe potentially problematic issues. I asked her why she did not have a list of items that she might observe for quality considerations, and just query her database of patients for same. For example, if a drug alert was triggered for a patient, and she wanted a list of patients for whom drug alerts had been triggered last month, could she not just obtain such a list? She replied no. She had to search through each EHR for each patient.
Troubled that this highly skilled professional was not making the best use of her time, and was not able to utilize her clinical knowledge to the fullest in quality initiatives, but rather was spending her time on what appeared to be more mundane administrative tasks, I asked why does someone not just draft a program that will provide you with this information each month. Then, you could use this information to assess quality and work toward improving it.
Unfortunately, the nurse stated that the EHR system deployed in the hospital would not accommodate such a program, but if it could, this information would be quite useful to her, and she could spend more of her time addressing clinical issues. My immediate thoughts were that an incredible amount of highly sophisticated clinical talent was not being deployed effectively, and how much quality might be improved, if it were. Also, from a job satisfaction perspective, the nurse said she would be much happier, and rightfully so.
After another commentary that I penned for The Lund Report, I received communications such as we are almost there or we will be there with our EHR implementation. When I asked: But are your systems interoperable across other systems, there is often a pause. I had not thought about asking whether the EHR system could provide such necessary quality information on demand. I naively assumed that it could. Can it? Does it depend upon the system? The vendor? The EHR’s flexibility?
Being a biomedical informatician lawyer, when I observe a situation like this, I immediately begin to think of all the other things that EHR systems might not be to do because of their lack of adaptability or flexibility in the early stages. Many ask how can we measure quality and reduce costs in our healthcare system? We might want to ensure that the newly developed EHR systems upon which billions of dollars are being expended can facilitate quality initiatives. We might want to ensure that the quality nurse in Denmark can spend more of her time actually working on quality initiatives, and less of her time reviewing screenshots of EHRs to “data mine” the quality issues. There does not appear to be much of a difference in one looking at a paper record or a screenshot of EHRs if the EHRs cannot be easily queried for the information one might need to work on for quality initiatives.
When some say we in the US may be spending twice what we need to on healthcare, I will often think of that visit to the hospital outside of Copenhagen which is in a country where the quality of healthcare is seen as better than that of the US and the cost substantially lower. If the Danes can increase their quality and decrease their costs with the ability to query their EHR for certain information, one wonders what type of advancements the US can make in such areas. Some say we are there, but are we truly there or do we need to come up with a health information technology solution to each of these issues. They do exist, and some EHRs have them.
I often say I learn something every day. I learned many things on my visit to Denmark which will make me explore more areas and help me as a biomedical informatician attorney continuing my research in the areas of quality and cost-effectiveness. But I may just keep thinking, if only if….!
Paul R. DeMuro JD, CPA, MBA, MBI (Biomedical Informatics)
Schwabe, Williamson & Wyatt, PC, 1211 SW 5th Avenue, Suite 1900, Portland, OR, 97204 ([email protected])
National Library of Medicine, Post-Doctoral Fellow in the Ph.D. Program at Oregon Health & Science University ([email protected])