Quality: Are We Far Enough Along to Get There?

The commentator suggests electronic health record systems should be developed to facilitate quality initiatives.‎


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])

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