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David R. Hunt, MD, FACSChief Medical Officer and Acting Director, OHITA
Office of the National Coordinator for HIT
Health IT and Patient Safety:ONC Context
Medicine used to be simple, ineffective and relatively
safe.
Now it is complex, effective and potentially dangerous.
The role and education of doctors in the delivery of healthcare.Hollister Lecture delivered at the Institute of Health Services Research, Northwestern
University, Illinois, USA. October 1998. Lancet 1999;353:1178–81.
Sir Cyril Chantler
“As to diseases make a habit of two things - to help, or at least, to do no harm.”
Epidemics I
Hippocrates :
4
Quality = Help
Safety = Do no harm
5
Quality Healthcare
Effective
Patient-Centered
Timely
Equitable
Safe Efficient
6
7
Solo 6%
EHR Adoption by Practice Size
DesRoches, V, et. al.; Electronic Health Records in Ambulatory Care — A National Survey of Physicians N Engl J Med July 2008;359:50-60.
25
20
15
10
5
0
4%
Physicians*
Per
cent
age
of p
hysi
cian
s
With notes, Rx orders, & ability to order and obtain lab results
Dual 9%
3-5 physicians22%
>10 physicians35%
6-10 physicians28%
8
Capacity to select contract, install, implement
Transition productivity loss
Concerns about system obsolescence
Finding an EHR to meet needs
Uncertainty of return on investment (ROI)
Amount of capital needed
Major Barriers to Adoption of Electronic Health Records
DesRoches, V, et. al.; Electronic Health Records in Ambulatory Care — A National Survey of Physicians N Engl J Med July 2008;359:50-60.
“…reckoning that all such matters should be kept secret…”
Hippocratic Oath
10
Principles, Policies, Procedures, ProtectionsPrivacy
11
25550 Federal Register/ Vol. 74, No. 101/ Thursday, May 28, 2009/ Notices
12
54% Finding an EHR to meet needs
44% Concerns of obsolescence
39% Capacity to implement
SEC. 3012. HEALTH INFORMATION TECHNOLOGY IMPLEMENTATION ASSISTANCE.
(a) Health Information Technology Extension Program- To assist health care providers to adopt, implement, and effectively
use certified EHR technology that allows for the electronic exchange and use of health information…
(c) Health Information Technology Regional Extension Centers-
(1) IN GENERAL- The Secretary shall provide assistance for the creation and support of regional centers (in this subsection referred to as `regional centers') to provide technical assistance and disseminate best practices and other information learned from the
41% Transition productivity loss
13
NEW! MEA CULPA Errant mouse click leadsTo negative laparotomy
14
THE MISTAKE: Three days later, a third check of antibody levels revealed a value of >90% (normal, <3%) pointing to autoimmune hypoglycemia.
FIGURE: Normal imaging Despite a normal CT scan, the surgeon reluctantly offered surgical exploration.
DISCUSSION: Insulin levels were far too elevated for a usual insulinoma. When faced with a patient with all signs and symptoms of hyperinsulinism, checking insulin, c-peptide, glucose, and sulfonylurea levels is appropriate. However, extreme insulin elevation (typical insulinomas reveal values of 15–90 Iu/mL) suggests another source. Insulin antibody elevations are rare. The treatment is observation and supportive care. It resolves spontaneously.
A “systems problem” may explain the surgical team’s failure to preoperatively check insulin antibody levels. The data is only available via electronic medical records (EMR) with a right mouse click. A left click didn’t show anything, so we assumed the value was normal. Mea Culpa. Our institution is now fixing the EMR display feature.
THE PATIENT: An 80-year-old woman with classic symptoms of neuroglycopenia underwent a battery of tests confirming the Whipple triad….
NEW! MEA CULPA
15
Hippocrates
Decorum 11
You better know what you should do before you enter, for in many cases help is needed,
not thought.