Is Mom at risk of falling?

Electronic medical records (EMR) efficiently capture physician’s keystrokes—yes or no—to this question and tuck it along side other data about our so–called medical lives.The physician’s judgment has to take into account many factors: is the patient elderly and ‘frail,’ do they have an orthopedic or neurological problem causing them to lose their balance, can they get up from a chair without having to use their arms to push-off, importantly do they live alone. Most of the answers to these questions come quickly through discussions with the patient or their family, or by simply observation. Nine times out of ten physicians can predict that a patient will fall before it happens.

Now, the EMR owns this critical piece of information. But the next most obvious question, as many of you can guess, seems clear: now what?

Ideally by clicking yes, a sequence of events occurs; (a) Home health receives an electronic message requesting a patient safety visit. Specially trained home health nurses look for loose rugs that may slip out from under the patient, extension cords waiting to snag an unsuspecting foot, toilets without support for getting up and down, or the need for an electronic alert system bringing help quickly (b) An alert goes to the patient’s pharmacy requesting a drug–drug interaction report, detailing which drugs interfere with each other causing precarious side effects. Alerts also goes to the primary physician highlighting which of the patient’s medication tend to cause problems in the elderly (c) Schedules an appointment with physical therapy for balance and strengthening exercises (d) Arranges for a visual examination and hearing test, after checking on previous tests. These steps become placed into motion within a nanosecond after clicking ‘yes.’

Or does the electronic system just create a list of all patients—that is if anyone thinks of querying the system—whose physician clicked yes to that question? This is critically important and goes to the heart of the promise of new technology. The government suggests that EMR systems are the end all to solving our health care inefficiencies and exorbitant costs. But as we have just learned, the power is not having the data—its knowing what to do with the data we have. Moving information to action. If we can almost predict that a patient is going to fall, without using anything other that our eyes and ears, what physicians need is help quickly arranging for solutions to prevent a fall from occurring in the first place. Any respectable Accountable Care Organization, relying on EMRs to revolutionize patient care, has to have this seemingly basic ability in place now. Otherwise, we just have patient data collecting dust and we can do better than that.

Steve P. Sanders, DO, MBA, FACOI, FACPE was formerly the Chief Medical Officer for Carondelet Health System in Kansas City, MO with responsibilities for medical management, quality initiatives, residency training, long-term care initiatives and patient safety for St. Joseph Medical Center and St. Mary’s Medical Center. Clinically, Dr. Sanders now serves as a traditional internist providing outpatient medical care and hospital services for patients ages 16 and beyond. He continues to write on issues in medicine and the promotion of patient-centered creation of value in health care at Knowmoremed’s Blog.

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8 Responses for “EMR and the Falling Patient”

  1. tim says:

    “Ideally by clicking yes, a sequence of events occurs; (a) Home health receives an electronic message requesting a patient safety visit. Specially trained home health nurses look for loose rugs that may slip out from under the patient, extension cords waiting to snag an unsuspecting foot, toilets without support for getting up and down, or the need for an electronic alert system bringing help quickly (b) An alert goes to the patient’s pharmacy requesting a drug–drug interaction report, detailing which drugs interfere with each other causing precarious side effects. Alerts also goes to the primary physician highlighting which of the patient’s medication tend to cause problems in the elderly (c) Schedules an appointment with physical therapy for balance and strengthening exercises (d) Arranges for a visual examination and hearing test, after checking on previous tests. These steps become placed into motion within a nanosecond after clicking ‘yes.’”
    Sounds like a lot more money. I wonder if the Federal GOD panel will allow it.

  2. Wonderful!!
    That is exactly what computerization should be all about – proactive, real-time operations support, instead of gigantic, elaborate, data-mining repositories.

  3. Ariella says:

    Or, as done at my hospital, EHRs can promote the worst of all worlds….
    An elaborate (i.e., time consuming) Fall Risk Scale that is required to be done many times a day with a Risk Score that can vary many fold (from low risk to high risk) over several days with no relationship to the patients meds or clinical condition!
    And when the Fall Scale triggers an alert, the fall precautions don’t include any thing that would reduce risk but simply include things like putting a star on the patient’s door.

  4. pcp says:

    “Sounds like a lot more money”
    They make it up by having the primary physician, who manages the information, signs the orders, and assumes the liability, do all this for no pay.

  5. Vera says:

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  6. Danny Dave says:

    Despite the fact that the real purpose of EMR is to improve patient care, it becomes dormant when functions are added without an overall focus on patient care. Computer technology was intended to make our lives easier, but many medical practitioners has reservations as they struggle to use their EMR system.

  7. acne gel says:

    I really felt it was a positive step if the first system in the patient care so that families and friends, health care workers from the bottom on some warning signs. The depth of the message depend on the severity of the instability…

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