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TECH: More on CPOE

Typepad (the hosting service I use) was down on Friday, giving THCB an involuntary day off. Here was my FierceHealthcare editorial on Friday. You can use this as a continuation of the discussion from last week:

There is little doubt that the big story in health IT circles continues to be
the CPOE study in Pediatrics which found an alarming increase in
mortality rates at Children’s Hospital of Pittsburgh. Those conclusions
generated a fierce debate as to whether we need CPOE systems, and whether EMRs
can be adapted for critical patient care situations. Yesterday, leading patient
safety expert Bob Wachter likened the phase medicine is undergoing to one
similar to that in aviation in the middle of last century–from independent test
pilots to team players–as described in Tom Wolfe’s The Right Stuff.
Even though no pilot would go back to doing things the old way, it was not a
painless transition. What is clear is that the introduction of new technology
requires a detailed examination of virtually every care process, and in some
cases the benefits can only be realized if the process is changed to fit the
technology. That is a very complicated sell.

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Billing SoftwareNarayanachar MuraliMichael WalshmattTom Leith Recent comment authors
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Guest

Hi great Blog. Ill bookmark you.
You can check this Billing software for health IT circles.

Narayanachar Murali
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Narayanachar Murali

Regarding Allan’s comments above: Allan: Thanks for clarifying the issues so eloquently I cannot agree with you more on the scary prospect of using the verbosity of clinical documentation to justify payments. It is being done however in the name of EMR in the Emergency rooms and offices all over the country! It is hard for computer programmers and system administrators to understand that the way doctors think is “not structured”. In fact, the outcomes would be terrible for an occasional patient who does not fit the algorithm . A way a computer analyzes information is very structured and generally… Read more »

Tom Leith
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Tom Leith

> Perhaps it would be useful to have tighter
> integration between developers and clinicians?
Sure. But there’s a whole essay in here, and I’m sure somebody else has already written it. Maybe I’ll look around a little and see what I can find.
t

Michael Walsh
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Michael Walsh

If I may add a few comments to the discussion as a practicing primary care physician, using an enterprise EHR, with an IT background: The structure of clinic notes can be customized to user preference if the end user has the expertise and if the program supports such modifications. The issues that hang up providers I’ve talked with are that either they lack the expertise or the program they selected for their practice does not support the option to customize. I have written a blog entry about putting more effort into educating residents on the components of an EHR so… Read more »

Tom Leith
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Tom Leith

Allan — they’re NOT standardized at all! Different physicians will use different terminology to describe the exact same disease or condition. Slee doesn’t want to impose a standardized terminology on the physicians because he sees that as information loss. He leaves it up to the natural language parser to build a representation using a standardized vocabulary of the “original” clinical record. He has some criticisms of SNOMED, but for the time being it is apparently the best thing we have, and for clinical purposes beats ICD-9 and (certainly) DRG. Matt — I also think auto-translation is a scary prospect for… Read more »

matt
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matt

I think that auto-translation of clinical notes into billing records is a scary prospect for many providers. It’s no coincidence that the billing and clinical data are two separate worlds…

Allan
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Allan

To what extent are clinical notes that are seen as critical standardized?

Tom Leith
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Tom Leith

Allan writes: > A care-focused EMR/CPOE system will feed the E/B > process, but is not a derivative of that process. This is one of Virgil Slee’s big points: there is a “clinical process” that goes on in human and medical terms, and we need a couple of different abstractions of it for the two big purposes: getting paid, and medical management & research. He thinks an ideal system preserves EVERYTHING a doctor takes note of and does, and produces the required abstractions from that. When the technology that produces the clinical abstractions improves, the original notes could be re-abstracted… Read more »

Allan
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Allan

Sorry, forgot to address this bit: “What is clear is that the introduction of new technology requires a detailed examination of virtually every care process, and in some cases the benefits can only be realized if the process is changed to fit the technology. That is a very complicated sell.” I take issue with the idea that “…process is changed to fit the technology.” It would be more accurate to say that “the full benefits of applying these technological tools to the care delivery process are only realized if the care process is broken down, made repeatable, and (hopefully) optimized,… Read more »

Allan
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Allan

Back in the previous thread, Narayanachar S. Murali wrote: “The currently availabe EMRs are terrible. Absolute waste of time. Each practice needs to know its work flow and design the IT it needs. There is no one size fits all when it comes to EMR. ” I assume that he is talking about small-practice EMRs based on his comments later in his writing, and I’ll basically agree (without a lot of detailed knowledge of this particular marketplace in terms of the offerings). I’m guessing that the big issue for this market is that the vast majority of IT offerings are… Read more »