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ASH 2016

ASH Symposium on Quality Addresses Health IT Challenges for the Provider and the Patient

Surabhi Dangi-Garimella, PhD
The Special Symposium on Quality at the 58th American Society of Hematology Annual Meeting & Exposition, looked at how health information technology can be utilized to improve healthcare quality, enhance patient-provider shared decision-making, and facilitate efforts in quality research.
A key finding of the Institute of Medicine Committee on the Quality of Health Care in America’s report, "Crossing the Quality Chasm: A New Health System for the 21st Century," published in March 2001,1 was that information and communication technology is essential to improve quality of care. Subsequently, billions of dollars were invested to assist physicians, hospitals, and other healthcare settings, in adopting health information technology (IT or HIT).

In the last decade, significant strides have been made to incorporate health IT into clinical practice. However, despite the emerging evidence of the impact of health IT on communication, healthcare quality, and efficiency, its impact on health-related outcomes is limited.

The Special Symposium on Quality at the 58th American Society of Hematology Annual Meeting & Exposition, looked at how health IT can be utilized to improve healthcare quality, enhance patient-provider shared decision-making, and facilitate efforts in quality research. Co-chaired by Anita Rajasekhar, MD, MS, Shands Hospital, University of Florida, and Vishal Kukreti, MD, Princess Margaret Cancer Centre, panelists included Hardeep Singh, MD, who heads the Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center, Houston, Texas; Douglas W Blayney, MD, Stanford Cancer Institute, Stanford University, Stanford, CA; and Doris Howell, PhD, RN, The Princess Margaret Cancer Centre, Toronto, Ontario, Canada.

Singh, who is also associate professor in the department of Medicine, Baylor College of Medicine, Houston, Texas, posed the question, “Why is there disillusionment in health IT?” He pointed out that while health IT changes clinical practice, implementation of changes is often prone to failure. Quality and safety benefits need a while to implement, Singh said, and then there often are unintended consequences that we are not prepared for.  

“However, the bottom line is to ensure patient safety,” Singh emphasized.
  1. Electronic health records (EHRs) must be safe
  2. EHRs should be used safely, and episodes of reckless copy/paste should be avoided
  3. EHRs should be used to improve safety.
Research conducted by Singh’s group found that there are human errors involved at various stages of EHR use. He cited examples such as communication gaps because the physician did not read the nurse’s notes, notes that are not accurate or are confusing, or wrong quality measures being implemented.

“Gaps in data and in communication result in data being lost in the bargain.” Singh explained this with an example of how physicians might open an alert raised by the EHR system, but may not necessarily follow-up on it. “Too many EHR alerts may lead doctors to miss them,” Singh said. “We have had some initial success in the VA and we are trying to prospectively use some algorithms to correct the situation,” he added.

Singh added that patient engagement in their care can significantly boost follow-up on their test results, and this can be achieved by sending patient data directly to patient portals. “However, the raw information might be difficult for patients to interpret.”

Singh stressed that there is no single solution to the existing EHR troubles that our healthcare system is facing. “We need to address every dimension of the EHR problems,” he said and provided the following solutions:
  1. Software: need better tools/functions and design of EHR
  2. Content: need smarter alerts and diagnostic decision support
  3. Usability: need better user interfaces; increase signal/noise ratio
  4. Workflow: needs improvement so there’s time for physician-patient interaction
  5. People: need both patients and providers to be better engaged
  6. Organization: need protocols for closed-loop test results follow-up
  7. External rules are very important such as reimbursement for cognitive work
  8. Evaluation and measurement: need to measure performance to ensure implementation and performance improvement


 
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