The move towards precision medicine is gaining more traction though the project faces limitations. One area that we can anticipate will be influenced by precision medicine programs as healthcare IT technologies continue to spread in the healthcare market is in EMR/EHR solution integration and functionality.
Ahhh, the age old question. Can (or should) tasks that humans can do very well, but perhaps not very efficiently, be automated with technology? While the views on this topic would vary greatly from an abstraction service provider to a low-budget medical research project manager, there are perhaps a few things that could be defined to help one decide what is best for their particular medical record abstraction situation. Consider these ideas:
While I've never worked directly for a healthcare organization, I'm proud to say that I've spent the last 13 years working for two great companies who are making great strides to improve these very problems. At Extract, we are working tirelessly to get more data into the EMR discretely and marching towards ridding the EMR of the hide-and-seek for critical clinical data that is buried in scans, faxes, and unstructured blocks of text.
Abstraction is the process of reviewing large or small data sets or documents for information that will be needed in the future for decision making. The crux of the problem is having domain knowledge that allows one to accurately and swiftly sift through the important from the unimportant. When completed in accurate fashion, the result of data abstraction is the compression of a large amount of information to its essence without loss of meaning or usefulness. Abstraction is used to manage complexity so that great decisions can be made quickly and with confidence.
It couldn’t happen to us.
I doubt anyone still feels that a HIPAA breach is impossible in their organization. Results speak louder than words.
A quick search reveals that every year there is a large number of breaches in the US. There is no doubt these organizations know the threat of HIPAA breaches have taken some number of steps to protect against a breach but there is always more that could have been done to reduce/eliminate the exposure.
Despite massive adoption of electronic medical records over the past several years, the promise of easy and nearly effortless chart abstraction from electronic medical records enabled by an interconnected web of interoperable EMRs sharing standardized data has yet to be fully realized. You need to look no further than the media tab to see the evidence that we have yet to arrive at this Utopian future.
Recently, Andy Slavitt, the CMS acting administrator, announced that CMS will likely end the Meaningful Use program this year.
Does that mean that the hopes of an internet-worked healthcare system that’s able to seamlessly share health information are completely dashed before interoperability truly got off the ground?
There’s no question that users rely on the EMR In Basket for day-to-day workflow management. The “In Basket” or “Inbox,” depending on what EMR you’re using, provides a centralized location to receive notifications and important patient information, such as admission and discharge notifications, new lab results, refill requests, patient calls, appointment reminders, patient portal communication and much more.
What I know for Sure:
Discrete, trending data is the bread and butter of a specialty clinic.
Hunting and pecking through the media tab to track down information on a patient is infuriating! And not only for the doctors. For nurses. For abstractors. For the patient! Trending a post-transplant patient's drug levels alongside their medication doses, rejections, infections, transplant history, UNOS data, procedures, and relevant transplant-related scores is of paramount importance to a clinician and is very time sensitive. Getting all patient data into the EMR is the holy grail when it comes to specialty medicine.
Specialty clinics, especially transplant clinics, are mini-ACOs.
When you are treating an acute, chronic disease it is critical that everything about the patient is known regardless of where they are being treated on a daily basis. Luckily, we now live in a world of Care Everywhere, CCD documents, and reference labs…BUT, despite what everyone wants to believe, these things are not a panacea.
Paper is very much alive and well in the healthcare world.
Sometimes clinicians are "closet paper users," other times they just lay it out there. But don't make any mistake about it…they are using. In the transplant world, you may be familiar with the "wall chart." Also known as "the flowsheet" or "the flowchart." You know the one. The monstrous grid that is the holy grail for the transplant clinic, but is the disdain of the HIM team and the project team trying to migrate clinicians to the EMR. But there are good reasons for this chart and the other paper being used. Many hospitals have not implemented effective document management strategies that classify documents in useful ways. And many hospitals don't have the resources to support entering (and QAing) important data discretely as it comes in from external sources (or even internal sources such as the pathology lab).
Specialty clinics are crazy busy.
There were times during my tenure at Epic that I felt stressed. That I felt my days were busy. That I felt it was hard to create work/life balance. And then I'd go onsite and spend a week in a transplant department. Wow. My workday was like a walk in the park! The chaos that is the life of a person in a specialty clinic is very hard to explain or quantify. It seems there is not a moment to breathe. And this isn't just for the doctors and nurses. Even the folks doing data entry are getting calls, being pulled into other things, being tapped on the shoulder constantly. It is nearly impossible to give something 100% of your attention.
Extract's products can help.
I'm a passionate person. I don't back something I don't believe in and I don't work for companies whose product doesn't excite me. When I first encountered the Extract product I was very skeptical. Optical Character Recognition (OCR) with clinical data? Fuggettabout it! However, I've been able to peel back the curtain. The magic isn't in the OCR, it's in the rules, logic, and processing that Extract has fine-tuned while working with numerous healthcare organizations. I've seen it in action. I've seen the product improve with features that allow more reliable mapping to patients and existing orders. I've seen it process large documents and auto-classify subsections of that document and route them accordingly (think referral packets, transplant folks!). I've seen it work. I believe in the product and think it can improve data quality, care quality, data entry efficiency, EMR user happiness, and much more.
Extract's products aren't restricted to specialty clinics.
Yes, it is very easy to see the benefit of using the product to discretely enter lab results or split/file referral packets in a specialty clinic. But once you've seen it in action, it's very hard not to let your imagination run wild. Have an HIM department that is backlogged and needs some help classifying and discretely filing data? Have a natural speech recognition engine that needs some intelligent processing and filing after the output is generated? Have Care Everywhere but wish that you could get some more discrete data from it, such as labs? Still have paper DNR, release forms, or patient surveys coming in and want them to be discrete?
Have any other ideas?
We want to hear them! You can email me directly to discuss your ideas further.
About the Author: Rob Fea
He has spent 12 years partnering with IT teams and clinicians at major hospitals and clinics worldwide during his tenure on the technical services team at Epic. For the vast majority of his time at Epic, Rob supported Epic's Phoenix product, playing a major role in project kickoffs, installation, data conversions, ongoing support, and optimization. During his tenure at Epic, he watched the Phoenix customer base expand from 0 to 55 live and installing transplant organizations. It was a terrific experience and he loved every minute of it. It gave him expansive insight into the healthcare world, especially the solid organ transplant industry. Rob has spent countless hours on the floor in transplant departments observing multidisciplinary visits, committee review meetings, data entry, data trending, reporting, medication dosing, and more.
An ounce of prevention is worth a pound of cure. Or, reduce medical errors through better documentation. Which one of these expressions do we tend to remember? In healthcare we hear quite a bit of talk these days on reducing medical errors. Of course this is with good reason. When getting data into the EMR, errors such as inaccurate or delayed results, can negatively impact patient health and lead to extended hospital stays, unnecessary treatment or worse. As a matter of fact, many healthcare organizations are now striving to eliminate mistakes and streamline efficiency by adopting principles such as Six Sigma and other business practices which are designed to continuously evaluate and improve best practices.
Tracking data in your transplant care software is a key component of QAPI programs, not only for CMS, but now also with UNOS debating the requirement of QAPI programs. One of the most challenging aspects of transplant program management is ensuring that your Quality Assessment and Process Improvement programs are measuring meaningful and actionable items that lead to program improvement.
Transplant Evaluation Process Part 3 in a 6 part blog series
Once the transplant evaluation visit has been completed, the required testing and other consults that were ordered or deemed necessary need to be completed. Frequently, this is the most time consuming segment of the evaluation process and where automation can be most useful.