Winners of White House’s Health Design Challenge Create Mobile EMR

With the firm belief that the look and feel of electronic medical records needed a major overhaul, the White House launched the Health Design Challenge to make EMR more mobile and user-friendly, whether that user is a physician or patient. Collaborating with the White House Administration, a community of web design mentors and investors collectively known as Designer Fund organized the contest. The winners have been announced and their designs will be open sourced and used as the EMR format for Veterans Affairs. The contest was targeted at startup designers with a prize $25,000 for the winner and have their creation used in the largest EMR network in the country.

Health Design Challenge Objectives:
1. Improve the visual layout and style of medical data
2. Create a people-friendly design, making it easier for patients to manage their own health
3. Make information easier to understand and use by healthcare providers
4. Find a way to include family members and friends in the care of the patient

Best Overall Design - Nightingale
Best Medication Design - M.ed by Josh Hemsley
Best Problem/Medical History - Grouping by Time by Matthew Sanders
Best Lab Summaries - Health Summary by Health Ed

A combination of the winning designs will be put together for the VA to help their patients understand their medical records. The EMR designs will also be open-sourced on Github, allowing them to be integrated with other EMRs as well as accept continuous contributions to the project from physicians and other designers. Click here to see the winners’ showcase.

Snoring More of a Heart Disease Risk than Obesity

Who would think that something as benign (and annoying) as snoring could have life-threatening repercussions?  A new study from Henry Ford Hospital warns that snoring puts patients at more risk of heart disease than obesity, high cholesterol and smoking.   The underline message of the study for physicians was to take note in their cardiology EMR and ask patients (or their significant others) about their sleep habits.

Conducted by Henry Ford Hospital in Detroit, the research studied the medical records of 913 patients on their snoring habits who were evaluated by the hospital’s sleep center from December, 2006 to January, 2012.  Out of the 913, 54 patients completed the researchers’ snoring study and underwent a carotid artery duplex ultrasound, measuring the intima-media thickness of the arteries to detect and monitor the progression of atherosclerosis.  Since none of the patients had obstructive sleep apnea (OSA), research results led the study authors, Drs. Robert Deeb, M.D. and Kathleen Yeremchuk, M.D., to believe that the risk of cardiovascular disease caused by snoring is a prelude to OSA, contrary to previous belief that OSA leads to the risk of cardiovascular disease.

When given the carotid artery ultrasound, snoring patients were found to have greater intima-media thickness than non-snorers.  The swelling in artery wall thickness, theorized the researchers, was most likely caused by trauma from the vibration in the throat from snoring.  As a message to cardiologists to annotate the occurrence of snoring in their cardiology EMR, the authors of the study warn that the noisy sleep habit should no longer be shrugged off.   “Snoring is generally regarded as a cosmetic issue by health insurance, requiring significant out-of-pocket expenses by patients. We’re hoping to change that thinking so patients can get the early treatment they need, before more serious health issues arise,” says Dr. Deeb.

Alarming Number of Doctors Copy EMR Progress Notes

Starting from the first day of kindergarten, schools teach children that copying is a definite no-no.  However, according to a new study, doctors seem to have forgotten this rule somewhere along the way as over half of intensive care unit physicians were shown to copy and paste information in patient progress notes in the hospital’s EMR system.

The Society of Critical Care Medicine conducted a study that analyzed 2,068 progress notes for 135 patients in an ICU, written by 62 residents and 11 attending physicians.  The study showed a disturbingly high occurrence of copied material in the notes, ranging from 20 to 61 percent.  82 percent of resident physicians copied information from previous progress notes and pasted it into a new one, all in the name of cutting corners to save time.  The attending physicians studied didn’t fare much better, as 74 percent of them were guilty of copying information.  Following at least one day off work, the percentage of attending physicians who copied information from their own prior notes increased to 94 percent. 

 Not only is the copying of EMR progress notes (information cloning) seen as immoral from a societal standpoint, but more importantly, this practice can also be very detrimental to the patient’s health and treatment.  Cutting and pasting medical data that’s a day old, or even a few hours old, can skip over and disregard pertinent information about the patient’s condition that occurred between the time when the physician saw them last, such as an event or changes in medication.   Information cloning can also lead hospitals and physicians to be investigated for insurance fraud if found to have consistent repeated diagnosis billing codes.  Medicare has vowed to crack down on record copying saying, “Identification of this type of documentation will lead to denial of services for lack of medical necessity and the recoupment of all overpayments made.”  

AMA Urges CMS to Find an Alternative to ICD-9

In a letter to the acting administrator of Centers for Medicare and Medicaid Services, Marilyn Travenner, the American Medical Association acknowledged the Obama administration’s decision to delay the implementation of ICD-10 by one year to October 1, 2014.  Despite their appreciation for the decision, the AMA requested that a more appropriate replacement for ICD-9 be found instead of ICD-10.  Updating medical practice management software for the implementation of ICD-10, says the AMA, will create only problems for small practices with no benefit to patient care.

The International Classification of Diseases 10^th Revision, or ICD-10, stands as the standardized coding system for outpatient diagnostic codes used in HIPAA transactions, replacing ICD-9.  The letter to Travenner was signed by not only the American Medical Association, but by a multitude of medical organizations such as the American Academy of Family Physicians, the Endocrine Society and the Medical Group Management Association.   AMA’s reason for asking CMS to halt the implementation of ICD-10 is that it competes financially with EMR implementation and upgrade projects that practices are taking care of to comply with other CMS HIT reporting programs.  They fear that the financial stresses of complying with both ICD-10 and the HITECH Act - and the financial penalties physicians face if they face if they don’t - could be enough to put many smaller practices out of business. 

One argument for the cessation of the implementation was that between training staff to learn the 55,000 additional codes and upgrading practice management software will prove to be too costly, ranging from $83,290 to $2.7 million, depending on the practice’s size.  The AMA also feels that for physicians to learn from and correct errors to avoid penalties before the implementation date would be an impossible feat.  “Stopping the implementation of ICD-10 is a critical, necessary step for removing regulatory burdens on physicians and ensuring that small physician practices are able to keep their doors open.”  The AMA suggested that instead of implementing ICD-10, Travenner and CMS find an appropriate alternative replacement for ICD-9 that will keep physician participation in Medicare programs on track and will greatly reduce the costly financial burdens they face. 

Shared Psychiatric Electronic Medical Records Decreases Hospital Readmission

Maintaining patient privacy remains priority number one when handling information-sensitive medical records.  HIPAA aims to protect the confidentiality of identifiable clinical information in found in charts; however, a new study finds that too much privacy may hamper the quality of care patients receive.  Allowing non-psychiatric physicians access to the electronic medical records that include mental health information was shown to decrease the likelihood of patient readmission.

A study by a research team at Johns Hopkins University found that keeping a patient’s mental health records separate from that of their physical health in an electronic medical record in the name of privacy can actually hinder the care they receive.  After surveying the psychiatric departments of 18 of the highest ranked hospitals by U.S. News & World Report’s Best Hospitals of 2007, the team found that less than 25 percent of the hospitals gave non-psychiatric physicians full access to patients’ mental health EMR charts.  Of those who allow non-psychiatric access to mental health records, patients were 40 percent less likely to be readmitted within a week of discharge, whereas the patients of hospitals who did not allow access were 27 percent less likely to be readmitted.         

When hospitals choose to exclude mental health data in EMRs, it leaves a gap in information surrounding diagnoses and medications prescribed.  This only keeps primary care physicians and other specialists in the dark about the patient’s overall condition.  Depression and other mental illnesses sometimes make it difficult for patients to follow physicians’ instructions after a heart attack or stroke and are less likely to take proper care of themselves.  The real danger of not sharing psychiatric medical records lies in drug interactions.  Being uninformed about medications prescribed by a psychiatrist can cause the primary care physician to prescribe medications that create adverse reactions.  For instance, when mixed with Klonopin for seizures, SSRIs can depress the central nervous system activity and respiration in patients. 

As an indicator of poor quality of care, hospitals now receive financial penalties by the Centers for Medicare and Medicaid Services for patient readmissions.  Physicians cannot provide patients with top notch holistic care if they remain uninformed on the patient’s whole condition.  Hiding mental health information in electronic medical records only feeds the stigma and shame surrounding mental illness instead of treating it as one would any other illness.  

Electronic Medical Record Use Increases Repetitive Stress Injuries

The implementation of electronic medical record technology certainly helps patients, but may end up hurting health care providers.  Many doctors and nurses report muscle and joint pain due to increased computer and tablet use after the implementation of an EMR in their clinic.  Professors at Duke University advise health care providers to stay mindful of posture and office layouts when adopting new technology.

Professors Alan Hedge and Tamara James conducted an ergonomics survey study in the clinics at Duke University Medical Center.  The questionnaire asked physicians about their musculoskeletal discomfort, computer use, knowledge of ergonomics and the level of typing skills they exercised while at work.  Out of the 179 physician responses, the majority reported experiencing pain in their neck, shoulders, thoracic and lumbar spine at least once on a weekly basis.  Weekly repetitive stress injuries and pain in the right wrist were also reported by 40 percent of women and 30 percent of men.  Hedge and James explain that the women spent an hour longer per day on the computer than their male colleagues. 

The survey results concerned the Duke researchers; repetitive stress injuries could pull doctors and nurses away from their jobs, reducing their availability to their patients.  To reverse and prevent repetitive stress injuries from the increased use of electronic medical record technology, OSHA recommends keeping the workstation monitor at or just below eye level, maintain the head and neck in line with the torso, pull elbows close to body, and use a lumbar support while sitting.  Tablet use increases to popularize as well.  Using a separate keyboard and a tablet arm can help avoid neck and shoulder strain.  

NFL Implements Electronic Medical Record Software Technology

First the Olympics, now the NFL: electronic medical record software swiftly makes its way into the world of athletics.  The number of players over 300lbs has increased from only one in 1970 to 394 in 2000, which translates to harder body slams and more severe brain and spine concussions.   Officials announced the implementation as a means of treating on the field concussions more seriously and effectively.

The National Football League will be adopting EMR technology for all 32 teams over a two-season period.  The implementation goal makes the players’ medical records completely portable from handheld devices on the field to the workstation in the hospital or doctor’s office.  Portable records allow team and personal physicians to track the players’ injury and general medical history.  This is particularly helpful should a player happen to get traded to another team.     

The NFL’s use of electronic medical record software should greatly improve the quality of medical care in the event of a concussion; wireless technology will prove to be helpful if a player gets injured on the road.  Off-field physicians can view submitted a video clips of the game or practice that illustrate exactly how injury occurred, enabling them to provide the appropriate care needed to treat the specific injury.  The NFL currently uses a manual-entry electronic injury reporting system which they plan to synch with the new EMR technology.  Tracking head and spine injuries through electronic medical records will help neurologists better understand the effects and consequences of repeated concussions in professional athletes.