Reports/Studies on EHR, CPOE, BCMA, etc.
Below are a collection of reports and studies, from a variety of independent sources, on electronic health record (EHR), computerized physician order entry (CPOE) and bar-code medication administration (BCMA) systems.
2010
Revisiting the HITECH Act
The federal government's multi-billion-dollar investment in health IT through the Health Information Technology for Economic and Clinical Health Act of 2009 has the potential to make measurable improvements in the nation's healthcare, according to "HITECH Revisited," a June 2010 report from Manatt Health Solutions.
The first comprehensive review of HITECH—a key part of the American Recovery and Reinvestment Act (ARRA) of 2009—the report points to the need for a number of course corrections to ensure the Act's transformative potential is reached. Supported by the California HealthCare Foundation, among others, the report candidly assesses progress made to date and challenges that lie ahead, and advises Congress and the Obama Administration on what is needed to fully jump-start health IT adoption. For instance, "HITECH is a necessary but not sufficient step to achieve greater quality and efficiency in health care. Building on the recently passed Affordable Care Act, additional policies should be developed, targeted especially toward Medicaid and the commercial health insurance markets, to encourage physicians and hospitals to organize into systems of care that deliver high performance through the use of health IT."
Click on Manatt/CHCF for a synopsis and link to the full report.
NEJM: Bar-code technology study
"Serious medication errors are common in hospitals and often occur during order transcription or administration of medication," says Eric G. Poon, MD, MPH, in the May 6, 2010, New England Journal of Medicine. To help prevent such errors, technology has been developed to verify medications by incorporating barcode verification technology within an electronic medication-administration system (barcode eMAR)."
Poon, an assistant professor in medicine at Harvard Medical School, and his colleagues, report on the "Effect of Bar-Code Technology on
the Safety of Medication
Administration." Access the NEJM abstract and link to the full report (May 2010)—by clicking on Bar-Code Technology and Safety.
AHRQ: EHR study
In a May 2010 study prepared for the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services, vendors uniformly dinged the CCHIT certification process. "Providing the functionality for 'checking the box' to meet a certification requirement," some noted, "(sometimes) involves a backward step and a lowering of a potentially innovative internal standard." However, "as meaningful use has entered the picture . . . vendors are striving to provide their customers with products that will comply with this definition and plan to participate in any associated certifications." To access pertinent excerpts, click on AHRQ EHR; AHRQ EHR Usability Study for the full report. [The VA and VistA were surveyed for this report, but no detail is offered. Microsoft and McKesson were represented on the Expert Panel but no open-source vendors.]
Kaiser study: HIT helped patients meet cholesterol guidelines
"Kaiser Permanente is crediting healthcare information technology and care coordination as helping more than 40 percent of very high-risk patients reach national cholesterol guidelines—a feat that past studies indicate is difficult to achieve," according to a May 14, 2010, HealthcareIT News report. Click on Health IT Care Coordination to read the news report and be directed to the full May 2010 Journal of Clinical Lipidology study.
Better patient safety with BCMA and eMAR
While medication errors are among the most common errors in most hospitals, many experts believe they are also the most easily addressed by the use of health IT. This New England Journal of Medicine (May 2010) study conclusively demonstrates how "incorporating bar-code verification technology within an electronic medication-administration system (bar-code eMAR)" caused medication errors to fall at the Boston hospitals studied. Click on Patient Safety to access the NEJM abstract (subscription required to access the full study).
EHR implementation lessons from Premier
Click on EHR Implementation Lessons to access an April 2010 Health Affairs report by Susan D. DeVore and Keith Figlioli on "Lessons Premier Hospitals Learned About Implementing Electronic Health Records."
2009
NEJM: US hospitals use of EHR at just 1.5%
Harvard School of Public Health's Ashish K. Jha, MD, MPH, and a team of researchers that includes National Coordinator of Health IT David Blumenthal, MD, found that only 1.5% of U.S. hospitals have a comprehensive electronic health records system (i.e., present in all clinical units); an additional 7.6% have a basic system (i.e., present in at least one clinical unit). Computerized provider-order entry for medications has been implemented in only 17% of hospitals. Larger hospitals, those located in urban areas, and teaching hospitals were more likely to have electronic-records systems. Respondents cited capital requirements and high maintenance costs as the primary barriers to implementation, although hospitals with electronic-records systems were less likely to cite these barriers than hospitals without such systems.
Click on NEJM/Jha Abstract for an abstract of the study published in the April 16, 2009, New England Journal of Medicine; click on N Engl J Med 2009 for the full study.
2006
Lessons Learned from Massachusetts' CPOE Experience
Led by the Massachusetts Technology Collaborative and the New England Healthcare Institute, the Massachusetts Hospital CPOE Initiative was designed to promote CPOE adoption in all Massachusetts hospitals. Click on CPOE Saves Lives to access "Saving Lives, Reducing Costs." This Sept. 2006 First Consulting Group paper documents "Computerized Physician Order Entry Lessons Learned in Community Hospitals."
2002
JHIM: BCMA and Patient Safety
"Bar Code Medication Administration software, as developed by the Veterans Health Administration, is an innovative, automated system that uses wireless, point-of-care technology with an integrated bar code scanner. The BCMA system can dramatically reduce medication administration errors by letting clinicians verify a patient’s identity and validate medications against active orders."
Authors Connie L. Johnson et al. report on "Using BCMA Software to Improve Patient Safety In Veterans Administration Medical Centers," in the Jan. 2002 issue of Journal of Healthcare Information Management (HIMSS). Click on BCMA Safety to access the full article.
2001
CPOE adoption
Click on VistA CPOE to access "Assessing Physician Satisfaction with Two Order Entry (CPOE) Systems" by Harvey J. Murff and Joseph Kannry in the Sept./Oct. 2001 issue of the Journal of the American Medical Informatics Association.