• Hospitals
  • ICD-10's resulted in lower productivity for US hospitals

    As African countries develop and apply their interoperability (IOp) plans, there’s a salutary lesson from USA hospital. A survey by Himagine Solutions, a coding company, says hospital productivity dropped after hospitals switched to WHO’s International Classification of Diseases and Related Health Problems Series 10 (ICD-10) the standard diagnostic tool for monitoring the incidence and prevalence of diseases and other health problems. It’s also an essential data source for Diagnosis Related Groups (DRG) and their derivatives.

    ICD-10’s a statistical tool requiring compliance with WHO’s definitions and rules. The data enables accurate, consistent and comprehensive capture of data for secondary purposes, including billing. It’s not designed for recording by clinicians at points of care. That’s Systematized Nomenclature of Medicine--Clinical Terms’ (SNOMED CT) role.

    Himagine’s survey and Benchmark Report says 75% of respondents predicted the adverse productivity impact from ICD-10 is more than 30%.

    Large hospitals, those with more than 250 beds, reported a productivity drop of 30 to 45% for inpatient services, and a 20 to 40% drop for outpatient services. Community hospitals, which have fewer than 250 beds, the inpatient productivity drop was 22 to 33%, and 35 to 40% for outpatients. 

    Large Hospitals (over 250 beds) are seeing a 30-45% reduction on the Inpatient side and a 20-40% reduction on the Outpatient side. When it comes to Community Hospitals (under 250 beds), the Inpatients reductions are much lower ranging in a productivity decline of 22-33% while the outpatient is higher on average hovering around 35-40%. Teaching hospitals reported an average 40% drop in inpatient productivity, with a 10 to 35% ranges for outpatients.

    It may be that part of the explanation may be an increased rejection of reimbursement claims due to incomplete supporting data, so a loss of income, rather than a productivity drop. Either way, it’s a considerable disruption to hospital’s operational and financial performance. Part of the solution may be better and more training for coders and billing teams and greater use of eHealth solutions. Another part is the low use of Computer Assisted Coding (CAC), about 56%. This could increase to 75% in a year’s time.

    As Africa’s health systems move their eHealth on and rely more on health insurance schemes, it’s important they don’t have a similar experience to the USA. eHealth can be disruptive. It’s a bad idea for hospitals to have strained productivity and income too.

  • PatientSource can fit Africa's hospitals

    A doctor working in England’s emergency services has developed a wide-ranging EHR that’s available for African countries. Dr Michael Brooks set up PatientSource. It has several modules developed by clinicians: 

    eCase notes ePrescribing eObservations Investigations as Computerised Physician Order Entry (CPOE) Patient administration eDischarge Diabetes management Bespoke specialty modules Community mHealth Interoperability (IOp) tools Auditing 

    These enable benefits of:

    Better responses to abnormal vital signs Improved patient safety Health workers’ time savings User friendly for nurses Better monitoring for patient outliers.

    PatientSource works on tablets, so clinicians can take their eHealth to bedsides. Because it’s built around doctors and nurses working with their patients, and it has several IOp tools, it can fit into most healthcare settings in different health systems. It offers an effective EHR option for Africa’s hospitals.

  • Seattle Children's Hospital has proven analytics

    Analytics for better healthcare’s a growing trend that Africa’s citizens and health systems can benefit from. A post in Healthcare Informatics describes how Seattle Children’s Hospital’s setting a pace. It has a Data and Analytics Team that ‘s been focusing on leveraging large and complex data to improve patient safety and outcomes, reduce costs, broaden population health access and experience, and drive innovation. The hospital’s been using analytics since 2007, so has a track record.

    The team’s leader, Dr Eugene Kolker, calls it “Data-informed decision-making, and execution.” It’s part of the hospital’s Benchmarking Improvement Program that uses clinical outcomes measures to benchmark our clinical performance against the best-performing patient care organisations.

    The operational model has two main steps. First, the team uses data and analytics to provides service teams with comprehensive and unbiased views of their current situation to help them to identify where they can improve. Second, the team integrates that information with service teams’ institutional knowledge and insight to develop specific recommendations and effective strategies for change.

    The team links into the US News and World Report (USWNR), a USA media company, for hospital ranking data, and the National Association of Children’s Hospitals and Related Institution’s (NACHRI) database. The objective is to identify areas of improvement, opportunity and business growth, the set priorities for action. Examples of the teams benchmarking successes are hospital-acquired infections, lowering the rate of unintended removal of breathing tubes, breast milk management, and in minimising 30-day readmissions.

    For Africa’s health systems to adopt a similar approach, they’ll need access to benchmarks. These aren’t readily available. They’ll also need a team of skilled analysts. Both of these need investment. Hospitals can begin with teams that can help health workers improve clinical services.

  • Why eHealth's a bit like history

    The team at the African Centre for eHealth Excellence (Acfee) sees eHealth as a combination of people, health ICT and healthcare transformation. It can also include time as the temporal dimension needed for them to interact. Computer World Hong Kong has a valuable case study that shows how these themes play out, and keep playing out.

    It’s from the Hong Kong Hospital Authority (HKHA). In the early 1990s it computerised its clinical operations and healthcare services. In 1995, it launched phase 1 of its clinical management system (CMS) for clinical documentation and order entry. Now, all HKHA’s public hospitals run CMS 3.0, and doctors use it to read investigation results, enter medical records and place clinical orders. Since 2006, it uses Public-Private Interface-electronic patient’s Record (PPI-ePR) to share patient’s records between Hong Kong’s 42 public and 11 private hospitals.

    Doctors use PPI-ePR to read patients’ essential health data, including problems, diagnoses summary, laboratory summaries, encounter summaries, allergies, adverse drug reaction and summaries of prescribing histories. Privacy’s regulated by the Personal Data (Privacy) Ordinance (PDPO) and specific EHR legislation. An EHR Commissioner can issue codes of practice and guidelines. A goal is to instil public confidence in the system.

    An important eHealth objective is making hospitals safer. The Prince of Wales Hospital (PWH) audited the top errors in its medication process in 2011-2013. Findings suggested that almost half the medical incidents involved wrong drug prescriptions. This helps to design and target the actions needed to improve. Automating drug order placement is part of the response.

    In 2014, PWH implemented the In-Patient Medication Order Entry (IPMOE) system. It’s tried different mobiles with different user groups and used desktops for doctors to review medications at patients’ bedsides in real time. Nurses use a 2D barcodes from prescribed drugs packs to transfer data to IPMOE. They’re alerted when patients have an updated drug prescription, when they need to take their prescribed medicine and when some drugs are reaching the end of their usable life. The IPMOE system led to big workflow changes. It’s now in 40% of PWH’s wards and has planned roll out to two other hospitals by 2017 and the rest by 2018.

    In 2011, the Adventist Hospital implemented a CMS to help nurses to administer the right drugs for the right patient. Since then, it’s launched a CMS mobile application that supports nurses in 22 clinical functions. Some aren’t used, like the Operation Theatre Time-Out OTTO) function. Nurses said it needed too much time.

    HKHA’s story’s about people, health ICT, healthcare transformation and time. It shows how eHealth’s a bit like history, just one thing after another, and no end to it. Each country has to follow its own sequence. HKHA has offered illuminating sign posts for the long eHealth journey.

  • ICUs need telemedicine too

    Traditionally, telemedicine is associated with consultations over considerable distances and often with the equivalent of a preliminary to an outpatient appointment.  There’s a growing case for telemedicine driven from ICU. A research study, by Marshall University in West Virginia, USA, published by Telemedicine and e-Health.

    ICU telemedicine needs are different. They have higher implementation costs than outpatient versions, but hospitals could benefit more, both for healthcare quality gains and financially, the research says. Quality benefits included better patient safety and patient satisfaction. Teamwork, supervision and communications between health workers improved too.

    Affordability of ICU telemedicine may be a challenge, but the costs and benefits are worth exploring, especially for large tertiary hospitals. As they realise benefits, they provide evidence for the case for further expansion, or no expansion.

  • Apple HealthKit now available in US hospitals

    Apple HealtKit, was officially launched in June 2014. It’s spreading quickly among major US hospitals. A report by Reuters says Apple’s healthcare technology is showing early promise as a way for doctors to monitor patients remotely and cut costs.

    Reuters contacted 23 top hospitals in the country, 14 of which were rolling out the pilot program of Apple’s HealthKit services. Apple’s service acts as a repository for health information generated by patients, like their blood pressure, weight and heart rate.

    Apple’s HealthKit works by gathering data from sources such as glucose measurement tools, food and exercise-tracking apps and Wi-fi connected scales. The company’s Apple Watch, due for release in April, promises to add to the range of data, which with patients’ consent can be sent to an EMR for doctors to view.

    The pilots aim to help physicians monitor patients with chronic conditions such as diabetes and hypertension. HealthKit holds the promise of allowing doctors to watch for early signs of trouble and intervene before a medical problem becomes critical. It could help hospitals avoid admissions and repeat admissions, lowering cost and providing a better service for patients.

    Whether or not this services makes its way to African countries remains to be seen. While Africa has seen an uptake in iPhones, many hospitals don’t have the infrastructure or the manpower to maintain such a system.

  • Epic's incident at England's Addenbrooke's

    Addenbrooke’s Hospital is a top institution in England’s NHS. It recently declared a major incident and turned people and ambulances away for five hours. The cause wasn’t a security issue or a big, bad bug. ehealth insider has a post saying its EHR and pathology system weren’t matching test results to patients, so GPs were asked to stop all routine blood tests at short notice. Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s parent body, said that most of the problems reported by its local clinical commissioning group were shortly after go-live, and they’re addressing them.

    A report on the Epic implementation from the NHS Cambridgeshire and Peterborough Care Commissioning Group (CCG), that uses NHS money to buy healthcare for patients, was sent to Cambridgeshire County Council’s health committee. It identified part of an investigation into local healthcare pressures.

    Addenbrooke’s is the first NHS hospital in the UK to use Epic’s eHospital system. It’s used in many US hospitals, and cost Addenbrooke’s about £200m, more than US$300m, its biggest, single patient care investment. It was turned on in October this year, but the report says it faces significant problems, including issues with pathology and referrals. Some of these are already rectified.

    For African countries, it’s another EHR episode that confirms the need to take great care and plenty of time to procure and test eHealth initiatives. At the big scale end of the eHealth spectrum, initiatives are a combination of high value and high risk.

  • RFID helps to improve safety and efficiency in US hospitals

    More and more hospitals in the US are using a Radio-Frequency Identification (RFID) system called Kit Check. It’s an automated pharmacy stocking system which relies onRFID technology to improve patient safety and healthcare efficiency. A post in Healthcare IT News says that cloud-based software and an RFID scanning station allows pharmacy technicians to manage the inventories of dozens of medications in seconds. Previously, technicians had to inspect each kit vial individually, which takes up to ten times longer.

    When medication trays are returned to pharmacies from the operating rooms or emergency rooms, all the RFID-tagged medications in the drug kit are scanned and Kit Check tells the pharmacy technician which drugs were used and which ones are about to expire. The tray could hold as many as 198 medications. The technology not only allows the pharmacy to refill a kit much faster, it also eliminates occasional errors when incorrect or expired drugs are in the kits.

    “We can help hospitals decrease the amount of medications that they need to have on hand and reduce waste in terms of expiration,” said Kevin MacDonald, co-founder and CEO of Kit Check. “That decreases inventory cost.” 

    The demand for this type of technology is growing. At the end of 2012, just two hospitals were using Kit Check, now more than 100 hospitals are using it. It’s easy to envisage how RFID technology will expand to other countries and regions, and especially Africa.

  • Nurses aren't convinced about EHRs either

    Not only doctors are unconvinced of EHR’s value, as posted earlier on eHNA. A Black Book report now shows that nurses have similar views. The team surveyed 13,650 US nurses to gauge their satisfaction with their hospitals’ EHR system. Full results are promised later this month and they charge for the full report. iHealthBeat has a short summary on the results.

    The report’s findings are full of lessons for African countries considering the costs and benefits of implementing EHRs. Thought to be a tool for improving information sharing and quality of care, the results are staggering. They include that:

    92% of nurses reported being dissatisfied with their organization’s inpatient EHR system 94% of respondents said they do not believe that communication between the nurse and the rest of the care team has improved 90% said their EHR system has adversely affected communication between nurses and patients 85% said they struggle daily with flawed EHR systems Only 26% agreed with the statement: “As a nurse, I believe the current EHR at my organization improves the quality of patient information”

    African countries face tough human resource challenges, with EHR vendors frequent claiming to help deal with these. It’s noteworthy that the report describes 79% of job-seeking nurses said the reputation of a hospital’s EHR system is a “top three” consideration for employment. Getting it right is important.

    On the cyber-security front 67% of nurses reported being taught workarounds in flawed EHRs to enable other providers to view appropriate patient information; and only 30% of nurses said their IT departments respond quickly to fix potential vulnerabilities in documentation.

    A particular warning for those procuring systems in Africa is that 88% of nurses blamed their hospitals’ financial administrators and CIOs for choosing low-performing systems based on price, rather than quality of care delivery. It’s a cogent reminder of the Ruskin quote, from Tom Jones’ August 2014 eHNA post on affordability “It’s unwise to pay too much, but it’s worse to pay too little.”

  • How ready are hospitals for security breaches?

    If hospitals think they can dodge a data breach without putting in the necessary work, they need to think again. Data breaches are on the rise and hospitals need to be ready.

    September’s Ponemon Institute report examined organizations’ breach readiness across 14 different sectors. Most groups have seen more than one big breach this year, about 60% of the total. For the report, researchers surveyed 567 US executives from various industries on how well they believe their companies are positioned to respond to a potential data breach. Specifically, 13% of the respondents were from the healthcare and pharmaceutical industries.

    The healthcare sector has seen its several data breaches recently. In the US, nearly 39 million individuals have had their protected health information compromised in privacy and security breaches since 2009. Last month, the FBI issued a warning that the number of cyber-attacks against health care organizations is on the rise. The alert came days after Community Health Systems announced that an external group of hackers attacked its computer network and stole the non-medical data of 4.5 million patients. It was the second largest Health Insurance Portability and Accountability Act 1996 (HIPAA) breach ever reported and the largest hacking-related HIPAA data breach ever reported.

    It’s not all bad news. Organizations, including those in the healthcare, have made progress in adopting data security plans. Key findings from the report include:

    More companies have data breach response plans and teams in place than they did a year ago Most companies have privacy and data protection awareness programs Data breach or cyber-insurance policies are becoming a more important part of preparedness plans.

    The report sets out a number of recommendations to improve breach readiness. They include action plans such as:

    Developing a data breach preparedness plan and incorporating training and awareness programmes Reviewing data breach response plans frequently Completing risk assessments and continuously monitoring information systems for unusual or anomalous traffic Incorporating fire drills, ensuring senior executive oversight and adequate budget dedicated to preventing data breaches.

    Research has shown that a comprehensive plan that is in place in advance of a data breach can reduce overall costs and minimize the damage. Hospitals and other healthcare organisations can’t just hope for the best, they need to plan and prepare for the worst. This is a big challenge for Africa.