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Electronic Health Records vs. Niche Software that is actually useful for Family History. Kevin S. Hughes, MD, FACS Co-Director, Avon Comprehensive Breast Evaluation Center Massachusetts General Hospital Bruce Lin Project Director, Family History for Prenatal Providers

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electronic health records vs niche software that is actually useful for family history

Electronic Health Records vs. Niche Software that is actually useful for Family History

Kevin S. Hughes, MD, FACS

Co-Director, Avon Comprehensive Breast Evaluation Center

Massachusetts General Hospital

Bruce Lin

Project Director, Family History for Prenatal Providers

Manager, Public Health Initiatives

March of Dimes

slide2
The EHR has tremendous promise as a means of decreasing workload, decreasing cost and improving quality of care
slide3
The EHR has tremendous promise as a means of decreasing workload, decreasing cost and improving quality of care
  • Reality
  • EHRs decrease productivity or are neutral
  • EHRs have not been shown to increase quality
  • EHRs have not been shown to decrease cost
  • Consider what Jonathon Bush (AthenaHealth) calls the ‘Cash for Clunkers’ program. Doctors have to be paid to install these EHRs
slide4
EHR HIT has tremendous promise as a means of decreasing workload, decreasing cost and improving quality of care
slide5

Clinical Decision Support

Apply Algorithms/Guidelines to patient data

Identify best course of action

Results displayed as intuitive Visualizations

BRCAPRO Mutation Risk 25%

Suggest Genetic Testing

Facilitates best action as part of workflow

computerization hasn t saved a dime nor has it improved administrative efficiency
“Computerization hasn't saved a dime, nor has it improved administrative efficiency”
  • 4,000 hospitals 2003 to 2007
  • Computerization
    • Weak correlation
      • Quality for MI
    • No correlation
      • Cost savings
      • Improvements in administrative efficiency
      • Quality for pneumonia
      • Quality for heart failure
      • Overall quality (MI, heart failure, pneumonia)

Himmelstein, The American Journal of Medicine (2010) 123, 40-46

ehr and productivity varies by specialty 100 internists pediatricians and family practitioners
EHR and productivity varies by specialty100 internists, pediatricians and family practitioners

Hemant Bhargava, UC Davis Graduate School of Management

  • 25 to 33 percent drop in MD productivity
  • Over time
    • Internists slightly above original productivity
    • Pediatricians /family practitioners never recovered
slide9

Quote from a breast surgeon beginning EHR use

  • …our productivity is down 28%
  • I am the highest paid transcriptionist in the state
  • Each cancer patient chart takes me apprx 1 hour
  • For the first time in my career, I turned down an add-on patient
currently paper memory
Currently: Paper + memory

Patient completes paper form

Reviews data using memory of guidelines

Documents and Orders

Orders Genetic Testing

ehr paper extra work memory
EHR: Paper + extra work + memory

Patient completes paper form

Staff enters data into the EHR

Reviews data using memory of guidelines

Documents and Orders

slide14
EHR

Same interface for every Specialty

Small

Database

Meds

Allergies

Generic Interface

Mostly

Filing Cabinet

Or

Document Management System

slide15
EHR

Cardiovascular

Pathology

Anesthesia

Generic

Mammography

it ehr
IT ≠ EHR

Role of the EHR in Family History

…close to non-existent

While EHRs do poorly for most aspects of medical care, they are worse relative to family history and genetics

health it
Health IT

EHR

Designed to manage the entire spectrum of medical care

Created by large corporations

E.g., NextGen, Allscripts, eClinicalWorks, Misys, Centricity, Eclipse, LMR

‘Niche’ Software

Designed for specialty areas

Homegrown or developed by small vendors

E.g., My Family Health Portrait, Jameslink, GREAT, Progeny, HughesRiskApps

health it1
Health IT

EHR

Designed to manage the entire spectrum of medical care

Created by large corporations

‘Niche’ Software

Designed for specialty areas

Homegrown or developed by small vendors

health it and clinical care
Health IT and Clinical Care

EHR

‘Niche’ Software

slide20

EHRs are limited to major areas

Notes

Allergies

Path Reports

Problem

List

Meds

Lab

slide21

Adding new features for small markets is expensive

Notes

Genetics

ӨPedigree

Allergies

ΘFamily History

Path Reports

Risk

Problem

List

Meds

Lab

ehrs have difficulty improving
EHRs have difficulty improving

AHIC Core Data Set

Published 2008

No EHR Vendor has adopted it

HL7 Pedigree model for interoperability

Approved 2006

No EHR Vendor has adopted it

Family history upgrade to EHR at my institution

submitted 2006

slated for analysis 2009

Implementation 2013 or later

slide24
The American Health Information Community (AHIC) Personalized Health Care Workgroup Recommendations to Secretary 2007

… Modular family history tool

… collection of family health history within the EHR…messaging of … information to a variety of richer … tools that perform risk analyses… results of … calculations … returned to the EHR … for curation

slide25

Niche/Modular Software

Innovative approaches to data entry

Patient data entry

Clinician data interface

Innovative approaches to CDS

Risk Algorithms/Guidelines

Visualization appropriate to user

Pedigree drawing

EHR as a repository

Core data set

Interoperable

Testing and iteration possible

ehrs and niche software
EHRs and Niche Software
  • EHR vendors say:
  • Wait for the EHR to do this
  • Niche software is not needed
  • EHR should not exchange data with Niche Software
slide30

Hereditary Risk Identification

Click open 4 screens

BRCA1+

slide32

Typical EHR

HughesRiskApps

better workflow
Better workflow

Patient enters data

Tablet PC

iPad

Website

Patient educational materials

Clinical Decision Support

Reviews Report & Pedigree

Reviews suggested

management

EHR

Clinical Decision Support

Documents and Orders

hughesriskapps breast surgery module
HughesRiskAppsBreast Surgery Module

Kshughes@Partners.org

www.HughesRiskApps.net