Positive vs Negative Reinforcement to Promote Use of EHR

Secretary of Health and Human Services Kathleen Sebelius says in Kaiser Health News:

Today, in almost every other sector besides health, electronic information exchange is the way we do business. A cashier scans a bar code to add up our grocery bill. We check our bank balance and take out cash with a debit card that works in any ATM machine.

But despite the clear benefits of health IT, only two in ten doctors and one in ten hospitals use even a basic electronic record system.

The most promising sign for the future of our health care system is not what stakeholders were saying, but what they’re already doing.

• Major insurers like Aetna, United and WellPoint announced their own provider loan and training programs for electronic health records.
• The Federation of State Medical Boards announced that is taking the first steps toward encouraging the use of health IT to maintain professional licensing.
• And two of the nation’s largest provider groups, Delaware’s Christiana Care Health System and Partners HealthCare in Massachusetts, said that in the future they’re going train and support providers who adopt electronic health records, and avoid providers who don't make the switch to health IT.

http://www.kaiserhealthnews.org/Columns/2010/August/082610Sebelius.aspx

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We've all been hearing about positive reinforcement like bonus payments for meaningful use of an EHR. Negative reinforcement in the form of being dropped by insurers, avoided by provider groups -- and losing one's license! -- would be more effective.

Five Drawbacks to Converting Professional Guidelines into Decision Support

Effective decision support must be integrated into the referring physician workflow to qualify for meaningful use incentives beyond 2012 and avoid penalties beyond 2014.

As the radiology community searches for the best source of decision support and decision support to quell inappropriate use, the question of tapping into professional guidelines such as American College of Radiology (ACR) Appropriateness Criteria inevitably arises.

"These guidelines serve many critical functions … but there is little evidence that the traditional methods of guideline dissemination lead to substantial improvement in the test-ordering behavior of referring physicians," wrote Ramin Khorasani, MD, MPH, vice chair of radiology at Brigham and Women’s Hospital.

One of radiology’s top decision support experts, Khorasani identified five drawbacks to converting professional guidelines into decision support:

1. Guidelines are not actionable. Most describe the relative merits of one approach over another rather than prescribe an appropriate course of action.
2. The professional societies that develop and disseminate guidelines fall short on EMR and health IT know-how.
3. Many existing guidelines lack the strength of evidence necessary to spur widespread adoption by clinicians.
4. Effective decision support must be up-to-date and frequently updated.
5. Decision support must incorporate consequences for ignoring rules in order to insure maximum impact.

http://www.cmio.net/index.php?option=com_articles&id=23704

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Issues 2-5 seem relatively straightforward (which isn't to say easy) to address, but issue 1 might require a fundamental rethinking of what constitutes a "professional guideline". What Khorasani calls the "next generation of decision support" may call for the next generation of professional guidelines.

Local Server vs Web Based EMR

In certain situations one type of EMR might win over another. For example, if you’re in a place where your internet connectivity is not reliable, then you probably should go with an in house EMR instead of a web based EMR. Many doctors who don’t have formal IT support avoid an in house server and go with a web based hosted EMR to avoid the lack of IT support of the in house server.

http://www.emrandhipaa.com/emr-and-hipaa/2010/08/18/emr-question-and-answer-local-server-emr-vs-web-based-saas-emr

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This reminds me of an issue we're going to be debating at AMIA, Customization vs. Standardization to Promote Adoption of EHRs. Local Server = customized, Web Based = standardized.

A rapid, Web-based method for obtaining patient views on effects and side-effects of antidepressants

Carlos Rizoa, Amol Deshpandea, Alton Inga and Neil Seeman report:

The method entails a systematized search of many URLs (Uniform Resource Locators, or Web page addresses), using keywords and phrases to extract the named drug and symptom that are reliably relevant to the medication being taken by the individual reporting the experience online.

Given the increasing number of patient narratives about drug experiences on open-access Web forums, this rapid novel method will have increasing utility in post-marketing surveillance and in comparing the effects of psychiatric medications.

J Affect Disord http://dx.doi.org/10.1016/j.jad.2010.07.027

(via @psydir and Neuroskeptic)

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I think it has more potential for post-marketing surveillance than comparing medications, since the methodology is anecdotal.

Are We Passionate or Psychotic about Social Media?

@PhilBaumann writes:

Passion enables you to seek out the things that help you get things done.

Psychosis drives you to see things that aren’t there, or to think in ways that are disconnected from reality.

http://philbaumann.com/2010/08/12/beware-psychosis-in-social-media

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Can anybody point to any examples of social media "psychosis"?

Healthcare Suffers More Data Breaches Than Financial Services

The high numbers [of disclosed breaches so far this year] are due to lax handling of how data is stored and accessed within these databases. This atmosphere, along with the extreme portability of healthcare data due to consumer devices and laptops and increasing numbers of malicious insiders seeking to profit from electronic medical records (EMRs) and other patient data, has formed a poisonous combination within the industry.

original article, requires cookies:
http://www.darkreading.com/database_security/security/attacks/showArticle.jhtml?articleID=226600307



summary, doesn't:
http://www.securitymagazine.com/Articles/Blog_Products/BNP_GUID_9-5-2006_A_10000000000000880240

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The problem isn't the technology, it's the people.

I think it's ironic that the original article is so secure that I couldn't access it (without accepting cookies were).

Should Walgreens train people in how to use social media?

Should Walgreens train people in how to use social media?

--Allan Khoury, MD, PhD, Chief Medical Officer, Walgreens Take Care Health Systems

health care can either take advantage of patients’ shared wisdom (and innovate) or ignore it (and fail)

--SusannahFox, Associate Director, Digital Strategy, Pew Research Center's Internet & American Life Project

http://e-patients.net/archives/2010/06/patient-communities-at-walgreens.html

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That same "privacy advocate" is quoted again!