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JHL Article EHRs and the Hospital Librarian Ellie Bushhousen October 2012 1 Short Title: Electronic Healt h Records Full Title: Electronic Health Records and Hospital Librarians Ellie Bushhousen Health Science Center Libraries, University of Florida, Gainesville, Florida, USA Abstract The electronic health record has made monitoring the patie nt treatment cycle easier and with fewer error s. H ospital librarian s must develop ways to include health related information as part of the electronic health record. Keywords: electronic health record, hospital librarians, treatment cyc le Many hospitals in the United States today are usi ng electronic health record (EHR ). EHRs are designed to c onsolidate patient treatment, tests, lab results, billing along with other healthcare provided information into a single portable record. In the April 2006 report Electronic he National Institutes of Health and the National Center for Research Resources quote Jennifer Allan and Jane Englebri ght definition EHRs as follows: (EHR) is a longitudinal electronic record of patient health information generated by one o r more encounters in any care delivery system ( 1 ,2 ) The idea was to create a system that put patient information into a single record as opposed to multiple separate pieces of information from different healthcare departments. Baseline patient information (height, weight, gender, age), diagnosed
JHL Article EHRs and the Hospital Librarian Ellie Bushhousen October 2012 2 illness es, treatments, medications, therapies used, length of hospital stays, names of physicians and allied healthcare professionals and other patient care information would be reside in one record. This record could be accessed using EHR software the hospital has p urchased and installed One of the most used EHR software is Epic. Kaelber and colleagues describe the impact of Epic and one of its functions: an estimated 50 million patients see healthcare providers who use the EPIC EHR (Electronic Health Record) soft ware system, which includes a tethered PHR product. The EPIC based portal that allows patients access to a variety of PHR functions, such as reviewing test results and scheduling appointments. (3 ) EHRs enable recordkee ping in healthcare facilities become a more cohesive process. Before EHRs different hospital units that were in some way providing a service for one patient did not interact with each other. For example, billing tests were being done in pa thol ogy ; pharmacy did not know what physical therapy was doing; appointment scheduling had difficulty arranging for the patient to see one or more doctors about the different levels of care needed or recently completed. Each of these piece of the treatment puzzle fit. An EHR lets the disparate healthcare units and departments enter their portion of data about the one patient so all the information can be seen at a glance. Physicians,
JHL Article EHRs and the Hospital Librarian Ellie Bushhousen October 2012 3 pharmacies, therapists, billing can watch the cycle of care and notice where there are gaps. The EHR provides vital data on the physical condition of a patient. The question hospital librarians need to ask up information on resources the In a July 2010 article in the Jou r nal of th e Medical Library A ssociation Jones and colleagues describe ways librarians can assist healthcare professionals as well as patients with health information. An information information ( 4 ) One role a hospital librarian can undertake is to create a n information statement, as Jones and colleagues suggest that puts reliable healthcare websites and resources right to the patient. This resource could have the added benefit of pointing the patient towards articles and studies to discuss with their health care provider Hospitals in the United States have been buying the necessary software to create EHRs since the 1990s. EPIC is one of the best known. Leonard and Tozzi report that organization They can log into the system, check their medical records, and correspond with doctors vi One of the biggest problem s with EHRs is the lack of standardization for the software. There no one part of HER software that is developed or designed in a similar fashion even though the programs provide very similar results. Leonard and Tozzi report about a n EHR incompatibility situation that occurred in Denver. Kaiser
JHL Article EHRs and the Hospital Librarian Ellie Bushhousen October 2012 4 Permanente used the Epic EHR software, its two other clinics in Denver used another EHR product. Sure communicate with them electronically (5) Often, the hospital librarian is the sole librarian for a hospital or a group of healthcare facilities. Much of the time involves researching and sending articles, URLs staff has more requests than others, etc. While the EHR is smoothing and coordinating the patient care cycle, the hospital librarian needs to take in the big picture to know what kinds of patient/consumer health information is appropriate for a given patient. If the librarian is fortunate eno ugh to attend clinical rounding with residents or participate in morning report meetings, a great deal of information can be gleaned and sifted into useable packages. This kind of nd Portability Act (HIPPA). Identifying information on a patient must not be part of the possible for a literature search to be performed that could be of use to the res idents. current healthcare resources could be part of the EHR as Jones and colleagues have suggested(4). If the hospital librarian learns emergency tracking and fulfilling offers of support for literature searches and emailing results could become complicated quickly. The hospital librarian was able to handle information requests from disparate areas of the hospital. Electronic databases that were crucial to the hospital lib conduct literature searchers were often seamlessly integrated
JHL Article EHRs and the Hospital Librarian Ellie Bushhousen October 2012 5 IP address network so access was on demand. However in her January 2006 blog post, The Krafty Librarian raised a cautious question regarding the compatibility of some library online resources potentially having trouble trying to work HER system (6). If the hospital librarian was stymied attempting to fulfill an information request because an online vendor cannot work with the EHR software, what might happen if a neighboring healthcare facility that collaborates with the larger h ospital but uses a different EHR software cant their requested literature? The electronic health record is a great leap forward to improve patient care by librarian can and should be p art of this cycle of care by providing customized groups of relevant and trusted healthcare resources and websites that can be appended to the EHR and made available upon discharge. Total healthcare is a team effort and the hospital librarian is a valuable part of the team.
JHL Article EHRs and the Hospital Librarian Ellie Bushhousen October 2012 6 References 1. National Institutes of Health/National Center for Research Resources (2006) Electr onic Health Records Overview http://www.ncrr.nih.gov/publications/informatics/ehr.pdf (3 Jun 2010) 2. Allan A, Englebright J. (2000). Patient centered documentation: an effective and efficient use of clinical information systems. J Nurs Adm. 2000 Feb;30(2):90 5. http://www.ncbi.nlm.nih.gov/pubmed/10689400 (3 Jun 2010) 3. Kaelber D.C., Jha A.K., Johnston D., Middleford B., Bates A research agenda for personal health records (PHRs). J Am Med Inform Assoc, 2008 Nov Dec; 15(6): 729 36 4. Jones D.A., Shipman J.P., Plaut D.A., Selden C.R. Characteristics of personal health records: findings of the Medical Library Association/National Li brary of Medicine Joint Electronic Personal Health Record Task Force. J Med Libr Assoc. 2010 Jul; 98(3) 243 49. 5. records? http://www.businessweek.com/articles/2012 06 21/ (12 Sep 2012) 6. The Krafty Librarian (2006) Elsevier announces iCONSULT to be offered as part of Epic electronic health record http://kraftylibrarian.com/2006/01/elsevier announces iconsult to be.html (8 Oct 2012
JHL Article EHRs and the Hospital Librarian Ellie Bushhousen October 2012 7 Things so not have to be so dire for the solo hospital librarian. If the hospital is considering or has already implanted an electronic healthcare record system, now is a good time to raise the issue of online vendo r compatibility with the HER system. In an earlier article for the Journal of Hospital Librarianship, I commented that librarians need to work more closely with IT staff. The issue of online v endor and HER compatibility is a subject that should be raised n ow.
JHL Article EHRs and the Hospital Librarian Ellie Bushhousen October 2012 8 Why Don't More Hospitals Use Electronic Health Records? When people in health care talk about the promise of digital medical records, they often Hawaii electronic medical record Kaiser has the largest nongovernmental digital depository of medical records in the world, and the insurer says it has used this data to improve care. For instance, it has a large clinic in Denver that works closely wi th two non Kaiser electronically. Thankfully, the hospitals had fax machines. The case for EHR has long been compelling: It can help recognize and contain epidemics, speed claims processing, and, of course, cut costs. The U.S. is spending $2.7 percent of gross domestic product. The siz e of the problem is spurring a philosophical change, from a system where doctors are paid for the volumes of procedures they complete to one in which they are paid for keeping their patients healthy. (Paradigm shift)
JHL Article EHRs and the Hospital Librarian Ellie Bushhousen October 2012 9 There are, however, some roadblocks to implementing an HER system in a given incompatibility. The example of a Kaiser Permanente clinic in Denver trying to work with two other hospitals is a prime example. The Kaiser Permanente hospital and the other two hospital s could not trade information because they both had different HER software programs. did not have the sample HER software so the records could not be accessed.2 The hospital role igital Library) by mbschell27 on June 2, 2010 identifies four key areas that hospital librarians need to consider: The idea that librarians might have to create different relationships with physicians to collaborate on EHR implementation. Hospital libr arians may need to step back and watch the directions and developments their primary healthcare facility takes regarding implementation of EHRs. Existing online library resources, such as medical databases, may be caught in the struggle to implement EHRs The hospital librarian should be strategically ready to document and explain the need for continued access to online recourses in the new EHR environment Government legislation is examining new forms of telecommunication and information transfer daily. The issue of patient information collection and transfer is of particular interest due to the Health Information Protections and Portability Act (HIPPA).3
JHL Article EHRs and the Hospital Librarian Ellie Bushhousen October 2012 10
JHL Article EHRs and the Hospital Librarian Ellie Bushhousen October 2012 11 The push to have hospitals use electronic health records (EHR) (or personal health records as some call them) began in 2009 with the American Recovery and Reinvention Act. (huffington Post Elizabeth gardener for U.S. News, Sept. 4, 2012. Over $2 billion dollars was used as an incentive for doctors and hospitals to use EHRs. Hospital l ibrarians are often the sole source for access to medical information and up to information directly to the healthcare node making the request. As many hospitals are now learn ing, however, not every hosptital is using the same EHR software. This makes it difficult to coordinate patient records if the patient moves to a new area and the new This non communicati on between EHR software also poses problems for the hospital librarian. If the current hospital uses EPIC EHR software the hospital and the librarian
JHL Article EHRs and the Hospital Librarian Ellie Bushhousen October 2012 12 may have a system in place that affords direct research uploads to the particular node in the EHR system. If a different hospital is using another type of EHR program, not only In a speech to the Health Science In stitute in Kansas City, Missouri, the percental of US hospitals using EHRs has doubled in the last two years. http://www.medicalnewstoday.com/articles/241871.php Written by Catharine Pad dock PhD Copyright: Medical News Today Not to be reproduced without permission of Medical News Today Retrieved Oct. 22, 2012 U.S. Warning to Hospitals on Medicare Bill Abuses By REED ABELSON and JULIE CRESWELL Published: September 24, 2012 Saying there records to bill for Medicare and Medicaid reimbursement, the Obama administration vigorously prosecute doctors and hospitals implicated in fraud. http://www.nytimes.com/2012/09/25/business/us warns hospitals on medicare billing.html?_r=0 Retrieved Oct. 22, 2012 Hospital Strategies Among the leading strategies of hospitals are to: Participate in formative or existing regional information networks Participate with vendors to explore connectivity and financing solutions
JHL Article EHRs and the Hospital Librarian Ellie Bushhousen October 2012 13 Collaborate with other healthcare organizations to control costs Identify physician champions Start by providing physicians with electronic access to information that they most need to receive http://www.ehrinstitute.org/articles.lib/items/Hospitals and EHR Sy etrieved Oct. 22, 2012 How EHR helps improve ED wait times March 16th, 2011 by Stuart Hirsch When HealthAlliance of the Hudson Valley (HAHV) consolidated two emergency departments into a newly renovated, state of the art, 35 bed ED at The Kingston Hospital, we set the aggressive goal of having 95 percent of the patients seen by a clinician within 30 minutes of check in. To accomplish the objective, our three hospital health system in 2010 implemented a comprehensive electronic health record system from EDIMS that has enabled the organization to dramatically improve ED operations and put us within a few whiskers of meeting our desired wait times. As of January 2011, 87 percent of patients presenting daily at the ED were seen within 30 minutes, up from 47 percent when HAHV launched its initiative in April 2010. Before that, the average wait time was 47 minutes, which was within the national range of 47 to 55 minutes; however, it was not acceptable for the hospital's high standards for care delivery. We are confident that we would have hit 94 percent had we not maintained a percentage of "hold" patient s in the ED due to Kingston Hospital (150 beds) being at capacity for six days during January. [More:] A key driver behind our improvement is a time stamp feature in the EHR. This function allows us to analyze the wait times from the moment each of the 1 50 patients we see
JHL Article EHRs and the Hospital Librarian Ellie Bushhousen October 2012 14 daily are registered, triaged and placed in the room for treatment. Every morning the operations team runs a report on the previous day, briefs ED and inpatient clinical leaders, and posts performance results for clinicians to review. B uy in and willingness from clinicians to work as a team also have played a key role in the progress we have achieved over the past 10 months. Every ED clinician shared the goal of treating patients as quickly as possible with the best standard of care from the get go, but getting them to adopt the EHR and to be on the same page was challenging. That's because we had to merge nurses from a secular hospital and a religious facility -that had competed with each other for years -while simultaneously introducing the EDIMS EHR and bringing in a new emergency physician staffing group. To ease the transition for clinicians, we spent two years integrating the medical services of Kingston and Benedictine Hospitals, leaving emergency care for last. The organization al so trained and educated staff on the use of EHR and wait time metrics, held regular meetings and solicited employee input on governance issues. The results show the organization's strategies were successful. More importantly, they indicate that other heal th facilities are likely to have an easier time implementing EHRs to reduce ED wait times -and improve care and patient safety -because those institutions probably will not have to overcome as many issues or cultural differences as we had to. While we are very pleased with the progress made to date, we will reset our target to 100 percent as soon as clinicians see 95 percent of patients within 30 minutes for three consecutive months. This ambitious goal, which we anticipate will occur this year, is reachab le: For the week of Jan. 17, we hit 99.5 percent! It is possible we could have reduced wait times using paper records, but we certainly could not have done it as quickly or efficiently as we were able to with the assistance of an EHR. It would take severa l people hours to manually analyze wait times for 250 patients compared to the few minutes per day it takes one person to perform that task now.
JHL Article EHRs and the Hospital Librarian Ellie Bushhousen October 2012 15 Stuart Hirsch is administrative director of emergency services at the HealthAlliance of the Hudson Valley. htt p://www.hospitalimpact.org/index.php/2011/03/16/how_ehr_helps_improve_ed_wait_t imes Retrieved Oct. 22, 2012 President Obama's emphasis on comparative effectiveness research may encourage medicine to use what works for patient populations on a large s cale. Practitioners need the literature base to determine what is effective and where exceptions exist and, at some point, to enable payment for genetic variations or innovations. The electronic health record (EHR) can effectively distribute such practice guidelines, and librarians are already actively involved in integrating practice guidelines with KBI resources [14, 15]. Deepening their involvement with the EHR, librarians are using their classification and electronic record knowledge to inventory physic ian order sets and develop record databases . Beyond installation, librarians stay on to educate staff in information retrieval, as training is a long standing function for librarians. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2901006/ Retrieved Oct. 22, 2012 different processes throughout the hospital, and the day to day details were all new and Blog post http ://alisha764.com/2011/05/05/my emr educator hat/ Retrieved Oct. 22, 2012 One of the questions that keeps lurking in the back of mind is; What does this mean for companies like UpToDate who have been experimenting with electronic medical records? Does that mean other companies like UpToDate will not be able to integrate their product with Epic's EHR now that they have a partnership with Elsevier? If so, then I foresee the product (UpToDate, iConsult, etc.) that a hospital uses is dependent on what EHR softw are they use. http://kraftylibrarian.com/2006/01/elsevier announces iconsult to be.html Retrieved Oct. 22, 2012
JHL Article EHRs and the Hospital Librarian Ellie Bushhousen October 2012 16 Benefits of Electronic Health Records Centralized recordkeeping; easy to track patients treatment, EHRs hold a great deal of promise for hospitals and clinics. However, just as these similar problem exists for the hospital librarian. Problems Different sites using different EHR software makes transfer of information difficult or impossible.