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Patient safety update

I’m passionate about patient safety. I’m happy to report a couple of things that aren’t exactly breaking news, but still worth bringing to your attention.

First off, there is a fairly new peer-reviewed journal called Diagnosis, and it’s about exactly what the title suggests. The first, quarterly issue, from German academic publisher De Gruyter (North American headquarters are in Boston), came out in January, so the second issue should be published soon. The online version is open access. That means it’s free. (A print subscription is $645 a year.)

A highlight of the premiere issue is a submission from the legendary Dr. Larry Weed and his son, Lincoln Weed, discussing diagnostic failure and how to prevent it. “Diagnostic failure is not a mystery. Its root cause is misplaced dependence on the clinical judgments of expert physicians,” they begin. The answer? Clearly defined standards of care and wider use of clinical decision support tools. It’s not anything new. Larry Weed has been advocating this for a good 50 years and saying that the unaided human mind is fallible for probably 60 years. Yet, medicine still largely relies on physicians’ memory, experience and recall ability at the point of care.

This doesn’t mean evidence-based medicine ,which is based on probabilities. Probabilities are fine when the patient has a common condition. They’re useless for outliers. No, Weed has long said that IT systems should help with diagnosis by “coupling” knowledge to the patient’s particular problem, and this starts with taking a complete history.

Weed, of course, created the SOAP (subjective, objective, assessment, plan). I recently talked to a CMIO who is advocating flipping that around a bit  into an “APSO” (assessment, plan, subjective, objective), which he said works better with electronic records. I’ll have more on that in an upcoming article for a paying client, and I’ll probably want to dive into that again in the near future.

For those who still believe American healthcare is safe, effective and efficient, ProPublica worked with PBS Frontline and marketing firm Ocupop last year to produce a video “slideshow” called “Hazardous Hospitals.” It’s worth a view for healthcare industry insiders, and definitely merits sharing with laypeople. I recommend that you share it. Please. Do it. Now. I’m serious. Patient safety is a problem that doesn’t get enough attention. :)

 

March 25, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

EMRs for mental health?

I’ve been wondering, has anyone in mental health truly had success with an EMR? I can’t imagine any psychotherapist sitting at a computer typing notes while there’s a patient on the couch. That would be particularly bad for a patient with self-esteem issues.

I imagine that tablets like the iPad may make this a little easier, but what psychotherapists really need is something like a pen tablet (with a stylus rather than touch-screen) or digital ink to mimic taking notes on a pad of paper.

The other issue related to EMRs in mental health is the exchange of notes with other physicians. Will an electronic note from therapist back to the primary care physician wind up in the electronic chart that might get sent, say, to an orthopedist or gastroenterologist? The only thing other specialists really would need to know is the patient’s medication list, not a psychiatric diagnosis or treatment history, right? Segmenting out sensitive parts of an EMR like treatment for mental health and sexually transmitted diseases is something vendors and CIOs have struggled with for years, and I believe continue to struggle with.

In both cases, I’d love to hear your anecdotes here.

April 22, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

MTIA changing its name

I’ve just learned that the Medical Transcription Industry Association will be changing its name to the Clinical Documentation Industry Association. This change reflects the fact that the transcription profession is evolving into an editing function with the advent of EMRs.

The new name and expanded organizational mission will be introduced Feb. 21 at the HIMSS conference. The CDIA will focus on the human interaction necessary to make electronic documentation more usable, a process likely to grow more complicated as the healthcare industry migrates to ICD-10 coding.

The cynic in me knows that the public (or mainstream media) won’t notice much of a difference because there’s still the widespread perception that medical transcription is a booming industry. All those “work at home transcribing medical records” offers can’t possibly be misleading, could they?

I guess it’s up to those of us who really understand healthcare to spread the word that transcription is dying and that the real growth potential is in higher-skilled editing of clinical documentation.

February 8, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.