MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'cpoe'. Sat, 03 Sep 2011 02:43:13 +0100 http://www.medworm.com/index.php?rid=5174703&cid=t_224285_113_f&fid=34634&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FEmrAndHipaa%2F%7E3%2Fg_faMvFVu7k%2F Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts. A great deal of work, discussion, and debate by the HIT Policy Committee and its Workgroup members went into developing the recommendations for meaningful use Stage 2 (discussed in the last two Meaningful Use Monday posts). Meetings were frequent and lengthy, but I tried to listen in on most of them to gain some insights into the thinking behind the decisions being made and the future direction of me... EMR and HIPAA blogs http://www.medworm.com/rss/comments.php?id=5174703 Mon, 29 Aug 2011 17:35:33 +0100 5174703 http://www.medworm.com/index.php?rid=5159280&cid=t_224285_113_f&fid=34634&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FEmrAndHipaa%2F%7E3%2FTRWtDdOJM_4%2F Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts. In addition to the Meaningful Use Stage 2 recommendations discussed in last week’s Meaningful Use Monday, the HIT Policy Committee proposed a new framework for the reporting of clinical quality measures that was designed by its specifically-tasked Quality Measure Workgroup. The recommended concept is depicted in the graphic below—the intention is to broaden the scope of reporting to address a wid... EMR and HIPAA blogs http://www.medworm.com/rss/comments.php?id=5159280 Mon, 22 Aug 2011 15:19:08 +0100 5159280 http://www.medworm.com/index.php?rid=5139648&cid=t_224285_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F08%2Fsafe-technology-factors-contributing-to.html Conclusions Duplicate medication order errors increased with CPOE and CDS implementation. Many work system factors, including the CPOE, CDS, and medication database design, contributed to their occurrence. Duplicate orders can result in over-medication, failure to discontinue, or other medication errors if not caught. They by definition increase risk. The questions are simple: Considering that this was a "Northeastern US community tertiary care teaching hospital", not a small hospital in a remote town somewhere lacking in HIT experience, and that "duplicate medication order errors increased with CPOE and CDS implementation", is CPOE: A safe technology, in a practical sense in the complex clinical setting (with complexities that are 'Hiding in Plain Sight'), in 2011?A technology ready f... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=5139648 Thu, 18 Aug 2011 15:50:00 +0100 5139648 http://www.medworm.com/index.php?rid=5130856&cid=t_224285_113_f&fid=34634&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FEmrAndHipaa%2F%7E3%2F7izZd7JZcgo%2F Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts. A few weeks ago, the HIT Policy Committee forwarded its Stage 2 meaningful use recommendations to CMS. CMS is expected to issue a Proposed Rule in early 2012 and the Final Rule in mid-2012.  The first recommendation—intensely debated, but overwhelmingly supported in the end—is to delay the start of Stage 2 until 2014, recognizing the unrealistic time pressure that vendors and providers would fac... EMR and HIPAA blogs http://www.medworm.com/rss/comments.php?id=5130856 Mon, 15 Aug 2011 16:43:35 +0100 5130856 http://www.medworm.com/index.php?rid=4767931&cid=t_224285_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F04%2Fcpoe-cesspool.html An accomplished physician who read my post on CPOE at Memorial Sloan Kettering causing medical errors and near misses, and lack of FD&C regulation of health IT medical devices, relates the following:So I want to stop medications on a patient. The device only allows me to stop one at a time, and for each one, it requires me to type in a reason.Then, I get another pop up screen to enter my password.Six clicks and two manual entries to stop an aspirin, not counting the click to get to the med list. [What a valuable use of physician time! - ed.]Also, I have found that when I want an order for something that is labor intensive to enter, and I ask house staff [trainees - ed.] to do it, I get balking as to why I want that treatment or infusion.The arguments, I have found, are not really about... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4767931 Sat, 30 Apr 2011 15:16:00 +0100 4767931 http://www.medworm.com/index.php?rid=4762728&cid=t_224285_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F04%2Fwhen-will-first-class-action-lawsuit-on.html At this post a few weeks ago about FDA (non)regulation of health IT, I observed several salient points:FDA's Chair of the Center for Device and Radiological Health (CDRH) Dr. Jeffrey Shuren, a physician and lawyer, stated that under the Federal, Food, Drug, and Cosmetic Act [that regulates all drug, medical devices, etc. in the United States - ed.] HIT software is a medical device (link to testimony);FDA is aware of HIT risks of injury and death, including specific examples, and issued an internal memo (direct link to memo PDF) taxonomizing these risks in great detail. The memo was publicly divulged by the Huffington Post Investigative Fund; The aforementioned chair of CDRH believes these incidents - including 44 reported injuries and 6 reported deaths - are likely just the "tip of the ice... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4762728 Thu, 28 Apr 2011 17:21:00 +0100 4762728 http://www.medworm.com/index.php?rid=4753798&cid=t_224285_113_f&fid=34634&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FEmrAndHipaa%2F%7E3%2F0KFMueXj3ss%2F CPOE (Computerized Provider Order Entry), is the direct entering of orders into a computer (or mobile device), so that the order is documented in a digital, structured, and computable format. Meaningful Use Core Measure: CPOE More than 30% of unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE. Exclusion: providers who write fewer than 100 prescriptions during the reporting period. CPOE is one of the measures that elicited quite an animated response from the provider community. When initially proposed, this measure required 80% of all orders to be directly entered by the provider. To overcome objections to the scope of the requirement and the burden it would impose, CMS ultimately limited the measure to ... EMR and HIPAA blogs http://www.medworm.com/rss/comments.php?id=4753798 Mon, 25 Apr 2011 15:41:02 +0100 4753798 http://www.medworm.com/index.php?rid=4709169&cid=t_224285_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F04%2F1-toward-meaningful-usability-five-keys.html In a 2011 "White Paper" from a company PatientKeeper entitled "Toward Meaningful Usability: Five Keys to Creating Physician-Centric CPOE" (PDF), an organization whose motto is "Enabling Physicians to Focus on Patients ... Not Technology", I again note a common phenomenon.Certain verboten terms are absent.What might those terms be? More on that in a moment...They speak of "the failure of CPOE":The failure of CPOE to date can be attributed to many factors that ultimately lead to a lack of physician adoption. CPOE systems have historically been designed to support the workflow of the departments responsible for fulfilling the orders rather than the physician workflow around entering orders. As a result, entering orders electronically can take significantly longer than written or verbal orders... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4709169 Wed, 13 Apr 2011 13:14:00 +0100 4709169 http://www.medworm.com/index.php?rid=4560274&cid=t_224285_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fadvice-from-the-emr-trenches%2F2011.03.07 The latest from moi: “Implementing Electronic Medical Records: Advice from the Trenches” in the March/April 2011 issue of HIT Exchange magazine. An excerpt: The news released in late December from the Centers for Disease Control and Prevention that more than half of the nation’s physicians are now using electronic medical records (EMR)—double the adoption rate of just five years ago—is surely worth celebrating. Until, that is, you take a look and realize that just a fourth of office-based physicians have access to a “basic” EMR system including patient history, demographics, problem lists, clinical notes, and computerized physician order entry (CPOE), while just one in 10 has a “fully functional” system, which also includes the communication system required for me... Better Health blogs http://www.medworm.com/rss/comments.php?id=4560274 Mon, 07 Mar 2011 23:00:00 +0100 4560274 http://www.medworm.com/index.php?rid=4086230&cid=t_224285_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F10%2Fmedical-center-has-more-than-6000.html As I have written at Healthcare Renewal before, computerized physician order entry systems (CPOE's) are known to present risks to patients through induction of medical errors.This technology is held out to be ready for national diffusion, right up to the POTUS. Per ONC director Blumenthal in the July 13, 2010 NEJM:The widespread use of electronic health records (EHRs) in the United States is inevitable. EHRs will improve caregivers’ decisions and patients’ outcomes. Once patients experience the benefits of this technology, they will demand nothing less from their providers. Hundreds of thousands of physicians have already seen these benefits in their clinical practice.Vendors deny major problems with their CPOE and other health IT products.The true story is a bit more complex.Fortunate... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4086230 Wed, 20 Oct 2010 15:35:00 +0100 4086230 http://www.medworm.com/index.php?rid=3861971&cid=t_224285_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2010%2F08%2Fno-one-is-perfect-not-even-computers.html By HERBERT MATHEWSON My last post described how a precisely regimented dosage of intravenous medication delivered to me over six hours by a state-of-the art computer actually depended on the existence (and the survival for 6 hours) of a handwritten... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=3861971 Wed, 11 Aug 2010 23:00:00 +0100 3861971 http://www.medworm.com/index.php?rid=3816354&cid=t_224285_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2010%2F08%2Fthe-yellow-stickie-aint-dead-yet.html By Herbert Mathewson I’m sure that many of us “old timers” can remember the early days of computer implementation in our hospitals. At that time you couldn’t help but notice the dozens (or more) Yellow Stickies plastering the nurses’ station... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=3816354 Sun, 01 Aug 2010 23:00:00 +0100 3816354 http://www.medworm.com/index.php?rid=3733036&cid=t_224285_87_f&fid=34470&url=http%3A%2F%2Fwww.thehealthcareblog.com%2Fthe_health_care_blog%2F2010%2F07%2Fleapfrogging-cpoe.html By MARGALIT GUR-ARIE Last week, yet another alarming Computerized Physician Order Entry (CPOE) study made headlines. According to Healthcare IT News, The Leapfrog Group, a staunch advocate of CPOE, is now “sounding the alarm on untested CPOE” as their new... (Source: The Health Care Blog) The Health Care Blog blogs http://www.medworm.com/rss/comments.php?id=3733036 Tue, 06 Jul 2010 23:00:00 +0100 3733036 http://www.medworm.com/index.php?rid=3123435&cid=t_224285_113_f&fid=34634&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FEmrAndHipaa%2F%7E3%2FUIqaRHjnRx0%2F Conclusions: A basic CPOE system in a community setting was associated with a significant reduction in medication errors of most types and severity levels.” Note, this study is about CPOE which is not featured in all EMRs and I think that HIMMS has even been trying to get HHS to back off on making CPOE required for the stimulus $. But here is real data that shows real benefits. This study is about error rates and not dollars – but if errors are reduced then lawsuits are reduced and hopefully malpractice insurance premiums follow. IMO, we never needed the tax payer funded stimulus to begin with. Malpractice insurance companies should offer radically reduced rates to physicians that use CPOE and that would be all the “stimulus” that is needed to move doctors toward EH... EMR and HIPAA blogs http://www.medworm.com/rss/comments.php?id=3123435 Fri, 18 Dec 2009 17:33:10 +0100 3123435 http://www.medworm.com/index.php?rid=2851873&cid=t_224285_113_f&fid=34634&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FEmrAndHipaa%2F%7E3%2Fx7IrcBcSi0E%2F If you’ve had enough of my posts from a talk Marc Probst gave, then you’ll be glad to know this is the last one. There’s no hiding my respect for Marc and hearing him in person did nothing but elevate that respect for him. Some of the comments below will feel a bit random, but I thought they were interesting enough to share with you all. Meaningful Use and Certified EHR Overlap I asked Marc about the challenge of reconciling the overlap between the certified EHR criteria modeled after the meaningful use matrix and meaningful use itself. It seemed that they were measuring basically the same thing. Marc’s response was, “That’s a battle I lost.” Then, Marc muttered under his breathe something about certifying the software versus the users. Basically, ... EMR and HIPAA blogs http://www.medworm.com/rss/comments.php?id=2851873 Wed, 30 Sep 2009 15:23:46 +0100 2851873 http://www.medworm.com/index.php?rid=2314698&cid=t_224285_113_f&fid=34625&url=http%3A%2F%2Fclinicalit.blogspot.com%2F2009%2F03%2Femr-hits-close-to-home.html Regular readers might recall that my dad chose to have surgery last November at Washington Hospital Center in D.C. rather than at a hospital closer to home, because the surgeon preferred the WHC facilities and because the other place had been in the news at the time for its high rate of hospital-acquired MRSA infections.I didn't mention the other hospital at the time because I didn't think it was necessary, but I will tell you now that it is Suburban Hospital in Bethesda, Md. It's relevant now because McKesson announced this morning that Suburban has contracted to deploy Horizon Clinicals and Horizon Enterprise Revenue Management for EHR, CPOE, medication managment and revenue cycle management.I couldn't find an online link to the press release just yet, but here's the text:News ReleaseSub... Neil Versel's Healthcare IT Blog blogs http://www.medworm.com/rss/comments.php?id=2314698 Mon, 30 Mar 2009 16:04:00 +0100 2314698 http://www.medworm.com/index.php?rid=2288979&cid=t_224285_113_f&fid=34634&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FEmrAndHipaa%2F%7E3%2F9DAVsTKRKA4%2F I recently came across an interesting term that I’d never heard of: Information Therapy. Here’s the wikipedia description of Information Therapy: Information therapy works by engaging the consumer in the process of care. Unlike health information which a patient or family member may find on an open website like webmd or yahoo, information therapy is providing plain language evidence based medical information to a patient at the exact time that a patient needs it to help them in their heatlh care process. An example would be when a person who leaves a doctor’s office is provided an after-visit summary of instructions on how they can take care of their ailment at home. Information therapy may be prescribed by a clinician, (i.e. nurse, doctor or other health professional), b... EMR and HIPAA blogs http://www.medworm.com/rss/comments.php?id=2288979 Wed, 25 Mar 2009 14:48:37 +0100 2288979 http://www.medworm.com/index.php?rid=2152892&cid=t_224285_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F02%2Fwhen-we-detect-possible-vioxx-moment.html I recently read the article "Clinical Information Technologies and Inpatient Outcomes" , Archives of Internal Medicine 169(2), Jan. 26, 2009 and found it fascinating. Full text is available as of this writing at this link .The authors conducted a cross-sectional study of urban hospitals in Texas using a "Clinical Information Technology Assessment Tool" (CITAT), a questionnaire designed to measure a hospital’s level of automation based on physicians' reported interactions with actual information systems.They then examined whether greater automation of hospital information was associated with reduced rates of inpatient mortality, complications, costs, and length of stay for 167,000 patients older than 50 years admitted to responding hospitals between Dec. 1, 2005, and May 30, 2006.Here is ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2152892 Mon, 02 Feb 2009 19:14:00 +0100 2152892