Archive for March, 2012

“What’chu talkin’ ‘bout, Willis?”

Tuesday, March 27th, 2012

“What’chu talkin’ ‘bout, Willis?”

Catchy title, but I know many of you are going to stop reading after the first few lines once you figure out what I am writing about. I promise you that it is worth your time to keep reading!

Convergence. Transparency. Interoperability. HIE. TIGER. MU. OMG! The Healthcare Information Management and Systems Society (HIMSS) held its annual conference last week, and these terms were casually tossed around by attendees like we toss around cachexia, dysphagia, and BMI. Just like the titular famous catch phrase from the television show Diff’rent Strokes, I was not sure what many people were talking about. The only thing I was sure about is the fact that we all need to get up to speed pretty quickly, because health care as we know it is ending and a new era already has begun.

The HIMSS exhibit halls were filled with vendors offering every aspect of health care technology imaginable, as well as those you have never even dreamt about. Many of these will change the way we do our jobs or perhaps even eliminate our jobs, just as switchboard operators and travel agents have come and gone, unless we can prove our worth and value with outcome measurements.

So while you may think that this technological revolution does not pertain to you, trust me when I tell you it does. Every aspect of health care is undergoing change. Rather than resist it, it is time to embrace it. Some of these things will make our jobs better!

Here is an example. I worked at a nursing home where one of the residents required dialysis. She was sent by medivan three times a week to a dialysis center located only 1 mile from the nursing home. This seems simple enough, and I am sure this is routinely done in nursing homes across the country. My frustration came every time I had to do a quarterly review for this resident. I never found any lab data in her chart. Obviously, labs were done at the dialysis unit, and I wanted them! I called repeatedly to ask for copies, but rarely got them. I was told that they sent them with the medivan driver, they would fax them later, they would remember next time, and so on. It was a constant problem that seemed so simple to fix. I could have walked the mile to the dialysis center and picked them up myself in the time it took to discuss this repeatedly with the team.

Now consider something called the Health Information Exchange (HIE). HIE provides the capability to electronically move clinical information among disparate health care information systems, while maintaining the meaning of the information that is exchanged. A slightly different version of this is called the Direct Project or simply Direct. Simply put, Direct is a secure e-mail system that allows providers to communicate with one another and their patients. I get secure e-mails from my banker all the time, so why not from my doctor?

The key to all of this high-tech communication is compatibility. Imagine if the dialysis center sent me my resident’s lab work, but when I received it, I could not open the file. I am sure we have all tried to download a file and gotten the dreaded error message that our computer could not open it. It is maddening when it is only a photo of my nephew. Imagine if it is important health information or test results. The word for this function is interoperability.

HIE, Direct, and interoperability will solve some other common problems as well. One problem that arises in many of the lawsuits that I review is lack of continuity of nutrition care. For example, consider the elderly wound-care patient living in a nursing home with an order for a regular diet (according to the facility’s liberalized diet policy), an amino-acid product for wound healing, and thickened liquids to honey consistency for a swallowing problem. The resident is transferred to the hospital at the family’s urging, because they feel her cognitive status has deteriorated and she has become disoriented. After a 48-hour stay at the hospital, she is returned to the nursing home with orders for a 2-gram sodium diet, but with no orders for the amino acids or thickened liquids. The registered dietitian assesses that patient on the 4th day of this new admission and puts in a request to the physician for the regular diet, the amino acids, and the thickened liquids. These orders are written 2 days later or on the 6th day of admission.

This is a common occurrence and a legal liability. Now imagine utilizing technology that can speak a common language understood by whatever electronic health record (EHR) the nursing home and the hospital uses. If the core data (pertinent information, including demographic data) are ported from the nursing home to the emergency room (ER) before the resident even leaves the nursing room and is waiting on arrival at the ER, the resulting care is more continuous. Our job now is to make sure the people in our facilities understand how important it is to include nutrition information in every aspect of this as they build these systems.

Hopefully, you now understand a bit about how information will travel with the patient. If you do not know where your facility is on this, just ask and show an interest. The other thing I am 100% certain of after attending HIMSS is that not enough trained personnel are currently available to handle the growth in this area. I am sure your facility would welcome your interest and input.