Does the US Technology Gap Push Med Errors into the Third Leading Cause of Death?

Guest post by Thanh Tran, CEO, Zoeticx, Inc.

Thanh Tran
Thanh Tran

Hardly a day goes by without some new revelation of a US IT mess that seems like an endless round of the old radio show joke contest, “Can You Top This”, except increasingly the joke is on us. From nuclear weapons updated with floppy disks to needless medical deaths, many of which are still caused by preventable interoperability communication errors as has been the case for decades.

According to a report released to Congress, the Government Accountability Office (GAO) has found that the US government last year spent 75 percent of its technology budget to maintain aging computers where floppy disks are still used, including one system for US nuclear forces that is more than 50 years old. In a previous GAO report, the news is equally alarming as it impacts the healthcare of millions of American’s and could be the smoking gun in a study from the British Medical Journal citing medical errors as the third leading cause of death in the United States, after heart disease and cancer.

The GAO interoperability report, requested by Congressional leaders, reported on the status of efforts to develop infrastructure that could lead to nationwide interoperability of health information. The report described a variety of efforts being undertaken to facilitate interoperability, but most of the efforts remain “works in progress.” Moreover, in its report, the GAO identified five barriers to interoperability.

CMS Pushing for “Plug and Play” Interoperability Tools that Already Exist

Meanwhile in a meeting with the Massachusetts Medical Society, Andy Slavitt, Acting Administrator of the Centers for Medicare & Medicaid Services’ (CMS) acknowledges in the CMS interoperability effort “we are not sending a man to the moon.”

“We are actually expecting (healthcare) technology to do the things that it already does for us every day. So there must be other reasons why technology and information aren’t flowing in ways that match patient care,” Slavitt stated. “Partly, I believe some of the reasons are actually due to bad business practices. But, I think some of the technology will improve through the better use of standards and compliance. And I think we’ll make significant progress through the implementation of API’s in the next version of (Electronic Health Records) EHR’s which will spur innovation by allowing for plug and play capability. The private sector has to essentially change or evolve their business practices so that they don’t subvert this intent. If you are a customer of a piece of technology that doesn’t do what you want, it’s time to raise your voice.”

He claims that CMS has “very few higher priorities” other than interoperability. It is also interesting that two different government entities point their fingers at interoperability yet “plug and play” API solutions have been available through middleware integration for years, the same ones that are successfully used in the retail, banking and hospitality industries. As a sign of growing healthcare middleware popularity, Black Book Research, recently named the top ten middleware providers as Zoeticx, HealthMark, Arcadia Healthcare Solutions, Extension Healthcare, Solace Systems, Oracle, Catavolt, Microsoft, SAP and Kidozen.

Medical Errors Third Leading Cause of Death in US 

The British Medical Journal recently reported that medical error is the third leading cause of death in the United States, after heart disease and cancer. As such, medical errors should be a top priority for research and resources, say authors Martin Makary, MD, MPH, professor of surgery, and research fellow Michael Daniel, from Johns Hopkins University School of Medicine. However, accurate, transparent information about errors is not captured on death certificates which are the documents the Center for Disease Control and Prevention (CDC) uses for ranking causes of death and setting health priorities. Death certificates depend on International Classification of Diseases (ICD) codes for cause of death, but causes such as human and EHR errors are not recorded on them.

According to the World Health Organization (WHO), 117 countries code their mortality statistics using the ICD system. The authors call for better reporting to help capture the scale of the problem and create strategies for reducing it. “Top-ranked causes of death as reported by the CDC form our country’s research funding and public health priorities,” says Makary in a press release. “Right now, cancer and heart disease get a ton of attention, but since medical errors don’t appear on the list, the problem doesn’t get the funding and attention it deserves. It boils down to people dying from the care that they receive rather than the disease for which they are seeking care.”

The Root Cause of Many Patient Errors

Better coding and reporting is a no-brainer and should be required to get to the bottom of the errors so they can be identified and resolved. However, in addition to not reporting the causes of death, there are other roadblocks leading to this frighteningly sad statistic such as lack of EHR interoperability. Unfortunately, the vast majority of medical devices, EHRs and other healthcare IT components lack interoperability, meaning a built-in or integrated platform that can exchange information across vendors, settings, and device types.

Various systems and equipment are typically purchased from different manufacturers. Each comes with its own proprietary interface technology like the days before the client and server ever met. Moreover, hospitals often must invest in separate systems to pull together all these disparate pieces of technology to feed data from bedside devices to EHR systems, data warehouses, and other applications that aid in clinical decision making, research and analytics. Many bedside devices, especially older ones, don’t even connect and require manual reading and data entry.

Healthcare providers are sometimes forced to mentally take notes on various pieces of information to draw conclusions. This is time consuming and error-prone. This cognitive load, especially in high stress situations, increases the risk of error such as accessing information on the wrong patient, performing the wrong action or placing the wrong order. Because information can be entered into various areas of the EHR, the possibility of duplicating or omitting information arises. Through the EHR, physicians can often be presented with a list of documentation located in different folders that can be many computer screens long and information can be missed.

The nation’s largest health systems employ thousands of people dedicated to dealing with “non-interoperability.” The abundance of proprietary protocols and interfaces that restrict healthcare data exchange takes a huge toll on productivity. In addition to EHR’s physical inability, tactics such as data blocking and hospital IT contracts that prevent data sharing by EHR vendors are also used to prevent interoperability. Healthcare overall has experienced negative productivity in this area over the past decade.

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Sharing of Secure Patient Information Requires Strong Breach and Notification Policies

Roy Bossen
Roy Bossen

Guest post by Roy Bossen, partner, Hinshaw and Culbertson.

With the implementation of the Affordable Care Act pushing hospitals and health systems to provide services more efficiently, a significant number of hospitals, health systems and providers are sharing secure patient information through health information exchanges (“HIEs”), and accountable care organizations (“ACOs”). The advent of both the HIEs and the ACOs are additional opportunities for protected health information to be shared by hospitals, doctors and other providers.

HIEs allow for patient information, including lab tests, imaging tests, prescriptions and treatments, to be shared by the participants in the HIE. The development of these electronic HIEs allow for the secure exchange of health information among entities participating in the HIE. Generally, the rights and responsibilities of those entitled to share the information is governed by participation agreements. Many providers believe that sharing data will improve healthcare and promote not only quality of care, but efficient care, as well. Similarly, the development of ACOs by otherwise independent providers results in more patient information shared in electronic fashion. The advent of both HIEs and ACOs provide another medium for possible breaches of the privacy rule.

The privacy rule requires that covered entities verify the identity and authority of persons requesting Protected Health Information (“PHI”) if the individual requesting it is not known to the entity.  The Rule, however, does not specify in great detail the verification that must be made and, thus, there is flexibility that can be applied with regard to HIEs and ACOs.

Generally, in a HIE, the participants agree, by contract or otherwise, to provide to the HIE a list of authorized persons so the HIE can appropriately authenticate users of the network. Documentation required for uses and disclosures may be provided in electronic form, and documentation requiring signatures may be provided as scanned images. It is important from an HIE perspective for the various participants to agree on a common set of privacy safeguards that are appropriate to the risk associated with exchanging PHI to and through the HIE. Similarly, with ACOs, the ACO should establish a common set of privacy safeguards that are appropriate to the privacy risks associated with multiple providers using PHI. These common standards would include a breach notification policy or procedure. To fully understand what must be done, one must have a basic understanding of what is considered a breach.

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How Patient-centered, Value-based Care Will Drive Innovation in Healthcare

Fauzia Khan, MD

Guest post by Fauzia Khan, MD, FCAP, is chief medical officer and co-founder of Alere Analytics.

This has been a very interesting year for the healthcare industry, which appears to be on the brink of a real sea change. Government mandates are driving transformative discussions in the C-suite circles on topics such as meeting meaningful use Stage 2 and Stage 3 requirements, satisfying Accountable Care Organization (ACO) standards, care delivery models in the patient-centered medical home and much, much more.

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An Introduction to Health Information Exchanges, and the Question of their Adoption

Some of the most concise, yet useful, information about health information exchanges must come from Medicity. In a “primer” page (that might be written for the HIE novice) there’s quite a nice bit of information about the importance of the technology.

Obviously, Medicity is biased, as HIE is what it does, but I admit that after reading some of the points Medicity makes about the importance of HIEs, I’m sold (though I already was).

Let’s dig in.

As we know, health information exchanges help connect healthcare providers with information they likely would not have through paper records, and in many cases, not even with electronic health records as the EHRs are often fragmented or don’t depict the entire health scenario of a patient.

As noted by Medicity, HIEs help create efficiencies in the care setting in many ways, primarily by helping make information available across many platforms and even across many care locations.

Additionally, and I’m paraphrasing here: HIEs help reduce duplicate testing of patients; help create a more complete picture of a patients’ care and prior treatment protocols; and they help eliminate costs and fees associated with redundancies.

The best case I can make for an HIE (probably for an EHR, as well) is a story from a former colleague. Her mother was diagnosed with an aggressive form of cancer. At best, she was given months to live. However, after multiple specialist visits, redundant tests, labs and scans delivered the same information as the previous test, the woman died just a few weeks after initial diagnosis.

Moral of the story is this: according to my colleague, for every specialist she and her late mother visited, each one requested the same tests as the previous doc because the doc didn’t have an accurate, or complete, record. To make matters worse, the records were paper. My former colleague said the task of trying to assemble a complete care record was beyond arduous, not to mention difficult to construct given the red tape each practice had in place as the gate keeper of the records it kept.

If only the information had been in a single repository, perhaps her mother wouldn’t have wasted so much time on taking the same tests and she could have received the care she needed, my colleague said. I agree.

So does Medicity, which operates on the belief that HIEs change all of that. Simply and clearly put, HIEs “break down silos and make information available” to providers at virtually any location that’s connected to the HIE when the information is needed and required.

HIEs, like EHRs I suppose, can change and possibly save lives. Interestingly enough, at least to me, is that HIE’s lag in favor or in the very least have a history of not being able to generate the support they need to thrive (perhaps survive?).

As the government continues to place more importance on the availability of health information through exchanges and electronic records, the market will find a way to monetize HIEs (probably the biggest hurdle vendors face when considering whether to develop technologies to support them).

There are now, though, several vendors with their own HIE-like devices that can function within their EHRs the same way their patient portals work. They are able to trasmit data to other users of their company’s specific technology.

As these vendors continue to develop their own HIEs, and try to sell them, it will be interesting to see which technology – private or public – will be adopted by the healthcare community.