Is the integration of urgent, emergent, inpatient and
care of patients with
acute medical conditions.
Health IT including electronic health records
By Mike Harrington
About thirty years ago, I was an accountant for Arthur Young. One of my auditing clients was a young emergency physician group in Oakland. I remember working long hours and coming home late at night exhausted, watching Johnny Carson on The Tonight Show, and thinking about that physician group and its amazing culture. They were devoted to helping others, and they went about their business in such a positive way.
When I decided to jump ship to truly join the healthcare sector, I went to work for that young physician group. At the time, many of my colleagues were going to high profile jobs in the financial services industry and investment banking. But I think I made the best choice.
By Thomas Sugarman, MD, FACEP, FAAEM
As physicians in the Acute Care Continuum, we want to treat our patients' problems quickly, especially their pain. While I would prefer to give pain medications to many people who do not need to be treated rather than to deny one person in pain, it would be ideal to know who really needs these drugs. Fortunately for physicians in California, a database reporting application called the Controlled Substance Utilization Review and Evaluation System (CURES) provides timely information aiding in the process of making this determination.
Steve Jobs knew that the key to Apple’s success was simplicity.
Apple products are painstakingly designed for simplicity. Updated Apple products are always better than their predecessor. If you question this, visit an Apple store at the release of the next iPhone or iPad.
Quite the opposite is true in the EMR-healthcare arena. The result: hospital executives are pressured to buy systems that “fit” into their existing IT platform regardless of physician usability. My intention is not to pile-onto the existing discussions about the 15-30% drop in productivity when EMRs are implemented. Unfortunately, I can attest to those numbers within our own organization (thus, the development of the scribe program).
The merits of the HITECH Act, the EHR Federal Mandate, and The Stimulus Package have been greatly discussed. I could argue that EMRs do not provide better patient care.
I want to know who will save physicians, hospitals and patients from the existing, pathetic breed of EMRs available today?
By Nic Curry
The physician I work with calls me his “right hand man”.
As the worlds of software technology and medicine continue to become more intertwined, scribes are playing an important role in the transition to electronic medical record (EMR) systems in the emergency room. EMRs are a solution for the future in saving time and money in healthcare. Based on my experience as a scribe, I can see that scribes are a bridge to the future between the medical world and the software world.
The purpose of scribes in the emergency room, according to Jason Ruben, MD, is to document treatments at the physician’s direction so that the doctor can focus on patient care. The physician I work with says that, thanks to my work, he “goes home on time.” This is because I save him hours he would have to put in charting at the end of his shift.
By Katherine Ahern, MIMS
In Victorian London, people were used to death. But the cholera epidemic of 1849 had people afraid to breathe, believing that cholera was an air borne illness. One letter from the time describes a hard-hit area, “The inhabitants themselves show in their faces the poisonous influence of the mephitic air they breathe. ”
John Snow, MD, learned otherwise. When he placed small rectangular bars representing cholera deaths on a map of London, it showed clearly that the deaths were clustered around an infected water well. The day officials removed the handle from the Broad St. pump in London was the last day of the cholera epidemic, which had taken over 50,000 lives. Snow’s map is now included among important texts of information visualization and is considered the birth of epidemiology.
By Denise Brown, MD
As I described in my last blog, the effective use of palliative care can actually lead to patients living better and longer lives. This practice of using fewer hospital resources while achieving better patient outcomes is something that will only grow in the future. But palliative care today is currently provided in an uncoordinated fashion. This can change as it becomes integrated with the emerging Medical Home and with the increased care coordination that is taking place across the Acute Care Continuum.
Coordinating the best palliative care for the patient is both a challenge and an opportunity within the Acute Care Continuum. The challenge is to get everyone who provides palliative care on the same page, and multi-disciplinary teams are already starting to connect with patients in order to facilitate palliative care. In the process of this emerging home patient care delivery system that resembles an ACO, the next logical step will be the interaction of the home care model with the ED in the most effective and efficient manner.
By Christina Palombo, RN
What is medical reconciliation (MedRec), and why is it important within the acute care continuum? The Joint Commission (TJC) on Medication Management has stated in its 2012 list of goals that EDs must: “Maintain and communicate accurate patient medication information.” Dirk Stanley, MD, summarizes the medical reconciliation challenge nicely. He says it is obtaining from the patient the ‘home med list’ of what the patient usually takes, creating a current list of what the patient is taking at that moment, and then generating a new current med list of “what does the patient need to be on right now.” MedRec includes identifying omissions, duplications, contradictions, unclear information and changes and giving the new list to the patient when leaving the medical setting. Beyond its obvious value in patient care, MedRec is important to the ED because failure to adhere to a TJC National Patient Safety Goal can result in loss of accreditation.
Gaining a grasp of this workflow is inherently filled with uncertainty. For example, how can a provider even know for sure whether a patient takes the medications they state they take or if the patient is divulging all the medications they are taking? To meet the MedRec challenge, inter-department coordination and EMR utilization will be key parts of the solution. In a sense, the challenge and the accomplishments made in MedRec coordination can be seen as a microcosm of the future path towards breaking down department silos across the healthcare continuum to create efficiency and integration.
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