Japanese Philosophy and EMR Implementation Work Hand-in-Hand

With thoughts and prayers headed towards our friends in Japan, I thought it would be a good time to focus on their contributions towards work flow and process analysis, the cornerstones of health care consulting and EMR implementation.  

As many of you know, EMR implementation is more than buying a software package and a few machines and hitting the ‘on' button.  Prior to any of these investments, there are processes and efficiencies that must be identified and implemented such that an office, group or hospital can maximize the use of EMR to improve patient outcomes.  Several organizational methodologies exist to conduct such analysis and implementation: Sigma 6, Lean Thinking, Deming Cycle, etc.  One specific Japanese philosophy, 5S,has received a lot of attention of late as we transition towards complete EMR implementation.

5S represents a philosophy built around the principles of building an efficient workplace with standardized work procedures.  The tenets of 5S involve simplifying, reducing waste and non-value activity while improving quality efficiency and safety.   There are five words that this philosophy is built around.  They include:

1. Sort (Seiri): elimination of wasteful items around the workplace.  To do so, a process called red tagging is completed in which a red tag is placed to identify any item that is wasteful around an office.  All red tagged items are then removed and put into a central area where they can be evaluated.  Such items that are unneeded are discarded while those with occasional use are moved and organized.  This process allows for valuable work space to be freed up and clutter to be removed.
2. Set in Order (Seiton): focuses on efficient and effective storage methods.  For any given item, one must ask him or herself: What do I need to do my job? Where should I locate this item? How many of this item do I need? All shared items should have a place where employees can find it (e.g. mop, stapler, etc.) Everything has a place.
3. Shine (Seiso): Having rid yourself of waste and set in order the remaining goods in the office space, cleaning those areas thoroughly shall be the next focus.  A daily scheduled follow-up cleaning will help with sustaining such improvements while ensuring the remaining goods are looked after and kept in their best order.
4. Standardize (Seiketsu): creating a system of standardized practices is the next part of the 5S philosophy.  All employees doing the same job should be able to switch to any station with the same function and reproduce the work task.  Involving employees to participate in the process will only help make them feel invested and increase compliance with new standards.  
5. Sustain (Shitsuke): literally means implement and achieve.   While humans are quite resistant to such change, this process can and will prove to be one of the most difficult to complete.  The tendency always is to revert back to “old ways.”  Employees should always be thinking about ways to improve the work place and processes; in the event that some sort of issue arises where an improvement can be made, one must review the first 4 S’s and how they relate to the new process prior to making the appropriate change.

While sticking to the 5S principles won’t guarantee the smoothest implementation, there are some great reminders of what it takes to make a system work.  As you continue to consider EMR implementation or a career as an Implementation Clinician, Informatics Specialist, and/or Clinical Consultant, understanding work flow, process analysis and process implementation should be your highest priority.  With your solid clinical background and this framework to help guide health care facilities to more efficient results, you will begin to understand what it takes to take on such a job.  

EMR = MSQ (A Massive Security Quagmire)

With the emergence of electronic medical records, the amount of intimate data being stored on any given patient is enormous.  This begins with identifying information such as age, race, sex, social security information, billing information, etc.  Such data is invaluable to identity thieves and marketers alike. Last week it was reported that a group of hackers broke into the Emory Health Care System and stole the records of at least 77 patients at an orthopedic clinic.  

Alarmingly, the hospital IT department did not detect nor identify any security problems.  The security breach was picked up by an ongoing case being pursued by the FBI.  In a statement by a hospital spokesperson for the Emory Health Care System, the intentions of the thieves were revealed, ”According to the IRS this information appears to have been subsequently used for the filing of fraudulent federal tax returns with the intent of collecting associated tax returns."

Despite the perception of being a secure network, I find it amazing that such security breaches could occur without any clue of its occurrence by the IT department. This event speaks volumes as to the distance we have to go to prevent the compromise of highly sensitive patient data.  

As I continue through my HITECH program, I learn every day about a new creative way hackers have accessed such sensitive data.  Creating a secure system truly is a monumental task requiring both education of health care workers, increased hardware and software resources, and a better trained more prepared IT team. Along with creating a unified language as being one of our nation's largest hurdles for system-wide EMR implementation and adoption,  top-rated health IT security will prove to have an equally immense resource cost.  

EMR: No Shortage in Standards

As we transition to a full EMR system, one of the largest current challenges to our health care model is the need to share information at different sites: hospitals, clinics, nursing homes, tertiary care centers, etc. To help facilitate this interoperability between health care sites, standards are needed to guide us towards this end.

Even to begin to set such standards and/or goals towards interoperability, there first must first be a focus to aggregate patient data towards a unified standard. In setting the stage for this ‘consensus’ standard, all stake holders who represent some specific arm of medicine must come together and define the standards that allow them to work together across sites and distances.

Many of these respective groups that create standards have a tight relationship; some have absolutely no connection whatsoever. Thus, it’s easy to see this creates an inherent redundancy in standards in some areas of gap in others. Such redundancy and scattered coverage in standards have created the need for harmonization.

 

The graphic above represents the 43 major international health care standard developing organizations (SDO's) that are working together to create seamless interoperability. Many of these organizations have a need for assistance, and are free to join and have openings for volunteer opportunities. If you are interested in breaking into HealthIT, anyone of these organizations could mark the start of your transition towards this career.

As I continue to navigate through my HITECH program, I will continue to highlight many of these organizations and give you a bird's eye view of their role in the EMR interoperability equation. If you'd like to learn more about EMR transition and the mountain we are facing, click here.

About the author:

Mehdi Rais is a physician, medical lecturer, medical writer, and self-proclaimed “tech nerd.” When Dr. Rais isn’t honing in on his trades, he spends his time scouring publications and the web for the latest trends in technology in the medical field, new applications in Health Information Technology, and emerging legislative & regulatory changes in medicine.

Dr. Rais' interests are greatly focused in the realm of mobile computing and the use of cell phone technologies in the clinical setting. He received his Medical Doctorate from St. Christopher’s College of Medicine after spending his undergraduate years at the University of Texas at Dallas.

Dr. Rais can be reached on LinkedIn or followed at his blog here. Look for him on Twitter @DrMedBlog.

EMR Transition: It's all in the Words....

Seamless care through EMR requires establishing interoperability between different systems (i.e. organizations, hospitals, clinics, networks, etc.)  The starting point for achieving this interoperability is producing a controlled vocabulary to input within a database.  Naturally, over time development organizations have created such data sets in vocabulary for the specific aim to explain a specific arm of medicine.  Gradually, these organizations have broadened their purpose to encompass all medical terminology.  With this in mind, it is important to note that none of these initial data sets were ever intended to cover all of medicine and thus the reason we have overlap in terminologies, descriptions, etc.

If one were to simply take a look at a single term/data set and the variance in definitions of this term, it would be easy to see how the transition to EMR could effectively come to a grinding halt in its attempts to achieve complete interoperability.  A recent study examined the term myocardial infarction (MI). We all have our own conceptual model of MI and a respective qualitative/quantitative description to fit this model. The study I am referring to found 60 different scientific definitions of myocardial infarction.  Take this example one step further, and imagine the EMR interoperability nightmare if the records of one MI patient had to seek care or advice from a different institution. The flow of that data set from one institution to the next would immediately be severed simply because of the differing definitions and descriptors given. Now multiply this problem by every diagnosable disease.  The thought of standardization of language and disease description becomes a staggering one, and here lies the mountain of work we must climb to achieve seamless EMR interoperability.

To put this into further perspective, the following table elaborates the choices in terminology for specific recordable data sets and the respective organizations that are attempting to develop a controlled language.  While there may be overlap in some of the language in one or two of the systems, there is by no means a consensus language. 

 '+' represents the amount of use of a controlled terminology set within the U.S.; '$' represents a respective cost to the end user.

Having said this, clinicians cannot sit back and simply think that EMR transition will be done by IT people alone.  Definitions and vocabulary are the back bone of this system. Such terminology can only be given by clinicians.  Currently the Office of the National Coordinator estimates 50,000 people will be needed to assist in this effort over the next 4-5 years to reach our goal of 100% transition to EMR.  

I for one had no idea of the scale of the interoperability problems without having started the HITECH Workforce Program only a few weeks back.  I look forward to presenting many more of the big issues that we are facing during this EMR transition in the coming months.  

About the author:

Mehdi Rais is a physician, medical lecturer, medical writer, and self-proclaimed “tech nerd.” When Dr. Rais isn’t honing in on his trades, he spends his time scouring publications and the web for the latest trends in technology in the medical field, new applications in Health Information Technology, and emerging legislative & regulatory changes in medicine. 

Dr. Rais' interests are greatly focused in the realm of mobile computing and the use of cell phone technologies in the clinical setting.  He received his Medical Doctorate from St. Christopher’s College of Medicine after spending his undergraduate years at the University of Texas at Dallas.  

Dr. Rais can be reached on LinkedIn or followed at his blog here. Look for him on Twitter @DrMedBlog.

The HITECH Workforce Progam: A Free & Fast Education in EMR Implementation

Today I began a six month certificate plan in the HITECH Workforce Program.  The program is a pivotal piece to the recently passed HITECH (Health Information Technology for Economic and Clinical Health) Act with specific aims:

• Nationwide adoption of Electronic Health Records
• Information exchange across health care providers and public health authorities
• Redesign of workflows within health care settings to gain quality and efficient benefits of EHR
• EHR Transition while maintaining privacy and security of medical information.

The program was designed to cross-train individuals in health care and Information Technology (IT).  Those with a medical background (most of us), will have a primary focus on IT issues (networks, databases, and programming) and those with an IT background will focus on health care issues.  As an incentive to increase enrollment, the Department of Health and Human Services and the Office of the National Coordinator is offering 100% tuition reimbursement for those who finish the program within 6 months until funding runs out. 

The training curriculum was developed by industry leaders and educators at Duke University, University of Alabama, Oregon Health Sciences University, Columbia University and Johns Hopkins University. This uniform curriculum is based online with all reading material, power point presentations, quizzes, etc. made available through Blackboard at approved regional sites. 

There is a real need for health care professionals like ourselves to dive into this program.  According to the Labor Bureau of Labor statistics and the Department of Education, the federal mandate for nation-wide implementation of Electronic Health Records by 2015 will require 50,000 qualified health information technology workers. 

In projecting these numbers, several workforce roles have already been identified.  Among the applicable ones to health care workers (others exist for IT) include:

• Clinician/Practitioner Consultant
• Practice workflow and information Management Redesign Specialist
• Implementation Support Specialist
• Implementation Manager

Employers for these roles can include but are not limited to health care facilities, vendors, state/city public health agencies, and regional extension centers.  The members of these roles will be considered of mobile adoption support and will help implement at the aforementioned sites and upon completion will move on to new locations. 

If you enjoy traveling, a highly variable work environment and different daily challenges, this may be just for you.  As the course progresses, I will run down the responsibilities for each applicable role, suggested background, projected pay, and typical education. In addition I hope to give you my impressions of the course.

For more information on the program, click here.