David R. Hunt, MD, FACSChief Medical Officer and Acting Director, OHITA

Office of the National Coordinator for HIT

Health IT and Patient Safety:ONC Context

Medicine used to be simple, ineffective and relatively

safe.

Now it is complex, effective and potentially dangerous.

The role and education of doctors in the delivery of healthcare.Hollister Lecture delivered at the Institute of Health Services Research, Northwestern

University, Illinois, USA. October 1998. Lancet 1999;353:1178–81.

Sir Cyril Chantler

“As to diseases make a habit of two things - to help, or at least, to do no harm.”

Epidemics I

Hippocrates :

4

Quality = Help

Safety = Do no harm

5

Quality Healthcare

Effective

Patient-Centered

Timely

Equitable

Safe Efficient

6

7

Solo 6%

EHR Adoption by Practice Size

DesRoches, V, et. al.; Electronic Health Records in Ambulatory Care — A National Survey of Physicians N Engl J Med July 2008;359:50-60.

25

20

15

10

5

0

4%

Physicians*

Per

cent

age

of p

hysi

cian

s

With notes, Rx orders, & ability to order and obtain lab results

Dual 9%

3-5 physicians22%

>10 physicians35%

6-10 physicians28%

8

Capacity to select contract, install, implement

Transition productivity loss

Concerns about system obsolescence

Finding an EHR to meet needs

Uncertainty of return on investment (ROI)

Amount of capital needed

Major Barriers to Adoption of Electronic Health Records

DesRoches, V, et. al.; Electronic Health Records in Ambulatory Care — A National Survey of Physicians N Engl J Med July 2008;359:50-60.

“…reckoning that all such matters should be kept secret…”

Hippocratic Oath

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Principles, Policies, Procedures, ProtectionsPrivacy

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25550 Federal Register/ Vol. 74, No. 101/ Thursday, May 28, 2009/ Notices

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54% Finding an EHR to meet needs

44% Concerns of obsolescence

39% Capacity to implement

SEC. 3012. HEALTH INFORMATION TECHNOLOGY IMPLEMENTATION ASSISTANCE.

(a) Health Information Technology Extension Program- To assist health care providers to adopt, implement, and effectively

use certified EHR technology that allows for the electronic exchange and use of health information…

(c) Health Information Technology Regional Extension Centers-

(1) IN GENERAL- The Secretary shall provide assistance for the creation and support of regional centers (in this subsection referred to as `regional centers') to provide technical assistance and disseminate best practices and other information learned from the

41% Transition productivity loss

13

NEW! MEA CULPA Errant mouse click leadsTo negative laparotomy

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THE MISTAKE: Three days later, a third check of antibody levels revealed a value of >90% (normal, <3%) pointing to autoimmune hypoglycemia.

FIGURE: Normal imaging Despite a normal CT scan, the surgeon reluctantly offered surgical exploration.

DISCUSSION: Insulin levels were far too elevated for a usual insulinoma. When faced with a patient with all signs and symptoms of hyperinsulinism, checking insulin, c-peptide, glucose, and sulfonylurea levels is appropriate. However, extreme insulin elevation (typical insulinomas reveal values of 15–90 Iu/mL) suggests another source. Insulin antibody elevations are rare. The treatment is observation and supportive care. It resolves spontaneously.

A “systems problem” may explain the surgical team’s failure to preoperatively check insulin antibody levels. The data is only available via electronic medical records (EMR) with a right mouse click. A left click didn’t show anything, so we assumed the value was normal. Mea Culpa. Our institution is now fixing the EMR display feature.

THE PATIENT: An 80-year-old woman with classic symptoms of neuroglycopenia underwent a battery of tests confirming the Whipple triad….

NEW! MEA CULPA

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Hippocrates

Decorum  11

You better know what you should do before you enter, for in many cases help is needed,

not thought.

DavidR.Hunt@hhs.gov

202-690-6341

http://healthit.hhs.gov