Sometimes taking a conservative approach to technology can be an advantage. The folks at the bleeding edge pay a premium and, in some cases, get left behind because they invest so much in new technology they can’t afford to rip and replace to take advantage of the next big leap forward. The folks who wait awhile often pay lower costs and have the opportunity to learn some important lessons from the challenges the early adopters struggle with.
The healthcare organizations in Qatar chose to take a conservative approach to Electronic Health Records (EHRs), carefully assessing needs and giving the technology time to mature. That caution is now paying off. As they built their vision for technology-enabled healthcare in Qatar, they were able to learn a very important lesson from the difficulties American hospitals and physicians faced: interoperability matters.
When Hamad Medical Corporation and Primary Health Care Corporation decided to go digital, they worked together to create a one-of-a-kind, country-wide EHR. The two health systems are based in Doha, Qatar, and together serve more than 90 percent of the country’s population of 2.3 million people. Over the last four years HMC and PHCC have deployed a full suite of clinical, administrative and financial solutions across eight different hospitals, 23 health centers and a variety of clinics and other venues of care.
In other countries, where interoperability is lacking, physicians and hospital staff are frequently frustrated by their inability to access patient data. Physicians often know there are lab results and imaging studies for a patient, but the patient isn’t sure where those records are, or they reside in system to which the physician has no access. Getting that access could take longer than doing the work all over again, and the physician ends up ordering duplicate tests.
Prescription drug management can be challenging in that environment, especially if the patient has seen multiple physicians who don’t share a common EHR. Often the patient is taking multiple drugs but doesn’t have a complete list to give the physician, who doesn’t know if the drug they are about to order will react with something the patient is already taking or duplicate the effects of another prescription. That’s dangerous for the patient, and a scary proposition for a physician.
In Qatar, physicians no longer have to worry about these issues, because all the physicians are on the same system, giving them access to ALL the patient’s records.
The EHR promise fulfilled
With complete interoperability between locations, the patient safety and efficiency promises of EHRs can become a reality. And physicians have an amazing range of advanced tools to help them improve care. For example, the system has embedded within it the Cerner St John Sepsis Agent, which constantly monitors inpatients for deteriorating vital signs, organ dysfunction and potential sepsis. The algorithm alerts clinicians when a patient’s vital signs suggest the onset of sepsis, which enables the care team to intervene earlier.
Sepsis, for readers who are not clinicians, is a condition in which an infection, trauma, inflammation or a combination of these creates an overwhelming response that shuts down or damages major organ systems. It’s also called systemic inflammatory response syndrome (SIRS). If not recognized quickly, it can rapidly lead to severe sepsis and septic shock, which can be fatal.
At HMC’s Khor Hospital, nearly 40 percent of the patients with an alert for SIRS were progressing to a more serious sepsis alert. Within 11 months of implementing the algorithm, that percentage dropped to 17 percent, because the system alerted physicians before the patients’ conditions deteriorated. The clinicians at Khor Hospital estimate the system has helped save approximately 64 lives during that time.
Add to that the efficiency of not repeating tests and avoiding medication errors with a barcode system that matches patients and medications, and you can clearly see that patients are safer and costs are lowered by the system.
Common EHR also enhances outpatient care
While the hospital results are impressive, outpatient clinics benefit, too, through better coordination of care. Access to complete patient data means far fewer instances of elderly patients with multiple and conflicting drug prescriptions. And primary care physicians can quickly see if a patient has been to the emergency department because of an accident or health crisis and can follow up to see if intervention is necessary. For example, elderly patients that have injuries from falls may need a medication change, vision checkup or home modifications to prevent future falls.
Patients with chronic diseases often need complex medical management, and that is far easier with an EHR, too. And with a complete medical history, clinicians can be more confident and efficient in making diagnoses. They don’t have to wonder what information is missing that could affect their understanding.
Direction is more important than speed
The Qatar healthcare organizations did not do this overnight. Critical to their success was assessing their needs and creating a strategic roadmap to guide their project. They also put some effort into governance and change management, to ensure that the system design reflected the needs of users and prepared clinicians for the change. It’s a big deal when you move clinicians from paper to digital, because it changes more than just how you document care. Workflows change, and specific tasks are often done differently. For example, under the new barcode system for hospital patients, nurses and other clinicians had to be trained to systematically check the patient’s wristband to ensure that medications, tests and treatments were accurately matched to the patient. For nurses that had been giving meds for 20 years using a set routine, changing that routine takes time and training. The Qataris wisely paid attention to this issue and spent six years designing the system, preparing the staff and implementing the system nationwide.
It will be interesting to watch how this affects the outcomes of Qatari patients over time. I think it will pay off in more coordinated care, which usually means better outcomes for patients.
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Post Date: 8/23/2017