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Kevin S . Hughes , MD, FACS Co-Director, Avon Comprehensive Breast Evaluation Center

Creating the EHR of the future Using Computers to Decrease Workload and Improve Quality Israeli Association for Medical Informatics. Kevin S . Hughes , MD, FACS Co-Director, Avon Comprehensive Breast Evaluation Center Massachusetts General Hospital Associate Professor of Surgery

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Kevin S . Hughes , MD, FACS Co-Director, Avon Comprehensive Breast Evaluation Center

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  1. Creating the EHR of the futureUsing Computers to Decrease Workload and Improve QualityIsraeli Association for Medical Informatics Kevin S. Hughes, MD, FACS Co-Director, Avon Comprehensive Breast Evaluation Center Massachusetts General Hospital Associate Professor of Surgery Harvard Medical school

  2. The EHR has tremendous promise as a means of decreasing workload, decreasing cost and improving quality of care

  3. EHR HIT has tremendous promise as a means of decreasing workload, decreasing cost and improving quality of care

  4. EHR and productivity varies by specialty100 internists, pediatricians and family practitioners 25 to 33 percent drop in MD productivity Over time Internists slightly above original productivity Pediatricians /family practitioners never recovered HemantBhargava, UC Davis Graduate School of Management

  5. “Computerization hasn't saved a dime, nor has it improved administrative efficiency” 4,000 hospitals 2003 to 2007 Computerization Weak correlation Quality for MI No correlation Cost savings Improvements in administrative efficiency Quality for pneumonia Quality for heart failure Overall quality (MI, heart failure, pneumonia) Himmelstein, The American Journal of Medicine (2010) 123, 40-46

  6. Quote from a surgeon beginning an EHR • …our productivity is down 28% • I am the highest paid transcriptionist in the state • Each cancer patient chart takes me apprx 1 hour • For the first time in my career, I turned down an add-on patient

  7. EHR Minimal Generic CDS Small Database Meds Allergies Generic Interface Mostly Filing Cabinet Or Document Management System

  8. Specialty Specific CDS EHR Specialty Specific CDS RT Interface Specialty Specific CDS Pathology Interface Database Breast Surgery Interface Specialty Specific CDS Specialty Specific CDS Breast MedOnc Interface Mammography Interface

  9. Clinical Decision Support (CDS) Apply Algorithms/Guidelines to patient data Identify best course of action Results displayed as intuitive Visualizations BRCAPRO Mutation Risk 25% Suggest Genetic Testing Facilitates best action as part of workflow

  10. Genetic Testing and Risk CDS

  11. Genetic Testing and Risk Click open 4 screens BRCA1+

  12. Genetic Testing and Risk

  13. Programs exist that can fill this gap • HughesRiskApps • Progeny • Jameslink • CancerGene • BRCAPRO

  14. Using free text for CDS will require Natural Language Processing and is not trivial

  15. Natural Language Processing of breast pathology reports

  16. Natural Language Processing of breast pathology reports 21 negations before diagnosis ( No evidence of …) 12 negations after diagnosis ( … was not seen)

  17. Specialty Specific Systems ask for specialty specific data and in return provide specialty specific CDS Providers will enter Structured Data if they get value in return or if it saves them time

  18. EHR: Paper + extra work + memory Patient completes paper form Staff enters data into the EHR Reviews data using memory of guidelines Documents and Orders

  19. Patient enters data Tablet PC iPad Website Patient educational materials Clinical Decision Support Reviews Report & Pedigree Reviews suggested management Clinical Decision Support Documents and Orders

  20. Breast Cancer PatientPrint 3 Op Reports and 3 Path Reports Accession Number: Report Status: Updated Type: Surgical Pathology Pathology Report: CASE: PATIENT: Date Taken: 12/11/2008 Source Care Unit: Path Subspecialty Service: Results To: Signed Out by. ********** Addended Report *********** Accession Number: Report Status: Updated Type: Surgical Pathology Pathology Report: CASE: PATIENT: Date Taken: 12/11/2008 Source Care Unit: Path Subspecialty Service: Results To: Signed Out by. ********** Addended Report *********** CLINICAL DATA: Accession Number: Report Status: Updated Type: Surgical Pathology Pathology Report: CASE: PATIENT: Date Taken: 12/11/2008 Source Care Unit: Path Subspecialty Service: Results To:

  21. Specialty Interfaces/CDS Specialty Interfaces/CDS Specialty Interfaces/CDS Specialty Interfaces/CDS EHR Specialty Interfaces/CDS Specialty Interfaces/CDS Will allow us to increase quality while decreasing cost

  22. HughesRiskAppsBreast Surgery ModuleFree software available at: Kshughes@Partners.org HughesRiskApps.net

  23. Patient enters data Tablet PC iPad Website Patient educational materials Clinical Decision Support EHR Reviews Report & Pedigree Reviews suggested management Clinical Decision Support Documents and Orders

  24. Demo • An explanation of HughesRiskApps

  25. HughesRiskAppsBreast Surgery ModuleFree software available at: Kshughes@Partners.org HughesRiskApps.net

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