Note: This story was originally written by Charles Plain and appeared on the School of Public Health website
Regular medical care is critical for people with HIV to manage their health and recent estimates suggest only 54 percent of patients see their providers as directed, far below the national goal of 90 percent. New research by Eva Enns, Ph.D., assistant professor in the School of Public Health, shows how HIV clinics could use HIV surveillance data collected by state health departments to help routinely and accurately determine the status of patients who appear lost to care.
The study was published in AIDS Patient Care and STDs.
Many patients drop out of a clinic’s care because they’ve stopped seeking medical treatment, but a lot also leave due to events like moving, changing providers, or dying. The problem is, if a patient, for example, moves and establishes care with another provider but doesn’t tell their previous clinic, that clinic has no idea what has happened to them. The job of retaining and re-engaging HIV patients in care is a responsibility that largely falls to health care providers. Locating patients who appear lost to care is resource-intensive and time-consuming, requiring staff to painstakingly search for missing patients through phone calls, records searches, and footwork.
Enns wanted to see how many re-engagement investigations could be averted if clinics had easy, integrated access to state HIV surveillance data, which maintains records to measure the disease burden in states by tracking information like HIV cases, provider care data, and death records.
She tested the idea by merging 2008-2014 electronic medical records from a hospital-based clinic in Minneapolis with state surveillance data.
“We found that, for the Minneapolis clinic, access to the state’s HIV surveillance data would equal a 29 percent reduction in the number of case investigations you’d have to do over a seven-year period,” said Enns. “The reduction is impressive, and since the data is already being collected for surveillance purposes, it’s low-hanging fruit.”
Enns said the results show health care systems integrating surveillance data into clinic electronic medical record systems could be a cost-effective way to determine the status of patients and more easily identify patients who are truly out of care.
“Health department surveillance staff spend a great deal of effort maintaining and reviewing their surveillance records, and I think it’s gratifying when they can see how it can be used, not just for reporting purposes, but also to directly improve patient health,” said Enns.
Enns encourages health systems and state health departments to continue exploring the prospect of improving patient retention through integrating HIV surveillance data with clinic operations. She also adds that there are a number of security, privacy, and legal concerns that would need to be addressed before establishing a routine data-sharing system.
She plans to continue building on this research by looking at how patterns of care, such as provider choice and location, change over a patient’s lifetime.
Chronic kidney disease affects more than 20 million Americans, but primary care providers often miss the condition, because it tends to be asymptomatic and is associated with other important comorbidities, or chronic conditions.
Utilizing electronic health records (EHR) could help identify chronic kidney disease (CKD) sooner, and identify ways to better manage the condition, says University of Minnesota faculty member and researchers with the National Kidney Disease Education Program (NKDEP). Researchers gave recommendations to apply that concept in the Clinical Journal of the American Society of Nephrology today.
“Using EHR data, we can identify high-risk populations, and help providers and patients manage CKD more efficiently,” said Paul Drawz, M.D., lead author of the report, and assistant professor in the Department of Medicine in the Medical School. “It’s possible that EHRs could even improve patient outcomes.”
EHR systems have the potential to improve efficiency and quality of patient care management, physician collaboration, and accuracy for diagnoses and treatments. But current systems tend to be difficult or inconvenient, and lack usability functions that could streamline processes.
“Electronic health records should be built better,” Drawz said. “If we can make it easier for patients and clinicians to access health data in a secure way, we could improve care, satisfaction, and possibly even outcomes.”
How so? One example would be pinpointing medications that would be harmful to people with CKD. Most patients with CKD take several medications, so EHRs could also help physicians and pharmacists identify medications that may be interacting poorly with one another. Another example is that EHRs could provide physicians with better access to a patient’s health data through well-designed flow sheets that include relevant and longitudinal data to help clinicians better diagnose and manage CKD.
EHRs could also supports more robust research projects, the authors pointed out. Readily available population level data could assist in developing stronger research designs or identifying potential clinical trial candidates.
With improved EHRs, researchers, clinicians and patients can find health information faster and more easily, without jeopardizing patient privacy.
To make this possible, the authors recommend:
- Developing improved, intuitive patient and provider-facing interfaces with secure access
- Using standard codes and units for CKD related laboratory results and medications
- Implementing EHR systems that support exchange of CKD-related information across health care settings
- Expanding functions to allow CKD surveillance and more effective data collection
The NDKEP will explore these options further by collaborating with industry leaders, medical professionals, and researchers. With additional research, the authors are hopeful that the technology and improved processes for EHR-related CKD applications can be implemented.
“We must make improving EHR systems and informatics a priority,” Drawz said. “This could improve care, research and hospital efficiency for many conditions and diseases, not just CKD. When we develop improved EHRs, everybody wins.”
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Sharable, comparable nurse data is lacking in the nation’s electronic health records, according to Bonnie Westra, Ph.D., R.N., associate professor and director of the Center for Nursing Informatics at the University of Minnesota.
But it’s not for lack of nurses entering patient health information into the record. There’s arguably, in fact, too much patient data being entered.
“What we’re faced with is a challenge of how do we better streamline data, standardize terms used, and standardize documentation to better reuse the data coming in?” said Westra.
In other words, usability of the data has room to grow.
With nurses making up the single largest group of health care hospital workers in the United States, making full use of the patient data being entered is a big opportunity. Complete records on pressure ulcers and patient safety errors, for example, could lend health researchers and health systems a better understanding of patient needs and care improvement opportunities.
Effective electronic record keeping is still relatively new to much of the health care field. And while the electronic health record’s primary purpose is to track an individual patient’s health, the record has a secondary use—setting it apart from paper records—as well. Big data can help identify trends in population health and improve hospital workflow in a way paper charts could not, creating opportunities that are much more impactful.
“A lot of unnecessary money is spent,” said Westra, referring to the sizable sum health care agencies sink into manual chart reviews. Instead of pulling data out of systems in a cost-efficient way, manual reviewers must go through records one-by-one in search of the information they seek. That system is “getting better” according to Westra, but in some cases still can involve faxes and paper, and different or incomparable nursing language used across systems.
The need for improved implementation and optimization is widely acknowledged. National Public Radio’s Shots Blog recently elaborated on the physician-reported frequent inefficiency of electronic health records.
According to Westra, who has also sat on the Minnesota e-Health Initiative Advisory Committee since 2007, there are common nursing languages that already exist, enabling the opportunity for making some progress toward universal adoption. If widely implemented, it could make pulling data out of big systems much more streamlined.
Last year, Minnesota Commissioner of Health Edward Ehlinger approved a recommendation to implement a standardized nursing language across EHRs statewide. The U of M Center for Nursing Informatics is leading a national collaboration to streamline nursing documentation across the U.S. as well.
Added to that, informatics competencies are now built into nursing school curriculums nationwide – U of M School of Nursing curriculum included. That new standard just might provide an advantage to the next generation of health care providers, looking to make nurse data more easily exchanged … to the health benefit of all.
The post Expert Perspective: Sharable, comparable nurse data lacking in electronic health records appeared first on Health Talk.
If you’ve followed health reform efforts, you know that every policy debate and system change center around one set of objectives: better outcomes at lower costs with improved patient experiences. The “triple aim” of health care.
But often overlooked in the reform discussion is the question of just how we’ll assess the impact of system changes. How will we know what we’re doing is working? The answer, quite simply, lies in unprecedented access to data.
Through an intensive focus on data and health informatics, the University of Minnesota is front and center in shaping how data is leveraged within research and clinical care. The University has long maintained a robust health informatics program and has also made substantial investments in technology to position itself as a leader in both data collection and analysis.
Our friend and colleague Kevin Coss, from the Office of the Vice President for Research (OVPR), recently highlighted a variety of University informatics efforts in a piece for the OVPR blog Research @ the U of M. Within, Kevin quotes Dr. Genevieve Melton-Meaux of the U’s Institute for Health Informatics and the chief medical information officer for University of Minnesota Physicians, who said that the “repository and analysis of the large amounts of clinical data will help with clinical research discovery and help forecast what kind of care patients will need, which in turn improves the patient’s treatment.”
We encourage Health Talk readers to visit Kevin’s profile of University efforts within the field of health informatics. His piece can be viewed in its entirety here.
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Wednesday, kids in SCRUBS Academy at the University of North Dakota practiced telemedicine with graduate students in the University of Minnesota Health Informatics department. The students learned about how new technology can help patients and doctors cross boundaries, save money and save time.
You may not know it, but you may be one of every three Americans who will sleepwalk during their life.
University of Minnesota Medical School Professor of Neurology Mark Mahowald, M.D. and fellow researchers from across the nation found that 29% of adults will sleepwalk during their lifetime and 3 to 4% of us–or 8.4 million Americans–have sleepwalked in the past year. Mahowald and his colleagues’ findings were published this week in the journal Neurology.
“It was formerly thought that sleepwalking was seen commonly in children but not in adults,” says Mahowald. In reality however, sleepwalking is “very, very prevalent”.
Sleepwalking’s prevalence among the general population is much higher than many medical professionals and members of the community think.
Because parts of the brain can be awake while other parts are still asleep, the brain is capable of carrying out complicated behaviors (such as sleepwalking) while the conscious mind is still asleep.
While Mahowald and colleagues’ study found that Americans already suffering from sleep disorders such as sleep apnea or insomnia, those taking sleeping pills and those suffering from depression or obsessive-compulsive disorder (OCD) were more likely to sleepwalk than other groups, Mahowald emphasizes that anyone can sleepwalk.
“Initially, it was thought that it was related to psychiatric and psychological problems,” he says. “People don’t want to bring it up because they are afraid they will be told it’s psychiatric. But, clearly, it’s not related to psychiatric problems.”
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