Thursday, June 06, 2013

Poor integration between hospital EHRs and NICUs

Responding to my story about lack of funding for electronic health records for pediatric nursing homes, Brian Carter, a superb neonatologist at Children's Mercy Hospital in Kansas City, notes:

The limits of meaningful use for HITECH also exclude all of my patients – newborns and young children (age 2 or less). These children, especially those managed in neonatal intensive care units, comprise a significant portion of the pediatric population dependent upon medical technology – even upon their discharge home – and are affected by complex and sometimes chronic diseases of childhood (pulmonary, cardiac, gastrointestinal and neurologic). Neonatal ICUs have long utilized EHRs, but often this occurred in large hospitals that either didn’t develop or adapt EHRs system-wide, or had a different system for other units of care. Today, many hospitals are hampered by EHR adoption, and many NICUs by having to integrate a smoothly operating NICU-oriented EHR system into the new broader hospital EHR, or totally refit or rebuild the NICU system and lose years of meaningful and accessible data.

Brian quotes a colleague: "Children are often little considered in broad societal or systemic healthcare changes, because they are little people, with little problems, and have little power (there is no lobby for children akin to the AARP), so they receive ‘little’ budgets."

Brian cites a recent paper by Kelly Stuart at the Virginia Health System on the matter. Entitled "You can't get there from here: Misplaced incentives can undermine the goals of health care reform in the NICU setting," it is summarized in this abstract: 

The article discusses the exclusion of babies from the benefits of meaningful use standards. This will undermine the goal of decreasing health disparities in the Affordable Care Act (ACA). Transition of the healthcare system to electronic medical records (EMRs) and the unsuitability of meaningful use standards for the neonatal intensive care unit (NICU) are the reasons hospitals are left without a means of addressing patient needs in Health Information Technology (HIT) when it comes to babies.

Here's an excerpt:

It is difficult to determine why babies were not considered when meaningful use standards were created.  Perhaps the reason resides in the fact that the exemplar HIT model for meaningful use is that used by the Veterans Administration and the VA does not see babies.  Perhaps it is because neonatal care requires different thought processes and benchmarking that time constraints ruled out. In any case, this is a justice issue for a vulnerable group.

Stuart argues, in fact, that babies under 2 years old should be considered a special category with increased incentives rather than no incentives. 

I wish you could read the article for yourself, as it is quite persuasive, but unfortunately it requires a fee or a subscription.

On that point, here's some free political advice to the neonatologists. You have important things to say to the body politic. Put pressure on your journals to make public policy articles like this free and widely available so that your advocates can use them to support your positions. The New England Journal of Medicine does so with no loss of revenue and with a concomitant increase in political influence.

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