ASCO HIT/EHR Symposium Day 2

ASCO HIT/EHR Symposium Day 2

Peter Paul Yu, MD, FASCO, FACP

Nov 06, 2011
Let me start by mentioning 2 things I missed earlier about Day 1 of the ASCO HIT/EHRs Symposium.  In the session on Usability, Karen Bell, Chair of CCHIT, mentioned 3 areas where EHRs may impact malpractice risk; Communications, Documentation and Medical Errors. Each of these has the potential to increase the risk of litigation if neglected. Communications within a practice team, with external providers or with patients can all be facilitated by EHRs, but communicating poorly or not at all is a recipe for trouble.  The Meaningful Use goals of interoperability, care coordination, and patient and family engagement in shared decision making revolve around the capabilities of EHRs to improve communications. It is a requirement that EHRs documentation includes tracking provider actions with a time stamp.  Who saw what and what they did or did not do about it, is all recorded and discoverable information.  And any diagnostic or treatment errors are there for the looking.  There is ongoing debate within usability circles as to the best practices to address these aspects of usability which will deserve close attention.

Also on Day 1, Chuck Friedman brought up the topic of Ultra Large Systems, a concept originally introduced by the Department of Defense that views knowledge sourced from digital information as a strategic weapon (and before you react to that, remember who brought us the internet).  The DOD sees the battlefield of the future as littered with multiple information and weapon systems, some, legacy, some cutting edge, and all subject to catastrophic system failure.  Communications between front line troops and battlefield command may be lost or sporadic. Retaining operational command and winning the battle while wrapped in this fog of war is the goal of Ultra Large System theory. In such situations, the traditional features of information system design such as fail safe, disaster recovery and standardization of systems are just not feasible and when systems reach a tipping point in size, the system design must take this into consideration  The parallels with our large, fragmented healthcare delivery system have been recognized by the IOM.

Day 2 included sessions by many of the ASCO HIT WG members.  Mia Levy and Kevin Hughes shared a session presenting new apps developed at Vanderbilt and MGH to assist in using genomic information for treatment decisions and to assist is surgical office workflows, respectively.  John Cox chaired a session on new practice models looking at the oncology patient centered home and pathways for chemotherapy prescribing.  Larry Shulman moderated a session on quality improvement through HIT.

If nothing else, the ASCO HIT/EHRs Symposium has made it very clear that HIT in 2011 already encompasses much more than replacing a paper chart with a digital version.  It is about redesign of the international health care delivery systems, speeding knowledge generation, quality improvement and improving shared decision making with patients.  Unlike today, when day light saving went into play, we are not going to be able to turn back the clocks on the adoption of HIT.


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Robert S. Miller, MD, FACP, FASCO

Nov, 06 2011 6:57 PM

Congratulations to Dr. Yu, the other members of the organizing committee, and all of the ASCO staff especially Jeff Kan for putting together a great meeting. When I think back on the first Symposium in 2007, the focus was primarily on the vendors. Many oncologists were considering buying an EHR in the "early days" because of the perception that an EHR would capture missed charges and enhance revenue. While an EHR may still very well do that, this year's meeting made it clear that the real value of an EHR is to enhance care quality and improve patient safety, as well as serving as a key enabler of health care reform. It is great to see that evolution.

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