Electronic health record (EHR)

What's working — and what's not — in the effort to revolutionize patient record-keeping

Lydia Ramsey

US President George W. Bush looks at an electronic medical-record system during a visit to the Cleveland Clinic in Ohio on January 27, 2005. Reuters

If you've ever moved to a new city or found yourself in the market for a new doctor, then you've likely faced the challenge of transferring your medical records.

For all the work that's been put into health-information technology systems, in 2014 only 34% of doctors surveyed were very satisfied or satisfied with the ones they were using.

Each hospital had its own electronic health-records system, but connecting those, at the moment, is almost impossible. And they're still being described as "clunky," or stuck in the 1990s compared to the flashy consumer technology that we use every day. Those two shortcomings are what healthcare experts hope changes, and soon.

When it comes to innovating electronic health records, "We're at the tip of the iceberg," Dr. Robert Robbins, CEO and president of the Texas Medical Center, told Business Insider.

 

A mandatory push into technology

In 2009, Congress passed the Health Information Technology for Economic and Clinical Health (HITECH) Act, which set up incentives for hospitals to get off pen-and-paper charts and onto electronic systems. Over the next six years, hospitals could buy these information-technology systems, implant them into their hospitals, and receive money in return for doing it.

And this did make a big shift in how many people had an electronic health record (EHR). Before, fewer than half were on a system. By 2015, more than 80% of hospitals in the US had an EHR system in place.

But when legislation got underway, it set out a defined list of what an electronic health record had to be. Companies that had already been building hospital IT systems suddenly had to comply with all the qualifications that the government set as to what makes a piece of software an "EHR."

So, systems that were just set up to handle bills suddenly had to be retrofitted to track patients so that doctors could use them during appointments. And it all had to check out under the new regulation.

"A lot of companies had to do compliance, so innovation got slowed down," said Jessica S. Ancker, a professor of healthcare policy and research at Weill Cornell Medical College.

 

Getting doctors to use EHRs and hospitals to share data

While that innovation had to pump the brakes, that left room for two shortcomings, Ancker said: usability and interoperability.

These aren't technologies that doctors are flocking to. Sure, they contain a wealth of information and aim to make the doctor's job easier when chatting with a patient. But user experience just hasn't been as high a priority, for better or worse, for those building the systems.

"Doctors don't hate technology," Dr. Todd Rothenhaus, chief medical officer at AthenaHealth, a health IT company that offers a cloud-based electronic health system, which puts it in competition with some of the established EHR vendors that build IT systems in-house.

When it comes to new devices or the latest implant, doctors are early to pick it up because it adds value to what they do. IT, maybe less so.

"It's IT that was broken from the beginning," he said.

Rothenhaus said that Athena has been working to redo the front end so that it's as intuitive and easy to use as any other app.

As for interoperability, or the ability for one product to communicate to another and share data — say, to transfer your medical history from one hospital to another — that's a trickier sell. For one, hospitals tend to be fiercely competitive when it comes to their patients. And the health records housed in one hospital might speak an entirely different language from the hospital system across the street.

Ancker compared hospitals to banks in this regard: Banks have an incentive to share their data, since it will help them make money. With hospitals, though, that's not the case.

One way that could change, Ancker said, is if hospitals start getting paid based on the quality of care they provide. If they have to start thinking about the entire lifetime of the patient, then that might mean that they're going to have to bite the bullet and share their data more freely.

"It's driving people to think, 'Guess what? We need to share information,'" she said.

When will we see this innovation hit?

So would there be a day when we could just rip up all the messy, convoluted systems that we've put in place and replace them with an entirely new system that made it way easier to share data and have healthcare professionals use?

"There's a way it would feel very satisfying," Ancker said.

But for political — mainly privacy — and financial reasons, that's not likely going to be how this all shakes out over the next decade.

Cloud-based systems could help cut down on costs because hospitals wouldn't have to lay down the hardware of having an in-house IT system, nor would they have to hire people to manage it. But for many major hospital systems, who may have already put hundreds of millions or more into the process, it would be a hard sell to get them to immediately ditch that investment and pick up another.

But that might be changing. Hospitals will likely hold on to their on-premise health IT systems for a while before thinking about replacements. That's where cloud-based companies could have the edge.

"We like to think we suck the least," Rothenhaus said.

Mudanças na ANASEM

Conheça as mudanças na Avaliação Seriada de Estudantes de Medicina

Compare nos quadros abaixo as mudanças nas regras da Avaliação Nacional Seriada dos Estudantes de Medicina (Anasem).

Os trechos suprimidos estão em vermelho tachado, os acrescentados estão em azul sublinhado e os que foram transpostos estão em verde.

Como era                               Como ficou

Conflict management

The art of resolving conflict in the workplace

 

Ray Hull

I have presented workshops on “The Art of Communication in Our Professional Life” around the U.S. and in other countries.

And, according to audiences, one of the most interesting components of those workshops is the section on “The Art of Conflict Resolution.”

I suppose the reason is that for most of us, working in a close business relationship can be both delicate and confusing.

Just how do we resolve potential conflict in environments where we are working closely with others?

Each of us has opinions on matters that can affect the work environment or the ongoing functioning of our place of employment. Some people seem to be innately more forceful than others.

Others have opinions on matters that they feel are definitely better than the status quo, or perhaps more organizationally efficient than those of others in the group. And, they feel so strongly about them that it can become difficult to continue a meeting that may have begun as a pleasant experience.

In staff meetings, and on the job, just how can we best handle the loudest and most demanding of the group?

Here are some suggestions that can help those who desire to keep matters moving in a positive and constructive direction:

1. Keep a sense of humor.
2. Do not become emotional! Never get into a shouting match over issues, no matter how close they are to you. If you do, you will only regret it later.
3. Let others know how you feel, but do it with respect and civility.
4. Don’t expect others to read your mind.
5. Never – never – take a cheap shot, no matter how good it might make you feel at the moment.
6. Don’t make a big deal out of a trivial issue. If you start to, ask yourself “What is the reason?”
7. If you are the leader of the group, give honest and sincere appreciation for other persons’ opinions, and let them know that they will be taken into consideration.
8. Talk in terms of what the other person wants and help her/him achieve it to the degree possible – within reason.
9. If you see an argument on the horizon, become a good listener instead. Let the other person vent while you listen quietly. The person venting may resolve the concern on their own while you are listening.
10. It’s important to know when to let an argument go. If we can’t come to an agreement, then we can simply agree to disagree. Then, disengage and move on. Remember, it takes two to keep an argument going.
11. Remember, no one ever wins an argument. Truthfully, have you?
12. The only way to get the best of an argument is to avoid it.
13. Do whatever is possible to help the other person save face. No matter how wrong we might think the other person is, we only destroy ego and potentially good working relationships by embarrassing the other person and hurting their dignity.
14. Hurting someone’s dignity can be extremely damaging to an otherwise positive working relationship.
15. And, remember: You will never get into trouble by admitting that you may be wrong.

* Ray H. Hull is a professor of communication sciences and disorders at Wichita State University.

Read more here: http://www.kansas.com/news/business/biz-columns-blogs/article97573412.html#storylink=cpy

Health research in the Americas

PAHO and EQUATOR Network provide tools in Portuguese to promote excellence in research reporting

The Pan American Health Organization (PAHO) and the EQUATOR Network recently launched their newest collaborative project to promote quality health research in the Americas: a Portuguese interface of the EQUATOR website that will translate key material on good research reporting and bring together existing Portuguese translations of reporting guidelines.

The Portuguese translation effort will build on previous work in Spanish to help improve the quality of health research in the Americas.

Read more about this collaborative work:
http://www.equator-network.org/2016/02/22/paho-and-equator-network-provide-tools-in-portuguese-to-promote-excellence-in-research-reporting/

Access the Portuguese interface on the EQUATOR website:
http://www.equator-network.org/library/resources-in-portuguese-recursos-em-portugues/

Higher Education in South Africa

An Open Letter to the State President and the Ministers of Higher Education and Finance

Save our public universities

We, academics of South African universities, call on our government to address the funding crisis in higher education.

A key strategy that post-apartheid governments undertook to reduce race and class inequality after apartheid was to substantially increase access to universities in South Africa. Between 1994 and 2014, the number of students in our public universities more than doubled.(1) During the same period the proportion of black students at universities increased from 52% to 81% of the student population.(2) We have welcomed the massification and deracialisation of access to universities as a necessary democratisation of higher education after apartheid, and as our contribution to building a better society.

The problem is that massification has not been matched by adequate funding. Year on year we have seen a decrease in real terms of government funding to public universities. The effect of this has been to create conditions of austerity in universities, as well as to force universities to grow their revenue by increasing tuition fees and ‘third stream’ income. Despite increases in NSFAS, high student fees continue to cause exclusions and our students are increasingly stressed by mounting debt, which has risen staggeringly since the mid-1990s.(3) Public universities have thus been put in slow decline: the quality of teaching and infrastructure of our institutions of higher learning is deteriorating because of long-term austerity, and this has been accompanied by a submission to privatisation and debt.

Our public universities can in fact barely be called public, with national government subsidies to university budgets falling from an already low 49% in 2000 to 40% in 2012.(4) This has placed enormous pressure on the maintenance and improvement of core educational infrastructure such as laboratories, libraries, lecture theatres and student residences. Furthermore, staff:student ratios have continuously increased because the employment of full-time academic staff has not matched increases in student numbers. There is also a growing tendency to casualise academic labour through short-term appointments, which has led to the exploitation especially of younger academics, while undermining the quality of teaching, and increasing the administrative burden on full time academic staff. Crucially, casualisation and increased workloads at universities undermine our research capacity. The impact of high quality original research on national development cannot be overstated, and the threat to research capacity has enormous consequences for the future of our country.

Lack of investment in our public universities is not only a national crisis, but has negative effect on our standing in Africa. Since the end of Apartheid, our universities have trained cohorts of postgraduate students from the region and across the continent. South Africa’s tertiary institutions currently educate many of the continent’s best students, who are increasingly turning to South African universities as Africans are de facto excluded from British and North American institutions. Investing in our universities would maintain our reputation on the continent, create strong connections between future African leaders, and produce goodwill and opportunities for South Africa in decades to come.

The Council on Higher Education, established by the Department of Higher Education and Training itself, argues that despite the fact that ‘higher education in South Africa has been regarded as a key to social and economic development… its expenditure on higher education is much lower than desirable or needed.’(5) South Africa spends a mere 0.6% of GDP on its universities, lagging behind many other countries (Russia at 1.8%, Argentina and 1.4, India at 1.3%).(6)

With government not funding in full the financial shortfall resulting from the 0% fee freeze in 2016, universities have had to cut costs further from their already-stretched budgets. This has impacted all of us in our daily work, but Historically Black Universities have been the hardest hit because of a historical deficit in reserves and reduced access to private income. Thus, a further hierarchisation of our universities is taking place, compounding older race and class divisions in higher education.

In short, our universities are chronically underfunded. We are being threatened with cuts to our teaching programmes, our research budgets, hiring is being frozen, posts down-graded, and the core functions of universities are being put under threat. We have reached a limit. We simply cannot weather any further cuts without jeopardizing the academic project.

As academics responsible for the quality of South African universities, we call on government to take seriously the worth of university education as a public good, and to reverse the decline in public higher education by substantially increasing the state subsidy to universities.

Circulated by the academics of the School of Social Sciences, University of the Witwatersrand

1. Student numbers rose from 495,000 in 1994 to almost a million students in 2014. Council on Higher Education. 2016. South African Higher Education Reviewed: Two Decades of Democracy. Pretoria.
2. Higher Education South Africa. 2014. South African Higher Education in the 20th Year of Democracy: Context, Achievements and Key Challenges, pp.1-2. These numbers do not of course capture the manner in which institutions remain differentially racialised.
3. Steyn and De Villiers. 2006. The Impact of changing funding on higher education institutions in South Africa. Higher Education Monitor, No.4, March.
4. PriceWaterhouseCooper, Funding of public higher education institutions in South Africa. www.pwc.co.za/en/higher-education/Funding-public-higher-education-institutions-SA.html
5. Council on Higher Education. 2016. South African Higher Education Reviewed: Two Decades of Democracy. Pretoria.
6. Bozzoli, ‘Behind the university funding crisis’ Politicsweb 19 October 2015. www.politicsweb.co.za/news-and-analysis/behind-the-university-funding-crisis.

 

Successful Leadership

How To Demonstrate Successful Leadership In The Workplace

Dionne Mahaffey

Business psychologist, chief executive of The CPAI Group, Inc. and founder ofThe Life Purpose Coaching Institute

As with all skills, some of us are more adept at leadership than others. However, if you find yourself lacking in this area, keep in mind that your current struggles may be taking you down the pathway to eventual success.

After all, you can leverage the key fundamentals of successful leadership in order to impact your team and become the leader you desire to be.

Understanding Effective Communication

Successful leaders are effective communicators. In fact, communication will most likely be the major building block of your success in leadership. What makes a communicator effective, exactly? Through my experiences as a business and leadership coach, I have found the following guidelines to be helpful:

• Always consider all angles before crafting your message. Think about the “who,” “what” and “how” of the situation. Keep the following questions in mind: What is the issue at hand? How can it be solved? Who am I asking to take action? What are the possible obstacles? What tools will I need to provide to make the process easier?

• Make sure your message is understood. Anyone can deliver a message, but not everyone confirms that the message is understood. Don’t hesitate to repeat yourself to make a point. Always ask your team members if they have any questions or comments. Wait five-to-10 seconds before moving on in order to give your team time to process the information and formulate responses.

• Manage and prevent conflicts with consideration and purpose. Handle conflict between employees immediately. Otherwise, you risk the creation of a toxic environment where employees fail to see you as a capable leader. Stay a step ahead and strive to prevent conflict by observing your employees and learning their emotional triggers. For example, consider your employees’ working styles: some are very methodical, plugging along to the end. Others procrastinate and then rush to accomplish everything at the last minute. A way to avoid conflict is to pair employees with similar working styles.

• Give specific and appropriate praise for individual and team efforts. When you specifically state what you appreciate, your praise should translate as being authentic, not as an empty gesture. For example, “The candid testimonials you gathered gave us valuable insight on the product that we wouldn’t have had otherwise.” This conveys exactly what impressed you, and offers the bonus of reinforcing desired behavior.

Engaging Others

To be a successful leader, you must be able to engage others. Engaging a team takes some extra time and forethought, but the payoff can net huge gains in productivity and trust.

• Consider each individual’s strengths, weaknesses and interests. Assign tasks based on your observations or on feedback from individuals. When team members are skilled and interested in what they are doing, their productivity will soar.

• Keep your team apprised of any important changes or plans that are on the horizon. The additional time that you invest will be well worth it. A group email can easily keep everyone in the loop. This strategy will help team members feel trusted and will foster their loyalty toward you.

• Encourage feedback regarding team assignments, project agendas or workplace policies. Have a policy that allows employees to comfortably approach you as needed. For example, tell them that if your office door is open, you are available to talk. This will make employees feel that you care about their concerns.

Being Resourceful

Drawing upon certain resources can help you stay on track if you encounter obstacles when trying to achieve your leadership goals. Both of the following resources can help you overcome the problems you encounter on your way to becoming a successful leader:

• Executive training focused on leadership development. Trainings based solely on lectures, reading handouts and watching presentations or demonstrations do little to promote retention. Instead, look for trainings that incorporate discussion groups, allow for small-group practice of concepts taught, and encourage teaching others what you’ve learned. The active learning process is invaluable when retaining information.

• Find a mentor. Keep in mind that a mentor doesn’t have to work in the same industry as you. It’s more important that this person is someone who has the same leadership philosophy as you. You’re not looking for someone to push you to reinvent yourself; you’re looking for support and guidance regarding your leadership goals and management style. Seek out someone you feel comfortable spending time with, who has experience and wisdom to offer, and who will be honest with you.

Demonstrating successful leadership is rarely second nature and is often filled with trial and error. But you should’t be afraid to fail in your quest to becoming a leader. Failures bring you closer to becoming the leader you want to be, because they allow you to discover the areas in which you need to improve.

Once you feel you’ve reached a measure of success, don’t stop improving. Continuing to hone your leadership skills throughout your career will allow you to excel as a professional, enjoy your work more thoroughly, and be respected by others.

Teaching practice

Student surveys are destroying my confidence, says new academic

I’m a new academic and I keep being told that my lectures are boring. Is this really the best way to develop as a teacher?

When I walked into a classroom to deliver my first lecture, early in 2014, I was terrified. Not long out of undergraduate studies myself, I felt like an imposter. Nervousness flooded every inch of my body and, once the lecture had finished, it immediately became a blur in my mind.

It took time for my confidence to grow but I slowly began to have more faith in my teaching. Engaged and responsive students fuelled my enthusiasm and boosted my self-esteem. As I began to understand classroom dynamics, I was able to adapt my lesson plans in response to a particular session or group rather than focusing my energy on making sure I got through every slide and remembered every point. Standing in front of a room of students began to feel normal.

But our mandatory student feedback surveys are crushing that confidence. They report that I seem “inexperienced” and the block that I teach is “uninteresting”.

The point about inexperience is accurate, of course; some of the staff I teach alongside have taught for 20 years, while I have taught for 20 hours (over two and a half years of PhD research). What’s more, those 20 hours have been passed my way in bits and pieces, spread across numerous courses and year groups, meaning that I rarely have long enough to learn student names or get used to a group dynamic. In terms of content, I have little control over what I teach and I am often called upon at the last minute, with little time to prepare.

I have always jumped at the opportunity to gain teaching experience. I know that it is essential if I am to secure an academic post after my PhD – otherwise I am unlikely to be even considered for roles that involve teaching. I also relish the opportunity to share my knowledge and enthusiasm for my subject. I want to inspire students in the same way that my lecturers inspired me.

Perhaps I’m just not cut out to teach. I have often asked myself this. But observations and feedback on my teaching practice from academics and fellow PhD researchers (from both within and outside of my discipline) have always been positive, encouraging and constructive. So what is happening with the student feedback?

Perhaps the issue is not with feedback from students, but with the way feedback is collected and used. I often teach on courses taught by up to five members of staff: each tutor teaches a segment of the course, which are all linked by a common theme. But the student feedback surveys do not take this fragmented structure into account. Instead, students are asked to respond to broad questions about the course as a whole: “What did you enjoy?” and “What could be improved?”.

I don’t blame the students for the negative feedback. In my department, these surveys are distributed in the final 10 minutes of a 50-minute lecture. I don’t think this set-up is conducive to thorough contemplation: they’re already eager to get away and may not be inclined to put in the effort to provide useful feedback.

Add to this the well-reported problem of gender bias in student evaluations and the value of these surveys disintegrates further. Are students reacting to the fact that I am a woman, as well as a young one?

Rather than encouraging young researchers to improve their practice, negative feedback from students at this very early stage can have a detrimental, demotivating effect. But as university students become consumers, more emphasis is placed on consumer responses and demands. So, rather than being guided through the early stages of teaching, PhD students are being exposed early on to the bruising student-consumer market.

Institutions should question how useful this feedback can really be to their long-term academic success. Perhaps student feedback is just a waste of everyone’s time – as well as putting PhD students off university teaching careers.