The Good, The Bad, And The Ugly

Jason Morneau RT(T) Chief Therapist Boston VAMC

http://geofflivingston.com/2011/02/21/the-good-the-bad-and-the-ugly-of-online-cause-marketing/

Briefly discuss technological advances in treatment

EMR vs. EHRThe positive and negative outcomes of

technologyOverview of human errorPublicized treatment errors/incidencesDiscuss the use of online incident reporting

services.

news.stanford.edu/ fastcodesign.com

studio5.ksl.comvarian.commediluxhealthcare.us

EMR vs. EHRElectronic Medical Record

Electronic Version of a Paper Chart Record and Verify Systems

ARIA/Varian MOSAIC/ELEKTA

Electronic Health Record What is it? HL7 Developed in the start of 1970’s 1971 tested at Brunswick Naval Air Station 1978 launched at 20 VA’s 1981 named DHCP and put into law Finland Hospital first outside US

www.wikipedia.com www.healthit.gov/buzz-blog/electronic-health-and-medical-records/emr-vs-ehr-difference/www.elekta.com www.varian.comhttp://www.uwlax.edu/md/studentresources/Documents/Heath%20Revised%20Manuscript.pdf

• Recovery and Reinvestment Act of 2009 Health Information Technology for Economic and Clinical Health Act or HITECH ActPresident Obama wanted all hospitals paperless by 2014$17 Billion of funds available in incentivesMedicare and Medicaid want it by 2015What is Meaningful Use?

http://www.elekta.com/healthcare-professionals

1. Use of CPOE (computerized provider order entry) for medication orders;2. Drug to drug and drug allergy interaction checks;3. E-Prescribing (eligible professionals only);4. Recordation of demographics and smoking status, and changes in vital signs;5. An up-to-date problem list;6. Active medication list and medication allergy lists;7. One clinical decision support rule;8. CQM as specified by the Secretary;9. Providing patients with an electronic copy of their health information (eligible professionals and hospitals) and discharge instructions (hospitals only);10. Providing clinical summaries for patients for each office visit (eligible professionals only); and Protecting electronic health information.

• Medicaid-– Physicians whose caseloads include at least 30%

Medicaid patients are eligible to receive up to $63,750 over the course of 6 years

• Medicare – – Physicians seeing Medicare patients can receive up to

$44K over the course of 5 years• Eligible professionals who cannot demonstrate that

they are meaningful– January 1, 2015, will receive an adjustment to their

Medicare fee schedule of 99% for 2015, 98% for 2016, and 97% for 2017 and each subsequent year.

www.gfrlaw.com

Eligible professionals who cannot demonstrate that they are meaningful users of certified EHR by January 1, 2015, will receive an adjustment to their Medicare fee schedule of 99% for 2015, 98% for 2016, and 97% for 2017 and each subsequent year.

Technology Positives and Negatives

“WITH GREAT POWER THERE MUST ALSO COME - - GREAT RESPONSIBILITY! “-Stan Lee Amazing Fantasy #15 (August 1962)

Better patient careShare patient information securelyDose distribution and escalationDecrease side effectsLiving longerImproved QATreating the untreatableDecrease in treatment time

More organized and timelyThank you computerNo more missing chartsNeat charts/save roomFaster Turn around timeMD approval of films

The computerSlow or stuck computersServer issuesTrusting the computer is always

right.Outdated procedures, QA

Education and TrainingUnder staffed departmentsNew generation of studentsClinical based vs. Technical based

knowledgeDirty Word

“Competency”Proper QA/Commissioning of the

machines

Digital Immigrant vs. Digital Native

Digital Native: K through college – represent the first generations to grow up with new technology.

Digital Immigrant: Everyone else. Have become intrigued by the computer age and want to learn.

Marc Prensky Digital Natives Digital Immigrants ©2001 Marc Prensky

New grads are experiencing a whole new world of learning.Education has come into the digital ageThe need to teach things from the past as well past

The veterans are trying to keep up with a whole new world.AHHHH you want me to what?Getting left behind

New York Times articlesA series of articles “The Radiation Boom.”

by Walt Bogdanich Cases looked at in Radiation Therapy

IMRT plan missing for 3 treatmentsMissing filter for 27 treatmentsField Size issue

Cases in other modalities.

• Release of statements– ASTRO

• Letter to the New York Times January 25, 2010 Tim R. Williams MD.

• Radiation therapy 99.99 percent safe and effective • The White Papers

– ASRT• ASRT Responds to New York Times Article Jan. 27, 2010,

Diane Mayo, R.T.(R)CT)– NESRT

• We must look to and support our regional representation

www.asrt.orgwww.astro.org

Definition: Human error, the propensity for

certain common mistakes by people; the making of an error as a natural result of being human (www.dictionary.com)

30 patient=150 treatments per week = 600 treatments a month and 3600 in 6 months.

1 incident occurs1/3600=0.003% probability of an error

or 99.997% reliability factor.(Swain, 1963)

IHE-RO was established in 2004www.wiki.ihe.netVendor equipment connectivity issues

Patient Safety OrganizationsGE PSO

Radiation Oncology reporting systemsHospital basedAHFMR/HTAROSIS

www.ihe.ca/documents/HTA-FR22.pdfwww.astro.org/Practice-Management/IHE-RO/In/www.rosis.infodex.aspx

What do we as therapists need to do The development of the reporting

cultureThe trail of the incidence reportIncidence vs. Reportable medical

eventDPH 105 CMR Section 120.435

Voluntary incident reporting systemDiscussed last year at the VA Radiation Oncology

Meetingswww.rosis.info