David R' Hunt, MD, FACS

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Health IT and Patient SafetyONC Context

• David R. Hunt, MD, FACS
• Chief Medical Officer and Acting Director, OHITA
• Office of the National Coordinator for HIT

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Medicine used to be simple, ineffective and
relatively safe. Now it is complex, effective
and potentially dangerous.
Sir Cyril Chantler

• The role and education of doctors in the delivery
  of healthcare.
• Hollister Lecture delivered at the Institute of
  Health Services Research, Northwestern
  University, Illinois, USA. October 1998. Lancet
  1999353117881.

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As to diseases make a habit of two things - to
help, or at least, to do no harm.
Hippocrates

• Epidemics I

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Quality Healthcare
Efficient
Safe

• Timely
• Equitable

• Effective
• Patient-Centered

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Solo 6
EHR Adoption by Practice Size
Dual 9
gt10 physicians 35
3-5 physicians 22
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Percentage of physicians
With notes, Rx orders, ability to order and
obtain lab results
6-10 physicians 28
Physicians
DesRoches, V, et. al. Electronic Health Records
in Ambulatory Care A National Survey of
Physicians N Engl J Med July 200835950-60.
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Major Barriers to Adoption of Electronic Health
Records
DesRoches, V, et. al. Electronic Health Records
in Ambulatory Care A National Survey of
Physicians N Engl J Med July 200835950-60.
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reckoning that all such matters should be kept
secret

• Hippocratic Oath

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Privacy
Principles, Policies, Procedures, Protections
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25550 Federal Register/ Vol. 74, No. 101/
Thursday, May 28, 2009/ Notices
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SEC. 3012. HEALTH INFORMATION TECHNOLOGY
IMPLEMENTATION ASSISTANCE.

• Health Information Technology Extension Program-
• To assist health care providers to adopt,
  implement, and effectively use certified EHR
  technology that allows for the electronic
  exchange and use of health information

(c) Health Information Technology Regional
Extension Centers- (1) IN GENERAL- The Secretary
shall provide assistance for the creation and
support of regional centers (in this subsection
referred to as regional centers') to provide
technical assistance and disseminate best
practices and other information learned from the
39 Capacity to implement
41 Transition productivity loss
44 Concerns of obsolescence
54 Finding an EHR to meet
needs
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Errant mouse click leads To negative laparotomy
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THE PATIENT An 80-year-old woman with classic
symptoms of neuroglycopenia underwent a battery
of tests confirming the Whipple triad.
THE MISTAKE Three days later, a third check of
antibody levels revealed a value of gt90 (normal,
lt3) pointing to autoimmune hypoglycemia.
DISCUSSION Insulin levels were far too elevated
for a usual insulinoma. When faced with a patient
with all signs and symptoms of hyperinsulinism,
checking insulin, c-peptide, glucose, and
sulfonylurea levels is appropriate. However,
extreme insulin elevation (typical insulinomas
reveal values of 1590 Iu/mL) suggests another
source. Insulin antibody elevations are rare. The
treatment is observation and supportive care. It
resolves spontaneously. A systems problem may
explain the surgical teams failure to
preoperatively check insulin antibody levels. The
data is only available via electronic medical
records (EMR) with a right mouse click. A left
click didnt show anything, so we assumed the
value was normal. Mea Culpa. Our institution is
now fixing the EMR display feature.
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Hippocrates
You better know what you should do before you
enter, for in many cases help is needed, not
thought.

• Decorum  11

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DavidR.Hunt_at_hhs.gov

• 202-690-6341
• http//healthit.hhs.gov