Santa Clara County Grand Jury • 2004-2005

2004-2005 Santa Clara County Civil Grand Jury Report Santa Clara County Electronic Healthcare Records – the Time is Now

Published: May 25, 2005 19 pages

View Original PDF

⚠️ Translation Notice: This content has been automatically translated. The original English text is the official version. Translation may contain errors.

⚠️ Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.

Findings and Recommendations 5 findings

Among the major health care providers in the County, Santa Clara Valley Health and Hospital System stands alone in not having top management commitment to move aggressively in implementing an integrated EHR system. The Executive Director of SCVHHS asserts that “there are no significant benefits to an EHR and there have been no known successful implementations of EHRs locally or nationally.” To the contrary, the Grand Jury is aware of successful EHR implementations almost everywhere one looks locally, nationally, and internationally and there are many studies that have documented successful implementations and benefits of EHRs. The Grand Jury believes that by taking a more aggressive approach, the patients who use SCVHHS each year (632,000 outpatients and 117,000 inpatients) will benefit because there will be fewer medical errors, more efficient healthcare, and better management tools to ensure long-range savings to County taxpayers.

Related Recommendations (1)

The Santa Clara County Board of Supervisors should direct the Executive Director of SCVHHS and his staff to visit local healthcare organizations that are implementing EHRs and to review the current medical literature that clearly documents the value of EHRs. Decisions about implementing an EHR for SCVHHS facilities should be based on up-to- date, objective information. An objective, outside advisory group, drawn from local experts at Palo Alto Medical Foundation, Sutter Healthcare, Kaiser Permanente, and El Camino Hospital, and including other outside subject matter experts might be effective in collecting and assessing relevant information to help guide SCVHHS decisions about an EHR. 13

The County healthcare system is in an excellent position to take a leadership role in working toward the development of interoperable EHR systems among County and regional providers. The Executive Director of SCVHHS has stated an explicit unwillingness and/or an inability to take on such a leadership role.

Related Recommendations (1)

If the Executive Director of SCVHHS is unwilling or unable to bring the County into a leadership role in the region, the Santa Clara County Board of Supervisors should direct that this role be delegated to an individual who will have the authority and resources needed to undertake such a responsibility, including authority over SCVHHS EHR efforts.

Despite the reservations of the Executive Director of SCVHHS, a number of efforts are currently underway within SCVHHS, DOC, Probation Department, and Social Services Agency to implement partial EHR systems, several without the knowledge or interest of key members of the senior management team at SCVHHS. The management of these efforts is chaotic – the projects are largely uncoordinated and the Grand Jury could find no documented long-range vision or integrated plan for these projects. The Grand Jury believes this managerial neglect is a recipe for long-term failure – in fact the County seems headed for one of the most inefficient, costly, and failure-prone approaches possible by doing nothing to coordinate efforts and letting each local stakeholder and organization with an immediate need implement their own idiosyncratic system.

Related Recommendations (3)

R3a

to develop an appropriate phased plan and “fast track” it through development and implementation. The urgent healthcare needs of groups like adult inmates must be factored into the phasing of implementation plans. In the future, the task force must work effectively and proactively to understand the business needs of the parts of the healthcare enterprise and to work cooperatively to meet those needs based on negotiated priorities.

R3A

The Santa Clara County Board of Supervisors should direct the County Executive to ensure that the SCVHHS Executive Director, the County CIO, and other relevant County leadership form a comprehensive task force to define, plan, coordinate, implement, and fund an interoperating set of EHR systems that encompass the needs of all of the SCVHHS patient population. The scope of this planning should include inpatient care, outpatient care, inmate care, mental health care, drug and alcohol care, and public health. The taskforce should include a wide range of subject matter expert consultants from both inside and outside SCVHHS to ensure that the system(s) meet end user needs. The leadership group must have backing from the BOS affirming that the program is critical in the short- and long-term for the well-being of patients and for the more effective management of the SCVHHS healthcare enterprise. 14

R3B

The Santa Clara County Board of Supervisors should direct the task force identified in

The current “incremental” approach being taken by the SCVHHS CIO to developing SCVHHS EHR technology is ineffective, costly, and slow. This approach appears to be the result of limited management support, limited resources, and correspondingly limited goals of the SCVHHS CIO. Other local healthcare enterprises, such as Palo Alto Medical Foundation, Sutter Healthcare, El Camino Hospital, and Kaiser Permanente, are moving energetically and successfully to implement fully re-engineered EHR systems based on modern vendor technologies.

Related Recommendations (1)

The Santa Clara County Board of Supervisors should direct the SCVHHS CIO, in conjunction with the enterprise EHR task force outlined in Recommendation 3a, to revisit current EHR design plans and reconfirm that they are rooted in systems, computer, and communications technologies appropriate for today, not the 1990s. Top management, including the BOS, should not require as a design condition of this effort that the vendor choices made ten years ago be maintained.

Despite its overall criticism directed toward SCVHHS senior management, the Grand Jury would like to acknowledge that there are several noteworthy efforts at developing EHR components underway at SCVHHS. The systems implemented by Pharmacy Services of SCVHHS are one such example. Another is the planning for an inmate healthcare record system under the Associate Director for Custodial Healthcare Services and County CIO. Finally, in spite of limitations noted in this report, the partial EHR implemented for SCVHHS inpatient and outpatient care incorporates a number of good ideas and has made progress despite limited management support. 15

Related Recommendations (1)

The Santa Clara County Board of Supervisors should direct the task force identified in

Conclusions 23

CL1 Page 13

Among the major health care providers in the County, Santa Clara Valley Health and Hospital System stands alone in not having top management commitment to move aggressively in implementing an integrated EHR system. The Executive Director of SCVHHS asserts that “there are no significant benefits to an EHR and there have been no known successful implementations of EHRs locally or nationally.” To the contrary, the Grand Jury is aware of successful EHR implementations almost everywhere one looks locally, nationally, and internationally and there are many studies that have documented successful implementations and benefits of EHRs. The Grand Jury believes that by taking a more aggressive approach, the patients who use SCVHHS each year (632,000 outpatients and 117,000 inpatients) will benefit because there will be fewer medical errors, more efficient healthcare, and better management tools to ensure long-range savings to County taxpayers.
CL2 Page 14

The County healthcare system is in an excellent position to take a leadership role in working toward the development of interoperable EHR systems among County and regional providers. The Executive Director of SCVHHS has stated an explicit unwillingness and/or an inability to take on such a leadership role.
CL3 Page 14

Despite the reservations of the Executive Director of SCVHHS, a number of efforts are currently underway within SCVHHS, DOC, Probation Department, and Social Services Agency to implement partial EHR systems, several without the knowledge or interest of key members of the senior management team at SCVHHS. The management of these efforts is chaotic – the projects are largely uncoordinated and the Grand Jury could find no documented long-range vision or integrated plan for these projects. The Grand Jury believes this managerial neglect is a recipe for long-term failure – in fact the County seems headed for one of the most inefficient, costly, and failure-prone approaches possible by doing nothing to coordinate efforts and letting each local stakeholder and organization with an immediate need implement their own idiosyncratic system.
CL4 Page 15

The current “incremental” approach being taken by the SCVHHS CIO to developing SCVHHS EHR technology is ineffective, costly, and slow. This approach appears to be the result of limited management support, limited resources, and correspondingly limited goals of the SCVHHS CIO. Other local healthcare enterprises, such as Palo Alto Medical Foundation, Sutter Healthcare, El Camino Hospital, and Kaiser Permanente, are moving energetically and successfully to implement fully re-engineered EHR systems based on modern vendor technologies.
CL5 Page 15

Despite its overall criticism directed toward SCVHHS senior management, the Grand Jury would like to acknowledge that there are several noteworthy efforts at developing EHR components underway at SCVHHS. The systems implemented by Pharmacy Services of SCVHHS are one such example. Another is the planning for an inmate healthcare record system under the Associate Director for Custodial Healthcare Services and County CIO. Finally, in spite of limitations noted in this report, the partial EHR implemented for SCVHHS inpatient and outpatient care incorporates a number of good ideas and has made progress despite limited management support. 15
CL6 Page 17

Starr P, “The Social Transformation of American Medicine, The rise of a sovereign profession and the making of a vast industry,” BasicBooks 1982.
CL7 Page 17

Institute of Medicine, National Academy of Sciences, “The Computer-Based Patient Record: An Essential Technology for Health Care,” 1991 with an update in 1997; http://books.nap.edu/html/computer/ [Accessed 5 April 2005].
CL8 Page 17

Wiesenthal, AM, MD, Associate Executive Director, The Permanente Federation Kaiser Permanente, Testimony on Kaiser Permanente’s Commitment to Health Care Information Technology, to the Subcommittee on Health, House Committee on Ways and Means, 2004, http://ckp.kp.org/kpindepth/archive/indepth_wiesenthal.html. [Last accessed 8 April 2005]
CL9 Page 17

Institute of Medicine Committee on Data Standards for Patient Safety, National Academies of Sciences, "Patient Safety: Achieving a New Standard for Care," 2004, http://www.nap.edu/books/0309090776/html, [Last accessed 15 April 2005].
CL10 Page 17

Brailer DJ, "Interoperability: The Key to the Future Health Care System," Health Affairs, 2005 Jan 19, hlthaff.w5.19, http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.19v1, [Last accessed 15 April 2005].
CL11 Page 17

Walker J, Pan E, et al., "The Value of Health Care Information Exchange and Interoperability," Health Affairs, hlthaff.w5.10, 2005 Jan 19, http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.10v1, [Last accessed 15 April 2005].
CL12 Page 17

Garg, AX et al., “Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review,” JAMA 293 (10): 1223-1238, 2005.
CL13 Page 17

Joint Clinical Decision Support Workgroup, “Clinical Decision Support in Electronic Prescribing: Recommendations and an Action Plan,” Bethesda, MD: American Medical Informatics Association, www.amia.org/pubs/whitepapers/index.html, 2005.
CL14 Page 17

Kawamoto, K, et al., “Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success,” British Medical Journal Apr 2;330(7494):765. Epub 2005 Mar 14 BMJ Online First, 2005.
CL15 Page 17

Koppel, R et al., “Role of computerized physician order entry systems in facilitating medication orders,” JAMA 293 (10): 1197-1203, 2005
CL16 Page 17

Wears, RL and Berg, M, “Computer technology and clinical work: still waiting for Godot,” JAMA 293 (10): 1261-1263, 2005. 17 Documents (cont’d.)
CL17 Page 18

National Research Council, “For the Record: Protecting Electronic Health Information,” National Academies Press, 1997 http://books.nap.edu/catalog/5595.html [Last accessed 9 April 05]
CL18 Page 18

Tang PC, Black W, Buchanan J, et al., "PAMFOnline: integrating EHealth with an electronic medical record system," AMIA Annual Symposium Proceedings, pp 649- 53, 2003.
CL19 Page 18

Memorandum from the Executive Director, Santa Clara Valley Health & Hospital System to the County Board of Supervisors, Subject: “Delegation of Authority to Execute Amendments to the Siemens Agreement Relating to the HIPAA Program," December 17, 2002, Document # HHS04 121702.
CL20 Page 18

Sierra Systems Group, Inc., “Adult Custody Health Services, Business Process Review and Strategic Plan – Project Charter,” 31 Jan. 2002.
CL21 Page 18

Sierra Systems Group, Inc., “Adult Custody Health Services, Current Situation Analysis,” 25 March 2002.
CL22 Page 18

Sierra Systems Group, Inc., “Adult Custody Health Services, Transition Plan,” 26 July 2002.
CL23 Page 18

County of Santa Clara, Procurement Department, “Request for Proposal #0143 for Offender management System (OMS) and Jail Medical Information Management System (JMIMS),” 25 Aug. 2004 (Including Attachment 1 for OMS System Requirements and Attachment 2 for RFP for JMIMS System Requirements). Interviews

No Responses Found 1

Government entities assigned to respond to this report. No response documents have been linked in our database.

Santa Clara County Board of Supervisors Elected County Office