How the Future of Work May Impact Our Wellbeing – RWJF

Work is a powerful determinant of health. As these stories about taxi, care, and cleaning work from a new report show, it is a central organizing feature of our lives, our families, our neighborhoods, and our cities. And work—its schedules, demands, benefits, and pay—all formally and informally shape our opportunities to be healthy.

Source: How the Future of Work May Impact Our Wellbeing – RWJF

The Electronic Health Record Problem | Commonwealth Fund

EHRs have one critical performance requirement: generating clinical revenues. In the fee-for-service world

Source: The Electronic Health Record Problem | Commonwealth Fund


It’s no secret that many physicians are unhappy with their electronic health records (EHRs). They say they spend too much time keying in data and too little making eye contact with patients. They say their electronic records are clunky, poorly designed, hard to navigate, and cluttered with useless detail that colleagues have cut and pasted to meet documentation requirements. Meanwhile, the data they really need are buried almost beyond retrieval.

Not all physicians feel this way. Two-thirds of primary care physicians say there are satisfied with their current EHRs, according to a 2018 survey by The Harris Poll. But the critics have a point. Current EHRs are not well-designed to meet the needs of users. And they don’t do enough to make clinicians smarter and more efficient. This doesn’t mean we would be better off in the paper world of 10 years ago. But it does mean that EHRs need improvement.

As we think about improving them, we need to broaden the discussion of EHRs and their role. We need to reckon with the underlying causes of EHRs’ problems, how to correct them, and how to ensure that their enormous potential benefits are understood and realized.

The Causes

EHRs are a technology. Like most technologies, they can be used in a variety of ways for a variety of purposes. Their human masters decide.

In our current health system, EHRs have one critical performance requirement: generating clinical revenues. In the fee-for-service world, this means supporting providers’ billing and documentation to generate as much revenue as possible for each clinical service. EHRs also must help providers meet regulatory requirements that may have financial or accreditation implications.

This means that current EHRs were not created to support many of the things that physicians, patients, and policymakers value: better care experiences, reduced costs, or improved care quality and population health management. They were not created to make physicians better diagnosticians or more cost-effective prescribers. The reason: our health care system has mostly not rewarded these activities. They have not been mission-critical for providers or, therefore, EHR designers.

For that reason, EHRs have only the most minimal capabilities related to clinical decision support, which has been proven to increase the quality of care, or to the collection of information on duplicate and unnecessary testing, or on the aggregate health of providers’ patient populations.

To put it simply, improving EHRs will require changing the priorities governing their design. That means moving away from fee-for-service payment toward risk-sharing by providers and, ultimately, some form of prospective compensation. Until then, optimizing the usability and value of EHRs will be an uphill struggle.

EHRs’ Undervalued Benefits: Empowering Patients and Advancing Human Health

Because the benefits of EHRs may be less visible than their burdens, some of their contributions are overlooked and undervalued.

One of these benefits is giving patients access to their medical information. Meaningful-use requirements spurred the adoption of patient portals, which, though sometimes clunky, have enabled patients for the first time to routinely see their test and procedure results. Patients can also now download their entire digital record and share it with third parties that can analyze its contents and educate them on their significance. Apple, for example, has agreements with over 100 health systems and practices to perform this function, which is likely to spawn a deluge of consumer-friendly health care applications based on patients’ own information.

Another underrated EHR benefit is that, by capturing billions of patient encounters worldwide, electronic records are generating a vast store of digital health data that are available for novel uses, including research into the causes and cures of disease and the detection and prevention of threats to public health.

Think of these data as the equivalent of a new natural resource, like water or minerals; they sit in the cloud, ready for extraction, refinement, and application. Their value is increasingly understood by technology companies, new startups as well as old stalwarts, that are pouring billions into exploiting them. There are obvious privacy and security issues raised by this development. But never before in human history have we had access to this novel (un)natural resource.

In entering all that data at the point of clinical care, health professionals and patients are creating a public good. But they get little tangible in return — at least in the short run. This maldistribution of benefit and cost lies at the heart of the current EHR controversy.

What Next?

To make health professionals’ work easier, and to exploit the vast potential of EHRs, a number of interventions make sense.

The most important is unrelated to the technology. Clinicians unhappy with EHRs have a huge stake in moving from fee-for-service to value-based payment, so that providers and their EHR vendors start to prioritize the production of health and the reduction of waste in health systems. This will reduce documentation requirements, spur the creation of decision support and information exchange that make clinicians’ lives better, and focus attention on getting value from the information so laboriously recorded by doctors and other health professionals.

A second requirement will be to lower the burden of data entry. Many providers have started using scribes to take notes during visits. While many physicians love scribes, they are expensive. A better long-term solution would be to use natural language processing and artificial intelligence to enable clinicians’ conversations with patients and their subsequent assessment and treatment plan to be recorded in real time. Given the increasing power of these technologies, such applications will soon be available.

Another approach to assisting data entry is to systematically redesign records for ease of use and to prune away unnecessary recording requirements. A recent New England Journal of Medicine commentary provided an excellent example of the benefits of this intervention.

A third requirement for EHR improvement falls to health professionals. When I was a medical student, I spent hundreds of hours learning how to take notes in the paper world. More experienced clinicians reviewed and graded these write-ups. Later, as a young physician, I observed the notes of clinicians I admired, and emulated them. This process of professional education in record-keeping unfolded over years and forever shaped my note-writing habits. If physicians are unhappy with how their colleagues use EHRs, they should start educating young physicians — and their peers — on how to properly keep records in the electronic world. What and how data get recorded are ultimately a professional responsibility.

Lastly, we need to find a way to correct the maldistribution of costs and benefits that now plagues the use of EHRs. By creating vast troves of electronic data and enabling patient empowerment, clinicians and their patients perform a valuable public service that has thus far been unrecognized and unrewarded. Reducing the cost of data entry will help, but as the benefits of EHRs and their data become monetized — as they will — some way to share those gains with clinicians and patients at the frontlines should be considered. This could be accomplished in a variety of ways such as voluntary contributions from businesses that rely on EHR data to an EHR innovation fund and/or directing a share of the taxes paid by these businesses to EHR improvement. But at least until EHRs become much more user friendly, this problem of unfair allocation of benefit and cost needs attention.

We are not going back to the paper world, but EHRs need to work better. As they pursue this goal, clinicians, policymakers, managers, and vendors need to understand and address the root causes of the problem they are trying to solve, and the full array of options for addressing it.

 

Project SEARCH and HealthMatters Program 2019 Webinar Series: Employment, Health, and Wellness

Please mark your calendars for the upcoming webinars.

These webinars are hosted by the HealthMatters ProgramTM in partnership with Project SEARCH® and funded by The Rehabilitation Research and Training Center on Developmental Disabilities and Health (RRTCDD). The RRTCDD is funded through United States Department of Health and Human Services, Administration for Community Living (ACL), National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), Grant # 90RT5020-01-00 and the Ohio Developmental Disabilities Council, Grant # 17CH03FA19.

Please visit Project SEARCH and HealthMatters YouTube Playlist for the 2017-2018 Project SEARCH and HealthMatters Program Employment, Health, and Wellness Webinar Series.

Tentative Webinars and Schedule for 2019


PLEASE NOTE

  • There is no cost for these webinars.
  • CEUs are not offered for these webinars.
  • For disability accommodations email Jasmina Sisirak (jsisirak@uic.edu) at least 10 days before the webinars.

The webinars are hosted by the HealthMatters ProgramTM in partnership with Project SEARCH® and funded by The Rehabilitation Research and Training Center on Developmental Disabilities and Health (RRTCDD). The RRTCDD is funded through United States Department of Health and Human Services, Administration for Community Living (ACL), National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), Grant # 90RT5020-01-00 and the Ohio Developmental Disabilities Council, Grant # 17CH03FA19.

Opportunity Insights

Source: Opportunity Insights

The Opportunity Atlas: Mapping the Childhood Roots of Social Mobility

The Opportunity Atlas

Which neighborhoods in America offer children the best chance to rise out of poverty?

The Opportunity Atlas answers this question using anonymous data following 20 million Americans from childhood to their mid-30s.

Now you can trace the roots of today’s affluence and poverty back to the neighborhoods where people grew up.

See where and for whom opportunity has been missing, and develop local solutions to help more children rise out of poverty.

Office of Disability Employment Policy Publications

Source: Office of Disability Employment Policy Publications | Pueblo.gpo.gov

Disability Employment Publications

Order FREE disability employment guides for employers, job-seekers, educators, and employment service providers.

Employers can find information to help recruit, hire, and retain employees with disabilities. Job-seekers with disabilities can find information to develop their skills and find the support they need to get a job.

You may preview products by clicking on each product’s name. Adobe Acrobat Reader is required to view the products and is available for download at: http://get.adobe.com/reader

“America’s Workforce: Empowering All” 

Source: NDEAM 2018 | “America’s Workforce: Empowering All” | Office of Special Education and Rehabilitative Services Blog

Note: October is National Disability Employment Awareness Month

National Disability Employment Awareness Month (NDEAM), observed each October, celebrates the contributions of workers with disabilities and promotes the value of a workforce inclusive of their skills and talents. Reflecting a commitment to a robust and competitive American labor force, this year’s NDEAM theme is “America’s Workforce: Empowering All.”

To recognize NDEAM, the Office of Special Education and Rehabilitative Services (OSERS) will publish a series of blogs, in partnership with the Council of State Administrators of Vocational Rehabilitation, throughout the month. The series will celebrate the career successes of individuals with disabilities who received vocational rehabilitation (VR) services and highlight some of the partnerships state VR agencies have established with businesses across the country.

For more information about NDEAM, visit our partners at the U.S. Department of Labor’s Office of Disability Employment Policy.

Health Care Coverage and Access in Your State

 

Health care is top of mind for a lot of voters going into this November’s mid-term elections, with many  concerned about the costs of care and about funding for Medicare and Medicaid. To provide an overview of health care coverage and access around the U.S. in the years since the Affordable Care Act expanded health coverage, we’ve created facts sheets for each state and the District of Columbia. The fact sheets show changes over time in: the percentage of uninsured adults and adults going without care because of costs, enrollment in marketplace plans and Medicaid, and the amount of federal support for health coverage.

Visit Health Care Coverage and Access in Your State to get the facts on health care coverage and access in your state.

Main conclusions agreed during the Summit on Intellectual Disability and Dementia

PRINCIPALES CONCLUSIONES ACORDADAS DURANTE LA CUMBRE SOBRE DISCAPACIDAD INTELECTUAL YDEMENCIA

ISSN: 0210-1696

DOI: http:/ /dx.doi.org/10.14201/scero2018492115122

Matthew P. JANICKI University of Illinois at Chicago, USA

Karen WATCHMAN University of Stirling, Scotland, UK

Juan FORTEA ORMAECHEA Centro Medico de Down de la Fundaci Catalana de Sindrome de Down (FCSD) y Servicio de Neurologia def Hospital de la Santa Creu i Sant Pau jfortea@santpau.cat

Y miembros de! International Summit on Intellectual Disability and Dementia

Health indicators in intellectual developmental disorders: The key findings of the POMONA‐ESP project

Source: Health indicators in intellectual developmental disorders: The key findings of the POMONA‐ESP project – Folch – – Journal of Applied Research in Intellectual Disabilities – Wiley Online Library

Annabel Folch, Luis Salvador‐Carulla, Paloma Vicens, Maria José Cortés, Marcia Irazábal, Silvia Muñoz, Lluís Rovira, Carmen Orejuela, Juan A. González, Rafael Martínez‐Leal

Abstract

Background

The aim of this paper was to summarize the main results of the POMONA‐ESP project, the first study to explore health status in a large representative, randomized and stratified sample of people with intellectual developmental disorders in Spain.

Methods

The POMONA‐ESP project collected information about the health of 953 individuals with intellectual developmental disorders.

Results

Diseases such as urinary incontinence, oral problems, epilepsy, constipation or obesity were highly prevalent among the participants; with gender‐differentiated prevalences for certain conditions, and age and intellectual disability level as risk factors for disease. Overmedication was common in the sample, and drugs were often prescribed without any clinical indication or follow‐up. The present authors also found a lack of important relevant information about the participant’s health and a lack of adequate genetic counselling.

Conclusions

Our findings may contribute to a better understanding of health status and needs of people with intellectual developmental disorders and suggest several courses of action to improve their health care.

Using Social Media to Enhance Community Participation

Using Social Media to Enhance Community Participation
Source: Temple Collaborative on Community Inclusion https://bit.ly/2Kgri55
Looking for ways to be more active in your community? This manual examines ways in which individuals with mental illnesses can use social media networks to enhance community participation. Social media features and functions are examined as well as specific networks such as: Facebook, Twitter, Instagram, LinkedIn, MeetUp, and Yelp. Also reviewed are considerations and risks when using social media. Produced by Temple Collaborative on Community Inclusion
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