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Abstract

  1. Top of page
  2. Abstract
  3. Missing the Mark
  4. KEY POINTS
  5. N.Y. Man Admits Organ Trafficking
  6. Reference
  7. Appendix

Not all hospital-wide electronic medical record systems accommodate the specific needs of the transplant center. This month, “The AJT Report” investigates what's missing, and what the transplant team can do about it. Also in this issue, a New York man is convicted of organ trafficking, and UNOS appoints a new director of their Department of Evaluation and Quality.


Missing the Mark

  1. Top of page
  2. Abstract
  3. Missing the Mark
  4. KEY POINTS
  5. N.Y. Man Admits Organ Trafficking
  6. Reference
  7. Appendix

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When your hospital implemented an electronic medical record (EMR) system, did administrators categorize “Transplant” as just another clinical service filed under “T” that happens to follow “R” for “Radiology”? Is your hospital EMR lacking the functionality required to address the specific needs of your transplant clinic? If so, then you are not alone, and perhaps it is time to speak up.

Transplantation significantly influences a hospital's contribution margin, and even though it may be a small percentage of the facility's services, its practitioners tend to command some influence with the administration in choosing EMR services. Paul Kenyon, chief technical officer and co-founder of HKS Medical Information Systems in Omaha, Neb., which developed the transplant-specific OTTR software, tells the story of a hospital in the process of implementing a system-wide EMR that would also be used by the transplant clinic. “Then they hired a new transplant surgeon from another center. He demanded a specific transplant database, and he had the clout to get it,” says Kenyon.

This “in your face” effort by transplant surgeons may be necessary when it comes to implementing an electronic records system, as large hospital-wide EMR companies are capturing hospital market share and developing transplant modules that may not always meet transplant's very specialized needs. Indeed, many of the major players in the EMR business have been slow to embrace the specific needs of the transplant community. Two developers of software for hospital-wide EMRs, Epic (which also manufactures a new transplant module called Phoenix) and Cerner, declined to be interviewed for this story.

Transplant's Specific Needs

Ghassan Khabbaz, president of TeleResults in San Francisco, says the management of a transplant patient has distinctive requirements that are not typically built into a general hospital EMR, such as linking donor and recipient records, evaluating them simultaneously and handling separate tracking and reporting requirements during various phases of the transplant process. Kenyon adds, “We’ve had some of our [transplant] centers say they’ve been pressured to consider the hospital system. Often, they’ve looked at it and then remained as our customers.”

But when a hospital spends in the neighborhood of $40 million for a general, hospital-wide EMR system, it's likely there will be pressure on transplantation to become part of it. Khabbaz says that while transplant-specific features could be built into a general hospital EMR, to do so would require “a deep understanding of the transplant process and a lengthy development effort, making it pricey compared to a stand-alone transplant application.”

Khabbaz finds it baffling that some hospitals won't consider having two systems (both hospital-wide and transplant-specific) that can interface, estimating that the additional cost to the hospital to implement such a workflow might range from $120,000 to $600,000 for an adjuvant system. Jeffrey Sneddon, founder of TransChart in Dublin, Ohio, and currently assistant director of transplant clinical systems at the Ohio State University (OSU) Medical Center in Columbus, says the installation of a trans-plant-specific system might cost between $150,000 for a small center with minimal professional services and up to $1 million for larger centers. “[Hospitals] are reluctant at first, but if you put the cost into perspective, it's very minor compared to what is paid for a hospital EMR.”

Sneddon, who is familiar with hospital EMR transplant modules, says they are not sophisticated enough for transplantation. “There are a number of issues I see,” he says, noting that enterprise-wide systems are still episode based and can't accommodate a patient who has had labs or imaging done elsewhere. “We put the data into our system so that we have a continuum of care from wait listing to transplant to post-transplant follow-up.”

Paul A. Markham, chief operating officer of HKS Systems, notes that EMRs also face the challenge of meeting government-mandated “meaningful use” because they are inherently “provider centric” rather than “patient centric.” Another issue is that reporting requirements and the field of transplantation itself are continuously evolving, and hospital EMR vendors usually depend on consultants to implement software and configure templates, after which they move on. “Who will be responsible in the future for the update of the application and database as new requirements become mandated?” asks Khabbaz.

KEY POINTS

  1. Top of page
  2. Abstract
  3. Missing the Mark
  4. KEY POINTS
  5. N.Y. Man Admits Organ Trafficking
  6. Reference
  7. Appendix
  • • 
    Hospital-wide EMR systems may not address some of the requirements necessary to manage transplant patients, such as linking multiple patients and handling separate tracking and reporting requirements during various phases of the transplant process.
  • • 
    Some U.S. transplant programs integrate general EMRs into their transplant-specific systems, while still trying to manage the distinct needs of transplantation.
  • • 
    Hospital-wide systems are able to provide limited functionality, but experts advise transplant teams to discuss transplantation's specific needs with their administrators.

When the Hospital System Works

Hospital-wide systems aren't always a problem. The University of Iowa Organ Transplant Center in Iowa City has been using Phoenix, Epic's transplant-specific module, since 2009. “One of the biggest advantages I find as a transplant administrator with

It's very important to form an alliance with your IT department, to ensure an awareness of the specialty needs of transplantation's clinical data.—Janie Morrison

Epic/Phoenix is that both physicians and transplant staff can talk the same Epic language when discussing reports, improvements to the process, research and future upgrades with Phoenix,” says Ian Jamieson, the transplant center's chief administrative officer. “Our physicians have to use Epic and so, by default, have to use Phoenix.”

The University saw Phoenix as a solution that would fit both the hospital's and the transplant center's needs, says Jamieson, adding that they kept extra money in their budget to cover the cost of an alternative transplant-specific system for two fiscal years, “just in case.” They released those funds this past year. Jamieson expects that the next phase of Phoenix, called Denali, will incorporate even more functionality, making it more competitive with custom-developed transplant-specific software.

Hybrid Systems

Some U.S. transplant programs are integrating EMRs into their transplant records, while still trying to manage the unique needs of transplantation. “We found that there is an 80/20 rule,” says Janie Morrison, director of the Transplant Institute at University Hospitals (UH) of Cleveland, Ohio. “Eighty percent of the information we need to take care of our patients and to meet our compliance standards is in a hospital EMR,” but the 20% that isn't included are items they can't live without, such as tracking patients through their phases of care, getting test results from outside sources and sending reports to the United Network for Organ Sharing/Scientific Registry of Transplant Recipients.

Jeffrey Sneddon of OSU reports that a nurse who came from a center that replaced a transplant-specific system with a hospital-wide EMR says that the hospital now manages their transplant wait list on paper.

Build Relationships

According to Sneddon, there is concern among transplant centers that big EMR companies will come in to hospitals, at the expense of transplantation. “You have a hospital administrator and the IT department who are purchasing the software,” he says. “I have been to about 100 transplant centers over the past six years speaking with these departments and very few, if any, understand how transplant works. … They think they can get a big-box system that takes care of all of their needs, but that never works.”

While everyone who works in transplantation knows what their requirements are, they’re not the ones who ultimately purchase the software, adds Sneddon. So, who is educating the administrators, IT people and consultants about these specific needs?“It's very important to form an alliance with your IT department, to ensure an awareness of the specialty needs of transplantation's clinical data,” says Morrison.

Jamieson admits that with an enterprise-wide system, “you give up control of the ‘transplant island,’ but you benefit from everybody's input over the patient spectrum of care. … One downside is that you may be beholden to information-systems leadership; however, it is up to transplant to build good relations with this leadership.”

N.Y. Man Admits Organ Trafficking

  1. Top of page
  2. Abstract
  3. Missing the Mark
  4. KEY POINTS
  5. N.Y. Man Admits Organ Trafficking
  6. Reference
  7. Appendix

Late last year, Levy Izhak Rosenbaum, a resident of Brooklyn, New York, and a citizen of Israel, became the first person to be convicted in the U.S. for the black-market sale of human organs from paid donors. According to the United States Attorney's Office in the District of New Jersey, each of the four counts against Rosenbaum carries a maximum five-year prison sentence plus a fine of up to $250,000.1 Rosenbaum agreed to forfeit $420,000 in property that was derived from the illegal kidney sales.

He was arrested in July 2009 after agreeing to sell a kidney to an undercover FBI agent. He later told authorities he had bought organs from people in Israel and resold them to wealthy customers in the U.S. Prosecutors did not release the names of the hospitals where the transplants took place.

Reference

  1. Top of page
  2. Abstract
  3. Missing the Mark
  4. KEY POINTS
  5. N.Y. Man Admits Organ Trafficking
  6. Reference
  7. Appendix
  • 1
    Brooklyn man pleads guilty in first ever federal conviction for brokering illegal kidney transplants for profit [press release]. Trenton , NJ : United States Attorney's Office, District of New Jersey; October 27, 2011.

Appendix

  1. Top of page
  2. Abstract
  3. Missing the Mark
  4. KEY POINTS
  5. N.Y. Man Admits Organ Trafficking
  6. Reference
  7. Appendix

Anderson Named to UNOS Position

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Rebecca Anderson has been named director of the Department of Evaluation and Quality (DEQ) of the United Network for Organ Sharing (UNOS). In her new role, she will oversee activities associated with routine member compliance monitoring, the Membership and Professional Standards Committee reviews and corrective action, investigation of time-sensitive patient safety threats and processes that ensure the speedy handling of member exceptions requests.

Previously, Anderson was assistant director of the department, and before that was director of transplant, dialysis and bariatric services at Memorial Medical Center in Springfield, III.