DOM In the News
Read about how the Department of Medicine is responding to the outbreak of the coronavirus respiratory illness COVID-19. See related COVID-19 publications.
Department of Medicine Covid-19 Grand Rounds - The Delta Variant, and Lessons from the Pandemic (with Andy Slavitt)
The Delta Variant, and Lessons from the Pandemic (with Andy Slavitt)
Session moderated by Bob Wachter
In this UCSF Department of Medicine Covid-19 Medical Grand Rounds, we begin with an update on the pandemic from UCSF epidemiologist George Rutherford, with a particular focus on the Delta variant, which began in India and is both more infectious and partly vaccine resistant. It has now become the dominant virus in the UK, and threatens to do the same in the U.S.
The bulk of the session will be an interview with Andy Slavitt, who recently left his role as White House senior advisor on Covid-19 and whose book, “Preventable: The Inside Story of How Leadership Failures, Politics, and Selfishness Doomed the U.S. Coronavirus Response,” was published this week. Slavitt will reflect on the successes and failures of the past 18 months, describe the inside story of how the Biden team approached the vaccine rollout, and discuss how the pandemic has changed the healthcare system forever.
Speakers:
George Rutherford, MD, is Professor of Epidemiology and Biostatistics at UCSF. He serves as the Medical Director of Prevention and Public Health Group. His research focuses on the epidemiology and prevention of infectious and tropical diseases of public health.
Andy Slavitt, MBA, was President Biden’s White House Senior Advisor for the Covid-19 response from January to June 2021. He has led many of the nation’s most important health care initiatives, serving as President Obama’s head of Medicare and Medicaid and overseeing the turnaround, implementation and defense of the Affordable Care Act. 
He is the founder of United States of Care, a national non-profit health advocacy organization as well as a founding partner of Town Hall Ventures, a healthcare firm that invests in underrepresented communities. He chronicles what goes on inside the government and across the nation at town halls, in USA Today, and on Twitter. A graduate of the University of Pennsylvania and Harvard Business School, he is host of the popular Covid-themed podcast “In the Bubble.”
Zoom Information:
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The session will be recorded for later play :
https://medicine.ucsf.edu/covid-19-news-coverage
Hospital organizational strategies associated with advanced EHR adoption
In a recent Health Services Research article, Julia Adler-Milstein, PhD, and colleagues provide some of the first national-level data characterizing hospital organizational strategies surrounding electronic medical record (EHR) adoption and use, and identify which strategies are associated with adoption of advanced EHR functions.
Following the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, EHRs were rapidly adopted by hospitals across the United States, but regulations have been criticized as being overly prescriptive and constraining hospitals and as a result, hospitals digitized records but have fallen short of realizing their full potential for patients or clinicians.
While EHR implementation and optimization practices vary significantly across hospitals in the United States, Adler-Milstein and colleagues believe their results may partially help to explain why a range of studies have shown an inconsistent relationship between EHR adoption and outcomes and suggest that specific organizational strategies are associated with more advanced EHR adoption. These organizational practices coalesce around three main strategies related to greater engagement of senior leadership, a higher proportion of clinicians on the IT team, and greater integration across systems, particularly clinical administrative systems. For hospitals seeking to drive adoption of more advanced EHR functions, engagement from leadership and integration across systems may help enable patient engagement EHR functions, and systems integration may help in the clinical analytics functions.
Understanding which organizational strategies are associated with adoption of advanced EHR functions is a first step to suggest hypotheses about where to conduct further investigation of how to help hospitals increase the benefit from health IT. Unlike identifying structural characteristics associated with IT adoption, organizational strategies are more actionable and can be broadly disseminated. Health system leaders interested in developing IT-enabled patient engagement may find it useful to know of the association between a more involved Board of Directors and advanced patient engagement EHR functions. Similarly, the researchers’ results show an association between investing in systems integration and the type of advanced data analytics that requires data flows and linkages from multiple clinical and administrative sources.
Advanced EHR functions may require specific organizational approaches, which to date have not been part of federal policy efforts. While the government is not an appropriate entity to mandate organizational strategy, policymakers could play a role in identifying and disseminating best practices. Specifically, dissemination through mechanisms such as the EHR Reporting Program included in the 21st Century Cures Act. While the focus of this Program is on reporting provider experiences with health IT, complementing these with context about IT strategy could help understand differences in experiences as well as make such strategies more transparent to facilitate learning and benchmarking.
Policymakers should consider supporting future research examining how organizational practices contribute to adoption of advanced EHR functions and ultimately outcomes, especially the difficult task of identifying causal relationships. Given the importance of the topic and the difficulty of generating strong evidence, funders should consider prioritizing these projects to generate actionable strategies for hospitals to maximize EHR performance.
The new evidence provided by Adler-Milstein and colleagues on how organizational strategies are associated with advanced EHR functions is an important first step in understanding how hospital management can work toward realizing the potential of electronic health records.
Hospital organizational strategies associated with advanced EHR adoption.
Holmgren AJ, Phelan J, Jha AK, Adler-Milstein J. Health Serv Res. 2021 Mar 29. doi: 10.1111/1475-6773.13655. Online ahead of print.