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The Healthcare IT Guy

January-17-2012

8:00

This is the next post in my series of Do’s and Don’ts Healthcare IT. As we all know, some of our most important citizens live in rural settings, small cities, the countryside, or remote areas. These areas have smaller populations and less direct access to vital healthcare resources. In the past 15 years or so we’ve made some great strides in remotely accessible healthcare; these offerings, called telemedical tools, provide important clinical care at a distance. Here are some do’s and don’ts of telemedicine:

  • Do use commonly available web meeting and online video tools bring expert caregivers anywhere. WebEx, GotoMeeting, Adobe Connect, Skype, and a variety of other “web meeting” tools used mostly in professional office settings and remote sales pitches are wonderful tools to connect caregivers in populated communities to their rural patients. A simple $30 to $50 per month account on the physician side with almost no direct cost for the patient is an excellent way to engage with patients. These kinds of web meetings can happen securely either at the patient’s home or patients can be brought into satellite offices with high-quality telepresence. Then, instead of waiting for days or weeks for a health professional to travel to an area or patients having to take off many hours or entire days traveling to experts in big cities, care can be given almost immediately with less inconvenience. Don’t assume that kinds of web meeting solutions are HIPAA compliant out of the box; however, do realize they can be made HIPAA compliant with appropriate protections.
  • Do use medical devices for remote monitoring of in-home care improve clinical observations. While web meetings are great for basic primary care, it’s not perfect for elder care, long-term care, and other types of clinical requirements. There is a new class of devices that can put near-hospital-quality patient monitoring devices into patient homes and “beam” that data to monitoring centers that can watch for important events across many patients in different geographical areas. Toss in a nurse or other caregiver that can visit once a week or once a month to calibrate the devices and you can see how much more convenience patients can have and have their physicians, wherever they may be, have immediate access to their actual vitals and clinical status.
  • Don’t assume that medical device connectivity will be fast or easy to do on your own — you’ll need something like Qualcomm’s 2net platform. 2net is a trustable, Class I FDA-listed, standalone gateway with an embedded cellular component that sends clinical data truly “in the cloud” without requiring local internet connectivity. Medical data can be sent from devices in the same way that e-books can be read on Kindle devices – using 3G cellular, from mobile phones, and software APIs.
  • Don’t always send patients to labs; instead, take labs to patients with mobile imaging and lab specimen collections that allow remote reading and web-based report distribution. It’s difficult for many rural communities to have their own full diagnosticians but mobile imaging centers and lab specimen “kiosks” can do the X-rays, take pictures, and perform collections and then send the data electronically to large populated centers where they can be “read” and analyzed; the reports can be distributed via secure e-mail or other web-based applications to doctors in the rural areas or physicians remotely available and connected through web meeting or other similar tools.
  • Do try and make behavioral health, mental health, and related care made more accessible. Veterans of our foreign wars are coming home with many problems that can be easily diagnosed with proper access and many of the veterans live in rural communities; while primary care and specialty care is difficult to get in smaller population regions, behavioral and mental health is even harder to access. Telemedical assistance through online chat, Skype-like video conversations, and secure online messaging can provide quick relief.
  • Don’t leave patients on their own and encourage them to join online communities. Online community building tools allow populated city citizens to meld with their rural counterparts. Patients helping other patients is a terrific approach to extending care; sometimes what a patient needs is not necessarily a health professional but a curated session with fellow patients going through the same problems. Online, electronic, community tools such as PatientsLikeMe.com can connect geographic communities and bring them closer together without increasing costs or requiring anything more than a simple mobile phone or computer.

What do’s and don’ts would you add to a telemedicine strategy? Drop me a comment below.

January-13-2012

7:39

I recently wrote, in Do’s and Don’ts of hospital health IT, that you shouldn’t make long-term decisions on mobile app platforms like iOS and Android because the mobile world is still quite young and the war between Apple, Microsoft, and Google is nowhere near being resolved. A couple of readers, in the comments section (thanks Anne and DDS), asked me to elaborate mobile and mHealth strategy for healthcare professionals (HCPs) and hospitals.

A couple of the key points were:

  • (Anne) how can you avoid making long-term mobile decisions at this point?  After all, hospitals that don’t steer their doctors are going to be managing whatever technology the doctors invest in, aren’t they?
  • (DDS) the risk is that people will take this to mean that they shouldn’t move at all on mobile app platforms, and this would be a mistake. This is the perennial issue with health IT; if it’s not perfect, then wait.

The approach I recommend right now for mobile apps, if you’re developing them yourself, is to stay focused on HTML5 browser-based apps and not native apps. So, to answer Anne’s and DDS’s question specifically, no you shouldn’t wait to allow usage of mobile apps by anyone; but, if you’re looking to build your own apps and deploy them widely (not in simple experiments or pilots) then you shouldn’t write to iOS or Android or WP7 but instead use HTML5 frameworks like AppMobi and PhoneGap that give you almost the same functionality but protect you from the underlying platform wars. In the end, HTML5 will likely win and it’s cross-platform and quite functional for most common use cases. If you’re not developing the apps yourself and using third-party apps, then of course you must support the use of iOS native, Android native, and soon Windows native apps on your network.

So, from a general perspective you should embrace mHealth but do so in a strategic, not tactical manner. Here are the most critical questions to answer in a mHealth strategy — it’s not a simple one size fits all approach:

  • How will you allow doctors’ or patients’ own devices within your hospitals / organizations — simply by providing connectivity and wireless access on the production network or some other means?
  • How will you allow doctors’ own devices to connect to hospital IT systems?
  • How will you extend hospital IT systems via hospital-owned mobile devices?
  • How will you allow the hospital or organization to “prescribe” the use of apps to patients and track the usage of apps?
  • How will you approve or deny the use of certain apps that may not meet FDA regulations if they get close to MDDS or Class 1/2/3 devices?

If there is interest in this topic, I will expand on my list of Do’s and Don’ts — mHealth is a very complex topic and requires a good strategy. Just saying that you allow the use of mobile devices like smartphones in your hospital is not an mHealth strategy. :-)

January-10-2012

6:45

In case you haven’t seen it, MU attestations data is now available on Data.gov and it includes analyzable vendor statistics.

The data set merges information about the Centers for Medicare and Medicaid Services, Medicare and Medicaid EHR Incentive Programs attestations with the Office of the National Coordinator for Health IT, Certified Health IT Products List. This new dataset enables systematic analysis of the distribution of certified EHR vendors and products among those providers that have attested to meaningful use within the CMS EHR Incentive Programs. The data set can be analyzed by state, provider type, provider specialty, and practice setting.

The data set does not include dollar amounts or the difficulty of attestation (e.g. how many times it took to pass). I’ll try and find out if that data might be available in the future. It’s also unclear whether the provider counts were broken up into each line (meaning one provider per row) or if multiple providers were aggregated into lines (meaning multiple providers were grouped).

The dataset is available now on Data.gov at http://www.data.gov/raw/5486 and is worth checking out. Since the file has been downloaded over 75 times, it’s clear some of you already know about this so if you’ve done some analysis with it; if you’ve done any analysis or posted results please drop me a note below so that everyone can benefit.

January-8-2012

21:01

Last year I started a series of “Do’s and Dont’s” in hospital tech by focusing on wireless technologies. Folks asked a lot of questions about do’s and dont’s in other tech areas so here’s a list of more tips and tricks:

  • Do start implementing cloud-based services. Don’t think, though, that just because you are implementing cloud services that you will have less infrastructure or related work to do. Cloud services, especially in the SaaS realm, are “application-centric” solutions and as such the infrastructure requirements remain pretty substantial – especially the sophistication of the network infrastructure.
  • Do consider programmable and app-driven content management and document management systems as a core for their electronic health records instead of special-purpose EHR systems written decades ago. Don’t install new EHRs that don’t have robust document management capabilities. Do consider EHRs that can be easily integrated with document and content management systems like SharePoint or Alfresco.
  • Do go after virtualization for almost all apps – as soon as possible, make it so that no applications are sitting in physical servers. Don’t invest more in any apps that cannot easily be virtualized.
  • Do start looking at location-based asset tracking and app functionality; your equipment should be aware of where it’s physically sitting and be able to “find itself” and “track itself” using location-based awareness. Don’t invest heavily in systems that can not support location-based awareness (like potentially allow or disallow logins based on where someone is logging in from as well as enable / disable certain features in applications on where logins are occurring).
  • Do start implementing single sign on and common identity management with CCOW integration. Don’t invest in any systems that cannot meet common identity or SSO requirements.
  • Don’t make long-term decisions on mobile app platforms like iOS and Android because the mobile world is still quite young and the war between Apple, Microsoft, and Google is nowhere near being resolved. A platform that looks strong today may be weak tomorrow and become legacy quickly; however, HTML5 is not going anywhere and will be ultimate winner of the next 15 years just like HTML4 is the winner from 1995 to now. Do start investing in HTML 5 and CSS3 and away from HTML4. Don’t install any more apps that require IE6/7 or older browsers and don’t invest in systems that don’t have HTML5 in their roadmaps.
  • Don’t write applications on top of legacy EHR platforms; write applications with proper HL7 connectivity and platform independence. Most EHR platforms are using technologies that are either ancient or need to be replaced; by integrating deeply but remaining independent of their technologies you’ll get the best of both worlds.
  • Don’t buy any medical devices from vendors that don’t have a deep and thorough medical device to healthcare IT enterprise connectivity strategy. If a device doesn’t have wired or wireless TCP/IP access, doesn’t have data export or HL7 connectivity is not worth purchasing.
  • Don’t buy any thick-client applications that do not have thin-client “remote viewers” available.

January-2-2012

10:57

One of the most important activities you can undertake before you begin your EHR implementation journey is to standardize and simplify your processes to help prepare for automation. Unlike humans, which can handle diversity, computers hate variations. Before you begin your software selection process, get help from a practice consultant to reduce the number of appointment types you manage, reduce the number of different forms you use, ensure that your charting categories (“Labs”, “Notes”, etc.) don’t look different per patient type or physician, determine how you will manage medication lists and problem lists across the patient population, and deal with how you’ll manage paper in your digital world.

If you spend even just a few hours a week doing the prep-work before you buy any software, you will be better prepared in your selection process. Without some level of standardization your EHR implementation will either fail, be delayed, or have many unhappy users; the more you can standardize and simplify, the more likely you will have a successful outcome. A strong project manager with authority to make decisions will be the difference maker in the simplification process.

To help you with your workflow assessment and standardization efforts, check out the The Agency for Healthcare Research and Quality (AHRQ.gov) Workflow Assessment for Health IT Toolkit. Even if you’ve done workflow assessments before, the toolkit is worth checking out.

December-24-2011

8:59

As most of my regular readers know, I work as a technology strategy advisor for several different government agencies; in that role I get to spend quality time with folks from NIST (the National Institute of Standards and Technology), what I consider one of the government’s most prominent think tanks. They’re doing yeoman’s work trying to get the massive federal government’s different agencies working in common directions and the technology folks I’ve met seem cognizant of the influence (good and bad) they have; they seem to try to wield that power as carefully as they know how. Since most of you are in the technology industry, albeit specific to healthcare, I recommend that you learn more about NIST and the role it plays – they can make your life easier because of the coordination and consensus building work they do for us all. I, for one, was thrilled when NIST was picked as the governing body for the MU certification criteria. These guys know what they’re doing and I wish they got more involved in driving healthcare standards.

A few years ago NIST came up with the first drafts of the seminal definitions of Cloud Computing; they ended up setting the stage for communicating complex technical concepts and helping making “Cloud” a household name. After 15 drafts, the 16th and final definition was published as The NIST Definition of Cloud Computing (NIST Special Publication 800-145) in September. It’s worth reading because it’s only a few pages and is understandable by the layperson. No computer science degree is required.

Yesterday I was speaking to a senior executive in the EHR space and we had a great discussion on what healthcare providers are doing in terms of cloud computing and how to communicate these ideas to small practices as well as hospitals. It reminded me of the numerous similar conversations I’ve had with other senior executives we serve in the medical devices and other regulated IT sectors. In almost every conversation I can remember about this topic over the past couple of years, I had to remind people that NIST has already done the hard work and that we can, indeed, rely on them. Most of the time the senior executive was unaware of where the definitions came from so I figured I’d put together this quick advisory.

My strong recommendation to all senior healthcare executives is that we not come up with our own definitions for cloud components – instead, when communicating anything about the cloud we should instruct our customers about NIST’s definition and then tie our product offerings to those definitions. The essential characteristics, deployment models, and service models have already been established and we should use them. When we do that, customers know that we’re not trying to confuse them and that they have an independent way of verifying our cloud offerings as real or vapor.

Below I have copied/pasted from NIST 800-145 their key definitions. Imagine how many debates you would avert with technicians at clients when, during conversations with a client, you communicated some of the following information first, showed them how it was a “standard definition” and handed them a copy of the publication, and then mapped your offerings and discussions to the different areas. Your sales teams and the marketing teams would appreciate the clarity, too.

Note that you do not need to map every offering you have to every definition – just start mapping the obvious ones and then figure out how you can communicate the “gaps” as being not applicable to your products / services or if those gaps will be filled in the future as part of your roadmap. Treat these definitions as canonical but not inclusive – meaning that just because your SaaS offering doesn’t fit every essential characteristic doesn’t mean that you’re not “cloud” – it just means partially cloud.

If you’ve got questions about how to map your product offerings, drop me some comments and I’ll assist as best as I can.

Here are the key definitions from NIST 800-145, copied directly from the original source:

Cloud computing is a model for enabling ubiquitous, convenient, on-demand network access to a shared pool of configurable computing resources (e.g., networks, servers, storage, applications, and services) that can be rapidly provisioned and released with minimal management effort or service provider interaction. This cloud model is composed of five essential characteristics, three service models, and four deployment models.

Essential Characteristics:

On-demand self-service. A consumer can unilaterally provision computing capabilities, such as server time and network storage, as needed automatically without requiring human interaction with each service provider.

Broad network access. Capabilities are available over the network and accessed through standard mechanisms that promote use by heterogeneous thin or thick client platforms (e.g., mobile phones, tablets, laptops, and workstations).

Resource pooling. The provider’s computing resources are pooled to serve multiple consumers using a multi-tenant model, with different physical and virtual resources dynamically assigned and reassigned according to consumer demand. There is a sense of location independence in that the customer generally has no control or knowledge over the exact location of the provided resources but may be able to specify location at a higher level of abstraction (e.g., country, state, or datacenter). Examples of resources include storage, processing, memory, and network bandwidth.

Rapid elasticity. Capabilities can be elastically provisioned and released, in some cases automatically, to scale rapidly outward and inward commensurate with demand. To the consumer, the capabilities available for provisioning often appear to be unlimited and can be appropriated in any quantity at any time.

Measured service. Cloud systems automatically control and optimize resource use by leveraging a metering capability1 at some level of abstraction appropriate to the type of service (e.g., storage, processing, bandwidth, and active user accounts). Resource usage can be monitored, controlled, and reported, providing transparency for both the provider and consumer of the utilized service.

Service Models:

Software as a Service (SaaS). The capability provided to the consumer is to use the provider’s applications running on a cloud infrastructure2. The applications are accessible from various client devices through either a thin client interface, such as a web browser (e.g., web-based email), or a program interface. The consumer does not manage or control the underlying cloud infrastructure including network, servers, operating systems, storage, or even individual application capabilities, with the possible exception of limited user-specific application configuration settings.

Platform as a Service (PaaS). The capability provided to the consumer is to deploy onto the cloud infrastructure consumer-created or acquired applications created using programming languages, libraries, services, and tools supported by the provider.3 The consumer does not manage or control the underlying cloud infrastructure including network, servers, operating systems, or storage, but has control over the deployed applications and possibly configuration settings for the application-hosting environment.

Infrastructure as a Service (IaaS). The capability provided to the consumer is to provision processing, storage, networks, and other fundamental computing resources where the consumer is able to deploy and run arbitrary software, which can include operating systems and applications. The consumer does not manage or control the underlying cloud infrastructure but has control over operating systems, storage, and deployed applications; and possibly limited control of select networking components (e.g., host firewalls).

Deployment Models:

Private cloud. The cloud infrastructure is provisioned for exclusive use by a single organization comprising multiple consumers (e.g., business units). It may be owned, managed, and operated by the organization, a third party, or some combination of them, and it may exist on or off premises.

Community cloud. The cloud infrastructure is provisioned for exclusive use by a specific community of consumers from organizations that have shared concerns (e.g., mission, security requirements, policy, and compliance considerations). It may be owned, managed, and operated by one or more of the organizations in the community, a third party, or some combination of them, and it may exist on or off premises.

Public cloud. The cloud infrastructure is provisioned for open use by the general public. It may be owned, managed, and operated by a business, academic, or government organization, or some combination of them. It exists on the premises of the cloud provider.

Hybrid cloud. The cloud infrastructure is a composition of two or more distinct cloud infrastructures (private, community, or public) that remain unique entities, but are bound together by standardized or proprietary technology that enables data and application portability (e.g., cloud bursting for load balancing between clouds).

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January-16-2012

11:33

By Sheldon Needle

The real problem of an established medical practice moving into the realm of EHR is not the cost of the medical software package; it is not the training necessary for staff; and it is not security and backups.

The real problem of moving into EMR/EHR is the problem of unstructured medical data.

If you are involved in a new or relatively new practice, this is a no-brainer. Begin with a serious search to compare medical software vendors who are available to answer your questions honestly. It is not truly so difficult to get on a friendly medical screen to enter your patient’s blood pressure or lab test values. You can get used to that.

Neither is it difficult to take notes on a notebook that upload to the EHR system.

The real problem is taking your notes and dictation on a patient that go back 15 years and finding a way to get his possible symptoms, his worry about IBS, his headache history, and his worries over his children into a metrically available rendition that that does not take you or a member of your practices days to decipher. These notes are usually on dictation, hand written notes, and referral letters.

The concerns are many: this can take what feels to be forever, and the anxiety issues and unclear symptoms may not translate easily into metrics but may be critically important in future diagnoses.

There are two critical questions here:

  1. 1) Is it worth it? and
    2) If it is worth it, what to do to make this work efficiently?

In the long run, it doesn’t even matter if it is worth it. It will happen. Medicine as well as the rest of our cultural world, is becoming electronically-based whether we like it or not. But in the long run, it is worth it. Think of a patient going in to the hospital after a car accident, all by himself, and having all his data available to the admitting doctor in an instant: blood type, history, etc.

Think of a patient being referred to you, the specialist, and having all his patient history available in less than a minute. What a time saver! What insight!

Medical informatics has a number of methodologies it is using to translate unstructured data into useful and structured data.

Three basic methodologies exist to accomplish this:

  • String matching
  • Natural language processing for Medicine (NLP), which uses syntactic rules in extracting data from text documents
  • Concept-based indexing which uses data base codes to group and relate medical concepts

These methods will be refined, utilized, and integrated in some way into most decent medical vendor software packages over the next few years. For you the physician or practice manager, this may start to pay off in a while, but you still have to get from hand written records into the database.

The obvious way to proceed makes use of our culture idea of, “going forward”:

  1. Start with today’s records being input into the database electronically – this is the easy part.
  2. Then get help in moving 1 year of back data scanned and automated. Get someone technically savvy and talk to the support people whose EHR software you are considering about OCR (optical character recognition) software that may be available from vendors.
  3. Most vendors of decent repute will have voice recognition software incorporated into their total EHR solutions. Have them demonstrate how well it works in moving data into their files.

The real message to practitioners moving to electronic health records is, don’t look at the top of the mountain when you start climbing, just put one foot in front of the other. Delaying the climb will not get you anywhere, but starting the march will move faster than you think!

Source:

January-10-2012

14:26

Having recently spent time as an observer in a hospital setting, I was struck by the lack of intelligent planning and forethought made for doctors trying to move into an EMR / EHR environment.

Though I saw a well-known EHR panel on the computer screens within an ICU, and the EHR being used to record certain patient data, doctors were taking their notes in long-hand. Later on the same day I saw the same doctors transcribing their notes onto their computers. The doctors, doing double duty on note taking were not available to their patients because they were acting as secretaries.

When a large clinical environment is incorporating an EHR it has to be done in a modular way that does not impact productivity any more than it has to. The task is hard enough. If you are using an EHR to record point of care patient information, give your doctors a Notebook so they can take their notes electronically. In fact, insist on electronic note-taking. Incorporate change with some forethought to peoples’ time and effort.

This real-life observation just underscores the need to plan for transition to an EMR rather than throwing an institution into the chaos of change for its own sake, or for the sake of Meaningful Use incentive payments. As in all things, the old US Coast Guard motto holds true: Semper Paratus! Always be ready and prepared.

Most good EMR / EHR systems can offer medical clients some guidance as to best practices in incorporating EMR / EHR systems within their practices.

December-29-2011

12:20

By Sheldon Needle

The prospects for EHR in the coming year are exciting but more than a little daunting.  The issue is really how to find an EMR/EHR system that will organize and centralize the functions of your practice, without bankrupting you and throwing your staff and yourself into turmoil.

If you look at the websites for EMR vendors today, you can see that the functions they describe within their system –the integration of clinical records with practice management data, e-prescription, patient portals — could conceptually do wonderful things for you and for your patients in the way you handle their individual cases, but many of the details are still not working smoothly.

Here are some of the things to be aware of:

  1. If you are getting a client/server system, make sure your internet connection has the bandwidth to support the sheer number crunching your system will need.  Otherwise your system may well freeze up on you or move at the speed of molasses.
  2. If you are a small practice and getting SAAS software, hurray for you!  This could be just the right way to move towards EMR.  But beware of sticker shock.  The prices quoted to you on-line for monthly subscriptions to SAAS may well not mention additional fees you need to pay for licensing, installation, initial training.  Make sure everything is clearly stated in your contract.
  3. Think hard about how you are going to transition your current paper based system to digital records.  Who will do the scanning?  What will you do with your dictation?   The whole issue of free form data (things like scanned documents that need to be OCR’ed in order to get into the database, your dictated notes, etc.).  It is not enough to just get everything on paper scanned.If you can afford to get a service that does transitions like this for a reasonable fee, consider this as a viable strategy.  It may save you lots of headaches.
  4. Not everyone can necessarily get the benefit of “Meaningful Use” incentive payments right away.  It will depend on the nature of your practice, your specialty, your patient base, as well as how many Medicare or Medicaid patients you service, just to name a few variables. Do not let “Meaningful Use” be the only criterion you use in evaluating EMR software.
  5. Find a company that will do serious training for you and your staff, and will not nickel and dime you for every question you have for them as you move into the implementation and use phase.

Remember, always read the fine print and ask every question you need to. Know that EMR software decisions is a very competitive business. The vendors need you just as much as you need them!

December-23-2011

14:42

By Sheldon Needle

5010 is not only a date 3,000 years in the future: ANSI 5010 is the newest version of the HIPAA transaction standards regulating electronic transmission of medical and healthcare transactions. The existing standard is called 4010, and 4010 does not support ICD-10 coding.

The current coding standard for diagnosis and procedure coding is the ICD-9, and it has outlived its possibilities –it limits the number of new procedure and diagnostic codes that can be created.

This is how the CMS.gov (center for Medicare and Medicaid services, at: http://www.cms.gov) defines the ICD-10:

About ICD-10
ICD-10-CM/PCS (International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System) consists of two parts:

  1. ICD-10-CM for diagnosis coding
  2. ICD-10-PCS for inpatient procedure coding

ICD-10-CM is for use in all U.S. health care settings. Diagnosis coding under ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the format of the code sets is similar.

ICD-10-PCS is for use in U.S. inpatient hospital settings only. ICD-10-PCS uses 7 alphanumeric digits instead of the 3 or 4 numeric digits used under ICD-9-CM procedure coding. Coding under ICD-10-PCS is much more specific and substantially different from ICD-9-CM procedure coding.

The transition to 5010 is supposed to happen by January 1, 2012. This means that electronic transmissions including claims, eligibility inquiries and remittance advices must be made in a 5010-compliant format. Healthcare providers, health plans and clearinghouses for transactions are all expected to upgrade their transmissions. Non-compliance may result in claims denied or slower payment.

Systems that are certified as ONC-ATCB for 2011/2012 are already 5010 compliant. If you are contemplating buying a system that is so certified, you do not have to worry about the software compliance, but you do need to educate your staff, including yourself, if you are the physician or the P.A., on what the differences between 4010 and 5010 mean to their everyday work.

If you are using old medical software that has not been updated, or are contemplating installing software that is not certified as ONC-ATCB for 2011/2012, you need to update to a newer version, or face delays and uncertainties in your billing and claims submission. In other words, do some serious upgrading, or else!

December-4-2011

8:47

By Sheldon Needle

November 30, 2011: Today HHS Secretary Kathleen Sebelius announced incentives to speed the adoption and use of health IT in the form of meaningful-use qualified EHR in doctors’ offices and hospitals nationwide, which will improve health care and create jobs nationwide.

The new administrative actions announced today, which will be made possible by provisions of the HITECH Act, will loosen requirements for doctors and other health care professionals to receive incentive payments for adopting and meaningfully using health IT.

“When doctors and hospitals use health IT, patients get better care and we save money,” said Secretary Sebelius.  “We’re making great progress, but we can’t wait to do more. Too many doctors and hospitals are still using the same record-keeping technology as Hippocrates. Today, we are making it easier for health care providers to use new technology to improve the health care system for all of us and create more jobs.”

The press release continues to state: “HHS also announced its intent to make it easier to adopt health IT.  Under the current requirements, eligible doctors and hospitals that begin participating in the Medicare EHR (electronic health record) Incentive Programs this year would have to meet new standards for the program in 2013.  If they did not participate in the program until 2012, they could wait to meet these new standards until 2014 and still be eligible for the same incentive payment. To encourage faster adoption, the Secretary announced that HHS intends to allow doctors and hospitals to adopt health IT this year, without meeting the new standards until 2014. Doctors who act quickly can also qualify for incentive payments in 2011 as well as 2012.”“ (The italics are ours.)

We need to understand what acting quickly means: buying in 2011? Incorporating EHR within the next month, so that meaningful use occurs in 2011? This is not yet clear.

HHS is redoubling its effort to reach out with information, education, and the possibility of incentive payments to doctors and hospitals and vendors about stepping up the pace of transitioning practices and HER software to meet standards of Meaningful Use. What Meaningful use means to the individual practice depends on size, degree of implementation of the EHR, and the nature of the client base (how many Medicare or Medicaid patients, for instance, figures into the formula of Meaningful Use.

The Obama Administration is working to create a nationwide network of 62 Regional Extension Centers, comprised of local nonprofits, to help eligible health care providers learn how to participate in the Medicare and Medicaid EHR Incentive Programs and meaningfully use health IT.

See the HHS press release, at: http://www.hhs.gov/news/press/2011pres/11/20111130a.html to learn more.

Keep your eyes on the newspapers, government announcements and on this blog to learn about EMR and EHR news and updates.

November-21-2011

11:30

By Sheldon Needle

You know that your medical practice will have to bite the EMR bullet sooner or later (actually, sooner). The digital handwriting is on the tablet, isn’t it? So what is it stopping you from moving ahead at a planned pace rather than being forced into converting your medical practice to an EMR at the 11th hour?

Here are some of the most common obstacles people face in converting their practices to the use of electronic medical record software, and here are some strategies to deal with them or get the process going:

1. How will we migrate from paper to digital images? Conversion of paper medical records to digital format: If you have your eye on an EMR, learn how tolerant it is of varying formats: does it accept PDF files? JPG format? Ascii text files? Extracts from excel files?

Don’t bit off more than you can chew to begin. If you are practice with reams of folders full of paper files to convert, decide how many years back you need to go in getting your EMR up and running. Perhaps you can start with one year of files via EMR? Or perhaps you need to go much further back?

Look into the possibility of having a consultant specializing in data conversion take charge of your files. There are companies that specialize in just such medical data conversions. If you are really desperate, hire your responsible college students, make the specs clear, and pay her decently!!

2. How will we train everyone in such a new system? Training your self and your staff: Once you have chosen your EMR system, engage the company’s own training staff; that way, you are sure you are being oriented in the current system, using the right documentation. Before you chose your EMR, see what kind of training options the company offers. You might go for a short orientation up front, with a good help desk that is available 24/7. Check reliable Electronic medical records ratings to see which companies provide good in person and on the phone / online support

3. Do we have to set up all the hardware and maintain the software? I don’t think we can manage that. Consider a cloud-based EMR solution: If you are reluctant to invest in a server and commit to the upkeep of hardware and software, consider a Web-based EMR solution, in which you log onto an EMR that worries about security, and updates to hardware and software.

4. How can I compare products so that my practice knows what it is getting into? How much can I trust referrals from other practices? Don’t put all of your EMR decision eggs into one basket: While personal referral are extremely helpful and reassuring, not all are meaningful for your unique EMR practice situation. There are many good EMR products to choose from, and each has its strengths, and its weaknesses.

The right choice will depend as much on the nature of your medical practice and the answers to many questions: What is your medical specialty? How many employees do you have? How expensive is the EMR, per year? How much money can you dedicate to investing in your EMR annually? Can you integrate your medical billing software with your proposed new EMR? Can you afford to hire a dedicated IT employee? How comfortable you and the others in your practice are with using an electronic device as the main source of medical input to your system. These are just a few of the many questions you need to ask yourself.

Talk to people in other practices, yes; but learn to ask the right questions and compare apples to apples and oranges to oranges. Great EMR comparison tools are available to you at no charge, and they can educate you to ask the right questions and maintain a solid baseline for comparison when choosing an EMR.

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January-19-2012

20:10

It seems like everyone I talk to or interact with in the Health IT world is in full on HIMSS 12 preparation mode. I only attended my first HIMSS 2 years ago in Atlanta. So, I’m mostly a newbie at HIMSS. I sometimes long for the days when I just went to HIMSS with little real planning. I just went and enjoyed myself.

As you can imagine, HIMSS is a perfect place for me and my business. I’ve often told people that the core of my business is great content and advertisers. Turns out that every booth and every person at HIMSS is possibly both. For me, it’s like being a kid in a candy store. So, many exciting things to try (and you might even say you get sick after “eating” too many as the flavors all run together). To be quite honest, I love the entire experience. I was meant for the system overload that happens at HIMSS. I love large crowds of people and being overstimulated. I guess that’s why I love living in Las Vegas (which is also convenient for this year’s HIMSS).

HIMSS Attendee and Exhibitor Count
Enough about me. What can we expect at this fantastic affair called HIMSS 2012? Last year there were 30,000 attendees and I wouldn’t be surprised if this year it’s somewhere in the neighborhood of 35,000 people attending HIMSS. During an #HITsm twitter chat about HIMSS, I said that there would be at least 1000 vendors exhibiting at HIMSS. If I remember right (I can’t find the tweet), one of the HIMSS staff corrected me and said there would be 1100 companies exhibiting at HIMSS this year.

What does all this mean? Well, as my mother always told me: You can’t do everything. I’d always look at her shaking my head saying, “You’re right….but I’m sure going to try.” I think this describes my approach to HIMSS as well. Although, each year I am getting more selective on what I spend my time doing.

Press at HIMSS
I’m sure that many reading this are wondering how they can get some coverage on the Healthcare Scene blog network at HIMSS. Considering the 40 or so emails from PR people that I have filed away already, I’m going to have to apply a pretty strict filter.

What then are my filters?

First, if you’re an EHR company, then I’m probably interested in connecting with you in some form. Although, if you’re an EHR company that’s just seen me and has nothing new to say, then I’ll probably pass at this HIMSS. To be honest, I could probably fill my entire schedule with just EHR companies considering how many EHR companies there are out there. Plus, I think I’m going to bring around my flip video and do an EHR series called “5 Questions with EHR Companies.” I’ll see how many EHR companies I can get to answer the same 5 questions.

However, an entire week of just EHR talk would be a little rough. Plus, I asked on Twitter if I should look at things outside of EHR and they all said I should. I’m a man for the people, so I must listen. How then could another healthcare IT company get me interested in meeting with them at HIMSS?

The best way to get me interested in talking with your company is to provide something that will be interesting, unique and insightful to my readers. Remember that my main goals are great content and advertising. If you provide me with great content that my readers will love, then I’ll love you and likely write about that content.

I didn’t realize this when I started blogging, but I’m not like a lot of journalists. I don’t go to any conference with stories in mind. I’m not digging around HIMSS to try and find an ACO story for example. Instead, every person that I talk to I’m trying to discover what stories are being told at HIMSS that are worth telling. I’m always happy when people help me find interesting stories.

Social Media at HIMSS 12
Speaking of finding stories. One of the most interesting ways I use to find stories and connect with people is through social media and in particular Twitter (see this post I did on EMR and HIPAA about Twitter). I guarantee you that Twitter usage at HIMSS 12 is going to be off the charts. There is going to literally be no way to keep up. I love the idea that Cari McLean had of the HIMSS Social Media Center summarizing the most important tweets during HIMSS. Granted, that’s an almost impossible task to ask anyone to do.

Of course, the HIMSS related hashtags will be another great way to filter through the various HIMSS related tweets that are happening. Here are some of the ones I’m sure I’ll be using:
#HIMSS12 — official hashtag for the event
#HSMC — HIMSS Social Media Center
#HITX0 — HIT X.0: Beyond the Edge specialty program
#LFTF12 — Leading from the Future specialty program
#eCollab12 — eCollaborative Forum
Here’s a bunch more HIMSS related social media hashtags you might want to consider:

HIMSS Social Media Center
If you love social media like I do, then you’re also going to love the HIMSS Social Media Center. They’re doing a number of Meet the Bloggers sessions again and I’ve been invited to participate in the Health IT Edition of Meet the Bloggers at HIMSS. I’m on the panel along with: Brian Ahier (Moderator) Health IT Evangelist, Mid-Columbia Medical Center, Jennifer Dennard, Social Marketing Director at Billian’s HealthDATA/Porter Research/HITR.com, Neil Versel, Freelance Journalist and Blogger, Carissa Caramanis O’Brien, Social Media Community and Content Director, Aetna. Should make for a pretty interesting conversation. Plus, you know I always like to mix it up a bit.

New Media Meetup at HIMSS
More details coming soon. We’ll have to work on Neil Versel’s idea of starting a Twitter storm to get Biz Stone to come to the HIMSS meetup.

Dates of HIMSS
Be sure to check the dates of HIMSS. As Neil Versel noted, it’s a little different days than it’s been in the past. I personally like these dates better than the other ones.

There you have it. I thought I’d do a short post on HIMSS and I guess I had a lot more to say. I’d love to hear if you’re going to HIMSS. If you know of any events, sessions, parties, announcements, technologies etc. that I should know about at HIMSS, let me know.

And the most exciting part of HIMSS…seeing old friends and making new friends. I can’t wait.

No related posts.


January-18-2012

14:28

One thing that I love about this industry is its willingness to collaborate, and I’m not just talking about collaborative care. I’m talking about healthcare IT’s propensity to brainstorm new ideas as the drop of a hat. Put two HIT folks – be they physician, vendor or blogger – in a room, and 20 minutes later you’re going to have a new idea related to care delivery, product development or possible partnership on your hands. It gets even more prolific when editorially minded marketing folks like me are added to the mix.

I’ve been pleasantly surprised at how even blogs can foster this sort of collaboration. Last month in “Finding an EMR Job Champion,” I chatted with Rich Wicker, HIMS Director at Shore Memorial Hospital in New Jersey, about how this industry can best align recent graduates of HIT certification programs with training and jobs. Some of you may have noticed several comments left on that post by Sean McPhillips, a man of many hats. He is currently an adjunct instructor at Cincinnati State – a community college in the HITECH College Consortia; project manager at the Kentucky Regional Extension Center; and creator of the HITECHWorkforce.com, a free resource to help students enter the HIT work environment.

In his comments, he advocates for a mentor-protégé program: “Students still need some more help finding jobs. What I think needs to happen is a “Mentor/Protégé” model. That is, pairing students with industry professionals who can mentor them into the industry. I’ve passively done that…to success. I think that will work.” He later followed up with the news that he hopes to work with HIMSS, which is developing a similar program, to get this model off the ground.

I recently had the opportunity to speak with McPhillips a bit more about his idea. I was eager to find out just how he plans to jumpstart it:

It seems as if you’ve been kicking this idea around for a while. How did it come about?
Being with the extension center, I’ve mentored a handful of people along the way, and I think there needs to be a more structured process so that students coming out of these [HITECH College Consortia] programs who want to be mentored have a place to go, they know how to get and stay engaged in the process. I think that there is with HIMSS, but I don’t think it’s really been tightly coupled with the workforce development program.

When I spoke with Helen Figge, Senior Director of Career Services at HIMSS, she was really excited to talk with me, and pointed me to HIMSS’ career development page to look around and see what they have out there. I’m thinking of how we can connect [what they’re already doing] into the workforce development program within the overall HITECH project structure, so that we can connect students who come out of these programs with their local HIMSS chapter, which could then pair them up with a mentor that’s in their region. That’s what’s really missing. That’s what’s really necessary to get people plugged into this profession – especially if they’re coming from outside of this profession.

HIMSS does not already have some sort of relationship with the college consortia?
They kind of do, but I don’t think it’s really tightly coupled. I think HIMSS recognizes this, so they’ve been developing their career development program. They’re near completion of a new, entry-level certification called the CSHIMS certification. That is something where you don’t need to have a whole lot of experience in health information technology, but you need to demonstrate some degree of knowledge in subject matter to obtain that certification. That might be a good way to help these students take the next step into the profession, when they’re looking to get a job. That could be part of the whole mentorship program concept.

Isn’t there a double-edged sword to it financially? Wouldn’t students have to become paying members of HIMSS, and then would they have to pay for certification? If they’re looking for jobs, finances might be tighter than usual.
That’s a great point. The question is, what are the costs associated with certification and becoming a member. There is a student membership discount. There’s a cost to certification, obviously, so these are things that are to be considered. That has not escaped me, so that’s going to be part of my brainstorming session. I’m going to meet up with them in Vegas when I go out to HIMSS.

One of the things I want to be able to do is make this attractive for people, particularly students, and if they have to lay out $500 or $1,000, and they’re already unemployed or they’re financially strapped, it becomes not just a double-edged sword, it becomes a disincentive.

I wonder if the vendors couldn’t get involved and offer scholarships.
It’s funny that you mention scholarships because that might be something the local HIMSS chapters can do. I know the Ohio HIMSS chapter used to do a $1,000 scholarship every year for students. So this might be something that the boards or the individual chapters could subsidize.

If you’re in the HITECH workforce development program, maybe HIMSS would be willing to waive membership for one year. That might be something they may be interested in doing.

This is part of the whole brainstorming session that I’m going to try to have over the next month or so. I’ll vet this through HIMSS over the next couple of weeks and hopefully we’ll come up with a good strategy by the end of February. And then we’ll start piloting it in the March timeframe.

I hope to run into McPhillips in Vegas to see how his chat with the HIMSS career development folks is coming along. It’s nice to know that one industry insider’s idea, and subsequent blog comments, might actually create job opportunity in the industry.

Related posts:

  1. Finding an EMR Job Champion
  2. Emdeon Gets in the Holiday Spirit with Donation of EHR Technology
  3. EMR Job Seekers Get Their Big Break


January-17-2012

12:22

I recently saw a tweet to the National Conference of State Legislatures (NCLS) list of “Top 12 Legislative Issues of 2012.” It’s an interesting look into issues that state legislatures will be dealing with in 2012. Plus, it makes an interesting observation at the outset that state budgets have been cut so much in past years that lawmakers won’t have to focus all of their initial energy on budget shortfalls.

Most of the list is not surprising with managing the state budget and jobs are at the top of the list. However, there are a couple healthcare and health IT related sections in their list of top government issues as well.

One of the issues is Medicaid: Efficiencies and quality. It talks about how the tough economy is making the Medicaid budgets in states a real challenge and many are looking for cost containing actions. Plus, it points to ACO type reimbursement based on patients’ health outcomes, medical homes and streamlining services. The ACO part was quite interesting to me. I wonder how much of an effect lack of Medicaid budget will push forward a new model of healthcare.

The disturbing part of the report comes in the “Health: Reform in the states, health care exchanges, technology and benefits. Here’s the section on health IT, the EHR incentive money and HIEs.

HEALTH INFORMATION EXCHANGE: One focus for state legislatures in 2012 will be how to move health care providers, especially those participating in the Medicaid program, toward the adoption of certified electronic health records (EHRs). Essentially, instead of having a different health record at each doctor or provider you visit, an EHR will serve as one file that all of your doctors can see. EHRs, once fully implemented, are expected to provide doctors and health professionals with easier access to patient histories and data, resulting in cost-savings and better health outcomes by removing costly errors and duplications in services.

I love how this basically assumes that by having widespread adoption of EHR software, that we’ll then have one patient record that each doctor you visit can see instead of having a different health record at every doctor. Of course, those of us in the EHR world know that this is a far cry from the reality of EHR software today. In most cases you can’t even share a patient record with someone using the same EHR software as you let alone sharing a patient record with a doctor who is using a different EHR.

The sad part is that whoever wrote these legislative issues must have realized that there was some issue with EHR software exchanging information, because then they wrote the following about the state HIE initiatives.

In addition, states are responsible for building and implementing health information exchanges (HIEs) where those EHRs can be accessed by health care providers. HIEs function like an online file cabinet where your medical record is securely stored, and can be accessed by any doctor or health care professional you visit. By mid-year 2012, every state should have Medicaid EHR Incentive programs in place and will be working toward building an HIE by late 2014 or early 2015 as required by deadlines attached to federal cooperative agreements.

So, wait. If EHR software has created one file where any doctor can access our patient record, then why do we need “an online file cabinet” for our medical records? We know the answer is that we need the online filing cabinet because EHR software isn’t connected and there isn’t one patient record. Each doctor maintains their own patient record and that’s not going to change any time soon.

The above quote also implies that every state is working towards an HIE program per the federal program. I must admit that I haven’t gone through every state, but is every state working on an HIE? I certainly know there are a lot of states working on some sort of HIE project, but I didn’t think that every state had funding for HIE. I guess maybe the question is whether there is any state that doesn’t have some sort of HIE program in the works.

Reading issues described like this, you can understand how government passes legislation with limited understanding. Based on this resource, EHR software creates one patient record. Wouldn’t that be nice if it were the case?

Related posts:

  1. How do ACOs Deal with Non-compliant Patient?
  2. Watching the Leaves Fall and EMRs Install in North Carolina
  3. What’s Next in Health Information Exchange (HIE)?


January-16-2012

10:06

EMR and EHR Readers, have you already started breaking your New Year Resolutions? I know I have. My New Year resolution was a very unambitious I will exercise at least every other day, and I couldn’t hold on to that for a week. However, all is not lost. Even if you’re falling short on fulfilling your resolutions, you can still make a compelling video on some kinds of health IT related resolutions and maybe walk away with a decent cash prize. Don’t know what I’m talking about?

The Office of National Coordinator on Health IT is hosting a health IT challenge. Participants need to create a short (upto 2 mins) in length video that covers:
a) what your health resolution for 2012 is
b) how you will use IT to fulfill your resolution and
c) how you maintain your resolution using health IT tools.

Here are some examples listed on the ONCHIT website:

I will set up an online personal health record for myself (or another family member) so I can have all of my health information conveniently stored in one place.

I will ask my doctor for a copy of my own health records — electronically if available — and help him or her to identify any important information that may be missing or need to be corrected.

I will find an online community that helps me figure out the best ways to manage my health condition (depression, cancer, diabetes, etc.)

I will use an electronic pedometer to help me track my physical activity and will try to take 10,000 steps per day.

I will find an app on my smartphone to help me track my food intake so I can lose 10 pounds by my high school reunion.

I will sign up for a text reminder program on my cell phone to help me stop smoking or remind me to take my medications on time.

Please note that these are just suggestions, not listed topics. In fact ONCHIT encourages you to get creative and create your own HIT resolutions.

Of course, being as it is 2012, and well into Web 2.0fication of our lives, it’s not enough to make resolutions about improving our health. If you want to participate in the ONCHIT challenege, you’ll have to find ways to incorporate health IT into your resolution. I’ve worked pretty much my whole adult life, barring some exceptions, in the IT industry. But even so, I believe that IT can only solve some classes of problems, so I’m a bit wary when developers and programmers bring their hey-I-can-create-an-app-for-that attitudes whenever they’re confronted with any problems. That said, I do think some aspects of health IT can be useful. And I’m excited to see what creative things people will come up with.

No related posts.


January-13-2012

12:40

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I met someone at a conference who commented that they liked this series of posts. I hope you’re all enjoying the series as well. This is the second to last post in the series of EMR tips

10. Build performance dashboards, not just quality dashboards
Yes, Dashboards can work well for clinicians, but for support people as well. If you start measuring something and displaying the results of that measurement, then the measurement improves. Study after study has shown this.

9. Flexibility with physician devices is important, but you still need to standardize
I think this is a little bit of an evolving issue. However, it’s unreasonable to expect your IT staff to support every platform, every version, and every type of device out there. Tech innovation is moving way too fast and an attempt to go this route will lead to failure. Create some standards so you don’t have your IT staff spinning their wheels and cursing your name for a bad policy.

8. Do time studies
My gut reaction to this one is two fold. First, get the data. Don’t assume you know the data. Get as much data as possible and focusing on the time it takes to do things is one of the best places to get data since this is incredibly important for users. Second, don’t shy away from the truth. If your EHR software has doubled the time it takes to do something, don’t be afraid to find that out. It’s better to know that there’s a problem and try to fix it than to let the problem fester because you didn’t want to know the truth.

7. Make sure IT shadows the clinicians
I’d probably take this one step further. If your IT doesn’t want to shadow the clinician, then you might want to find other IT. There’s no way that IT can help to design the proper system for the clinicians if they don’t understand the daily processes that the clinician has to do. Clinicians need to be willing to let IT in on what they do as well. It takes two to Tango and this is certainly true when you’re talking about implementing an EHR. It’s not nearly as pretty if they aren’t dancing together.

6. Use predicative analytics
I’m definitely not an expert on predicative analytics and its application, so I’ll just give you Shawn’s summary:
Predictive analytics are old hat in most industries. However, health care hasn’t put PA in a real forefront of the clinical practice. If you want your physicians (especially in a ED / UC) to be able to prepare for trends due to environment or time, make sure to have PA built into your EMR and easily available for all providers.

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.

Related posts:

  1. 101 Tips to Make Your EMR and EHR More Useful – EHR Tips 81-85
  2. 101 Tips to Make Your EMR and EHR More Useful – EHR Tips 61-65
  3. 101 Tips to Make Your EMR and EHR More Useful – EHR Tips 41-45


January-12-2012

13:16

As most of you know, I’m attending the Digital Health Summit at CES this year. As happens at most conferences, it’s hard to blog about the happenings at the conference while attending the conference. Particularly with all the CES traffic issues (it’s a literal zoo) and the packed CES Press Room. Although, I must admit that I haven’t found too many things all that impressive. More on that later.

For today, I thought I’d give you a little picture view of what I call the Garden of Eden booth that United Health Group has at CES (click twice to see full size image):

They seriously have grass on the ground and a wood path through their booth. Plus, they have some of the only benches at CES (many really enjoyed those including myself). They’re also doing the pedometer promotion they did last year at CES and that they did at mHealth Summit, but this time you record your findings through the OptumizeMe app. I better win the iPad for all the walking I’m doing at CES. At least this time we’re not up against the exercise demo lady in the booth across from United Health Group. That was totally unfair (No, I’m not bitter).

Also, I’m surprised how few people know about SOPA. So I thought I’d do my small part to get the word out to more people. SOPA is an abomination that they’re trying to push through Congress. Here’s the tweet I sent out recently about it:

As you can see I’ve put the STOP SOPA badge on my Twitter icon and will be doing it on some other places, likely including the blog logo above. I’m good with legislation that actually works to stop copyright infringement, but SOPA does nothing to stop it and does a lot to really screw up the internet as we know it today. I hope others will join me in helping to stop SOPA. This weekend I’ll see if I can do a full post on why SOPA is bad if people are interested.

No related posts.


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April-26-2010

15:40
Over the last couple of weeks I have been running across various success and failure stories of EMR implementation in various settings, ranging from small practices to large hospital wide implementations. 

The number one factor in a successful EMR implementation from all the read reports have been due to physician/surgeon buy in.  Makes sense, after all these are end users of the applications and if you don't have anyone on the provider side vying for a successful workflow adaptation, there is no reason to implement an EMR.  Also, if you have an M.D. as your champion, won't the rest of the staff have to buy in for fear of replacement of someone who will?  I know in other occupations, what the boss says, goes.  The true is same in healthcare, no?

The next seemingly most important factor is the ability to customize the application in a way that will best benefit the providers.  This is absolutely a main component in the success factor of an EMR in my opinion.  Vendors have to do what they can to include everything in their system that a practice, clinic or hospital may use.

In a hospital system, this problem is very clear.  A hospital system has to be a nightmare to the specialists who use it.  Why would a provider want to sift through literally thousands of medications when they typically only prescribe certain ones for their patients.  This is where careful planning and delegating comes in.  The customer needs to understand that the hospital system is meant to meet the needs of all providers in the entire system.  It is recommended that each specialty department within the community appoint select staff to create a list of "Favorites" within the medications, procedures, diagnosis, orders etc. tabs.  This way, time will be saved when completing a patient visit.

In a smaller setting, I have to recommend going with a specialty specific vendor.  In doing this, the provider will have a more robust system specifically catered to their needs and will not include any additional data fields that they will never have a need for.  The specialty specific vendors are also more likely to already have certain reporting tools already preloaded in the system to generate specialty specific and relative reports, such as those required for Centers of Excellence.  Exemplo Medical (www.exemplomedical.com)  is one such company that develops specialty specific software.  For example, Exemplo's application for Breast Cancer, eMD for Breast Centers, is an application designed in conjunction with Breast Surgeons and staff that only shows pertinent workflows that a typical Breast Center or Practice may use.  The workflow includes specific data fields for patient visits, orders, medications, procedures and so on.  They even have a specific report that automatically generates a NQMBC report that is easily submitted to the National Consortium of Breast Centers for their COE compliance.

Of all the success stories these two themes: provider buy in and customization seem to be at the top of the list and perhaps the easiest to attain.  Some may disagree with that statement of being "easy to attain" however if a provider has been given a clearly painted picture of the benefits of EMR implementation, then it should be a no brainer on their end.  As for the customization...providers do your homework, there are wonderful systems out there that you will be amazed to find how easily adaptable they are to any practice.


December-16-2009

9:52
Two studies were published in the Archives of Internal Medicine this past Monday showing "The risk of cancer associated with popular CT scans appears to be greater than previously believed".

I originally read this article in the WSJ and they included a nifty graph showing the increase in CT scans over the years (1993-2006, and included projected 2007 numbers). I can't say I was shocked. Obviously there will be an increase, population increases year over year.

As expected, the American College of Radiology (ACR), released their own statement in response to the recent studies. The ACR statement was wonderfully put together and basically stated that if an imaging center abides by the standards put forth, then there should be no increased risk as the benefit of the scan outweighs the risk. Seems like common sense to me.

This is where I believe that patients need to take more responsibility for their own health by asking questions instead of just going along with whatever their physician says. After all, when you break it down, its a business that strives to make a profit. I am not putting down all clinicians who perform CTs, I am putting down the clinicians who abuse the system to make the money to pay for their fancy state-of-the-art equipment. Those machines come with a hefty price tag and the ROI must be met somehow. Some clinicians go about it the right way, others don't unfortunately. They are human after all.

Now for the other issue with this...clinicians have to protect themselves. If a patient comes in complaining of a mild condition that a CT may show, its up to the doc to determine the severity of the situation. This is a very fine line due to the liability involved. Unfortunately we live in a world of money hungry individuals who are willing to sue if their coffee if too hot. This is where the relationship of the physician and patient comes into play. There has to be a level of understanding and trust for the situation at hand.

Personally, I have a wonderful relationship with my GP and others specialists that I see because I feel comfortable with them. If you don't feel comfortable asking the hard questions with your provider, maybe its time to look into a different one. Good ones are out there, more good than bad fortunately for us. But it is up to us to sift through the population to find one that fits best. Unfortunately for doctors now a days, it is getting harder and harder to make money and that is unfortunate because I believe that some of the "good" docs may be susceptible to becoming more focused on business side rather than patient care, which I can't say I don't necessarily blame them, they have bills to pay too, big ones like student loans, salaries, mandatory EMR adoption etc.

Now for my cynical comment....I wonder which diagnostic test or treatment or whatever will be next to take some heat in order to cut healthcare costs? Keep in mind this is at the expense of the public who desperately wants change, but I have to ask, at what price? So far it has been more about money than human lives.



December-11-2009

11:43
The National Consortium of Breast Centers (NCBC) has just released their position statement regarding the recent mammography guideline changes:

“The National Consortium of Breast Center's Board of Trustees has given their consent to the following position statement reflecting their stand on the issue of mammographic screening, in response to the recommendations made by the US Preventive Services Task Force.

National Consortium of Breast Centers, Inc.

Position Statement regarding the Mammography Screening Recommendations of the United States Preventive Services Task Force (USPSTF)

The National Consortium of Breast Centers (NCBC), the largest national organization devoted to the inter-disciplinary care of breast disease, requests the USPSTF rescind their new position on mammography screening.

The U.S. Preventive Services Task Force (USPSTF) published a paper detailing model estimates of potential benefits and harms to women screened for breast cancer with mammography.1 They provided an updated USPSTF recommendation statement on screening for breast cancer for the general population that alters currently accepted guidelines for women over 40 years old.2

The NCBC opposes the new guidelines as written. We cite specific evidence that screening mammography leads to early detection which leads to improved survival.3 In every country starting population screening, mortality declines coincide with onset of screening, not systemic therapy. These USPSTF models are not based on sound data, namely different denominators in the “harms” vs. “benefits” groups leading to invalid comparisons. Recent data from randomized controlled trials reveal significant mortality reductions evident approximately five years after screening programs were initiated. The reductions in age-adjusted, disease specific mortality (30-40%) since 1990 define screening program benefits not seen in the prior six decades. In the United States, these mortality declines continue at a rate of approximately 2% per year. 4 This mortality improvement counts as a remarkable public health achievement.

In addition, the USPSTF panel (comprised almost exclusively of primary care physicians) did not include breast imaging specialists nor was it represented by any of the multiple other specialists who collaborate to optimize patient outcomes. These specialists include pathologists, surgeons, medical oncologists, radiation oncologists, reconstructive surgeons, technologists, geneticists, nurse navigators, educators and others.

The NCBC does not understand the assumptions used by the USPSTF to value human life. We note the cited literature was selective and failed to acknowledge equally powerful and credible peer-reviewed literature, which supports currently accepted breast cancer screening guidelines.

We would also like to note that quality of life has a significant value, not just survival. It is well established that if we discontinue mammography for women in their 40’s, the cancers eventually detected will be larger, more likely need more aggressive surgery, more likely need chemotherapy and more likely lead to other significant socio-economic concerns.

The NCBC requests input into future guideline development and vows to work with government, scientists and industry to keep the process transparent and keep the focus on the patient. We recommend further efforts target screening, risk assessment, education and awareness regarding the implications of positive and negative screening findings. Funding for further research is imperative and supported by the controversy these articles have generated.

Finally, we note the USPSTF article states, “whether it will be practical or acceptable to change the existing U.S. practice of annual screening cannot be addressed by our models.”1 The NCBC agrees with this comment and finds their screening guideline suggestions unacceptable. The NCBC believes many women’s lives will be placed at risk if current screening guidelines are altered. We respectfully request the Task Force rescind their position on this specific women’s healthcare screening policy.

# # # #

About NCBC: The National Consortium of Breast Centers (NCBC) is the largest national organization devoted to the inter-disciplinary care of breast disease. In keeping with our mission, to promote excellence in breast care through a network of diverse professionals dedicated to the active exchange of ideas and resources including: 1) To serve as an informational resource and to provide support services to those rendering care to people with breast disease through educational programs, newsletters, a national directory, and patient forums; 2) To encourage professionals to concentrate and specialize in activities related to breast disease; 3) To encourage the development of programs and centers that address breast disease and promote breast health; 4) To facilitate collaborative research opportunities on issues of breast health; and 5) To develop a set of core measures to define, improve and sustain quality standards in comprehensive breast programs and centers.

References:

1. November 17th edition of the Annals of Internal Medicine, Vol. 151, Number 10, 738-747.

2. November 17th edition of the Annals of Internal Medicine, Vol. 151, Number 10, 716-726.

3. Tabar L, Vitak B, Chen HT et al. Beyond randomized controlled trials: organized mammographic screening substantially reduces breast cancer mortality. Cancer 2001; 91: 1724-1731.

4. American Cancer Society, Breast Cancer Facts and Figures, 2009-2010.

All content and design © 2009 by the National Consortium of Breast Centers, Inc.”


As mentioned in the recent post, "Scrapping the Barrel to Support Health Reform", it seems like the current Health care reform plan is costing the nation a trillion dollars yet is taking away money from preventative care of deadly diseases, mainly its been cancer that has been hit the hardest.


The optimist in me at first said that with these changes, maybe techniques and other medical procedures will be forced to improve based on this change. I still believe this will be the case, but does one outweigh the other? The best approach would be to do both of course. Maintain the guidelines that have been proven effective through various published trials, and allocate ARRA funds to increase R&D of new treatments or improved quality of current techniques. Who knows, there may be money left over from the HITECH stimulus funds by ARRA if physicians are unable to collect the 44k in order adopt EMR.

Once improved procedures allow for a change in the guidelines, then the change is warranted. If not, guidelines should not be altered.

The National Consortium of Breast Centers (NCBC) is currently the largest national organization devoted to the care of Breast Disease. Through their quality measures program, the National Quality Measures for Breast Centers (NQMBC), breast care centers have the opportunity to collect and standardized data to the NCBC in hopes to improve clinical care of Breast Cancer Patients.



December-7-2009

12:57
As usual, its been a busy few weeks in the Health IT world and things continue to get shaken up with many recent announcements.

In a press release on 10/22/2009 the Certification Committee for Health Information Technology (CCHIT) announced that they are seeking candidates to serve as Trustees and Commissioners.

Another press release on 11/13/2009, announced that CCHIT's well known Chair, Mark Leavitt will be retiring in March of next year after 5 years of service.

Once the first press release came through on my feed, I thought it was only a matter of time before this happened. Changes need to be made by the CCHIT to gain acceptance by many skeptics. Then I received the second feed, an interesting decision made by Dr. Leavitt to announce his retirement, especially since the CCHIT has been under major scrutiny lately for being the sole certifier of EMR systems and carrying a rather large price tag, so large in fact that most of the smaller vendors are unable to afford the certification. I'm just not sure if leaving his organization now, especially announcing it, was the greatest business decision for the CCHIT.

The CCHIT has also been accused by it's critics for catering to the larger EMR vendors that also conveniently sit on their Board of Trustees and Commissioners.

I find it quite coincidental that after undergoing such a large amount of scrutiny for favoritism that the CCHIT is now holding interviews to replace some of it's Board Members. I know that you are probably thinking, damned if you do damned if you don't. Thats not where I'm headed. I want to give kudos to the CCHIT and Dr. Leavitt for their accomplishments in the past years as well as the realization, or wake up call, that changes need to be made their board, specifically the board member ratio, which I'm sure will be affected. The positions are open to members of physician practices and hospitals, payers, health care consumers, vendors, safety net providers, public health agencies, quality improvement organizations, clinical researchers, standards development and informatics experts and government agencies. I would imagine that the vendor to healthcare provider ratio will be severely affected.

As for Dr. Leavitt leaving, personally I don't think this is the greatest time the CCHIT during this critical time, especially when the certification business is open for business according to Health and Human Services. Who know's, maybe its a career move...he would be a perfect candidate to head up a start-up certifying company.

That brings me to my next topic, the Drummond Group may prove to be a worthy alternative. They had their own press release on 11/02/2009 that they will submit to become a certifying body. I haven't heard of any progress, but if anyone out there has heard anything, please let me know. For those of us who are new to the Drummond Group, they are a company specializing in interoperability testing. Rik Drummond, CEO of Drummond Group was quoted in the press release saying, "Drummond Group has been supporting Fortune 500 industries and government by certifying the transfer, identity and cybersecurity of their internet information flow over the last ten years. We have also done testing for the CDC, DEA and GSA. Certification of EHR is a natural extension of our testing program, and we believe we can provide great value for the medical community. We look forward to the publishing of the ONC requirements in the days ahead so we can get started."

There seems to be a lot of progress within the Certification realm. My only other questions and worries are targeted towards getting everything in place in time for physicians to get their reimbursements.



November-20-2009

10:41
What a past couple of days in the Healthcare realm. First of all, the Health Reform bill passed in the House with a price tag of $1 trillion. The money has to come from somewhere and it seems like it is coming down to the preventative care of women as for now. In other releases, separated by one day each, new guidelines came out for mammograms and pap smears. Another release just came out regarding a 5% tax on non-elective plastic surgery procedures.

I have to wonder who is influencing these recently altered guidelines and their research findings. I have my opinions on research...data can be manipulated to prove a desired point. I have to assume this is what is going on in these recent releases regarding the preventative care for serious cancers that specifically target women. For the past year I have heard more news to promote preventative care than ever before. Why? Because it saves lives and yes money too. So now, why are they changing these guidelines that promote a higher level preventative cancer? Has anyone thought that the numbers may be down because of the preventative measures that have been in place?

With a $1 trillion price tag, one has to wonder is its to free up funds to pass this bill. Unfortunately, these changes are going to be just the beginning I believe.

As for the elective plastic surgery procedures, in 2008 it was reported that $10.3 billion was spent on these procedures. People choose to get certain procedures to benefit their quality of life in some way, which can ultimately change certain mental conditions such as depression and anxiety which both play an enormous factor in the progression of other serious health factors. Not everyone who elects to get plastic surgery are the typical "trophy wife" getting a different nose every 5 years, its also those people that have little money to pay for a procedure to correct something that may have been caused by an accident for example. Now, these people who have to spend thousands of dollars, that may have had to scrape it together, are expected to spend 5% more. Is that fair to the little girl who was in a car accident and suffered injuries to her face that left her scarred for life without plastic surgery? This is just an example, but it is also a reality of how people are going to be affected by this health care reform push.

I believe something has to change in Healthcare, but at what cost? Certainly not time, after all the current administration is rushing this thing out without the proper time to think of how it will actually pan out in the future.

Its going to be an interesting couple of years to say the least.



October-19-2009

11:11
Since the inception of ARRA, there has been mixed emotions of whether or not throwing money at a situation will benefit the struggling incumbent health care system. Having only worked in Healthcare IT for a limited amount of time I believe I can shed some light on the subject from an outsider's perspective rather than a biased, perhaps jaded, insider's view.

First lets talk some basics. Approx $19.2 bill in incentives available to physicians who adopt a certified, meaningful use EMR system. This breaks down to around $44k/provider on up to $64k/provider depending on Medicaid/Medicare patient ratio (the more CMS customers, the higher stimulus awarded). Incentives start this 2010 and penalties start 2015.

The main debates have been lying in the "certified" and "meaningful use" or simply "MU" realms. Let's first talk about certification. The only certifying body to date is the CCHIT which was spawned off of HIMSS and even has a former HIMSS member as its leader. For those of you that are new to this area, the Certifying Commission on Health Information Technology (CCHIT) is a non-profit group based out of Chicago, near HIMSS HQ, that is comprised of different executives who have vested interest in the large EMR vendors...because they run and/or work for them. That is all I will rant about for this post on the CCHIT.

The next big issue, which needs to be radically simplified is MU. Every practice and specialty are different. Meaningful use may vary from specialty to specialty. This needs to be a simplistic model, not a complicated matrix that was originally released, for everyone to understand. There also has to be a lot of gray area as well in this definition to allow for proper payment if a practice is able to show that they use MU.

These 2 criteria, certification and MU, have yet to be decided on. Deadlines are set, but as we all know and have experienced, they may be moved again.

So back to the original question in the title, has the stimulus money caused a boom for HIT or has it been a bust thus far?

Certain areas of the HIT market has seen an increase due to the stimulus funds for HIT for sure, but on the same note, many HIT vendors have seen a lull in sales. Why, when there is at least 44k on the table and adoption needs to happen quickly in order to qualify for the 1st and biggest stimulus handout.

The stimulus money has put providers on a bit of a "wait and see" mentality. There are far too many providers who do not see the value of EMR. Should this stimulus money have been allocated differently? Should more money have went to education and research rather than purchase and implementation?

EMR is not a thing of the future. It is a technology that has been around and in use for over a decade. They have time over time proven effective, efficient and reliable. I am not going to go into detail because the case studies are out there. The only problems that I have seen are due to bad matches between vendor and customer, not the idea or technology itself.

Look at our world now, smartphones that allow us to answer emails while out of the office, telecommuting from home to save on overhead costs etc. Technology will continue to improve upon quality. Be it quality of care or quality of life.

EMR is a way to do both. The incentive from ARRA is there yes, but treat it as a bonus for adopting a new way of patient care and reporting to improve the overall quality of care and patient health for futures to come by adopting and embracing a sound technology that you may, or may not, get some extra cash from.



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Technical

ELINCS Connection

June-8-2011

17:33
Recommendation: Promote adoption and use of technical coding/terminology and lab data interchange standards.

•A collaborative of public and private organizations is needed to identify a “starter set” of LOINC® codes for the top 200–300 lab test codes in use across the country and to promote its broad adoption and use.
•A large-scale collaboration between ONC, the National Library of Medicine, and private sector organizations should strongly encourage the adoption and use of standards, such as LOINC® and the EHR-Lab Interoperability and Connectivity Specification (ELINCS), that align with standards supporting health IT and meaningful use.
•Medicare and commercial contracts should make incentives available to lab vendors to adopt and use LOINC®.

Full Report is available here.

May-19-2011

19:59

Every year CAP Today magazine posts a listing of the leading vendors for Physician office link software. This year there are 23 vendors.

Click here to view vendor listing.

May-19-2011

19:18
SmartlinkEMR in action at a physician practice in Carmel, Indiana.

At this implementation, the application aggregates reports from the Indiana Health Information Exchange (IHIE), LabCorp and Quest Diagnostics into a single database providing a one stop Patient Diagnostics Information System. Office staff are able to find patient reports in seconds instead of many minutes saving them chunks of time throughout the day.

The time savings from office staff is incredible as they report at least two to three hours saved in each workday.






May-19-2011

19:06
In March 2011 the California HealthCare Foundation, in collaboration with a multi-stakeholder group, completed a draft version of the ELINCS Orders specification. Public comments were accepted through April 11, 2011. The final specification will be published in summer 2011.
Click here to view the draft specification.

March-6-2010

18:23

The Centers for Medicare and Medicaid Services (CMS) yesterday clarified that a 1988 law setting up national quality standards for medical testing labs does permit the labs to electronically exchange test data, an essential feature of the administration’s health IT adoption plan.

In issuing guidelines on the Clinical Laboratory Improvement Amendments (CLIA), CMS aimed to clear up confusion about the impact of the law on fledgling health information exchanges and networks.

“We have the concern that the interpretation of CLIA has sometimes stood in the way of easy info exchange,” said Dr. David Blumenthal in remarks made yesterday at the Healthcare Information and Management Systems Society annual conference in Atlanta.

In some cases, for instance, providers said they believed the law permitted only physicians who ordered a test to receive the results, according to hearings conducted last year by a panel of the Health IT Policy Committee, which advises Blumenthal.

In its revised guidance, CMS said lab results could be sent to the ordering physician as well as others designated by the physician. That includes providing patients access to their lab data unless a state specifically prohibits it, CMS said.

full article here...

January-20-2010

11:08

Experts predict a surge in the number of physicians using electronic medical record systems

By dangling as much as $20 billion in front of physicians to encourage their adoption of electronic medical record (EMR) systems during the next few years, Congress has created a new and expensive challenge for the nation’s clinical laboratories. That challenge is the need for every pathology laboratory to establish a high-function interface from its LIS to the office-based physician’s EMR.


http://www.darkdaily.com/clinical-pathology-labs-face-an-increasing-need-to-interface-with-electronic-medical-records-emr-119


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Blog url: 
http://labinterface.blogspot.com/
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Influential
MedTech and Devices

EMR Medical Software Information and Resources

November-13-2008

0:42
Of the 36% of physicians with an electronic health record (EHR) system surveyed by Medical Economics, more than half (58%) have had their EHRs for more than two years. Only a small group (6%) of respondents said their practice had adopted an EHR within the past six months.


The survey also found that of the 65% of physicians without an EHR system in place, approximately one in three (30%) said they planned to adopt an EHR system within the next year.

What were the top three reasons for adopting an EHR system? Physician respondents cited better documentation, improved access to records and enhanced quality of care, according to the survey. The ability to defend a malpractice suit was ranked as the least important reason by survey respondents.

The results are based on a December 2006 survey of 548 physicians, and were published in Medical Economics.

November-13-2008

0:42
There are two schools of thought when it comes to implementing an electronic medical records (EMR) system.

One camp says you should take baby steps; learn to crawl before you try to run. We'll call this the incremental approach. The other group advises making the transition to electronic records all at once; face your fears, work out the kinks and enjoy your new software. Let's call this one the big bang approach.



Each implementation strategy has benefits and drawbacks, especially depending upon the size and type of physician office that will use the EMR. The incremental approach tends to lend itself best to larger physician practices, multi-specialty groups and environments where "office politics" runs high. It also works well when you're implementing a very complex electronic medical record system. The big bang approach, on the other hand, tends to work well with small (fewer than 10 physicians) practices, or offices where strong leadership exists.

Here are some of the pros and cons associated with both implementation strategies. If you're considering an electronic medical record purchase, think about which approach might work best in your practice.

The Incremental Implementation Strategy

The Pros
• Reduces "change shock" to staff and physicians
• Spreads out costs of software and implementation over a longer period of time
• Portions of EMR functionality are rolled out in phases across all units
• In many cases, the project is less likely to lose momentum

The Cons
• Total training, implementation costs may be higher
• Longer overall implementation of your electronic medical record
• ROI is not achieved as quickly
• Morale may decrease as implementation lags
• You may introduce a training lag if implementation phases are too far apart from training sessions

The Big Bang Implementation Strategy

The Pros
• Everyone goes live at once
• Paper processes cease shortly after the EMR is "turned on"
• You're less likely to end up with a dual system
• You'll shorten the parallel paper/EMR operation period
• ROI is achieved more quickly
• When it is over, it's over!

The Cons
• If you choose a complex electronic medical record system, there's a higher risk of blow up
• You'll likely encounter significant productivity reduction when you begin using the software system, and this could last for up to three months
• Inadequate planning may jeopardize full implementation
• Staff or physicians resistant to change may become overwhelmed

No matter the strategy you choose, it's important to stay focused (and committed!) to successfully implementing your electronic medical record system. Even the most affordable EMRs represent a considerable time and financial investment. With a little strategic planning, you'll get the most out of your software.

November-13-2008

0:41
A new survey by the Healthcare Information and Management Systems Society (HIMSS) finds a majority of respondents believe electronic medical records systems (EMRs) offered by health insurance plans should have robust privacy and security features.

Survey respondents were most likely to believe that EMRs (also known as electronic health records, or EHRs) offered by insurance plans should include insurance company data, such as claims data. However, about two-thirds of respondents also said they believed that payer-offered EMR systems should include clinical data derived from hospital and ambulatory visits, as well as consumer-generated data, writes iHealthBeat.org


Twenty-four percent of survey respondents said they thought payer-offered EHRs would boost patient safety, while 21 percent said they expected them to verify insurance eligibility and benefits. Improved billing collections and improved quality of care each were selected by 18 percent of respondents.

The results were based on a survey of 101 physicians in July, 2007, by HIMSS.

November-13-2008

0:41
Election day is more than twelve months away, but the contest for president of the United States is already shaping up to be a fierce one. Many presidential candidates have either released or announced their intention to release a comprehensive plan for health care reform. Following is an attempt to summarize each candidate's position on health care information technology such as e-prescribing and electronic medical records. You are encouraged to visit each candidate's Web site on your own, as their positions may change in the future.

Joe Biden (D): His home state of Delaware is a leader in adopting new health information technology, and the candidate notes the Delaware Health Information Network (DHIN) is a state-wide health information and electronic data interchange network for public and private use. Biden says the potential savings to the health care industry from full adoption of electronic medical records is substantial. He notes that researchers at the RAND Corporation estimated that full adoption of electronic medical records could save $77 billion annually. RAND also determined that by 2004, 15 to 20 percent of U.S. physician offices had adopted electronic medical records systems.

To get to 100 percent adoption of EMR/EHR software, Biden says he would invest at least $1 billion dollars per year in moving to electronic health records systems, provide grants to states to develop electronic medical records and other health IT systems, and assist hospitals, medical facilities and doctors in upgrading to electronic record systems and implementing them in their practice.

Electronic Medical Records Information and Resources

Sam Brownback (R): Brownback advocates for lifetime electronic medical records. On his Web site, he notes that he is " ... the sponsor of a bill that would offer patients both ownership and control over their personal health information and ensure that personal health information is not used by third parties without the consent of the patient. This proposal would also offer patients debit-like cards containing their private and portable personal health information."

Hillary Clinton (D): In her comprehensive plan for health care reform, Clinton pledges to ensure that all health care providers and insurance plans use privacy-protected information technology. She says her proposal will give doctors financial incentives to adopt health information technology and facilitate adoption of a system where high quality care and better patient outcomes can be rewarded. Clinton also notes on her Web site that the Business Roundtable, SEIU and AARP estimate that “widespread adoption [of such IT reforms] raises the potential savings to $165 billion annually.”

Chris Dodd (D): In his plan, Dodd says health insurance premiums will be affordable based on leveraged negotiating power, spreading risk, reduced administrative costs and incentives for adoption of information technology and savings from better care. He implies that technology such as electronic health records and practice management software systems will help integrate clinical information tools, monitoring technologies and care management such that chronic diseases are kept under control.


John Edwards (D): Edwards advocates for universal health care, and healthcare information technology will be critical to ensuring his model delivers high quality care without breaking the bank. On his Web site, the presidential candidate notes: "Many insurers and hospitals still rely on cumbersome paper systems and incompatible computer systems. The outdated 'paper chase' causes tragic errors when doctors don't have access to patient information or misread handwritten charts. It creates needless administrative waste recreating and transporting medical papers, performing duplicative testing, and claiming insurance benefits. Edwards will support the implementation of health information technology while ensuring that patients’ privacy rights are protected."

Edwards pledges to support new technologies, such as handheld devices and electronic medical records, to give doctors the latest information at their fingertips. Edwards also promises to support public-private collaborations that reduce medical errors through electronic prescribing (e-prescribing).

Rudy Giuliani (R): Giuliani has pledged to invest in health information technology to reduce medical errors, improve efficient and detect health threats, noting that thousands of hospital deaths each year are attributed to preventable medical errors. He sais public-private partnerships to improve and set standards for health IT but without overbearing regulations can play a major role in improving quality of care and reducing health care costs.

Mike Gravel (D): It does not appear that Gravel has a position on the role of information technology in health care reform; if he does, we were unable to find it.

Mike Huckabee (R): Huckabee is famously known for losing 100 pounds after being diagnosed with diabetes, and for his steadfast support for preventive health care. He has not released a comprehensive plan for health care reform, but he does note that health care can be made more affordable by adopting electronic record keeping, among other strategies such as medical liability reform and health insurance portability.

Duncan Hunter (R): There's no mention of health care on his Web site, let along discussion of electronic medical records.
Kucinich's proposal is for universal, single payer health care plan completely funded by the government.

Dennis Kucinich (D): Kucinich has proposed a universal, single payer health care plan completely funded by the U.S. government, called the United States National Health Insurance Act (H.R. 676). In his proposal, he calls for the creation of a "standardized, confidential electronic patient record system in accordance with laws and regulations to maintain accurate patient records and to simplify the billing process, thereby reducing medical errors and bureaucracy," and that "notwithstanding that all billing shall be preformed electronically, patients shall have the option of keeping any portion of their medical records separate from their electronic medical record."

John McCain (R): He says that reforms to federal health care policy and programs should focus on enhancing quality while controlling costs, but we were unable to find any references to health care information technology in his campaign materials.


Barack Obama (D): In his Plan for a Healthy America, Obama calls for lowering costs through investment in electronic health information technology systems, acknowledging that paper-based medical records make it difficult to coordinate care, measure quality and/or reduce medical errors. He also says processing paper claims costs twice as much as processing them electronically.

Obama pledges to invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records. He will also phase in requirements for full implementation of health IT, and promises to "commit the necessary federal resources to make it happen." He also pledges to ensure that these systems are developed in coordination with providers and front line workers, including those in rural and under served areas.

Ron Paul (R): He's a Medical Doctor, but he has not proposed a plan for health care reform, and makes no mention of electronic medical records in his campaign materials.

Bill Richardson (D): To achieve health care for all, Richardson proposes streamlining health care administration by using "21st Century Health Care Bonds" to invest in health information technology, thereby saving the system $22 billion per year.

Mitt Romney (R): In August, Romney shared his health care reform plan with physicians in Florida, where he underscored the importance of bringing market dynamics and modern technology to health care. In his presentation, Romney supported the idea of federal incentives to foster more widespread adoption of electronic medical records technology.

Tom Tancredo (R): He has announced a very basic plan for reform, but there's no mention of electronic medical records or other types of information technology.

Fred Thompson (R): Thompson says he is committed to a health care system with five key attributes. One of those five guiding principles: "Modernized delivery and administration of care by encouraging the widespread use of clinical best practices, medical information technology, and other innovations."


For more information on each candidate's health care ideas, visit the Association of Health Care Journalists.

November-13-2008

0:41
We know the adoption rate of electronic medical records software is low among physicians, but what about e-mail? Are doctors e-mailing their patients?

It turns out there's not much difference between the percentage of physicians who use an EMR and the percentage of doctors who regularly e-mail their patients. Thirty-one percent of physicians in 2007 said that they communicate with their patients via e-mail, up from 24% in 2005, according to a January 2007 survey by Manhattan Research. However, the remaining 69% of physicians said that concerns -- such as liability, lack of reimbursement and technology integration -- still remain barriers to adopting the technology.


The survey also found that most physicians approve of patients bringing information that they found online to an office visit. Sixty-five percent of physicians said it is a good thing when patients bring in information they found on the Internet, while 34% of physicians said it was a bad thing, according to the survey.

Many more physicians (50%) reported using a personal data assistant (PDA), most often relying on the device to store a prescription drug reference database, according to the survey.

Results are based on a telephone survey of 1,353 physicians in Q1 2007.

March-31-2008

18:15
A new research study by Purkinje, a healthcare technology and services firm, finds that three out of four (75%) Americans would prefer to have their prescription(s) filled in their doctor's office instead of a retail pharmacy if given the choice. The research was conducted by Opinion Research Corporation on behalf of Purkinje.

The study examined consumer attitudes of an FDA-approved service known as in-office medication dispensing or point-of-care dispensing. The practice involves distributing pre-packaged medications directly to patients at the point of care, saving them a trip to the pharmacy and allowing them to immediately begin their treatment.

Overall preference for office-based medication dispensing appears to be driven by the prospect of saving time and improving quality of care, according to Purkinje. A majority of respondents (84%) said such a service would be more convenient, and 62% said it would help them better manage their health.

According to their media statement, "Thousands of progressive medical and dental offices around the nation are adding medication dispensing as a way to heighten the patient experience and create a new source of revenue," said Tom Doerr, M.D., chief medical officer for Purkinje and a practicing physician. "Patients like the comfort of having their prescription filled in the privacy of their physician's office, and the convenience of starting their treatment right away."

Purkinje says software programs are usually integrated with in office medication dispensing services to double check to ensure patients are receiving the right medicine, cross-check against known allergies and look for potentially adverse interactions. Medications arrive in safety sealed bottles, they say, prepackaged offsite under the supervision of a licensed pharmacist. Apparently, point of care dispensing can also be integrated with electronic medical records systems.

Our own brief research suggests the practice of in office medication dispensing (or point of care dispensing) has been around for more than 20 years, although it has failed to meet initial expectations. Although some 15,000 - 20,000 physicians dispense medications at the point of care, the vast majority of doctors do not offer this service.

This could mean one of two things. Either in office dispensing is a promising but untapped new service for physicians, or its promises don't hold up in real practice. Nevertheless, it appears a majority of Americans are receptive to this type of medication service in their physician offices.

Fair disclosure: Purkinje is currently a sponsor of this blog. (Note their advertisement)
Blog url: 
http://electronic-medical-record.blogspot.com/
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Technical

A Scanner Brightly

December-8-2010

12:46
This article was written by Jodi Smith of HealthInsuranceQuotes.org, an online resource for those seeking the best health insurance quotes. HMO, PPO, POS… Huh? If you look at these commonly used acronyms and are completely clueless as to what they … Continue reading

October-26-2010

20:16
Back in 2002 I was asked to make a hospital-level report card for a couple dozen hospitals in New York on some Pneumonia measures. Seemed like a fun project, and it went off without a hitch. Since then I have … Continue reading

May-12-2010

9:43
My boss – Dr Anthony Shih – is co-author of the chapter “Achieving the Vision: Payment Reform” in the recently published book “Partners in Health”, available in Hardcover and Kindle. Partners in Health: How Physicians and Hospitals can be Accountable … Continue reading

May-3-2010

10:04
As many of you already know, health care transparency evangelist Paul Levy, CEO of BIDMC in Boston, is having a bit of of trouble with his professional life apparently colliding with his personal life. Details are unknown, but include an inappropriate relationship with a subordinate. Mr Levy apologised to his staff via e-mail for his lapse in judgement, and little else is known. Continue reading

March-24-2010

8:40
ATLANTA, Georgia, March 19, 2010 (LifeSiteNews.com) – A new poll reveals that President Barack Obama’s health care reform may push as many as a third of the nation’s practicing doctors into shuttering their offices and getting out of the medical … Continue reading

March-22-2010

12:12
I received a link this morning to a cutesy video wherein Doctor Marshall advocates for Congress to come visit a hospital on a field trip and truly learn what’s broken in health care. Obviously, a day late for me, but … Continue reading
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May-30-2007

10:12

We were included in a nice article on EMR consulting and it's impact on adoption.

Waldren says it often becomes a quandary for physicians           because they don’t have the financial resources or desire to pay           for expert advice, but they are reluctant to start the process of EMR           adoption due to fears that the wrong decisions will be made. “You           need to show value, and you need to build trust. Those are the two things           consultants have to answer for,” Waldren emphasizes. “I           do see some uptake [with EMR consultants], but I also see that they           have a difficult marketing challenge ahead of them [with physicians].”

That pretty much encapsulates both the article and our feelings on the subject.  But do click through so you can read my quotes!

March-16-2007

12:39

Buzz is growing for Sermo, an online information sharing community "developed by physicians, for physicians."  Check it out.

Welcome to the only online community where physicians around the nation exchange the latest medical insights with each other and improve patient outcomes - 24/7.

Link

March-16-2007

12:36

We've posted on Practice Fusion before here and the feedback we've heard was that using "de-identified" patient data to subsidize a free EHR was going to be a serious problem.  Practice Fusion just announced a partnership with Google wherein the web-based application will still be delivered for free but now it will be subsidized by advertisements that come up based on keywords in the patients' records.  No word as to whether the initial model has been scrapped or if this new concept is complementary.  One thing's for certain, it still raises the hackles of privacy advocates.

"It still comes down to the fact the company is using people's sensitive, personal information for profit," said Allison Knight, staff attorney for the Electronic Privacy Information Center in Washington.

Link

March-15-2007

9:49

We've seen much debate in the past on security and patient privacy.  Here's a brief reminder that (as we've argued) security is an ongoing process and not a one time fix.

“There’s nothing in security that you can do once,” says Kate Borten, president of the Marblehead Group, a consulting firm in Marblehead, Mass. “Risk assessment never stops. This is supposed to be ongoing.”

Everyone benefits when organizations focus on putting policies in place that make it more difficult to steal (or lose) sensitive data.

March-14-2007

11:04

FierceHealthcare.com posts on a recent survey of "550 randomly chosen general internists" that suggests that primary care physicians agree in principle that physicians should be rewarded for a high level of care but are not happy with the current P4P schemes.

While most PCPs felt that physicians should be rewarded for providing high quality care--provided that the measurements were accurate--less than one-third felt that current measures would do the trick. A majority (66 percent) felt that health plans and the government were unlikely to exert the effort to make such measures accurate. Roughly eight out of ten worried that pay for performance schemes would force doctors to avoid high-risk patients--or even kick such patients out of their practices.

Link

March-14-2007

10:45

Tim Gee at Medical Connectivity Consulting reviews the latest entry on the medical tablet scene.

Did I mention it has a 12 hour battery life? Wow, I'm impressed. We have yet to reach perfection, but this device comes close for a clinician carried use model. This is a very, dare I say, sexy device.

Unfortunately the target market is physicians. There are several large institutions that could spring for a device like this, but nothing like a majority of the hospital market. Another bit of a miss is targeting EMR applications - actual EMR adoption is quite a bit behind all the hype - although the early adopters will probably be the large institutions who might actually buy something like this for their physicians (places like Kaiser, Cleveland Clinic, Mayo and large university teaching hospitals come to mind).

Link

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January-19-2012

14:38


While I definitely had quite a bit of excitement over this year’s CES and Digital Health Summit, I have to admit that I ended up leaving CES a bit disappointed. I’m trying to decide if it being the fifth year I’ve attended CES is making me immune to the hype that surrounds the event or if I’ve just been going to too many conferences in general and so I’ve already heard much of the hype. At the end of the day, I describe this year’s CES as incremental versus trans formative.

There were a few exceptions of things that caught my eye while navigating the CES circus that are worth mentioning.

Ion Proton Genetic Sequencer
Probably the most amazing thing I saw for healthcare was the Life Technologies Ion Proton Genetic Sequencer. Plus, I’m not alone with this feeling. Dan Costa of PC Mag called it “The Coolest Thing I Saw at CES 2012.” To be quite frank, it is pretty amazing. It’s part of the amazing movement happening in bringing genomic data to healthcare.

The Ion Proton Genetic Sequencer (they need a better name) is awesome cause you can do a full genome in a day on a machine that costs about the same as an MRI machine. Plus, I personally think they’re just getting started on optimizing the technology. As they continue to improve the technology the cost of the machine and the time and cost to do the analysis will continue to drop. We still don’t know exactly how to use the genomic data in healthcare, but machines like this are going to make it possible for us to find new ways to use this data for good.

I still can’t help but imagine an EHR having all of our genomic data available to it.

Liquipel
Probably the coolest general technology and innovation that I saw at CES was called Liquipel. Liquipel is a technology that makes your device repel water using a nano coating. The best way to understand how it works is to check out some of the Liquipel videos and I’ll embed one below that gives a nice overview.

Of course, they have the disclaimer that it should never be submerged in water, but it was amazing to see it repel the water and still work. Plus, probably the coolest demonstration they did was with a Kleenex. They’d applied the nano-coating to a Kleenex and then they placed it in water. You’d think it would shrivel up and absorb the water. Nothing. I then asked if I could touch the Kleenex to see if I could feel the coating. Nothing. It felt like a Kleenex.

Many health IT people would love this technology. Then, it wouldn’t be such a concern to put your iPad next to the sink in the exam room. I wonder if the nano technology can do anything with infection control with devices. I imagine it doesn’t solve that issue.

I’m sure many are wondering how they can get their device treated with Liquipel. Right now they said you have to drop it by their office in California to get it done over a lunch or something. However, they’re working with phone manufacturers to get their technology in every phone. Pretty amazing stuff.

John Sculley
Another highlight of CES for me was the chance to hear John Sculley talk at the Digital Health Summit. I can’t say he said anything too groundbreaking. Although, he did say that health IT companies should stop focusing their revenue model on corporate health programs. I found that interesting. The most interesting comment came from colleague Dan Munro after John Sculley’s talk. He commented how interesting it was that so many of these older ex-CIO’s of major tech companies are getting into healthcare. I carried the thought through for Dan that as you age, you start to care about healthcare a lot more than you did when you were younger and healthier. I wonder if we’ll see this trend continue as more tech people get older and start to care more about healthcare.

Related posts:

  1. Healthcare Invades CES – Digital Health Summit
  2. No @ Sign for Healthcare
  3. Jeopardy!’s Watson Computer and Healthcare

January-18-2012

18:18


For that don’t know, there’s a really strong chat happening on Twitter each Friday morning around the hashtag #HITsm. The number of people showing up is growing and growing and quite frankly it’s almost impossible to be able to keep up with all the tweets that are flying around along with the back channel conversations with those participating in the chat as well. It’s an hour long Twitter chat where you’re flooded with interesting bits of health IT information.

Of course, some of you might be overwhelmed by the thought of a Twitter chat. The key is to realize that you don’t have to know anything about Twitter to participate. To get started, just visited this #HITsm twitter page and hit the reload as it tells you there are more tweets. This is like turning on the TV and watching what’s on. Nothing wrong with being a lurker of the #HITsm Twitter chats if that’s what you prefer.

Now for those like me who can’t keep their mouth tweet shut, you’re going to want to participate as well. It’s easy and free to sign up. I’m sure many of you are like my Health IT friend Stacey who is fantastic at Health IT, but was a little nervous on how to start down the Twitter path. I told her to just go for it and now you can find her @HealthITgirl.

I introduced her to 3-4 people on Twitter and she already has 19 people following her on Twitter. Those followers will get her started off right and then as she adds more people and interacts with more people she’ll start to find the real value of Twitter.

Let me repeat my most common comment about Twitter: Twitter is about connecting people.

Certainly Twitter can be used for other things, but Twitter’s most powerful function in my opinion is to connect people. The other thing to realize is that you can’t break it, you can’t break the rules, and there’s no right or wrong way to use Twitter. So, just start using it and testing what ways it can be valuable to you.

If you’re on Twitter or sign up for Twitter let me know @techguy and/or @ehrandhit. I’ll be happy to introduce you to some smart people on Twitter too.

Related posts:

  1. Thoughts on Top #HITsm Contributor Awards
  2. HIPAA and Football #HITsm
  3. Email and Twitter Follow Up With Patients

January-17-2012

13:13


I first heard about the new Secure, Branded App Store for Hospitals and Healthcare called Happtique in early December on Techcrunch. At its core, I think it’s an interesting idea to try and filter through what the article claims are “23,000 mobile health apps available for iOS and Android.” Helping physicians and hospital administrators filter through these apps could be valuable. Plus, most hospital administrators would love a way to have a phone that was limited on which apps it could download.

Well, it seems that the company has shifted gears a little bit. As Brian Dolan from Mobi Health News reported, Happtique is taking the first steps to setting up a certification for mobile health apps.

Happtique, a healthcare-focused appstore, announced plans to create a certification program that will help the medical community determine which of the tens of thousands of health-related mobile apps are clinically appropriate and technically sound. The company has tapped a multi-disciplinary team to develop the “bona fide mHealth app certification program” within the next six months. The program is open to all developers and will be funded by developer application fees.

It will certify apps intended to be used by both medical professionals and patients.

While I think that providing some way for people to filter through the large number of mobile apps, I think certification is a terrible way to go about it. Many people know I’ve written many an article about CCHIT pre-EHR incentive money and how screwed up the CCHIT EHR certification was for the industry. I think it’s just as bad news for Happtique to create a certification for the mobile health industry.

Turns out that Happtique seems to have agreed with this idea back in October 2010 where they said in a MobiHealthNews interview, “We are not in the business of opining whether an app is ‘good’ or ‘bad’ though. That’s not our role. Apple doesn’t do that and others don’t either. If the FDA indicates that an app is a medical device and needs to be regulated, well, that’s a different situation and we can take it out of the store.” Seems they’ve seen a different business opportunity.

They have a couple recognizable names on their board to create their certification including Howard Luks and Dave deBrokart (better known as e-Patient Dave), but I believe they’re going to find that it’s an impossible task. First, because they won’t have the breadth of knowledge needed to create certification requirements for every type of mHealth app. Second, what value will the certification really provide? Third, how do you make the certification broad enough to apply to all 20,000+ apps while still providing meaning to those using a very specific mHealth app? Plus, I’m sure there are many other issues I haven’t thought of yet.

The problem with these certification ideas is that they start with great intentions, but always end up bad.

Related posts:

  1. Around Healthcare Scene: The mHealth Summit, DentiMax PM Software, and Getting Physicians Onboard with mHealth
  2. CCHIT Certification as Default Certification
  3. CCHIT As The HITECH Certification Criteria Poll

January-16-2012

11:24


HITECH Answers recently posted a great post that gives a run down of the EHR Incentive program’s progress in 2011. Here’s their list with my own analysis and commentary of each point.

123,921 Eligible Professionals have registered for EHR Incentives, 15,255 have successfully attested to meaningful use in the Medicare program.
This seems like such a HUGE difference in numbers. That’s just over 12% of Eligible Professionals that registered attested to meaningful use. Does this mean that we’re going to see a tidal wave of meaningful use attestation in 2012? Possibly.

I believe that we’ll see more eligible professionals attesting to meaningful use in 2012. However, the question is how many of those other 108,666 will attest to meaningful use in 2012 and how many are like the Happy EMR Doctor who just registered to see the MU process. I wonder how many first hand meaningful use experiences by doctors will scare doctors away from MU attestation.

3.077 Eligible Hospitals have registered EHR Incentives and 604 of those have successfully attested to meaningful use.
This is almost 20% of hospitals that have registered that have attested to meaningful use. It’s not surprising that this number is a lot higher than eligible professionals. I still believe that the wave of meaningful use attestation will come from these other 2473 hospitals and probably many more that still haven’t registered. I haven’t seen a good number of how many hospitals are in the US. Does anyone know that number? The EHR incentive money that goes to hospitals will dwarf those of eligible professionals.

$2,533,689,145 has been paid out in Medicare and Medicaid Incentives.
$2.5 billion sent out in 2011. I just went back to the first time I tagged meaningful use on this site on April 3, 2009 (coincidentally I have 19 pages of 10 posts each tagged with Meaningful Use). Amazing to think that it’s taken basically 3 years to spend $2.5 billion on EHR.

277 hospitals have received payments under both Medicare and Medicaid and of those 12 were CAHs.
That’s about half of the hospitals that have attested to meaningful use under Medicare are also getting the Medicaid EHR incentive money as well.

22% of eligible professionals that have been paid EHR incentives are Family Practitioners and 20% are Internal Medicine.
I must admit that I would have thought that the percentage of family doctors that got paid EHR incentive money would have been a lot higher. I guess when you have so many other specialty areas I shouldn’t be that surprised. I also wonder why the internal medicine number is so high. These numbers actually make me believe that a lot of family practice doctors are sitting out when it comes to meaningful use.

41 States Medicaid programs were open for registration. Two additional States launched in January of 2012.
I wonder what’s holding back the other 7 states. From what I’ve seen all the states will eventually get there.

More than 1500 EHR products have been certified by ONC-ATCBs.
That’s a lot of EHR software. I still put the EHR company list at about 300 EHR vendors. 1500 includes multiple versions of the same software, partial EHR certification for products like data warehouses, ePrescribing, etc. The best thing that’s come from the ONC-ATCB program is that it has made EHR certification basically irrelevant in the EHR selection process. Every EHR vendor is certified now. This is much better than the false assurances that EHR certification provided before. I still dislike what EHR certification has done to the industry, but at least it’s not misleading doctors the same way it was before.

Related posts:

  1. Are You Ready for 2012? – Meaningful Use Monday
  2. How Critical is the October 1, 2011 Deadline? – Meaningful Use Monday
  3. Exemption from 2012 eRx penalties: The Process is Now in Place – Meaningful Use Monday

January-16-2012

0:18


Here is a quick look at some of the other articles recently posted on some of the other HealthcareScene.com websites:

EHR and EMR Videos

David Collins of HIMSS Discusses the Course of Global Health at the 2011 mHealth Summit- David Collins, Senior Director of Professional Development at HIMSS, speaks at the 2011 mHealth Summit about HIMSS’ involvement in this year’s Summit, and about how HIT X.0 is affecting the course of Global Health.

Cerner Smart Room Technology Overview Video- An updated view of Cerner’s Smart Room technology. The Cerner Smart Room incorporates technology and workflow software to improve consumer care and clinician efficiency. The Smart Room is powered by CareAwareTM device connectivity architecture.

EHR and EMR Screenshots

These three posts provide numerous screenshots from the DentiMax Dental Practice Management Software.  Are there special considerations for a dental practice as opposed to a regular medical practice when it comes to EHR/EMR/PM?

Screenshots from the DentiMax Dental Practice Management Software
More Screenshots from the DentiMax Dental Practice Management Software
Appointment Book Pro Screenshots from the DentiMax Dental Practice Management Software

Smart Phone Health Care

How to Get Physicians Onboard with mHealth- No matter how great an app or device may be, it will be difficult for any developer to be successful if they don’t get some level of buy in from physicians in general.  People will always resort back to their physician when it comes to the quality of medical products.

Axial’s Care Transition Suite Wins “Ensuring Safe Transitions from Hospital to Home” Mobile App Challenge- In a recent online discussion I had concerning an article I recently wrote, the point was raised that for an app or device to be successful it must fulfill a need.  While I don’t think that it is absolutely essential to success, it certainly makes the path to success much more realistic.

Related posts:

  1. The Healthcare Scene Writers
  2. EHR Summit by Healthcare Billing and Management Association (HBMA)
  3. What Keeps EMR and HIPAA Running and New Healthcare Scene Service

January-13-2012

17:57


I recently started to think about some of the implications associated with multiple languages in an EHR. One of my readers asked me how EHR vendors correlated data from those charting in Spanish and those charting in English. My first response to this question was, “How many doctors chart in Spanish?” Yes, this was a very US centric response since obviously I know that almost all of the doctors in Latin America and other Spanish speaking countries chart in Spanish, but I wonder how many doctors in the US chart in Spanish. I expect the answer is A LOT more than I realize.

Partial evidence of this is that about a year ago HIMSS announced a Latino Health IT Initiative. From that today there is now a HIMSS Latino Community web page and also a HIMSS Latino Community Workshop at the HIMSS Annual Conference in Las Vegas. I’m going to have to find some time to try and learn more about the HIMSS Latino Community. My Espanol is terrible, but I know enough that I think I could enjoy the event.

After my initial reaction, I then started wondering how you would correlate data from another language. So, much for coordinated care. I wonder what a doctor does if he asks for his patient’s record and it is all in Spanish. That’s great if all of your doctors know Spanish, but in the US at least I don’t know of any community that has doctors who know Spanish in every specialty. How do they get around it? I don’t think those translation services you can call are much help.

Once we start talking about automated patient records the language issue becomes more of a problem. Although, maybe part of that problem is solved if you use could standards like ICD-10, SNOMED, etc. A code is a code is a code regardless of what language it is and computers are great at matching up those codes. Although, if these standards are not used, then forget trying to connect the data even through Natural Language Processing (NLP). Sure the NLP could be bi-lingual, but has anyone done that? My guess is not.

All of this might start to really matter more when we’re talking about public health issues as we aggregate data internationally. Language becomes a much larger issue in this context and so it begs for an established set of standards for easy comparison.

I’d be interested to hear about other stories and experiences with EHR charting in Spanish or another language. I bet the open source EHR have some interesting solutions similar to the open source projects I know well. I look forward to learning more about the challenge of multiple languages.

Related posts:

  1. Nuance and MModal – Natural Language Processing Expertise
  2. Think About the Problems with Paper Charting
  3. Customized EHR Content, 6 Week EMR Implementation, Redundant Charting, and Increased HIT Investment

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January-11-2012

22:13

This is the topic of my new blog post on HealthWorks Collective. Already received lots of traffic on Twitter and lots of views. Would like to see more about mobile standards in health care from Motorcycle Guy and others.

January-7-2012

23:22

DeliciousI am glad that Delicious is still around and being enhanced. I have used it for years to organize and tag my bookmarks. Now with almost 1200 bookmarks and several hundred tags, I often search my links to find a resource for a presentation or article. Recent links include:

So while links may be low on the priority list in social media with many more dynamic and “sexy” like Twitter and Facebook, Delicious has its place and does allow followers, RSS feeds and other social media features.
So if you are interested in what I am working on, my Delicious  may give you a clue.

January-2-2012

11:13

Like others (see Daniel Kraft) , I have my own opinions about what trends will be most influential for health IT in 2012.

  • Big Data and real-time analytics and decision support – IBM Watson and Explorys are in this space, others will follow and adoption will grow enabled by cloud computing, NOSQL/Hadoop and natural language processing
  • Continued focus on EMR adoption as more health systems pursue meaningful use. This will again be the main focus at HIMSS as well as other conferences
  • Social media in health care will continue to grow among patients as the e-Patient movement continues to gain in strength and public awareness and as advocates like the Reshape Innovation Center find creative uses to influence the future of health
  • Mobile health and apps usage will expand but what is needed is a way to integrate personal health information, such as, PHRs and apps that promote wellness and disease management. For health care professionals, apps and mobile devices need to be integrated into clinical workflow rather than being an adjunct or distraction
  • Research will be further enabled by EMR data as more academic medical centers develop data warehouses for research and quality studies and as initiatives like QueryHealth make it possible to combine data across systems and states using health information exchange and other tools

There are many more but these are the primary one’s I will be following.

December-29-2011

14:14

There are many top 10 predictions for 2012 out there. I could probably add my own for eHealth and mHealth.
These 10 Business Intelligence Trends for 2012 from Tableau Software apply to healthcare as much as any business.

 

December-27-2011

22:23

In addition to having a great year traveling and presenting, I had additional accomplishments:

  • Appointed as the Co-director for Biomedical Research Informatics for the Clinical and Translational Science Collaborative, an NIH funded program through the Case Medical School
  • Joined the Editorial Board of Tech Now Briefs of the American Association of Medical Colleges
  • Invited to contribute to a theme issue on social media for Frontiers from the American College of Healthcare Executives
  • Became a featured blogger for HealthWorks Collective
  • Appointed as a reviewer for HIMSS 2012 abstracts – a new role for me
  • Authored chapter on eResearch to a book on medical informatics to be ePublished in 2012
  • Celebrated 30 years as an employee at Cleveland Clinic
  • Leading a project to develop a clinical data warehouse for research
  • Approaching 1000 connections on LinkedIn (969)
  • 2881 followers on Twitter
  • Klout score hovering around 42
  • Invited to be on the advisory board of a health related startup
Looking forward to more great opportunities in 2012.

December-26-2011

23:31

It was a big year for traveling to conferences:

  • February – HIMSS Annual Conference in Orlando – spoke at the Social Media center twice and presented on a panel on social media
  • March – AMIA Clinical Research Informatics Summit in San Francisco. Two podium presentations (CKD Registry and REDCap business model) and two posters
  • April – attended TEDx Maastricht in the Netherlands and a side trip to UMC Radboud in Nimegen.
  • April – ACRT meeting (Association for Clinical Research Training) in Washington, DC – panel presentation on REDCap.
  • May – Patient Experience Summit at Cleveland Clinic with Enoch Choi presenting
  • June – consulting at a hospital in Michigan on data warehousing
  • September – Medicine 2.0 Congress in Palo Alto, CA. Poster presentation
  • October – American Association of Medical Colleges meeting on Big Data in Washington, DC
  • October – Clinical and Translational Science Awards Informatics meeting at the National Institutes of Health. Bethesda, MD – poster presentation
  • October – Panel at Case Medical School, Cleveland on Social Media in Clinical Trials
  • November – Senior Workers Conference in Minneapolis, MN – presentation on Social Media and Electronic Medical Records
  • December – Center for Health Services Research and Policy at MetroHealth Medical Center, Cleveland, on Disease Registries using EMR Data
Most of these are posted on SlideShare. Looking forward to many opportunities in 2012 as well.
Next post – Accomplishments in 2011
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