Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and EHR for FREE!

Warm, Fuzzy EHR Selection Website Looking for a New Best Friend

Posted on May 15, 2015 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

After 15 years running the EHRSelector, a free, interactive app for finding an EHR, my partner, Cali Samuels and I want to sell or give it to someone who can help it meet its potential.

What’s the Selector?

The Selector’s idea is simple: Give those looking for an EHR an objective way to find a new EHR that centers on what it can do.

Here’s how it works. You go down an extensive EHR feature list. As you click what you want, it instantly shows which products match. You can then compare them like this: EHR Selector Side by Side.

Here’re its major categories. Each has a clickable feature list. For example, you can choose among 50 medical specialties. We also show which features are HIPAA or MU required.

EHRSelector Major Categories

What’s the Problem?

So, why do we want to sell it or give it away? Simple, we can’t crack two problems. Vendors don’t update their profiles and, consequently, there’s low user interest.

The selector depends on vendors subscribing to it and keeping their product lists up to date. Even though it’s free, we can’t convince vendors to update their information.

We’ve written and called, but we run into several problems. Often it’s impossible to get through to a person. When we do, we get bounced among sales, marketing and technical types. Contacts who we’ve dealt with are often gone and no one knows who can speak to all product features.

Then there’s the connected question of driving users to the site. If our vendor list isn’t up to date, we can’t expect a high user volume. As it is, we get some users who understand that while not everything is current, few EHRs take out features. Occasionally, whole college classes sign up. We’re pleased to serve them, but that rarely interests vendors.

How Does It Make Money?

It doesn’t. For several years, we ran the selector on a subscription basis for both users and vendors. This paid for hosting and maintenance, but the marketing firm that ran it lost interest and it began to lose subscribers.

Two years ago, my partner and I took it back, put on a new home page, added a blog and made it free for everyone. We hoped to get enough traffic to sell ads. That hasn’t worked out. We get a few hundred hits a week, but we don’t have the user or vendor interest to justify ads.

What Are We Looking For?

We would like to turn the site over to someone who shares our interest in an objective, interactive EHR selection tool. Obviously, we want someone who has the marketing clout to get vendors interested.

The Selector’s written in classic ASP. Its functions work, but it could stand a good rewrite making it more intuitive and less 2001. Finally, we’d love to add a mobile app, user ratings and graphics comparing products.

Sell or Buy?

Cali and I have enough cash and sweat equity in the selector to build a Tesla. It’s never paid, but we’ve been content to run it break even or even at a loss, because we believe it’s an important service.

We’d love someone to dump goo gobs of dough on us for it, modernize it, etc., – are you listening Google? However, we’re realistic enough to look for someone who shares our interest in giving users a useful EHR tool finding tool and who has the wherewithal to carry it on. You can reach me at: carl@ehrselector.com

Blind Woman Enjoys 3D Printed Ultrasound of Her Baby

Posted on May 14, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Since I’ve been focusing on patient stories this week, I thought that I’d share this viral video that I’m sure many of you have seen. If you haven’t seen it, this is the video of a lady who is blind as she gets to touch and feel a 3D printed ultrasound of the shape of her baby. It’s a pretty amazing video and the ladies reaction to it is quite extraordinary.

I love this video because he provided me a new understanding of the challenges people with disabilities can have in their patient experience. However, as a tech junkie, I also totally love how all these technologies could come together in such a tremendously beautiful way. This is why I’m so optimistic about the next 10 years of healthcare. We’re just getting started when it comes to technology improving healthcare.

A Patient’s Perspective on Accessibility – Carly Medosch

Posted on May 13, 2015 I Written By

The following is a guest blog post by Carly Medosch. You can find more about Carly on her blog and on Twitter @carlyrm.
CarlyRM
It seems like every day there is a new use of technology available to assist patients. The just-launched Apple Watch already includes several health and fitness features, and the company shows promise for more scientific breakthroughs with the ResearchKit for iOS. There are smartphone apps and websites for patients to research medication costs, identify pills, and find help from patients with the same diagnosis. Some patients can visit their doctor virtually using telehealth platforms.

This week I have been reading Regina Holliday’s memoir “The Writing on the Wallwhich details her husband, Fred’s, struggle to get appropriate care for his stage IV kidney cancer. In the book, Regina mentions going home from caring and advocating for her husband in the hospital, caring for her two young boys, and then spending hours on the Internet doing health research. Regina Googles words the oncologist says during his quick stop by the room. She uses Facebook and other websites to coordinate support care for her children. She researches medical and legal issues large and small.

You may think that it is great that just a wondrous resource exists, but I am saddened by the fact that this hard working woman, a wife, mother, caregiver, art teacher, and toy store manager, was forced to pull a night shift as a medical researcher. This was precious time that took her away from her dying husband, her young children, and her own important need for proper rest.

I am upset about these things because they have affected me, too. At age 13 I was diagnosed with Crohn’s disease. This year my chronic illness turns 21 years old. I’ve lived far longer as a sick person than a well one. I spend my spare time doing advocacy work supporting patients.

It is endlessly frustrating for me to hear very smart people, with excellent academic pedigrees, and gobs of VC funding, tell me about their exercise app for dogs. Or their plan to let patients research endless information about their doctor’s conflicts of interest. Or a map for patients to find outdoor activities to increase public health.

These are products created by people who do not understand illness. Originally I thought they just didn’t understand chronic illness, the endless parade of doctors, medical appointments, medications, and bills. The piles of paperwork and the endless to do lists, to which we now add the incessant intrusion of electronic alerts.

But these products are not created for the acutely ill, either, not really. Even if you are a perfectly healthy adult a vehicle may strike you as you cross the street. In that example, are you going to research the best doctor, the hospital with the best safety score, the emergency room with the shortest wait time? No. If you are able to do anything, you will try to call 911. Most likely someone else will call for you. You are powerless and all the technology in the world won’t help you.

I believe technology could help us. But I think there’s an image problem. I don’t think it’s seen as sexy to market a product for the chronically ill. Companies are trying to sell an image, and that image is easier to sell if it’s world-class athletes, women in high heels, and health. A product is presented as making regular people feel powerful, in control of their lives and their health. You can use your fitness tracker to become healthier. It will reward you for taking the actions of healthy people. A fitness tracker could easily be tweaked to offer a warning for people that need to limit their steps. Some people with chronic fatigue syndrome are advised to get a small amount of activity – a sweet spot that’s “some” but not “too much.” A fitness tracker could be programmed to encourage more activity up to a point, and then warn the user to slow down as the step count grew too high. But the marketing campaign for that type of product would discourage sales growth.

We are given products and features that are billed as empowering, but seem to translate to just being more work. More items on our endless to do list, more things to squeeze into our maxed-out budgets, less time with the people and activities we love. The products are more sleek and beautiful (which is quite an improvement), but they are rarely designed for people with vision issues, or arthritic hands, or jittery movements. The more we need technology, the harder it is to grasp.

Recently I was struck with a terrible migraine. At home I would go to the clinic across the street, receive an injection, and go home to sleep it off. I would lose the day, but I would only pay about $30 with my insurance. The treatment was in my chart, so although I may not see the same clinician each time, they could easily look up what to administer.

This time I was in Chicago, a city I’d never visited. I took out my smart phone and used Google Maps to see the locations of walk in clinics. Google Maps has a rating feature for businesses and I could see this one has several stars. My vision was blurry, and my body was weak and racked with nausea, but I was able to call one. With some difficulty I asked the wait time and if they did injections for migraines. The voice on the other line asked me if I had the medicine. Of course I didn’t have the medicine! If I had it, why would I go to a clinic? Then they asked what the medicine was called, and that is when my brain decided it had functioned enough. I stammered. I paused. I couldn’t think of the word and I couldn’t think of the other words to explain the confusion was caused from my medical distress. Powerless, I hung up.

I walked to a first aid station in the building and was advised to go to the emergency room. I was assured that the hospital was close and good. The man in the first aid station gave me an ice pack, which I pressed firmly to my head as I staggered out to find a cab.

The world spun and my stomach churned, but eventually I got to the hospital. I arrived to a packed waiting room full of people who looked like they had been there a long time. The care was poor, but it seemed due to overcrowding and underfunding. The staff was kind. I was in the loud, bright waiting room for hours. I’ve received a bill for over $100 from the hospital, and I suspect I will receive another from the physician who eventually saw me.

There was no app to tell me the wait times, but I’m not sure I could have endured the cab ride to a hospital farther away. I could barely use my smart phone to make a call, so there was no way I was going to be able to research facilities, or prices. It was difficult for me to seek help from family and friends, as both light and noise made the pain worse, and anyway I was so far from home.

When people develop technology for patients, they often don’t even consult with a single patient. It is my dream that this not only be completely reversed, but that a variety of symptoms and conditions be considered when developing and testing the product. Can the product be used by a 40 year old healthy man, can it be used by a child with smaller hands, can it be used by a person with poor eyesight, can it be used by someone in severe pain, can it be used quickly in an emergency? Are your product solving actual problems and enhancing life for your customers, no matter their health status?

Comprehensive vs. Complete: Creating a Truly Representative Health Record

Posted on May 12, 2015 I Written By

The following is a guest blog post by Stacey (@coffeemommy), an empowered patient and breast cancer survivor.

According to my EHR, I had breast cancer. And I had two mastectomies and I’m currently on Tamoxifen. If you read a little deeper, you’ll discover I also had a colonoscopy at age 39. It was clean.

According to my EHR from another institution, I had a colonoscopy at age 37 and two polyps were removed. I also had a series of ideopathic headaches. Beyond my verbally sharing this information with my current care team, they would have no record of these activities.

According to my EHR from yet another institution, I had a miscarriage in 2000 and went on to have two full-term healthy deliveries after that. More headaches and migraine medication. Again, these items are not reflected in detail in my current healthcare record.

And there are more health records of mine spread across the country.

Everything in those respective EHRs is accurate but my “electronic health record” is not really a record at all. My EHRs are snippets of time spanning several states of residency and ultimately dating back to a thick paper folder that, as a child, I remember checking out from the ground floor before appointments at the now defunct Wilford Hall Medical Center.

Beyond my memory of surgeries, inoculations and well visits past, I question whether documentation of my early health history really exists at all at this point.

And therefore, the burden of tying the highlights of my health history together for every new health care provider, falls on my shoulders. A doable task but certainly not an easy task in the typical 15 minute visit window.

Electronic health/medical records lack true interoperability and therefore are not comprehensive for most of the population. Teams of no doubt brilliant people are allegedly working on solutions and voices demanding interoperability and advances in the health IT space are loud.

However, even if my EHR were comprehensive tomorrow in the above context, it would still be incomplete. While every physician who treats me has read/write access to the record I, as the very subject of the record, am unable to add my two cents.

And my two cents would add a lot of context.

As an example, for the past 22 months, I have been on Tamoxifen to keep my estrogen-loving breast cancer from recurring. For 21 of those 22 months, I have had random soft-tissue swelling, random bilateral rashes and a face tingling turned numbness that progressed to such a point I was running to a mirror to see if my left side was drooping. Since there is no documentation of these symptoms as a side effect of Tamoxifen, I’ve been told to take Loratadine for swelling and have had two brain MRIs to rule out a tumor.

What my current team struggles to understand is that historically, I am reactive to many things. Soaps, shampoos, penicillin, sulfa drugs, ciprofloxacin, lanolin and a variety of other substances trigger rashes and soft tissue swelling in my body. So, starting on a new drug and having ‘undocumented’ side effects was not an unusual series of events for me.

When I asked to take a half dose and was told, “We don’t have a protocol for that.”

Again, what is missing from my EHR is the history of my taking half doses of many of the drugs I have been prescribed and having therapeutic results. As a child this was never a problem. For the first 22 years of my life, I was considered a US military dependent and the continuity of care, regardless of what base we were stationed at, was solid. The next twenty years has been a scatter shot of services across zip codes, providers and payors.

A comprehensive (including all of my past) and complete (including my two cents) would save time, money and headaches. Instead of emailing pictures and bringing a written diary of skin rash and swelling, I could simply upload directly to my own record. Instead of emailing a physician with my side effects and saying, “Please add this event to my record” I could add it myself for no cost to the healthcare system treating me. Patterns could be clearly seen and treatment could be modified appropriately if the situation was warranted. Side effects could more accurately be documented and communicated to other patients as trends were noticed.

The idea of patient reported outcomes being included in the EHR seems incomprehensible to some. I’ve heard, “But you can’t trust patient data” and “Patient supplied data is unreliable.” Really? To me it seems that patients themselves are the only ones who could supply this level of data to enrich the health record. And they have the biggest interest in comprehensive care. And, by the way, providers trust my input when I document my health history on the long sheet of paper on an initial visit – why is my information suddenly invalid as a patient?

To be clear, I’m not asking that patients have the ability to edit or rewrite what the healthcare practice has so diligently recorded. I am simply asking that our record reflect more than the set of symptoms we present with at any given visit. Tracking trends real-time will prevent the dreaded question, “How long has this been going on?” The answer will be front and center.

So as the great minds gather to create the interoperable EHR, please consider the patient voice. Interoperability may allow for a comprehensive record but, until my side of the story is reflected, the documentation will remain incomplete.

My body, my data and my health. Please allow me to participate.

Stacey is a strategy and communications consultant inspired to empower patients and caregivers through collaborative education and community building. Runner. Cyclist. Coffee drinker. Organic gardener. Wife to one. Mom to two. Empowered patient and breast cancer survivor almost two years NED. Connect with her on Twitter @coffeemommy

The Patient Voice

Posted on May 11, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

For years I’ve been hearing over and over from various places that we need more of the patient voice in healthcare. These messages have come largely from prominent patient advocates like Regina Holliday and ePatientDave. The Society for Participatory Medicine has also had a strong voice in the fight to include the voice in healthcare and in particular in healthcare IT. While each of these people and organization have compelling stories to share, I’ve wondered if they’re really making the impact they want to achieve.

One problem I’ve seen with this effort is that Regina and ePatientDave are seen over and over and over again at conferences. While it’s great that each of them is advocating for the patient voice to be included in healthcare, I wonder if the healthcare IT community has basically tuned out the message because they’ve heard it over and over and from the same two people. If this was a really massive movement, then why don’t we have dozens or even hundreds of patients that are sharing their stories in prominent places?

I’m sure there are some really compelling reasons why we don’t hear from more patients and not the least of which is that they’re not invited. I don’t think that Regina and ePatientDave really want the lime light. They just want the message they espouse to be heard. So, I wonder if their goal wouldn’t be better served if they started sharing their spotlight with hundreds of other patients. I realize this can be a tricky proposition.

However, I first saw this happening at HIMSS where Regina worked together with HIStalk to have a number of patients attend HIMSS and share the patient voice with the healthcare IT Community. I thought this was a great idea and a really good step forward to diversifying the number of patient voices we hear.

As I’ve thought about this a bit, I decided that I wanted to do more to share the patient voice on my network of blogs as well. So, I decided to reach out to a number of patients and provide them a platform where they can tell their story. In some cases this will be about healthcare IT and how it impacted patients. In other cases it might just be a story about the healthcare system in general. Some will be good. Some will be bad. I told them that my goal was to add a little more of the humanity back into what we think about when we think about healthcare.

I’ve got a couple of these patient stories queued up for this week and hopefully we can make this a monthly (at least) fixture across the network of Healthcare Scene blogs. If you are a patient with a story to share, or know someone who does, we’d love to hear about it on our contact us page. I’m especially interested in hearing stories from lesser known patients. Hopefully we can use this platform to share more of the patient perspective. Be sure to let me know what you think of the patient stories this week.

HHS’ $30B Interoperability Mistake

Posted on May 8, 2015 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Sometimes things are so ill-advised, in hindsight, that you wonder what people were thinking. That includes HHS’ willingness to give out $30 billion to date in Meaningful Use incentives without demanding that vendors offer some kind of interoperability. A staggering amount of money has been paid out under HITECH to incentivize providers to make EMR progress, but we still have countless situations where one EMR can’t talk to another one right across town.

When you ponder the wasted opportunity, it’s truly painful. While the Meaningful Use program may have been a good idea, it failed to bring the interoperability hammer down on vendors, and now that ship has sailed. While HHS might have been able to force the issue back in the day, demanding that vendors step up or be ineligible for certification, I doubt vendors could backward-engineer the necessary communications formats into their current systems, even if there was a straightforward standard to implement — at least not at a price anyone’s willing to pay.

Now, don’t get me wrong, I realize that “interoperability” is an elastic concept, and that the feds couldn’t just demand that vendors bolt on some kind of module and be done with it. Without a doubt, making EMRs universally interoperable is a grand challenge, perhaps on the order of getting the first plane to fly.

But you can bet your last dollars that vendors, especially giants like Cerner and Epic, would have found their Wilbur and Orville Wright if that was what it took to fill their buckets with incentive money. It’s amazing how technical problems get solved when powerful executives decide that it will get done.

But now, as things stand, all the government can do is throw its hands up in the air and complain. At a Senate hearing held in March, speakers emphasized the crying need for interoperability between providers, but none of the experts seemed to have any methods in their hip pocket for fixing the problem. And being legislators, not IT execs, the Senators probably didn’t grasp half of the technical stuff.

As the speakers noted, what it comes down to is that vendors have every reason to create silos and keep customers locked into their product.  So unless Congress passes legislation making it illegal to create a walled garden — something that would be nearly impossible unless we had a consensus definition of interoperability — EMR vendors will continue to merrily make hay on closed systems.  It’s not a pretty picture.

Patient Experience Compared to Airline Experience

Posted on May 6, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was digging through my archive of draft posts and I came upon this tweet that I’d saved for future posting from last year. The tweet is still as applicable today as it was last year. Stephanie Zaremba raises an interesting point of comparison between the patient experience and the airlines experience. Can we learn something from this comparison?

Stephanie is totally right that the airline experience is going down quickly. I hate flying more and more every time I fly. That’s partially because I’m tired of being away from the family, but partially because they keep changing things and very rarely is the change for the better. However, do we really have a choice? If we need to travel, we purchase the plane ticket and grin and bear.

Does this sound a lot like healthcare? Sadly I think it does. Especially the last part. We all need healthcare and so we mostly just grin and bear. We’re seeing a slight change in that mindset with new high deductible plans. However, the medical industry is so complex that most patients just give up on trying to figure it out.

As I’ve thought about this comparison, I’ve wondered what would really change the patient experience. What could really cause things to change? Sadly, I think there’s a desire by many (doctors leading this charge) for a different system where it is a beautiful patient experience, but I don’t see a pathway to that new reality from our current reality.

Reminds me of one of my favorite thought exercises. What if you created an EHR that was focused on the patient and patient care and not on billing and government regulations? That EHR would look totally different than what we have today. Maybe it would look like a Care Management System.

Customizable EMRs Are Long Overdue

Posted on May 5, 2015 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

EMRs can be customized to some extent today, but not that much. Providers can create interfaces between their EMR and other platforms, such as PACS or laboratory information systems, but you can’t really take the guts of the thing apart. The reality is that the EMR vendor’s configuration shapes how providers do business, not the other way around.

This has been the state of affairs for so long that you don’t hear too much complaining about it, but health IT execs should really be raising a ruckus. While some hospitals might prefer to have all of their EMR’s major functions locked down before it gets integrated with other systems, others would surely prefer to build out their own EMR from widgetized components on a generic platform.

Actually, a friend recently introduced me to a company which is taking just this approach. Ocean Informatics, which has built an eHealth base on the openEHR platform, offers end users the chance to build not only an EMR application, but also use clinical modules including infection control, care support, decision support and advanced care management, and a mobile platform. It also offers compatible knowledge-based management modules, including clinical modeling tools and a clinical modeling manager.

It’s telling that the New South Wales, Australia-based open source vendor sells directly to governments, including Brazil, Norway and Slovenia. True, U.S. government is obviously responsible for VistA, the VA’s universally beloved open source EMR, but the Department of Defense is currently in the process of picking between Epic and Cerner to implement its $11B EMR update. Even VistA’s backers have thrown it under the bus, in other words.

Given the long-established propensity of commercial vendors to sell a hard-welded product, it seems unlikely that they’re going to switch to a modular design anytime soon.  Epic and Cerner largely sell completely-built cars with a few expensive options. Open source offers a chassis, doors, wheels, a custom interior you can style with alligator skin if you’d like, and plenty of free options, at a price you more or less choose. But it would apparently be too sensible to expect EMR vendors to provide the flexible, affordable option.

That being said, as health systems are increasingly forced to be all things to all people — managers of population health, risk-bearing ACOs, trackers of mobile health data, providers of virtual medicine and more — they’ll be forced to throw their weight behind a more flexible architecture. Buying an EMR “out of the box” simply won’t make sense.

When commercial vendors finally concede to the inevitable and turn out modular eHealth data tools, providers will finally be in a position to handle their new roles efficiently. It’s about time Epic and Cerner vendors got it done!

Early Warnings Demonstrate an Early Advance in the Use of Analytics to Improve Health Care

Posted on May 4, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Early warning systems–such as the popular Modified Early Warning System (MEWS) used in many hospitals–form one of the first waves in the ocean of analytics we need to wash over our health care system. Eventually, health care will elegantly integrate medical device output, electronic patient records, research findings, software algorithms, and–yes, let us not forget–the clinician’s expertise in a timely intervention into patient care. Because early warning systems are more mature than many of the analytics that researchers are currently trying out, it’s useful to look at advances in early warning to see trends that can benefit the rest of health care as well.

I talked this week to Susan Niemeier, Chief Nursing Officer at CapsuleTech, a provider of medical device integration solutions. They sell (among other things) a bedside mobile clinical computer called the Neuron that collects, displays, and sends to the electronic medical record vital signs from medical devices: temperature, pulse, respiration, pulse oximetry, and so on. A recent enhancement called the Early Warning Scoring System (EWSS) adds an extra level of analytics that, according to Niemeier, can identify subtle signs of patient deterioration well before a critical event. It’s part of Capsule’s overarching aim to enable hospitals to do more with the massive amount of data generated by devices.

For more than 18 years, CapsuleTech provided bedside medical device connectivity products and services that captured patient vital signs and communicated that data to the hospital EMR. Rudimentary as this functionality may appear to people using automated systems in other industries, it was a welcome advance for nurses and doctors in hospitals. Formerly, according to Niemeier, nurses would scribble down on a scrap of paper or a napkin the vital signs they saw on the monitors. It might be a few hours before they could enter these into the record–and lots could go wrong in that time. Furthermore, the record was a simple repository, with no software observing trends or drawing conclusions.

Neuron 2 running Early Warning Scoring System

Neuron 2 running Early Warning Scoring System

So in addition to relieving the nurse of clerical work (along with likely errors that it entails), and enhancing workflow, the Neuron could make sure the record immediately reflected vital signs. Now the Neuron performs an even more important function: it can run a kind of clinical support to warn of patients whose conditions are deteriorating.

The Neuron EWSS application assigns a numerical score to each vital sign parameter. The total early warning score is then calculated on the basis of the algorithm implemented. The higher the score, the greater the likelihood of deterioration. The score is displayed on the Neuron along with actionable steps for immediate intervention. These might include more monitoring, or even calling the rapid response team right away.

The software algorithm is configured in a secure management tool accessible through a web browser and sent wirelessly to the Neuron at a scheduled time. The management tool is password protected and administered by a trained designee at the hospital, allowing for greater flexibility and complete ownership of the solution.

Naturally, the key to making this simple system effective is to choose the right algorithm for combining vital signs. The United Kingdom is out in front in this area. They developed a variety of algorithms in the late 1990s, whereas US hospitals started doing so only 5 years ago. The US cannot simply adopt the UK algorithms, though, because our care delivery and nursing model is different. Furthermore, each hospital has different patient demographics, priorities, and practices.

On the other hand, according to Niemeier, assigning different algorithms to different patients (young gun-shot victims versus elderly cardiac patients, for instance) would be impractical because mobile Neuron computers are used across the entire hospital facility. If you tune an algorithm for one patient demographic, a nurse might inadvertently use it on a different kind of patient as the computer moves from unit to unit. Better, then, to create a single algorithm that does its best to reflect the average patient. The algorithm should use vital signs and observations that are consistently collected, not vitals that are intermittently measured and documented.

Furthermore, algorithms can be tuned over time. Not only do patient populations evolve, but hospitals can learn from the data they collect. CapsuleTech advises a retrospective chart review of rapid response events prior to selecting an algorithm. What vital signs did the patient have during the eight hours before the urgent event? Retrospectively apply the EWSS to the vital signs to determine the right algorithm and trends in that data to recognize deterioration earlier.

Without help such as the Early Warning Scoring System, rapid response teams have to be called when a clear crisis emerges or when a nurse’s intuition suggests they are needed. Now the nurse can check his intuition against the number generated by the system.

I think clinicians are open to the value of analytics in early warning systems because they dramatically heighten chances for avoiding disaster (and the resulting expense). The successes in early warning systems give us a glimpse of what data can do for more mundane aspects of health care as well. Naturally, effective use of data takes a lot more research: we need to know the best ways to collect the data, what standards allow us to aggregate it, and ultimately what the data can tell us. Advances in this research, along with rich new data sources, can put information at the center of medicine.

5 Lessons Providers Can Learn from Payers Infographic

Posted on May 1, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

ClinicSpectrum has been putting out a whole series of healthcare IT infographics. I recently saw one of them that really caught my eye as it came across my Twitter stream. The infographic offers 5 things providers can learn from payers. I’m sure that concept is a bit unsettling for some providers, but the list is quite intriguing:

  1. Leverage Data to Identify High-Risk Patients
  2. Help Patients Manage Their Meds
  3. Designate a Patient Engagement Advocate
  4. Build Partnerships
  5. Seek Interoperability Opportunities

What do you think about these ideas? Check out the full infographic below for more details:
5 Lessons Learned from Payers
Full Disclosure: ClinicSpectrum sponsors posts on Healthcare Scene.