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Dealing with Old Paper Charts in an EHR World

Posted on January 10, 2014 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.

To preview this post, start by enjoying this quick 1 minute video preview:

Such a well done video by ChartCapture. Plus, it intrigued me enough to get me interested in what they had to offer. I think I’d actually met them at the Canon booth at HIMSS before, but somehow I did’t capture the full simplicity of their chart scanning solution until I saw this video demonstrating how their solution works:

I love really simple and straightforward appliances and chart capture is the perfect solution for an appliance like this. It’s beautiful to have a plug and play appliance with no server, no setup, and just ready to go without having to get IT to make it a priority.

As I talked to Scott Ferguson from ChartCapture, I asked him when most customers chose to start using their product during an EHR go live. He responded, “Most customers typically drop us in 90 days prior to go live (or as soon as the have the “realization moment”).”

I love the concept of the realization moment and anyone who’s worked on an EHR implementation knows what I’m talking about. It’s that moment during the EHR implementation that the users ask the question “what about the paper charts?” For some reason many people just think that the EHR vendor will somehow magically just deal with the paper charts. The realization moment is when they realize that they’re going to figure out what to do with the paper charts.

I’ve long been a proponent of scanning in your old paper charts. I still love the outsourcing option because some of the quality they can provide in the scanning process. However, that option is cost prohibitive to many. So, an appliance like ChartCapture is a nice alternative solution for scanning your paper charts at a lower cost. Just be sure if you choose to scan in house that you make sure you hire detail oriented people for the job. It’s a monotonous job and requires detailed effort to do it right.

Scanners – The Forgotten Device Series

Posted on November 20, 2013 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.

Far too often in healthcare IT we get so caught up talking about the big projects, big software systems, and huge hardware buys that we forget about many of the little guys that make so much difference in our lives. This isn’t always a bad thing. When $36 billion in government money is available, we should talk about EHR. Although, there are a bunch of little things that can impact an organization as much as the large projects.

In this series of posts, I want to look at the Forgotten Devices that can make or break a user’s healthcare IT experience but we sometimes forget about them. In most cases, these devices are used multiple times a day and can have a significant impact on the happiness of your healthcare organization. In some cases, these devices are hidden from view, but facilitate all of the work done in healthcare.

To start this series off, we’re going to look at: SCANNERS.
DR-M160
Scanners unfortunately seem to be an afterthought in most healthcare organizations. For some reason we have the false perception that once we move to EHR, we’ll be paperless and so the idea of needing a scanner is somewhat foreign. I know in my first EHR implementation I went cheap on the scanners as I underestimated the volume of scanning that would be required post-EHR implementation. I quickly learned post EHR implementation that I better rethink my scanner strategy.

The reality is that paper still plays a key role in every healthcare organization. It’s really romantic to think of the paperless healthcare environment. However, in many respects EHR software are great at printing out reams of paper. Not to mention paper signatures are still required in many environments. Plus, there are waves of paper coming in from outside your healthcare organization which has to be incorporated into your IT systems. A well implemented scanner strategy is the cornerstone to converting this paper into your IT systems.

The great part is that scanner technology has come a long way as well and comes in a variety of options. You can buy a scanner like the Canon DR-M160 all the way up to the Canon ScanFront 300P network scanner. All of these can handle the heavy workload that’s required in healthcare at a much more reasonable cost than we have ever had before.

Outside of the daily scanning needs, many organizations also have to apply a scanner workflow to their old paper charts. I won’t dig into all of the various approaches organizations take to scanning old paper charts since we’ve done so many times previously. However, many organizations still opt to scan the old paper charts in house. In fact, many still take a scan as you go approach to incorporating old paper records into their EHR. The same scanner you use to capture the daily paper inflow can also be used for this scan as you go approach. Certainly there are even higher volume scanners that can be used for scanning a whole chart room, but those really aren’t necessary for most healthcare organizations.

The other issue many people forget with scanners is doing regular scanner maintenance. This is not a hard task to do, but it will really impact the scanners effectiveness if you don’t do it regularly. There’s nothing more frustrating for an end user than putting the paper in the scanner and having it jam. You can imagine the frustration a busy nurse experiences when she tries to scan something and runs into a jam in the scanner. With proper maintenance, this issue can be generally avoided.

Another major challenge with scanning is handling the document workflow. Most EHR systems support the standard TWAIN driver that comes with most scanners today. This makes it really simple to scan directly into the patient chart. Otherwise, you can build really advanced workflows that are deeply integrated into the scanner software itself. In healthcare, the former is much more common than the later. However, it will be interesting to see how smart scanners continue to improve the scanning workflow.

As with most technology, you don’t need to focus on scanning every day, but it’s important to regularly consider your approach to scanning and whether it enhances or detracts from your workflow. Scanning will be an important part of every healthcare organization for the foreseeable future. If you don’t keep up with the latest scanning technology and regular scanning maintenance, it can have a negative impact on your end users’ experience. Nothing’s worse than hearing about a bad user experience that could have been avoided.

Sponsored by Canon U.S.A., Inc.  Canon’s extensive scanner product line enables businesses worldwide to capture, store and distribute information.

Improving the EHR Interface and Topol Saves Patient’s Life on Flight Home

Posted on March 5, 2013 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.

As I thought through my day at HIMSS, a theme started to emerge from all the dozens of meetings I’ve already had at the show (with many more still to come). The theme I saw coming out was ways to improve the EHR interface. This is a much needed change in EHR’s, so it was interesting to see a whole series of companies working on ways to make the EHR interface better. Here are some of the highlights from companies I talked to at HIMSS.

SwiftKey – While the SwiftKey product can be used in the consumer space as well, it was interesting to see the technology applied to healthcare. SwiftKey is basically a replacement for your mobile device keyboard. In fact, I’d call SwiftKey a smart keyboard for your mobile device. What does it do to make your mobile device keyboard smart?

First, it offers word suggestions you can easily choose as you start to type. Most people are familiar with this base functionality because it exists in some form in most mobile keyboards (or at least it does on my Android). However, they’ve taken it a couple steps further. They actually use the context of what you’ve typed to predict what word you may want to type next. For example, if you type, “nausea and” then it predicts that you’ll want to type vomiting. If you type “urinary” then it will predict tract and then infection. Plus, they told me their algorithm will also learn your own colloquial habits. Kind of reminds me of Dragon voice recognition that learns your voice over time. SwiftKey learns your language habits over time.

I’m sure some of these predictive suggestions could lead to some hilarious ones, but it’s an interesting next step in the virtual keyboards we have on mobile devices. I’ll be interested to hear from doctors about what they think of the SwiftKey keyboard when it’s integrated with the various EHR iPad apps.

M*Modal and Intermountain – Thinking back on the demos and products I’ve seen at HIMSS 2013, I think that the app M*Modal has created for Intermountain might be the coolest I’ve seen so far. In this app, a doctor would say an order for a prescription, and the M*Modal technology would apply voice recognition and then parse the words into the appropriate CPOE order fields. It was pretty impressive to see it in action. Plus, the time difference between speaking the order and trying to manually select the various order fields on the mobile device was incredible.

I was a little disappointed it was only a demo system, but it sounds like Intermountain is still doing some work on their end to make the CPOE happen. I’m also quite interested to see if a simple mobile app like this will see broad adoption or if more features will need to be added to get the wide adoption. However, it was almost like magic to see it take a recorded voice and convert it into 5-7 fields on the screen. I’d be interested to see the accuracy of the implementation across a large set of doctors, but the possibilities are quite interesting for transforming the CPOE interface.

Cerner Mobile – One of the new Cerner ambulatory EHR features is an iPad interface for the doctor. I’m sure that many will think this is old news since so many other iPad EHR interfaces are out there. In some ways it is, but there was a slickness to their app that I hadn’t seen a lot of places. In fact, the demo of their ambulatory EHR iPad app reminded me a lot of the features that I saw in this video Jonathan Dreyer from Nuance created (bottom video) that demonstrated some of the mobile voice capabilities. Plus, the app had a nice workflow and some crazy simple features like doing a refill. One swipe and the med was refilled. Almost makes it too easy.

Canon – This is a little different than some of the other EHR interface things I talk about above. In the case of Canon it was interesting to see the tight integration that’s possible between the Canon scanners and EHR software. Instead of the often laborious process of scanning to your EHR and assigning it to a patient, Canon has a scan direct to EMR option including analyzing the cover sheet to have the scanned document attached to the right patient and EHR chart location. While we’d all love to have paper gone, it will be a part of healthcare for the forseeable future. The scan direct to EMR is a pretty awesome feature.

Those are a number of the EHR interface things that I’ve seen so far at HIMSS. I’m sure there are dozens of others out there as well. I think this is a great trend. Sure, each of these things is only a small incremental change, but with hundreds of EHR vendors all doing small incremental changes we’re going to see great things. That’s good, because many of the current EHR interfaces are terribly unusable.

In an related topic, Eric Topol gave a keynote address at HIMSS today. He had glowing reviews from what I could tell. Although, what’s an even more powerful story is to see the message he shared at HIMSS in action. On Topol’s flight home to San Diego a patient was having some medical issue. He did the ECG right on the plane using his smartphone and the passenger was able to make it safely to the destination. You can read the full story here. What’s even more amazing is that this is the second time something like this has happened to Topol. This probably means he flies too much, but also is an incredible illustration of the mHealth technology at work. Truly amazing!

Full Disclosure: Cerner and Canon are advertisers on this site.