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Tech We Take for Granted in Healthcare

Posted on March 26, 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.

Every once in a while I like to take a step back and think about all the tech that we take for granted. Yes, it’s easy to get stuck in the discussions of what’s missing from our tech life or ways in which tech could be implemented better in healthcare. However, there’s a whole series of technologies that we use all the time and barely give it a second thought.

Certainly there are some rural areas of the country where their internet connection isn’t very good, but for a large portion of healthcare a nice internet connection is just a feature. Most clinics don’t give their internet connection a second though. It just works. They go online and do what they need to do. Sure, you might have an outage here or there (and those are brutal), but most of the time the internet just works.

Related to this is Wifi. Unless you’re in a clinic where the wifi implementation isn’t very good (and there are still plenty of those), you roam around with your laptop, tablet or other wireless device and it just works. It’s amazing to watch my kids, because they really don’t have any idea on how it works. They just open up the iPad and watch movies as they wish. They literally have no idea what’s required to make that possible. Yep, they take it for granted because the tech has become so good.

We’re now starting to see the next level of ubiquitous internet with 4G speeds being nearly as good as Wifi for many applications. Soon we’ll be taking for granted that we can get good internet speeds almost everywhere we go. The same is true for cell phone connection. The only time I can remember looking at my phone to see how many bars I had was when I was deep in the heart of a National Park. Yes, there are a few places in the wilderness where phone coverage is not likely to hit. However, for 99% of most people’s activities the phone just works.

Another great example is email. I totally take for granted that email just works. If I send an email I assume it’s going to be delivered. Sure, there are times when your email service provider goes down and we have to deal with spam folders, but I don’t really give much thought to whether my email is going to work or not. I just do it all day every day and it just works.

Instant Messenger is another application I use that just works. I know some healthcare institutions that use it, but so far not for PHI. It’s amazing technology that I can see whenever someone is online and send them a message. They can reply almost instantly. The beauty is that most people have become really mature with the use of this technology. It’s a use as needed thing. I don’t greet every person that comes online, but it’s there if I need to get a hold of someone quickly.

Often related to IM is video chats. Unfortunately this hasn’t taken hold very much in healthcare and it’s unfortunate. Video is built into most IM platforms: Skype, Gchat, MSN Messenger (or whatever it’s called now). With video cameras built into so many laptops or desktop cameras available for as cheap as $30, doing a video chat with someone is almost trivial. Add in things like FaceTime on the iPad and the idea of doing a video chat with anyone anytime you want is almost here.

I’m sure there are a hundred other technologies that I could list. The reason I find this so fascinating is that I think we’re going to have the same thing happen with EMR. In the next 5 years, EMR is just going to be another technology that we use without really even thinking about it. We’re not there yet, but it will happen.

I look forward to the day when we start to take EHR for granted.

What Your EMR Would Say If It Could Talk

Posted on October 25, 2012 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.

In this column we spend a lot of time talking about EMRs, but do we ever listen to them?  Maybe it’s time for an “EMR Whisperer” to turn up and tell us what EMRs are trying to tell us. Or since I don’t know where to find one, I’ll do some listening myself.

Here, for your consideration, are some messages EMRs are trying to share. Don’t take offense…they’re only trying to be honest.

-Anne

* Too many clicks?  I’ll bet you never say that to your World of Warcraft host.

* There’s not enough expansion slots in all of China to integrate that mess.

* So, I went down for a few hours.  Don’t I deserve a break now and then?

* Don’t lie — you’re planning to tear me out and replace me with a younger upgrade.

*  I wish you’d stop telling me F/U.

*  I’m not user-friendly?  What about that smiley I put at the end of that 600-page data dump?

* I thought you loved me for my intelligence, not my interface.

* Your doctors have been saying mean things about me. My feelings are hurt. 🙁

*  Sure, I interoperate, but I always come back to you…

Cutting EMR Training Budget Can Create Serious Problems

Posted on April 17, 2012 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.

Not long ago, American Medical News ran an article on training up medical practice staffers for EMR use. The piece concluded that while practices may save some bucks on the front end, they generally end up regretting it later.  An anecdote from the piece:

Nine months after All Island Gastroenterology and Liver Associates in Malverne, N.Y., went live with its electronic medical record system, practice administrator Michaela Faella realized things had not gone as smoothly as planned.

Even though the staff had used other health information technology systems for many years and considered itself tech-savvy, it had taken everyone six months to learn how to use the new EMR system. Several months later, the staff still had not become proficient at it.

The problem was not with the staff, but that the practice cut training short to save time and money. “Training was not placed high on the priority list, and we paid the price for it,” Faella said.

As the piece notes, many practices assume that the training bundled into the cost of their new EMR will meet their needs, and find out to their regret that this isn’t the case.  (In fact, I’d argue that this is more the rule than the exception, based on anecdotes I hear in the field and in conversations with physicians.)

A consultant quoted in the piece suggests that practices should consider three main issues when planning for training:

1) How much data they’ll be dealing with, which can vary greatly depending on whether all data is imported in advance or done patient by patient

2) Whether the practice will be integrating new systems into the EMR, such as e-prescribing, or conversely, adding an EMR to existing systems

3) Whether using the EMR will call for using new hardware such as tablet computers

Personally, I’m not satisfied by that list at all.

What about, first and foremost, assessing the staff’s existing skills more precisely, walking staffers through the various layers of the EMR on a daily basis, forming teams of superusers within the organization to help the less skilled and taking steps to be sure EMR problems don’t interrupt critical functions (a backup/workaround plan for the short term)?

What do you think?  Does the list above cover the critical EMR practice integration issues?  Am I just being testy?

Genomics Based EHR

Posted on January 10, 2012 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.

This is a pretty old tweet that I’d stored away, but I’m completely interested in the idea of a Genomics based EHR. I meant to reach out to Don Fluckinger to see what he was talking about. I don’t think that there is any EHR that is based on Genomics. Although, if there is I’d love to know about it. Instead, I’m pretty sure that Don is just talking about integrating Genomics into EHR software.

I’ve made this prediction for a number of years now: Genomics will be part of the EHR software of the future. Genomics is one of the core elements that I think a “Smart EMR” will be required to have in the future. I really feel that the future of patient care will require some sort of interaction with genomic data and that will only be able to be done with a computer and likely an EHR. I love some of the quotes by Shahid Shah in this eWeek article about Digital Biology and Digital Chemistry.

As I think about genomics interacting with EHR data and the benefits that could provide healthcare going forward, I realize that at some point doctors won’t have any choice but to adopt an EHR software. It will eventually be like a doctor saying they don’t want to use a blood pressure cuff since they don’t like technology.

Medical Siri on the iPhone and iPad

Posted on November 11, 2011 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.

One of my regular physician readers, Brian, left the following comment on my post about the mythology of the Perfect EMR.

The reality is that we are now comparing EMR to our iPhone 4s’s. Our consumer technology is so far ahead of hospital technology that it is jarring and annoying to use work tech. This is what I want: “Siri, give me a differential for elevated amylase. Thank you. Now order CBC, Chem 14, TSH and free T4. Good. Now I will dictate. The patient is a 41 year old man with abdominal pain…”

Certainly we could have a long discussion about the difference in consumer technology and popular healthcare technology. However, I couldn’t help but wonder how many doctors have tried out Siri on their iPhone in order to get healthcare information. I bet this is pretty common. Although, I wonder how good the answers are that Siri gives.

If you’re a medical provider that’s used Siri for accessing health and medical information, I’d love to hear about your experience. I bet there are probably also a bunch of funny experiences trying to use Siri for medical info. I’d love to hear those as well.

Are there ways that “Siri” like technology could and should be implemented in EMR and EHR software?

EMR Usability Standards: Do They Make Sense?

Posted on June 12, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

The other day I was at a conference where several EMR industry insiders presented on user interface issues. I’ll confess, I was expecting the usual defensiveness — “our user interface is just fine, it’s just that our users don’t understand it” — but instead heard a lot of earnest discussion about the problems with today’s EMR UIs. The problem is, none of them seemed have any clearly-defined ideas on how those problems will be addressed.

Speakers at the conference, who included vendor reps, clinicians, academics and more, did seem to agree that few EMRs had achieved satisfactory usability. More than one cited research suggesting that many EMR interfaces just don’t cut it.

If there could be said to be any consensus, it was that usability standards were at best a slippery issue and at worst, might force development in the wrong direction by measuring the wrong thing. One speaker noted that even if clinicians were satisfied with a system’s UI, this might not be the best way to study its value, as it doesn’t mean that the system is particularly efficient.

But that could be a bit of a cop-out. According to a HIMSS paper from 2009, there are several methods which could emerge as front-running approaches to measuring usability and efficiency (which, it seems, are too often addressed separately).

Interestingly, the HIMSS authors said that two completely unrelated safety programs might provide some  insight into improving developing EMR usability standards:

* The National Highway Traffic Safety Administration Child Safety Seat Usability Rating Program

According to HIMSS, this program offers several lessons, including that the NHTSA spent two years to develop the program, that  it collected data to see how well its ratings were working, and that officials have been flexible enough to change their standards as the market changes.

* FDA and Human Factors Regulation and Guidelines for Device Manufacturers

As some of you may know, the FDA requires device manufacturers to follow Human Factors regs. HIMSS researchers argued that a few aspects of this program can be applied to directly to setting EMR  usability standards, including the requirement that the manufacturer be educated in Human Factors, that manufacturers should adhere to standards set by other standards bodies as well as their own, and that manufacturers must be able to prove Human Factors compliance at any stage of the inspection process.

Folks, I don’t know if the anti-standards talk I heard at the conference was just a bunch of posturing, or whether developing usability standards is a great idea, but this is certainly a hot issue. Where do you stand?  Can the EMR industry benefit from an externally- or even internally-developed set of usability standards, or are there better ways to spend development time?

Lousy EMR User Interfaces Aren’t Getting Enough Attention

Posted on May 13, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Though EMR vendors might argue the point, I keep hearing the same complaints from the field — that virtually none of them offer an intuitive user interface.

Readers of this blog are well aware of this issue, I’m sure, but I’d argue that it’s still worth discussing. After all, few if any EMR firms seem to have solved the problem. (If you know of an EMR you consider intuitive to use, please let me know and I’ll discuss it in a future article.)

Given the incredible problems clumsy UIs can create, I’m surprised pundits and consultants don’t speak out on the subject more often. My journalistic colleagues turn out story after story about wayward doctors who won’t use their institution’s EMR, but few dig into what’s wrong with the EMRs themselves.

Far too many EMR front-ends feel like jury-rigged database interfaces, rather than systems designed to support clinician workflow.  If I had to get my work done using counterintuitive forms, menus and checklists, I think I might leave journalism!

Unfortunately, the decision-makers who buy big EMR systems — you know, the ones who spend hundreds of millions over several years — don’t seem to be very concerned about this issue.  I assume it’s because they’re more worried about systems integration than user satisfaction, and hope they can force kludgy interfaces down clinicians’ throats. Under these circumstances, vendors don’t have a lot of incentive to change.

So, is there a way to change this dynamic? A couple of interesting, though unlikely, possibilities come to mind:

* I may have said this before, but isn’t it about time someone got Apple to design an EMR interface? I know the company has some serious detractors, but even if you don’t buy into the Apple legend  it hard to argue that it’s created some of the most usable interfaces on earth.

* Why not to develop a standard for measuring EMR usability, one which is publicly shared and built by consensus? I’m not saying it would be easy to develop such measures — in fact, I’m sure it would be very complicated — but if we could establish a few user experience benchmarks, it would be very helpful.

The bottom line, though, is that vendors do what the market demands.  Until providers dig their heels in and refuse to buy clumsily-designed systems, nothing’s really going to change.  Maybe CIOs will get more demanding when users stage a revolt and refuse to touch their painfully awkward EMR?

EMR Mobile Integrations

Posted on April 7, 2011 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 can’t quite figure out why EMR software was been so slow to integrate with various mobile technologies. Certainly we’ve seen quite a bit of effort when it comes to EMR and the iPad. However, I’m talking more about patient focused mobile apps.

I started thinking about this when I saw the video below. It’s a sales video, but demos some interesting mobile features that I think should be part of most EMR software:

Something as simple as appointment reminders should be part of every EMR, but sadly it’s not and I’m not sure why. I’m sure some will cry HIPAA, but that’s a total cop out. Besides the fact that you can obtain consent, you can text an appointment reminder without violating HIPAA. It’s not that much different than an automated call system calling to remind them for the appointment.

The automatic welcome text with directions to the office is a nice touch too. Some of the Cisco mobile integrations I’ve seen before in a few EMR, but it definitely adds to the complexity of the EMR implementation. That’s something that I think you have to be careful with as an EMR vendor.

However, the mobile nurse notification is something that could be really interesting. This is a little harder to implement properly since you need to balance the nurses need to know the information and alert fatigue. Or in other words you don’t want to bombard the nurse with so many messages that she stops looking at them because there’s too many and many are outdated since she can’t keep up with the messages.

What about using the bump or bump like technologies to give patients their clinical summaries on their mobiles to satisfy the meaningful use requirements? I’m sure there’s many more.

Why don’t we see more functions like this? Sadly, I’m afraid the answer is that these features won’t likely sell more EMR software.

Teletrauma, A Precursor to Video EMR?

Posted on May 19, 2009 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.

Neil Versel wrote an interesting piece over on Fierce Mobile healthcare which talks about EMTs and hospitals using technology to facilitate better care for patients. Neil however argues (rightly so) that not many emergency physicians are going to make a diagnosis based on a grainy photo. Then, he goes on to talk about video. Here’s a small section of his article:

Now, imagine if doctors and nurses could provide real medical advice to help EMTs treat patients in transit based on high-quality, two-way live video. That’s exactly what they have been doing in Tucson, AZ, for nearly two years, thanks to a 227-square-mile Wi-Fi grid that covers most of the city. East Baton Rouge Parish, LA, which includes the city of Baton Rouge, recently launched a similar system that eventually will link to seven hospitals across the parish.

Tucson’s University Medical Center saves $5,000 each time it can prevent an unnecessary activation of a Level 1 trauma team and, more importantly, can save lives by providing remote diagnoses and triage and making sure the trauma team is ready while the patient is still in transit. I wrote about this technology in the May issue of Hospitals and Health Networks, but that short piece only tells part of the story.

I just love the fact that hospitals are looking at this. However, I couldn’t help but have my mind drift off into an EMR. I wonder if this same video technology won’t one day be introduced into an EMR. Only makes sense to me. Hard drives are getting bigger. Video technology is getting smaller. One day a doctor won’t need to chart at all. They’ll just have the full video.

Now we just have to ask ourselves if that’s a good or a bad thing for doctors.

UPDATE: I started thinking and seemed to remember having a similar idea before. I thought it was with recorded audio. I did some digging and sure enough back in March of 2006 I wrote about what could be a video EMR. Interesting to think how some things go full circle.