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

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.

March 5, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

The Future of Physician – Patient Interaction

I’m hearing more and more people cry foul about the physician patient interaction trend. The obvious complaint is that more and more physicians are spending time in the exam room focused on the computer as opposed to the patient. There are a number of people doing really interesting things to try and solve this problem. In the following video Dr. Nick van Terheyden, CMIO of Nuance, discusses one view of how the future physician – patient interaction will happen.

December 17, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

EMR Masters, Smart EHR, and Congressional Hearing on Meaningful Use


I think this is definitely the case. I wish that EMR would embrace its place as the database of healthcare and enable an entire eco system of people to provide the add on functionality.


I always love seeing a provider asking for something I’ve been writing about for a long time. We need smart EHR, but as you see from the first tweet in the Twitter roundup I don’t think one company is going to make them smart. It’s going to take an ecosystem to make them as “smart” as they need to be.


I saw another tweet somewhat related to this. It asked if meaningful use was going to fall off the fiscal cliff. My short answer is: No.

November 18, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

EHR Upcoding, Meaningful Use Stage 2, Interoperability, EHR Consolidation, and ACOs Video – Burning Topics with Dr. Nick

I recently sat down with Dr. Nick van Terheyden, CMIO of Nuance to talk about some of the Burning Health IT topics. In the following video Dr. Nick and I talk about EHR Upcoding, Meaningful Use Stage 2, Interoperability, EHR Consolidation, and ACOs. Enjoy and I hope you’ll extend our conversation in the comments.

October 24, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Dr. Nick, CMIO of Nuance Talks About Their Acquisition of Quantim and J.A. Thomas & Associates

While at AHIMA 2012, I had a chance to sit down with Dr. Nick van Terheyden, CMIO of Nuance Communications, to learn a little bit more about the recent Nuance acquisitions of Quantim (HIM division of QuadraMed) and J.A. Thomas & Associates. I asked Dr. Nick to describe how these acquisitions will fit into Nuances portfolio in the following video.

October 4, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

HFMA ANI Las Vegas: That’s a Wrap

Though it was only my second time attending the annual HFMA ANI show, I think it’s fast proving to be my favorite when compared to HIMSS – at least when both are held in Las Vegas. The shorter exhibit hall hours; a smaller, more manageable venue; and a general feeling of being less rushed to accomplish every task I set myself was a welcome contrast to the breakneck speed at which we all seem to attend HIMSS.

Though the ANI show had a more laid back vibe, it was by no means any less meaningful to its attendees and exhibitors. Some of the exhibitors I spoke to noted that while booth traffic wasn’t as brisk as they’d have liked, they were having deeper, more meaningful conversations with the folks that did stop by. Others told me that it didn’t seem like many members of the hospital C-suite were in attendance, and decided to send their seconds-in-command instead. (Perhaps they were too busy back home attending to projects related to any of the following healthcare IT acronyms – EMR, HIE, ACO, CPOE, ICD-10, SCOTUS.)

I didn’t get a chance to attend any educational sessions, but from the tweets that I saw, most folks really enjoyed keynotes from Olympian Carl Lewis and renowned pilot Sully Sullenberger. Speaking of tweets, the volume of chatter on Twitter was pretty dismal. There were a few devoted tweets around the #ANI2012 hashtag of course, but for the most part, Twitter (and social media in general) was non-existent.

I walked the show floor Tuesday to see if I could spot any technologies tied into EMRs, and didn’t find much to choose from – at least not as many as I came across last year. I did have some interesting conversations with the folks at Nuance about new solutions being sold under the Dragon Medical umbrella.

Population health management was a phrase I heard (or saw) a number of times, as was predictive analytics and the ubiquitous “Big Data” – all three of which tie together in the world of hospital CFOs. In my mind, it seems that it will be necessary from a financial standpoint for hospitals to get a firm grasp of what “Big Data” means to their organization, and then how to use predictive analytics to derive meaning from that data in their population health management programs, especially if they plan on successfully participating in any sort of coordinated or accountable care program. MedAssets is doing some interesting work around this concept that I hope to learn more about once I get back home and settled.

I’d be interested to hear your thoughts about the show, especially if you were an attendee. How did it compare to last year? Did you think, like me, that many folks were seduced by the lure of the pools at Mandalay Bay to the detriment of folks working the exhibit booths? Gather your thoughts while you peruse a few pictures I took on the show floor:

I stopped by the MedAssets booth to talk population health management with Carol Romashko, Director of Marketing.

AfterHours UR intrigued me with its pleasant logo and hospital utilization review service founded by nurses.

The folks at Executive Health Resources had a catchy come-by gimmick with a caricaturist creating portraits on etch-a-sketches.

 

EnableComp definitely had kid-friendly schwag. I'm still kicking myself for not going by there during the last hour of the show.

Emdeon's Cash Stacker games seemed to be a big hit on the show floor.

HumanArc knows that creativity really does pay off, at least when it comes to attracting passers by with Lego-inspired logos.

It was interesting to me, being an Atlanta native, to note how many Georgia-based revenue cycle management clients MediRevv has.

My favorite part of the Nuance booth was the tag line "Use it for Good."

Objective Health, formerly known as McKinsey Hospital Institute, had a very inviting booth. It was nice chatting with their CEO, Dr. Russ Richmond.

I didn't see any "whack a mole" type attractions, but this game from PNC definitely grabbed attendees' attention.

I didn't get a chance to stop by the Premier booth, unfortunately, but it was certainly eye-catching.I heard several interesting customer success stories from the Protiviti team, which I hope to cover in greater detail in the near future.

The VisiQuate booth impressed me with its high-tech feel.

It certainly wasn't all work and no play. I enjoyed Dell's evening event at the Shark Reef Aquarium with Stephen Outten, Content Marketing and Social Media Strategist at Dell, and Amanda Woodhead, Manager of Corporate Communications at Emdeon.

June 28, 2012 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

“Non Structured Data Is More Valuable to Practitioners Than Discrete Research Oriented Data”

In my post on the EHR Bubble, Don B offered this strong statement:

“Recognizing the non-structured information is more valuable to the practitioner than discrete researcher oriented data.”

I love people that make strong statements and this is no exception. This is a comment that will no doubt hit people the wrong way when you consider how much focus things like meaningful use have focused on discrete data. I can already hear the chorus of doctors asking why meaningful use wants all this discrete data if the non-structured data is where the value is for practitioners.

There are a lot of nuances at work that are worth discussing. I agree with Don B that at this point in time the non-structured information is more valuable to a physician than the discrete data. I’d also extend that comment to say that non-structured information will likely always have value to a practitioner. There are just certain parts of physician documentation that can’t be discrete or at least cost far too much to make them discrete. I’m sure the EHR narrative crowd out there will love this paragraph.

Although, even proponents of the EHR narrative realize the value of discrete data elements. That’s why companies like Nuance and MModal are investing so much money, time and effort into their various NLP (Natural Language Processing) and CLU (Clinical Language Understanding) offerings. The key question for these companies has never been whether there was value in discrete healthcare data, but in how you capture the discrete healthcare data.

When thinking about discrete healthcare data I hearken back to a post I did in 2009 that asserts the Body of Medical Knowledge Too Complex for the Human Mind. This concept still resonates with me today. The core being how does a physician take in all the patient data, device data, lab data, medical data, research data, etc and provide the patient the best care possible. This will never replace the physician (I don’t think), but I expect the tools will become so powerful that a physician won’t be able to practice medicine without them.

Much of the power required for computers to assist physicians in this way is going to come through discrete data.

Over the next 2-3 years we’re going to start seeing inklings of how healthcare will improve thanks to discrete data (often captured through and collected by an EHR). Then, in the next 5-10 years we’re going to see how healthcare couldn’t survive without all the detailed healthcare data.

June 19, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

AHIMA Wrap-Up: Domestic vs. International Transcription Still an Issue

All of the product literature I collected at the recent AHIMA show in Salt Lake City finally arrived in the mail the other day. As I sat sifting through all the pamphlets, brochures, case studies and white papers trying to remember why I had picked them up in the first place, one tag line in particular caught my eye: “Has your transcription seen more continents than you?”

Yes, there were plenty of technologies and services on hand relating to electronic medical records (EMRs) and electronic health records (EHR), depending on which term is your flavor of the week. But what really got my attention was the number of booths I went to that boasted transcription and coding services based right here in the good ole’ US of A, and their competitors that still internationally outsource these types of services.

Most booth reps I spoke with proudly told me that their services were located in the US. On the flip side, one company boasted that all of its services have been totally off-shored in order to meet customer demand for more competitive pricing. So what’s a provider to do?

I am, admittedly, new to the world of coding, and as this was my first AHIMA show, I was unaware of the schism that has developed in the world of domestic and international coding services. But, as a consumer that has been assisted – both competently and disastrously – by call center reps that I’m 99-percent sure were not located in the United States (despite their insistence on being located somewhere “in the Midwest”), I am aware of the consumer backlash that can result from a business’s decision to outsource its customer services.

I can only imagine, however, the pressures providers must feel when they are making decisions along these lines. Do they adhere to what their bottom line indicates is the best choice, which I assume means going international? Or do they stick with US-based companies to ensure that native English-speakers are picking up all the right nuances in documentation?

The brochure featuring the eye-catching tag line above continued its strong messaging with: “You’ve probably heard horror stories about what can happen when transcription services send work overseas. With language barriers, training deficiencies and rapidly changing regulations, mistakes – serious mistakes – are inevitable.”

Really? Inevitable is a pretty strong word. Is it a legitimate one to use in this circumstance?

A white paper from webmedx (now a part of Nuance), “Finance Leaders Rethink Transcription: Six Critical Criteria in a Changing Landscape,” provides a bit more insight into the issue: “Perhaps it was the black market sale of patient information in India …. Perhaps it was the worldwide economic meltdown and loss of U.S. jobs in 2009. Or maybe it is the pressure of tighter HIPAA regulations under ARRA’s HITECH Act. Whatever the cause, the effect is clear. Healthcare providers who sent medical transcription offshore in the past are bringing it back home.”

Are there any providers in the audience who’d care to speak to either side – why they chose to go domestic, or feel that the quality of transcription is just as good abroad? Has “cheap” become overrated?

Chime in with your comments below in answer to my question above.

October 19, 2011 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.