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A National Universal Health Record (UHR) Database – Doable Any Time Soon?

Posted on January 31, 2012 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

Could a single, mammoth database solve all our health data needs? Margalit Gur-Arie, whose writing and ideas I greatly admire, has been arguing for one quite passionately on her personal blog in a couple of recent posts (part I, part II).

The crux of her posts is this:
– There should be a single, standardized national database to which physician practises, and ultimately EMR vendors, must submit mandatory data, “in real time”. The requirements will be along the lines of current Meaningful Use requirements.
– This database will be accessible to vendors and entrepreneurs alike, and can have multiple EHRs or apps built atop them.
– Since the patient data is available, and easily accessible (no one “owns” the data, they only own the proprietary bells and whistles they perform on the data), this is a near perfect patient utopia.

It’s a great idea and perfect for an ideal world. Except:
Massive databases cause massive headaches, as commenter Omowizard pointed out. There is a price to pay for data available at all times, all places, and by everyone. And if I may add, in Gur-Arie’s model, it’s not clear who’s left holding the bag. Presumably the government. Which opens a entirely different can of worms about data ownership.
Real time updates of data is no joke. At my current place of work, we perform quasi-real time (twice daily) updates of patient visits to client databases from a central repository. The sheer volume is enough to bring down the database servers for a good hour or two.
– We haven’t been able to agree on a standardized schema passed for a healthcare database. What are the odds of this idea ever catching on?
How are we going to mandate data population? After physicians and care organizations, will EMR vendors be the next recipients of government bribes/largesse/sops to induce them to populate the database?
– Gur-Arie herself points out that American enterprise being what it is, if there are no financial benefits to data ownership, they’re going to be a hard sell.

And while it’s easy for me to write a smart alecky blog post about the infeasibility of the mammoth database idea, I shudder when I think of what we have now: disjoint EHRs that don’t “speak” to one another, walled gardens and proprietary ownership of data that pretty much lock physician office in, PHR offerings from companies like Microsoft who will do God knows what with OUR health data.

I don’t think there are any easy answers. I’m leaning more towards an open source health “OS” platform rather than a single database. But at the very least, Gur-Arie offers some great food for thought.

EHR Evolution Can Improve Doctors’ Lives

Posted on I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

Or is it the doctor’s evolution with an EHR?  Recently, John Lynn of EMRandHIPAA.com asked me to comment on how the evolution of EHR can improve a phyisicans life.  This was sparked by the announcement by an EMR vendor that their electronic prescribing process was made simpler, moving from a 6 screen click process to a 2 screen process.  Although I think I’ve put this into some of my posts, perhaps in a scattered fashion, it’s a good topic to keep discussing.

More recently, I’ve been trying to pare down my EMR documentation to just the essentials, and it’s surprising after more than two years in private practice working with EMRs (two different vendors) that I can still find places to cut corners and make my life even easier, … ahem, … I mean better.  I wouldn’t want to give anyone the wrong impression that my life is easy.

Most recently, I’m working on fine tuning my templates and cutting out things that don’t seem to matter, like the section for chief complaint.  This has now become just an automatically populated field with the time and date stamp of the appointment and when the patient actually showed up.  Anyone who reads the “History of Present Illness” section will know what the chief complain is anyway since it’s reiterated there.  Ah, I love redundancy!

Although I didn’t mention much about it, my EHR system has evolved and “upgraded” its programming over time, and these changes have mostly been good and needed ones.  Most of these changes, however, are behind the scenes alterations that the end user will never know about unless they get announced.  One comment I can make is that, in 2011, software changes in order to meet Meaningful Use has derailed a lot of the more potentially innovative, dreamy ideas that could be so much more if the EHR vendors weren’t having to jump though creativity-stifling, complex hoops to redo their systems to meet even Stage 1 MU.  This will probably get worse as the hoops become more onerous in Stages 2 and 3.

However, back to my more productive line of thought.  The best part of continually refining one’s strategies for using their EMR system is that it leaves them with even more time to use for other more beneficial things in one’s professional life.  Life is so short, so I highly recommend choosing wisely how to spend it.

DrChrono EMR Raises $2.8 million and Has 15,000 Registered Providers

Posted on January 30, 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.

A few days ago the news came out that Y Combinator startup company DrChrono has raised another $2.8 million in funding. Here’s the summary from Techcrunch:

Drchrono, a startup that simplifies the professional lives of doctors by bringing electronic health records and much more to the iPad, has raised $2.8 million in funding led by Yuri Milner, with Google’s Matt Cutts and other investors participating. The startup had previously raised $1.3 million in seed funding from Milner, General Catalyst, Charles River Ventures, 500 Startups, Gmail creator and FriendFeed cofounder Paul Buchheit, Cutts, and the Start Fund.

It’s an interesting mix of people that are funding DrChrono. Matt Cutts interests me a bunch since he works on the search engine team at Google in charge of Spam. Obviously, this is a quite different space.

The most interesting information in the Techcrunch article is the number of providers and patients that DrChrono has in its system.

The company also announced it now has more than 15,000 registered providers, and more than 400,000 patients using the drchrono platform.

Of course, we know how EMR companies are with these numbers. It’s one thing to have a registered provider and it’s quite another to have them actually using the EHR software. Also, I can’t help but wonder if the 400,000 patients includes imports of a physicians past patients. I’d love to hear some real numbers. For example, how many daily active users (doctors) do they have using their iPad EHR?

I also find it interesting that DrChrono has only taken $4.1 million in funding versus funding like CareCloud’s $27.3 million and Practice Fusion’s $38 million. Seems like DrChrono has chosen the much more conservative EHR software route as opposed to the more ambitious healthcare platform route that the others are working on.

When Physicians Own Practice, EMR Implementation Feels Tougher

Posted on 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.

Here’s an EMR adoption study which interested me largely because it runs counter to what I would have predicted.  The study, which surveyed physicians pre- and post- EMR implementation, found that doctors who owned a stake in their practice found their rollout to be tougher than physicians who didn’t have a stake.

I don’t know about you, but I would have assumed that the folks with more control — the owners — would have found it easier than those who have to adapt to the decisions others make.  But it seems that physician-owners simply feel the pain of change more acutely.

To conduct the study, which was published last week in the Journal of the American Medical Informatics Association,  researchers surveyed 156 physicians working with the Massachusetts eHealth Collaborative.  The surveys included a pre-implementation questionnaire  in 2005 and a post-implementation questionnaire in 2009.

Thirty-five percent of doctors who responded reported that implementation was very difficult, 54 percent said it was somewhat difficult and 12 percent not difficult. Those numbers square pretty well with what I’ve seen elsewhere. The twist here was that 38 percent of physicians with full or partial ownership stakes in their practices voted “very difficult,” versus 27 percent of non-owners. That surprised me. After all, aren’t most of the complaints coming from doctors who try to use the new systems?

According to Marshall Fleurant, MD, one of the study’s authors, the owners “probably experienced more underlying challenges associated with EHR implementation and workflow transformation” given their broader operational responsibilities.

While this study is interesting, it’s hardly the last word. Teasing out just which factors predict how doctors will react to EMR implementation, much less what it takes to support them, is still a new science.  But it never hurts to bear in mind that physicians making critical management decisions get support, too.

Around Healthcare Scene: ADP AdvancedMD, Care360 EHR/EMR Screenshots, 24/7 Flu Hotline, and Tricorder X Prize

Posted on January 29, 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.

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

EHR and EMR Videos
Software Demo of ADP AdvancedMD + EMA Ophthalmology
This medical billing and EHR software demo presents how medical practices can use ADP AdvancedMD as their practice management to collect more money, faster. EMA for ophthalmology helps doctors utilize an iPad to manage clinical charting and see more patients faster. A software bridge (data integration) has been built to help staff work faster without doing double data entry.

HIMSS Analytics: Data, Research and Consulting for Healthcare IT

Gain a deeper, more vibrant understanding of the HIT space through HIMSS Analytics. Knowing who needs what, when they need it and who to contact will enable you to sell proactively to receptive customers. Our market intelligence will help you optimize your marketing and sales strategies to advance the future of healthcare.

Steve Hinajosa Explains Advantages of DocBook MD 3.0

Travis County Medical Society Membership Director, Steven Hinojosa explains why local county Medical Societies should be interested in DocBookMD 3.0.

EHR and EMR Screenshots

The links below represent screenshots from the Care360 EHR/EMR including images from the EHR, the iPad app, and the mobile app.  Do you think it is necessary for EHRs to use multiple platforms for access, or is it unnecessary vanity?

Screenshots from the Care360 EHR/EMR

iPad App Screenshots from the Care360 EHR/EMR

Care360 EHR/EMR Mobile App Screenshots

Smart Phone Health Care

Consult A Doctor Offers 24/7 Flu Hotline That Costs Less than $40

Flu season is generally miserable for everyone.  Even if you don’t actually get sick you spend half your time avoiding the people who are sick.  Then you start to get symptoms but you wait as long as humanly possible to actually see a doctor because it is so expensive and time-consuming.  Consult A Doctor is releasing a new service designed to change all of that.

Qualcomm Tricorder X Prize Offering $10 Million Prize to Developers

We all remember those awesome little tricorders from the Star Trek series that could analyze a person’s level of health almost immediately.  All the doctor had to do was push a button and he immediately knew exactly what he needed to do to help the person.

Qualcomm and the X Prize Foundation have announced a development competition designed to create just such a device.  The two CEO’s of the respective companies, Dr. Paul Jacobs, Qualcomm Foundation Chair and Qualcomm Incorporated Chairman and CEO, and X PRIZE Foundation Chairman and CEO Dr. Peter Diamandis, announced during the keynote address at CES that the prize would be $10 million dollars.

My HIMSS 2012 Session List #HIMSS12

Posted on January 27, 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.

I’m sure that some of you might have seen me complaining on Twitter about the challenge of trying to sift through the 300+ educational sessions at HIMSS. I even tried to convince the HIMSS expert Neil Versel to offer up some suggestions on which HIMSS 2012 sessions to attend. He suggested just leaving all of the education times open and decide later. It’s a good idea, but I think I prefer meeting with people more than some of the available sessions. Neil enjoys the sessions a bit more than I do.

One of my favorite old Neil Versel posts was when he basically said, “HIMSS is more than just the exhibit hall.” With 300+ sessions at HIMSS 2012 there should be something you will find interesting, so HIMSS should be more than just the exhibit hall.

Today I started ripping through the HIMSS sessions to try and identify those I found interesting and worth putting on my schedule. While they might make it on the schedule, that doesn’t mean I’ll necessarily attend. I debate attending based on the flow of the conference, people I’m with at the time, and if I’d already heard enough on that subject for one HIMSS. Plus, I often put multiple sessions that are at the same time on my schedule. In those cases, I use the above criteria to decide which ones I should attend.

The other X Factor with this all is that I still have to schedule my meetings with vendors I find interesting during HIMSS as well. I’ll start doing that now that I know which HIMSS sessions are happening when. At least now I won’t schedule a meeting with a vendor during the Biz Stone keynote. That would be a travesty.

Below you’ll find my HIMSS 2012 schedule of sessions (which will likely continue to change), but for those interested here’s the process I did to find interesting sessions. First, I added the exhibit hall hours and keynotes. Next, I went through the HIMSS Specialty Programs and HIMSS Social Media Center schedule (My HIMSS Panel on Wed, 2/24 from 4-5 made it on my schedule from this list). Then, the HIMSS Education section has the sessions broken out into “Core Education” areas. I found the Federal Participation at HIMSS 12, Senior Executive sessions and EHR Best Practices sections quite interesting.

There you have it. I’m sure I missed some sessions I should attend, so if you know of some that you think are worthwhile do let me know and I’ll check them out. Now without further ado, my current schedule for HIMSS 2012:

As you can see it’s going to be a full and crazy week for me at HIMSS 2012, but as I said before HIMSS is great for me. Everyone goes there with a little different plan on what they want to accomplish and learn, but hopefully my list of sessions will be helpful to someone else navigating the HIMSS 2012 gauntlet.

Let me know if you have any questions about particular sessions and I’m happy to tell you why they made the list as well.

Care Innovations Summit Challenge Announcements

Posted on January 26, 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.

Today was the Care Innovations Summit in Washington DC. If you want to read more on what’s been happening at the Care Innovation Summit, you can check out the lengthy #cisummit Twitter hashtag to hear what’s being talked about.

One of the things that seems to be sweeping Washington (I think Gingrich mentioned this in one of the GOP debates recently) is the idea of challenges. I like the idea of challenges and encouraging people to strive to do something interesting and useful and rewarding them for it. I don’t know why, but for competitive people like me, the idea of a challenge gets the juices flowing.

In the morning Ignite section of the Care Innovations Summit a number of challenges were presented. Here they are for those who like a good healthcare challenge:
Sanofi Diabetes Challenge

KP HIV Challenge

Janssen at Johnson & Johnson Connected Care Challenge

Allscripts Million Hearts Challenge

Pfizer + Janssen Alzheimer’s Challenge

HHS ONC Care Transitions Challenge

What do you think of these healthcare challenges? I think it’s great that you can earn some reward while doing something beneficial for healthcare.

Just What the Doctor Ordered: Mobile Access to Your Kaiser EHR

Posted on 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.

Recent news that Kaiser Permanente has made its patients’ electronic health records available via mobile devices comes as no surprise. Kaiser often seems to be at the forefront of interoperability and coordinated care, in large part due to its integrated nature and sheer volume of patients. As the company’s press release mentions, it maintains the “largest electronic medical records system in the world.” Now, 9 million of its patients can view their EHRs via a mobile site or Android app, with an iPhone app expected to launch in the near future.

On a macro level, I think this is a great step towards further empowering patients to take control of their health. By giving 9 million folks instant access to their own health information, I’d like to think that this will in turn prompt their friends and relations to ask, “Why doesn’t my doctor do that? What benefits am I missing out on?” And perhaps these same folks will then have a conversation with their provider about adopting this type of mobile access.

I’d be interested to see six months to a year from now, statistics comparing use of the mobile app/site to use of the tools found on the traditional website. Will Kaiser see a tremendous increase in the amount of emails between doctors and patients via its mobile apps? Are its doctors prepared for the potential onslaught of correspondence? I wonder if a few have balked at the possibility of being overrun by emails from particularly communicative patients.

Will they be able to tie these usage statistics to a jump in quality outcomes? Will mobile access ultimately become a criteria measured within accountable care models or patient-centered medical homes? Will mobile health truly equal better health?

On a micro level, I would certainly appreciate the effectiveness of access like this, which includes the ability to view lab results, diagnostic information, order prescription refills and the aforementioned email access to doctors. I can’t tell you how many times I’ve been on the phone with a pediatric advice nurse and drawn a blank when asked what my child’s current weight might be. It would be nice to be able to quickly pull that data up on my cell phone, especially while we’re on the go or out of town. I could eventually see patient charting apps being layered on top of this, so that in the event of a high, overnight fever, I could log temperatures via the mobile app and review them with our pediatrician – possibly alerted every time a new temp or symptom is entered – the next morning.

The possibilities seem endless. I think the big goal for Kaiser now is to get folks engaged and using these new access points.

Would National Patient Identifiers Work?

Posted on January 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.

Right now,  healthcare organizations have to go through some pretty tricky maneuvers to link patient data across varied systems and settings.  It’s possible to connect patient info electronically through database hacks, but more often than not, matching patients to clinical data gets done by hand.

Given the insane complexity of the existing system, would it make sense to create a national patient identification number for every U.S. patient?  The question is worth revisiting, given the immense level of error and wasted time generated by the existing system. After all, not only would putting an NPI in place make it easier to track patients within a hospital or health system, it would simplify the rollout of HIEs dramatically, wouldn’t it?

Dr. Robert Rowley of EMR vendor Practice Fusion notes that the biggest enemies of establishing a National Patient Identifier are privacy advocates who feel that an NPI would expose patients to greater risk of breaches or misuse of data.

But is that a realistic concern? Probably not. I agree with Dr. Rowley, who asserts that it’s hard to imagine that PHI would be at greater risk simply because of how it’s indexed.  As he notes, PHI breaches are nearly always often haphazard affairs in which a laptop is stolen than Big Government or corporate conspiracies. (If you’re afraid the government is covertly siphoning your health data off to study it, not having an NPI won’t protect you, anyway.)

No, the real barrier to this kind of administrative simplification measure is time, money and resources, the same barriers that hold back any other proposed HIT project.  It’s hard to imagine the resources that would be involved in instituting such a system — the idea makes my head hurt — and I have to assume it’d be several years before it was anything like mature.

Still, it’s good to bear in mind that at least some members of the public are afraid that creating an NPI would compromise their privacy. If the only barrier to improving patient matching in our EMRs is technical, that’s one thing — but if it’s patient fears, that’s another thing entirely. Sometimes, it’s good to remember that most of the world doesn’t think like a health IT exec.

State of the Small Practice Infographic

Posted on 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.

Free EHR vendor, Practice Fusion, has put out their 2012 State of the Small Practice infographic and survey results. Here’s the infographic they created (click on the image to see it full size):
Infographic State of the Small Practice 2012

You can see the full press release about the 2012 State of the Small Practice Survey or read some of the key findings below:

  • 45 percent of doctors report that their practice is doing better this year compared to last year while 14 percent report that their practice is doing worse and 33 percent report no change.
  • In the 2011 State of the Small Practice Survey, only 26 percent reported that their practice was doing better than the year before, while 41 percent reported doing worse.
  • 60 percent of small practices report that new technology has made things easier.
  • 26 percent of practices use computers that are less than a year old. Thirty-eight percent report that the computers in their practice are over three years old, a major improvement from 73 percent the previous year. (Seven percent of practices have computers in the five to six-year-old range, down from 21 percent in 2011.)
  • An overwhelming 89 percent of doctors report being satisfied or extremely satisfied with their career despite challenges, a 20 percent increase from the year before.
  • Most practices ranked insurance and reimbursement as the top negative pressure (69 percent), followed by patient compliance issues (64 percent) and practice administration concerns (48 percent).
  • Positive trends are led by advancements in medicine (68 percent), patient compliance (53 percent) and improvement in the healthcare workforce (51 percent).