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!

New Survey for EHR Etiquette

Posted on November 29, 2012 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.

As more doctors deploy electronic medical record (EMR) systems in their practices, some physicians have reported difficulty balancing bedside manner with inputting information into their EMRs.  With a recent report stating that nearly 70% of U.S. primary care physicians now use electronic medical records, this discussion will be a hot topic moving forward.  A key question is: What’s the best strategy for balancing EMR use and physician/patient interactions?

Denise Amrich wrote on ZDNet Health in July about the Kaiser Permanente method for EHR etiquette.  Called LEVEL, the method advocates:

-Letting the patient look on;
-Eye contact;
-Valuing the computer;
-Explaining what you’re doing; and
-Logging off.

Undoubtedly, some physicians have developed their own best practices for EHR etiquette.  Software Advice is currently hosting a survey to analyze how EMR systems have impacted physician/patient interactions, and what physicians have done to effectively use the technology in their practices.  The survey is only a few questions, and should take only a couple of minutes to complete.

The Software Advice blog is hosting the Patient Interactions with EMR/EHR Use survey.  Data will be collected over the next few months, and a final report and analysis will be shared on the Software Advice blog after the survey has closed.

Healthcare Regulations, EMR Overbilling, and Bandu: Around Healthcare Scene

Posted on November 11, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

This weeks roundup is actually a compilation of posts from the past two weeks, because I wasn’t able to get last weeks done. Enjoy!

EMR and HIPAA

Dating EHR vs Marriage

It may seem like an interesting analogy, but what is the difference between “dating” and EHR, and settling down a “marrying” one. This post has some interesting thoughts on the matter, including the idea, “You may treat me great when we’re “EHR Dating”, but how are you going to treat me once we’re married?”

Keeping Up with Healthcare Regulations

Many physicians have the same complaint — it’s hard to keep up with healthcare regulations. A new program called HCPro Comply, has basically answers and suggestions to every question, all bundled into one place. It also has an “Ask an Expert” section, for those who may need a little more help or clarification.

 Hospital EMR and EHR

Gap Between Small/Rural and Large/Urban Hospitals Closing

Most of the time, it is said that small and rural hospitals are lagging behind in the adoption of EMR. However, Modern Healthcare suggests otherwise. CPSI, a vendor that typically is for smaller hospitals, is shown to be the vendor for 19 percent of the hospitals that have totally integrated EMRs, which is much larger than some of the larger EMR companies. While there is still a long road ahead for smaller hospitals and EMRs, it’s encouraging to see numbers like this.

EMR Overbilling Investigations Sling Mud At Meaningful Use Program 

There recently were allegations in the New York Times, accusing overbilling and upcoding of increasing since the rise of EMR. Whether these allegations were warranted or not, the ONC has taken action, and a study is being conducted to see if providers use EMRs to upcode billing. This is just another issue for providers to worry about as they implement EMRs.

Smart Phone Healthcare

Five Medical Apps Every Parent Should Have

For the first time parent, or the seasoned one, there’s several apps that have been created to help manage a child’s health. These apps range from sleep trackers, to symptom checkers, to an electronic medical ID card. While not every parent will find each one helpful, there’s sure to be at least one for everyone.

Bandu: Can Monitoring Your Stress Levels Help Lower Them? 

In a world where it seems everyone is constantly on the go, stress levels are likely to be higher than ever. However, a company is working toward helping people control their stress. Neumitra created a wearable device that monitors stress levels and identifies locations or situations where stress may be a little to high. It helps people recognize when they need to try and de-stress a little, and have a healthier, happier life.

Meaningful Health IT News

My First Portal Experience

Although he has been writing about Health IT for years, Neil Versel has never actually used one for his own personal benefit. However, he recently had the opportunity to when he received an email about some changes that were made. In this post, he talks about what it was like, what was available, and his feelings about it.

Happy EMR Doctor

EMRs’ Slippery Slope of Cloning Notes

A problem with EMRs is the temptation to clone notes from one record to another. While not all doctor’s take advantage of the “cut-and-paste” function, some do and rob the system in the process. There are some solutions and they must be considered in order to cut down on those who are taking advantage of it.

EMRs’ Slippery Slope of Cloning Notes

Posted on November 10, 2012 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.

Given all of the recent hubbub regarding cloning of medical office notes using electronic medical records systems, I thought I would write in with my opinion on this topic. You know, just as one fabulous new technology comes about that enables much more efficient documentation of patient encounters in physicians offices, it seems like critics are quick to try to take away that ability from doctors. Most doctors work hard at what they do and are just trying to do a good job in providing the best of care using all the modern digital tools available.

Since there are no official published guidelines in this area, it seems yet another of many many MANY (did I mention many?) gray zones in the world of digital and mobile health technology.

Like it or not folks, the cut-and-paste function available on any computer is here to stay. It’s up to physicians and other providers like nurse practitioners and physician assistants to choose to use this technology responsibly. Furthermore, I believe that it is not impossible to do so. That would only be logical. Otherwise, we could never acquire anything that made our lives as providers a little easier.

I understand that the Medicare system is practically bankrupt as it is and seeks to minimize fraudulent payouts. I also recognize that there are nefarious individuals out there posing as medical providers who can crank out EMR notes that are identical in a mass-production fashion in order to financially rob the system again and again.

However, let’s not take an anti-EMR philosophy.  Let’s not throw the baby out with the bathwater.  I don’t have the perfect solution, but rather then forbidding medical providers to use the technology in a powerful way to see more patients with less busywork at the end of the day that does not benefit patients whatsoever, I think we need to put more thought into solving this problem. What do they expect doctors to do with EMRs anyway?  Write everything from scratch every time?  Such an approach would be both nonsensical and naive.  And the solution should not be to withdraw the technology or force doctors to do things that are unconventional.

On the contrary, we need guidelines that make sense and do not add needless work to already harried medical professionals.  We need simplicity and not complexity.  We should not seek to recreate the debacle that some people came up with long ago that is the tax code-like nightmare of Evaluation & Management (E&M) guidelines, which are still quite gray in many areas.  We need to be able to empower doctors, NP’s and PAs even further with technology rather than retract abilities that the technology enables.

I’m purposefully not getting into specific examples in this post for the sake of brevity.  But I’ll be happy to take any questions my readers may have.  Who knows, it could lead to interesting future discussions.  For example, the precise definition of “cloning notes”, what qualifies?

Clinical Data Access, New Open Source EHR, and Striiv – Around Healthcare Scene

Posted on October 28, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Hospital EMR and EHR

Call Me Maybe at #CHIME12

One of the most popular songs among teens recently is “Call Me Maybe.” Well, at CHIME 2012, a music video of this song was created, featuring many of the participants in #CHIME12. It’s a fun little video, and the song sure is catchy.

Senators Join Initiative to Scrutinize Meaningful Use

After four GOP leaders have demanded that HHS Katherine Sebilus account for “failures” they found with Meaningful Use. Recently, a few senators have joined in the fight as well. Several questions were raised about EMRs, Medicare, and Meaningful Use. Is this the push that was needed in order to get Congress interested in the future of EMRs?

EMR and HIPAA
SXSW Accelerator Event for Health Startups

SXSW has long been known as an amazing music, film and now IT event. In fact, many people laud the event as a great place where creative people from all industries come together. This year SXSW has a whole health IT campus and a section of their Startup Accelerator competition that’s just devoted to healthcare IT startups. It will be a great place for healthcare IT to mix with the rest of the IT startup world. Plus, I expect a number of very interesting health IT companies to launch in the SXSW accelerator.

Access to Clinical Data Too Easy Via Phone

Most doctor’s offices will verify information by asking for a name and birthdate. However, this system could easily be compromised. Is there a better way to verify this type of information, before discussing medical issues? This post talks about different ideas, and how patient portals might be the solution.

New Open Source (Free) EHR Offering Developed by A Doctor

A new open source EHR is about to be released. And it was developed by a physician. Michael Chen, MD,  the doctor behind it, was interviewed on EMR and HIPAA. He discusses why he wanted to create an open source EHR, future plans, and any challenges that might be associated with it in this post.

Happy EMR Doctor

EMR Use Improves Primary Care: New Study

While there has been some debate about if EMR improves patient care, a recent study indicates that it does; at least in some health specialties. Over 7000 patients with coronary artery disease and diabetes were studied over the course of nine months, and the results ruled in the favor of EMRs. Dr. Michael West has found in his own personal observations, EMR does indeed improve patient care as well.

Smart Phone and Health Care

Five Challenges of mHealth

While mHealth has many advantages and has improved health care in many ways, there have been some challenges that have come about. These challenges include privacy, data security, and funding.

Striiv Ups the Standard for Pedometers — Games, Challenges, and Charity Incorporated

A new generation for the classic pedometer has been created. Striiv recently released a $99 pedometer that really gives the old kind a makeover. It incorporates fitness games, goals, and a charity to convince people to get walking. For those that don’t want to spend $99 on a pedometer, the (free) mobile app is available for the iPhone, and has a lot of the same functions.

EMR use improves primary care: new study

Posted on October 21, 2012 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.

There seems to be a lot of buzz in the news lately around the question of whether electronic medical record documentation can lead to a higher quality of care.  Last year, a study came out suggesting that this might be true for diabetes care.  More recently, my attention came to an article published in the Journal of the American medical informatics Association in May 2012, Method of electronic health record documentation and quality of primary care.

A group of researchers led by Dr. Jeffrey Linder at Harvard University’s Brigham and Women’s Hospital studied primary care physicians taking care of 7000 patients with coronary artery disease and diabetes over nine months. The study authors assessed 15 quality measures, three of which were found to be performed significantly less by physicians using a typical dictation system for record-keeping as opposed to those keeping records by electronic medical records systems.  Two of the three standards of care measures that dictating physicians were less likely to provide were tobacco use documentation and diabetic eye examinations.
This parallels my own findings as an endocrinologist using electronic medical records. During the period of my early years before I instituted widespread use of templating, I was much less likely to hit all of the quality care measure marks compared with after instituting templates.  It’s actually quite commonsensical that a medical provider can hit all of the marks if they are prompted by the computer.  In a sense, the care goes on autopilot.  No matter how chaotic a given point in the day of a busy doctor might be, it becomes impossible to complete a note without performing all of the prompts unless doing so deliberately.

There has been at least one or two studies that I’m aware of that have doubted or not found the conclusion that electronic medical records improve the quality of care patients receive.  I think that most likely these studies did not find a significant association because they were not properly designed.  When one considers the volume of quality measures pertinent to a typical patient visit with diabetes or coronary artery disease, there are so many measures that unless every physician has the measures memorized and never forgets anything, gets flustered or has to hurry through the visit, there will almost be a guarantee that not all measures will be addressed at a visit.  I’ll take that bet and win every time.

The fact that there are now at least two studies showing a positive relationship between the quality of care given to diabetic patients in the use of electronic medical records documentation is even stronger evidence that this is a real phenomenon.  Personally, I can’t believe that anybody would think that electronic medical records don’t lead to better care, regardless of the degree of such improvement.  That is, unless they’re not using the templating advantage.

Meaningful Use Is Not For Specialists

Posted on October 1, 2012 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.

You know, I’ve been thinking a lot about Meaningful Use lately. I previously I’ve had pretty negative opinions of it, and my thoughts seem to be echoed by a lot of doctors currently in practice.

Rob Lamberts, MD, wrote an interesting post titled Ten Ways to Make the EMR Meaningful and Useful. I have to admit, his suggestions made an awful lot of sense. They started me thinking about how useless much of my own documentation is because of its origination in archaic rules for receiving insurance reimbursement money. Unfortunately, it seems that a lot of these rules stem from the medical profession itself rather than have been having been thought of exclusively by insurance moguls. For example, the family history is usually almost entirely irrelevant to what my scope of practice generally entails. The Review of Systems (ROS), which is the part of the exam where we as doctors ask the patient a myriad of questions regarding their symptoms, is typically exhaustive, unproductive and usually despised by most practicing physicians. Patients are generally very forthcoming about any active symptoms that they are currently experiencing, and a few additional questions around their symptoms typically suffices for a doctor’s purposes.

The majority of old medical records that I get from previous practices in which the patient has been involved are usually either illegible, irrelevant, or not directly related to the reason the patient is coming in to see me. If I am seeing them for the same purpose and they are just transferring their care to me, I generally will ask much of the same questions that have been asked before, rendering the review of records of even more limited value.

I think that getting meaningful use out of our own individual records could be greatly helped by an overhaul of the medical profession’s recommendations to insurance companies on the types of information that needs to be included in medical office notes for the purposes of providing excellent healthcare. In the increasingly complex and technologically-advanced society in which we live, information “noise” really should be kept at a minimum, especially in providing appropriate healthcare recommendations to patients. Medical records should not be in a habit of containing information that does not change or impact the medical management of the patient. We really need to revisit the idea of “gee whiz” type of data and cut out any extraneous documentation.

This would, of course, require that meaningful use become much more personalized and individualized to specific doctors and their specialties. The current state of meaningful use is actually fairly limited in that it applies mostly to primary care providers making recommendations for preventive health care. Preventive health care, unfortunately, is almost never the reason why patients seek the advanced medical knowledge of specialists and subspecialists in specific areas of medicine.

In summary, I agree with Dr. Lamberts that we need to overhaul meaningful use into something that is much more meaningful and usable.

Wireless Health, HIPAA, and Patient Engagement – Around Healthcare Scene

Posted on September 30, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

EMR and HIPAA

Wireless Health Data Collection Innovations Getting Hot

Some of the newest health data innovations are wireless. From a chip that can test blood sugar levels to an ECG that connects to a cell phone through blue tooth. The possibilities are endless when it comes to wireless devices.

HIPAA Infographic

HIPAA violations happen frequently. Some are criminal, others civil. This infographic explains some of the most common reason for HIPAA violations, and the penalties associated with them. Last year, over 12,000 companies have either been investigated or had issues resolved concerning HIPAA violations. Definitely an interesting infographic to look over.

Hospital EMR and EHR

FCC Says Wireless Health Should Be “Routine” Within Five Years

An announcement from the FCC pushes for mHealth to be a standard practice in the medical world by 2017. Some doctors are hesitant to implement mobile devices, so this may be difficult for some to grasp. The FCC is working to make this easier, by doing things like working with the FDA to help with creating and introducing devices into the market.

Happy EMR Doctor

Patient Engagement: Who are the Real Targets?

While creators of health technology claim they are trying to reach patients most, what does that mean? Many people who would benefit from these types of technology are lower class, however, upper class people are probably more likely to embrace it. Should companies invest more time in discovering who target markets are?

Smart Phone Health Care

Traqs: One Tool to Rule Them All

Having trouble keeping track of all the health apps and devices that are being created? Traqs, a new device, does it for you. This innovation can track multiple devices and create graphs about activity on them. It makes it much easier to take control of your health and exercise devices.

Patient Engagement: Who are the Real Targets?

Posted on September 24, 2012 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.

As I further considered the ideas generated by the breakfast panel I had the opportunity to participate in recently, Doctors and Patients: Bridging the Digital Divide, I was reminded of a stimulating comment made by Nikolai Kirienko, a patient advocate with Crohn’s disease. He stated that we need to use the current technology to reach patients who need it most.

But who are these patients, really?

Are they the well and well-to-do, middle to upper-class population who are internet-savvy, highly educated, and compliant with following the plans suggested by the healthcare provider?

Are they the patient struggling with chronic illnesses, the symptoms of which may tend to wax and wane on a daily basis, making their issues a daily struggle?

Are they the poverty-stricken residents of typically lower class neighborhoods in metropolitan areas, who may have more limited access to digital technology?

From my personal experience in a downtown metropolitan area, namely Washington, DC, I can tell you that most of the patients who are engaged in seeking out new information regarding their health conditions tend to be highly educated, middle to upper-class patients with excellent access to digital technology.

But I have to come back to the initial comment in question, which begs the question of who should we really be targeting?  Who can really take the most advantage to gain from the digital healthcare revolution?

I could take the Pollyanna-esque view that everyone should be able to take advantage of everything equally and we should all just get along and be happy.  However, real-world experience tells me that there may be a different answer this question.  There are also limited resources for healthcare outreach campaigns.  Therefore, it would seem appropriate to do more research into the area to really define who the best targets are for the maximum benefits. It certainly seems like a valuable question to answer and one that’s worth going after.  What do you think?

Patient engagement in the digital era

Posted on September 17, 2012 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.

In the not-so-old days of medicine, patient engagement used to involve things like looking the patient in the eye when speaking to them, facing the patient, asking them how they felt, and asking them if they had any other questions before ending the visit. These so-called rules of engagement have now been augmented by the computer in between the patient and the provider.

No longer are the former etiquette protocols sufficient for interacting in the digital era. Now, patient engagement includes Internet searches using “Dr. Google” for what in my opinion are typically anxiety-fueled questions that are frequently unnecessary and irrelevant and would not have been asked prior to the arrival of Internet searches.

However, the internet isn’t going anywhere anytime soon, and so providers have to be able to deal with this new level of interaction. Fortunately, not all patient engagement is so maladaptive.

Patient engagement is a funny thing though. It seems to be confused by doctors, staff and patients. Some people think patient engagement involves E-medicine, or rather electronic visits over secure messaging systems. I laughed the other day when I viewed a YouTube video showing a woman talking about a third party for-profit software vendor company using their technology to allow patients to pay bills online and therefore be more” engaged”. Right. That’s twistier than Presidential campaign rhetoric.

Another speaker put it well when he said that “reality struggles to keep up with the rhetoric” when he was commenting on the difficulty in defining patient engagement, yet everyone wants to use the jargon liberally.

I prefer to think of patient engagement in the digital era as being positive in several respects. I expect the patients to take an active role in their healthcare, in gaining knowledge about their disease, and in gaining knowledge about health prevention and treating ongoing illness issues. In doing so, the patient becomes empowered to take an active role in the decision-making process during the testing and treatment phases of care. This is not to say the patient should get to consult Dr. Google and then dictate what tests are being done on them regardless of what the ordering provider thinks is appropriate. I think the most ethical and appropriate response to such requests are to, first, consider them seriously; second, discuss with the patient which tests are medically indicated and which tests are medically unnecessary; and finally, to stand one’s ground in either writing or not writing for any medically unnecessary tests to be ordered.

I also completely agree with the definition of patient engagement as defined by the Society for Participatory Medicine. It says that patient engagement is a movement in which networked patients shift from being mere passengers to responsible drivers of their health, and in which providers encourage and value them as full partners.

In order to get patients more engaged in participating in their healthcare, I think we need to make it fun, make it interesting, and communicate using means where the patient actually is, on multiple levels of “is”. In the case of the digitally connected patient, we should be considering communicating using the Internet, smartphones, and mobile devices such as iPads. We need to be able to make this communication valuable to the patient so that they, in turn, want more of it, and so that the movement grows.

Health IT Q&A, Speciality EMRs, and Secure Messaging: Around Health Care Scene.

Posted on September 16, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

EMR and HIPAA

Health IT Q&A With Scott Joslyn, CIO and Senior Vice President, MemorialCare Health System

This post features Scott Joslyn from MemorialCare Health System. He talks about a few different Health IT topics, including benefits and disadvantages to EHR and voice recognition. Joslyn is definitely an expert on Health IT, so this is a post you don’t want to miss.

Verizon Hopes To Be Secure Healthcare Network For All

Verizon is more than just switches, routers, and cables. Katherine Rourke discovered what the company has in store in the future with mHealth. She talked with Dr. Tippett from Verizon, who said Verizon’s Connected Health Division is “aiming to set the bar higher.” The company is hard at work, so expect some great things coming from Verizon.

Hospital EMR and EHR

Specialty EMRs: Behind the Curve? 

Are specialty EMRs worth investing in? There is debate on both sides of the issue, and a general consensus doesn’t appear to be developing anytime soon. Anne talks about assertions made in a statement recently about specialty EMRs, and offers her own two cents on the topic.

Study Suggests Most HIEs Aren’t Sustainable

HIEs are very expensive. Unfortunately, according to a recent study, the investment in them don’t seem to have any financial or clinical payback. There’s so much time and effort being put toward HIEs — would money be better spent elsewhere? Likely, but Anne Zieger doesn’t see things changing anytime soon.

Smart Phone Health Care

App Developers Urged to Consider Older Generations

There are apps developed that could make managing diseases like diabetes so much easier. However, these apps may not be designed with all age groups in mind. Researchers from North Carolina State are urging app developers to keep older generations in mind, who aren’t able to use certain apps as they are currently designed.

Happy EMR Doctor

EMRs’ Big Gaping Hole of Secure Messaging

This post is the first in a series from Dr. West, highlighting insights from his recent participating at a breakfast panel in Washington D.C. He talks about issues with secure messaging, including the lack of EMRs that have secure messaging included in their system. In the end, he discusses how secure messaging could impact patients and doctors positively.