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MIPS Twitter Roundup – MACRA Monday

Posted on December 11, 2017 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 post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program (QPP) and related topics.

As we near the end of 2017, I found a number of tweets from CMS and other people that I thought would be useful to those that are interested in MACRA and MIPS.

First up is this tweet from CMS that it’s not too late to still participate in MIPS and collect some performance data before the end of 2017. This is them promoting the Test Option which would allow you to avoid the 4% penalty:

Next up is a fact sheet from CMS which outlines the different between 2017 and 2018 when it comes to MACRA/MIPS. I particularly like page 6 of the document. As you go through it, you’ll realize why 2018 is going to be much harder than 2017.

Next up is a stat from MGMA. I’d be interested in learning about the 14% of practices that think that their value-based reimbursement is going to decrease. Are these people going to direct primary care? I don’t see it going down for almost anyone. What do you think?

Finally, Matt Fisher asks a question about whether MIPS should be voluntary. I don’t think they can make it any more voluntary given the current legislation and do any of us think that congress is going to take up this topic? I don’t. So, it’s kind of a moot point. However, there is a lot of doctor angst about MIPS/MACRA. I just don’t see enough of it to really move the needle on things. I think we’re stuck with MACRA/MIPS for the forseeable future.

MIPS Penalties Include Medicare Part B Drugs – MACRA Monday

Posted on November 13, 2017 I Written By

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program (QPP) and related topics.

I’m sure most regular readers can tell that we’re pretty worn out and tired of MACRA, MIPS, and related government regulation. No doubt you’ll see us posting fewer MACRA Mondays going forward, but we’ll still try to cover major MACRA events as they occur. We just won’t be publishing MACRA Monday every Monday like we’ve been doing.

Jim Tate recently posted about the Real MIPS Timeline which included:

  • Phase 1 – Denial
  • Phase 2 – Shock/Anger
  • Phase 3 – Acceptance

You should read his full writeup, but he’s right. There’s a lot of denial that’s going to lead to shock and anger until the majority of healthcare have to finally accept that MIPS and MACA aren’t going anywhere.

Jim Tate also wrote another important piece related to the MIPS penalties and Medicare Part B drugs. You can read the full details of the change, but for those too lazy to click over, here’s the summary:

  • Many organizations argued that Medicare Part B Drug Costs Shouldn’t be Included in the MIPS Penalties (I mean…payment adjustments)
  • The MACRA Final rule still includes Medicare Part B drug costs (for the majority of people) in the MIPS reimbursement and eligibility calculations

If you’re a practice with a high volume of part B drugs, you better start figuring out your MIPS strategy now! Otherwise, that payment adjustment is going to hit pretty hard.

Thanks Jim for the great insights into MACRA and MIPS. If you need help with MIPS, be sure to check out Jim’s company MIPS Consulting.

MACRA Twitter Roundup – MACRA Monday

Posted on October 30, 2017 I Written By

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program (QPP) and related topics.

We took last week off from our MACRA Monday series of blog posts. It seems like we’re in a kind of lull period for the program. Either you’ve started collecting the data you’ve needed or you haven’t. Plus, we’re kind of waiting for the next MACRA Final rule to drop for more details.

With that in mind, I did want to see what some of the latest things that were being shared on Twitter when it comes to MACRA. I found a lot of strong opinions about the program, some good resources, and some forward-looking thoughts on what could be coming in the next MACRA final rule.


It’s hard to argue with John. Not just because he’s a smart guy, but because he’s right that it’s hard to imagine a path forward that’s fee for service and doesn’t include a shift to value based care in some form or fashion. At least given the current market dynamics.


This caution from Workflow Chuck should have us all nervous about the shift. I see a lot of healthcare organizations going after the target as opposed to the goal of value based care.


MACRA is going to impact your biz. I liked the way Kelly broke it out into 4 areas. No doubt some of these things could be argued both ways.


This is still how most doctors I know feel about MACRA and even meaningful use before it. They feel like they’ve been thrown under the bus.

Here are two forward looking resources that look at what we might get from the MACRA Final Rule:

What else are you hearing about MACRA? Would love to hear your thoughts, insights, questions, perspectives, rants, etc in the comments.

Optimizing Your EHR for MIPS and Other Quality Payment Programs – MACRA Monday

Posted on October 9, 2017 I Written By

The following is a guest blog post by Meena Ande currently acts as Director of Implementation for Advantum Health. This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program (QPP) and related topics.

As quality reporting requirements ramp up under value-based payment programs like MIPS, healthcare organizations are busy retrofitting their EHRs to make way for new measures. In some settings, not much has changed by way of tech utilization since initial EHR investments were made. Many outpatient settings still lack the internal expertise needed to optimize their implementations.

The truth is many EHRs have the functionality providers need for quality reporting, but many providers don’t know that due to limited exposure to the system. Couple that stunted tech knowledge with the well documented lack of familiarity with MACRA and the recent rise of the service model in healthcare is no surprise. Many practice administrators are relying on their EHR vendor or engaging outside experts to help lead the charge on system reconfiguration to meet Quality Payment Program demands.

There are several EMR capabilities providers can take advantage of to support QPP reporting efforts. Here are a few tips to keep in mind as you customize your EHR for MIPS and other value-based models.

Don’t boil the ocean when selecting CQMs.

Most EHRs give the option of tracking more than what is required for quality reporting. Initially, track applicable measures that exceed reporting requirements. After three to four weeks you’ll know which are your strong areas. Pick the best of the litter and proceed.

Providers can be overwhelmed by too many measures, particularly in multi-specialty practice settings. While it can be difficult to find overlap in measures between specialties, taking advantage of shared metrics whenever possible can reduce reporting burdens. Sit down as early as possible and develop an EHR configuration that works for your practice’s various clinicians.

Case in Point:

A gastroenterologist and a cardiologist may work in the same multi-specialty organization and on the same EHR, but the clinical quality measures they care about differ. There is no reason to give the gastroenterologist access to the cardiology problem list in the EHR. Specialty views improve ease-of-use and support more complete documentation.

Most EHRs offer role-based and specialty-based customization. Administrators can enable or disable EHR features related to some quality measures at the practice level and sometimes at the individual provider level. Clinical quality measures are based on details about the patient, but what is captured at each point of care should be tailored to the specific provider role.

Consider the roles impacted by different CQMs.

Keep the role of the person who may be responsible for different quality measures and Advancing Care Information workflows in mind when selecting and carving out space for CQMs in your EHR. Select measures that spread reporting work across multiple roles to relieve clinicians of unnecessary burdens.         

Case in Point:

The insurance eligibility verification required under Meaningful Use is managed by the front office. Front-office staff members should be made aware of the processes they need to complete before a patient checks in, and where to document that task in the EHR.

Control what is included in MIPS denominators.

Like Meaningful Use, patient encounter volume is important under MIPS. The size of the patient pool under any given quality measure directly impacts your adherence percentage. While most primary care encounters do meet patient visit requirements under MACRA, that is not always the case in specialty settings. Clinicians can exercise some control in determining what is included in patient denominators when reporting under MIPS.

Case in point:

Some primary care visits can be omitted. Let’s say a two-physician practice sees 50 patients a day. Only 15 of those patients might be seen by a physician. The rest of the patients may be there for a simple procedure like a blood pressure screening, stress test, or echocardiogram, where quality reporting elements are not verified. Such visits should be excluded.

Evaluate your reporting paths.

MIPS offers both EHR-based and registry-based reporting paths. Most specialties can submit CQM data via their EHR while others will have to rely on paid registry reporting. Additional reporting options might include submitting through associations that member clinicians are affiliated with, or through registries created by large hospital affiliates to help related providers.

Another hurdle for clinicians is deciding whether to submit data as a group or independently. Groups interested in participating in MIPS via the CMS web interface or administering the CAHPS for MIPS survey had until June 30, 2017, to register. Beyond that, clinicians have until the March 31, 2018, MIPS submission deadline to decide whether to report independently or as a group.

Case in point:

Big groups with different levels of EHR proficiency among providers may be better suited reporting at an individual level. Individual reporting takes more time for attestation, but the advantage is that higher-performing clinicians can avoid a penalty if the group doesn’t collectively meet reporting criteria.

Each month, sample 10 percent of EHR CQM data, including instances where criteria have been met and where it has not. Catch outliers with trouble following through on processes and extend targeted training to the team members bringing numbers down.

Conclusion

Optimizing the EHR and other tech resources providers have in place can be a huge MIPS enablement factor. Up-front customization work helps providers meet reporting requirements and save time over the long run. EHR optimization also enables future value-based care initiatives and lays the groundwork for population health management programs. Gains made in EHR use benefit the life of the practice through increased efficiency and, at the end of the day, better patient care.

About Meena Ande
Meena Ande currently acts as Director of Implementation for Advantum Health where she manages Implementation of services along with EHR optimization, with emphasis on workflow management for value-based reporting.

Should We Return to the Move from EMR to EHR?

Posted on April 8, 2016 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.

Over the 10 years I’ve been blogging about EMR/EHR, it’s been amazing to watch the evolution of the terms and how people use them. Based on most people’s usage, I’ve long been an advocate that the two terms should and are used interchangably. If you say one or the other, most people are assuming the broadest use of the term. Although, the HITECH Act’s use of the term EHR has certainly made it more popular and in vogue (even if most doctors I know still call it an EMR).

Semantics aside, now that meaningful use has matured, I believe that healthcare is ready for a return to the conceptual differences between an EMR and an EHR. Conceptually an EHR was a record that included the patient provided data along with the clinic’s data (ie. EMR data). This concept was partially included in meaningful use, but not in a very meaningful way.

What are some patient features that would constitute an “EHR”?

Medical Record Access – Patient access to the EMR data should be a core feature of an EHR. Most EMR/EHR vendors provide this feature and more and more doctors are excited to give their patients digital access to their medical record. However, along with access to the medical record we need to build features that allow the patient to submit corrections to the medical record.

Secure Messaging – Patients are increasingly demanding electronic access to their doctor’s office. This secure messaging is often done through the EHR. Most EMR/EHR software have this as an option, but many doctors are afraid of what this messaging will mean for their workflow. Luckily, more and more doctors are sharing the experience that this type of messaging makes their workflow faster and better. High maintenance patients are going to be high maintenance regardless of options they have available to access you.

Patient Generated Data – This feature is still something that many are trying to figure out. Can they allow patients to submit their own health data to the doctor? If they do, what’s the doctor’s liability for that data? How can/should the doctor use the data that’s being shared with the clinic? There are plenty of questions about how this should be executed, but there are also a lot of opportunities. It’s time we start working through these challenges.

There’s a whole suite of other services that we should look at offering patients as well such as: online appointment scheduling, online patient payment, refill requests, etc etc. However, if we could start with just the above 3 items we could truly start calling our systems an Electronic Health Record and not just an Electronic Medial Record. Regardless of what we call it, I believe these types of features and even more patient focused access are going to be the future wave of what patients will expect from their doctor.

Wow, That was Fast

Posted on February 19, 2016 I Written By

Dr. Michael J. Koriwchak received his medical degree from Duke University School of Medicine in 1988. He completed both his Internship in General Surgery and Residency in Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center. Dr. Koriwchak continued at Vanderbilt for a fellowship in Laryngology and Care of the Professional Voice. He is board certified by the American Board of Otolaryngology-Head and Neck Surgery. After training Dr. Koriwchak moved to Atlanta in 1995 to become one of the original physicians in Ear, Nose and Throat of Georgia. He has built a thriving practice in Laryngology, Care of the Professional Voice, Thyroid/Parathyroid Surgery, Endoscopic Sinus Surgery and General Otolaryngology. A singer himself, many of his patients are people who depend on their voice for their careers, including some well-known entertainers. Dr. Koriwchak has also performed thousands of thyroid, parathyroid and head and neck cancer operations. Dr. Koriwchak has been working with information technology since 1977. While an undergraduate at Bucknell University he taught a computer-programming course. In medical school he wrote his own software for his laboratory research. In the 1990’s he adapted generic forms software to create one the first electronic prescription applications. Soon afterward he wrote his own chart note templates using visual BASIC script. In 2003 he became the physician champion for ENT of Georgia’s EMR implementation project. This included not only design and implementation strategy but also writing code. In 2008 the EMR implementation earned the e-Technology award from the Medical Association of Georgia. With 7 years EMR experience, 18 years in private medical practice and over 35 years of IT experience, Dr. Koriwchak seeks opportunities to merge the information technology and medical communities, bringing information technology to health care.

Well that sure didn’t take long…

In response to CMS Administrator Andy Slavitt’s comments last month regarding the future of the Meaningful Use Program and the need to recapture the hearts and minds of physicians I posted on open letter to Mr. Slavitt yesterday in an attempt to reach out to him regarding those issues.

I did not expect what happened next.

He answered within a couple of hours:

“Very thoughtful letter and I think likely reflects the views of many. I will share it internally because culturally people need to see the gulf between the policy ideas and the front line of medicine.

Believe all the fatigue and the laws we still need to implement and the current state of technology means it will take some time before differences are felt where they matter. Implementing laws like MACRA is a complex undertaking but the core of what you said I believe is the most important thing– It all begins with listening. The details matter here more than the principles but I’m a believer in that’s where it starts. And we have more focus groups and front line interactions than I have seen before. We are not just listening to “Washington” docs.

I try to always begin by calling it like we see it including hard truths. I believe we have work to do and want to orient people to the proper course. You always risk setting expectations when you lay out an agenda, particularly when there is no silver bullet. But it’s better than the alternative.”

Within moments I also received equally gracious responses from Patrick Conway and Kate Goodrich, also from CMS:

We both inherited the “meaningful use program” 6-12 months ago and do think the MACRA legislation providers an opportunity to transform the program, lessen burden, make much more simple, and flexible to meet docs needs. Happy to take ideas and input from you anytime and thanks for your work.”

Wow. You have to admit that this is not what one would expect from the “faceless, heartless bureaucrats” I have been criticizing in print and on Internet radio all this time. Is the paradigm changing? Maybe. Maybe not. But one thing is for sure – we physicians have to give them the chance to make good on their rhetoric. I certainly intend to to that.

Stay tuned….

An Open Letter to Andy Slavitt, Acting Administrator CMS

Posted on February 18, 2016 I Written By

Dr. Michael J. Koriwchak received his medical degree from Duke University School of Medicine in 1988. He completed both his Internship in General Surgery and Residency in Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center. Dr. Koriwchak continued at Vanderbilt for a fellowship in Laryngology and Care of the Professional Voice. He is board certified by the American Board of Otolaryngology-Head and Neck Surgery. After training Dr. Koriwchak moved to Atlanta in 1995 to become one of the original physicians in Ear, Nose and Throat of Georgia. He has built a thriving practice in Laryngology, Care of the Professional Voice, Thyroid/Parathyroid Surgery, Endoscopic Sinus Surgery and General Otolaryngology. A singer himself, many of his patients are people who depend on their voice for their careers, including some well-known entertainers. Dr. Koriwchak has also performed thousands of thyroid, parathyroid and head and neck cancer operations. Dr. Koriwchak has been working with information technology since 1977. While an undergraduate at Bucknell University he taught a computer-programming course. In medical school he wrote his own software for his laboratory research. In the 1990’s he adapted generic forms software to create one the first electronic prescription applications. Soon afterward he wrote his own chart note templates using visual BASIC script. In 2003 he became the physician champion for ENT of Georgia’s EMR implementation project. This included not only design and implementation strategy but also writing code. In 2008 the EMR implementation earned the e-Technology award from the Medical Association of Georgia. With 7 years EMR experience, 18 years in private medical practice and over 35 years of IT experience, Dr. Koriwchak seeks opportunities to merge the information technology and medical communities, bringing information technology to health care.

Mr. Andrew Slavitt
Acting Administrator
Centers for Medicare and Medicaid Services
Washington, D.C..

Dear Mr. Slavitt:

No doubt you were surprised at the strong, widespread reaction to your comments regarding the Meaningful Use Program as part of your speech to the JP Morgan Healthcare Conference several weeks ago. Your quote regarding the hearts and minds of physicians was particularly noteworthy. After decades of Federal regulatory hostility towards physicians, some of us doctors were pleasantly surprised – even shocked – to hear you acknowledge:

– physicians exist beyond just being another cog in the healthcare machine.
– physicians actually have hearts and minds.
– physicians’ opinions might have value to you.
– programs that are poorly designed distract physicians from patient care.
– CMS aspires to a “cultural focus on listening and learning”

Many of us physicians reacted like starving prisoners when the Commandant announces that there will be extra cockroaches for dinner. Though the news was small, many of us were overjoyed.

But most of us (60% by a recent survey) reacted differently. The majority of us understand the political savvy of saying something controversial about your enemy. Such a move can create a useful distraction, driving the enemy to argue amongst themselves while you continue with work that you would rather we didn’t notice…and that is exactly what has happened. Like an octopus squirting ink into the water you have created an effective smokescreen to let you spend the next few months coding Meaningful Use into MACRA without any interference from us.

So the purpose of this letter is to ask the question: Which of the above interpretations of your comments is correct? What are your intentions?

If your comments are sincere then consider this letter a warm introduction to the group of rapidly growing, grass-roots full time practicing physicians whom this letter represents. Over the past few years we have acquired the policy expertise and political skills to be effective leaders and collaborators with you to bring truly meaningful improvements to America’s health care. Realize that the leaders of organized medicine with whom you currently work – including the AMA , whose membership represents less than 15% of practicing physicians – do NOT represent the “hearts and minds” of physicians that you profess to seek. If you mean what you say then we are reaching out to you.

If, on the other hand, your comments are nothing more than political subterfuge, then this letter serves as a warning. We are not buying the political offal that you are selling. This physician group will use all of its intellectual, financial and political resources to make it far more difficult for you to destroy what is left of health care in America.

The choice is yours. We look forward to hearing from you.

Michael Koriwchak, M.D.
Vice President
Docs4PatientCare Foundation

Do We Really Like the JASON Recommendations for Interoperable Health Data?

Posted on August 28, 2014 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The health IT community has been abuzz over the past few months about a report released by the Agency for Healthcare Research and Quality. Although the report mostly confirmed thoughts that reformers in the health IT space have been discussing for some time, seeing it aired in an official government capacity was galvanizing. The Office of the National Coordinator has held several forums about the report, known by the acronym JASON, and seems favorably inclined toward its recommendations.

Even though only four months have passed since its publication, we can already get some inkling of how it will fare at the ONC, which is going through major realignment of its own. And to tell the truth, I don’t see much happening with the JASON recommendations. In this article I’ll look at what I see to be its specific goals, and what I’ve heard regarding their implementation:
Read more..

Taking the Anxiety out of Healthcare IT (and Cost of Care)

Posted on March 21, 2014 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.

I’m prone to anxiety when it comes to unexplained aches and pains, though I tend to internalize it in an effort to not come across as a hypochondriac. I’m sure I let my inner, extreme worrier come through just a tad during a recent doctor’s appointment. I was visibly relieved to learn that what I had been quietly fretting about for weeks was in fact quite normal. My relief must have been extremely visible, because my doctor was quick to explain that what patients often consider irregular, doctors treat as run of the mill. What I lose sleep over, they don’t bat an eye at. (If only her practice offered a patient portal with secure email, so that we could correspond about my health at our leisure.)

She then told me of a recent trip to the doctor with her mother, and that she had a newfound appreciation for the patient’s side of the visit as she saw things from her mother’s point of view. It was quite refreshing to hear. I might temper my anxiety before my next appointment by playing this mobile game, should it ever be made available in the app store. According to a recent study published in Clinical Psychological Science, 25 minutes of play reduces levels of stress and anxiety. Researchers are looking to see if the effects are the same with shorter bursts of playtime. It’s got to be a cheaper (and healthier) alternative than a prescription for Xanax, right?

Speaking of healthcare costs, I read with interest the news that not only did Castlight Health’s IPO perform better than expected, but that it also partnering with the Leapfrog Group to analyze hospital survey data. Castlight seems poised for success because it is striving to do what healthcare desperately needs done – to bring transparency to and better understanding of healthcare costs in this country. With the Leapfrog project, it seems they are set on tackling quality, safety and patient satisfaction, too. It would be nice, as a patient, to have one trusted resource to go to for consumer-friendly healthcare information so that we could make smart decisions for our families and ourselves.

It would be interesting for a company like Castlight to combine financial, quality, safety and satisfaction data with a notation as to whether hospitals and physicians use EHRs. I noticed that recent results from the latest NCHS Data Brief from CDC show that 42.8% of physicians in Georgia have EHRs – not significantly different than the national average, according to NCHS survey findings. Only nine states ranked above the national average for EHR usage.

I’m off on a tangent here, but I have to ask, when will all 50 states get above 50%? When will everyone be above the national average? With budgets tightening, hospitals closing, and IT deadlines looming, I have a feeling it will be later rather than sooner – if at all.

What do you think? When will your state reach 100%? How do you relieve stress before a doctor’s visit? Would knowing a physician had competitive prices and secure messaging impact your decision to book an appointment? Please share your thoughts in the comments below.

Making Tablets More Effective for Data Capture

Posted on February 27, 2014 I Written By

Dr. Michael J. Koriwchak received his medical degree from Duke University School of Medicine in 1988. He completed both his Internship in General Surgery and Residency in Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center. Dr. Koriwchak continued at Vanderbilt for a fellowship in Laryngology and Care of the Professional Voice. He is board certified by the American Board of Otolaryngology-Head and Neck Surgery. After training Dr. Koriwchak moved to Atlanta in 1995 to become one of the original physicians in Ear, Nose and Throat of Georgia. He has built a thriving practice in Laryngology, Care of the Professional Voice, Thyroid/Parathyroid Surgery, Endoscopic Sinus Surgery and General Otolaryngology. A singer himself, many of his patients are people who depend on their voice for their careers, including some well-known entertainers. Dr. Koriwchak has also performed thousands of thyroid, parathyroid and head and neck cancer operations. Dr. Koriwchak has been working with information technology since 1977. While an undergraduate at Bucknell University he taught a computer-programming course. In medical school he wrote his own software for his laboratory research. In the 1990’s he adapted generic forms software to create one the first electronic prescription applications. Soon afterward he wrote his own chart note templates using visual BASIC script. In 2003 he became the physician champion for ENT of Georgia’s EMR implementation project. This included not only design and implementation strategy but also writing code. In 2008 the EMR implementation earned the e-Technology award from the Medical Association of Georgia. With 7 years EMR experience, 18 years in private medical practice and over 35 years of IT experience, Dr. Koriwchak seeks opportunities to merge the information technology and medical communities, bringing information technology to health care.

Six months ago I wrote about the virtues of using an iPad Mini tablet in the patient care setting.  At that time I was using my tablet almost all day, every day for multiple purposes including EMR data capture.  Things went well for a while, but as time passed I used the tablet less and less.  Eventually I stopped using it almost altogether except for displaying and annotating CT images during patient visits.  At first I did not understand why.  Was the non-Retina display finally getting to my 50+ year old eyes?  Was the external microphone I used to improve speech recognition losing performance?  Was the battery fading after 9 months of charge / discharge cycles?  Or was the “gadget lust” of a new tech-toy finally wearing off?

Each of the above may be just a little bit true.  But two other reasons are most relevant to me.  First, my efforts to add a medical vocabulary to the embedded speech recognition failed.  But most importantly, I became frustrated with how difficult the tablet was to hold for extended periods of time.  When I wrote that the tablet was “easily and comfortably held by its edge” I was wrong.  Tablets are beautiful to behold, but their clean lines and smooth surfaces make holding them for extended periods of time very cumbersome.

So I created something that would fix the problem by making a tablet more comfortable and safe to hold.  Now that the provisional patent application is registered I can share the design:

                 figure 11                     

The photos are of a nonfunctional mockup I made out of Styrofoam, balsa wood and spackling compound.  It is a grip that attaches primarily to one edge of a tablet computer and facilitates holding the tablet by its edge rather than the back.  It is shaped to fit the hand and allows both proper hand positioning and proper viewing angle.  It provides a mechanical interface between the tablet edge and a semi-pronated (handshake position) hand/forearm.  Its purpose is to facilitate extended use of the tablet by minimizing orthopedic strain to the hand, wrist, forearm, elbow, shoulders and neck.   The interface with the remaining 3 edges is minimal, preserving the ability to store the tablet-grip assembly in a coat pocket.

The external shell is a composite of plastic, rubber, metal, leather or similar materials.     There may also be a thin covering over the back and/or front faces of the tablet for protection and mechanical stability.  The top side is contoured to engage the thumb and guide the thumb to the home button.   The bottom is contoured to engage the fingers.  This shape gives the thumb and fingers stability and purchase to counter the tablet’s weight and torque in the yaw and roll axes.  The gripped portion has bilateral symmetry to allow left hand or right hand grip.  Openings and mechanical and/or electronic pass-throughs provide access to tablet buttons, ports, etc.  It could also include a stand for self-support on a tabletop and a place to store a stylus.  Some panels could be customized for color, shape (i.e., for different hand sizes) or material.

There is space available within the grip to add hardware and enhance functionality.  Examples include – but are not limited to – extended battery, external microphone / speaker, Bluetooth keyboard interface (to make the composite device appear as a keyboard to an external workstation), wireless USB, and apps that use cloud-based speech to text capability.  Any companion software component – an app – would be loaded into the tablet itself.

I need your help both to estimate the potential of this idea and get some advice on what to do with it next.  If you think this is an idea worth pursuing give me a like on Facebook at the bottom of the article.  If you feel strongly about it give it a Tweet as well.  And if you have some advice I would be grateful to hear it.