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Our First Year with a Patient Portal

Posted on August 11, 2013 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.

Last month marked the end of our first year with our web portal.  It has been a steep but worthwhile learning curve.  Similar to every other component of our IT system there were many bumps along the way.  Here are some observations worth sharing:

  1. If you build it – and promote it – they will come.  There is no question that patients in our North Atlanta market like the portal.  Over the first 12 months 12,518 patients have signed up and completed over 130,000 health, demographic and general consent forms.  Participation has increased steadily as we have refined web page usability and improved the reliability of the system.  Subjectively I think about 2/3 of my new patients are using the portal to enter their demographic and personal health information prior to their initial appointment.
  2. Overpromotion backfires.  Our telephone-greeting message says, “To schedule an appointment, dial 0 or go to www.entofga.com.”  Sounds reasonable enough, but patients have misinterpreted this message as meaning that we don’t want to talk to them.
  3. If it doesn’t work, patients get angry – with good reason.  Nothing is more frustrating than spending 45 minutes filling out all your information at home and then getting handed the same forms on paper at the office because your online data was lost.  The IT folks seem to think if the explanation for the failure is fancy enough that will make everything OK.  It doesn’t.
  4. Patients who choose not to use the portal at home don’t want to use it in the waiting room, either.  We have tried iPads, laptops and desktop kiosks.  We have trained our front office folks to promote it and even “walk patients through” the portal.  Nothing has worked.  We have considered recruiting those patients with a different technology such as scanned #2 lead pencil bubble forms, at least for the discrete data.
  5. Patients have little interest in using the portal as an ongoing tool.  After the initial creation of the account, data entry and first appointment, they rarely use the portal again.  Last month with over 12,000 patients enrolled we got only 6 prescription refill requests and 24 “ask the doctor” questions.   Appointment requests were slightly better at 134.  Our telephone appointment schedulers tell me they frequently get calls from folks who made an appointment request online but then immediately call for the same appointment because they were not comfortable with the online appointment concept.  One could argue that this is unique to our specialty practice or that the online forms and workflow need improving.  That may be true, but I am convinced that at least a part of this phenomenon represents cultural pushback from patients.
  6. The ROI on the web portal is in some ways an all-or-nothing situation.  For a while the portal was passing to EMR only about 15 of the 20 data fields required to complete our demographic database.  Intuitively one would think the portal was therefore “75% useful”.  The problem is if I have to pay staff to open the patient’s file to manually enter the 5 remaining fields, I may as well have them manually enter all 20 fields.  That makes the portal 0% useful.  I can’t reassign staff to better things until the portal passes 100% of the data to the EMR.  This also relates to the reliability issues described above.  Until we reach near 100% reliability the return on investment is limited.
  7. As with every health IT product we have ever tried, it doesn’t work completely as advertised.  Although the new patient workflow is going fairly well other features remain severely compromised.  In our vendor’s defense this is partly because our parent EMR has had some upgrades which in turn requires our vendor to update the portal to adapt to the EMR changes.  The point is that none of these products is “plug and play” and the industry has a long way to go before these products become easy to use and practical for everyone.
  8. There are unintended consequences of a web portal.  Unbeknownst to us our portal was directing patients to the vendor’s personal health record product.  The transition is apparently pretty seamless so patients often still thought they were still inside our portal when they encountered very personal questions (i.e., sexual history) that had no relevance to their ear / nose  / throat appointment.

As an “early adopter” practice we are pleased overall with the portal but I’m not sure how a more typical practice would feel.

“Fat Finger Syndrome” Not Just a Google Problem

Posted on December 19, 2012 I Written By

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

In trying to keep things light this week, I’ve taken inspiration from two very different sources – NPR and Homer Simpson. A recent Morning Edition piece on “Fat Fingers Blamed for Mobile Ad Clicks” highlights the problem many smart phone users face –  large fingers on a small screen usually result in the occasional misspelling, accidental click on a field or image, or unintended dial.

The story concentrated on “Google’s launch of a new type of mobile ad that aims to combat the ‘fat finger’ problem. As the smart phone market grows, mobile ads have become more important to the tech giant, which makes most of its revenue through advertising.”

homeriphone

Listening to the piece, which started off with a hilarious sound bite from the Simpsons, made me wonder if EMR developers face this same type of problem when developing their software for mobile devices. What sort of consequences do providers face as a result of unintended clicks or incorrect data entry?

I polled a few friends who work in healthcare IT user experience (coincidentally, a topic that I heard come up quite often during the fall conference season), and they brought up numerous cases – some with dire consequences – of mistaken medication administration because of very similar patient names.

I also came across the ubiquitous drawback of using tablets in healthcare: “The iPad is difficult to type on, [one provider] complains, and his “fat fingers” struggle to navigate the screen,” according to a Kaiser Health News story last year.

But, providers, as they so often do, are creating workarounds. One family practice in particular has “introduced a stylus since some people occasionally suffer from ‘fat finger syndrome’ (some people just have an innate ability to miss the buttons in the questionnaire when they use their fingers).”

How have you, your practice or your colleagues dealt with pleasantly plump pads of the finger? Please share your anecdotes in the comments section below.

Homegrown Health IT Innovation Takes Center Stage

Posted on November 29, 2012 I Written By

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

I’ve had the good fortune over the last few months to be involved in the marketing efforts surrounding the Health IT Leadership Summit happening next week at the Fox Theatre in my hometown of Atlanta. A joint effort of the Technology Association of Georgia’s (TAG’s) Health Society, the Metro Atlanta Chamber of Commerce and the Georgia Department of Economic Development, the annual event does a wonderful job of spotlighting the strides Georgia is making in healthcare IT, both on the provider and vendor sides.

I’m particularly excited to learn more about the four finalists of the Intel Innovation Award, which will be presented to the winner at the summit. I think it’s no coincidence that Solo Health, last year’s winner, has seen a number of newsworthy business developments happen since accepting the award in the Fox’s Egyptian Ballroom last November.

I thought I’d share a brief synopsis of the finalists (courtesy of their respective websites), and then take bets on who will take home bragging rights!

AirWatch (@airwatchMDM)
“AirWatch is the leader in enterprise-grade Mobile Device Management, Mobile Application Management and Mobile Content Management solutions designed to simplify mobility. More than 4,700 customers across the world trust AirWatch to manage their most valuable assets: their mobile devices, including the apps and content on those devices. Our solutions are comprehensive, built on a powerful yet easy to use platform by leaders in the mobile space.”

In a word, it’s all about security in healthcare right now, as iPad minis, iPhone 5s and yes, even a new Blackberry or two make physicians that much more likely to join the BYOD movement. AirWatch is certainly in the game at an opportune time.

CardioMEMS (@cardioMEMS)
“CardioMEMS is a medical device company that has developed and is commercializing a proprietary wireless sensing and communication technology for the human body. Our technology platform is designed to improve the management of severe chronic cardiovascular diseases such as heart failure and aneurysms. Our miniature wireless sensors can be implanted using minimally invasive techniques and transmit cardiac output, blood pressure and heart rate data that are critical to the management of patients. Due to their small size, durability, and lack of wires and batteries, our sensors are designed to be permanently implanted into the cardiovascular system. Using radiofrequency, or RF, energy, our sensors transmit real-time data to an external electronics module, which then communicates this information to the patient’s physician.”

I first came across this company nearly two years ago, when I heard founder Jay Yadav, M.D., speak at a TAG luncheon, and I’ll be eager to see how their technology has evolved since then. From an EMR perspective, I’m especially interested in where the real-time data goes when a physician receives it. Is it fed into an EMR, perhaps? I’m taking a field trip to the CardioMEMS office next week, so hopefully I’ll find out. I’d also like to get their thoughts on the FDA’s move to regulate mobile health apps, which I assume will impact them in some tangential way.

Cooleaf (@cooleafhealth)
“Cooleaf is the easiest way to enroll in classes and programs for your health while earning rewards. Our mission is to harness the power of classes and programs to enhance the well being of the planet. We founded Cooleaf on the following principles:

  • There is no “one size fits all” solution in health and wellness
  • Living a healthy life should be easy
  • If you live a healthy life, you should be rewarded
  • If you live a healthy life and get rewarded, you should own those rewards
  • If you’re guided by experts face-to-face, you’re more likely to achieve your health goals (and enjoy yourself)”

Certainly the most consumer-oriented of the bunch, the Cooleaf website seems like a great way to get employees engaged in wellness initiatives. I wouldn’t be surprised if a few payers start sniffing around as its user base grows, and resource database moves beyond Atlanta-based locales.

Monocle Health (@monoclehealth)
“Monocle Health Data is the only company solely dedicated to providing independent, unbiased healthcare provider ratings and rankings based on both price and quality, for both episodic care and chronic illnesses.

Monocle’s tools – price rankings, quality ratings and analytics-based reporting – are the foundation of true healthcare price and quality transparency.”

As a patient – especially one who is in need of new family physicians – I am especially interested in transparency. How do the doctors in my area stack up against each other when it comes to patient satisfaction, quality and what my hard-earned dollars will get me? As patient engagement efforts continue to take off, so too I think will provider comparison tools such as this.

Only time will tell which of these Atlanta-based companies will win. I’ll follow up in a subsequent post with the victor’s details, and future plans for continuing to change the landscape of healthcare IT.

The Immortal Life of Healthcare IT

Posted on September 5, 2012 I Written By

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

As any one of my family or friends will tell you, I’m a voracious reader. I’ll read anything I can get my hands on – blogs, online news, books, magazines. I’ll even confess that after a week of keeping up with healthcare IT editorial, I typically enjoy a good, diverting issue of Entertainment Weekly on the weekend. Having an e-reader in the house has only increased my propensity to check out books from my local library, thanks to its new e-book lending program. Mobile technology has certainly aided and abetted my habit.

That being said, I find myself juggling two books right now – “The Immortal Life of Henrietta Lacks,” by Rebecca Skloot (great New York Times book review here); and “Healthcare Business Intelligence: a Guide to Empowering Successful Data Reporting and Analytics,” by Laura B. Madsen. One is for pleasure, while the other is to help me better understand the buzz behind BI. Both have much to say on the subject of healthcare. In the simplest of terms, they are two sides of the same coin. Skloot’s work of non-fiction tells the tale of what happens when patients and their families are kept in the dark, while Madsen’s guide denotes the possibilities that come with dissecting data in meaningful ways for patient benefit – freeing information, if you will, from silos for the benefit of better clinical outcomes.

I’m not too far into The Immortal Life, but one paragraph has jumped out at me in light of the current state of heightened patient engagement in healthcare:

“… like most patients in the 1950s, she deferred to anything her doctors said. This was a time when ‘benevolent deception’ was a common practice – doctors often withheld even the most fundamental information from their patients, sometimes not giving them any diagnosis at all. They believed it was best not to confuse or upset patients with frightening terms they might not understand, like cancer. Doctors knew best, and most patients didn’t question that.”

My how times are changing. (Granted, you’d hope that in 60+ years they would.) Patients are seeking information out before they even think to call their doctor. And they are no longer afraid to question diagnoses, or even obtain second opinions. Patients are becoming more interested in the value of their care – is the financial outlay worth the result? And some are beginning to wonder when their doctors will catch up.

By pure coincidence, HIMSS is asking the question “How will health IT make a difference a year from now at the next National Health IT Week?” as part of its first annual blog carnival, in an effort to highlight the week’s activities and reflect on the strides healthcare IT has made in the six preceding years the event has been held.

I would have to say that as the next year passes, we’ll see healthcare IT increase patient engagement – digital or otherwise. More doctors will implement EHRs, participate in HIEs, sign up for ACOs. Along the way, they’ll find themselves confronted with patients who are used to having instant access to up-to-the-minute information on everything, and who think access to their personal health information should be no different.

Couple this with the increasing consumerization of healthcare and IT – be it the new iPhone, the smaller iPad, fitness and weight-loss apps, cars that help you keep up with your quantified self, and other gadgets that let you “check your body as often as your email,” and you’ve got a population of patients ripe for aiding and abetting this transformation of healthcare we’ve been hearing so much about.

How interesting it is to think that Henrietta Lacks’ cells are still alive today to inadvertently be a part of this movement, when she herself was kept in the dark by the systemic problems of a society that never thought to question its care.

More Than Half of US Hospitals Plan Medical Device Integration Investments

Posted on August 14, 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.

When used right, EMRs can be very powerful. But I think most of us would agree that the endgame — the greatest level of benefit they can offer — will be when hospitals succeed at integrating EMRs with medical devices.  A new study from CapSite suggests that hospital CIOs agree completely with this analysis.

The CapSite study, which surveyed more than 300 hospital leaders, found that 54 percent of U.S. hospitals plan to purchase new medical device integration solutions over the next 24 months. When asked why, 40 percent of hospitals said “quality improvements” were the primary reason for their planned investment.

Now, integration is a fairly broad term. I doubt we’re looking at a 24-month horizon for some of the following:

  • In a May study by KLAS, more than half of 251 providers surveyed said that EMR connectivity will be a factor when they next invest in infusion pumps.  But at present vanishingly few hospitals are actually implementing new smart pumps with wireless EMR connectivity.
  • If you consider an iPad a “medical device,” it’s worth remembering that iPad-to-EMR integration is still dicey at best. Smartphones aren’t well integrated either, especially Android devices. And getting them in synch with EMRs is no trivial matter.
  •  At least one vendor — like the first of many — is offering a software solution which integrates data from wireless sensors on the patient’s body into a cloud-based, open-source EMR. This is a great idea, but still in its infancy.

All that being said, there’s definitely some integration which should take place more quickly. For example, integration of voice recognition technology with EMRs is moving at a fast clip. Doing this for dictation within an EMR is a no-brainer. The next level will to see how far speech and natural language understanding get in filling out more of the encounter data and (brace yourself) coding the visits for doctors.Though many of the more intriguing apps are still in their babyhood, it seems we’re on for seamlessly connected EMR-to-device experience in hospitals fairly soon.

drChrono EHR Featured on Apple’s iPad Website

Posted on August 6, 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.

Carl Bergman recently sent me a link to a video on the Apple iPad website that profiles an urgent care center in St. Louis using the DrChrono EHR software. Here’s the intro about the urgent care facility using the iPad:

iPad makes the rounds with physicians.
Trained to handle any medical condition that comes in the door, emergency room physician Dr. Sonny Saggar treats everything from life-threatening issues to small cuts that need a few stitches. Dr. Saggar is also the medical director at Downtown Urgent Care in St. Louis, MO — and its sister location, Eureka Urgent Care in West St. Louis County. He and his staff rely on iPad to help them deliver efficient, high-quality health care. “We can often get patients precisely the care they need in less than 20 minutes,” he says.

I think it’s brave for any doctor to put a time on how long it takes to give care. Does DrChrono have a module that tells you average patient times. Did Dr. Saggar get those times from the EHR? Plus, he says that they often can which I guess could mean that they often can not? Of course, the above copy was probably written by some intern at Apple.

The page also offers these benefits to using an iPad EHR:
-Health records go paperless
-Better communication at the point of care
-Smooth operation
-More personalized care

Are these the benefits you see of using an EHR with the iPad?

We’ve written a lot about ipad EMR software on EMR and EHR. In fact, we were writing about the iPad together with EMR well before the iPad even was officially released. While doctors love the iPad, I’m still not seeing very many doctors use the iPad for their daily documentation needs. The challenge has and still is that the iPad is a great consumption device, but has yet to be a great documentation tool. I’ll be interested to see if someone will be able to crack that second nut.

What’s Next For Physician Tablet Use?

Posted on July 23, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Not long ago, Manhattan Research released a study offering details on how doctors’ consumption of digital devices and media is progressing.  The survey, which surveyed 3,015 physicians in 25 specialties, looked at doctors who were online in the first quarter of 2012.

Among the most interesting — if not surprising — findings was that tablets have more or less officially hit the medical mainstream. According to the research firm, tablet use among doctors has nearly doubled since last year, hitting a whopping 62 percent in this year’s study.  You also won’t be shocked to learn that iPads dominate medical tablet use, in part due to their high-res screen and ease of  use.

Why the greater rush to adoption?  I think the following comment, which Monique Levy of Manhattan Research made to InformationWeek, offers a nice insight:   “It used to be that you had to solve the problems of security access, validation, and data security first and then adopt,  (but) what’s happened is that the system has turned upside down. We’re now at adoption first and solve the problem later.”

As Levy notes, the first wave of adoption has been driven largely by access to lower-risk information, and less for patient data. We can expect to another round of resistance when physicians are tethered to EMRs largely by tablets, she predicts.  I’d add that as long as there’s no native client physicians can use to access EMRs on the iPad, it will make things worse.

Given that resistance, maybe medical use of tablets will expand in other areas first. According to IT prognosticators and researchers at the Gartner Group, top medical uses of tablets also include waiting rooms, e-prescribing, diagnostic image viewing and appointment scheduling. (I’m amazed more practices aren’t doing the waiting room check-in thing.) Maybe one of these other areas will evolve breakout apps before doctors are really hooked up with patient data on their tablet.

EMRs Coming to a School Near You

Posted on July 5, 2012 I Written By

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

As I mentioned in a previous post, my family and I are experiencing one of our busiest summers ever. With our decision to become landlords comes a simultaneous decision to move to a new area, for the usual reasons. We’ve found ourselves in love with a house in an entirely different county, and thus a new school system.

Now I don’t know about you, but summers seem to be getting shorter and shorter when it comes to the school calendar. Weeks between Memorial Day and Labor Day seemed to stretch on endlessly. But now we’re lucky to get a full eight weeks of summertime fun. Needless to say, we’ve got just about four weeks to get into our new home before the school year starts.

I’ll be registering our oldest daughter soon after the 4th of July break, and on my list of questions will be “Is there a school nurse on campus at all times?” After reading a recent article at LeHighValleyLive.com, I may just have to add, “Does the school participate in exchange of electronic medical records with local healthcare facilities?”

The article relates that Pennsylvania’s Bethlehem area school district’s board has approved “joining a regional partnership that would make the electronic medical records of Bethlehem and Allentown School District readily available to emergency room doctors and nurses alike.”

The Children’s Care Alliance is a partnership between the school districts and four hospital/healthcare systems. You can read the article linked to above for most of the details.

I’d also be interested to learn how they are going to go about choosing an EMR vendor. Will it be a strictly pediatric solution? It would be interesting to see an EMR created from scratch for the sole purpose of serving students in public school populations. Barring any HIPAA-related concerns, the opportunity for population health management research at this level would be enormous.

Being in the marketing business, I’d also be interested to know how they are going to get students and their parents to opt in to the program, and what sort of choices students will be left with if they opt out. Will they partner with local pediatricians to create support on that end? It seems like a great teaching tool with which to start creating a younger, more engaged patient base. Wouldn’t it be cool to have the school nurse come in to health class one day to explain the benefits of an EMR, and how students can access it or a corresponding, school-sponsored personal health record from the computer at their desk, or their iPads at home?

I do wonder, though, just how easily this alliance could be created in other communities. The price tag of $2.3 million seems high.

Perhaps I’ll ask that very question when I head to the school registration offices next week.

Healthcare IT’s Success is Truly in the Eye of the Beholder

Posted on May 16, 2012 I Written By

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

I’ve come across few articles recently that really validate the notion that the success of healthcare IT is really in the eye of the beholder, or in some cases, the editorialized results of a study.

Take, for example, the following headlines:

“EHR Use Not Linked to Improved Diabetes Care Quality, Study Finds”
and
“App Improves Diabetes Management Among Teenagers, Study Finds”

I find it hard to believe that if formally connected, the second study couldn’t somehow influence the first. In other words, if a mobile health app can improve diabetes management among teenagers, shouldn’t whatever data that app is capturing transmit successfully to the teen patients’ EHRs for easy access by their doctors? And then couldn’t that doctor digest that information, picking out patterns in the patient’s behavior that is either positively or negatively impacting their diabetic condition and overall health, to better inform care protocols?

I’m taking big leaps of logic here, since the first study found that not only was there no correlation between the use of an EHR and “increased adherence to clinical guidelines for care processes and treatments,” but there was actually a “higher probability of meeting certain targets for blood pressure and A lc levels after two years” at practices without such systems. (Seems like these outcomes might be due more to end-user experience than the technology itself.)

The second study doesn’t even mention EHRs, but I wonder how many of the 20 teens participating in the study see doctors who have this type of technology, how many of those doctors know their patients are participating in the study (all I’d assume), and how many are feeding the app’s info into an EHR.

Surely if a smartphone app is helping a diabetic teenager better adhere to medication regimens, then the EHR their doctor could potentially be using would somehow tie in to better clinical outcomes. Another study to start, perhaps?

The second set of headlines that gives me pause (and kinda makes me chuckle) includes:

“Physician Use of Tablets has Nearly Doubled Since 2011”
and
“Not all Doctors and Nurses are Happy with an iPad in the Hospital Setting”

Neither headline surprises me. We all know that adoption of mobile health tools is growing, if not by leaps and bounds then at least steadily. It would make sense that providers are adopting tablets in relation to this. Every technology has its detractors, so of course not everyone is going to be happy with how an iPad works in a clinical setting, just as not every provider is going to want to install an EHR. I do wonder, though, how the same set of users mentioned in the second article would rate a different kind of tablet if given the opportunity to use one.

I find the first sentence to be kind of hard to believe: “It looks as if most doctors and nurses would rather not touch the iPad at work (or deal with any other kind of tablet computing).” If “most” doctors and nurses would rather have nothing to do with tablets at work, than how can physician use of tablets have doubled since last year?

So you see, the “success” of healthcare IT seems to depend on whose writing about it. I have a feeling the American Forest and Paper Association might be behind the very first one.

Who Moved My Cheese (or Paper Charts)?

Posted on April 11, 2012 I Written By

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

I got just a glimpse yesterday of what clinicians must feel like when they log into an EMR for the first time – giddy with anticipation, hopeful that its use will ultimately lead to better patient outcomes and easier workflows for all. On the flipside, there was also frustration, impatience, and a bit of confusion.

Just before bedtime, I fired up Calorie Counter, my newest iPad app. As with any community you join, I first had to fill out a member profile, which took some time. I then had to learn through trial and error how to navigate through the program – search for, find and choose the foods I had eaten earlier that day, make adjustments for portion sizes, then log the data. The app’s drop-down menus included some of the foods I ate, but not all. “How do I add foods to the stock menu?” I wondered, thinking at the same time that this must be what doctors feel like when they can’t find what they need in an EMR.

It didn’t take long, and I’m sure now that I’ve at least done it once, future data entry will be more intuitive, and quicker. I do wonder about the rate of retention for this type of app, though. Do people stick with it for more than a few days or weeks?

I’ll have to either keep a running paper list of the foods I eat throughout the day, or bring my iPad with me wherever I go in order to log my calories. I was bummed that I couldn’t find this particular app for both the iPad and iPhone. (Those that were developed for both just didn’t seem to be as robust.) Perhaps this twinge of disappointment has been felt by doctors who have fallen in love with their new EMR, only to realize they can’t access it via their chosen mobile device.

It will take dedication on my part to keep up with daily logging of calories and activity, but I am convinced it will be worth it. After just one day, I’ve already had a nutritional wake-up call: Just seeing how much cheese I eat has made me decide to cut back before bathing-suit weather.

The beauty of the app isn’t the comprehensive list of foods already plugged in from which to choose from, but the calorie recommendations it makes based on members’ profiles (weight/height/activity level/age/gender, etc.) and the analytics that will result after I have a few days/weeks/months logged. Patterns will emerge that will give me a clearer picture of my diet – foods I should keep eating, those I should eat in moderation, and those I should avoid all together as long as I’m trying to reach a certain daily caloric intake. Not quite as important, but still similar in my mind to the aggregating power EMRs have when it comes to clinical data.

Other than keeping up with the daily log, I also have the option of joining the Calorie Counter community on Facebook, and I think there’s a brief tutorial out there I can take a look at. Depending on my time available, I may not do either – a course of action I’m sure a few doctors also opt to take with their EMRs, which I assume is ultimately detrimental to the results they’ll see with the technology.

In addition to trying to get a bit healthier, I’m overcoming my resistance to change (as if I really want to eat less cheese!), which as my colleague John pointed out in a recent post at EMRandHIPAA.com, is “the number one reason doctors aren’t adopting EHR software.”

But change is usually good, and as John also points out, “resistance to change is going to be the reason why EHR adoption will become the norm.” I’ll let you click over to his post to find out why. In the meantime, I’m going to try and resist the bagel with cream cheese that seems to be calling my name from the kitchen.