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Modular Software Unleashes Innovation – Major EHR Developments Per Halamka

Posted on September 23, 2011 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.

In my ongoing series of Major EHR Developments from John Halamka (see my previous EHR In The Cloud post), his second major EHR development from the Technology Review article is: Modular Software Unleashes Innovation. The following excerpt from his article sums it up well:

Until very recently, innovation in medical IT has depended upon the development schedules of a few very large vendors who sell hospital systems with $100 million price tags. In the future, electronic health records will become increasingly modular, similar to the online app stores where consumers download games or programs for their phones.

The idea of modular healthcare IT has been around for a long time. I think I first saw this concept when I learned about a group called the Clinical Groupware Collaborative. I haven’t heard much out of them recently, but every once in a while I see that they’re still working to make Halamka’s comments about modular EHR software a reality.

I’m certain that Judy from Epic would argue that such modular EHR software is a risk to the healthcare industry. She’s probably right. There are risks to modular software. However, there are even more risks and disadvantages associated with a monolithic EHR vendor that won’t interact with other modular clinical software. I believe that one day this will come back to bite Epic as new CIO’s who weren’t part of the $100 million hospital software purchase will start to embrace a more modular strategy.

Turns out that I think providers will actually be the strongest proponents of the modular strategy. They’re already buying mobile devices with money out of their own pockets and so they’re going to start using apps that will help them provide better care. Hospitals will have a hard time controlling it and they’ll eventually realize that the best way to control it is to embrace it.

The most unfortunate part of this EHR development is that it’s going to take a long time for this development to become a reality. However, little by little we’ll get there.

EHR In the Cloud – Major EHR Developments per Halamka

Posted on September 14, 2011 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.

As most of you know, John Halamka is publishing content everywhere. In fact, maybe I should see if he’ll publish some here. Halamka is really smart and respected by many for good reason. So, I was intrigued to find an article in the Technology Review (an MIT publication) where Halamka higlights what he considers the major EHR and healthcare IT developments over the next five years.

I’ve been doing a number of series lately on EMR and EHR & EMR and HIPAA and since people seem to really like them, I decided I’d make Halamka’s major EHR developments into a series as well.

The first Major EHR Development is: EHR In the Cloud

In the article above, Halamka offers some interesting comments about doctors being doctors and not tech people, the issues of privacy in the cloud and hospitals leaning towards “private clouds.” Let’s take a look at each of these.

Doctors Don’t Want to be Tech People
While there are certainly exceptions to the rule, it’s true that most doctors just want their tech to work. They don’t want to spend a weekend installing a server. There’s little argument that a SaaS EHR requires less in office tech. This fact will end up being a major driving force behind the adoption of SaaS EHR software over the client server counterparts.

Certainly, many doctors will still feel comfortable with their local IT help doing the work for a client server install. Also, many still feel more comfortable having their EHR data stored on a server in their office. This issue will continue to fester for a long time to come. At least until the SaaS EHR vendors provide doctors a copy of their data which they can store in their office. Plus, SaaS EHR are much faster today than they were, but there’s still a few things that a client server can do that is just flat out faster than client server.

I still see the ease of implementation and “less tech” helping SaaS EHR software to continue to gain market share.

Privacy in the Cloud
The biggest problem here is likely that doctors aren’t technical enough to really understand the risks of data in the cloud or not. Plus, I think you can reasonably make an argument that both sides have privacy risks. Most people are becoming much more comfortable with data stored in the cloud. I expect this trend to continue.

Private Clouds for Hospitals
Halamka claims that he, “estimates that moving infrastructure and applications to my hospital’s private cloud has reduced the cost of implementing electronic health records by half.” Of course, we have a lot of possible definitions of “cloud” and I’m not exactly sure how Halamka defines his private cloud. However, anyone who’s managed client installs of EHR software, including client upgrades, etc knows some of the pains associated with it. I’d be interested to know what other savings Halamka and Beth Israel Deaconess Medical Center get from their “private cloud.”

Cloud and EHR
There’s one thing I can’t ever get out of me head when I think about EHR and the cloud. Someone once told me (sorry I can’t remember who), “The cloud has always won in every industry. It will win in EHR too.” I hate when people use terms like always and every, but I haven’t (yet?) found an example to prove that person wrong.

EMR in the Age of Skype

Posted on September 12, 2011 I Written By

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

The physician community has something of a split persona. Doctors are probably the only community still dedicated to using pagers to communicate with their offices. And yet, it’s no secret that the medical establishment is among the fastest growing segment among smartphone and tablet users. A widely quoted statistic from Manhattan Research stated that 81 percent of doctors would own a smartphone. Manhattan now states that the 81 percent rate has already been reached in 2011, while average America is at 40 percent adoption, according to Nielsen.

So, the medical establishment is clearly ahead of the curve in some ways.

But you just have to juxtapose pagers and smartphones against each other to understand the real advantages of the smartphone. If you have an iPhone and your doctor has one too, you’re going to probably take it to the next level, right? Yeah, FaceTime. (Surprisingly enough, that’s not what the statistics show. A full 78 percent of respondents said they didn’t want to chat or IM with their doctors, according to this recent article on Technology Review.)

For this kind of face to face interaction to work, it really depends on how good a rapport you have with your doctor, but if there’s a good doctor-patient relationship, you might just consider making the move. Let’s be clear, doctors are not taking to video-conferencing via Skype or Face-Time in droves (or rather, there are no published statistics from the bean-counting firms about the trend), but there are some anecdotal stories on blogs like Dr. Brian Goldman’s on CBC.ca. But it’s interesting to think ahead to how video consultations might change EMR.

The Pros:
Direct connection with your doctor, in an instant: Great for the patient, furthers doctor-patient relationship but could be something of a double-edged sword.
Show, don’t tell: For those times, when you don’t know whether a symptom needs an in-office visit, or when you’re not in town and some conference magic and ePrescribing can save the day.
No more Lost in Translation: The paging process has that additional office staff layer in between, who convey your message to the doctor. It’s tempting to think that you can axe the middleman with Skype.

The Cons:
Direct connection with your doctor, in an instant: How long before patients are calling at all hours of the night demanding FaceTime? Blackberries and iPhones might simply be another way to tether yourself to your business (Next time you see 24-7 IT support, know that there is a person dreading the Blackberry ping somewhere in the world)
Too many interruptions spoil the day: Pagers let the doc put off calling till she’s done with the task at hand, not when the patient demands.
Privacy issues: From an EMR perspective, this is the big kahuna. There are several nuances to consider. The doctor-patient line has to be securely done, with HIPAA in mind. For CYA purposes, video-cons will probably need to be recorded.

Microsoft’s main intent behind its purchase of Skype might be its conferencing features for business, but wouldn’t it be awesome if Skype also showed up in HealthVault (which only has image saving capabilities so far, according to this Q&A on MSDN forums)? Or if any advice dispensed via Skype could be saved into your doc’s EMR system and become part of your health profile. There are several possibilities out there when you throw video into the mix, and they seem quite interesting.