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Tag: EHR

Healthcare’s Privacy Problem (Hint: It’s Not What You Think It Is )

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By LYGEIA RICCARDI

Picture 27 I recently applied for life insurance. The broker, whom I’ve never met, asked about my health history. “So you’ve just had a baby,” he began. I asked him how he knew. “You’re on Twitter.”

In the last couple of years concerns about the privacy of online health information have grown, as health care finally catches up to other sectors in its use of information technology (IT). The Stimulus package will pump $19.2 billion into healthcare IT, especially electronic medical records for doctors.

While technology can make your medical records safer in some ways than they’d be in a paper chart (using encryption, fire walls, audit trails, etc.), the fact is, no system is totally fail-safe. And when screw-ups happen, technology tends to super-size them. Continue reading…

Apple Targets Healthcare Enterprise

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By JOHN MOORE

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While the Apple iPhone was first targeted at the general consumer, Apple has been taking the necessary steps to bring this device into the enterprise, directly competing with RIM’s Blackberry.  Unseating the Blackberry in many sectors, such as finance, may be near impossible but healthcare is another story.  Within healthcare, Palm, with its Treo was extremely popular as it was not only a communication device (cell, email, etc.) but also supported other apps such as the very popular Epocrates.  Palm lost its focus, sat on its laurels, the Treo became dated, barriers to entry lowered.  Enter the iPhone, its intuitive interface, a touch screen, an ever increasing number of medical apps and Palm is basically out in the healthcare.

The iPhone was first adopted by physicians independently of the organizations (hospitals) they worked for to do simple communication and access numerous apps that helped them in their day-to-day activities.  Seeing this adoption trend. some of the EMR vendors also started to get on-board offering iPhone access to their app (AllScripts introduced theirs at HIMSS’09). But this adoption, for the most part, remained separate from broader enterprise (hospital) initiatives as early versions of iPhone’s operating system (OS) were simply not enterprise ready.

But this is changing.

Apple’s iPhone OS, which has seen significant improvements since its introduction and now has robust enterprise features, including security ( HIPAA compliance), integration to the ever popular Microsoft Exchange Server (calendar, email, etc.), and an SDK to build apps for internal purposes.

To showcase the iPhone in enterprises, Apple now has a section of their website dedicated to showcasing customer deployments of the iPhone in an enterprise.  Of the 15 enterprise case studies presented, 20% of them are dedicated to the healthcare market; Mt. Sinai in Toronto, Memorial Hermann in Houston and Doylestown Hospital in Pennsylvania. Of all the enterprise verticals to profile, dedicating 20% of case studies to one market, healthcare, signals Apple’s intent to invest in this market.

Common threads in each story:

1) Security features of iPhone OS insure HIPAA compliance.

2) Ability to use Microsoft Exchange ActiveSync for email and calendaring features.

3) iPhone’s intuitive interface minimizes training requirements.

4) iPhone is readily portable and can deliver the right information at the right time to the right individual.

5) iPhone’s ecosystem of applications allows a hospital and its clinicians to tap a wide range of applications to customize the iPhone to their particular needs. Many of these apps are free thus not a drain on ever tight IT budgets.

As Hermann Memorial’s CIO, David Bradshaw stated:

Healthcare is a real-time business.

And as we’ve said before:

Health is mobile.

The combination of an ecosystem of relevant applications with enterprise connectivity in a secure, easy to use, mobile construct is the future of healthcare IT, at least for clinicians.  The next step is bridging the divide between clinician and consumer through the use of such technologies. We’re not there yet, but hopefully, Apple is working with a healthcare organization (or at least will uncover one) and present such a case study in the near future.
John Moore is an IT Analyst at Chilmark Research, where this post was first published.

Andy Wiesenthal, Kaiser Permanente

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By MATTHEW HOLT

Those of you with really long memories may remember that Kaiser had a little kerfuffle with a guy named Justen Deal. As part of that incident, I did a rather unorthodox interview with Andy Wiesenthal from The Permanente Group in 2006 which is still a hell of a read—mostly about the history of how KP got to the Epic decision and where it was in the middle of the installation process.

Fast forward the better part of 5 years. HealthConnect is done. And the pain and not inconsiderable expense is somewhat forgotten. But now it is done, what happens next? A long and somewhat philosophical interview. But a very interesting discussion.

Jonathan Bush, quickly

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By MATTHEW HOLT

Jonathan Bush gave me a quick interview at HIMSS ten days ago. We had a chat about what the recent restatement of accounting was all about (stock off about 12%), and last night they released numbers that apparently made Wall Street a little happier (stock up 6% after hours)

More interestingly we also chatted about the uptake of the clinicals product (pretty well), and whether and when athena would open its network to other application vendors (in a while).

The Surprise

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By BRIAN KLEPPER

Brian Klepper

Check out this March 3rd article – ( click here ) – from the recent HIMSS conference, in which Dave Garets, President and CEO of HIMSS Analytics,“gazes into the future and predicts major trends for the next 12 months.” HIMSS Analytics is the research and consulting arm of the health IT vendors’ association, and presumably on Health IT’s leading edge.

From the article:

“Q: What will constitute the surprise of 2010 – the one technology or policy or X-factor that no one saw coming.”

“A: Clinical groupware in the ambulatory market that may be the disruptive innovation of ambulatory EMRs.”Continue reading…

It’s Not About Meaningful Use …

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By JOHN MOORE

MucartoonWith the impending comment deadline for Meaningful Use (MU) fast approaching, many organizations, from CHIME to AHA to AAFP and others are asking for some form of relaxation of MU criteria in the final version.  Now it is not to say these concerns are not justified, it just may be that they are misplaced for the vast majority of those who currently do not use an EHR, small physician practices and clinics.  It is within these small practices, which are really just small businesses, that the majority of patient care occurs and where possibly the biggest benefit may be derived in the use of EHRs. It is also here where we may find the highest adoption hurdles, and those adoption hurdles are not so much about MU criteria, but more about productivity losses in adopting an EHR.

This past weekend I spent some time with a nurse who works in a primary care/pediatrics clinic in Vermont.  There facility, part of a network of several clinics, recently adopted and went live with a new EHR system (about 18 months ago). According to the nurse, this EHR, from one of the big names in ambulatory systems, has been a complete disaster for the clinic.  Productivity is way down, countless glitches have occurred, whole system crashed during a recent upgrade and the list goes on.  For 2009, this clinic, which has been in operation for a few decades, had its first ever loss last year, the year they went live with this EHR. The clinic puts the blame squarely on the EHR, which has severely constricted their ability to see patients and as all readers know, clinicians get paid for seeing patients, not trying to use a complex and difficult to use EHR.

It is stories like this that concern me.

This is a clinic trying to do the right thing, trying to use an EHR in a meaningful way (note, did not say meaningful use) and they are struggling. Yes, they do want to deliver the best patient care, but at the end of the day, they, like any business have bills to pay.  They are losing money far in excess of what HITECH Act incentives will provide. This story is, unfortunately, not unique, though few EHR vendors will come clean on the productivity hit to a practice.  Maybe instead of guaranteeing that their application(s) will meet MU criteria, EHR vendors should guarantee that the productivity hit of using their solution will not exceed HITECH incentive payments.  Now that would be an interesting value proposition.

Thanks to Michael Jahn of Jahn & Associates for the MU cartoon.

John Moore is an IT Analyst at Chilmark Research, where this post was first published.

Epocrates–reference present and EMR future

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By MATTHEW HOLT

I met with Bob Quinn the CTO and Geoff Rutledge, the CMO, of Epocrates at HIMSS last week. The company has a big footprint in mobile (and web) reference content for physicians. The big news is that it’s looking to move into an EMR product. Bob and Geoff explain what they do and where they’re going.

Epocrates from Health 2.0 on Vimeo.

Why Rush Vendor Certification of EHR Technologies?

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By DAVID C. KIBBE, MD and BRIAN KLEPPER

A surprise move by ONC/HHS indicates the wheels may be falling off health IT reform at about the same rate they’ve fallen off Democrats’ broader health reforms.

David Blumenthal and his staff have unveiled two separate plans to test and certify EHR technology products and services. We don’t think this is a good idea. We’ve supported the purpose and spirit of the ARRA/HITECH incentive programs, and believe ONC’s/HHS’ re-definition of EHR technology puts it on a trajectory to improve the quality and efficiency of health care in the U.S. But this recently-announced two-stage EHR technology certification plan bears all the marks of a hastily drawn up blueprint that, if rushed into production, could easily collapse of its own bureaucratic weight.

The new Proposed Rule puts vendors through the wringer, twice. As defined by ONC, vendors with “complete EHRs” and those with “EHR modules” will have to find an “ONC-approved testing and certification body” (ONC-ATCB) that will take them through a “temporary certification program” from now until end of 2011. Then in 2012, under a “permanent certification program,” they’ll have to switch over to a National Voluntary Laboratory Accreditation Program (NVLAP)-accredited testing body for testing, after which they must seek an “ONC-approved certification body” (ONC-ACB, not to be confused with ONC-ATCB) that can provide certification. The ONC-ATCB will be accredited by ONC, but the ONC-ACBs will be accredited by an “ONC-approved accreditor” (ONC-AA).Continue reading…

From Pain to Poverty

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By STEVE SANDERS, MDPicture 17

“What am I going to do now Doc?” asked Mike, a down on his luck, 29 year–old recently unemployed truck driver, as he handed me his hospital bill.

Mike was seen at our local emergency department on a Friday evening with complaints of indigestion. Earlier that day he and his wife Susan celebrated their second anniversary by splitting a store bought pepperoni pizza. Mike had just lost his job and his wife, already working two jobs, managed to keep them afloat. When Mike later complained of indigestion, Susan became alarmed. She had just read about the symptoms of heart disease in the local paper. Mike wanted to get some antacids but Susan demanded he go to the hospital. Mike stated he initially protested, but when it came to his health he looked to his wife for advice.

He said he wanted her to drive him to the hospital and told me his wife wouldn’t hear of it. “We’re going to call 911, she told him. “You could die on the way to the hospital.” Now, Mike admitted, that made him scared and he quickly agreed. Fifteen minutes later he was on a gurney rolling through the double doors of the emergency department.

Physical assessment by the emergency resident physician came quickly followed by an EKG, chest x-ray, CT scan of the chest (“they said I might have had a blood clot”), and lab, specifically including cardiac enzymes. Mike said his only complaint was it took over five hours before he heard any news.Continue reading…

Should the Feds Certify EHR Usability?

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By ROBERT ROWLEY, MDRobert.rowley

In an interesting turn, the Commerce Department’s National Institute for Standards and Technology (NIST) says it is looking to develop standards for evaluating ease-of-use of health IT systems. This raises some questions about the appropriate federal role in guiding the evolution of Electronic Health Records (EHR) systems – should the feds be specifying “usability standards” in the first place?

The NIST notice is currently very preliminary – they are simply looking for companies with expertise in quantifying and measuring Usability in health IT systems. However, the NIST has been charged with developing the specific testing and process documents that will be used (by organizations yet to be selected) to certify EHR systems. The overall policy and specification about Meaningful Use of a Certified EHR, which is needed to access ARRA stimulus moneys available beginning in 2011, have been published for open commentary. However, the specific nuts-and-bolts of certification is being hammered out by the NIST. They have already contracted with Booz Allen Hamilton to help with this process.Continue reading…

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