Welcome to EMR and HIPAA

Many people in the medical industry probably don’t know too much about open source. They’ve probably heard of linux and they may have heard the words open source, but they don’t really know what that means. I don’t intend to explain open source here, because any search on google for open source will give you a plethora of information. If you don’t know how to do a google search on open source you probably shouldn’t use any open source product. For that matter I’m not sure you should do EMR at all, but I guess everyone could learn with the right motivation.

Back to my real intention for this post. I do hope to expose people interested in the idea of open source to some of the open source projects out there. I think one of the biggest problems is figuring out which one is best since a number of them are all competing for the same space. In the end, like many things in life 2 people could look at the same thing and see 2 different things. EMR is no different.

A Health Wiki has been started that gives a good basis for open source and lists a couple of major open source EMR projects and is a good place to start for those interested. Many of them build off of the other. For example, MirrorMed is built off of and shares code with OpenEMR and FreeMed. Maybe later I will investigate the difference in these products.

Finally, I think it is worth making mention that there are other Free EMR’s that are not open source. An example I found was LifeRecord which I found last night and it looks very interesting. You can find another list of free resources at EMRUpdate. On that list I like the progress I’ve seen with Al Borg’s EMR and Medscribbler.

http://tkfp.sourceforge.net/links.html

http://www.informatics-review.com/wiki/index.php/Free_and_Open_Source_EMRs

I decided to start a list of EHR and EMR vendors that I could eventually demo and write a review for. I’d been meaning to do this for a while, so tonight I finally decided to just start it. I’ve only added two for now because I started to look at Life Record EMR and found it very interesting. I didn’t want to lose it from my list since I hadn’t seen it many places. Thus the list began. I also added my EMR since I know the website. I have a whole slew to add still so don’t feel bad if you don’t see your EMR yet. Eventually I’ll post when I have added all that I can find. Until then please feel free to post a comment to this post and I’ll be happy to add you to the list.

I came across an EMR’s website and found something quite interesting. Besides the fact that it is open source it had a list that I thought portrayed my problem with all the acronyms and names associated with Electronic Medical Records. Here’s the list:

MirrorMed is a free and open source Electronic Health Record.
MirrorMed is a free and open source EHR.
MirrorMed is a free and open source Electronic Medical Record.
MirrorMed is a free and open source EMR.
MirrorMed is a free and open source Medical Practice Management System.
MirrorMed is a free and open source Health Practice Management System.
MirrorMed is a free and open source Medical Billing System.

I guess this is the list of what I’m really talking about on the site. Although, I usually shy away from billing for now, but I’ll take on that beast later. I will post what I find out about billing, and I’m really for having an integrated billing with EMR. I digress!

In order to work on understanding all the names I plan on making a page devoted to explaining some terms. Watch for that in the next couple months.

The AAFP reported an interesting piece on a request that the Continuity of Care Record (CCR) be used by HHS to carry forward their IT Healthcare goals. While I’m glad I don’t do this kind of political jockeying I love to read about it. Here’s part of the letter that was sent to HHS:

* The CCR standard has been endorsed by multiple physician organizations and health IT vendors and is already in the market and available for use.
* The standard is a comprehensive clinical content standard with 16 sections, including patient demographics, encounters, diagnoses, medications, allergies and immunizations.
* The CCR standard will permit interoperable exchange of personal health data between disparate electronic health record systems used in medical practices.
* The standard is an open standard and is free of licensing fees.

I really need to spend some more time on this subject. I found the Continuity of Care Record(CCR) website. Something that I don’t like already is that their “official CCR Implementation Guide” costs. Maybe this is standard, but I’m not sure I’m ready to pay to see the official guide. I guess they have to fund CCR some way or another.

I saw a really good article that seemed to be starting towards RHIO that everyone wants, but no one wants to work or pay for. The article discusses how Hospitals in Indianapolis have created an RHIO to exhange lab results, radiology reports, and discharge summaries.
It was really nice that it discussed some interesting challenges that face an RHIO. Foremost in my mind is that it requires someone a full day to be able to “copy and paste” the data from the records into a company’s EMR. They are looking at integrating it with HL7 so they don’t have to do this. I guess this is baby steps, but can you imagine having to enter lab result data all day. I did data entry for a while and it’s not any fun. Plus, this isn’t just data entry, but knowing which result field it should be added to in your EMR.
I wonder if they have any plans to integrate some of the data with the CCR standard. I think projects like this and the people behind them are going to really determine the future of medical interactions.

I had been getting some searches on the site for HIPAA Lawsuits or HIPAA cases and it started me thinking about what might be out there. Sure enough I found some interesting info in another HIPAA Blog.

Here’s the 2 points I took from these 2 HIPAA cases:
there’s no private cause of action against a covered entity for a HIPAA violation
This is good for those organizations to know that they can’t be sued for one person’s carelessness(or direct violation). At least that’s my understanding from what was written. It did say that Rite Aid could have a breach of privacy and negligence claim brought against them. I think this is what we are really mostly wondering about. I guess we’ll have to see how the courts work it out.

The second point was a parent trying to get a child’s counseling records. Essentially they weren’t able to do that. It looked like there good be a few state loopholes so that might be something of concern, but overall it seems like the court upheld the privacy of the patient from the parent. While I think it’s appropriate it is sad to think that so many parents would need to go to these extremes to get information on the child(pardon the social commentary).

I must admit that reading this information makes me glad I’m not a lawyer and confirms my current opinion that HIPAA is a necessary evil.

I guess today I’m feeling a little more techy since my posts are more about tech toys and software. It doesn’t really matter if you are an EMR user or not, but this software list can save you a bunch of money personally and in using an EMR. Not to mention implement some good security controls.
I ran accross this list at a blog by a modest construct

Here’s the ones I’ve tested and suggest:
Firefox
Trillian
FileZilla
Bittorrent
AdAware
SpyBot
CDBurnerXP Pro
WinAmp(I can’t believe this one’s still around)
Media Player Classic
VideoLan
Quicktime Alternative
Real Alternative
The GIMP
OpenOffice.org

SpyBot and AdAware are essential for good security and PC cleaning. I need to look through the anti virus programs on the list, but we have a site license for Norton and so it hasn’t been a good priority.

My favorite money saver is GIMP. It is nearly as good as Photoshop, but FREE!

I’ve started looking at purchasing some biometrics throughout my clinic. Here’s my favorite so far:

I really like the DigitalPersona biometrics that I saw at the MISTI HealthSec Conference in San Francisco. My favorite part is that it is integrated with Active Directory so I can set all my group policies and I don’t have to train each workstation on all the fingerprints. It seems like they have a good set of security and management abilities with their active directory implementation.

DigitalPersona sent me some interesting documentation on HIPAA compliancy. I must admit that I think that is mostly marketing. They make some good points on how biometrics can make you more HIPAA compliant, but I think that is due to biometrics and not necessarily tied to the specific company.

Something I’m still interested in learning from them is their ability to integrate with my existing EMR. I still think it would be great to capture a person’s fingerprint using the biometric device and then just matching the fingerprint whenever you need their signature on a consent, referral or some other document you. This type or electronic signature would be very reliable, very secure and yes I can’t wait until we have an electronic signature available. I’m tired of scanning.

I also asked DigitalPersona what kind of features they have for auto logout. I read something(I can’t remember where) that some biometrics have an auto logout feature when you leave the room. Don’t ask me if it is some proximity feature or what, but I’m interested to know what they have in mind.

I also have the Microsoft Biometric Fingerprint Reader(the one with the mouse and login separate). I actually think it is just a DigitalPersona unit with the Microsoft branding. The funny part is that I love the mouse more than the biometrics. I personally can type the password faster than I can fingerprint login. However, considering the number of calls I’ve gotten for users who forgot their password or had caps lock on or just don’t know how to type, I can’t wait for biometrics.

Integrate my EMR and biometrics with active directory and I can finally do what I was suppose to do at work.

Technically I have now passed over a month blogging, but with the holidays I didn’t really start posting much until the new year. However you count it, I am now 33 posts into my EMR and HIPAA blog. The amazing part is that I’ve only just begun posting things I’d like to post. Too bad I love watching the addicting statistics so much or I would produce more content for YOU my readers. As they say in Italian, “man mano”(”little by little” I think, but it really seems to translate more like hand over hand).

Thank you for all those who have visited the site and continue to return to see what I might suggest next. I have some good ideas waiting to be posted and new categories of posts so the site should really develop over the next few months. My biggest disappointment is with all of those who read the blog, but don’t post your thoughts and comments. I’m always interested in knowing what I’ve said wrong or other insights on what has become a most fascinating adventure “EMR”.

I must apologize to HIPAA since I haven’t given it much coverage at all. In the end I might have to rename the site to include HIPAA, but make EMR the star. I’m just too addicted to the entire concept.

Now that It’s been about a month I think I better start working on a domain name. Crashutah.com is my baby that I started when I was in college and will remain in my family forever I think. It is a great domain name, but doesn’t have meaning in regards to EMR and HIPAA. Therefore, I am looking for a good domain that is available.

Come on, if you’ve read this far you must be interested and want to give me some suggestions. Click the comments link and type away. Use Dragon Naturally speaking or hold a wooden dowel in your mouth to type(I actually saw this once). I don’t care, just let me know what you think.

No one really likes dealing with sales people. There is just a general feeling of mistrust that usually exists around salespeople. However, it is important that you create a good relationship of trust with that person so you can ask good questions. During an EMR demo you will see a lot of great features on the ideal system. Unfortunately, it is often the ideal system for a specific office for which it was designed. If your office is ideal then there isn’t a problem.

Since you are still reading I assume that you don’t have the ideal office(not to mention it doesn’t exist). This means that your office is going to have to adapt to the EMR software. Don’t expect the EMR software to adapt to you. Even with the most reactive customer service friendly EMR(which I consider mine to be at the top in this area), it just takes time to make changes to software, test them and then deliver them to the customer. So, the ease or difficulty in implementing a software depends on how close the software mimics your method of doing business.

Let me give an example for those visual learners. One of my evaluating clinicians asked, “Can your EMR handle a walk in ONLY system?” The EMR vendor had some great features to handle walk ins and intermix them into a clinicians schedule. However, somehow the ONLY was missed in a sales communication. It would have been much better to ask the EMR vendor, “How can your EMR handle a walk in ONLY system?” Then, follow it up with the question, “Can I see it?” Now you can actually envision what this EMR vendor would be like in your “ideal office” and what you would need to adapt to use that EMR in your environment.