Welcome to EMR and HIPAA

You may notice on the right a list of new pages that I just started to create. The idea is to create a resource for those interested in evaluating EMR as an alternative, purchasing an EMR or implementing the EMR. Right now the pages are quite empty, but I’m hoping to solicit my readers help. So, just comment on this post or email me directly to let me know what you think about the following topics:

EMR vs. Paper Charts
EMR Evaluating and Purchasing
EMR Features
EMR Implementation Ideas

Ok, so I’m focusing a lot of effort on EMR still. I hope to change that in the future and have a few more HIPAA related items, but EMR is my main interest for now. HIPAA has a strong tie with EMR since your EMR MUST be HIPAA compliant. In fact, that brings up a nice idea for another future page “HIPAA Compliant EMRs” Are they really HIPAA compliant?

Don’t by shy now! Just click the comment button and start letting me know what you think.

A recent article described a fascinating way of allowing people to pick up pharmacy refills using a kiosk machine. What a great idea!! I can really see how this could save you some money and really takes service to the next level. Their is definitely some risk involved with the process, because of what is required to authenticate that you are giving the drug to the correct person. I hope they have some sort of video surveillance or other security methods in order to satisfy all the HIPAA regulations(or whatever regulations pharmacies are required to follow). Either way there could be some serious consequences if those drugs were picked up by the wrong person. Also, what happens to the counseling that the pharmacist gives? I guess that is gone.

I really enjoyed a quote from the Asteres Company Website who is the creator of these kiosk machines.

The best customer service begins with choice.
There are times when we need personal attention
and there are times when every minute counts.

I for one am very grateful for companies like these. I’m not sure if it’s the same company, but I love renting DVD’s from a machine for a much cheaper price.

I saw a really good article written by EHR Insider that had a great idea in evaluating EMR companies. You should know and understand how much time and effort it will take to implement the EMR. Demo’s are usually on systems that have been set up extensively and designed to show you the best features. Knowing what effort it takes to get to that point is important. I would suggest that his request of what to configure seems to focus on how one company implements EMR. I’d prefer something more generic. Possibly a description of what you do now and how they suggest you implement your current process in their EMR environment.

Enjoy the article:
Tip #1, from EHRInsider.com…. Request a “Configuration Demo”!

What’s a configuration demo? Well… I just made up the term, but what I mean is that you need to schedule more than a “features demo”… (that’s when you have the rep shows you all the great things an EHR can do). You also need to have the rep provide a second presentation, the configuration demo. This demo shows you what it takes to build or setup the new EHR.

This is likely to just be for your smaller group of people who will be setting up the EHR during the configuration phase. When you buy an EHR you will typically create a small group comprised of a nurse, a provider and your new ‘EHR administrator(s)’ and this group will be responsible for setting up the EHR prior to your on-site user training and Go Live date many months down the road. This group of people simply must get a good idea on what level of computer expertise and how many man-hours are required to setup and configure this new system, and keep it running once it’s live.

This is the most shocking mistake I see. People are clearly buying $100,000+ systems and don’t have any idea about what it takes to build a new progress note template. Or create a new lab panel, a message template, a flow chart or add/modify new EHR screens. How hard is it to have the lab results drop automatically into your progress note? Or to change a health maintenance item’s due date? And your group will have to do all of this and much more before you take the system live.

Read more…

Microsoft is making a huge leap by allowing doctor visits online. Doctors will get paid $30 a visit with no cost to the patient. Here’s the article in The Seattle Times.

I really think that some system similar to this is in the future of Health Care. I hope that it is sooner or later. There really are some interesting insurance questions that have to be answered. Since Microsoft is self insured I can see some significant savings for them. I also don’t see why it couldn’t be create your online encounter in a way that it instructs you to get emergency care. Ok, so that doesn’t solve all the problems, but it’s just sad that there are some great benefits that will be missing because of the potential insurance liabilities.

College Health seems like it’s in a good position to offer these services since many have free Health Center visits and charge a Health Fee to all students. The health fee could account for any costs associated with the online encounters. Plus, it could easily be integrated with an existing EMR where all patient data and encounters could be seen.

Just think of the possibilities!!

I ran accross an interesting study which says that EHR won’t penetrate into the small office segment(which is the largest segment) until the year 2024 which is 10 years after when policy makers have asked it to be implemented. The study used actual data to make this prediction which is a step in the right direction. This is good and bad news for EMR vendors that now have nearly 20 years of business ahead of them but that means revenues will be strung out over 20 years. No dotcom boom at that rate.

In the NY Sun it was reported that there are around 1,200 companies doing EMR today. That is a lot of companies and a lot of choices. No wonder picking a company is so difficult. Unfortunately EMR programs aren’t like CD burning software which is similar enough to not matter that much. Not to mention you can switch if you don’t like it. They are way to complex and I’ll be quite honest that if someone asked my to convert my current EMR to a new one I would probably quit my job first. It’s just so complex.

Here’s is some good information to help those starting to evaluate all the different EMR companies.

There are many free software out there to choose from. You can find a good list here. Just remember that just because the software is free, supporting it isn’t free and often requires certain expertise and don’t forget about paying for any customizations you may require. It’s still definitely worth looking at.

Second, my friends at emrupdate.com and more specifically Naveen of DoctorsPartner have created a price matrix that includes a good number of EMR and their pricing. That should help you narrow down those companies that aren’t close to your budget.

There was a pretty good article recently in the NY Sun Times about plans to push EMR by government. While it still gave no specific plans here’s an excerpt of a few possible things:

“Dr. Brailer told the Sun that later this month the administration will start by unveiling “breakthrough” health information technology initiatives that may be completed by year’s end, increasing the issue’s visibility among the American public. The initiatives include nationwide computerized personal medication histories, so that a doctor anywhere in the country can know what medications a patient is taking before treating him; providing “secure messaging” to allow for private e-mail and other electronic correspondence directly between doctors and patients, and “bio surveillance,” which uses computerized records to monitor disease outbreaks and provide earlier detection and better treatment of pandemics or bioterrorism attacks.”

I thought the article was good because it gave some interesting statistics about EMR and tried to quantify cost savings and expenses. The above “breakthrough” technologies it said would only cost $100 million to $200 million dollars. I guess the reality is that the technologies cost much less, but it might take $100-200 million dollars to cut through the red tape.

I think one topic that has gotten a lot of coverage in regards to EMR is its ability to prevent medical errors. I read an article from the NY Sun that said, “between 44,000 and 98,000 Americans die each year from medical errors.” I think the argument of lives is a hard one to quantify because I think we’d all agree that even one life saved is worth it. The real question lies in our ability to quantify whether lives were saved because of EMR or not. That’s very difficult and I expect over the next couple years there will be studies done showing how many people lost lives because of EMR’s. Just a hunch.

I think the thought of saving lives is great, but I think there could be a related issue in regards to extending people’s lives and improving their quality of life. EHR has the serious potential to be able to do many of these things by giving patients better information on how to manage their health. What about adding excercise and other health education topics to an EHR in order to promote the well being of your patients. This could all be done electronically and encouraged by the doctor.

One other idea that was raised in the article linked above was, “The federal government estimates that nationwide electronic health records would save the health care industry $140 billion a year.” The real question is who is going to take that money home, the insurance companies, the doctors or the patient? In reality, in order to have those savings it is going to cost to implement the EMR and so in the short term no one is going to save. Eventually I can see EMR saving patients money or more importantly slow the ever rising cost of healthcare.

EMR implementation must follow an important instruction from the movie “What About Bob.”

BABY STEPS!!

I divided our implementation into a bunch of phases for our health center. That way they would have time to learn things in a step by step manner rather than all at once. After we did the first phase they started asking why they couldn’t just do it all. It made me laugh since they were so averse to ANY additional “changes” at the beginning.

Today I trained one of our more computer averse users on another feature we started using. What would have taken me an hour to train in the beginning was easily trained in 10 minutes.

I told her, “That wasn’t so bad, was it?”
She responded, “It was one of the easier things I have learned.”

The reality is that it was actually more difficult than most of the other things she had learned, but her technical skill was now higher and so she was able to grasp new concepts much easier. I should note that a more tech savvy ma learned the new feature in 2 minutes.

This CCR Initiative seems to show some interesting promise and I’m very interested to look more into it. I’m not sure how HL7 and CCR will work together(or against each other), but I expect to see the CCR abbreviation to become commonplace with EMR’s.

Here’s some good info I got from this website:

Continuity of Care Record Is Developed by

ASTM International Health Care Informatics Committee

W. CONSHOHOCKEN, Pa., 5 January 2006—A revolutionary new ASTM International standard will change the way in which healthcare professionals preserve and transfer healthcare information about their patients. The standard, E 2369, Specification for Continuity of Care Record (CCR), was developed by Subcommittee E31.28 on Electronic Health Records, which is under the jurisdiction of Committee E31 on Healthcare Informatics.

The Continuity of Care Record is a core dataset to be sent to the next healthcare provider whenever a patient is referred, transferred, or otherwise uses different clinics, hospitals, or other providers. The CCR will bring an end to physicians and other healthcare professionals having to act “blindly,” without easy access to relevant patient information. It will provide the necessary information to support continuity of care, thus reducing medical errors, achieving higher efficiency, and creating better quality of care.

During the past two years, U.S. President George W. Bush has called for greater interoperability of electronic medical records and personal health records. E 2369 represents a major step forward in assisting vendors and healthcare organizations in their search for simple, yet powerful tools that will help meet the president’s objectives.

Read more…