Welcome to EMR and HIPAA

Security
Biometrics Security is pretty impressive. We’ve joked a few times about what happens if you lose your finger (the situation at Wendy’s comes to mind). Let’s just say that the chances are good that this won’t be a problem. More importantly the biometrics people have really given you quite a few options on keeping it secure. One example is that with the biometrics you can also store a pin number that people can use. If I wasn’t so lazy in this moment I would pull out the part of HIPAA that says something about dual authentication methods. Your finger and a pin number sounds like dual to me. When you add in my previous article about False Acceptance Rate and False Reject Rate, then biometrics is a great option for securing EMR.

One other really nice feature with biometrics security is that you can choose to restrict people from using a password to get into certain programs. While this could be scary if something happens to the biometrics device it is an interesting concept. Since it is all managed by group policy in active directory I could train my end users on just using their fingerprints and never having them know their password(see below for password change policy). I would of course want to be able to use a password or biometrics, but there might be a few cases where you could literally restrict access to EMR to a fingerprint. Now that’s security!

Password Change Policy
One other impressive feature that I had never considered is how does biometrics handle the wonderful password change policies required by HIPAA? It’s not like your fingerprint can be changed. The units I’m testing can take care of this for you as part of the templates you create for each application. In fact, if you don’t want to have users know the password at all you can even have the biometrics software generate a password. I think this might be a little scary since then if the biometric device breaks or some other problem then you have no way of getting into your EMR program(or other application as desired).

I was approached the other day by my HIM (medical records) staff with a sheet of paper asking me to find which patient it belonged to.

Yes, unfortunately we have an electronic medical record with as little paper as possible, but you are always going to have papers floating around. Even with EMR you can’t stop patients from bringing in paper to you which you are then responsible to keep. Good thing you can at least scan the paper. Scanning is definitely worthy of another post though.

So, here I was charged to find which patient this stray sheet of paper belonged to. This paper had no identifying information for the patient (Don’t ask me how that happened). The only information that could really be gleaned from it was which doctor had seen the patient, the patient was a nursing student and that the patient was pregnant. Now many of you may be saying, well having many nursing student patients do you have which are pregnant? This is a valid question, but all those people balking at my example take a step back and imagine you didn’t have an electronic medical record. How would you find this patient?

Charts..
Charts..
More Charts!

Is there really anything else that could be done besides sifting through chart after chart? I can’t really think of much.

With an EMR it was no problem finding whose chart it must be. I pulled up all patients with a pregnancy diagnosis for that doctor and then looked for the patients that were in the nursing school. Patient Found!!

Sure, Dragon Naturally Speaking is amazing voice recognition software and very useful to an EMR. Biometrics is great for security and speed of access. Facial recognition still utterly amazes me. However, they all pale in comparison to this possible development:

The Berlin Brain-Computer Interface (BBCI) – dubbed the “mental typewriter” – was created by researchers from the Fraunhofer Institute in Berlin and Charité, the medical school of Berlin Humboldt University in Germany. It was shown off at the CeBit electronics fair in Hanover, Germany.

The machine makes it possible to type messages onto a computer screen by mentally controlling the movement of a cursor. A user must wear a cap containing electrodes that measure electrical activity inside the brain, known as an electroencephalogram (EEG) signal, and imagine moving their left or right arm in order to manoeuvre the cursor around.

“It’s a very strange sensation,” says Gabriel Curio at Charité. “And you can understand from the crowds watching that the potential is huge.”

“Mental Typewriter controlled by thought alone”

How amazing would it be for your thoughts to automatically get inputted into an EMR? This invention would not only revolutionize EMR, but just about everything we do. We really have no idea what new technology is going to be here 20-30 years down the road. Get in! Buckle Up and get ready for the ride. This technology is crazy!!

Looking over the search terms that have been used to find my site I’ve often been surprised by how many people are interested in my Google Portal for Medical Information. Well, I found some more information on Google looking at doing more with medical information.
Garrett posted on Googling Google about “Google Health What is it?” In it he makes a good point about why would google hire a “Architect, Google Health” if it wasn’t planning to do something nice for health? Well, the real question is what will Google come up this time in the healthcare arena?

eHealth offers some good ideas about Google Health being a mix of a “custom medical search, Google News, list of health search engines, video search, search local to find a doctor, Google scholar for medicine, etc.”, but it also says, “that would underestimate Google’s potential for innovation.”

This really should be interesting to see how google compares to other health search portals like Kosmix.com and the infamous WebMD.

Will this really affect an EMR? Probably not. It might be a nice reference, but it’s going to be quite a while until any portal is good enough to integrate with an EMR program.

Tablet Kiosk has posted its version of the Windows UMPC (code named Origami) with prices and some specs on the product.

Here’s some information from Ducknet who knows a lot about Tablet Kiosk:

New Name: EO V7110

Tablet Kiosk appears to the the first to take orders. Remember this is the high end product and not the unit coming out with the lower end processor. They have also provided options to configure your unit, with accessories to be ordered as available.

Origami UMPC from Tablet Kiosk

I really like the idea of a UMPC tied with an EMR. It won’t replace tablets or desktops, but it would be nice to have with an EMR. One option I’ve considered for a UMPC is for patient education where they need to read something. I also think a UMPC would be really nice to do a digital signature in an EMR. You could hand over the UMPC to the patient so they can read the consent for treatment form and then sign it digitally. This type of electronic signature would be pretty nice. Plus, you wouldn’t have to try and maneuver a tablet so they can sign it or use some other type of electronic signature technology. Just buy a couple UMPC’s that nurses and doctors can share for different patient signatures or patient education.

Other applications for UMPC devices in healthcare will certainly be coming. Just wait.

Here’s the press release:

TabletKiosk™ Introduces New UMPC Device
eo™ offers exciting new opportunities for mobile computing users
Torrance, CA, 3/27/2006

TabletKiosk™, a leader in Tablet PC and exhibit centric computing solutions, announces the much anticipated launch of their new Ultra Mobile PC, eo™ which will begin shipping the last week of April 2006.

eo™ represents the new generation of mobile computing. Measuring 9”W x 5.75”H x 1”D and weighing just under 2 pounds, eo™ is the most portable and convenient Tablet PC device for taking handwritten notes, accessing the internet, instant messaging, listening to music, viewing movies and playing games. eo™ enables you to connect, communicate and accomplish any task anywhere, any time, and be entertained and informed wherever life takes you.

Read more…

I’ve doing more reading on EMR and the likes since I finished a business plan I was writing. Here’s a few articles/blog posts that I found interesting:

Face Authentication Software
The Healthcare IT Guy posted an interesting review of some auto-recognition and auto-login system for healthcare workstations called FastAccess by Sensible Vision. A standard web cam, easily installed software that can recognize my face to log me in. I need to get me a demo so I can try it out.

US Healthcare System
This is a nice article saying that although the media describes the US Healthcare system as broken down, many “better” healthcare systems aren’t immune to problems.

Mirth Project
I really like the idea of an open source project that supports HL7 messaging. I just can’t get my head around what exactly this means and how they are making the wretched HL7 messaging any easier.

I’ve been reading quite a bit of discussion about a new CCHIT certification that is being created for EMR companies. I really think these medical certifications are interesting since you really have no requirement to be certified and certification really doesn’t mean you are necessarily better. However, with the number of EMR companies out there a consumer certainly will be looking at certification as some means of proof that an EMR has features that they will need or want. Too bad this isn’t necessarily the case. Either way, the CCHIT certification is coming whether you like it or not. Here’s a link to the CCHIT certification requirements. You have until March 31st for public comments.

Many of the smaller/free EMR companies out there are really frustrated with the certification process proposed by CCHIT and they’ve been making their frustration clear in an EMR forum called EMRUpdate. Theit frustration from my point of view lies mainly in the enormous cost to be CCHIT certified including a large yearly royalty fee and the requirement to code a bunch of useless enhancements just for certifications sake. I can’t say I disagree with these 2 items.

I also think the certification process is wrong because it is an all or nothing certification. That means if you are missing one feature then you would not be certified. This really doesn’t make sense. An EMR company should receive a grade instead of a certification. This would allow each EMR vendor the ability to justify why they got the grade that they did. Not only would this be fairer, but it would also give more information to doctors evaluatin an EMR.

A group at EMRUpdate have put together a letter that they are sending to CCHIT about flaws found in the CCHIT certification process. Any of those interested in participating in these recommendations can sign their name at EMRUpdate Draft Letter to Dr. Mark Leavitt, MD, Ph.D. You can see the thread that created this letter here.

Depending on the response to this letter, many of the people who participated in creating the content for this letter have talked about creating a new Certification sponsored by EMRUpdate.com. They’ve termed it SHOVEL - Software for Healthcare Organizations EMR Voluntary Ligitamacy and I better give some props to AlBorg who has done a significant amount of work on this idea. I like the idea, but as stated in the thread creating the idea, I think it will probably take 30-40 EMR vendors coming on board to make it work.

I guess we’ll see how much power an online group of vendors, consultants, doctors and EMR lovers are able to do. Let me know what you think of the certification process and SHOVEL.

Why would an EMR company not want to use these databases (or at least ones like them)?

I’ve recenly come accross SnoMed and RxNorm. I honestly don’t know too much about them, but my impression is that at a minimum these 2 databases list all the ICD9 codes and standardize the listing of Rx’s using the NDC number. Lists like these would have made my life so much easier. When I first implemented an EMR I really didn’t know what I was doing at all. I was learning the medical side as quickly as I could so I would know how to configure the software. I guess I could have sat back and said I’d be happy to just install the server, install the software and let the doctors deal with the medical side of it. However, if I did that I think that we wouldn’t be anywhere near an EMR implementation. So, I jumped in head first and tried to learn what needed to be uploaded to our new EMR system. I found myself having to upload all the ICD9 codes and find a way to add all the medications we wanted to prescribe into the EMR system. Anyone that has looked at these lists knows how much fun this was. Having access to some databases like SnoMed and RxNorm would have made my life so much easier. Even more important is that an EMR vendor should have this standard.

Ok, don’t start flaming this thread(although maybe I should encourage comments since this is a subject I don’t know that well), but there are some challenges for EMR companies wanting to implement it. I’m sure if you list every drug every created then I’m going to start complaining about that too. Not to mention every ICD9 code. At least you have to plan a way for me to sort through the lengthy list. Also, I don’t think it’s just a flip that is switched to turn this type of integration on or off. I also will give those older EMR companies a little slack since it’s going to be a definite challenge integrating these databases if you haven’t been using them in the past. However, it’s not impossible.

I think the biggest reason to implement some type of database like SnoMed and RxNorm is because of the potential integrations that can be done in the future. RHIO is a hot topic, but if we don’t all speak the same language as far as ICD9 codes and drug names then it will be difficult to integrate. The whole CCR initiative will be so much better if we have a standard language that we all use.

Ok, so I apologize for my primitive understanding on the topic, but I figured I had to start somewhere. More information to come.

I saw someone give a great idea about which part of the chart should be scanned into your EMR. I should do some more posting on how, what, when to scan into an EMR when implementing an EMR, but that will just have to wait. Until then, this might be a good idea to look at.

Here’s what was said in the original post:

A very common practice when a paper chart gets too thick is to ask a physician or nurse to “thin out the chart”. You are basically asking the clinician to select the important paperwork in the chart necessary to continue to take care of the patient. Typically a thinned out chart should include all of the patients clinical history ie PMH, FH, SH, Meds, Allergies, etc -this information you would find in the most recent H & P. Also drs and nurses also like to have the latest labs, X-rays, EKG, and other diagnostic studies as well as previous ones that were abnormal. There is no need to enter or even scan in years of normal UA’s, normal throat cultures, etc. All of those normal results (except for the most recent one) can all be put away in the paper chart. Remember in most states paper charts still need to be kept for about 7 years.

Many people who have come to my EMR and HIPAA blog have probably wondered why the address of the website is www.crashutah.com. Honestly, there is only one reason. I’m cheap!! I’ve had crashutah.com for a while and so it was free to host my blog on the same site. Today is my birthday and so I got myself a birthday present. I bought 2 different domain names that I could use for this site. I need your help to decide which one I should use. Here’s the 2 choices:
www.emrandhipaa.com
www.emrhipaa.com
So, they are pretty much the same, but I want to know which one is better. I think the first one is better since it is really the name of the site and so it matches nicely. I like the second one because it has fewer letters and would be easier to type. There is also the question of which one google would like better. In the end, they probably won’t care too much. If they cared too much about the domain name then I wouldn’t be getting all the google searches that I’m getting with crashutah as the domain name.

Let me know which you like better by just clicking the comment button below and telling me which one I should use as the main one. I also want to thank those of you out there that avoided purchasing these while I waited to purchase them. Today I went to buy a domain name I’d been looking at for a month and it was bought yesterday night. I couldn’t believe it. I was so mad. Mostly mad at myself for not buying it earlier.