Welcome to EMR and HIPAA

I think there is a ton of misunderstanding about digital signatures. So, hopefully in this post I can clear up some of the confusion of the various types of digital signatures that can occur. It’s important to understand some of the intricacies since there are a number of choices out there. I’ve been working through some of this digital signature stuff for months now and in the next month we’re finally going to have all of the digital signatures implemented in our office.

The first method of digital signature is basically using your login to sign something. This is the most common digital signature in an EMR and many people don’t even realize that what they are doing is digitally signing their chart. Some EMR programs don’t even ask you to physically sign the chart. Instead, they leave the note open for a certain time period. After that time period, then the note will essentially be locked so that nothing can be changed. Why does this type of signature work? Basically it knows that you were the one that logged in and the EMR logs who enters what piece of data. Essentially, the program is leaving your virtual signature throughout the chart as you enter your information. Pretty neat as long as that EMR has a good audit program so you can see who entered what information on a patient.

The second method is similar to the first in that it uses your username. Often, it may use some of the same principles of the first method by keeping track of who entered what information. However, in this method each electronic note requires you to click a button to “digitally sign” the clinical note. This can also apply to lab or x-ray results. This is the type of digital signature that we use most in our clinic. Each note has a button that lets you sign the note electronically. After clicking the button it imprints your name, credentials and the date and the time of the signature. The date and time is especially useful on lab results so we can know when a doctor may have read the lab results.

The third method is what I call “electronic signature” because it literally takes your physical signature and captures is electronically. Everyone should be familiar with this if they have been to a grocery store or Walmart. Basically all of the major chains are accepting your credit card signature electronically now. I can’t say how much I appreciate the digital signature in stores when I’m holding a baby. Have you ever tried to sign a piece of paper while holding a baby in one arm. It’s nearly impossible, but I digress.

I honestly haven’t heard of many (if any) doctor’s offices that are using a signature pad like Walmart does. However, it really is something that is an essential feature of an EMR that wants to have patients fill our their information electronically. Ok, some larger practices can distribute logins to all their patients. However, even then you’d probably need a physical signature to give them the login. My clinic is currently implementing this technology. The signature pads aren’t cheap, but I think they are well worth the money. It basically allows us to make every patient form electronic. This was never possible before since so many required a signature. Capturing a digital signature is what we’re doing to capture this information.

I hope for the signature pads to all to go live in the middle to end of August so look for more information on this coming soon. Is there anyone else using digital signatures with their EMR?

I’ve previously talked about having a HIPAA wiki for your offices HIPAA documentation. I still think that’s genius. However, I’ve extended that idea a lot more into having an offices internal documentation, policies and procedures and any other documentation on a wiki. It just makes sense. It’s the best way to keep things updated and accessible. No, those pile of word documents that people can search isn’t even close to as powerful as a wiki. Even if you have version control and use sharepoint.

Today I started thinking about how every EMR vendor should have an EMR documentation wiki for their software. I know my EMR vendor gave us a manual that was outdated before it could be printed. A paper based manual for EMR should not be useful for you. If it is, then you chose the wrong EMR. You should want an EMR that is innovating, changing and adapting with new technology that they can’t keep their manuals updated.

However, an EMR vendor with some help from their EMR users could create a pretty great wiki that had all sorts of great information that was relevant. I think I’m going to suggest this to my EMR company.

After my previous post on Michael Moore’s movie Sicko, I was glad to find someone else who shared my own thoughts on the subject. Bob Vineyard does a much better job than I did at explaining my feelings on the subject. Here’s the part that I think is the most important part:

You would think after watching Sicko that everyone, everywhere has better health care than we do and there is no downside to health care in Canada, Great Britain, France or even Cuba.

If so, then why do Canadians cross the border into the U.S. to receive treatment? Why do Brit’s have to get in the queue and have treatment for certain conditions denied? Why is it Cubans can apparently get the best in health care yet 75% of them are illiterate, almost no one owns land and unemployment is rampant. Cubans may have excellent health care, yet many die each year from curable diseases for lack of medicine.

Wonder how Sicko missed this fact?

I don’t really follow Michael Moore that much, but I do know he just came out with a movie called Sicko that basically nails the US Healthcare system. I’m sure that many of the stories he shows are dead on. However, the guy being interviewed on Charlie Rose was a complete idiot that didn’t show an understanding of the healthcare system. He mentioned other countries with government healthcare coverage as a model that we should follow. While I think there is a lot that can be learned from other countries healthcare systems, Michael Moore was going about it the wrong way. I think maybe Michael Moore should go to some of these other countries and do a video called Sicko2 which shows that even socialized medicine has its problems.

I also thought it was interesting that someone on Google came out against the movie Sicko. Here’s what a Lauren Turner of Google Health Advertising team said in regards to Sicko:

“While legislators, litigators, and patient groups are growing excited, others among us are growing anxious. And why wouldn’t they? Moore attacks health insurers, health providers, and pharmaceutical companies by connecting them to isolated and emotional stories of the system at its worst. Moore’s film portrays the industry as money and marketing driven, and fails to show healthcare’s interest in patient well-being and care.”

“We can place text ads, video ads, and rich media ads in paid search results or in relevant websites within our ever-expanding content network. Whatever the problem, Google can act as a platform for educating the public and promoting your message.”

Not a wise choice considering later Google said that didn’t represent Google’s opinions, but was Lauren’s alone. While I think that means that Google left Lauren out to dry, I am glad that blogging is available to allow people to express their true feelings on a subject.

Now where’s Google Health and Google PHR?