Welcome to EMR and HIPAA

My guess is that many of you are using an HL7 interface between your EMR and your lab. How does your EMR handle the signing of lab results?

We worked for an entire year testing, making requests, testing, more requests and more testing before we were able to launch an interface between our lab and EMR, but it’s been one of the best things we’ve done. The reason it took so long is the topic of another post, but it was for good reason.

One of the best advantages to a lab interface with your EMR is that you don’t have to worry about what to do with all those paper labs that you’ve signed. Inevitably all those signed paper labs will have to be scanned and attached to a patient in your EMR.

Really, that’s why a lab interface is so much better. The interface inserts the lab info right into your EMR so you don’t have to worry about:
1. Losing your lab results (before or after you sign it)
2. No need to scan your signed lab results into your EMR
3. You can run really cool reports on the data from those labs in your EMR (ie. blood sugar change over time)
4. Most EMR will notify you that there are lab results to read, so there’s no more waiting for the paper to somehow make it to you

In our EMR, a lab result gets easily signed off with the click of a check mark. Actually our labs our grouped into batches according to labs that were ordered at the same time. This makes it so all our lab results appear on one nice lab report as opposed to one lab report per lab. All doctors have to do is highlight all the labs and click “Mark as Read” and that whole batch of lab results are signed electronically in the EMR.

Of course, many of you will probably ask how we handle abnormal results. Well, I guess you’ll just have to wait to learn about that.

Some people have asked me how I rate the EMR I work with every day. I can’t bring myself to do it. It’s unfair to me and the people I work with. It’s not that I don’t have strong feelings about my EMR. I really do. I know the pros and cons, the ins the outs, and everything in between. However, it’s just hard rating my EMR and hopefully I can help you understand why.

My job is to implement this EMR the best way possible. That’s what I do. It doesn’t matter if it’s good bad or ugly. It’s counter productive for me to rate how good my EMR is. It is what it is. I haven’t been assigned the task of selecting an EMR. I’m not paid right now to see what other EMR vendors might be better than the one I have. I’m paid to do my very best at implementing the EMR that was chosen.

I don’t want to sound harsh here, but I think that many of the EMR failures are due to people worrying too much about what other EMR software can do and not enough about what their EMR software can do. The question shouldn’t ever be, can our EMR software do this? Instead you should ask, “how can we do this with the EMR software we’ve chosen?” This is two very different perspectives that reap very different results.

I’m not talking about someone who is in the process of selecting an EMR. I’m talking about someone who has already selected an EMR. It reminds me about one of my favorite quotes about marriage that says, “When you’re dating keep both eyes wide open, when you get married keep them closed.” You could just as easily say, “When selecting an EMR keep both eyes wide open, but once you’ve chosen an EMR keep both eyes closed and make the most of it.”

Of course, one thing I can’t help doing is answering people’s questions about EMR. I’ve had dozens of people call me about my EMR and I just love talking to them about the benefits, challenges and hassles of my EMR.

I just completed my very last class of my educational career (I’ll graduate with my Masters in IS on Saturday. Yeah Me!). My last class was a Business Intelligence class. While I wasn’t necessarily fond of this class or the teacher, I am definitely interested in business intelligence.

Business Intelligence to me is really just about being able to look at large amounts of data in really cool ways. EMR is basically synonymous with the concept of large amounts of data. Each and every day thousands of really interesting pieces of information are being entered into an EMR. Many times this data is organized in such a way that in can be easily accessed and reported on.

For my class, we’ve been using SQL Server 2005’s business intelligence components. While Microsoft may have its downfalls, they really have put some thought and effort into SQL Server 2005’s BI components. For my final project, I decided to extract some appointment data from my EMR (yes, I guess it’s really my PMS, except for things like the room for the appointment) and run some BI analysis on the EMR data.

I actually had to anonymize all the EMR data before using it, because I was working in a group where they weren’t allowed access to all the HIPAA related information. However, it wasn’t too big of a deal in the end. Although, it does lose some of the reporting ability when you do that.

Since we ended up only pulling out simple appointment data from the EMR database, we could only really run reports about appointments. Don’t get me wrong. There is some really cool stuff you can report on appointments. We reported on appointments by date (this includes day, month, quarter, year, etc), provider, gender, birthdate, ethnicity, etc. We also uploaded the room number that an appointment used so that we could measure the utilization of our exam rooms. Luckily our EMR stored all the information about exam rooms. We also pulled in the data that described when a patient arrived at the clinic, when the nurse started the intake and when the provider finally saw them. We haven’t actually built any reports on that time study data, but it would be really interesting.

That’s really just the beginning of what we were able to do with the EMR data, but I think you get the point. The real question at this point is what other EMR data could benefit from some quality BI analysis? Here’s a few of my thoughts:

-Blood pressure - Depending on how this is stored will determine how easy it is to report. However, it would be really interesting to see trends in blood pressure across our entire population. Add in a few filters for certain medications and you could see some amazing results
-Average Charge per Patient - Could be interesting to look at this and identify which patients are the most profitable. Wait, doctors aren’t about profit are they?
-Average Number of Visits per Patient - Would be interesting to see this grouped too.

Those are just a few off the top of my head. I’m sure there are a hundred more that could be done with diagnosis, prescriptions, charges, procedures, referrals, etc etc etc. Which reports would you find interesting from the data in your EMR?

The best part of this all is that in the next couple weeks I have planned to upgrade my EMR from SQL Server 2000 to SQL Server 2005. That means that I could really easily use all th SQL Server BI tools to create the various BI reports with all the data in my EMR.

Has anyone else done this type of EMR reporting before?

For those loyal readers of this blog, you’ll know that open source software and in particular open source EMR software has been a much discussed topic. I guess people love it when you talk about a free EMR. I must admit that I’m always intrigued by open source (free) software and open source EMR software is no different.

I recently came across a list of the top 100 Open Source Software Tools for Medical Professionals.

You know I’m a sucker for a list and I especially like EMR lists, so here’s their top 10 open source EMR software:
1. FreeMED
2. OpenEMR
3. OpenEMR Current
4. OpenEMR Virtual Appliance
5. FreeB
6. SmartCare
7. XChart
8. OpenMRS
9. Open Dental Software
10. ClearHealth

Quite an interesting list to choose from. Now if I could just get the data on number of installs for these applications. When I mean installs I mean doctors who actually use these open source EMR systems every day in their practice. Anyone want to let us know where we can find that data? Or any open source EMR packages want to fill us in on their progress?

I’ll update the post if I find anything or get that information in the comments.

Interesting. I wonder why none of these are CCHIT certified?

A little while back I got an email asking me if I was interested in writing an article for Medscape about “Choosing an EMR.” I figured that might be a fun experience considering I’d written so much about the topic of choosing an EMR on this blog that it would be pretty easy to do.

Luckily, all went well and they accepted the article that I wrote and published it to their site. I think the article turned out pretty good and offers some decent insight for someone interested in selecting an EMR. I think the selection process is probably the EMR industries biggest barrier to adoption right now. The technology is certainly there now, but there are just too many choices right now that it is really hard for a doctor to know which EMR is best for them. Unfortunately, many just choose to not make a decision and just continue on with paper charts. Hopefully this article will help a few doctors offices get on the right track and implement an EMR successfully.

In the end, it was a really fun experience going through the process of writing an article that’s going to be published. It’s much more difficult than writing about EMR on this blog. It took hours of work for me to write that article. I wanted to make sure that I provided significant value to the readers of the article and that I didn’t leave anything important out. By comparison, this post that I’m writing now won’t take more than 10 minutes. Blogging is better that way, because I know that my insightful readers will correct me if I post something that’s way off kilter.

At the end of the day, it’s really fun to see my writing published and my name alongside a contribution to the medical community. I also got a big kick the other day when I was helping one of my PA’s with something and I saw he subscribed to Medscape. Made me feel good that I was being published in what he considered to be a credible medical source.

One final thought, I’d love to hear people’s feedback on my article “Choosing an EMR.” Leave all your thoughts, good and bad, in the comments.

Just the other day I saw an old link to an EMR Jobs website. Of course, I’m always interested in seeing what type of EMR jobs are out there. I’m not currently looking for a new job, but I do finish my masters degree in May and so I may be looking for a new job in the EMR, EHR, Healthcare or possibly IT area soon. However, I was a little bit saddened by the list of jobs on that EMR job website. I even took a look at EMR jobs on Indeed.com to see what they had to offer. Looks like there is some decent potential there. A search on Monster for EMR jobs left me less enthusiastic.

Honestly, most of the jobs listed required specific knowledge of an EMR software. This really surprised me. Seriously, the EMR systems aren’t that different and an intense 2 days of training/playing on an EMR system and you’ll get a pretty good idea of that EMR. Certainly it makes sense to put that knowledge of the EMR is preferred, but often I think that someone without the cultural baggage of poor implementations or other biases might be better than someone with previous experience with the EMR. In fact, from a product perspective having a fresh set of eyes to give new feedback and suggestions could be incredibly valuable to a company.

In the end, I have a feeling that searching any of these job boards won’t be nearly as valuable as connecting to people you know. I guess that’s why I think this EMR and HIPAA blog could be very valuable for my career. Anyone else have advice for those looking to work in the EMR field?

Think about how wonderful the ability to send a discharge summary by email to a patient straight from your EMR. I think it’s pretty easy to see the tremendous benefits of this type of communication. Send the patient information to one place they probably visit every day and where they can read and process the information away from the hustle and bustle of the clinic. Certainly many doctors have been doing this with little pamphlets or handout sheets with clinical information. Unfortunately, too many of these sheets never get read. Certainly that same thing could happen with an email, but at least the next generation of patients are going to want this information in their email box.

Of course, the problem with sending this information in an email is that email is not secure. Email encryption hasn’t taken hold fast enough to make it encrypted. Is a user’s email box really a secure location where they want their health information? I personally don’t have a problem with it, but I would expect that many people wouldn’t want their health information in their email any more than their regular mailbox. Either way, without the encryption it wouldn’t be difficult for someone to sniff out what’s being sent in an Email containing for example a patient’s discharge. It would be going across the internet in basically plain text.

This situation actually happened in Austrailia a little while back in an article I read called “Unsecured email sparks dispute.” I know I wouldn’t be happy if a clinic just decided to send these unsecured emails. Not so much because I was personally worried about my information being lost. I personally have nothing to hide (yet anyway). However, I would feel uncomfortable patronizing an organization that would deal so flippantly with my information.

I’m sure that someone will chime in that this is the whole purpose of a Patient Portal or EHR interface that allows people a secure method to receive and send protected health information. This is all well and good, but from what I’ve seen this usually requires the doctor’s EMR company to support this type of interaction. Plus, even more serious of an issue is that you’re giving your patients one more login and password that they’ll need to remember. Certainly not a deal breaker, but one more inconvenience for our users and the staff that have to support our users when they forget their password. Unfortunately, I think that this is the future of secured messaging, but I can always hope that there’s something better that we’re just missing.

We should also realize that this isn’t going to get any easier. In fact, I think we can reasonably say that this is going to get harder and harder. Don’t be surprised if soon some patient would like their health information somehow incorporated into some site like Facebook. It’s really only a matter of time until some developer creates a health interface into Facebook.

It might not make sense to most people, but the next generation of patients are going to grow up living and breathing their online life in some sort of social network (Facebook is just one example of these). They are very comfortable with transparency and will be interested in being able to track and compare health information with other people. Not to mention interact in a social network with other people who have similar conditions. It seems like this isn’t a question of if, but when this type of interaction will happen.

Even if you think that health information on a social network like Facebook is far fetched, we are already seeing health information propagating to the web in Microsoft’s HealthVault and Google Health. Is this going to be ok? Will it become as synonymous as online banking has become to the banking world? It’s not that far of a stretch to think that Google Health could easily be tied into Google’s OpenSocial platform which would allow a patient’s health information to do all sorts of cool things.

The convergence of Health Care and IT is going to be really interesting. It’s taken health care a while to get going with IT, but I think almost everyone agrees that IT could do amazing things to better the health care a person receives.

I think I’ve written enough speculative posts about Google Health. I decided to turn to something EMR or EHR related.

I’m interested to know how people have sifted through the vast array of EMR and EHR software offerings out there. I personally think we’ve almost reached the peak number of EMR software companies and that soon we’ll start seeing consolidation and less people trying to enter the EMR market. Regardless of that speculation, I’d love to hear the process people used to select their EMR software.

Even more important than the process you used, I’d find it very interesting to know what was the key factor people used to finally select their EMR. Also, what would you have done different if you had the chance to go through the process again?

I have a few of my own thoughts, but I thought I’d put it out their for readers before I clouded your ideas with mine.

Today I was preparing a proposal to have my work send me to the HIMSS 08 conference. As part of that proposal I used the list of Keynote Speakers as a little justification as to why this conference would be incredibly interesting and useful for my job.

As I looked over the list I was impressed to see that Eric Schmidt is doing a keynote at HIMSS. Then it dawned on me that HIMSS would be the perfect place to announce Google’s launch into the healthcare industry with Google Health. We know it’s coming or why else would they have put up a Google Health beta page and then taken it down.

Anyone have any inside information that this is the case? If it is, then I’m even more interested in being there to hear the announcement.

If I’m able to make it, then I’ll have plenty to do. I’ll have some great meet ups with many people from the EMR Update forums. I’m sure there will be a meet up of Healthcare IT bloggers like there has been at past HIMSS conferences. I can’t find the link now, but I’m sure I’ll find it if I go. I’ll also be certain to catch up with Naveen and the team at DoctorsPartner. I also told Nick from EMR Update that I’d bring my eee with its built in video camera and make sure to capture some interviews with some people. That would be pretty fun.

Anyone else planning to go to the HIMSS conference?

UPDATE: Neil Versel blogged the following info about Eric Schmidt at HIMSS

As for Google, CEO Eric Schmidt is delivering a keynote at next week’s HIMSS conference, and actually is holding a 30-minute press conference afterwards. The Internet search giant also is throwing a cocktail party next Tuesday, with the theme, “Home is Where the Heart Is.” The invite says, “Come meet the health team at Google and learn more about what we’re working on.” About all I expect to learn from the secretive company is who actually works for Google (I know a couple of people already) and whether the bartender can mix a dry vodka martini.

Well, after Google (probably inadvertently) put up the Google Health beta page, it is now down. They put up the standard Google login page that includes links to their other services. I wonder if someone on the Google Health team got their hand slapped for letting that slip out. Or maybe it was an intentional way for Google to get a little feedback on Google Health and how people will react. Either way, the screenshots and content are spread across the web now. Now turning back at this point. Full steam ahead, let’s see what Google can offer in the health care arena.