Welcome to EMR and HIPAA

Choosing a microphone is one of the most important decisions you can make when implementing a speech recognition software like Dragon Naturally Speaking Medical 10. Thanks to Eric over at Speech Recognition I’ve gotten some interesting information about a microphone called the PowerMic II. Looks like it’s a microphone on steroids. Definitely one other microphone to consider when selecting a microphone to use with voice recognition software. Here’s an overview of the PowerMic II utilized with Dragon Medical 10 thanks to 1450, Inc. with commentary by Jay Goodfellow.

OVERVIEW:
The PowerMic II is a speech recognition microphone designed to be used with Dragon Medical 10.

However, the PowerMic II is much more than a hand held microphone. It is a powerful tool that enhances a physician’s control of dictation and navigation through documents, templates, electronic medical records and other applications. It has been designed specifically to be utilized with Dragon Medical 10, and the extraordinarily tight integration shows that to be true.

Not only does the PowerMic II have full mouse functionality, but there are 10 function keys that are programmable to provide practically any operation that a physician might want to do on his/her computer.

Yes, you can already use Dragon Medial 10 to do almost anything you want to on your computer by voice. However, using the PowerMic II and Dragon Medical, you substantially enhance your ability to do essentially anything you’d like on your computer, using the more convenient method at that moment: voice or function button.

The PowerMic II is designed to be fully functional with Dragon Medical 10 only. Dragon Preferred 10, Professional 10, and Legal 10 are not capable of using all of the programmable PowerMic II features.

Today I came across an organization called the Electronic Health Record Association (EHRA). It looks like it’s kind of a consortium of EHR vendors that are also members of HIMSS. I’ve just begun reading some of the work and goals they have. A very interesting organization. I have much to say about what I’ve read, but one of their main initiatives seems to be the EHRVA Interoperability Roadmap. I took a quick look at version 2 of the document to try and gain an idea of how they were trying to accomplish the lofty and difficult goal of interoperable EHR/EMR software.

Briefly looking at the document one section in particular caught my eye that was called “Prerequisites for Achieving Interoperability.” I was excited to read what they thought was important for interoperable EMR software and the following is what I found:

The path to interoperability is fraught with challenges. Some of them are technical – determining what standards should be used to achieve interoperability and implementing those standards within HIT systems. Some are cultural – encouraging both vendors and providers to share information. And some are financial – identifying sources of funding needed to acquire the technology and to establish and sustain health information exchanges.

Nonetheless, we believe that interoperability is achievable, under certain conditions outlined in this Roadmap.

I was really disappointed in their list of prerequisites. Not one mention of the legal issues related to interoperability? That seems like one of the largest problems with interoperable medical records. It kind of falls under cultural, but it still should have at least been mentioned under cultural if that was their intention. An interoperable EMR is no use if legally you can’t exchange those records easily.

At least they did talk about the need to find a motivation mechanism for vendors and providers to share information. The honest truth is that interoperable EMR software doesn’t sell more software. Not to mention, there’s very little financial benefit for a doctor to spend time sharing information either.

The key is that interoperability is important and finding ways to meet/overcome these prerequisites is important and worthy of significant attention.

One night this week I decided to take a look at some of the various research, conferences, etc that were being done by HIMSS. While visiting their site I came across an HIMSS virtual conference. You can imagine my intrigue since I’ve wanted to attend the HIMSS annual conference for a while and just haven’t been able to manage the scheduling or expense for the conference. That’s the great part of the HIMSS virtual conference: it’s free and I can watch it from the comfort of my office.

Don’t get me wrong, there are definitely some drawbacks to an online conference. There is something nice about seeing someone face to face and experiencing a live demo of a product. Not to mention the free conference giveaways and free dinners with vendors. However, there are also some great advantages to a completely virtual conference also. Take for example, the networking with colleagues. I think almost all of us are familiar with the feeling that we should be networking with those around us. Yet, there’s kind of this uncomfortable feeling of how to start a conversation with those around you. One nice thing about the internet is that it helps to take down those barriers and allows people to feel more comfortable interacting. It’s worked really well for guys meeting girls online and so I don’t see why a virtual conference couldn’t offer the same benefits to its attendees.

I applaud HIMSS for this move into the virtual conference world. I’m excited to see how it plays out this Wednesday, November 19th and Thursday, November 20th. There are a number of HIT sessions that look interesting along with some EHR, e-prescribing and even an opening keynote about healthcare and politics. You can see the full list of sessions here. I’d like to see a broader range of sessions and a larger “vendor floor” (albeit virtual), but for a first offering I think that HIMSS has done a great job.

I have a meeting here and there throughout the virtual conference that I have to attend, but I’m sure I’ll be active in the conference chat rooms when I am attending. Also, I’ll be posting updates to my Twitter account if you want to follow me there. You can also follow HIMSS on twitter now too.

Here’s a link to register for the HIMSS virtual conference. If you’re planning on attending also, let me know. I’d love to see what other bloggers plan on attending.

I’m sad that I didn’t see this list until now. Mike Gleason provides an interesting list of reasons why small practices aren’t implementing an EHR as fast as we’d like them to implement. Here’s his list of 10 reasons:

Fear
Ego
Money
War Stories
No one wants to go first
Product not perfected yet
Waiting on Govt mandates
Waiting on hospital install or Stark gift
I have people for that
Change

A really great list. Mike also discusses each of these points. As time permits I’d love to take some of his points and write some comments on each.

More important for this post, I wondered what other reasons might be missing from this list. Here’s a few others that I came up with:

I’m retiring soon
I don’t like computers (similar to “Computers Scare Me”)
Procastination/Lazy
Commitment problems (can’t decide on which EHR system)

Those last couple sound a lot like why many people don’t get married. Pretty interesting since I’ve compared implementing an EMR to marriage multiple times. Any other reasons for not implementing an EMR that we’ve missed?

Today, I decided to start a new web page that I believe will really grow over time. It’s basically a list of the possible benefits a doctor or clinic can receive from using an EMR or EHR rather than paper charts.

I haven’t take much time to make the list at all, but I think it’s better to start it and then as ideas come to my head I can add to it as time permits. I already have a number of other ideas (like quality of medical care), but I need some more free time to put all the details down. Now that I’m thinking about it a little bit more, maybe each benefit of an EMR should have it’s very own blog post describing the benefit that’s received by using EMR. We’ll see how that works. Seems like a worthwhile series of posts to me.

Also, in all fairness I’m certain that I’ll also soon be creating a list of problems associated with EMR. I think it’s important to keep the discussion well rounded and that people are well aware of both the benefits and challenges associated with using an EMR.

Finally, I certainly welcome comments from people on benefits or challenges associated with use of an EMR. I look forward to hearing ideas from other people’s experience to help me round out the list of benefits and challenges that many have already experienced first hand. Might as well try to pass on that knowledge to those who are still implementing or looking to implement.

I posted the 2008 CCHIT List of Ambulatory EHRs and asked if any EMR Companies were interested in commenting on the CCHIT process. Joe Rubinsztain of gMed was willing to do a guest post on gMed’s experience getting the 2007 CCHIT Certification and the motivation for an EMR to become CCHIT certified. Joe provides some interesting insight into an EMR company’s perspective on CCHIT.

CCHIT certification is the government’s way to ensure a common EMR denominator. In principle, this is a good idea to help confused physicians choose interoperable products with common features. In practice, however, CCHIT testing is young and requires fine-tuning to ensure that all requirements are practical and relevant.

About gMed
gMed was founded in 1997 to create a better alternative to the paper medical chart. Weston, Fla.-based gMed’s Digital Charting system integrates medical information, cuts costs, increases revenues, improves quality and reduces risks for selected medical specialties, including gastroenterology, cardiology and urology. More information is available at http://www.gmed.com.

Thanks Joe for the guest post. I always welcome guest posts from EMR and EHR CEO’s. Nice to get an EMR company executive’s perspective on an interesting topic.

Since I’m so interested in the EMR and EHR space, I’m always interested when the new list of companies is published of who has passed the CCHIT Ambulatory EHR certification. Not because I think the certification really means much. I’m more interested to see which EMR companies are spending the money to become and maintain certification.

Take a look at the list:
Community Computer Service Inc.
MEDENT 18

eClinicalWorks
eClinicalWorks 8.0

Epic Systems Corporation
EpicCare Ambulatory EMR Spring 2008

Greenway Medical Technologies, Inc.
PrimeSuite 2008

McKesson Provider Technologies
Practice Partner 9.3

MedLink International, Inc
MedLink TotalOffice 3.1

MedPlexus, Inc.
MedPlexus EHR 9.2.0.0

NextGen Healthcare Information Systems, Inc.
NextGen EMR 5.5.27

Pulse Systems
Pulse Patient Relationship Management 4.1

VIP Medicine LLC
SmartClinic 16

Interesting that only 10 companies are on the list considering the over 400 EMR companies I have listed. Plus, I’m sure my list is not complete by any means. That’s another project I’m working on that I hope to announce in the not so distant future.

Doesn’t certifying only 2.5% of the EMR companies out there pretty much make that certification useless. I hope people aren’t being wowed by the certification. I’m also not saying that all of the EHR companies on the list are bad “jabba the hut” EHR companies either. My point is to remind people that CCHIT certification doesn’t test usability of a system. So, EHR buyer be ware!!

I also love how most of the EHR companies listed have a child health component. I wonder if most of those on the list just did the certification this year so they could get the child health EHR certification. Hard to rely deny the marketing value of saying CCHIT compliant.

I’d love to hear from any of these EHR vendors that are CCHIT 2008 Ambulatory EHR certified. I’d be happy to dedicate a guest post from those interested in listing their reasons for paying all that money for this EHR certification.

Well, I’d been meaning to link to my friend Ducknet or as she calls her blog, The Medical Quack, for a while, but never got around to it. I figured it was about time since she’s been posting like crazy on that blog and deserved a little love.

I must admit that she posts a ton of medical related content. In fact, probably too much for me. I’m a little bit of a healthcare snob and have my preference for EMR and/or IT in healthcare. Ducknet has an incredible tech background with experience working at Intel and TabletKiosk. I’ve often turned to her on Skype to ask her details about the latest processors or the best tablet pc for my doctors to use with our EMR. She’s always been spot on.

Plus, she finds nice little nuggets of EMR industry knowledge that I hadn’t seen until now: Misys Purchases Allscripts. That’s a really interesting industry consolidation of what I would consider a very weak brand with a very strong brand. Kind of reminds me of when HP and Compaq came together (can’t remember who bought who in that one). The interesting question is which EMR software system will emerge from the Misys purchase of Allscripts.

Hopefully the Allscripts marketing team is kept in tact. I liked their use of social media to promote EMR.

My main hobby is playing with social media, website marketing and things people like to call viral marketing. So, you can imagine my interest in this EMR video from Allscripts describing the benefits of EMR ina really unique way.

I love what Allscripts is doing. They even have a channel on YouTube called AllscriptsTV. I’m not sure this is the right way to market an EMR, but I’m impressed with what they’re trying to do. Things like this will hopefully start to break down barriers to EMR adoption.

I will admit that a couple things disappointed me about the video. It was much too long. The same message could have been told in about 2-3 minutes instead of 5 minutes. Even the most entertaining videos are best at 2-3 minutes. With a subject as raw and uninteresting as EMR, 2-3 is plenty long.

I was also quite disappointed with the link at the end. The image seems to state that there will be a discussion of EMR at the website listed. However, instead of a discussion of the various EMR issues, it was just basically an advertisement for Allscripts with a few simple comments. Maybe I should have assumed that it was commercially driven, but I had hoped for more of a conversation if you’re going to claim it’s a conversation.

All in all, the video makes some amazing points for those looking at EMR. If I had the time I’d go through the video and list the points they make. They were just that salient.

In the past I’ve covered a number of different free emr software programs. However, honestly I don’t think I’ve touched the surface of the various free and open source EMR software that are out there on the market.

Today I came across a really interesting article talking about the first release of a free open source emr coming out of the Philippines called FFEHR.

“This is groundbreaking for several reasons: it is free, portable, and open source that even doctors can contribute to its development,” Dr. Alvin Marcelo, manager of the International Open Source Network (IOSN) Asean+3 node based in Manila, in an interview.

I wonder how many other similar EMR and EHR projects are going on in countries around the world? I’d love to hear about them if you are working on one. Also, there’s a small chance that I may begin a job working with mostly people from the Asia Pacific area and so I’ll be very interested in seeing how these open source EMR and EHR projects will affect the developing and developed nations in that area.