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Big Brother Or Best Friend?

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The premise of clinical decision support (CDS) is simple and powerful: humans can’t remember everything, so enter data into a computer and let the computer render judgement. So long as the data is accurate and the rules in the computer are valid, the computer will be correct the vast majority of the time.

CDS is commonly implemented in computerized provider order entry (CPOE) systems across most order types – labs, drugs, radiology, and more. A simple example: most pediatric drugs require weight-based dosing. When physicians order drugs for pediatric patients using CPOE, the computer should validate the dose of the drug against the patient’s weight to ensure the dose is in the acceptable range. Given that the computer has all of the information necessary to calculate acceptable dose ranges, and the fact that it’s easy to accidently enter the wrong dose into the computer, CDS at the point of ordering delivers clear benefits.

The general notion of CDS – checking to make sure things are being done correctly – is the same fundamental principle behind checklists. In The Checklist Manifesto, Dr. Atul Gawande successfully argues that the challenge in medicine today is not in ignorance, but in execution. Checklists (whether paper or digital) and CDS are realizations of that reality.

CDS in CPOE works because physicians need to enter orders to do their job. But checklists aren’t as fundamentally necessary for any given procedure or action. The checklist can be skipped, and the provider can perform the procedure at hand. Thus, the fundamental problem with checklists are that they insert a layer of friction into workflows: running through the checklist. If checklists could be implemented seamlessly without introducing any additional workflow friction, they would be more widely adopted and adhered to. The basic problem is that people don’t want to go back to the same repetitive formula for tasks they feel comfortable performing. Given the tradeoff between patient safety and efficiency, checklists have only been seriously discussed in high acuity, high risk settings such as surgery and ICUs. It’s simply not practical to implement checklists for low risk procedures. But even in high acuity environments, many organizations continue to struggle implementing checklists.

So…. what if we could make checklists seamless? How could that even be done?

Looking at CPOE CDS as a foundation, there are two fundamental challenges: collecting data, and checking against rules.

Computers can already access EMRs to retrieve all sorts of information about the patient. But computers don’t yet have any ability to collect data about what providers are and aren’t physically doing at the point of are. Without knowing what’s physically happening, computers can’t present alerts based on skipped or incorrect steps of the checklist. The solution would likely be based on a Kinect-like system that can detect movements and actions. Once the computer knows what’s going on, it can cross reference what’s happening against what’s supposed to happen given the context of care delivery and issue alerts accordingly.

What’s described above is an extremely ambitious technical undertaking. It will take many years to get there. There are already a number of companies trying to addressing this in primitive forms: SwipeSense detects if providers clean their hands before seeing patients, and the CHARM system uses Kinect to detect hand movements and ensure surgeries are performed correctly.

These early examples are a harbinger of what’s to come. If preventable mistakes are the biggest killer within hospitals, hospitals need to implement systems to identify and prevent errors before they happen.

Let’s assume that the tech evolves for an omniscient benevolent computer that detects errors and issues warnings. Although this is clearly desirable for patients, what does this mean for providers? Will they become slaves to the computer? Providers already face challenges with CPOE alert fatigue. Just imagine do-anything alert fatigue.

There is an art to telling people that they’re wrong. In order to successfully prevent errors, computers will need to learn that art. Additionally, there must be a cultural shift to support the fact that when the computer speaks up, providers should listen. Many hospitals still struggle today with implementing checklists because of cultural issues. There will need to be a similar cultural shift to enable passive omniscient computers to identify errors and warn providers.

I’m not aware of any omniscient computers that watch people all day and warn them that they’re about to make a mistake. There could be such software for workers in nuclear power plants or other critical jobs in which the cost of being wrong is devastating. If you know of any such software, please leave a comment.

April 9, 2014 I Written By

Kyle is Founder and CEO of Pristine, a company in Austin, TX that develops telehealth communication tools optimized for Google Glass in healthcare environments. Prior to founding Pristine, Kyle spent years developing, selling, and implementing electronic medical records (EMRs) into hospitals. He also writes for EMR and HIPAA, TechZulu, and Svbtle about the intersections of healthcare, technology, and business. All of his writing is reproduced at kylesamani.com

Effortless EHR Interaction

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I recently came across the really interesting device called MYO. I really can’t do the device justice, so I’ll just share this video which will do a much better job showing the gesture controls that are possible with the MYO.

I love how it senses even changes in the muscle. I love when description that says that the response sometimes feels like it responds before you even move since it senses your muscle before the movement is even done. Pretty amazing.

There are has to be so many possible uses for a next generation gesture device like MYO in healthcare. I’ve been thinking a lot about effortless EHR interaction and where it could go. I wonder if MYO and other gesture control systems can dramatically improve a physician’s interaction with an EHR.

Plus, the most exciting thing of all is that I think we’re still in the very early days of what’s going to be possible with gesture control and human computer interaction in general. Pair this with always on ubiquitous computing like is being shown with Google Glass and we’re just at the very beginning of the computing revolution.

I guess we’ll see if healthcare decides to lag behind these new technologies or whether we’ll ride the wave of transformation.

April 9, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Retina Scanning vs. Iris Recognition in Healthcare – Best Technology Seen at AHIMA

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While at AHIMA, I was lucky enough to meet John Trader from RightPatient (A part of M2SYS Healthcare Solutions). During our meeting he showed me the coolest technology I’ve seen in quite a while. Ever since I first started this blog, I had a serious interest in seeing how biometric solutions could benefit an EHR implementation. I’ve tried fingerprint, facial (and this review), voice, typing, etc and been amazed by the technology. Facial recognition was probably my favorite despite its weaknesses.

The funny thing is that I always shot down anyone that suggested the use of some sort of eye related biometric identification. Thinking to my only reference for retina scanning biometrics (movies like Mission Impossible), I didn’t see how that was going to integrate well with healthcare.

Turns out that I was wrong, and my big mistake was that I was looking at the technology from a doctor, nurse, front desk staff identification perspective as opposed to a patient identification perspective. Plus, I didn’t get the difference between retina scanning and iris recognition.

With this background, you can imagine my surprise when I fell in love with the RightPatient iris recognition technology that John Trader demoed to me at AHIMA. I shot this short video embedded below where John discusses the differences between retina scanning (the laser scan you see in the movies) and iris recognition. Then, John demos their iris recognition technology.


Much more could be said about how the iris technology works, but I think it’s best deployed at a hospital front desk during registration. Imagine the number of duplicates that could be avoided with good biometric iris recognition. Imagine the insurance abuse that could be avoided with iris recognition.

In the video I only showed one of the model’s that RightPatient deploys. They have another model that automatically swivels until it locates your iris. It’s hard to explain on the blog, but when you try it first hand it’s like magic.

November 1, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Wireless Health Data Collection Innovations Getting Hot

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This week, psfk.com and pharma partner Boehringer Mannheim published a list of the week’s top innovations in healthcare. All were interesting, but I was particularly intrigued by a couple which continue to stretch the boundaries of wireless medicine.

One innovation example comes from a German research team, which has developed a tiny chip (a two-millimeter device much shorter than an eyelash) which can sample blood sugar levels by testing tears or sweat. The chip is equipped to transmit the results wirelessly to providers, as well as sending patients alerts to their wireless phone.  Even cooler, the chip can be powered wirelessly through radio frequency, keeping it charged for weeks or even months.

Another entirely cool innovation comes from U.S. high school student Catherine Wong, who has invented an ECG made of off the shelf electronic components which can broadcast results wirelessly.  The device, which could make ECGs available to to the two billion-plus people without access to healthcare, picks up heart signals, then transmits them via cellphone to a healthcare provider.  The cellphone connects to the ECG using Bluetooth, and heart rhythms display on  a smartphone screen thanks to a Java app.

As readers know, the idea of broadcasting test results to remote providers via wireless devices is not a new one. The idea is so hot, in fact, that the FCC is holding a public meeting on September 24 to discuss how to accelerate the adoption of such approaches. (The event will be live streamed at http://www.itif.org/events/recommendations-mhealth-task-force at 2PM Eastern Standard Time.)

After watching projects like these germinate for a number of years, I’m thrilled to see more innovation arising in this sector of the mHealth space. Inventors, keep it coming!

September 25, 2012 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Will Growth In Mobile Use Compromise HIPAA Compliance?

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There’s little doubt that giving doctors mobile access to data via their personal devices can be valuable. We’ve probably all read case studies in which doctors saved a great deal of time and made the right clinical call because they reached to via an iPad, smartphone or Android tablet.

And this is as it should be. We’ve been working to push intelligence to the network for at least the two decades I’ve been writing about IT.

That being said, we haven’t yet gotten our arms around the security problems posed by mobile computing during that period, as hard as IT managers have tried.  Adding a HIPAA compliance requirement to the mix makes things even more difficult. As John wrote about previously, Email is Not HIPAA Secure and Text is Not HIPAA Secure either.

According to one security expert, healthcare providers need to do at least the following to meet HIPAA standards with mobile devices:

  • Protect their private data and ePHI on personal-liable (BYOD) mobile devices;
  • Encrypt all corporate email, data and documents in transit and at rest on all devices ;
  • Remotely configure and manage device policies;
  • Apply dynamic policy controls that restrict access to certain data or applications;
  • Enforce strict access controls and data rights on individual apps and services;
  • Continuously monitor device integrity to ensure PHI transmission;
  • Protect against malicious applications, malware and cyber threats;
  • Centrally manage policies and configurations across all devices;
  • Generate comprehensive compliance reporting across all mobile devices and infrastructure.

Just a wild guess here, but my hunch is that very few providers have gone to these lengths to protect the ePHI on clinicians’ devices.  In fact, my sense is that if Mr. Bad Guy stole a few iPads or laptops from doctors at random right now, they’d find a wide open field. True, the thief probably couldn’t log into the EMR(s) the physician uses, but any other clinical observations or notes — think Microsoft Office apps — would be in the clear in most cases.

Being a journalist, not a security PhD, I can’t tell you I know what must be done. But having talked to countless IT administrators, I can definitely see that this is a nasty, hairy problem, for many reasons including the following:

-  I doubt it’s going to be solved by a single vendor, though I bet you will be or are already getting pitches to that effect  – given the diversity of systems even a modestly-large medical practice runs.

- Two factor authentication that locks up the device for all but the right user sounds good, but add-ons like, say, biometrics isn’t cheap.

- Add too many login steps to doctors already tired of extra clicks and you may see mass defections away from EMR use.

- Remotely managing and patching security software on devices with multiple operating systems and network capabilities is no joke.

If you feel your institution has gotten a grip on this problem, please do chime in and tell me. Or feel free to be a mean ol’ pessimist like myself. Either way, I’d love to hear some of your experiences in protecting mobile data.  Maybe you have a good news story to tell.

May 31, 2012 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Catching up with Sensible Vision’s Facial Recognition Software

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If you’ve been reading EMR and HIPAA for a while, back in 2006 I came across a really cool company called Sensible Vision that does facial recognition software. You can read about my first experience setting up the facial recognition software and my love affair with facial recognition as the best biometric solution.

I admit that I still have a love affair with my facial recognition software. I use it every day when I sit down at my computer. I can’t imagine not having it. In fact, it’s almost time to replace my computer and I’ll be very sad if I can’t find a way to transfer the software to my new computer. It has its quirks, but I just love the added security that it gives me. I’m far too lazy to lock my computer screen myself and then log back in, but the facial recognition software does that for me. Not to mention the single sign on capabilities.

I was on a support call yesterday with my EMR vendor and when I opened the application my facial recognition single sign on kicked in and took care of the username and password typing for me. The EMR vendor told me that he was amazed at how fast I typed. I do type fast, but not that fast.

I should mention that we haven’t been able to implement this in our clinical environment. A mix of process issues and budget issues has prevented us from doing so. However, I think there are a number of places where facial recognition software could be great for security of your desktops.

I decided to go check on what’s happening with Sensible Vision since I hadn’t spoken to them in a while. Looks like they have a million devices installed and a deal with Dell to offer facial recognition with their computers. Very cool stuff. However, what I found most interesting was Sensible Vision’s reply to the Black Hat presentation about hacking facial recognition. It’s an interesting read for those looking at biometric authentication in health care. Now I just need to find the black hat presentation they’re talking about.

April 17, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Digital Voice Recorders Replacing Transcriptionists

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We’ve discussed before the voice recognition software Dragon NaturallySpeaking (Medical and Preferred) and the microphone options and even announced when Dragon NaturallySpeaking Medical first came available. It’s enough to say that we’re big fans of voice recognition software and Dragon NaturallySpeaking in particular. It’s a great companion to an EMR or EHR implementation.

Today, I came across the Sony Digital Voice Recorder with Dragon NaturallySpeaking Software and I wondered if any of my readers have used this before. It seems like it could be an interesting way to replace a transcriptionist.

Basically, the doctor would record his notes on this device and then the Dragon NaturallySpeaking software would convert it to text and could be easily placed in the EMR. For $150, that seems like a bargain.

Really, the only question is how good Dragon NaturallySpeaking is at converting the recorded voice into text. I imagine it’s at least as good as doing it in real time. Does anyone have experience with it? If I hear some good reviews, then I’ll add it to my list of EMR technologies. This seems like it could be a really good solution for that doctor that doesn’t want to give up his/her transcribing ways.

March 11, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Dragon Naturally Speaking Preferred Versus Medical

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I’ve always been a little bit skeptical about paying the $1000+ for the medical version of Dragon Naturally Speaking. $1000 just seems like a lot of money to be paying for what seems to amount to some medical dictionaries. However, someone who is very familiar with nuance and Dragon Naturally Speaking told me that doctors should really purchase the DNS Medical or they’ll end up dissatisfied.

Well, today I was reading the forum on Amazon for Dragon Naturally Speaking which asks if the medical version is worth it for doctors. The responses generally weren’t worth while, but someone who calls themselves “Pain Doc” suggested the following:

I have used DNS for about 7 years. I started with version 6 as I recall. I had my transcriptionist email me the text files from all my dictations for several years and then I “fed” those to DNS to learn the vocabulary. I then had a very serviceable medical DNS for my practice and an unemployed transcriptionist.

What a genius idea for anyone that’s currently doing transcription. A great way to save about $1000 on software.

Check out the following prices for the various versions of DNS on Amazon:
UPDATE: Dragon NaturallySpeaking Premium 12 is out now.
Dragon NaturallySpeaking 10 Preferred – Currently $151.49 with $50 rebate ($101.49 after rebate)
Dragon NaturallySpeaking 9 Preferred – Currently $92.97
I’m still looking around for the best location to buy Dragon NaturallySpeaking Medical.

Interestingly, this same person quote above also said, “I also upgraded to DNS 10.0 which is a total POS. I am back to 9.0 and wouldn’t recommend 10.0 to anyone.” I’d love to hear more people’s comments on this subject.

February 13, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Wireless Microphones for Dragon Naturally Speaking

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In a recent comment by Tom Hamilton, he gave a nice review of a wireless microphone that can be used with Dragon Naturally Speaking Medical. I figured I’d been covering enough EMR politics and implementation lately that it was about time to mingle a little bit of technical content in the middle.

I’ve been told a number of times that if you want to use Dragon Naturally Speaking medical, then finding a high quality microphone is absolutely essential to a quality voice recognition experience. Check out Tom’s review of the Samson Stage 5 Wireless microphone. Wireless is definitely the future.

Samson Stage 5 Wireless Microphone With Dragon NaturallySpeaking Review:<iframe src=”http://rcm.amazon.com/e/cm?t=crashutah-20&o=1&p=8&l=as1&asins=B0002ORQ56&md=10FE9736YVPPT7A0FBG2&fc1=000000&IS2=1&lt1=_blank&m=amazon&lc1=0000FF&bc1=000000&bg1=FFFFFF&f=ifr” style=”width:120px;height:240px;” scrolling=”no” marginwidth=”0″ marginheight=”0″ frameborder=”0″></iframe> 

We’ve just completed Phase 3 testing of the new Samson Stage 5 wireless microphone [$99 on Amazon] and you can read our complete review by clicking Samson Stage 5 Review but the short version is that the new Samson Stage 5 wireless VHF microphone combo includes both a lapel microphone and a headset microphone, costs $99-$105 and is as accurate as our best (starting at $115) theBoom “O” [$149.99 on Amazon] and $145 Sennheiser ME3 wired microphones [$135.83 on Amazon] which cost more and are not wireless. The Stage 5 even includes a three-year warranty. With the exception of end users who require extreme portability, we can’t imagine why anyone would want to pay extra for a wired microphone with a one or two-year warranty. Now everyone can afford to cut the cord!

KnowBrainer, Inc. Support Staff – Tom Hamilton
A Nuance Gold Certified Endorsed Vendor
ALWAYS Ask If Your Speech Recognition Vendor Is Nuance Certified

Thanks Tom for the review.

Check out the following prices for the various versions of DNS on Amazon:


I’m still looking around for the best location to buy Dragon NaturallySpeaking Medical.

February 12, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Selecting a Microphone for Dragon Naturally Speaking Medical 10

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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.

Check out the following prices for the various versions of DNS on Amazon:


I’m still looking around for the best location to buy Dragon NaturallySpeaking Medical.

November 19, 2008 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.