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Lost Laptop with Patient Names, Treatment Summaries and Other PHI

Posted on June 21, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This story coming out of Oregon came across my feeds today which tells of the Oregon Health and Science University contacting 1,000 patients after a physician’s laptop was stolen from a car parked at the doctor’s home.

This story made me think of two things:
1. Why is PHI being stored on the laptop in the first place? I wish I could find out if there was an EMR involved. If there was, then the EMR should be storing all of the patient information on the server and none of that data should be stored on the laptop. So, if it gets stolen there’s no breach. That’s the beauty of an EMR these days. There should be no need for this to happen.

2. There’s some really cool technology that’s been coming out in recent laptops that will allow you to remotely wipe out the laptop if it ever gets connected to a network. Basically, once your laptop is stolen you report it stolen and they start tracking it down kind of like they do with stolen cars (same people from what I understand).

Once the stolen laptop is connected to the network, it will call back to the main center and receive the command to wipe out the laptop. Then, it will also give them information about where it was connected in order for police to possibly recover the stolen laptop as well. We’re implementing this on all our new laptops. I’ll be very happy once we have them all with this feature.

CCHIT Certification’s Ties with EMR and HIPAA (this website)

Posted on March 19, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve definitely said my fair share of things about CCHIT. Sometimes I wonder what CCHIT thinks about my comments. I’m really not trying to be mean, hurtful or ugly about it all. I just want to share my own feelings about the certification and educate people as much as possible about what the CCHIT certification can and can’t do. It’s not my fault if I just find a lot more wrong with it than I find right with it. At the end of the day, I try to follow the advice of a radio personality don’t try to please everyone. Just try to be right.

The good thing for me on this blog is that when I’m wrong, people correct me in the comments. I always reserve the right to change my mind and make updates as are appropriate to make me right again.

However, relatively recently someone made a comment that kind of insinuated that I might have something to gain or lose based on CCHIT’s success or failure.

Let me clear this up once and for all. CCHIT’s success or failure won’t affect me and my work at all. The only exception might be that if CCHIT sticks around, then I’ll have plenty of content to write about on this blog for as long as they exist (rim shot).

Seriously though, I really have no ties to CCHIT certification and specifically whether or not it becomes the certification criteria for the HITECH act or not. In my day job we actually use a CCHIT certified EMR that is highly focused on our niche, college health. In this job, we don’t accept Medicare or Medicaid and so honestly the stimulus means nothing to us. We’re not going to get any EHR stimulus money so why would we care which certification criteria is selected? We don’t.

Even more interesting to consider is the following. I mostly work with 2 EMR implementations right now. One is my day job and the other I do because the wife (and also office manager) of the Dr. is so sweet that I feel like if I don’t help them she’ll suffer. What can I say, I’m a bit of a softy when it comes to REALLY nice people suffering. Probably more than you wanted to know, but those are the 2 I rather actively work on.

The cool part for both of those implementation is that they are each fully implemented with an EMR and they are very happy using an EMR regardless of EHR stimulus money. In fact, both of them made the decision to implement an EMR years ago and are very happy with the decision. In the doctor’s case, any EHR stimulus money he can get will just be like a bonus. However, regardless of whether he gets money or not, he’s very happy to have an EMR.

Basically my point is that I have no financial interest in the success or failure of CCHIT and in particular whether CCHIT becomes the certification criteria or not. It basically won’t affect my life. So, when I make comments about CCHIT, it’s purely out of my interest to educate people on the subject. I guess deep down I also hope that some of the things I write and share will make a difference in someone’s life. I guess time will tell if this is the case or not.

EMR Install Base – According to Vendors

Posted on March 17, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was recently reading a post on EMRUpdate (great EMR Forum) by a man I highly respect who goes by CEOMike. In his long post, he made the following short analysis that I thought was really interesting:

I thought by now you would have figured out EMR vendors are LIARS, making some of the bankers look like choir boys. I have done other posts on the install base claims of vendors. Figure it out 4% (studies show) of approx 400,000 primary care docs is only about 16,000 EMRs in use. Divide that by the approximately 400 EMRs [see my list of over 400 EMR companies] that have been listed in the last three years = 40 users per EMR Or go at the other way – take all claims by EMR vendors and add them up (I did this exercise a few years back) and you get something like over a million doctors using EMRs???

The million EMR installs seems a little high, but the point is well made. How do we really get accurate data about install base? The answer is that you really can’t from most vendors.

When we first implemented our EMR, we were told that they had close to 100 college health centers. Little did they ask (I wasn’t there when they selected this particular EMR) how many of the 100 health centers actually used EMR versus just their practice management system. Let’s just say I was quite surprised by the reality.

That didn’t deter me. In fact, if anything it motivated me to make it happen. Still today I think our clinic is the most cutting edge in our category for use of EMR. I enjoy that feeling and I enjoy when other clinics want to come and take a look at what we’re doing. Yes, I am sure they want to see our EMR and not just have a trip to Las Vegas.

EMR and Healthcare IT Job Search

Posted on June 10, 2008 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

If you’ve been reading my blog for any amount of time, then you know that I currently work in College Health at my local University. I started this job about 3 years ago and it has been a great learning experience for me in learning about EMR and healthcare IT.

When I started the job 3 years ago, I took advantage of working at the University and started classes for my Masters in Information Systems. Happily I completed my Masters a few weeks ago. With the completion of my Masters degree, I’ve decided to start looking around for other job opportunities. I already have a few leads, but I thought I’d post my availability to my blog in case any of my readers have potential job openings.

To be completely honest, I’m really jack of all trades when it comes to technology. I’ve done everything from server and database administration to workstation rollouts. I enjoy optimizing processes and analyzing how to revamp a process using technology. I don’t want to be a programmer and will probably avoid doing any hard core system or database administration, but those things are fine as a small part of my job. I much prefer working in a strategic position where I can plan and organize in a way that the company is well positioned for the future.

If anyone has some potential job openings in the EMR or Healthcare IT field, then I’d love to hear about the opportunity and I’ll have my resume handy. You can either leave me a comment or send me an email at john [at] emrandhipaa {.} com

EMR Vendor Site Visit

Posted on May 22, 2008 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This entire week my EMR vendor had someone in our clinic going over our EMR implementation. Yes, that’s nearly 4 entire days of our health and counseling staff meeting with our EMR vendor. You can imagine after the first few meetings it’s pretty hard to keep things straight. However, this type of EMR vendor site visit is so beneficial.

The biggest benefit is that it almost forces doctors, nurses, front desk staff, lab, pharmacy, etc to sit down and think about our EMR, how it could be made better and which parts of the EMR are just causing them pains, problems, frustrations, or other discomfort. We tried to make sure that each EMR meeting went over: our current EMR challenges, features of the EMR that we aren’t using and finally discuss ideas for enhancements to the EMR software.

We’re lucky that we selected a smaller EMR vendor that’s completely focused on the college health EMR market. That means that we have a strong relationship with the EMR company. In our final meeting the EMR “trainer” said that they really are our “partner” in not just the EMR, but they’re willing to support us beyond just software. The nice thing is that our EMR vendor really does try to do this. They don’t always succeed at it, but they certainly are sincere in their effort.

Another major benefit of having someone from the EMR vendor do a site visit is that they are looking at your clinic with fresh eyes. They can see things about the way your process works that you may not see. Plus, they have usually been to hundreds of other EMR installs and so they are aware of how other clinics are using the EMR software.

Of course, you can’t expect someone from your EMR vendor to come and work miracles. In fact, many of the ideas they have just may not work for the way you practice medicine. It takes a solid filter to be able to see the benefits, problems, and workarounds that will work best for your standards of care, legal regulations, and clinical organization. The biggest problems that an EMR vendor faces is that it’s really hard to build a one size fits all EMR. Different practices act differently. However, there’s something really valuable about discussing the various options of an EMR.

I highly recommend this type of collaborative approach to working with your EMR vendor. I believe it’s paid amazing dividends for our clinic. In the end, your EMR company better be a good partner or you’ll pay the price later.

Attending the PCCHA Conference

Posted on November 14, 2007 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’m currently attending the PCCHA conference which is basically the college health association conference for the west coast. The conference has been quite interesting. A few of the sessions ended up being quite useful, but more than anything it was just fun for me to talk to all of the various people working in the college health community. Most of my conversations centered around EHR and EMR implementation, but it was also fun to see these other college health professionals jealous of the really state of the art facilities we have on our campus.

My presentation on EMR went quite well and I think that many of the people in the audience got some useful information. At least that’s my hope. It was fun to present on EMR and the things we’ve learned. The interesting thing for me was that as I talked to people about EMR and EHR and using it in college health, I realized that over the past two years I’ve really learned a lot about what it takes to implement an EHR into a clinic. It can certainly be a daunting task if you look at all the intricacies.

In the end, my message to most of the people that I talked to was that while implementing an EHR can be overwhelming, it’s important to take small bite size pieces of it and accomplish those. Then, move on to the next problem and the next. The reality is that 2.5 years after implementing our EMR system, we’re still adding, modifying and changing our processes to be more effective.

Presenting on EMR at PCCHA Conference

Posted on October 18, 2007 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The day is fast approaching for me to present at the Pacific Coast College Health Association conference in Hawaii. In fact, I have less than a month to finish my preparations. I feel pretty good about my ability to present and also my knowledge of EMR, but presenting something always gets my nerves going. I think once I get started talking about EMR, then I won’t be able to stop. My real hope is that the people that attend my session will be interested in what I have to say, find it useful and ask good questions. Honestly, a part of me really wishes that I was a member of a panel where I just answered questions about EMR. I think that would be a lot of fun.

Since it’s not a panel, then I’d love to hear any feedback from people on things I should include in my presentation about “Lessons Learned from EMR Implementation.” I have a ton of things already planned about EMR implementation, but I’m sure there are some important things that I’ve missed. Time has a way of doing that to you.

Either way, I’ll be happy if one person in my session on EMR goes away saying they were better prepared to implement an EMR system, then I’ll be happy.

Self Check In – Patients Electronic Paperwork

Posted on August 2, 2007 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It looks like my previous post about Digital Signatures in an EMR drew quite a bit of interest looking at the stats. Really this isn’t surprising. How long have we been signing things electronically at Walmart. Longer than I can remember honestly. Sure, Walmart is worth billions of dollars, but the technology isn’t that expensive. The real advantage that Walmart has is a great legal team.

Setting the legal items aside, the technology of a digital signature is not rocket science by any means. In fact, it’s the legal questions that are harder mostly because there just hasn’t been much case law that has dealt with it. Just as a thought, I would highly suggest that whoever reads about this talks with a good legal team before implementing it.

Of course, reading the comments from my previous post made me realize that what we’re doing is really quite innovative. I’m not just talking about digital signatures. For more than two years now we’ve been collecting patients health history form in our Health Center and intake questionnaire in our counseling center electronically. These forms don’t require the patient or client to leave a signature. It’s basically just capturing information. I think most people can see why it’s valuable to have a health history form captured electronically. In our case it makes all of the necessary clinical information available in one place without dealing with the time consuming and inaccurate scanning. Even more significant for us as a state institution was the ability to do aggregate reporting on the type of patients we were seeing. How many other people can find out things like 20% of your patients have a family history of heart disease (not our actual number)?

I know there are a number of EMR companies out there that have a whole patient portal where this kind of stuff is done, but I’ve never seen any that use a kiosk at the doctor’s office to collect this information. If you are an EMR vendor that has this feature, please leave a comment. I think we’d all love to know who else does it.

Looking at it now, capturing digital signatures for HIPAA privacy forms, consents, etc is just the next step in ridding ourselves of paper. In fact, this addition means that our patients can bypass the front desk completely. They check in on the computer, fill out their necessary forms and then are directed to have a seat. This notifies the nurse that they have arrived and they are ready to be seen. No face to face contact. Privacy at its best.

Well, I got a few questions and comments in my digital signature post that prompted this post. I’ll do my best to answer them here.

Chris Kozloski said, “I like the idea. A kiosk for registration that they could fill out the paperwork online and sign the blocks on the screen would be really neat.”

See my notes above. It’s not just an idea. We’ve been having them fill out the paperwork for two years now. We also have the technology to do the signatures. Just waiting for the other signature pads to arrive and we’ll be implementing it.

One thing I’m not sure most people think about is how the computer will know which forms need to be filled out by the patient. I think that’ll have to be the topic for my next post.

Craig Briars asked, “What software are you using to do this with?”

This is a good question. We are using Medicat EMR. It’s an EMR that is focused on the College Health community, but could be used in a general practice if needed. I’m not sure how it is in a general practice, but I know that they have a ton of features that make it a solid choice for College Health offices interested in EMR.

Medicat has integrated it’s software with topaz signature pads. Medicat uses the Topaz software to capture the signature. It’s actually quite neat how the signature is captured and stored in the database. We did find that the LCD signature pads with the back light were the best. The cheap $100 topaz signature pads just wouldn’t capture my signature if I did it quickly. Plus, if it isn’t LCD, then I don’t know which part of the signature it missed so that I can correct it.

Digital Signatures in EMR

Posted on July 27, 2007 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

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?

Electronic Medical Record Site Visits

Posted on February 6, 2007 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The past couple weeks I’ve gotten a few emails and phone calls from my EMR vendor about having a few other college health clinics(doctor’s offices) come and take a look at our EMR implementation. I always go into these with a little bit of a mixed bag since I know that my EMR vendor would like me to speak positively to the client. In fact, in many ways it is in my best interest to help make my EMR vendor successful. The more offices my EMR vendor signs up, the more money they’ll have to stay around and continue to develop the product. However, I always wonder if the trade is really a fair one.

In the end, I love to have other people come and take a look at my EMR implementation. My wife just gave birth to our second child. You know I’m that proud daddy carrying around his little princess to show her off to all those around me. My EMR implementation isn’t that much different. It’s my little baby that I want to show off to other people.

Another part of the satisfaction of a site visit is that my EMR vendor is saying that our implementation of EMR is one of their premier implementations(yes, I know that is a run on sentence, but I’m too tired to fix it now). An EMR company wouldn’t send clients to a failed or shoddy implementation. I take real pride in that recognition.

However, the best part of site visits is the time to be able to connect and collaborate with other colleagues from around the country. It’s always fun to get a different perspective on what should be very similar processes. Plus, I just love interacting with people. We have two coming up in the next month. I’ll let you know how they go. If they don’t buy me lunch then you can guarantee they weren’t as good.