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HL7 Backs Effort To Boost Patient Data Exchange

Posted on December 8, 2014 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.

Standards group Health Level Seven has kicked off a new project intended to increase the adoption of tech standards designed to improve electronic patient data exchange. The initiative, the Argonaut Project, includes just five EMR vendors and four provider organizations, but it seems to have some interesting and substantial goals.

Participating vendors include Athenahealth, Cerner, Epic, McKesson and MEDITECH, while providers include Beth Israel Deaconess Medical Center, Intermoutain  Healthcare, Mayo Clinic and Partners HealthCare. In an interesting twist, the group also includes SMART, Boston Children’s Hospital Informatics Program’s federally-funded mobile app development project. (How often does mobile get a seat at the table when interoperability is being discussed?) And consulting firm the Advisory Board Company is also involved.

Unlike the activity around the much-bruited CommonWell Alliance, which still feels like vaporware to industry watchers like myself, this project seems to have a solid technical footing. On the recommendation of a group of science advisors known as JASON, the group is working at creating a public API to advance EMR interoperability.

The springboard for its efforts is HL7’s Fast Healthcare Interoperability Resources. HL7’s FHir is a RESTful API, an approach which, the standards group notes, makes it easier to share data not only across traditional networks and EMR-sharing modular components, but also to mobile devices, web-based applications and cloud communications.

According to JASON’s David McCallie, Cerner’s president of medical informatics, the group has an intriguing goal. Members’ intent is to develop a health IT operating system such as those used by Apple and Android mobile devices. Once that was created, providers could then use both built-in apps resident in the OS and others created by independent developers. While the devices a “health IT OS” would have to embrace would be far more diverse than those run by Android or iOS, the concept is still a fascinating one.

It’s also neat to hear that the collective has committed itself to a fairly aggressive timeline, promising to accelerate current FHIT development to provide hands-on FHIR profiles and implementation guides to the healthcare world by spring of next year.

Lest I seem too critical of CommonWell, which has been soldiering along for quite some time now, it’s onlyt fair to note that its goals are, if anything, even more ambitious than the Argonauts’. CommonWell hopes to accomplish nothing less than managing a single identity for every person/patient, locating the person’s records in the network and managing consent. And CommonWell member Cerner recently announced that it would provide CommonWell services to its clients for free until Jan. 1, 2018.

But as things stand, I’d wager that the Argonauts (I love that name!) will get more done, more quickly. I’m truly eager to see what emerges from their efforts.

Where is Voice Recognition in EHR Headed?

Posted on August 22, 2014 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 long been interested in voice recognition together with EHR software. In many ways it just makes sense to use voice recognition in healthcare. There was so much dictation in healthcare, that you’d think that the move to voice recognition would be the obvious move. The reality however has been quite different. There are those who love voice recognition and those who’ve hated it.

One of the major problems with voice recognition is how you integrate the popular EHR template documentation methods with voice. Sure, almost every EHR vendor can do free text boxes as well, but in order to get all the granular data it’s meant that doctors have done a mix of clicking a lot of boxes together with some voice recognition.

A few years ago, I started to see how EHR voice recognition could be different when I saw the Dragon Medical Enabled Chart Talk EHR. It was literally a night and day difference between dragon on other EHR software and the dragon embedded into Chart Talk. You could see so much more potential for voice documentation when it was deeply embedded into the EHR software.

Needless to say, I was intrigued when I was approached by the people at NoteSwift. They’d taken a number of EHR software: Allscripts Pro, Allscripts TouchWorks, Amazing Charts, and Aprima and deeply integrated voice into the EHR documentation experience. From my perspective, it was providing Chart Talk EHR like voice capabilities in a wide variety of EHR vendors.

To see what I mean, check out this demo video of NoteSwift integrated with Allscripts Pro:

You can see a similar voice recognition demo with Amazing Charts if you prefer. No doubt, one of the biggest complaints with EHR software is the number of clicks that are required. I’ve argued a number of times that number of clicks is not the issue people make it out to be. Or at least that the number of clicks can be offset with proper training and an EHR that provides quick and consistent responses to clicks (see my piano analogy and Not All EHR Clicks Are Evil posts). However, I’m still interested in ways to improve the efficiency of a doctor and voice recognition is one possibility.

I talked with a number of NoteSwift customers about their experience with the product. First, I was intrigued that the EHR vendors themselves are telling their customers about NoteSwift. That’s a pretty rare thing. When looking at adoption of NoteSwift by these practices, it seemed that doctor’s perceptions of voice recognition are carrying over to NoteSwift. I’ll be interested to see how this changes over time. Will the voice recognition doctors using NoteSwift start going home early with their charts done while the other doctors are still clicking away? Once that happens enough times, you can be sure the other doctors will take note.

One of the NoteSwift customers I talked to did note the following, “It does require them to take the time up front to set it up correctly and my guess is that this is the number one reason that some do not use NoteSwift.” I asked this same question of NoteSwift and they pointed to the Dragon training that’s long been required for voice recognition to be effective (although, Dragon has come a long way in this regard as well). While I think NoteSwift still has some learning curve, I think it’s likely easier to learn than Dragon because of how deeply integrated it is into the EHR software’s terminology.

I didn’t dig into the details of this, but NoteSwift suggested that it was less likely to break during an EHR upgrade as well. Master Dragon users will find this intriguing since they’ve likely had a macro break after their EHR gets upgraded.

I’ll be interested to watch this space evolve. I won’t be surprised if Nuance buys up NoteSwift once they’ve integrated with enough EHR vendors. Then, the tight NoteSwift voice integrations would come native with Dragon Medical. Seems like a good win win all around.

Looking into the future, I’ll be watching to see how new doctors approach documentation. Most of them can touch type and are use to clicking a lot. Will those new “digital native” doctors be interested in learning voice? Then again, many of them are using Siri and other voice recognition on their phone as well. So, you could make the case that they’re ready for voice enabled technologies.

My gut tells me that the majority of EHR users will still not opt for a voice enabled solution. Some just don’t feel comfortable with the technology at all. However, with advances like what NoteSwift is doing, it may open voice to a new set of users along with those who miss the days of dictation.

Power of the Cloud EHR – Hidden Technology

Posted on August 6, 2014 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.

Today’s post will be short. I’m hitting up the Black Hat conference in Las Vegas today and tomorrow. For those not familiar with Black Hat, it’s a hackers conference. It’s not quite as hardcore as Defcon when it comes to hacking, but they warn you about getting your devices hacked. I personally plan to play it safe and not bring my laptop and to turn my cell phone off. Anyway, hopefully I’ll do some future posts on security based on what I learn at the event. I always find deep value in going to a conference that doesn’t apply specifically to what I’m doing. Although, in the past they’ve had some medical device hacking sessions, but I digress.

The title of this post describes a concept I was recently considering. In fact, it was inspired by a comment on a previous post by Suzanne McEachron, that talked about a clinic needing to upgrade their in house EHR server from Windows Server 2003 to Windows Server 2008. Here’s the full comment:

Your statement, “While it’s sometimes disappointing to look at the old technology that powers healthcare,” must refer to an ambulatory vendor I am aware of, which installed its software onto a Windows Server 2003 just 3 years ago, and is now demanding the provider upgrade to Windows Server 2008. The provider wants to upgrade to Windows Server 2012, but the software company’s software won’t reliably work (yet) on that version. What is a poor country doctor to do?
He will be dumping his current vendor and finding a software company which uses the cloud instead of servers in his office.
Companies which continue to not keep up, will be left with few customers.

The last two lines are probably worthy of their own post. So, we’ll mostly set them aside for now. However, I was struck by Suzanne’s comment that they would be going with a cloud solution after this experience with an in house EHR vendor.

I’d never thought of this before I read this comment, but is one of the benefits of a cloud EHR that the user has no idea what type of back end technology you’re using to deliver the software? Sure, some of them will ask some questions during the EHR selection process, but I’ve never seen anyone ask a cloud EHR vendor how they’re doing at keeping their technology stack up to date. The reality for end users is that they don’t really care what technology is being used. They only care about the end result. Does it work? Yes. Is it fast enough? Yes. Then, since it’s in the cloud, who cares what technology is being used?

Of course, this may be exaggerating the situation a little, but not much. Certainly very few if any people are asking cloud providers how they’re doing at keeping their technology up to date. No doubt some do care about this and run into this problem even with cloud providers. My favorite example of this is when a cloud EHR provider requires a clinic to use an extremely outdated version of IE (internet explorer) to run the EHR. Yes, then they start to care a lot more.

Maybe it’s a mistake that practices don’t keep after their cloud provider more. However, the reality today is that the don’t. That makes it a huge advantage for cloud EHR providers. At least it does until they’re so outdated that they can’t hide it anymore. For example, when they can’t launch an iPad app because there’s no way for their old technology to work with it. Sounds like I need to create a new jokes series called, “Your EHR might be outdated if….” The problem is the jokes won’t be too funny if you’re suffering through it.

Side Note: So much for it being a short post.

Eyes Wide Shut – Patient Engagement Pitfalls Prior to Meaningful Use Reporting Period

Posted on June 30, 2014 I Written By

Mandi Bishop is a healthcare IT consultant and a hardcore data geek with a Master's in English and a passion for big data analytics, who fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

July 1, 2015 – the start of the Meaningful Use Stage 1 Year 2 reporting period for the hospital facilities within this provider integrated delivery network (IDN). The day the 50% online access measure gets real. The day the inpatient summary CCDA MUST be made available online within 36 hours of discharge. The day we must overcome a steady 65% patient portal decline rate.

A quick recap for those who haven’t followed this series (and refresher for those who have): this IDN has multiple hospital facilities, primary care, and specialty practices, on disparate EMRs, all connecting to an HIE and one enterprise patient portal. There are 8 primary EMRs and more than 20 distinct patient identification (MRN) pools. And many entities within this IDN are attempting to attest to Meaningful Use Stage 2 this year.

For the purposes of this post, I’m ignoring CMS and the ONC’s new proposed rule that would, if adopted, allow entities to attest to Meaningful Use Stage 1 OR 2 measures, using 2011 OR 2014 CEHRT (or some combination thereof). Even if the proposed rule were sensible, it came too late for the hospitals which must start their reporting period in the third calendar quarter of 2014 in order to complete before the start of the fiscal year on October 1. For this IDN, the proposed rule isn’t changing anything.

Believe me, I would have welcomed change.

The purpose of the so-called “patient engagement” core measures is just that: engage patients in their healthcare, and liberate the data so that patients are empowered to have meaningful conversations with their providers, and to make informed health decisions. The intent is a good one. The result of releasing the EMR’s compilation of chart data to recently-discharged patients may not be.

I answered the phone on a Saturday, while standing in the middle of a shopping mall with my 12 year-old daughter, to discover a distraught man and one of my help desk representatives on the line. The man’s wife had been recently released from the hospital; they had been provided patient portal access to receive and review her records, and they were bewildered by the information given. The medications listed on the document were not the same as those his wife regularly takes, the lab section did not have any context provided for why the tests were ordered or what the results mean, there were a number of lab results missing that he knew had been performed, and the problems list did not seem to have any correlation to the diagnoses provided for the encounter.

Just the kind of call an IT geek wants to receive.

How do you explain to an 84 year-old man that his wife’s inpatient summary record contains only a snapshot of the information that was captured during that specific hospital encounter, by resources at each point in the patient experience, with widely-varied roles and educational backgrounds, with varied attention to detail, and only a vague awareness of how that information would then be pulled together and presented by technology that was built to meet the bare minimum standards for perfect-world test scenarios required by government mandates?

How do you tell him that the lab results are only what was available at time of discharge, not the pathology reports that had to be sent out for analysis and would not come back in time to meet the 36-hour deadline?

How do you tell him that the reasons there are so many discrepancies between what he sees on the document and what is available on the full chart are data entry errors, new workflow processes that have not yet been widely adopted by each member of the care team, and technical differences between EMRs in the interpretation of the IHE’s XML standards for how these CCDA documents were to be created?

EMR vendors have responded to that last question with, “If you use our tethered portal, you won’t have that problem. Our portal can present the data from our CCDA just fine.” But this doesn’t take into account the patient experience. As a consumer, I ask you: would you use online banking if you had to sign on to a different website, with a different username and password, for each account within the same bank? Why should it be acceptable for managing health information online to be less convenient than managing financial information?

How do hospital clinical and IT staff navigate this increasingly-frequent scenario that is occurring: explaining the data that patients now see?

I’m working hard to establish a clear delineation between answering technical and clinical questions, because I am not – by any stretch of the imagination – a clinician. I can explain deviations in the records presentation, I can explain the data that is and is not available – and why (which is NOT generally well-received), and I can explain the logical processes for patients to get their clinical questions answered.

Solving the other half of this equation – clinicians who understand the technical nuances which have become patient-facing, and who incorporate that knowledge into regular patient engagement to insure patients understand the limitations of their newly-liberated data – proves more challenging. In order to engage patients in the way the CMS Meaningful Use program mandates, have we effectively created a new hybrid role requirement for our healthcare providers?

And what fresh new hell have we created for some patients who seek wisdom from all this information they’ve been given?

Caveat – if you’re reading this, it’s likely you’re not the kind of patient who needs much explaining. You’re likely to do your own research on the data that’s presented on your CCDA outputs, and you have the context of the entire Meaningful Use initiative to understand why information is presented the way it is. But think – can your grandma read it and understand it on HER own?

Vendor Creates EMR For Google Glass

Posted on June 20, 2014 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.

Well, here’s an interesting development. An EMR company has created an app allowing doctors using Google Glass to store patient data on a cloud-based storage and collaboration site.

The vendor, California-based Drchrono, is claiming that the application is the first “wearable health record.”  Whether or not that’s the case, this is clearly a step forward in the development of Google Glass as a practical tool for doctors.

According to a Reuters report, Drchrono worked closely with cloud-based storage and collaboration service Box along with Google Glass to create the app.

The new Google Glass at allows doctors — with the patient’s permission — to use Google Glass to record a consultation or surgery. Once the work is done, physician can store the video, as well as photographs and notes, and the patient’s EMR or in Box. The app also allows the data to  be shared with the patient.

The app is still in its infancy — so far, just 300 of the 60,000 doctors using Drchrono’s EMR platform have opted to use the Google Glass app, which is currently available at no cost to users.

But Google Glass apps and options are clearly on the rise, and not just among providers. A recent study by Accenture found that consumers are are very interested in wearable technology; they’re particularly interested in wearable smart glasses like Google Glass as well as smart watches.

As things stand, devices like Google Glass are in the very early adoption stage, so it’s not surprising that few of Drchrono’s physician users have opted to try out the new app. But things are likely to change over the next year or two.

I believe Google Glass will follow the same trajectory the iPad did in medicine. First it was a toy for the well-financed, curious and tech savvy, then an option for early adopters in medicine, then eventually a tool that made sense for nearly every provider.

For the next year or two, most Google Glass announcements will be like this one, reports of experiments whose only uptake will come from leading-edge experimenters in medical technology. But within the next two years or so, Google Glass uses will proliferate, as will the apps that make them a worthwhile investment.

This level of success isn’t inevitable, but it is likely. I’d bet good money that two years from now, you may be reading this blog on a Google Glass app and managing your EMR through one as well.  It’s just a matter of time.

Patient Safety And Process-Aware Information Systems: Interruptions, Interruptions, Interruptions!

Posted on June 12, 2014 I Written By

Chuck Webster, MD, MSIE, MSIS has degrees in Accountancy, Industrial Engineering, Intelligent Systems, and Medicine (from the University of Chicago). He designed the first undergraduate program in medical informatics, was a software architect in a hospital MIS department, and also VP and CMIO for an EHR vendor for over a decade. Dr. Webster helped three healthcare organizations win the HIMSS Davies Award and is a judge for the annual Workflow Management Coalition Awards for Excellence in BPM and Workflow and Awards for Case Management. Chuck is a ceaseless evangelist for process-aware technologies in healthcare, including workflow management systems, Business Process Management, and dynamic and adaptive case management. Dr. Webster tweets from @wareFLO and maintains numerous websites, including EHR Workflow Management Systems (http://chuckwebster.com), Healthcare Business Process Management (http://HCBPM.com) and the People and Organizations improving Healthcare with Health Information Technology (http://EHRworkflow.com). Please join with Chuck to spread the message: Viva la workflow!

This is my fourth of five guest blog posts covering Health IT and EHR Workflow.

When you took a drivers education class, do you remember the importance of mental “awareness” to traffic safety? Continually monitor your environment, your car, and yourself. As in traffic flow, healthcare is full of work flow, and awareness of workflow is the key to patient safety.

First of all, the very act of creating a model of work to be done forces designers and users to very carefully think about and work through workflow “happy paths” and what to do when they’re fallen off. A happy path is a sequence of events that’s intended to happen, and, if all goes well, actually does happen most of the time. Departures from the Happy Path are called “exceptions” in computer programming parlance. Exceptions are “thrown”, “caught”, and “handled.” At the level of computer programming, an exception may occur when data is requested from a network resource, but the network is down. At the level of workflow, an exception might be a patient no-show, an abnormal lab value, or suddenly being called away by an emergency or higher priority circumstance.

Developing a model of work, variously called workflow/process definition or work plan forces workflow designers and workflow users to communicate at a level of abstraction that is much more natural and productive than either computer code or screen mockups.

Once a workflow model is created, it can be automatically analyzed for completeness and consistency. Similar to how a compiler can detect problems in code before it’s released, problems in workflow can be prevented. This sort of formal analysis is in its infancy, and is perhaps most advanced in healthcare in the design of medical devices.

When workflow engines execute models of work, work is performed. If this work would have otherwise necessarily been accomplished by humans, user workload is reduced. Recent research estimates a 7 percent increase in patient mortality for every additional patient increase in nurse workload. Decreasing workload should reduce patient mortality by a similar amount.

Another area of workflow technology that can increase patient safety is process mining. Process mining is similar, by analogy, to data mining, but the patterns it extracts from time stamped data are workflow models. These “process maps” are evidence-based representations of what really happens during use of an EHR or health IT system. Process maps can be quite different, and more eye opening, than process maps generated by asking participants questions about their workflows. Process maps can show what happens that shouldn’t, what doesn’t happen than should, and time-delays due to workflow bottlenecks. They are ideal tools to understand what happened during analysis of what may have caused a possibly system-precipitated medical error.

Yet another area of particular relevance of workflow tech to patient safety is the fascinating relationship between clinical pathways, guidelines, etc. and workflow and process definitions executed by workflow tech’s workflow engines. Clinical decision support, bringing the best, evidence-based medical knowledge to the point-of-care, must be seamless with clinical workflow. Otherwise, alert fatigue greatly reduces realization of the potential.

There’s considerable research into how to leverage and combine representations of clinical knowledge with clinical workflow. However, you really need a workflow system to take advantage of this intricate relationship. Hardcoded, workflow-oblivious systems? There’s no way to tweak alerts to workflow context: the who, what, why, when, where, and how of what the clinical is doing. Clinical decision support will not achieve wide spread success and acceptance until it can be intelligently customized and managed, during real-time clinical workflow execution. This, again, requires workflow tech at the point-of-care.

I’ve saved workflow tech’s most important contribution to patient safety until last: Interruptions.

An interruption–is there anything more dreaded than, just when you are beginning to experience optimal mental flow, a higher priority task interrupts your concentration. This is ironic, since so much of work-a-day ambulatory medicine is essentially interrupt-driven (to borrow from computer terminology). Unexpected higher priority tasks and emergencies *should* interrupt lower priority scheduled tasks. Though at the end of the day, ideally, you’ve accomplished all your tasks.

In one research study, over 50% of all healthcare errors were due to slips and lapses, such as not executing an intended action. In other words, good clinical intentions derailed by interruptions.

Workflow management systems provide environmental cues to remind clinical staff to resume interrupted tasks. They represent “stacks” of tasks so the entire care team works together to make sure that interrupted tasks are eventually and appropriately resumed. Workflow management technology can bring to clinical care many of the innovations we admire in the aviation domain, including well-defined steps, checklists, and workflow tools.

Stay tuned for my fifth, and final, guest blog post, in which I tackle Population Health Management with Business Process Management.


Big Brother Or Best Friend?

Posted on 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

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.

Healthcare Data Centers and Cloud Solutions

Posted on March 4, 2014 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.

As a former system administrator that worked in a number of data centers, it’s been really interesting for me to watch the evolution of healthcare data centers and the concept of healthcare cloud solutions. I think we’re seeing a definite switch by many hospital CIOs towards the cloud and away from the hassle and expense of trying to run their own data centers. Plus, this is facilitated greatly by the increased reliability, speed, and quality of the bandwidth that’s available today. Sure, the largest institutions will still have their own data centers, but even those organizations are working with an outside data center as well.

I had a chance to sit down for a video interview with Jason Mendenhall, Executive Vice President, Cloud at Switch Supernap to discuss the changing healthcare data center and cloud environment. We cover a lot of ground in the interview including when someone should use cloud infrastructure and when they shouldn’t. We talk about the security and reliability of a locally hosted data center versus an outside data center. We also talk a little about why Las Vegas is a great place for them to have their data center.

If you’re a healthcare organization who needs a data center (Translation: All of you) or if you’re a healthcare IT company that needs to host your application (Translation: All of you), then you’ll learn a lot from this interview with Jason Mendenhall:

As a side note, the Switch Supernap’s Innevation Center is the location for the Health IT Marketing and PR Conference I’m organizing April 7-8, 2014 in Las Vegas. If you’re attending the conference, we can also set you up for a tour of the Switch Supernap while you’re in Vegas. The tour is a bit like visiting a tech person’s Disneyland. They’ve created something really amazing when it comes to data centers. I know since a secure text message company I advise, docBeat, is hosted there with one of their cloud partners Itrica.

iPad Lifecycle Versus Other Tablets

Posted on February 13, 2014 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.

Every once in a while I like to put my old IT hat back on (I am @techguy on Twitter after all) and look at some of the more physical IT aspects of EMR and healthcare IT. I still get really excited about EMR Technology products and the evolution of these products.

I’ve long argued that most IT administrators would much rather have a set of Windows 8 tablets in their environment over a bunch of iPads or Android tablets. The biggest reasons for this was because of the security and management of these devices. Most hospital and healthcare IT administrators are comfortable securing a Windows based device and they aren’t as comfortable with new tablets like the iPad or Android tablets. Plus, the tools for managing and imaging Windows based tablets is so much more developed than those of the iPad or Android (although, I think both of these are catching up pretty quickly).

While I think both of these arguments are reasonable, I heard two new arguments for why an organization might want to stick with Windows 8 tablets instead of moving to iPads and Androids.

The first reason is that the lifecycle of a Windows 8 machine is much longer than an iPad or Android tablet. A Windows 8 tablet that you bought 5 years ago could still easily be supported by an IT shop and will work with your various software systems. A 3 year old iPad could very well not work with your EHR software and Apple has already stopped supporting O/S upgrades on the original iPads which poses similar HIPAA Compliance issues to Windows XP.

The whole release cycle with iPad and Android tablets is intent on replacing the previous versions. They don’t quite make them obsolete, but they’ve been releasing new versions every year with the intent for you to buy a new one every year. This stands in stark contrast to the Windows tablet approach.

Another reason many IT admins will likely lean towards Windows 8 tablets over iPads and Androids is that they’re just generally more rugged. Sure, you can make iPads and Androids more rugged with certain cases, but then you lose the look and feel of having an iPad in your hand and nicely in your pocket.

This point is accentuated even more when you look at devices like the new Toughpad tablets from Panasonic. They’ve finally got the processing power in these machines to match that of a desktop so they can run any software you want. Plus, they are crazy durable. I saw them at CES last month and a journalist from India was slamming it on the ground and stepping on it and the thing kept ticking without a problem. I don’t need to explain to any of you why durability matters in healthcare where you’re always carrying around multiple items and drops are common.

Of course, the reality is that it’s “sexy” to carry around an iPad while you work. Software vendors are going to continue developing for the iPad and doctors are going to want to be carrying an iPad around with them. IT staff are likely going to have to support iPads and other tablets in their environment. However, when it’s left to the IT staff, you can be sure that the majority of them will be pushing for the more rugged, easier to secure, easier to manage, and longer lifecycle Windows 8 tablets. Unless of course, they’re ordering an iPad for their own “test” environment.

Barcodes, Integrating Bedside TVs, EHR, and Nurse Messaging Into Pain Management Workflow

Posted on February 7, 2014 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.

As I look across the healthcare IT landscape, I believe we’re just at the beginning of a real integrated solutions that leverage everything that technology can offer. However, I see it starting to happen. A good example of this was this case study I found on “Automated Workflow for Pain Management.”

The case study goes into the details of the time savings and other benefits of proper pain management in the hospital. However, I was really intrigued by their integration of bedside TVs together with barcodes, EHR software, and nurse messaging (sadly they used a pager, but that could have easily been replaced with secure messaging). What a beautiful integration and workflow across so many different technologies from different companies and this is just the start.

One major challenge to these workflows is making these external applications work with the EHR software. Hopefully things like the blog post I wrote yesterday will help solve that problem. Case studies like the one above illustrate really well the value of outside software applications being able to integrate with EHR software.

What I also loved about the above solution is that it doesn’t cause any more work for the hospital staff. In fact, in many ways it can save them time. The nurse can have much higher quality data about who needs them and when.

This implementation is also a preview of what Kyle Samani talked about in his post “Unlocking the Power of Data Science in Healthcare.” While Kyle wrote about it from the perspective of patients and getting them the right information in the right context, the same applies to healthcare providers. The case study above is an example of this shift. No doubt there will be some resistance to these technologies in healthcare, but once they get refined we’ll wonder how we lived without them.