Text messages are becoming more and more popular in the US. It’s funny, because the US is about 5 or so years behind Europe when it comes to the use of text messages. Better late than never I guess. The addiction is especially true with high school children, but the college ranks are ravaged with students who are addicted to texting. I’ve heard some parents say that a text message is the only way they can communicate with their child (how sad is that?).

Considering text messages are getting so popular, I wonder if any EMR companies have integrated text messaging into their software. The most obvious use would be to send a text message reminder about the appointment. I think many patients would love this service. A text message reminder for an annual pap smear or other follow up appointment would be really beneficial as well.

This really wouldn’t be that hard to implement since you can send an email which then goes to someone as a text message. The challenge is only figuring out which provider that person was on in order to send the email to the right place.

Is anyone doing text messages from their EMR? Certainly there are some HIPAA considerations here, but that should be covered by the agreement when they give you their cell number.

I recently became aware of a new open source tablet EMR that was going to be offered by Medscribbler. Everyone that reads this blog should know that I’m a huge fan of open source (see my previous posts about open source EMR). It’s about time that a really strong tablet based EMR software was available as open source software.

Open source EMR purists will probably be a little disgruntled that Medscribbler is built on top of other technologies which are not completely open source. However, I give them a pass for now since the open source community has so far failed to deliver very good tablet based software.

You can find more information about the free Medscribbler EMR software here or at their sourceforge page. The following is the official press release announcement:

Medscribbler is released as an Open Source electronic medical record

Scriptnetics, the leader in Tablet PC mobile healthcare applications, will announce Monday its release of the proprietary source code for Medscribbler electronic medical record, EMR, to the open source community. Installable components and the code for programmers are available at the globally recognized open source portal, Sourceforge.net.

“Releasing a Medscribbler Open Source EMR is the next logical step to drive the innovation that is needed to get to a point where the majority of physicians and other health care providers take up electronic medical records,” said Michael Milne, Chief Executive Officer of Scriptnetics. “We hope to encourage a stable, widely available and affordable entry level EMR that uses cutting edge technology with the mobility of the Tablet PC,” he continued.

To provide focus and stability to move the project forward Scriptnetics has assigned programmers to manage and contribute new programming code on a regular basis. Other programmers wanting to contribute but needing help in understanding the considerable amount of code that already exists can access live help and support. For programmers looking to maximize their skills, project suggestions are posted in a forum.

The new Open Source EMR is called Medscribbler Community and is the first vertical, enterprise level open source project to be designed specifically for handwriting recognition on the Tablet PC. Medscribbler Community is already being used by many healthcare providers both in stand alone computer situations and client server multi computer offices. This cutting edge EMR is also being used in Internet WAN mobile remote access situations.

Scriptnetics is the largest vendor of penable Tablet PC designed medical software in the world. The company’s flagship product, Medscribbler, has been distributed since 2003 and is being used by healthcare providers in the United States and Canada. Its offices are located in Wilmington, Delaware and Moncton, New Brunswick. www.scriptnetics.com and www.medscribbler.com

SourceForge’s web sites connect millions of technology professionals and enthusiasts each day. Combining user-developed content, online marketplaces and e-commerce, SourceForge is the global technology community’s information exchange network and the world’s largest open source software development and distribution environment. Its offices are located in Mountainview, California.

For more information on Medscribbler Community see: www.emrfreesoftware.com and sourceforge.net/projects/medscribbler/

Press Contacts:
Michael Ferguson
Scriptnetics
(506) 859-9271
prnews@scriptnetics.com

Full Disclosure: Medscribbler is a an advertiser on EMR and HIPAA.

Nick Harrington, EMRUpdate guru, is traveling around HIMSS recording some video presentations for those who couldn’t make it to the show. You can find his EMRUpdate videos on Vimeo.

So far he’s mostly posted some hardware related videos, but today he’ll be doing videos of NextGen, UserCentric and tomorrow eCW, e-MDs and SRSSoft. Plus, I’m sure he’ll catch a number of other ones just walking around. I’ll post some of the better ones I see.

Here’s one that I think is interesting since this is something we’ve looked at before. Basically, it’s a video showing the features of a computer cart. We’ve gone back and forth on these. Some people love them and some people hate them. We ended up just thinking they were too expensive. Take a look and see for yourself.

Check out other EMR technology products. I think I need to add a few computer carts to the list.

The other day I was thinking about the way EMR software has been designed. A common complaint by specialists is that a certain EMR was designed for General Medicine, but would not work for [insert specialty here]. Then, I asked myself the question “Why hasn’t an EMR vendor built a core with plugins so that other divisions of their company could focus on specialties?”

Yes, if you are a doctor you can probably stop reading right here.

Anyone who’s participated in a website content management system like Wordpress (which I use to run this blog) is familiar with the idea of Wordpress being the core and then plugins adding extra functionality that might be specific to a user. I wonder why no EMR vendor has decided to develop their software with this same type of flexibility. I believe this process could even work for a private company. It could have one department in charge of the core EMR functionality. Then, other divisions of the company could focus on creating various “plugins” that would expand the core functionality to meet different needs.

This could be the perfect way to be able to adapt the core EMR functions to meet the needs of various specialty clinics out there. This could even be a good way for an EMR company to adapt a product for different state regulations and requirements.

Of course, this model works even better when we’re talking about open source EMR (see also the open source EMR list on the EMR wiki). I’ve seen some different open source EMR, but I don’t personally know of any that are using this model. I’m guessing there has to be and I just don’t know about it. If anyone knows of an open source EMR that is using this model for development, please let me know in the comments. I’d also love to have someone do a guest blog post about this if it is occurring already.

Just some food for thought. Any EMR companies developing this way and I just don’t know about it? I’d love to hear about it as well.

I previously posted a summary of the Walmart EHR package with eCW and Dell.  Then, I followed it up with a doctor’s persctive on Walmart EHR.  At the end, I promised to follow up with a post on the Walmart EHR deal from Walmart, eCW and Dell’s perspective.

I think this was a great move by eCW, Dell and Walmart.  Honestly, what do they lose by trying this out?

Let’s not go overboard here.  I don’t see this offering completely changing the landscape of EHR.  Walmart has done that in a lot of areas, but EHR is not going to be one of them.

However, Walmart could be a good lead generator for eCW and Dell.  Dell certainly has reached a point where they have a strong brand established and scale is their friend.  They want to distribute their product through as many low cost channels as possible.  If this is successful, Dell tablets (a new offering for Dell – second generation just came out for those keeping track) will be in a lot more doctors’ offices.  If it fails, then Dell still will have gotten some PR in front of doctors saying that Dell offers tablets for doctors.  Don’t believe this is happening?  Do a quick search on google news and see all the stories about Walmart EHR.  This blog post is another example of the free PR Dell is getting from this deal.

eCW isn’t quite the brand that Dell has become, but they do have a substantial install base.  Scale really is their friend.  The more EHR software they can sale, the better for them as a company.  EHR sales is a numbers game and the more doctors they have viewing their product the more doctors they’ll have buying it.  Plus, if someone is thinking about EHR at Walmart, then that’s a high quality lead.  The leads won’t be as high quality as say advertising on EMR and HIPAA (excuse the plug), but a lead’s a lead.

Walmart really seems to have nothing to lose in this.  I guess they’re giving up floor space for the product.  I wonder what this will look like at Sam’s Club.  If anyone sees it, take a picture and send it to me so I can post it.  I’m not sure Walmart’s internal projections, but they threw out the number of 200k health care providers are members of Sam’s Club.  I’m a member of Sam’s Club as well, but I can’t remember the last time I was there.  My wife usually takes care of it.  I’m pretty sure many of these doctors are the same as me.

I do think this is a really interesting news item for Walmart.  Walmart has been doing a ton of things in regards to health care lately and so offering an EHR didn’t suprise me that much.  We have Walmart Clinics.  Free or cheap Walmart drugs.  Now we have a Walmart EHR.  Once they offer the Walmart PHR to compete with Google Health and Microsoft HealthVault, then we can really start to wonder if Walmart just has so much money they don’t know what to do with it.

As promised, I wanted to share a few thoughts about the newly announced Walmart EHR package. I previously posted a nice summary of how the Walmart, eCW and Dell EHR will work. If you’ve never heard about the Walmart EHR, then go read that post and come back.

Offhand it would be really easy to criticize this move by Walmart (really Sam’s Club). I can just imagine doctors going down the aisle of Sam’s Club: toilet paper, candy bars, EHR software, oh yeah, I almost forgot the salsa. Honestly, does that sound right to anyone?

However, I’m certain that many people said the same thing about getting TVs, vacation packages and tires at Sam’s Club when they first started offering those items as well. Toilet paper, candy bars and disney vacation doesn’t sound much better.

All of this said, I still think the idea is crazy. I’m not talking about Walmart, eCW and Dell being crazy. I’m saying that any doctor’s office that chooses to buy this package at Sam’s Club is crazy. Let me explain.

I’ve often talked about your EHR becoming the life blood of your practice. Once you’ve implemented an EHR it becomes apart of almost everything you do in a clinic. I can’t think of any part of a clinical practice that isn’t affected by the implementation of an EHR. Doctors spend as much time on their EHR as they do helping patients.

Yes, I know it’s a sad reality, but it’s the reality. Other people might tell you different, but I don’t think they’re being very honest with you. Is this reason for concern? No, because you could have just as easily said that Doctors spend as much time in paper charts as they do helping patients. Why this is the case is the topic for another post. The point is that the EHR becomes the center of a practice. Still don’t believe me? Watch for a future post on the topic which will include more compelling reasons EHR’s the core of a practice.

Since EHR is the core of your practice, do you really want to get your EHR package at Walmart?

Seriously, think about that. You’re trusting your livelihood and happiness (yes, EHR affects both of those things) to a $25k package you bought at Walmart?

I’m not saying that eCW, Dell and Walmart aren’t great companies. eCW has an EMR product that’s been very successful and is an EMR that many should and would consider for their clinic. I love Dell products and recommend them to anyone. I just don’t see why you’d purchase it at Walmart instead of going directly to Dell and eCW.

Let’s just think this through. First, I’d expect that if I’m buying this EHR package through Walmart, then I’m getting a better deal than if I bought each of the items separately. This means less revenue for eCW and Dell from the start. Next, you take out whatever Walmart’s getting paid to make the sale. The question then remains, how can these companies sell their products cheaper than normal AND share the revenue with Walmart? The answer is easy. They’re going to find other ways to lower their costs.

Let’s think about ways that they can lower your costs:

First, they should have saved money trying to sale you the product.  In theory this is great.  Walmart’s taking care of the marketing and sales of the product, so that’s why the product is cheaper.  Of course, the doctors should be asking themselves if they want Walmart to be the one showing them how the Walmart EHR will work for them.  Ahh, but certainly Walmart won’t be the ones demoing the product to the doctors.  eCW will be taking care of all the demoing and “sales” of the product.  Well, there goes the money eCW was saving by using Walmart.   That basically relegates Walmart to a lead generated for eCW.

Second, eCW could enjoy economies of scale as they support more istances of EHR.  Let me translate what this means for you as a doctor: POOR Support.  Try supporting 25k physicians (number using eCW per NYTimes) spread across the country in every specialty imaginable.  It’s pretty much impossible to expect that eCW could provide personal and quality service to such a large user base.  Just think about how many people eCW would need to hire and train to be able to provide the type of support you’d like to receive if you’re a doctor implementing an EHR (eCW is hiring for those searching).  I’m pretty sure that calling them and telling them that you bought your EHR at Walmart is going to put you at the front of the support line.

EHR vendor support is so important to having a successful EHR implementation.  I’m familiar with a large eCW implementation that was having troubles getting the support they needed.  It seemed that this was probably due to the popularity of eCW.  Credit the eCW sales team for doing a good job selling the product, but if I’m a doctor I’m not throwing my ring into an EHR vendor that can’t support me because they’ve oversold.  Considering you’re buying a cheap (isn’t that Walmart’s motto?) Walmart EHR, don’t expect World Class support when you’re paying Walmart prices.

I could keep going with thoughts about this announcement.  Suffice it to say that from a doctor’s perspective I think you’d be crazy to take it.  Now, if separately you’ve made a decision to choose eCW and the Dell computers they offer and you can get it cheaper at Walmart, great.  However, what are the chances of that happening?

There’s so much more that should be said about this topic.  I’ll be following up with another post tomorrow about the Walmart EHR from an eCW and Dell perspective.  I think you’ll enjoy that post.

I probably should have also mentioned that eCW does have a strong community of users that can be leveraged for support as well.  The point of this post isn’t to lower eCW or Dell in particular.  This could have been any EHR software vendor and hardware vendor and I’d have said the same things.  And yes, I’m still very excited to try out the 2 new Dell dual touch tablets I ordered yesterday.

One final parting thought: if you buy the EHR package at Sam’s Club, does the Sam’s Club return policy apply?  Now that’s something that could change my mind.

The EHR world is abuzz with the Walmart announcement that it would be selling EHR software through their Sam’s Club division. In case you missed it, here’s the important details from the NY Times:

The company plans to team its Sam’s Club division with Dell for computers and eClinicalWorks, a fast-growing private company, for software. Wal-Mart says its package deal of hardware, software, installation, maintenance and training will make the technology more accessible and affordable, undercutting rival health information technology suppliers by as much as half.

They also make a projection of how much Walmart EHR will cost:

The Sam’s Club offering, to be made available this spring, will be under $25,000 for the first physician in a practice, and about $10,000 for each additional doctor. After the installation and training, continuing annual costs for maintenance and support will be $4,000 to $6,500 a year, the company estimates.

Walmart estimates that 200,000 health care providers are among the 47 million Sam’s Club members. I also found the following quote from the same article interesting as it talks about how Walmart got into the EHR business:

Wal-Mart’s role, according to Mr. Osborne, is to put the bundle of technology into an affordable and accessible offering. “We’re the systems integrator, an aggregator,” he said.

The company’s test bed for the technology it will soon offer physicians has been its own health care clinics, staffed by third-party physicians and nurses. Started in September 2006, 30 such clinics are now in stores in eight states. The clinics use the technology Wal-Mart will offer to physicians.

“That’s where the learning came from, and they were the kernel of this idea,” Mr. Osborne said.

I’ll save my commentary on this subject for tomorrow. There’s certainly plenty to say about it.

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.

We now interrupt all this HITECH act EHR stimulus money talk for our regularly scheduled program.

If you are looking at implementing EHR, then you better become familiar with a nice high quality scanner. Don’t believe anyone who tells you that they are paperless. Sure, many don’t store paper, but even the very best EMR or EHR implementation has loads of paper that needs to be scanned.

Still don’t believe me, then how do you plan on handling a new patient who brings in a stack of paper records from their old doctor. I’ll leave the rest of the list of possible paper for another day. Suffice it to say that you’ll NEED a high quality scanner that can handle high volume.

When we first implemented we used a nice little all in one scanner. Worked well, except we literally burnt it out after less than a month of scanning.

After that we finally ponied up the money and bought some high quality, high volume fujitsu scanners. 4 years later we’re still scanning with no end in sight. We do have to do regular cleaning (about 5 minutes max) to clean off all the ink that gets on the feeder. Otherwise, these babies are the best I’ve seen. Here’s links to the 2 models fujitsu currently offers.

Fujitsu fi-6130 Duplex Scanner

Fujitsu FI-6230 Clr Duplex 40PPM/30PPM USB
Flat bed and ADF feeder:

One has a flat bed for those hard to feed scan items (ie. prescriptions) and the other is just the feeder for the high volume scanning.  Some may think it’s a little expensive for a scanner, but it’s worth it.

I’ll be updating my list of EMR and EHR technology with items like the scanners above. Many people have asked me which scanners are best, which computers are best, what about tablets, fax servers, etc, etc. Now you can just check out my list of software, tablets, computers, fax servers, scanners, printers, etc and see some recommended items to help your office.

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.