This Friday, July 11, the new Apple iPhone 3G becomes available to the public. The new $199 iPhone 3G will make mobile applications even more accessible to consumers and professionals. Healthcare is one of the most popular topics among consumers, and the iPhone 3G enables consumers to access many new healthcare applications including the free A.D.A.M. Symptom Navigator. According to Harris Interactive, nearly 117 million Americans have searched for health information online. Eighty-five percent of those have searched one or more times per month.

The free Symptom Navigator for the iPhone 3G helps consumers match medical symptoms with relevant assessments and appropriate treatments. Symptom Navigator empowers consumers to make the best use of the healthcare system and understand when self-care or a doctor visit is appropriate. To access the Symptom Navigator on the iPhone 3G, visit http://iphone.adam.com[Don't try to go there in a regular browser]. The tool offers possible causes of the symptom and medical condition, how to self treat, when it is an emergency, when you should call a doctor, and how to prevent it in the future.

Here’s my take on the two questions I posed above:

1. Should patients be diagnosing themselves?
The application described above is a very interesting idea. It’s also true that patients are trying to self diagnose whether we like it or not. I know that when something happens to myself or my kids, I always check what’s online. However, I don’t always trust what’s online. I just take it for what it’s worth and then use that to help me communicate in a more effective way with my doctor.

This iPhone application takes patient diagnosis of problems to the next level. I’m not sure I trust an iPhone to diagnose me. As a consumer, would I really benefit from the information it offers? There’s just something really comforting about calling and talking to someone and hearing someone’s voice tell you that your child is going to be fine and not to worry about it or instructions to take them to the doctor as soon as possible to resolve whatever issue they have. I don’t think I’ll get that same satisfaction out of an iPhone health application. Most likely what I’d see happening is people would check that application and then call the nurse just the same. Something every nurse and doctor in the country loves. Patients trying to diagnose themselves.

I also wonder what’s going to happen when the iPhone application misdiagnoses a person and tells them to stay home when they should be rushed to the hospital. Can you imagine the liability this company will have if someone dies because their iPhone told them not to worry about it? Makes me wonder how this company got investment. Now, I’m sick of liability ruining innovation, but you just have to wonder when we’re talking about life and death.

I should also mention that I’m a nerd by profession. If I, being a nerd, don’t think I’d use a service like this I wonder how many less computer literate people will be interested in this application.

2. Should EMR companies provide an EMR interface on the iPhone?
The first person I ever saw with an iPhone was actually a doctor I know. I wonder if he’s ever tried to access his EMR using his iPhone. The above email made me wonder how useful would it be to have an iPhone interface for doctors to access their EMR.

Of course, there’s no arguing the portability of the iPhone and the latest iPhone’s 3G technology means that it should have the bandwidth necessary to accomplish such a task. However, the iPhone is much like Dragon Naturally Speaking (DNS). DNS can pretty much work with any EMR. However, there are deep integrations that can be done with DNS that take DNS from a pure data entry application into something much more powerful. The iPhone can pretty much work with any web based EMR that works with the safari web browser. However, without an EMR interface designed for the iPhone, a doctor won’t benefit from all of the cool user interface and touch screen features the iPhone offers. Does this mean that EMR companies should build a special iPhone interface for doctors?

This is an important question for almost every EMR company. Even client server based EMR products need to ask themselves if they should build a special web based interface for the iPhone. Just because your a client server based EMR doesn’t mean that you can’t build another interface using web based technology. The question is should you?

The answer to the question becomes rather clear when you think about what advantages a doctor receives by being able to access their EMR on an iPhone. Most doctors have NEVER accessed their EMR on their phone. Those doctors I know that have accessed their EMR on their phone fall into one of the following two camps:
1. Tired of scrolling
The first category of EMR users said that accessing their EMR on a phone was painstaking because the scrolling was a constant annoyance. I think we’re all getting spoiled with big 19″ monitors. I know I’ve connected to some of my servers using a phone and scrolling was the biggest problem for me. So much so that I never tried it again. A number of companies are working on roll up screens, but until that happens scrolling seems apart of an internet phone experience. Certainly some could argue that with the iPhone you have an easier method of scrolling. This is certainly true, but it still only slightly diminishes the pains of scrolling in my book.
2. Just meds and allergies
This group seems sensible. What if an EMR vendor offered a small subset of the EMR that was available on the iPhone (or any cellular phone for that matter). Knowing someone’s medications and allergies would be nice to have available on your phone when your visiting a hospital. Why not be able to browse your EMR’s schedule of appointments on your iPhone. Many people probably do that now, but I’m not talking about synching your phone with your calendar. I’m talking about a true real time view of your appointments for that day. Would certainly be a nice way to prevent the doctor getting upset with someone from the front desk because his calendar wasn’t up to date with what was stored in the EMR.

It’s easy to see the advantages of offering a subset of your EMR information on the phone. There’s a lot of things that are useful that won’t ever happen. Unfortunately, I think this is one of those features. At least for now, I don’t know many doctors who are asking for phone integration as part of the EMR RFP process. EMR vendors are in the business of selling EMR software. If their users aren’t demanding it, then I don’t see many EMR vendors providing it.

No, I won’t be surprised if some EMR vendor comes out with an iPhone interface. Some EMR companies could do it rather quickly because of the way their EMR is designed and they might as well enjoy a little bit of PR benefit from having an iPhone application. I’ll be excited to see what that company provides, but don’t count on many EMR vendors to follow suit. It just wouldn’t be smart business for most.

One final thought. The iPhone has been a real internet darling that has garnered lots of good press. It’s what Steve Jobs is great at doing and the iPhone is no exception. The problem is that the last time I checked, the iPhone was less than 2% of all the phones sold in the US. The incredible user interface of the iPhone can’t be argued. The problem is that software companies very rarely want to develop software for 2% of the market. Until iPhone establishes user interface standards that other companies adopt, don’t expect EMR companies to start developing software for the iPhone.

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

Thanks to Medical Software Associates and emrexperts for advertising on EMR and HIPAA. I really appreciate your financial support of this blog and my wife appreciates it even more.

If there are any other advertisers interested in advertising on EMR and HIPAA, please leave a comment on this post or email john [at] emrandhipaa {.} com Visitors to this site stay an average of 4 minutes and 40 seconds and visitors are almost exclusively interested in EMR and health care related topics. A very nice targeted market for EMR vendors, EHR vendors or I would think it would work really well for pharmaceutical companies too.

It’s been a long time coming and so it will be interesting to finally take a look under the hood. I haven’t personally had enough time to do a full analysis of Google Health myself, but techcrunch posted the announcement live and an initial review.

I think that techcrunch summed up a major part of Google Health and its meaning for EHR software in the following:

Google is planning to open up APIs to Google health to make it easy for other partners to tap into its health platform. And make no mistake about it. That is what this is: a platform. Health apps anyone?

Sure does make for some interesting thinking about how an EMR or EHR could integrate with Google Health. Depending on how my next couple days go, I may see if Google Health has given any sort of specifications for importing a patient record into Google Health from an EMR or EHR software program. In my previous posts it was said to use some form of CCR to integrate Google Health with EMR and EHR software. I hope this is the case. If it is, I think I’ll try to be the first to integrate Google Health with my EMR. I don’t think most of it would be that difficult.

Do you want to improve the U.S. health care system? Or at least be part of the much-needed dialogue?

If you have ideas or solutions to improve the system, submit your ideas through ChangeNow4Health’s Innovation xChange and you can win up to $10,000 or have your ideas published in the e-book, Tomorrow’s Health Care.

The Innovation xChange is looking for practical ideas and suggestions for improving the health care system. All participants in the system, from providers and health plans to consumers and government, are encouraged to join in the discussion.

$10k isn’t a ton of money, but for just submitting an idea it’s not too bad. It’ll be interesting to see what happens with the contest and what kind of creative ideas come out of it. I wonder if any EMR applications or EMR features will make it into the contest.

Business Intelligence to me is really just about being able to look at large amounts of data in really cool ways. EMR is basically synonymous with the concept of large amounts of data. Each and every day thousands of really interesting pieces of information are being entered into an EMR. Many times this data is organized in such a way that in can be easily accessed and reported on.

For my class, we’ve been using SQL Server 2005’s business intelligence components. While Microsoft may have its downfalls, they really have put some thought and effort into SQL Server 2005’s BI components. For my final project, I decided to extract some appointment data from my EMR (yes, I guess it’s really my PMS, except for things like the room for the appointment) and run some BI analysis on the EMR data.

I actually had to anonymize all the EMR data before using it, because I was working in a group where they weren’t allowed access to all the HIPAA related information. However, it wasn’t too big of a deal in the end. Although, it does lose some of the reporting ability when you do that.

Since we ended up only pulling out simple appointment data from the EMR database, we could only really run reports about appointments. Don’t get me wrong. There is some really cool stuff you can report on appointments. We reported on appointments by date (this includes day, month, quarter, year, etc), provider, gender, birthdate, ethnicity, etc. We also uploaded the room number that an appointment used so that we could measure the utilization of our exam rooms. Luckily our EMR stored all the information about exam rooms. We also pulled in the data that described when a patient arrived at the clinic, when the nurse started the intake and when the provider finally saw them. We haven’t actually built any reports on that time study data, but it would be really interesting.

That’s really just the beginning of what we were able to do with the EMR data, but I think you get the point. The real question at this point is what other EMR data could benefit from some quality BI analysis? Here’s a few of my thoughts:

-Blood pressure - Depending on how this is stored will determine how easy it is to report. However, it would be really interesting to see trends in blood pressure across our entire population. Add in a few filters for certain medications and you could see some amazing results
-Average Charge per Patient - Could be interesting to look at this and identify which patients are the most profitable. Wait, doctors aren’t about profit are they?
-Average Number of Visits per Patient - Would be interesting to see this grouped too.

Those are just a few off the top of my head. I’m sure there are a hundred more that could be done with diagnosis, prescriptions, charges, procedures, referrals, etc etc etc. Which reports would you find interesting from the data in your EMR?

The best part of this all is that in the next couple weeks I have planned to upgrade my EMR from SQL Server 2000 to SQL Server 2005. That means that I could really easily use all th SQL Server BI tools to create the various BI reports with all the data in my EMR.

Has anyone else done this type of EMR reporting before?

Certainly you could make a good case that a patient portal or EHR is more Health 2.0. In fact, that really seems to cut to the heart of Health 2.0. Creating a powerful interface between doctors and patients so that patients are a part of the process. However, I think that most EMR in their current state don’t benefit from this type of interaction.

Of course, this begs the question of whether an EMR should have this type of interaction. My short answer is that it should, but until the payment systems catch up with the technology that creates these interactions we won’t see broad Health 2.0 application to EMR software.

I’d like to invite you to try out the eDrugSearch.com Community — a brand new social network for prescription drug consumers. To join, just go to www.edrugsearch.com/register and sign up; it takes only a couple of minutes.

Why a social network for drug consumers? At eDrugSearch.com, we believe that online communities will forever change the face of healthcare — by giving consumers the information and resources they need to ask better questions of caregivers, to support one another, and to save money on treatments and medications.

Prescription drug consumers, in particular, have shown a strong interest in social networks on general health sites, indicating an unmet demand for a niche community. U.S. drug consumers relish the opportunity to share their experiences — their discoveries, their frustrations, their solutions. These Americans are turning to each other rather than relying solely on pharmaceutical company advertising or rushed doctor’s appointments.

We want the eDrugSearch.com Community to be a place you can come for help, reassurance and advice.

Of course, this really begs the question of if we need a social network around prescription drugs. Of course, my gut reaction is that prescription drugs sounds like much to small of a category for a social network. I’m certain that a lot of niche social networks are going to do very well (in fact, I’m working on a sports one myself), but can prescription drug consumers support a social network.

Seriously, when I’m taking prescription drugs I want to get off them as soon as possible. Are people going to just visit the site for entertainment. Certainly there are people who have chronic illnesses that take drugs for a long time, but won’t they stop visiting the site after taking the same drug for so many years? I guess maybe they’re hoping for advancements or alternatives to that drug, but that still feels like a stretch.

The other part of me thinks that something like this might work. I’ve always felt like one of the advantages of my job is that I had access to not only a bunch of doctors, nurse practioners and PAs, but I also support a pharmacy. In the past three years, there have been a number of times where I make the rounds of doctors, APNs and the pharmacist to learn about the drugs that were prescribed to myself or my family. To me this illustrates the need for information that people have when they are prescribed a drug.

Of course, the biggest challenge of this all is can you trust the information that this prescription drug social network provides? How do you know when someone is qualified in the area or not? Not to mention I could see the drug companies really abusing this site with false information. I think we all have been to hotel sites where the ratings just sounded too good to be true. Sounds pretty easy for the drug companies to do the same thing.

Now, if they had a way to certify providers (MD, DO, APN, PA), then you could give some credibility to what was being said. In fact, a social network for these providers to discuss the various drugs is something that could be very strong and useful. That sounds pretty Health 2.0 to me.

Of course, the problem with sending this information in an email is that email is not secure. Email encryption hasn’t taken hold fast enough to make it encrypted. Is a user’s email box really a secure location where they want their health information? I personally don’t have a problem with it, but I would expect that many people wouldn’t want their health information in their email any more than their regular mailbox. Either way, without the encryption it wouldn’t be difficult for someone to sniff out what’s being sent in an Email containing for example a patient’s discharge. It would be going across the internet in basically plain text.

This situation actually happened in Austrailia a little while back in an article I read called “Unsecured email sparks dispute.” I know I wouldn’t be happy if a clinic just decided to send these unsecured emails. Not so much because I was personally worried about my information being lost. I personally have nothing to hide (yet anyway). However, I would feel uncomfortable patronizing an organization that would deal so flippantly with my information.

I’m sure that someone will chime in that this is the whole purpose of a Patient Portal or EHR interface that allows people a secure method to receive and send protected health information. This is all well and good, but from what I’ve seen this usually requires the doctor’s EMR company to support this type of interaction. Plus, even more serious of an issue is that you’re giving your patients one more login and password that they’ll need to remember. Certainly not a deal breaker, but one more inconvenience for our users and the staff that have to support our users when they forget their password. Unfortunately, I think that this is the future of secured messaging, but I can always hope that there’s something better that we’re just missing.

We should also realize that this isn’t going to get any easier. In fact, I think we can reasonably say that this is going to get harder and harder. Don’t be surprised if soon some patient would like their health information somehow incorporated into some site like Facebook. It’s really only a matter of time until some developer creates a health interface into Facebook.

It might not make sense to most people, but the next generation of patients are going to grow up living and breathing their online life in some sort of social network (Facebook is just one example of these). They are very comfortable with transparency and will be interested in being able to track and compare health information with other people. Not to mention interact in a social network with other people who have similar conditions. It seems like this isn’t a question of if, but when this type of interaction will happen.

Even if you think that health information on a social network like Facebook is far fetched, we are already seeing health information propagating to the web in Microsoft’s HealthVault and Google Health. Is this going to be ok? Will it become as synonymous as online banking has become to the banking world? It’s not that far of a stretch to think that Google Health could easily be tied into Google’s OpenSocial platform which would allow a patient’s health information to do all sorts of cool things.

The convergence of Health Care and IT is going to be really interesting. It’s taken health care a while to get going with IT, but I think almost everyone agrees that IT could do amazing things to better the health care a person receives.

-Google Health will not contain ads (although I bet that won’t stop them from using the information to target the ads it shows you other places)
-Eric Schmidt repeatedly said no data would be shared without the consumer’s consent (unless of course some hacker finds a way around Google’s security measures)
-1,370 volunteers at the Cleveland Clinic are beta testing the application
-Portability is the key (we heard that this was a form of CCR, but if it requires consent are people going to go to the effort to make it portable?)

Despite certain privacy questions and fears around Google Health I think that Eric Schmidt made a very good point about the way Google will protect your information from legal cases when he said:

“In the Google implementation, your personal health information will not be given to anyone without their explicit permission, which is not true completely for HIPAA-compliant systems. If we get a subpoena, we always check our judgment as to whether the subpoena is narrow enough. If we think it’s a fishing expedition, we will fight it in court. That has worked well for us so far.”

The battle of PHRs by Google Health and Microsoft HealthVault have begun. While I love to see the big players participating in healthcare, I’m not sure they’ve figured out the right motivational drivers that will make this a smashing success. It wouldn’t surprise me if in a few years we hear stories about a life being saved because of proper information and how even one saved life is worth it.

The biggest disappointment: No announcement about when we can get in and try it out ourselves.

UPDATE: Techcrunch think that whoever cracks the healthcare nut will have a huge new market. I don’t see it ever cracking. Marissa Mayer talks about Google Health on the Official Google Blog.