Today at MGMA, Fujitsu together with Osmosyz announced a new scanner that supports the relatively new CDA “Unstructured Document” HL7 standard at MGMA 2011. I must admit that the press release is a little intense. However, I find what they’re doing with a hardware product to support HIE is quite interesting.

I don’t want the title of this post to be misleading. While certainly HIE has generally become synonymous with some large health information exchange entity, in this case I’m describing a hardware device (a smart scanner if you will) that acts as a small health information exchange. Basically, it’s more along the lines of Direct Project as opposed to NHIN. Although, I imagine that it could send the documents to some larger health information exchange if someone wanted to do so.

The larger application I see of this technology is as a replacement for the fax machine. In some ways, it’s like a second generation fax machine. The major differentiation I see between a document sent using the CDA “Unstructured Document” HL7 standard and a fax is all the meta data that comes with the CDA document.

The fax or scanning workflow for most EHR software consists of receiving faxed documents or scanning documents into what amounts to basically a bucket of all the scanned documents. Then, it’s up to the user to go in and sort through all the various faxes that have been received or documents that have been scanned. At this point, the user can assign the document to a patient in the EHR. You can imagine the challenges that this can pose. I wonder how many documents scanned or faxed into an EHR have been assigned to the wrong patient accidentally.

That’s what makes this new Fujitsu scanner quite interesting. If it’s receiving the document from an outside source, it will come with the meta information for the document as part of the CDA standard. That can then be leveraged to more quickly assign that document to the patient. Not to mention, then all of that CDA information is available for other uses within the EHR.

For inside documents that are scanned in through the Fujitsu device you can actually assign the document to a patient on the scanner itself. That’s right, you can identify which patient a scanned document belongs to while you’re holding the document in your hand. A much better way to ensure that the document you scanned gets attached to the right patient in your EHR.

I’m just touching on a few of the features of what’s possible with this new Smart Scanner from Fujitsu and smart documents. You can do other things on the scanner like dividing document scans between multiple patients.

Meaningful Use Monday Angle
Of course, as most of you know, on Monday we usually do our regular Meaningful Use Monday series. Turns out that the CDA Clinical Document standard that I discuss above is being adopted by ONC as part of meaningful use. I’ll be interested to see how this plays out over time, but don’t be surprised if EHR software has to support this standard in the future.

What I find more intriguing is that the above scanner could be used by someone who doesn’t have an EHR, but wants to exchange patient information. I still think that the long term solution to interoperability of patient information has got to come from connections with EHR software. However, this does illustrate that technology solutions can and will be created to exchange health information. In fact, some combination of these solutions could be a way to meet some of the meaningful use requirements around exchange of health information. You still can’t get the EHR stimulus money without an EHR, but technologies like this could help you achieve meaningful use.

I’ll keep an eye on how this technology progresses. I wonder how many EHR vendors will integrate with this type of technology. Whether we like it or not, documents are going to be a major part of healthcare for the foreseeable future. We’ll see if smart documents and smart scanners are an intermediate step to the health information exchange nirvana (whatever that might be).

My guess is that many of you are using an HL7 interface between your EMR and your lab. How does your EMR handle the signing of lab results?

We worked for an entire year testing, making requests, testing, more requests and more testing before we were able to launch an interface between our lab and EMR, but it’s been one of the best things we’ve done. The reason it took so long is the topic of another post, but it was for good reason.

One of the best advantages to a lab interface with your EMR is that you don’t have to worry about what to do with all those paper labs that you’ve signed. Inevitably all those signed paper labs will have to be scanned and attached to a patient in your EMR.

Really, that’s why a lab interface is so much better. The interface inserts the lab info right into your EMR so you don’t have to worry about:
1. Losing your lab results (before or after you sign it)
2. No need to scan your signed lab results into your EMR
3. You can run really cool reports on the data from those labs in your EMR (ie. blood sugar change over time)
4. Most EMR will notify you that there are lab results to read, so there’s no more waiting for the paper to somehow make it to you

In our EMR, a lab result gets easily signed off with the click of a check mark. Actually our labs our grouped into batches according to labs that were ordered at the same time. This makes it so all our lab results appear on one nice lab report as opposed to one lab report per lab. All doctors have to do is highlight all the labs and click “Mark as Read” and that whole batch of lab results are signed electronically in the EMR.

Of course, many of you will probably ask how we handle abnormal results. Well, I guess you’ll just have to wait to learn about that.

I’ve doing more reading on EMR and the likes since I finished a business plan I was writing. Here’s a few articles/blog posts that I found interesting:

Face Authentication Software
The Healthcare IT Guy posted an interesting review of some auto-recognition and auto-login system for healthcare workstations called FastAccess by Sensible Vision. A standard web cam, easily installed software that can recognize my face to log me in. I need to get me a demo so I can try it out.

US Healthcare System
This is a nice article saying that although the media describes the US Healthcare system as broken down, many “better” healthcare systems aren’t immune to problems.

Mirth Project
I really like the idea of an open source project that supports HL7 messaging. I just can’t get my head around what exactly this means and how they are making the wretched HL7 messaging any easier.

I’ve been coming accross a few different EMR and Health Information Management organizations that I probably should have known about if I was going to claim to have an EMR blog. Here’s are a few that I have found during my start into EMR blogging. I admit that I’ve only found a couple so far, but I figured if I posted the few that I’ve found here I might here from some of my readers on other organizations I should know about and follow.
HIMSS – Healthcare Information and Management Systems Society
TEPR – Towards the Electronic Patient Record

ASTM – Continuity of Care Record(CCR) Standard
HL7 – HL7 Standard

I know I’m missing a lot, but I’m sure my trusty readers will let me know of any others worth mentioning. I also must admit that I wish I would have gone to either the HIMSS or TEPR conference this year. I should have planned better. The HIMSS 2006 would have been really cool because I could have gone to the blogger meetup. Maybe next year.

I saw a really good article that seemed to be starting towards RHIO that everyone wants, but no one wants to work or pay for. The article discusses how Hospitals in Indianapolis have created an RHIO to exhange lab results, radiology reports, and discharge summaries.
It was really nice that it discussed some interesting challenges that face an RHIO. Foremost in my mind is that it requires someone a full day to be able to “copy and paste” the data from the records into a company’s EMR. They are looking at integrating it with HL7 so they don’t have to do this. I guess this is baby steps, but can you imagine having to enter lab result data all day. I did data entry for a while and it’s not any fun. Plus, this isn’t just data entry, but knowing which result field it should be added to in your EMR.
I wonder if they have any plans to integrate some of the data with the CCR standard. I think projects like this and the people behind them are going to really determine the future of medical interactions.

If you are implementing an EMR you need to understand the difference in types of interfaces. Unfortunately I bet this is a significant misunderstanding that occurs when discussing interfaces in an EMR purchase. Maybe this opinion is biased because that is what happened to my clinic. After a few long discussions we finally understood the questions we should have asked rather than assuming we knew how an interface works.

The assumption that was made by my clinic(thankfull not me since I hadn’t been hired) was that the interface would be bi-directional. What does that mean? That means that when a Pharmacy is ordered by a Doctor the script would automatically be available in the Pharmacy program(one direction). Then, when the script was filled it would post the charge back to your EMR(second direction). The assumption was made that this would just happen without considering a few questions. First, what happens when someone doesn’t want to fill their script at our pharmacy? Then, the Pharmacy database is filled with a ton of scripts that they never needed to fill. Also, what happens when a drug is filled in your EMR that isn’t available in your Pharmacy program? How does your HL7 interface match a prescribed drug with the drug in the pharmacy database which has enough inventory? How does the interface pass the charge back when someone brings in a pharmacy from another doctor?

For those of you familiar with HL7 interfaces you know that many of these things can be solved. In fact, I hope that somebody will post some ideas on the best ways to accomplish this. However, these are important things to consider and discuss when purchasing an interface. In many cases the “mythical” concept of it all just working may leave you with a uni directional interface.

Not that a uni-directional interface is bad. The fact is that my clinic currently have two uni-directional interfaces. One direction patient information and insurance eligibility is passed. The other direction charges get passed back. This has worked out quite well even though we expected a bi-directional interface.

The moral of the story is to Ask Questions and then Ask MORE Questions! You aren’t an expert on HL7 and you have the right to know what your vendor means by an HL7 interface.

I imagine there are other options than HL7, but so far I haven’t seen any. So, I’ll assume for now that there aren’t any until someone corrects me.

This CCR Initiative seems to show some interesting promise and I’m very interested to look more into it. I’m not sure how HL7 and CCR will work together(or against each other), but I expect to see the CCR abbreviation to become commonplace with EMR’s.

Here’s some good info I got from this website:

Continuity of Care Record Is Developed by

ASTM International Health Care Informatics Committee

W. CONSHOHOCKEN, Pa., 5 January 2006—A revolutionary new ASTM International standard will change the way in which healthcare professionals preserve and transfer healthcare information about their patients. The standard, E 2369, Specification for Continuity of Care Record (CCR), was developed by Subcommittee E31.28 on Electronic Health Records, which is under the jurisdiction of Committee E31 on Healthcare Informatics.

The Continuity of Care Record is a core dataset to be sent to the next healthcare provider whenever a patient is referred, transferred, or otherwise uses different clinics, hospitals, or other providers. The CCR will bring an end to physicians and other healthcare professionals having to act “blindly,” without easy access to relevant patient information. It will provide the necessary information to support continuity of care, thus reducing medical errors, achieving higher efficiency, and creating better quality of care.

During the past two years, U.S. President George W. Bush has called for greater interoperability of electronic medical records and personal health records. E 2369 represents a major step forward in assisting vendors and healthcare organizations in their search for simple, yet powerful tools that will help meet the president’s objectives.

Read more…