Has anyone participated in the health social network iMedix? I first read about this idea a few years ago on TechCrunch and it looks like they’re still around and kicking. I really like the idea of an empowered patient. I like the idea of having good information. I’m just not sure that iMedix or many other websites are the places for patients to get that information.

I wonder if iMedix could possibly start partnering with EHR companies to provide their platform of information integrated with a doctor’s portal. I’m not sure the doctor would ever go for it or if they would want to take on that liability. However, iMedix is interesting as kind of a Yahoo Answers for medical questions.

I’ve certainly seen this a few other places on the web and whenever I see it, I think about my experience at the doctor. Usually they don’t have time to answer all of my questions or it feels rushed or other questions just come up after the fact. Plus, I kind of like to know all the nuances of what’s happening. Since I work daily with a number of doctors, I’ve often found myself going and visiting with those doctors to become more educated about the treatment suggested by mine or my children’s doctors. One time my son was prescribed some interesting drugs for Mastocytosis and so I went and talked with the pharmacist I support and learned about the drugs as well. I just wanted to learn everything I could about the treatment and disease.

At the end of the day, how different is it for someone to go on a health website and ask the questions that I asked the doctors and pharmacist I work with? I guess the main difference is the trust factor between information on a website and my colleagues at work. However, the motivation to get more information is the same.

What can’t be discounted is the power of these health social networks to help patients with similar chronic conditions to interact with each other. I find this type of interaction really interesting to follow.

The more I consider what Google Health and Microsoft HealthVault are doing, the more I think that they just might have found the real solution to interoperable health records. I’m still holding out final judgment, but I’m really impressed with some of the things there doing.

For example, Techcrunch reported that Google Health just recently partnered with CVS for Google Health to connect with CVS to try and create a comprehensive pharmacy history. Considering Google had previously signed up Longs Drugs and Walgreens, Google is making good head way towards this goal. No doubt Google Health is also in discussions with Wal-Mart and Target, two of the other major players in this space.

Of course, the next step is to get patients to actually start adopting this technology. I can’t see many pharmacists pushing this feature. In fact, I’m guessing this might be an annoyance for them to have to support. Patients are going to have to force the issue if they want to use this. At least until there’s widespread adoption.

We’ll also leave the privacy issues of these connections for another day as well. Either way, these types of partnerships are like gold for Google Health. It creates a good foundation to build their product. I just still like to see more connections with EHR software vendors. I haven’t seen as many of those happening as I’d like to see.

I just came across a few interesting tweets where Howard Luks, Web 2.0 and HC 2.0 savvy Orthopedist fascinated by Social Media and influence on healthcare delivery, posted his 100 patient “poll” on PHR. His first question was how many people were interested in PHR. The second one was how many patients would want their healthcare data online (cloud). Check out the responses.

66/100 not knowing what a PHR is seems high. I would have guessed more like 95/100 wouldn’t know what a PHR was. The split for those interested in their HC information being online seems pretty representative. Over half of the people don’t care or don’t know. So far no PHR vendor has really given us a reason to care.

I recently came across an interesting term that I’d never heard of: Information Therapy. Here’s the wikipedia description of Information Therapy:

Information therapy works by engaging the consumer in the process of care. Unlike health information which a patient or family member may find on an open website like webmd or yahoo, information therapy is providing plain language evidence based medical information to a patient at the exact time that a patient needs it to help them in their heatlh care process. An example would be when a person who leaves a doctor’s office is provided an after-visit summary of instructions on how they can take care of their ailment at home. Information therapy may be prescribed by a clinician, (i.e. nurse, doctor or other health professional), by a electronic system in a medical institution (i.e.an electronic medical record), or consumer-prescribed.

Interesting term. Learn something new every day. I must admit that I’m pretty horrible with terms. Abbreviations are even worse. Sometimes people contact me with a bunch of abbreviations and I’m just totally lost. So, I either Google them or look past them. Either way, I’m so practical that I don’t care about abbreviations much.

The one that’s always killed me is CPOE. I never remember what that even means. I prefer to call it doctors entering orders. Maybe the abbreviation DEO was already in use somewhere else.

Well, I’ll embrace the term Information Therapy at least for this post. Information therapy is interesting and a PHR really takes it to the next level. However, I think it gets even more interesting when a PHR goes beyond information therapy and actually helps a patient make decisions on their own without seeing the doctor. Yes, I know there are so many legal issues around this, but we’re all far too familiar of the times where you go to the doctor and they basically do nothing but send you home with a script.

I won’t get into all the issues related to this, but I think that the term Information Therapy should be expanded to include a PHR or other website that helps patient save a visit to the doctor or even possibly provides an online doctor’s visit.

Otherwise, I’ll just have to change the definition of Information Therapy to what you experience when reading this blog. Wait, maybe that’s called EMR therapy.

Recently I’ve been reading a fair amount about the movement that many are calling Health 2.0. I think the most simple description of Health 2.0 is applying many of the Web 2.0 concepts to health care. My question is whether EMR fits into Health 2.0. My personal feeling is that most of them don’t. Most Web 2.0 projects are consumer facing projects that allow people to interact, collaborate and participate in the process. EMR software is more about facilitating a doctor’s charting.

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.

Think about how wonderful the ability to send a discharge summary by email to a patient straight from your EMR. I think it’s pretty easy to see the tremendous benefits of this type of communication. Send the patient information to one place they probably visit every day and where they can read and process the information away from the hustle and bustle of the clinic. Certainly many doctors have been doing this with little pamphlets or handout sheets with clinical information. Unfortunately, too many of these sheets never get read. Certainly that same thing could happen with an email, but at least the next generation of patients are going to want this information in their email box.

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.

Today I was preparing a proposal to have my work send me to the HIMSS 08 conference. As part of that proposal I used the list of Keynote Speakers as a little justification as to why this conference would be incredibly interesting and useful for my job.

As I looked over the list I was impressed to see that Eric Schmidt is doing a keynote at HIMSS. Then it dawned on me that HIMSS would be the perfect place to announce Google’s launch into the healthcare industry with Google Health. We know it’s coming or why else would they have put up a Google Health beta page and then taken it down.

Anyone have any inside information that this is the case? If it is, then I’m even more interested in being there to hear the announcement.

If I’m able to make it, then I’ll have plenty to do. I’ll have some great meet ups with many people from the EMR Update forums. I’m sure there will be a meet up of Healthcare IT bloggers like there has been at past HIMSS conferences. I can’t find the link now, but I’m sure I’ll find it if I go. I’ll also be certain to catch up with Naveen and the team at DoctorsPartner. I also told Nick from EMR Update that I’d bring my eee with its built in video camera and make sure to capture some interviews with some people. That would be pretty fun.

Anyone else planning to go to the HIMSS conference?

UPDATE: Neil Versel blogged the following info about Eric Schmidt at HIMSS

As for Google, CEO Eric Schmidt is delivering a keynote at next week’s HIMSS conference, and actually is holding a 30-minute press conference afterwards. The Internet search giant also is throwing a cocktail party next Tuesday, with the theme, “Home is Where the Heart Is.” The invite says, “Come meet the health team at Google and learn more about what we’re working on.” About all I expect to learn from the secretive company is who actually works for Google (I know a couple of people already) and whether the bartender can mix a dry vodka martini.

UPDATE: Google Health Beta is now LIVE!

Today I saw an article on TechCrunch that talked about how Google Blogscoped found a Google Health login page (UPDATE: The Google Health Beta Landing Page has been taken down) for the hopefully soon to be released Google Health. Of course, there isn’t really anything all that special about the login page. It looks just like almost all the other Google login pages. However, the Google Health page did include the following information:

With Google Health, you can:

* Build online health profiles that belong to you
* Download medical records from doctors and pharmacies
* Get personalized health guidance and relevant news
* Find qualified doctors and connect to time-saving services
* Share selected information with family or caregivers

Too bad none of the other links work, but it does give some interesting information about what Google Health will be like. The part that is most concerning to me is downloading medical records from doctors and pharmacies. How are they going to do that? The answer is that they aren’t really going to do it. There are going to be a handful of the thousands and thousands of doctors and pharmacies that will be able to work with Google Health.

I hope that Google Health does the right thing and integrates with something like CCR since it is already beginning to be established in many Electronic Medical Record software programs. That would be a huge boon to CCR, but it would also open up an entire set of doctors that could support upload to Google Health. This could definitely be a nice differentiator from Microsoft Health Vault which can’t do this either (unless it’s been added since I looked).

If Google Health decides to create their own standard for a clinic to be able to upload to Google Health they are crazy. Doctors have almost no motivation to support Google’s standard for uploading medical records. I’m not sure many EMR companies will support it either. I can see a few of them do it as a PR move, but I’d be very surprised if many of them bit on this. Doctors don’t buy EMR software because their patients can get their record out easier. It just doesn’t make business sense for EMRs or doctors to really do any sort of uploading like this to Google Health.

Of course the good thing for this all is that having another big player like Google interested in helping the healthcare system with some Health 2.0 solutions is great by me.

You can see my previous coverage of Google Health and also the Google Health Co-op.

Update: Here’s a screen shot of what Google Health could look like.

Update 2: What CEO of Google Eric Schmidt said about Google Health at HIMSS08.

As I pointed out in my previous post on patients filling out forms electronically, it is absolutely essential that your EMR software supports a robust set of preferences for determining which forms a patient should fill out.

Let’s take three example forms to illustrate most of the needed options: HIPAA privacy form, Health History form, Consent for Pap Smear. All of these forms need to be filled out in different intervals.

HIPAA Privacy Form
I think that in most cases, the HIPAA privacy form is something that just has to be filled out one time. Once I’ve filled it out, then I don’t want to have to ever see that form again. What does this mean for the EMR self check in kiosk? That means the computer has to check my account and know if that form has been filled out already or not. Easy enough right. I check in for my appointment, the EMR checks to see if I’ve filled out a privacy form and presents the form to me if one doesn’t exist. No sweat…or is it.

Of course, you can’t forget about the case where the government decides to change HIPAA laws and so now you have to change your HIPAA privacy forms. Let’s assume you change this form on January 1, 2007. This now means that your EMR self check in kiosk needs to now provide the new HIPAA privacy form to anyone who has not filled one out since January 1, 2007. Can this be done? Of course, and it really isn’t that hard. However, it’s an important difference that must be planned for.

Health History Form
How often do you make your patients fill out a health history form? Some may only do it once and then never ask again. If that’s the case, then you can see my comments above on HIPAA privacy form. In our clinic (and I think most others), a health history form should be filled out every year [Emphasis Added]. My clinicians tell me it’s just good practice to get the history if it’s been more than a year, because you never know what else might have happened to them or their family in that time. Is this really possible with a paper chart? Not very easily. However, with a computer it’s no problem.

When a patient checks in for the appointment, the EMR self check in kiosk checks the patient’s notes for the last time they filled out the form called “Health History.” If the form is more than a year old, then the patient is prompted to fill out a new health history form. Of course, we’ve previously set a preference that the Health History form should have be filled out every year. Again, it’s not rocket science, but an important difference from the HIPAA privacy form.

Consent for Pap Smear
This form is even more difficult. Unless of course your EMR is like ours and requires you to use specific appointment reasons when scheduling an appointment. When scheduling an appointment our front desk will choose appointment reasons like Pap Smear, Wart Removal, etc. This makes it easy for the EMR self check in kiosk to quickly check the reason for the patient visit and require patients to fill out forms like the Consent for Pap Smear.

A few other points of note:

Minors: I could easily see an EMR self check in kiosk determining a patient’s age and displaying special minor consent forms for those that are under 18. We’ve solved this problem using conditional questions on our forms which I think I’ll leave for a future post if people are interested. Minors is another good reason to capture the electronic signature as opposed to just using some sort of individually identified login for a signature.

The Unseen Procedure: Often you won’t know if a patient needs to fill out a consent for treatment form until after they’ve seen the doctor. This is obviously a problem since they can’t just fill this form out when they check in for their appointment. We’re still working through this problem, but we’re either going to go with scanning a paper form or possibly some sort of portable workstation with signature pad. I sure wish that UMPC’s were a little farther along. I’ll let you know how it turns out. This could also apply to forms like birth control and the unplanned pap smear.

One thing that’s important to understand is just because you could sign the form electronically doesn’t mean that it’s always beneficial. Does it really matter if you have your consent for treatment or HIPAA privacy form in your EMR immediately? It’s certainly nice, but it’s not like someone’s going to go looking for it in the EMR the next day to see what was done. The EMR notes contain the time sensitive information. As long as it’s eventually scanned into the EMR, then some forms can wait. Of course, don’t forget to weigh the cost of scanning to the cost of signing it electronically.

In the end, there are a bunch of business and operational decisions that are required to make using an EMR self check in kiosk work properly.

I’m still seriously considering my idea to create a clinical website wrapped in some sort of content management system. I think it’s a scalable idea that would only cost me the cost of designing a new skin/theme/look and feel for the clinic. Next week I’m going to try and make time to visit the doctor’s office that I think will fund the development of the product. Then, I’ll use that product to roll it out to other doctor’s offices.

While thinking about a clinical website for a doctor’s office I started wondering why a doctor might want a website for their clinic. Here’s just a few of the things off the top of my head.

• Market their clinic
• List their products and services
• Show staff information
• Show clinic hours
• Contact information for their clinic
• Link to their Patient Health Record (PHR)
• Provide clinic announcements
• List Health Education materials
• Promote their clinical research

I think the most powerful tool could be marketing their clinic. With the right combination of keywords and an integrated blog where you post local news items, you could find a lot of referrals. I think this could also be true for those doctors who like to sell elective procedures that have high profit margins.

Is there anything I’m missing about what a clinical website could offer a doctor’s office? I expect there are probably a number of them that I haven’t considered.