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Inaccurate EMR Data, Patient Engagement, and Studycure: Around Healthcare Scene

Posted on September 23, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

EMR and EHR

Primary Docs See Hope For Stronger Financials With EMR

A recent study revealed that 51 percent of doctors felt the EMRs would help solve their problems. In fact, some believe that it will help them financially as well. Their theory? Better coding and documentation will lead to more efficiency and reduction of costs. Is this a worth-while belief, or are these doctors setting themselves up for disappointment?

EMR Data Often “Innaccurate” Or “Missing”, Study Says

EMR adoption is expected to reach nearly 80 percent of healthcare organizations by 2016. This may come as a relief to some who believe that EMRs eliminate data errors that come with paper-based systems. However, EMRs may not be as accurate and complete as everyone might hope. Symptoms on patients who die quickly may not be recorded, and accuracy can depend on if a patient was treated at night or during the day. Teamwork may be the solution to eliminating EMR-based errors.

Hospital EMR

Your Facebook-like Health and Status Feed

Should healthcare practices integrate a social media-like system, incorporating real health time and status feeds, into clinical workflow? In theory, it would be a great idea. However, as with Facebook and Twitter, not every status gets read. This may get information out quickly, but maybe not to who needs to see it.

Happy EMR Doctor

Patient Engagement in the Digital Era

Patient Engagement has gone from eye-to-eye contact to Googling health questions. While this may seem like patient engagement is becoming less personal, it can be positive. Patients can be more involved in their health care, and take control of it. Dr. Michael West discusses that and more in his article this week.

Smart Phone Health Care

Studycure: Experiment Your Way to Better Health

Need some extra motivation to meet goals? Studycure is part social experiment, part motivation, and aims to help people meet their health goals. By implementing a texting program that sends reminders throughout the day and questions concerning your goal, it analyzes after a certain period of time if the methods used to meet a goal are being met. Goals are customizable, can be shared with friends and family, and others goals can be tracked and used as inspiration.

EMR Templates

Posted on September 6, 2012 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’m always fascinated by a discussion of EMR templates. A little while back on the 3M blog, they wrote what I think is a pretty good summary of the pros and cons of EMR templates:

Using template-based documentation provided by most EHR vendors allows for documentation to be available almost immediately for communication with the rest of the care team, which is important especially for daily progress notes. Choosing templates over dictation-transcription eliminates the variable of transcription turnaround time, which can range from a few hours, to a day or more. Templates also allow documentation to be created in a consistent and structured format, with up-to-date problem lists.

There are clearly many benefits associated with the use of templates, however from what we’re hearing there also are a number of drawbacks to this strategy. Coding, communication with other care providers, and physician efficiency can all be impacted by template-based documentation. We’re seeing that physicians don’t capture as much information when they fill out a form-based template as they do when they are allowed to capture the patient narrative in their own words, either through writing or dictating. Key information may be missing, which impacts both the care team and coding—and could result in the dreaded “every patient looks the same from the documentation” issue. Some physicians tell us that templates slow down their daily workflow, making them frustrated with their organization’s EHR implementation.

The discussion of EMR template use is a complex one. In many cases you can see the benefits of using an EMR template, but there are also a lot of downsides to their use. I remember when Dr. West wrote a blog post about why he loves his EMR templates. As I thought about his views I realized what the difference was in his templates and the templates that many other doctors use. He created his own EMR templates that were specific to him. I think that makes all the difference in the world.

Turns out that no one really hates EMR templates or loves EMR templates. They’re just a means to an end. What then are the benefits and challenges of using EMR templates.

EMR Template Benefits:

  • Saves Time (if designed well)
  • Helps Ensure Standard of Care
  • Documentation Always Found in Same Location on the Page

EMR Template Challenges

  • Every Chart Looks the Same
  • Lots of Clicks (if designed poorly)
  • Abnormals are Difficult to Identify
  • Difficult to Document Multiple Chief Complaints
  • Template Not Physician Specific (or takes a lot of time to create ones that are)

I’m sure there are other points worth noting. I look forward to hearing which ones I might have missed in the comments. I think the key when considering templates is how to make sure you get the benefits while mitigating the down sides. I think this is possible, but it takes some time and a thoughtful approach to make it happen.

The Move to Cloud EHR

Posted on August 21, 2012 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’m pretty sure that many people missed the announcement that Amazing Charts now offers a Cloud EHR. For those who don’t eat, sleep and breathe EHR like me, you probably don’t realize that this is a pretty significant announcement on Amazing Charts part and I think represents a larger shift in the EHR industry.

I know the SaaS EHR purists will say that not all “Cloud EHR” are created equal. This is highlighted in the Amazing Charts press release where it says “without a web browser.” It’s an ironic statement when you consider that most SaaS EHR happily say, “with only a web browser.” (Although, the web browser only EHR software companies should read this post by Dr. West) However, my goal here isn’t to highlight the various nuances of hosted or cloud EHR software.

Instead, I wish to highlight how one of the popular, established, client server EHR software vendors was getting enough requests from doctors for a hosted EHR solution that they now offer a cloud based EHR. The reality is that many physician practices want to have to deal with as little IT support as possible. This is the major reason I’ve heard over and over again that many practices want to have a hosted EHR.

It’s worth pointing out that Amazing Charts focuses on the small physician practice market. It’s always been clear that the larger physician practices or hospital owned practices have better capabilities and a greater interest in hosting their EHR in house. While there are strengths and weaknesses to a hosted EHR vs an in house EHR, the hosted EHR is the compelling choice for the IT averse clinic.

Very soon we’re going to see almost all new EHR installs in small ambulatory practices using some sort of hosted EHR software. This doesn’t necessarily spell the death of client server EHR software. Many large practices will continue using and implementing client server EHR software. Not to mention many long time EHR users will continue with their existing client server installs. However, the shift to hosted EHR is happening and will start to really pick up pace in the next couple years.

Full Disclosure: Amazing Charts is an advertiser on this site, but they didn’t know I was doing this post.

The $9.99 iPad for Healthcare

Posted on September 8, 2011 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.

Many people in healthcare are still debating the value of the iPad in their medical practice. For example, Dr. West has expressed his iPad hesitations. That’s why I was fascinated when I saw this video which demonstrated a $9.99 iPad like tablet. This tablet even has some features the actual iPad has. Check out the video below to see what I mean:

I’m reminded of a previous post I did (which I can’t find right now) where I discuss the perfect solution to charting. It’s flexible, easy to learn, portable, etc….it’s a paper chart. Of course, don’t let the humor distract you from the benefits of an EMR or EHR.

Common EHR Implementation Issue – Inadequate EHR Templates

Posted on September 6, 2011 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.

Time for the latest entry in my series of Common EHR Implementation Issues. See also my previous posts on Unexpected EHR Expenses, EHR Performance Issues and a little follow up to avoiding the EHR performance issues altogether.

This weeks common EHR implementation issue is: Inadequate EHR Templates.

Before I begin with the major issues of inadequate EHR templates, it’s worth noting that there are a few EHR software out there that use a different EHR documentation paradigm than templates. For example, some use voice recognition to power their documentation. Others have a system that learns your documentation over time and based on that learning remembers how you want to document certain procedures. Others, use lots of independent documentation methods (one EHR vendor calls them controls – check box, radio button, freetext field, etc.) which can be grouped and used in interesting ways.

However, even with all of the above alternative documentation methods, there’s often an element of templating that’s occurring. They’re PR and marketing people will shudder at the term template, but concepts related to templates seem to pretty much always apply. For example, in voice recognition there’s something called a Macro. That’s basically a template. The EHR system that learns your documentation method is just using your initial documentation in the EHR to create personalized templates of how you like to document. The independent documentation methods often group those various “controls” into groups of common visits. That sounds like a template to me.

I’d be interested to hear of an EHR system that doesn’t use the principles of templates. It is worth noting that all EHR templates aren’t created equal. Some are much more flexible than others. Now to some details.

The inadequate EHR templates shows itself in a number of different ways.

No Specialty Specific EHR Templates – This has to be the complaint I hear the most. It usually goes something like this, “The EHR salesperson said they had templates, but they don’t have any templates I can use.” Did someone say EMR salesperson mis-communication? Yep, happens all the time. Let’s be honest for a second. How could the EHR salesperson know how good their cardiology or neurology templates really are? They just go by what they hear and what they’re told by the EHR company.

Incomplete or Unusable EHR Templates – You may have noticed a subtlety in the quote I put above. At the end the doctor says “templates I can use.” Maybe the EHR salesperson isn’t lying to you about them having those cardiology or neurology templates. Maybe they do have a bunch of templates for those specialties (or whatever specialty that interests you). However, just because they have templates for those specialties doesn’t mean that you’re going to want to use any of the templates that they’ve created.

My favorite complaint is when they say that the specialty templates seem to have been created be a general medicine doctor and not an actual specialist from that field. I’ve heard it far too much not to mention it.

The other major problem with this point is the unique documentation preferences of each doctor. Has there ever been any two doctors that document the same way? We could debate the good and bad merits of such documentation, but the point is that each doctor is very different. Some feel the need to over document the encounter. Other doctors want to just document the bare minimum. Plus, some (purposefully or not) do a terrible job documenting the visit. The templates in an EHR could reflect any of these various documentation patterns and depending on your perspective could mean that EHR has inadequate templates for your needs.

Hard to Modify, Add to, or Adjust – While not specifically an inadequate template, this is an important part of templates. Turns out that if a user can easily modify, add to or adjust a template that is inadequate, you’re going to be a lot better off. Some template systems are like pulling teeth to modify. Others are amazing at how you can on the fly modify the template.

One promise I can make you, You WILL want to modify their templates. I can’t say I’ve ever heard of someone using the templates perfectly out of the box. Well, maybe I’ve heard of one or two using them, but that was when they were complaining that they had no way to modify the things they wanted to change.

Avoiding EHR Template Inadequacies

The best way to avoid this issue is to test drive the EHR software and the specialty specific templates you hope to use. Run through the templates like you’re charting on some common patients. You’ll learn a lot about what templates are available doing this than anything else. You’ll see if the templates are overkill or below standard for your needs.

Another great test is to try using multiple templates for a complex patient. How easily is that done and how well does the documentation display?

Then, during your EHR demo with the EHR salesperson, ask them to modify part of the EHR template they’re using to document. Tell them you don’t like to ask one of those questions, so you’d like to see them remove it from the template. Many are likely to respond, “It can be done, but I’d have to switch systems to do it or I’d have to call in to tech support to make the change.” I think we all know the real message they’re sending.

For those not interested in EHR templates, you might take a second to read Dr. West’s Experience implementing EHR templates in his office.

EMR Perpetuates Misinformation

Posted on March 15, 2011 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 have a number of doctor friends that I know from church, scouts (yes, I’m an assistant scoutmaster), or other local group. I must admit that generally our focus is whatever activity is at hand, but every once in a while they or I will bring up the topic of EMR.

These types of discussions are especially fascinating because they give a nice insight into a doctor’s perspective from someone who’s not inside the healthcare IT bubble. You know, that bubble where we all know the difference between meaningful use stage 1 and 2, ONC-ATCB and CCHIT, and a whole set of other acronyms. Certainly these doctors know some of these terms or have at least heard of some of these terms, but they definitely don’t know all the details. In fact, that’s what makes it so interesting to see what they know and what they don’t know.

I bring all of this up because I had a short discussion with one of the really smart doctor friends of mine. When I say smart I mean it from a clinical standpoint (he’s seen me a few times), but he’s also a very smart businessman as well. So, with this respect I’m always interested to hear his take on things.

This doctor has been a user of an EMR for quite a few years. He’s quite satisfied with his EMR and in our discussion he is planning to get the Medicaid EHR incentive money. After a short discussion he stopped and told me, “John, you know the thing I dislike most about an EMR?”

Then, he proceeded to tell me, “The thing I dislike most about an EMR is that it perpetuates misinformation.”

I’d certainly considered the topic before, but I thought it was an excellent description of this EMR challenge.

Part of this reminds me of a guest post done by Dr. West about Copy and Paste in EMR (He now blogs at Happy EMR Doctor). Copy and paste has the challenge of perpetuating misinformation too. Although, I think his comment is much deeper than just copy and paste.

There’s a challenge in most EMR software to take whatever was entered as complete fact. It’s not usually as easy as putting a line through it to correct something that was entered incorrectly. There’s no reimbursement for correcting or updating records even if it’s really essential to great patient care. As a commenter on the above copy and paste post said, “It is not the machine or process, it comes down to ethics, professionalism, and accountability.”

Is cut and paste in EHR software really such a bad thing?

Posted on November 22, 2010 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.

The following is a guest blog post by Dr. Michael West. I recently met Dr. West and was really impressed with his approach to EHR. After reading a few of his comments on the site, I asked if he was interested in doing some guest blog posts. This is the first of what I hope will be many more blog posts by Dr. West.

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.

When, I was in residency at a large health system in Pennsylvania, several of the residents and interns got into the habit of templating hospital notes on their home computers the night before they would go in to see patients who were chronic players with multiple medical problems who would often stay for long times in the hospital. I’ll openly admit that I was one of the many who bought into the perceived need to make things more efficient in order to get out of the hospital sooner and have a better home life. The concept was simple: design a pre-templated note for each chronic patient, detailing the plans (which would rarely, if ever, change), and then save it and mass produce at will. Of course, this did not go over well with our purist administration who were in charge of ensuring the highest quality, authentic notes for each patient on each day. In their correctness, they noted that sometimes these notes would be put into patient charts without those small changes that would, in fact, take place from day to day, thus resulting in erroneous documentation.

Now, years later, in the world of EHRs, there seems to be a push-back against the “cut and paste” concept. I know this is out there for two reasons: one, because I have read a blog or two citing it, and two, because I have enjoyed doing it myself. In the cut-and-paste world of computerized documentation, it’s addictively efficient. Gutenberg, the inventor of the printing press which allowed mass production of books and changed the world, would be proud. The responsibility for using such powerful efficiency does fall to the individual health provider to carefully review, edit, add and subtract documentation to ensure current accuracy. However, if done correctly, it allows careful preservation of a summary of what came before.

For this, I have some personal recommendations. First, actually DO the editing, don’t just cut, paste, and sign. Second, go back and refine the previous note for word choice and economy. Otherwise, you will create endless run-on documentation that is unprofessional in appearance and a burden for your colleagues to wade through later. From a billing perspective, it facilitates and supports that you have actually reviewed the patient’s previous history rather than just asking them what’s going on today. I find that cutting and pasting the old plan prompts me to consider everything I was trying to accomplish after the last visit and promotes holding the patient accountable for getting all of their previous orders accomplished. If something was not followed up on by the patient despite my recommendation, then this definitely gets documented in the current note. And then, of course, I ask them to “try, try again.”

I find nothing inherently wrong in this process and my patients get the benefits of an accurate portrayal and review of their conditions with appropriate follow up evaluation and managent. So cut, paste, edit, and save your evenings for yourself, rather than dictating entirely new notes that regurgitate the same old information. Work smart, while still working hard.