Welcome to EMR and HIPAA

NaturallySpeaking (Medical) Version 10 is now available. Have any of the EMR and HIPAA readers used DNS 10? I’d be interested to know people’s reviews of DNS 10 as compared to 9. Luckily the upgrade is relatively inexpensive to go from one version to the next, but I’d be interested to hear people’s experience with DNS 10.

One of my blog readers already did their KnowBrainer 7 page pictorial preliminary review of DNS 10. Too bad the pictorial review is a pdf file. Also, that review is pretty technical, so if you’ve never used DNS before, then I wouldn’t suggest reading that review.

A few days ago I got the following email to my EMR and HIPAA email address. Ignore the part where the company is trying to sell their service and think about 1. Should patients be diagnosing themselves and 2. should EMR companies provide an EMR interface on the iPhone.

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.

In a recent comment, Tom Hamilton from KnowBrainer software sent some interesting insights about using Dragon Naturally Speaking. His observation about more and more physicians using Dragon Naturally Speaking with their EMR or EHR is very true. I expect this trend to continue for quite a while. I don’t know how many times doctors have asked me for this ability. Unfortunately, it is like any software program and takes some getting use to, but those that do get use to it seem to really love it.

Here’s what Tom sent me. I hope it’s valuable for those looking at voice recognition with their EMR or EHR. I always welcome guest posters who want to post information like this to my blog. If you’re an expert at something related to EMR, EHR, or other Healthcare IT related topics, then let me know if you’re interested in being a guest blogger.

EMR Software and Dragon NaturallySpeaking are being utilized together in more practices and by more physicians every year. In light of that fact I would like to offer this information to the curious.

1. If you’re using Vista you should have 3-4 GB of RAM. For an XP platform you will require 2 GB of RAM. The software will run on less but won’t be very as effective.

NOTE: If you’re looking at buying a new computer to use with DNS I would consider looking at ASUS computers. Regardless of what system you by, you want a Core2 Duo 2 GHz or better CPU speed, 2 GB of RAM an XP platform (3 GB on Vista), 2 - 4 MB of L2 cache, a SATA hard drive of at least 100 GB although you may be able get 160 for about the same price. Your soundcard will be important so go with a mid to high end Soundblaster.

2. Unless you’re using a Soundblaster card don’t depend on the integrated soundcard in your computer as it is probably poorly shielded. Get yourself an external soundcard (USB Pod) and use a USB port on the back of your computer as opposed to the front.

3. Here is a copy of the manual we wrote for version 9. It’s designed as version 9.5 upgrade manual but if you are a new user to DNS you can download a full copy manual at KnowBrainer.com. KnowBrainer Manual

4. Here is a copy of the KnowBrainer Quick Tips which is PDF help file for day to day troubleshooting that is updated all the time from questions answered on our forum.

5. Here is a copy of our DNS 9 Review. I think you’ll find it pretty thorough.

6. For research feel free to use the KnowBrainer Speech Recognition Forum as it is by far the largest and most active of its kind.

7. I know there are quite a few users of NaturallySpeaking version 9 who don’t know about the Free upgrade to 9.5. Then there are some that do but don’t have time to find a path to it and worry about difficulty installing it. You should always use the most updated software especially when it’s free. Version 9.5 consolidates the code between version 9 and 9.1 and contains a few minor tweaks. The main purpose for the upgrade is for Vista compatibility. Here is your path and instructions - DNS 9.5 Update Guide

KnowBrainer, Inc. Support Staff – Tom Hamilton
Now Providing FREE (1st 5 min.) Tech Support 615-884-4558
A Nuance Gold Certified Endorsed Vendor
ALWAYS Ask If Your Speech Recognition Vendor Is Nuance Certified

Thanks Tom for the information. I think I’m going to have to “borrow” the dragon naturally speaking software one of my users cast aside and try it for myself.