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EPOWERdoc and Unique Features of ED EMR Software

Posted on October 11, 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.

As many of you know, when an EMR or EHR vendor wants to show me their system, instead of getting a full demo of their EMR I instead ask them to show me the unique features of their EMR. Basically, I’m interested in seeing the features, functions, approach, etc that makes an EMR or EHR vendor unique from the 300+ other EMR companies in the market today. This was my approach when EPOWERdoc approached me with a request to take a look at what they’ve created with their EMRDoc software.

Turns out that EPOWERdoc has been around for 12 years and is already in 250 hospitals in 40 states. That’s a pretty good footprint for an Emergency Department comnpany. In fact, I read that they’ve done 17 million Emergency Department visits in North America in their 12 year ED EHR history. Of course, these numbers come from EPOWERdoc and we know how good EMR install counts are from EMR vendors. However, even if that numbers bloated it’s a decent sized install base. Update from EPOWERdoc: The client numbers and ED visits are correct, we started out as a Paper Template system from software printing and that is where the large client base is predominantly. We are 36 months into the EDIS market with the product you looked at and have 18 live and another 9 by first qtr 2012.

During the short demo, EPOWERdoc showed me 3 or 4 interesting things about their Drummond Group modularly certified EHR. However, the feature that hit me most was the EMRDoc prose generator. In fact, this demo was one of the reasons that I’ve started predicting an EMR documentation revolution against hard to read, bulky, clinical notes.

I wish EPOWERdoc had a video of their EMR notes prose generator to demo it. If they create a video, I’ll post it to my EMR, EHR and Healthcare IT videos website. Until then, here are before and after screenshots of the EPOWERdoc interface which shows the granular data entry and the note that was created (click on the image to see the full image).

And now the image of the outputted documentation:

We could certainly debate the finer points of the user interface for inputting the data. Plus, a screenshot doesn’t show some of the other elements they’ve created to be able to quickly handle the input of the granular data elements. What hit me was how much the second image read like a clinical note. To be honest, as I read it I felt like I was hearing someone dictating a clinical note. Are their subtle differences where dictation is better, definitely. However, they seem to have done a good job of taking the granular data and turning it into clinical prose. I’ll be interested to hear some doctors thoughts on the above to see if they agree or disagree.

There were a few other interesting EMRDoc features that stood out to me in my short EMR demo.
-As an ED EMR, you have a different workflow than an ambulatory practice. As such, you need the ability to manage multiple open records at the same time. What I think EMRDoc does really well is switching between patients, but then also tracking your last documentation location for that patient.
-Related to seeing multiple patients, EMRDoc documentation feedback tool provides the user (doctor, nurse, etc) with a real time feedback as to the status of the level of documentation for medical coding as well as what has been completed in the note. In the ED where you’re regularly pulled away to deal with a pressing problem, the feedback statuses are a great little feature.
-EMRDoc has a feature that forwards clinical information and data from the Nursing Record to the Physician Record and from various sections of the Physician Record to other sections. Pretty slick implementation that reduces having to document that same thing multiple times.
-One of the big questions for an ED EHR like EPOWERdoc is how they deal with the hospitals large HIS system. EPOWERdoc’s answer was a partnership with Iatric who uses technology allowing data insertion into non accepting systems such as Epic, Cerner, McKesson or Meditech. I’d seen Iatric (They had the amazing trick shot pool table guy at HIMSS), but it sound like I should get to know them a little more. Maybe I can get Katherine Rourke to cover them over on Hospital EMR and EHR as well.

As I said, I didn’t do a full scale top to bottom demo of the EMRDoc ED EHR system, but I thought these were some interesting features of their EHR that were worth sharing. I’d love to hear some first hand experiences from any EPOWERdoc users. Let’s hear what you think in the comments.

Real Innovation in EMR Will Come with Healthcare Innovation

Posted on March 31, 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.

It seems like EMR innovation has been a strong theme on EMR and HIPAA ever since I wrote about the lack of EHR innovation at HIMSS. I of course clarified my original post with this post on the future of EMR and EMR innovation and then wrote about the challenge that doctors have to differentiate EHR software amidst all the noise. I also think it’s worth noting that EMR software can be a tremendous innovation for a practice that is using paper charts. I just don’t see an EMR software that is the must go to EMR system. There’s no “iPad” of EMR software (yet?).

After careful consideration of these ideas, I can’t help but wonder if an EMR that provides innovation in healthcare is the innovation that will have an “iPad-onian” moment. Basically the EMR facilitates a dramatic change in the way healthcare is delivered. This isn’t some feature or function that the EHR company can announce at HIMSS. EMR features and functions will never be heard above the noise. EHR vendors are already saying they can do everything, whether they can or not. Instead I’m talking about a real change to the way healthcare is provided and that’s facilitated by an EMR software.

For example, is there a doctor brave enough to have an all iPad/iPhone medical practice? Their EMR software would all be in the cloud and would facilitate online visits with patients or in house patients with visits where the EMR software was easily accessible using wireless technologies. They wouldn’t even have an office. They would do half of their visits from the comfort of their homes and half at people’s houses. Would that cause people to talk? I think so. Would the business model for the practice need to be different? I think so. Would an EMR and related technology be essential to make this happen? Yes. Could an EMR company be built to facilitate this type of a medical practice? Sounds like an interesting franchise model to me.

I’m not sure if this is a good idea or not. Plus, there are certainly people a lot smarter, more informed and innovative than me that could make this type of idea even better. However, it’s becoming quite clear that building just one more feature and function isn’t going to differentiate you from the rest of the EMR companies. That’s why I won’t be surprised if the real “innovative” EMR company will likely be a startup company. They’ll likely not know very much about how healthcare is “suppose” to work. They’ll also likely be told that their model is impossible and just won’t work. Instead they’ll just focus on using technology to connect the doctors and patients in some non-traditional manner. To me, that’s the type of companies that healthcare really needs.

Rising Above the EHR and Meaningful Use Noise

Posted on March 23, 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.

There’s some really good comments happening on my previous post about EMR companies with an “In” with doctors. Check it out and join in with your thoughts. One of the comments reminded me of another interesting issue with all of these EMR vendors trying to vie for your attention. How does an EMR system rise above all the noise? Or if you prefer the doctor perspective, how can a doctor notice the really innovative and useful EMR companies amidst all the noise?

This is a serious problem and sadly I don’t know a very good answer. I talked with one company who was considering going into the EMR field and they said, “We know we can create a great product that works better than those that are present. Although, if we do, will anyone even notice.”

It’s a fine question that reminds me of my post about EMR software possibly being a commodity. Maybe it’s not a commodity, but the noise of 300+ EMR companies and meaningful use relegates it to a commodity because no one can tell the difference with all the noise. Bad singers sound a lot better in a noisy restaurant.

Basically, is there anything that an EMR system could say they deliver that would rise above the noise? In fact, this is essentially the question that I posted to the new Healthcare Scene LinkedIn group (You should join). I get a lot of pitches all the time running this site, and I’m not sure I’ve seen any EMR company have an iPad-onian (my new word for how the iPad revived the tablet industry) moment.

The biggest problem with this is that EMR vendors are saying everything under the sun. Including things that the EMR system can’t deliver.

Items that Make a Strong EMR System

Posted on February 10, 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.

Natalie Hodge MD posted an interesting list on Quora of what she considers a strong EMR system:

I am a pediatrician. Here is what I must have in 2011.
1. Usability. When I say usability, I mean I decide the definition of usability.
2. Patient Health Record. nuf said.
3. Lab interfaces that help my patients get convenient and timely blood draws that flow directly into their medical record.
4. Eprescriber that is easy to use and hosted within the same platform so I don’t have to worry about a third parties server being slow.
5. Secure messaging.
a. I need to be able to email patients in a secure fashion, and they need to be able to email me.
b. Text. I need to have secure text messaging visits with patients.
c. Video. I need to be able to do video visits with patients at times.
d. I need to be able to communicate with my team securely.
6. Inbound fax that brings any external communication directly into my emr system. Seriously it’s 2011.
7. Ecommerce. I do membership practice so I can’t be running to the bank all day long depositing checks.
8. Web based. I have to work in a web based world, because I don’t like the expense of maintaining servers and I have to be able to access my data from anywhere.
9. Iteration. I have to have a rapid feedback loop with the developers of the application. If I can’t continually give feedback that makes the emr better, then I may as well go buy an old dell desktop computer from 2004 and start using that.
10. Mobile. I must be able to access all of this on my mobile, right now, I’m Iphone 4 but next week I might be android.
11. Open. The EMR must continually create further opportunities to help physicians manage health of their patients, whether it’s by integrations with loseit.com, imoveyou.com or nike training camp’s iphone ap. Self tracking may be a key tool physicians may use to solving our nation’s health crisis.

So what I am saying is I have to be able to function in an entirely paperless loop, despite the distractions of reform, medicaid, medicare, meaningful use, and payors.

I’m sure many will have a lot to say about this list. Here are a few of my comments:
1. I wonder how Dr. Hodge defines usable. Of course, that’s the problem. She wants it usable, but likely can’t really define it.
5. I love a number of these ideas. Just a few HIPAA/security issues to deal with. Back in March 2006 I wrote a post with the idea of just having the full video recording from a visit in the EMR. I think it’s the long term future of healthcare. It is interesting that in many companies they want more video recording to protect them from liability. In other cases like many in healthcare, they don’t want video recording since it adds to their liability. I’ll be interested to see EMR vendors text message strategies going forward.
7. You don’t like the checks? Imagine that. Online bill pay. Amazing!
9. This is INCREDIBLY INCREDIBLY valuable. It’s one of the reasons why a smaller, but stable EHR vendor is often more desirable than one of the big name EHR vendors.

What do you think about this list? Is it reasonable? What’s it missing?

Guaranteed EMR Benefits – Accessibility of Charts

Posted on May 16, 2009 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 previously posted about the Guaranteed EMR benefit of legible charts. I told you this would be a series on the benefits of EMR and so here’s a link that will constantly update with the benefits of an EMR.

The second guaranteed benefit of an EMR is the accessibility of charts. This really encompasses a number of issues with paper charts.

Issue 1: Chart stored in Medical Records
I must admit that I’m always amazed at how quickly medical records staff can find a paper chart. However, just the fact that you have to call medical records to have them pull the patient chart takes time. Depending on your clinic, you probably have appointments and can pull the chart the day before and have it ready. However, this is much more difficult for those clinics that allow for patient walk ins. Not to mention when medical records staff are out sick or on vacation.

Plus, let’s not forget phone calls. How nice is it to be able to just pull up a patient’s record in the EMR while you’re on the phone with them. Try doing that in the paper world. Certainly is possible, but definitely takes more time to get the chart.

Issue 2: Where’s the chart?
Let me bargain to say that even the most organized practices have often had a paper chart go missing. I’m not talking about missing missing. I’m talking about a nurse, doctor, or medical records staff running around the clinic to see where the patients chart was placed last. Let me just list off a few possibilities: doctor’s desk, in the room (on the door), nurses station, unread lab results box, etc etc etc. Certainly there are ways to mitigate this problem, but it’s still a challenge.

Of course, the beauty of an EMR is that you never have to send out a search party to find a chart again. Just type in the patients name and you can pull up their chart. Another major time saver.

Issue 3: Multiple Users
I’m sure the nurses reading this will really appreciate this benefit. How many times a day does the nurse and the doctor both want to do their charting at the same time. Or maybe they just want to have that chart available so that when they have a free second they can do some charting. Most EMR support at least some ability for multiple people to view, access and add to the chart note at the same time.

Issue 4: Taking Charts Home
Maybe some doctors just really liked taking a stack of paper charts home. They love the smell of the paper chart and the print between their fingers. For everyone else, remote access to an EMR is so much nicer than having to run around with a stack of paper charts. Not only is it awkward to carry the charts, but misplacing the paper chart is a real possibility.

Broadband wireless connections are getting really cheap these days and provide a real benefit to be able to access your full chart electronically from almost anywhere. The time savings of figuring which charts to take with you is also a nice benefit. Not to mention the unplanned visit or call.

At the end of the day, EMR software really excels at making the chart easily accessible and can be a huge time saver for those utilizing an EMR.

EMR Salesperson Myth – Specialty Templates

Posted on May 11, 2009 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 to call out another myth that EMR salespeople love to use to sell their EMR system. Here’s the question and answer that will be familiar to many:

Doctor: Do you have templates for my specialty?
EMR Salesperson: Of course, we have tons of templates for your specialty.

Available templates is one of those myths that is perpetuated by many EMR companies. The problem with the question being asked is that “EMR salespeople” wouldn’t know the difference between a good and bad EMR template if they tried. Add in the idea of specialty specific templates and it’s no wonder they don’t know how to give a doctor a real answer to that question. They are also so far removed from the EMR template development that they can’t reasonably answer that question. So, stop asking the salesperson.

Instead, ask to see all of the specialty specific templates. At least then you’ll know up front the quality (or lack therof) of the EMR templates offered for your specialty.

I’d personally even take it one step further. Ask the EMR vendor to make a change to one of the templates you like. The harsh reality of templates is that almost every (and possibly EVERY) template you get from an EMR vendor is going to need at least some modification to make it look the way you want it to look. You might want to reorder the data, brand the note, add in missing options in drop down lists, or some other edit. Regardless of how big or small, you’re going to be editing the templates you’re given. Better to know up front the process for editing the template. If the person showing you the template baulks at your request to modify the template, that’s a really bad sign.

I’m not hammering on templates either. They can be very effective if created correctly. Just don’t expect a set of practice changing templates right out of the box.

Guaranteed EMR Benefits – Legibility of Charts

Posted on 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.

There are some absolute guaranteed benefits to implementing an EMR. These aren’t things that some will get. These EMR benefits don’t come from the government. They aren’t based on some certification. They are just absolute benefits to implementing an EMR system.

The crazy part about these absolute benefits of an EMR system is that most of these absolute benefits to using an EMR just get quickly swept under the rug. They are easily forgotten and never get the credit they deserve (like a good medical biller). People just begin to take them for granted once they have them that they forget what it was like before the implemented an EMR.

For those who haven’t implemented an EMR, most of the absolute benefits aren’t financial and so they don’t even make it on your list of reasons to implement an EMR. Well, I’m here to give these EMR benefits the proper acknowledgment they deserve in a multi part series highlighting each of these benefits of a doctor going electronic.

First EMR benefit….*drum roll*…

Legibility of Charts

I know it’s a generalization that all doctors can’t write legibly. However, why do you think that it became a generalization? Possibly because generally it’s true. The crazy thing is that this is going to get progressively worse. The next generation of clinical providers have used the computer so much, they don’t even know what the term penmanship is. I’m willing to admit that I don’t even really know how to write in cursive anymore (outside of signing my name).

Needless to say, being able to read what’s been written in a patient chart is extremely valuable. This becomes even more true when we’re talking about information sent through those high quality (sarcasm) fax machines in every doctors office. The legibility found on typed documents that are faxed is so much better. Of course, I don’t even really need to step out of the office to see the benefits of a nicely typed, legible note. The doctor reading the nurse note is more accurate. The doctor reading past notes is more accurate. In a group practice, the doctor reading other doctors’ notes. The list goes on and on.

Legibility of EMR notes is valuable. Difficult to measure, but incredibly valuable. Don’t discount this benefit of an EMR.

ePatient’s Experience Transferring Patient Data to Google Health

Posted on April 9, 2009 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 just finished reading a 2800+ word post talking about e-Patient Dave’s experience transferring his patient record from his hospital PHR to Google Health. If you’ve ever been to the doctor, I think it’s worth a read to learn about how doctors are charting and a little bit about where we are in patients’ owning their own health record.

I will just share a couple quotes from his experience that really stood out. First a look at why the EHR billing centric software we have now is a major problem for the future of PHR:

The really fun stuff, though, is that some of the conditions transmitted are things I’ve never had: aortic aneurysm and mets to the brain or spine.

So what the heck??

I’ve been discussing this with the docs in the back room here, and they quickly figured out what was going on before I confirmed it: the system transmitted insurance billing codes to Google Health, not doctors’ diagnoses. And as those in the know are well aware, in our system today, insurance billing codes bear no resemblance to reality.

For the love of insurance billing codes. Nice way to ruin valuable data.

Another nice quote is about the data integrity of what’s being put into the EHR system:

And you know what I suspect? I suspect processes for data integrity in healthcare are largely absent, by ordinary business standards. I suspect there are few, if any, processes in place to prevent wrong data from entering the system, or tracking down the cause when things do go awry.

And here’s the real kicker: my hospital is one of the more advanced in the US in the use of electronic medical records. So I suspect that most healthcare institutions don’t even know what it means to have processes in place to ensure that data doesn’t get screwed up in the system, or if it does, to trace how it happened.

I know this is a major challenge for our clinic. Our medical records staff have been doing regular EHR chart audits of our providers and sometimes we’re just amazed that someone would electronically sign something in the record. I don’t know how many times we’ve said, “What were they thinking?” Certainly the same thing happened in the paper world, but it is often much harder to “fix” errors like this in an EHR.

What other methods are people using to ensure reliable data being added to their EHR system?