Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and HIPAA for FREE!!

EHR and Mobile Health News Around the Country

Posted on February 24, 2013 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.

It may come as a surprise to some, but according to a study by eClinicalWorks, the majority of physicians like EMR-connected apps, and mHealth apps in general. 2,291 healthcare professionals were surveyed, and 649 were physicians. Over 90 percent of physicians feel it’s valuable to have their EMR connected to an app. The study also revealed other interesting things concerning physicians and medical apps.

And EHR vendors may want to consider this when developing and updating their EHR. From the Black Book Rankings, here is a list of top EHR vendors among hospitals. I bet some of these ones definitely have.

On a similar topic, there was a recent study about physican EMR use in the United States. Apparently, they are behind other countries. While usage has definitely increased recently, with 69 percent of doctors using some type of EMR in 2012, it’s still well-below the rates in the Netherlands, Norway, New Zealand, the U.K, Australia, and Sweden, all that have EMR usage rates above 88 percent.

For anyone that is interested, there is quite a bit of legislation on telemedicine this year across the United States. This chart shows all that’s going on in three different categories — legislated mandate for private coverage, legislated medicaid coverage (primarily interactive video,) and other proposed bills affecting medicaid coverage.

There’s always a lot going on in the mHealth world. Have you heard of FilmArray? It’s a device that was developed by a company in Utah. So what does it do? Well, it can detect 20 respiratory diseases in less than an hour. This will definitely make it easier for people to get their illnesses diagnosed quickly. In other news, HealthTap has released a new program called TipTaps. The program sends tips, created by health professionals, and personalized for a person’s lifestyle.

Access To Clinical Data Too Easy Via Phone

Posted on October 26, 2012 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Lately, I’ve had reason to be in touch with my health insurance company, my primary care doctor and multiple specialists.  In speaking with each, what I’ve noticed is that the data they collect to “protect my privacy” isn’t likely to do a good job. And I’ve been wondering whether an EMR can actually help tighten up access.

When I called to discuss clinical matters, both the payer and providers asked for the same information: My date of birth, my street address and my name. As far as I know, folks, you can get all of that information on a single card, a driver’s license.  So, anyone how finds or steals or has access to my wallet has all the info they need to crawl through my PHI.

So, OK, let’s say providers and payers add a requirement that you name the last four digits of your social security card.

There’s a few problems with that approach. First, anyone who has your wallet may well have your Social Security Card.  Second, storing patients’ SSNs in the clear in an EMR is an invitation to be hacked, as the SSN is the gold standard for identity theft. Third, if you want to store them in a form that only allows the last four digits to be read, that’s another function you need to add to your system.

So, what’s the solution? Would it work to have patients identify which doctor they see (something a thief wouldn’t know) or a recent treatment or procedure they’d had?  Probably, although some patients — forgetful elderly, or the chronically ill with multiple providers — might not remember the answers.

Seems to me that when there’s universal use of patient portals by both providers and payers, this problem will largely go away, as patients will be able to be looking at their own records when talking to providers. This will make a more sophisticated security screening possible.

But in the mean time, I’m troubled to know that my payer and several of my doctors use a security method which can be so easily compromised.  Do any of you have suggestions as to what those offices might do in the interim between now and when they have a useful portal to offer?

Doctors Expected To Get “Meaningful Choices” From Patients On HIE Data Use

Posted on October 19, 2012 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Making sure the clinical data flowing through HIEs is seen only by those patients designate is a tricky problem.  But according to the ONC, it’s a problem doctors need to take on and manage, according to recent guidance from the organization.

ONC’s logic is as follows:

As key agents of trust for patients, providers are responsible for maintaining the privacy and security of their patients’ health information. In turn, patients should not be surprised about or harmed by their provider’s collections, uses, or disclosures of their health information. 

In other words, patients should be given a “meaningful choice” as to how information is shared, rather than simply signing broad treatment-related disclosures.

And as ONC sees it, the treating professional is responsible for educating patients enough to give them meaningful awareness of their options, including how information will be shared and with whom, as well as obtaining and tracking the patient’s choice.

This strikes me as a pretty ambitious expectation to have of doctors, who in most cases need to do little to explain information sharing to patients. Educating them on the broad range of places data could go, under which circumstances, and the extent to which patients can opt in or out of such sharing, strikes me as a very large task.

I’m not saying that I think ONC’s recommendation is an unwise one.  In most cases, the doctor — who’s most likely to be the treating professional — is really the only person who’s in a position to do this kind of education.  Not only is the doctor the person the patient trusts, they’re also in a position to review how well patients have understood on an ongoing basis.

All that being said, it’s still a pretty complex lesson to teach. I hope someone, perhaps ONC itself, develops online self-education for patients which a doctor can simply offer during the visit.  Otherwise, I think the “meaningful choice” concept will be hard to pull off.

Verizon Hopes To Be Secure Healthcare Network For All

Posted on September 11, 2012 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

If you’re like me, you might be wondering how carriers are  looking at their role in the healthcare business — and whether some of their talk about mHealth is just noise.  (I’ve always seen mHealth as a space ripe to be be dominated by applications developers and device manufacturers, not carriers.)

To get my head straight, I recently had a conversation with Dr. Peter Tippett, chief medical officer and vice president of Verizon Connected Health Care. In it, he changed my view of what Verizon is doing in mHealth, and moreover,  what ground Verizon specifically hopes to own in healthcare over the next several years.

When I think Verizon I think switches and routers and cables, not consumer-facing applications and medical devices. And before I talked to Dr. Tippett, I assumed that Verizon’s main healthcare efforts likely involved going head to head with other wireless/wireline connectivity players for connectivity business in some form.

Well, think again.  Verizon’s Connected Health Division, says Tippett, is aiming to set the bar much higher.

“The question is, ‘what happens after wireless data?’,” Dr. Tippett said. “This isn’t a two month plan, this is a strategic extension of Verizon to transform the healthcare industry using our huge capability around the world.”

On the more immediate front, Verizon has mHealth technology under development which, to my mind, would solve a difficult problem.  For five years, he says, Verizon has been developing a new mHealtlh platform which will tie together data from testing devices like blood pressure cuffs, weight scales and EKGs into an analytics engine that makes sense of it all.

“No doctor wants four glucoses a day from 1,000 patients,” Dr. Tippett says. “Just mobilizing the data isn’t enough. You’ve got to create a cloud service that can do big data analytics on it and normalize the data, then trigger the alerts to the right people — including patients.”

I’m going to keep my eye on the mHealth platform, which definitely intrigues me.

But the really big play for Verizon in this space seems to be in HIPAA-secure data hosting and exchange.  Verizon already has a massive presence around hosting, app management, security, identity management and the cloud, having added Cybertrust and Terramark (enterprise hosting) to build up its lineup.

Verizon now offers secure data sharing on multiple levels:

*  A “medical data exchange” — not unlike the exchange banks use to pass transactions back and forth — allowing any member to share information using Verizon’s security services.

* An exchange “identity layer” which is secure enough to allow Schedule 2 drugs to be prescribed. According to Dr. Tippett, 40 percent of doctors in the U.S. are already using it.

* A global network of highly-secured data centers.

Members of the medical ecosystem who use secure Verizon services can consider their HIPAA compliance and security matters handled, then focus on their core business, Dr. Tippett says. And that can scale to hundreds of millions of users on the network, he notes.

Clearly, this doesn’t sound like the broadband carrier talking — these folks are out to take business from players as diverse as Verisign, IBM and the database giants.  It makes sense to me, on the surface, but in any grand vision there are holes to be picked.

You tell me:  Does Verizon sound like it’s positioned right to become the default secure healthcare backbone?

A Smart Approach To Medicine And Social Media

Posted on August 29, 2012 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

It’s always a pleasure to touch base with the thoughtful blog  (33 Charts) written by pediatric gastroenterologist Dr. Bryan Vartabedian. This time, I caught a piece on how Dr. Vartabedian handles social media communication with patients, and I thought it was well worth a share.

While your mileage may vary, here’s some key ways Dr. Vartabedian handles medical contact online with consumers:

* He never answers patient-specific questions from strangers

As he notes, people generally ask two kinds of questions, patient-specific and non-patient specific. While he’s glad to answer general questions, he never answers patient-specific ones from strangers, as it could be construed that he’s created a professional relationship with the person asking the question.

* He guides patients he’s treating offline

If an existing patient messages Dr. Vartabedian, he messages back that he’d be happy to do a phone call. He then addresses their concern via phone, while explaining to patients how both he and they could face serious privacy issues if too much comes out online. Oh, and most importantly, he documents the phone encounter, noting that the patient who reached out in  public.

* He flatly turns down requests for info from people he loosely knows

The only exception he makes is for family and very close friends.  In those cases he arranges evening phone time and spends 45 minutes getting facts so he can offer high-quality direction.

I really like the way Dr. Vartabedian has outlined his options here — it’s clear, simple, and virtually impossible to misunderstand.  It’s hard to imagine anyone being offended by these policies, or more importantly, having their privacy violated.  Good to see!

If you’re a doctor how do you handle your social media interactions with patients?

Does Changing EMRs Make Security Vulnerabilities Worse?

Posted on August 23, 2012 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

I don’t have good statistics on hand, but changing EMRs isn’t unusual, and changing them a few times isn’t as rare as it should be.  Readers here know that this is a painful proposition for many reasons, including cost and the need to re-tool workflow over at minimum several months.

But I’ve noticed that few if any IT pundits talk about the security risks that must come from making such a shift. A few common sense issues come to mind:

*  Retraining staff:  Your overall security policy might not change, but the security workings of the new software may be somewhat different.  As staff reacclimates, there’s plenty of room for mistakes.

* Transferring patient information:  Whether you’re currently a Web-based EMR or one installed on site, you’ll have to transfer a lot of information to the new system.  What happens if the isn’t encrypted and locked down during or after the transfer?

*  Back door vulnerabilities:  If your existing installed software has any back-door vulnerabilities in it, they may remain or even become even more deeply buried when the new software is put in place.

* Re-establishing device security:  Whatever you’ve done to secure mobile devices may have been sufficient for your last system, but what about your new one?   Even cloud systems with strong back-end data protections aren’t going to make sure smartphones and iPads and laptops are secure against security breaches, and you may need to re-do protections for them.

In proposing these ideas, I’ve mostly envisioned what small- to medium-sized medical practices face. If the EMR change is from Cerner to Epic rather than a small-practice system to another, the problem is vastly more complicated.  Either way though, it isn’t a pretty picture.

So readers, if you were responsible for such a shift, what would your next steps be?  Do you have a transition security checklist you can share?

Broadband Mobile Should Change mHealth Game

Posted on June 22, 2012 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

You never know what you’re going to learn when you wander into a cell phone store,  other than being hit with some fairly slick marketing slicks and rapid-fire pitched on that sweet, sweet iPhone upgrade. (Sorry, letting my Apple lust get in the way here.)

In all seriousness, this time I learned something which excited the heck out of me. While this is probably old news to some readers, I was surprised to learn that the cellphone industry is now rolling out support for new mobile protocols allowing for dramatic improvements in broadband mobile speeds.

One standard, LTE, can offer peak downlink rates of 300 Mbps and peak uplinks of 75 Mbps.  LTE, which takes advantage of new digital signal processing techniques developed roughly 10 years ago, is being rolled out by more or less every major U.S. carrier. Existing 4G networks are should shoot up in capacity as well. The next revision of the family to which 4G belongs, standards-wise,  should have a throughput capacity of 627 Mbps.

So let’s bring this around to our ongoing EMR discussions.  What are the HIT implications of these mobile nodes having the throughput to process live streaming video, download multiple imaging studies, conference effortlessly with parties across the world and more?

Well, for one thing, it’s pretty clear that our idea of mHealth will have to change. It makes no sense to plan networks around data sipping apps like the current iPhone crop when you’ll soon have iPads, Android devices and even Microsoft’s Surface tablet drinking it in gulps.

Obviously, the whole notion of telemedicine will evolve dramatically, with roving doctors and nurses consulting effortlessly over mobile video.  Skype calls will be as easy to conduct as traditional calls. And reviewing charts from the road will make much more sense, including looks at, say, CT scan results.

But all of this wonderfulness will be severely constrained if EMR makers keep forcing clinicians to use their systems via mobile-hostile devices. This is the time — this month, week and even day — to admit that desktop computers aren’t the platform of choice for smart clinicians.Vendors will have to step up with native clients for remote devices, and moreover, clients that take advantage of the emerging high-speed phones and tablets. If they hang back, the whole mobile high-speed revolution won’t be happpening.

Should EMRs Force Workflow Changes?

Posted on May 30, 2012 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Today, I was lurking in the EMR and HIPAA Facebook chat where some readers and publisher John Lynn were talking of things EMR-related.  During that chat, one exchange really brought home to me how far we have to go in even agreeing on how the ideal EMR should work.

During the discussion, one chatroom member said that the biggest problem with EMRs is still that they force doctors to break their workflow.  Another stalwart chatroom member, the insightful @NateOsit, retorted that EMRs should break workflow patterns, as this would promote healthy change.

Well, there you have a conundrum,  if you look closely enough. While people seldom speak of the issue this directly, we’re still arguing over whether EMRs should fit doctors like a glove or change their habits for the (allegedly) better.

This isn’t just an academic question, or I wouldn’t bore you with it. I think the EMR industry will be far more wobbly if the core assumption about its place in life hasn’t been addressed.

At present, I doubt EMR vendors are framing their UI design discussions in these terms. (From the looks of some EMRs, I wonder if they think about doctors at all!) But ultimately, they’re going to have to decide whether they’re going to lead (create workflow patterns that follow, say, a care pathway) or do their best to provide a flexible, doctor-friendly interface.

I’d argue that EMRs should give doctors as many options as possible when it comes to using their system.  Perhaps the system should shape their workflow, but only if the users vote, themselves, that such restrictions are necessary.

But the truth is that when a hospital spends a gazillion bucks on a system, they’re not doing it to win hearts and minds, no matter how much they may protest otherwise.  And when a practice buys a system, they’re usually doing it to meet the demands of the industry, not give their colleagues their heart’s desire.

So let’s admit it.  Though I don’t argue that they’ll ultimately be put to great uses in some cases, ultimately, EMRs are about dollars and bureaucratic face-saving.  So, today’s workflow will just have to take a back seat.

EMR Design Errors That Cause Patient Harm per NIST

Posted on March 28, 2012 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

As long as there have been EMRs, there’s been endless debate over what system designs are most appropriate. Unfortunately, no matter how heated a threaded discussion gets, it’s unlikely to solve big problems.

Now, however, we may have a chance to build a consensus on what NOT to do in building out EMRs. A new report from NIST has painstakingly analyzed which EMR design factors have an impact on usability (PDF), including one subset which seems likely to cause patient harm.

The section on design problems which may cause patient harm is (unfortunately) rather long, so I’ll only provide some of the highlights, but you can download the whole PDF by clicking on the link above. (The “potential for harm” section begins on page 66.)

One major area NIST addresses is patient identification errors.  For example, if EMR displays don’t have headers with two patient identifiers, lock out or control multiple accesses to records, or fail to provide full patient identification with integrated apps like imaging, the wrong actions could be performed on the wrong patient.

Another major concern NIST identifies is data accuracy errors. There’s lots of ways EMR design foster data errors, the report notes, including when information is truncated on the display, when accurate information isn’t displayed unless users refresh the data, when discontinued meds aren’t eliminated and when changes in status aren’t displayed accurately.

NIST also identifies data availability errors as a big issue. Among other concerns, clinicians can easily make mistakes if they can’t easily see all the information they need to understand doses without additional navigation; if complex doses aren’t easily understandable without extra navigation; and if information accurately updated in one place shows up accurately and efficiently within other areas or integrated software.

As you can imagine, NIST has a lot more to say here. The report also includes analyses of how mode errors, interpretation errors, errors when physicians are forced to remember data, lack of system feedback when clinicians make inappropriate actions for the context and other tricky designs cause errors that can harm patients.

While I’m not a clinician, so bear this in mind, my feeling is that everyone here ought to read this report. Lots o’ valuable insights here!

Do RECs Deserve Respect?

Posted on July 6, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

When I learned that HITECH included funds setting up the regional extension center system to support small medical practices in implementing EHRs, I thought, well, that sounds OK.

I wasn’t thrilled, mind you, as I wasn’t optimistic that a government-sponsored organization would produce the quick EHR adoption process HITECH demands, but it wasn’t a bad thing.

Since then, I’ve gone from mildly interested to downright irritated.  While I wasn’t expecting the RECs to blaze a path to glory, I thought it would be nice if they produced great educational materials and sessions, made themselves highly accessible to physicians and offered clear guidance on vendor selection. As far as I can tell, we’re largely zero for three.

Yes, as a recent a recent study notes, the RECs are doing better at some of these things of late. According to a recent study by the eHealth Initiative, they’ve now reached most of the 100,000 PCPs they’d hoped to enroll, and they’ve developed better vendor specifications.

That being said, they really don’t seem to be that focused. Hey, if a privately-funded organization took this long just to begin to get started with their work, they’d already be out of business.

Not only that, when I made one completely unscientific mystery-shopper call to a REC, the staff member I spoke to didn’t seem to have much on the ball. He didn’t have anywhere to direct me for further information, didn’t have any informational meetings pending, couldn’t define clearly what his group could do for me and didn’t even bother to get my contact information.

Of course, that may have been a freak instance, but I’m beginning to doubt it. The buzz I hear is that the RECs have barely a clue as to how to reach their target population, and don’t really speak their language. Some of my EMR-savvy buddies think they’re just about useless.

I do truly hope that the RECs get their act together — maybe all they need is better marketers — but I’m not holding my breath.  My advice to doctors: Keep pushing on your local medical society, your IPA, your hospital partners and your practice management consultants to shed some light on the EMR adoption process. You’ll get further, faster.