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.

Boy, back in the good old days, protecting patient data was comparatively easy. All you had to do was make sure that nobody got their hands on a patient’s paper chart who shouldn’t be looking at it.

After all, simple stuff like locking file rooms and making sure charts never get left in a public place are pretty easy to understand. Sure, paper records get stolen or rifled through now and then — no system is perfect — but putting processes in place to prevent unauthorized chart access isn’t that complicated.

On the other hand, introducing electronic medical records  – plus e-prescribing, digital sharing of lab results and more — is a completely different kettle of fish.

For one thing, providers must control access to medical information stored in their EMR in a far more sophisticated way than they had with paper charts.  For example, while role-based access to data may not sound too threatening to your average IT boss, it’s not exactly intuitive if you’re not a geek. Figuring out just who should get access to what gets a lot more complicated than when you used to just have to pull and route a chart.

Another issue: few clinicians know much about data security, and it’s not likely that they’re going to suddenly get wildly excited about encryption or VPNs.  Sure, you can warn them that it comes down to whether some random stranger (or even a staff member) will steal their patients’ Social Security numbers or broadcast medical secrets. But it’s just about impossible to explain security issues without wandering into scary jargon that will alienate the heck out of many doctors.

Of course, healthcare organizations can make sure their clinicians are trained to understand the importance of  securing their EMR. And they can even explain why specific types of security measures will limit their HIPAA exposure, the best pitch you can make to non-techies.

Still, the bottom line is that moving from paper to EMRs isn’t just a change-management exercise. It forces clinicians to think about how they use, distribute and share data on a profound level. I hope it does, anyway…cause if providers aren’t ready to think about these issues, things aren’t going to be pretty.

I find it interesting how many people are propping up electronic medical records as the silver bullet that’s going to solve our healthcare woes. It’s going to lower costs, improve care and solve world peace.

Let there be no doubt that the promises of electronic medical records are real. My problem is that many of them are just far overstated.

This time article does a pretty good job of putting some of these promises in perspective. The article on electronic medical records ends with this insightful commentary:

Doctors and patients live in a world of painful, pressing questions. The great physicians I’ve known seek answers through personal commitment to each patient and judgment born of practical experience — neither of which I have found in a machine.

I think this highlights an important point. Technology isn’t going to take a poor doctor and make them good. In fact, in some respects an EMR just exacerbates any problems a doctor has already. This isn’t just true for doctors. It’s true for anyone in a clinic. Rare is the person who poorly charts in the paper world and by some miracle is able to chart well in an EMR.

What technology does have the potential to do is take an already good doctor and make them great. Let’s just not think it’s some magical silver bullet.

In a recent post on the CCHIT website, they have the written testimony on electronic health records and “meaningful use” that CCHIT submitted to the NCVHS. Here’s a quote from that written testimony:

During our initial years, certification served as a confidence-booster for providers concerned about buying EHRs that lacked the needed functionality, security, and interoperability. Financial incentives for EHRs then began to emerge, but they pale in comparison to the bold goals and nationwide scale of the Recovery Act.

I love that CCHIT’s noble goals in the beginning were to be a “confidence-booster” for those purchasing an EHR. Sounds like a nice big marketing tool to me. I’m just really happy that they’re finally open to admit that was the goal of the certification. There’s no doubt that CCHIT has done a great job selling itself as a way for doctors to trust their EHR vendor more than they would have otherwise.

It’s just unfortunate, that CCHIT hasn’t done any reporting on how effective their certification has done for those EHR that have certified. You’d hope that having this certification would mean that certified EHR users would have more “functionality, security, and interoperability.” At least for now, I have yet to see any data that confirms this notion. In fact, I hear some noise that it could be the opposite. Possibly why we haven’t seen any of this data?

Now, for the real kicker. Here’s a second part of the statement by CCHIT for the NCVHS:

Certification must step up to fulfill a more strategic role, serving not only to reduce risks, but as a dynamic coupling mechanism between advancing policies and the real-world development, marketing, adoption, and use of health IT.

A noble and important goal. I just personally don’t see any EHR certification being able to achieve that goal.

I read this nice post about an EMR system reporting “number of patients.” Here’s a quick snippet of the EMR reporting problem:

They considered a patient to be someone who had started a course of treatment. However, the clinical operations considered a patient to be someone who walked through the door.

Both of these are valid numbers, but when finance asked for ‘how many patients did you see,’ the two came up with wildly different numbers.

I can’t tell you how many times I’ve had discussions like this. For example, I’ve been asked the question, how many patients have we seen in the clinic? Do you mean people who have come to the clinic or total appointments for those people? Do you include nurse only visits for immunizations or do you just mean doctors’ visits? etc etc etc.

The cool part is now we’re past those basic EMR reporting and can now start looking at cool questions like, how many patients with a BMI in a specific range were properly diagnosed as obese? Was this addressed during the patient visit? That’s when the data in an EMR starts to be really cool.

I love when senators come out and write bills requesting for the government to fund an open source EMR. Turns out the most recent request came from Senator John D. Rockefeller has proposed a new law which would establish federal grants to develop open source software and standards for electronic medical records. You can read more about it on ars technica.

I have to admit that I strongly support the concept of open source EMR and really open source software in general. I just don’t know why government thinks that government grants would really help open source software. I could be wrong, but has there ever been a significant open source software project that was grant funded by the government? It just generally seems contrary to the open source development model.

I guess I just wonder how a senator gets it in his mind to write a proposal for open source EMR grants. Did an open source project request for him to do it? Where did the senator get this idea that it was a good idea to have an open source EMR? Did he consult the existing EMR projects to see if this is something that they would find beneficial to the cause?

Maybe he in fact did do all of these things, but I wouldn’t be surprised to hear that Senator Rockefeller knows little about open source software and in particular the challenges that open source EMR software is currently facing.

I recently became aware of a new open source tablet EMR that was going to be offered by Medscribbler. Everyone that reads this blog should know that I’m a huge fan of open source (see my previous posts about open source EMR). It’s about time that a really strong tablet based EMR software was available as open source software.

Open source EMR purists will probably be a little disgruntled that Medscribbler is built on top of other technologies which are not completely open source. However, I give them a pass for now since the open source community has so far failed to deliver very good tablet based software.

You can find more information about the free Medscribbler EMR software here or at their sourceforge page. The following is the official press release announcement:

Medscribbler is released as an Open Source electronic medical record

Scriptnetics, the leader in Tablet PC mobile healthcare applications, will announce Monday its release of the proprietary source code for Medscribbler electronic medical record, EMR, to the open source community. Installable components and the code for programmers are available at the globally recognized open source portal, Sourceforge.net.

“Releasing a Medscribbler Open Source EMR is the next logical step to drive the innovation that is needed to get to a point where the majority of physicians and other health care providers take up electronic medical records,” said Michael Milne, Chief Executive Officer of Scriptnetics. “We hope to encourage a stable, widely available and affordable entry level EMR that uses cutting edge technology with the mobility of the Tablet PC,” he continued.

To provide focus and stability to move the project forward Scriptnetics has assigned programmers to manage and contribute new programming code on a regular basis. Other programmers wanting to contribute but needing help in understanding the considerable amount of code that already exists can access live help and support. For programmers looking to maximize their skills, project suggestions are posted in a forum.

The new Open Source EMR is called Medscribbler Community and is the first vertical, enterprise level open source project to be designed specifically for handwriting recognition on the Tablet PC. Medscribbler Community is already being used by many healthcare providers both in stand alone computer situations and client server multi computer offices. This cutting edge EMR is also being used in Internet WAN mobile remote access situations.

Scriptnetics is the largest vendor of penable Tablet PC designed medical software in the world. The company’s flagship product, Medscribbler, has been distributed since 2003 and is being used by healthcare providers in the United States and Canada. Its offices are located in Wilmington, Delaware and Moncton, New Brunswick. www.scriptnetics.com and www.medscribbler.com

SourceForge’s web sites connect millions of technology professionals and enthusiasts each day. Combining user-developed content, online marketplaces and e-commerce, SourceForge is the global technology community’s information exchange network and the world’s largest open source software development and distribution environment. Its offices are located in Mountainview, California.

For more information on Medscribbler Community see: www.emrfreesoftware.com and sourceforge.net/projects/medscribbler/

Press Contacts:
Michael Ferguson
Scriptnetics
(506) 859-9271
prnews@scriptnetics.com

Full Disclosure: Medscribbler is a an advertiser on EMR and HIPAA.

I’ve been hearing a lot about Obama’s plans to invest in health care as part of his economic recovery plan. Here’s a few snippets of things I’ve read. Once I have a few free minutes, I’ll try to take a few minutes to provide my thoughts on Obama’s plans to invest in health care IT and EHR/EMR software.

First, take a look at an excerpt of Obama’s technology agenda from his website change.gov:

Lower Health Care Costs by Investing in Electronic Information Technology Systems: Use health information technology to lower the cost of health care. Invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records.

I originally saw the above listed as “Obama to invest $50 Billion in Electronic Health Records” and it’s interesting to see the same thing quoted just a little bit different at the Health Informatics Blog. $50 billion is a lot of EHR software.

Next, the Washington Post wrote that Obama and Daschle is looking for feedback on the health care system:

“In order for us to reform our health care system, we must first begin reforming how government communicates with the American people,” Obama said in a statement yesterday. “These Health Care Community Discussions are a great way for the American people to have a direct say in our health reform efforts.”

As part of this, you can go and share your thoughts on health care in the US with Obama and his health care team on Change.gov. It will be interesting to see what happens with the information posted to that site. I’m not sure exactly how we’ll know if what we’re saying is heard or not. However, the idea that ti might be heard is great to think about.