Welcome to EMR and HIPAA

Think about how wonderful the ability to send a discharge summary by email to a patient straight from your EMR. I think it’s pretty easy to see the tremendous benefits of this type of communication. Send the patient information to one place they probably visit every day and where they can read and process the information away from the hustle and bustle of the clinic. Certainly many doctors have been doing this with little pamphlets or handout sheets with clinical information. Unfortunately, too many of these sheets never get read. Certainly that same thing could happen with an email, but at least the next generation of patients are going to want this information in their email box.

Of course, the problem with sending this information in an email is that email is not secure. Email encryption hasn’t taken hold fast enough to make it encrypted. Is a user’s email box really a secure location where they want their health information? I personally don’t have a problem with it, but I would expect that many people wouldn’t want their health information in their email any more than their regular mailbox. Either way, without the encryption it wouldn’t be difficult for someone to sniff out what’s being sent in an Email containing for example a patient’s discharge. It would be going across the internet in basically plain text.

This situation actually happened in Austrailia a little while back in an article I read called “Unsecured email sparks dispute.” I know I wouldn’t be happy if a clinic just decided to send these unsecured emails. Not so much because I was personally worried about my information being lost. I personally have nothing to hide (yet anyway). However, I would feel uncomfortable patronizing an organization that would deal so flippantly with my information.

I’m sure that someone will chime in that this is the whole purpose of a Patient Portal or EHR interface that allows people a secure method to receive and send protected health information. This is all well and good, but from what I’ve seen this usually requires the doctor’s EMR company to support this type of interaction. Plus, even more serious of an issue is that you’re giving your patients one more login and password that they’ll need to remember. Certainly not a deal breaker, but one more inconvenience for our users and the staff that have to support our users when they forget their password. Unfortunately, I think that this is the future of secured messaging, but I can always hope that there’s something better that we’re just missing.

We should also realize that this isn’t going to get any easier. In fact, I think we can reasonably say that this is going to get harder and harder. Don’t be surprised if soon some patient would like their health information somehow incorporated into some site like Facebook. It’s really only a matter of time until some developer creates a health interface into Facebook.

It might not make sense to most people, but the next generation of patients are going to grow up living and breathing their online life in some sort of social network (Facebook is just one example of these). They are very comfortable with transparency and will be interested in being able to track and compare health information with other people. Not to mention interact in a social network with other people who have similar conditions. It seems like this isn’t a question of if, but when this type of interaction will happen.

Even if you think that health information on a social network like Facebook is far fetched, we are already seeing health information propagating to the web in Microsoft’s HealthVault and Google Health. Is this going to be ok? Will it become as synonymous as online banking has become to the banking world? It’s not that far of a stretch to think that Google Health could easily be tied into Google’s OpenSocial platform which would allow a patient’s health information to do all sorts of cool things.

The convergence of Health Care and IT is going to be really interesting. It’s taken health care a while to get going with IT, but I think almost everyone agrees that IT could do amazing things to better the health care a person receives.

Well, my prediction that Eric Schmidt would announce Google Health at the HIMSS08 conference were pretty close. From what I’ve read so far, that’s all he really talked about. I’m still waiting to see my contact that was able to attend HIMSS to see his thoughts on what was said. Sounds like he mostly reiterated what we already knew. A few interesting points:

-Google Health will not contain ads (although I bet that won’t stop them from using the information to target the ads it shows you other places)
-Eric Schmidt repeatedly said no data would be shared without the consumer’s consent (unless of course some hacker finds a way around Google’s security measures)
-1,370 volunteers at the Cleveland Clinic are beta testing the application
-Portability is the key (we heard that this was a form of CCR, but if it requires consent are people going to go to the effort to make it portable?)

Despite certain privacy questions and fears around Google Health I think that Eric Schmidt made a very good point about the way Google will protect your information from legal cases when he said:

“In the Google implementation, your personal health information will not be given to anyone without their explicit permission, which is not true completely for HIPAA-compliant systems. If we get a subpoena, we always check our judgment as to whether the subpoena is narrow enough. If we think it’s a fishing expedition, we will fight it in court. That has worked well for us so far.”

The battle of PHRs by Google Health and Microsoft HealthVault have begun. While I love to see the big players participating in healthcare, I’m not sure they’ve figured out the right motivational drivers that will make this a smashing success. It wouldn’t surprise me if in a few years we hear stories about a life being saved because of proper information and how even one saved life is worth it.

The biggest disappointment: No announcement about when we can get in and try it out ourselves.

UPDATE: Techcrunch think that whoever cracks the healthcare nut will have a huge new market. I don’t see it ever cracking. Marissa Mayer talks about Google Health on the Official Google Blog.

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.

Today I saw an article on TechCrunch that talked about how Google Blogscoped found a Google Health login page (UPDATE: The Google Health Beta Landing Page has been taken down) for the hopefully soon to be released Google Health. Of course, there isn’t really anything all that special about the login page. It looks just like almost all the other Google login pages. However, the Google Health page did include the following information:

With Google Health, you can:

* Build online health profiles that belong to you
* Download medical records from doctors and pharmacies
* Get personalized health guidance and relevant news
* Find qualified doctors and connect to time-saving services
* Share selected information with family or caregivers

Too bad none of the other links work, but it does give some interesting information about what Google Health will be like. The part that is most concerning to me is downloading medical records from doctors and pharmacies. How are they going to do that? The answer is that they aren’t really going to do it. There are going to be a handful of the thousands and thousands of doctors and pharmacies that will be able to work with Google Health.

I hope that Google Health does the right thing and integrates with something like CCR since it is already beginning to be established in many Electronic Medical Record software programs. That would be a huge boon to CCR, but it would also open up an entire set of doctors that could support upload to Google Health. This could definitely be a nice differentiator from Microsoft Health Vault which can’t do this either (unless it’s been added since I looked).

If Google Health decides to create their own standard for a clinic to be able to upload to Google Health they are crazy. Doctors have almost no motivation to support Google’s standard for uploading medical records. I’m not sure many EMR companies will support it either. I can see a few of them do it as a PR move, but I’d be very surprised if many of them bit on this. Doctors don’t buy EMR software because their patients can get their record out easier. It just doesn’t make business sense for EMRs or doctors to really do any sort of uploading like this to Google Health.

Of course the good thing for this all is that having another big player like Google interested in helping the healthcare system with some Health 2.0 solutions is great by me.

You can see my previous coverage of Google Health and also the Google Health Co-op.

Update: Here’s a screen shot of what Google Health could look like.

Update 2: What CEO of Google Eric Schmidt said about Google Health at HIMSS08.

Part five of our five part series on the benefits of an EMR or EHR consultant is improved clinical buy-in.

Improved Clinical Buy-In

Hiring a proven EMR consultant alleviates fear and increases clinical buy in. However, more importantly, EMR consultants are able to provide a clinic the tools needed to show an EMR implementation’s ROI. EMR consultants should do a comprehensive analysis to show how an EMR implementation will reduce costs, increase revenues, and better care for patients. Quantifying the potential returns on an EMR investment generates significant buy in at all levels of a clinical organization.

See other parts of Benefits of using an EMR/EHR Consultant:
Benefits of Using an EMR/EHR Consultant - Selection Process
Benefits of Using an EMR/EHR Consultant - EMR Training
Benefits of Using an EMR/EHR Consultant - Clinical Process Mapping
Benefits of Using an EMR/EHR Consultant - Comprehensive Technology Support
Benefits of Using an EMR/EHR Consultant - Improved Clinical Buy-in

Part four of our five part series on the benefits of an EMR or EHR consultant is comprehensive technology support.

Comprehensive Technology Support

By providing a comprehensive set of technology support, a technical EMR consultant can alleviate doctor’s concern over the implementation of new technology. An EMR consultant’s proven track record of implementing these health care related technologies in doctors’ offices allows them to do it in a robust, efficient, and cost effective manner. Doctors save time searching through the numerous technology choices because EMR consultants can point them to the best brand of technology or even to technologies the doctor didn’t know existed.

See other parts of Benefits of using an EMR/EHR Consultant:
Benefits of Using an EMR/EHR Consultant - Selection Process
Benefits of Using an EMR/EHR Consultant - EMR Training
Benefits of Using an EMR/EHR Consultant - Clinical Process Mapping
Benefits of Using an EMR/EHR Consultant - Comprehensive Technology Support
Benefits of Using an EMR/EHR Consultant - Improved Clinical Buy-in

Part three of our five part series on the benefits of an EMR or EHR consultant is clinical process mapping.

Clinical Process Mapping

One of the hardest things for a doctor new to EMR to do is see how their current clinical processes will work electronically in an EMR. To alleviate this fear, EMR consultants can first map out a doctor’s clinical processes. They can then use their experience with other EMR implementations and show how current clinical processes will be done using an EMR. This will save doctors a lot of time mapping out these processes. It also provides a clear understanding of what a doctor’s clinic will look like electronically. However, the most important part of this process is that it provides a way to find problems that may occur with an EMR before you’ve actually implemented.

See other parts of Benefits of using an EMR/EHR Consultant:
Benefits of Using an EMR/EHR Consultant - Selection Process
Benefits of Using an EMR/EHR Consultant - EMR Training
Benefits of Using an EMR/EHR Consultant - Clinical Process Mapping
Benefits of Using an EMR/EHR Consultant - Comprehensive Technology Support
Benefits of Using an EMR/EHR Consultant - Improved Clinical Buy-in

Part two of our five part series on the benefits of an EMR or EHR consultant is EMR Training.

EMR Training

Using an EMR consultant’s experience in successful EMR implementations, they have a strong ability to train doctors on EMR and other related technologies. Some of this training occurs in an initial meeting where they discuss challenges related to EMR selection and implementation. EMR consultants also provide ongoing training on how to best use their EMR in their clinic. Furthermore, EMR consultants can train clinical staff on using the various technologies associated with using an EMR.

See other parts of Benefits of using an EMR/EHR Consultant:
Benefits of Using an EMR/EHR Consultant - Selection Process
Benefits of Using an EMR/EHR Consultant - EMR Training
Benefits of Using an EMR/EHR Consultant - Clinical Process Mapping
Benefits of Using an EMR/EHR Consultant - Comprehensive Technology Support
Benefits of Using an EMR/EHR Consultant - Improved Clinical Buy-in

A while back I wrote something about why having an EMR or EHR consultant could be beneficial to a doctor looking to implement an EHR. Here’s the first part of a five part series on reasons why I think a well qualified, experienced EMR or EHR consultant is valuable. The first part is how an EMR or EHR consultant helps with the selection process.

EHR Selection Process

By first evaluating a doctor’s needs and preferences EHR consultants are able to eliminate a majority of the EHR companies and provide doctors with a short list of high quality EHR vendors to evaluate. By providing a smaller pool of EHR vendors, doctors are more comfortable with the selection process and don’t get discouraged seeing hundreds of EHR vendors that don’t meet their needs. EHR consultants also help doctors through the evaluation process. EHR consultants often provide a list of questions that can be used to evaluate EHR vendors. These questions have been designed to tease out information which will better enable doctors to select the right software. EHR consultants also assist doctors that need help negotiating with EHR vendors. These services include requesting enhancements to meet doctor specific needs or even ensuring that EHR vendor pricing is comparable to other EHR implementations.

When it comes down to it, a good EHR consultant can save a doctor large amounts of time and money that would have been wasted looking amongst the hundreds of EHR companies. It’s not hard to say that doctor’s most precious commodity is time.

See other parts of Benefits of using an EMR/EHR Consultant:
Benefits of Using an EMR/EHR Consultant - Selection Process
Benefits of Using an EMR/EHR Consultant - EMR Training
Benefits of Using an EMR/EHR Consultant - Clinical Process Mapping
Benefits of Using an EMR/EHR Consultant - Comprehensive Technology Support
Benefits of Using an EMR/EHR Consultant - Improved Clinical Buy-in

I’ve been looking through my statistics lately (which I actually do most days) and it seems like most people aren’t searching for EMR anymore. It seems like there is a shift going on in people’s minds that they are now starting to search for EHR as opposed to EMR. There’s a whole discussion on wikipedia about whether the Electronic Medical Record (EMR) and Electronic Health Record (EHR) articles should be merged.

In my book they are pretty much the same in most people’s minds. Sure, some people like to argue that EHR has features that reach out to patients and allow patients to enter medical data, but most EMRs have those type of features anyway. I prefer to look at it as an EMR with a patient portal. However, the in thing to do seems to be to call a company’s EMR an EHR. The fact is that most people that have an EMR have a number of patient facing portions of their EMR. Does that make them all an EHR?

Regardless, I’m just wondering if one day I’m going to need to rename my blog to EHR and HIPAA. I’ve kind of grown fond of EMR and HIPAA, but I’m definitely not oblivious to the fact that people are starting to seach for EHR and not EMR. Renaming my blog might be a great thing to help with getting better google searches on the subject. Yes, I do enjoy having a lot of traffic to my blog. It makes me happy to think that people read my stuff and that I’m participating in at least some small way to shape the evolution of EMRs EHRs.