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Ensuring Patient Compliance Using Text Messages and a PHR

Posted on October 20, 2010 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.

One of the really interesting things that I’ve heard at the Mobile Health Expo has been the use of text messages to assist with patient compliance.

I think this is at least the third time at this conference that I’ve been hearing about the use of text messages in healthcare as a way to remind patients of their need to comply with the doctors instructions.

In one case, NoMoreClipboard is working with a hospital to use medical minutes (basically subsidizing their cell phone plan) for participants in a diabetes program. In this program, users would access the NoMoreClipboard PHR through their cell phone where they can update their blood glucose levels or other information as designed by their hospital.

This is pretty cool, but the interesting part is the way they’re using text messages together with the PHR. For example, if the patient doesn’t check in with their information, then a text message is sent reminding them to do so. Plus, once they enter in their information, they can get proactive messages about how they should deal with various blood sugar levels. For example, if their levels are low it might instruct them to eat or drink something to raise that level (although in a nice medically appropriate way).

I should have written down the exact numbers, but in the above case they found that they saved about $18,500 in treatment costs for a compliant patient vs. the non-compliant patient.

I of course had to ask if this could actually be a problem for the hospital. Sure, it improves healthcare, which is incredibly valuable. However, would this impact the revenue that a hospital was receiving previously to treat patients? Sure, it’s a bit ominous to think this way, but let’s be honest that the hospital revenue is an important factor.

Jeff Donnell from NoMoreClipboard brought up a good point that in many cases these patients were ones who had no health insurance and so the hospital was often not making money from treating these patients, but in fact was having to pay for these patients. So, being able to lower these costs is a huge benefit on top of the clinical benefits.

Of course, this is just one example of the usages of text messages in healthcare. I’m really finding it fascinating. Text messages seem to be one of the most innovative technology I’ve heard discussed and not all the various “Apps” that are out there. Yep, the simple text message is being used in all sorts of creative ways. Plus, text messages tied to a PHR or some other web source is really interesting as well.

Of course, I can’t help but imagine how text messages could be integrated into an EMR. Appointments is one obvious area. Patient compliance is another interesting one. What other areas of an EMR could benefit from the implementation of text messages?

One speaker said that on average text messages are read within 4 minutes. There has to be a way to leverage this attention in healthcare and EMR.

Phone Tree EHR Integration

Posted on October 7, 2010 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.

While at the AAFP conference recently, I saw a company called PhoneTree that I found interesting. They essentially take care of all the automated calling for the doctors office.

I was a bit surprised that a company like this is still around. Is there still a market for narrowly focused products like this? I know that many EHR vendors have integrated these types of features into their PMS and EMR software.

The other problem I had with this company was that they only have a one way interface for calling. Basically, you dump a csv file out from your scheduling system and they make the calls. However, there’s no method of getting the data back to the EHR software so you can know who confirmed and who didn’t in your EHR. Seems like a no brainer feature to me, but seemed to barely be on their radar. Probably because it would require an interface and interfaces are the worst to manage.

Of course, the really cool technology with phones is coming from the Cisco IP phones. I love the integrations that you can do with a Cisco phone and I love the idea of a soft phone on your computer even more. Too bad Cisco is so bloody expensive.

EMR Technology Exacerbates Problems

Posted on April 19, 2010 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.

One thing that I’ve mentioned many times in the 4+ years of blogging about EMR is the impact of technology on a clinic. I’ve regularly mentioned that you shouldn’t implement an EMR to try and fix process problems in your clinic. Instead, you should first address the process problems in your clinic and then implement the EMR with the proper processes already in place.

The reason for this is quite clear. Technology, in this case EMR, has a tendency to just exacerbate any problems that exist in a clinic. In fact, it will often bring to light problems that you didn’t know existed before EMR.

A simple example is doctors who are behind on their charts. In the paper world, you might not know how far behind they are on their charting. In the electronic world many EMR software make it abundantly clear how many charts still need to be completed.

In a call I had recently with the people behind the Mitochon EMR, they made a really interesting point about communication between doctors. It’s basically the same concept as I’ve described above. If communication between doctors is bad in the current world, then layering some sort of HIE or other technology on top of it will just make communication worse. Technology is going to accentuate and enhance (for good and bad) whatever might be going on currently.

Interestingly, this concept might add further light as to why so many EMR implementations fail. Sometimes it’s hard to look in the mirror for the first time and take a good hard look at what’s really happening in your clinic.

Pros and Cons of Thin Clients with an EMR

Posted on August 13, 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.

This is the second guest post by Bill Horvath II describing the pros and cons of thin clients with an EMR.  Also, take a look at his first entry discussing the pros and cons of laptops with an EMR.

Thin Clients

Overview

An office which chooses this approach will typically have one thin client terminal in each exam room, as well as in each physician’s office, and at stations occupied by non-mobile staff who need access to computerized records.  The terminals are typically managed or ‘driven’ by a server, which provides applications, data storage, and administrative control over the whole system.  Remote access to charts is usually provided via application server software.

Pros

  • Easy To Use – Thin clients don’t have to be carried or pushed from room to room, and don’t require recharging.  Some manufacturers also use smartcards or other technologies to offer location-independent desktop sessions, whereby the desktop session virtually ‘follows’ the doctor from room to room, eliminating the hassle of logging out and logging in at each station, or of figuring out how the last person to use the computer left it.  Many thin clients can go from off to fully ready to use in 15 seconds or less, and because they have no moving parts, they are silent when operating.  And because data storage is centralized, a complete backup strategy is straightforward.
  • Inexpensive – A fully-furnished thin client (with monitor, mouse, keyboard, and cabling) can be purchased at a price starting around $650, depending on the makes and models of the components.  Spare parts are inexpensive to keep in inventory, and individual parts can be replaced in the event of failure.  Because they are highly reliable (and their capabilities are usually determined by the central server which administers the network), they can remain functional for 7 years or longer.
  • Reliable – Modern thin clients have no moving parts, making them exceptionally resistant to normal wear-and-tear.  Since they aren’t typically moved by the doctor, they’re less likely to be broken through an accidental drop or collision.
  • Trivial to Replace – Since thin clients are usually controlled and configured by am administrative server, it’s trivially easy to replace one in the unlikely event of a failure.  In such cases, replacement of the device is simply a matter of unplugging cables from the old unit and plugging them into the new one.
  • Energy Efficient – Because they have no moving parts, thin clients use very little electrical power.  Around 5-15 watts or less is common, even when operating at full capacity.
  • Highly Secure – Thin clients, by definition, have no local data storage, meaning it’s impossible to lose data by way of theft or equipment failure, and a bad actor can’t use a stolen device to extort money or expose private or embarrassing information.  Some thin client manufacturers also provide two-factor authentication built into their products, which precludes access to the system entirely without an alternate means of identification, such as a smart card.  Under these circumstances, the thin client won’t even present a password request (or other user interface) without the required token.  It is also easy to physically lock a thin client in place to prevent theft.
  • Unlimited Scalability and Upgrade Capabilities – The capabilities of some manufacturers’ thin clients are completely determined by the managing servers, which means the maximum number and processing power of the thin clients in any particular installation are limited only by the capabilities of the controlling server.  To allow for more simultaneous users or more complex applications, only the servers need to be upgraded or replaced; the thin clients can remain unchanged.
  • Automatic Firmware Updates – Many thin client manufacturers provide software in their thin client server package which automatically keeps the firmware of the thin clients up-to-date.

Cons

  • Expensive Back End – A thin client installation with an administrative server will almost always be more expensive at the point of purchase than a set of laptops, especially if the laptops are deployed without an administrative server.
  • Single Point of Failure – If the server which provides administrative control to the thin clients fails, all of the thin clients may be down until the server is brought back up.  Exposure to this risk can be mitigated by using redundant servers, which themselves feature redundant systems (power supplies, memory, processors, etc.), however it can’t be entirely eliminated.
  • Everyone is Subject to Each Others’ Usage Patterns – The performance of thin client’s desktop sessions can be adversely affected by what other users on the system are doing.  Someone watching online videos, for example, may occupy significant processing power and bandwidth, which can drag down the performance of other user’s sessions.  This problem can be alleviated by upgrading the administrative server, but doing so engenders additional costs.
  • Limited Peripheral Support – Thin clients may have limited support for attachable peripherals, such as USB storage or printers.  (This will mostly depend on the operating system of the administrative server.)
  • Geographically Grounded – Because they aren’t mobile, a thin client terminal is needed for each location in the office at which a computer is desirable.  Power and network access are needed at each such location, which may require the installation of additional wiring.
  • Limited OS Options – Most thin clients come with a Linux desktop as a default option, as this doesn’t force any additional licensing costs.  Presenting a Windows-based desktop to thin client users currently requires Windows Server, Windows Client Access Licenses, and Windows Terminal Services licenses, each of which costs extra.  Furthermore, Apple does not currently offer a suitably efficient protocol for serving an OSX desktop to a thin client.
  • Server Requires Physical Security – The administrative server must be physically secured from theft, accidental damage, and power loss.  In addition, such servers are typically noisy, meaning placement in a closet, mechanical room, or soundproof rack is usually highly desirable, but may require additional wiring or other expenses.

Bill Horvath II is the CXO of DoX Systems, a company which offers medical office productivity solutions to physicians in private practice. Their flagship product is DoxCIS, an electronic medical records system.

Pros and Cons of Laptops with an EMR

Posted on August 12, 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.

In the comments of my previous post about Tablets vs. Convertibles vs. Laptop and EMR, we started an interesting discussion about “thin clients” in addition to laptops and desktops in the healthcare environment.  From that discussion I invited Bill to do a guest post about the various advantages and challenges of laptops and thin clients with an EMR.  Bill did such a detailed job I decided it was worthy of 2 posts.  The following is Bill Horvath II’s description of the pros and cons of laptops with an EMR.

Because doctors who have an EMR system need access to patient histories at the point of care, they need a computer in the exam room.  Traditional desktop computers have been used for this purpose in the past, however, more cost-effective laptops and thin clients are becoming much more common in clinical settings.  This post examines some of the pros and cons of laptops.

Laptops

Overview

An office which chooses this approach will typically have one laptop per physician, and possibly one for each of the other staff members who move between exam rooms, such as nurses.  In this scenario, traditional desktop PCs are usually used at the stations occupied by non-mobile staff, such as the receptionist.

Pros

  • Mobility – The doctor can take a laptop wherever he or she goes, including out of the office.  Remote access to charts is usually accomplished via a VPN.
  • Local Data Storage – The doctor can easily store files on the hard drive of the laptop, meaning those files are accessible wherever the laptop is, and regardless of whether it’s connected to a network or the Internet.
  • Many OS Options – Laptops are available for virtually all of the major operating systems (Windows, Apple, Linux, Unix, Solaris, BSD, Chrome).
  • Broad Peripheral Support – Laptops usually have built-in drivers for dealing with a wide variety of peripheral attachments, such as USB mass storage devices, cameras, printers, and scanners.
  • Flexible Performance – With a few minor exceptions, the performance of a laptop computer is determined solely by the capabilities of the computer itself, and how it’s used by the person sitting in front of it.

Cons

  • Require Recharging – When configured for mobile use, laptops run off battery power, which means they must be plugged in periodically to recharge, or the doctor must switch to a freshly charged battery when the available charge runs low.  Most laptops will provide two to four hours of continuous use on one battery charge.  Laptop battery capacity also typically declines approximately 20% per year, which adversely affects performance over time.
  • Expensive – Good quality, business-class laptops start at around $1000, and can range into $3000+ for more advanced units.  Necessary accessories (docking station, supplemental monitor, extra batteries, carrying case, etc.) can add significantly to the cost.  Support contracts for the laptop can be pricey as well, as the components are tightly integrated and difficult to replace.
  • Fragile – Most laptops have moving parts (typically fans, optical drives, and hard drives; also mechanisms such as the connection between the lid and the monitor) which will wear down, and which don’t respond well to being dropped.
  • Difficult to Repair – It is often not possible for the doctor or her staff to repair or replace the components of a laptop (such as the screen or keyboard) if they fail. Laptops often need to be shipped to the manufacturer to be fixed.
  • Hard to Replace on Short Notice – Even if a ‘hot spare’ laptop is kept in the office for emergencies, synchronizing applications, settings, and files between a (possibly broken) machine and the spare may not be trivial, nor is updating the operating system.  This effect is amplified when each doctor has their own particular configuration, and if there is no centralized management server (e.g., Apple Workgroup Manager, Windows Server Domain) in place.
  • Complicated to Secure – Because they are mobile, laptops are subject to theft.  This problem can be mitigated by encrypting the hard drive, but doing so creates challenges around encryption key management, especially in multi-laptop environments, and as laptops and hard drives are replaced over time.  In addition, laptops accidentally left in exam rooms with patients are particularly subject to a variety of security risks, such as accidental damage, malicious hacking, etc., especially if the laptop lacks a two-factor authentication system.
  • Limited Upgrade Potential – Most laptops are limited in how they can be upgraded over time (Typically RAM and the hard drive are the only user-upgradable components.)  This can become an issue in keeping current with software and operating systems, as new programs often have more stringent system requirements.
  • Noisy – The fans, hard drive, or optical drive on a laptop can spin up at inopportune times, creating a distraction, and making soft sounds harder to detect.
  • More Complicated Backups – Because a laptop’s data is stored locally on the hard drive, the laptop must be backed up on a regular basis to protect against data losses due to breakage or theft.  This typically requires action on the doctor’s part (connecting a cable, triggering the backup function, taking the backup medium off-site), though some systems come with an automated backup system which can function wirelessly.   However, changes to the laptop’s files which occur between backups may be irretrievably lost if the machine is compromised.
  • Require Individual Updates – Laptops which aren’t managed by an administrative server require individual patching to stay current with operating system and application updates.  Furthermore, since laptops aren’t typically on for automatic updating late at night, the update process which takes place during the day may interrupt the doctor’s workflow by forcing reboots at inconvenient times.  Laptop firmware also usually requires manual updating, a process which may not be especially ‘user friendly.’

Bill Horvath II is the CXO of DoX Systems, a company which offers medical office productivity solutions to physicians in private practice.  Their flagship product is DoxCIS, an electronic medical records system.

Tablets vs. Convertibles vs. Laptops and EMR

Posted on August 3, 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.

The one fundamental to every EMR is some sort of computer. Yes, I’m using this in the broadest since possible since there are many EMR today that are now even compatible with something like the iPhone. However, even the little iPhone is essentially a mini computer. However, computer makers have long believed that the tablet computers were great for healthcare.

As I look back over my 4 years writing this blog, it’s really interesting to see the evolution of the tablet technology. We first bought our tablet computers over 4 years ago as we implemented our EMR. Correction, we bought our first convertible tablet computers over 4 years ago. They served us quite well. The crazy thing is that almost none of our providers used any of the tablet functionality. I can count on my hands the number of times it was really beneficial to have the tablet functionality.

Since we actually ordered the convertible tablets (converts from a laptop to a tablet), all of our users pretty much just used it like a regular laptop. These convertible tablets came up for replacement as they went out of warranty and it was pretty much a no brainer decision to just purchase laptops instead of convertible tablets.

I’m not saying that the tablets aren’t without their merits. However, none of my users really adopted much of the functionality. In fact, I think I used it more than all of the clinicians combined. Although, there was one feature of the convertible tablets that was used quite often. The swivel screen. Yes, the least technical part of the convertible tablet technology is what they found so useful. They loved being able to swivel the screen to show another provider something in the EMR.

As I researched the various tablets available today as opposed to 4 years ago, I found that no computer manufacturer offered any convertible tablet larger than the 12″ screen. The ones we purchased for use with our EMR were 14″ and we didn’t want to go down. In fact, since we did away with the tablets and just went with laptops, we moved up to the 15″ monitors and all of the providers love the extra space to more easily navigate the EMR.

Of course, the computer manufacturers say that the reason they only do a 12″ size is because no one wants to carry the 14″ ones around. It’s true that 14″ is quite a lot for many providers to carry around. That’s why we just put computers in each exam room. No more carrying computers around and a nice size monitor for your EMR wherever you go.

This said, in one of my EMR consulting gigs I’ve done here locally, the doctor carries his 14″ laptop around no problem. He replaced his laptop recently and decided to continue with the same.

I was lucky enough to just get one of the second generation Dell convertible tablets. It has not only touch screen technology, but multi touch technology. It’s a lot of fun to demo and show off. However, I just don’t see much practical application for it. At least not until I implement an EMR that has touchscreen in mind when they develop the EMR.

What are your thoughts on Tablets, Convertibles and Laptops? Have you found a compelling reason to use the tablet technology in your office?

Best Scanners for High Volume Scanning in a Doctor’s Office

Posted on March 2, 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.

We now interrupt all this HITECH act EHR stimulus money talk for our regularly scheduled program.

If you are looking at implementing EHR, then you better become familiar with a nice high quality scanner. Don’t believe anyone who tells you that they are paperless. Sure, many don’t store paper, but even the very best EMR or EHR implementation has loads of paper that needs to be scanned.

Still don’t believe me, then how do you plan on handling a new patient who brings in a stack of paper records from their old doctor. I’ll leave the rest of the list of possible paper for another day. Suffice it to say that you’ll NEED a high quality scanner that can handle high volume.

When we first implemented we used a nice little all in one scanner. Worked well, except we literally burnt it out after less than a month of scanning.

After that we finally ponied up the money and bought some high quality, high volume fujitsu scanners. 4 years later we’re still scanning with no end in sight. We do have to do regular cleaning (about 5 minutes max) to clean off all the ink that gets on the feeder. Otherwise, these babies are the best I’ve seen. Here’s links to the 2 models fujitsu currently offers.

Fujitsu fi-6130 Duplex Scanner
Update: The Fujitsu Fi-6130 is no longer available, but here’s the Fujitsu Fi-7160

Fujitsu FI-6230 Clr Duplex 40PPM/30PPM USB
Flat bed and ADF feeder:
Update: The Fujitsu Fi-6230 is no longer available, but here’s the Fujitsu Fi-7260

One has a flat bed for those hard to feed scan items (ie. prescriptions) and the other is just the feeder for the high volume scanning.  Some may think it’s a little expensive for a scanner, but it’s worth it.

I’ll be updating my list of EMR and EHR technology with items like the scanners above. Many people have asked me which scanners are best, which computers are best, what about tablets, fax servers, etc, etc. Now you can just check out my list of software, tablets, computers, fax servers, scanners, printers, etc and see some recommended items to help your office.