I think people have enjoyed a collection of my best tweets from the healthcare IT and EMR conferences I’ve been attending. If you don’t like them, let me know in the comments. I think they’re interesting since they’re nuggets of interesting topics. The following tweets come from the Digital Health Conference in New York. It’s been a really well attended event and includes a lot of the real health IT movers and shakers in the New York healthcare scene. Plus, they’ve had some really great content as well.

Here goes (with my comments after the tweet):

I’ll be interested to see http://t.co/EnvXwoJ5 evolve and start sharing clinical provider quality information. #dhc11

December 1, 2011 6:24 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

Healthcare.gov is an interesting site. Still too new to decide its impact though.

Todd Park highlighting all of the healthcare data that the government makes available in APIs. #dhc11

December 1, 2011 6:34 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

Todd Park did make a pretty compelling case for the healthcare data they’re going to make available from the government and it seems like they’re just getting started. I could see a lot of startups leverage that data in their companies. I wonder what assurance an entrepreneur will get that the data won’t get yanked.

Great example by Todd Park of how mobile health can change healthcare using the asthma example. #dhc11

December 1, 2011 6:53 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

Simple examples like this is why mobile health is so fascinating.

Standing O for Todd Park’s keynote at #dhc11

December 1, 2011 7:06 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

Todd Park really did do a great job. Attendees were commenting on how good he’d done all day. As Matthew Browning said, Practice Makes Perfect!

Standing room only for #dhc11 session on HIE event detection and provider notification. http://t.co/aE6rwRMW

December 1, 2011 8:27 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

Obviously a lot of interest in the HIE stuff and in the notifications that they can do.

Did I hear right that NYC metro area has 4 RHIOs? #dhc11 RHIO is HIE for those not familiar with RHIO

December 1, 2011 8:43 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

I know that NYC is large and has a lot of people, but I’m having a hard time understanding how it has 4 RHIO. Are there 4 regions in NYC? I’m sure there’s a long political story behind it.

Dr. Calman hits the nail on the head-tech. is an enabler, doesn’t provide context. #DHC11

December 1, 2011 8:25 am via LinkedInReplyRetweetFavorite

@PeachBytes5

Babette Peach

This is why we’ll always need doctors. It’s just how they do what they do that will change.

I love that people are talking about concern over being flooded with information when right now were not sending any info. #dhc11

December 1, 2011 8:51 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

Such a good point. If they were actually getting all that information then they’d have reason to complain. Although, we can’t make the systems filter the flood properly when there’s no flood.

I’d never heard @MatthewBrowning tell his @yournurseison story. Fun to hear. #dhc11 #HITStartups

December 1, 2011 11:27 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

Great funding story. I bet there’s even more to it than he shared. I’ll have to get him to share the rest some time.

We bring a little Rock n Roll rhythm to the slow dancing healthcare industry. -@matthewbrowning #dhc11

December 1, 2011 11:30 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

Great quote from Matthew. I don’t mind a little slow dancing, but the dance floor usually empties for the slow songs and is hopping with the rock songs. This is a pretty systemic problem in healthcare. I met one healthcare salesperson who said he was just contacted about a deal he’d worked on 3 years ago with a hospital. They contacted him to say that they’d finally closed the deal. Too bad this sales person is no longer at the company.

I’m always on the lookout for new online communities around Healthcare IT. I test drive them for a little while and then decide how I’m going to incorporate them into my daily routine. I evaluate what benefits I get from participating. Sometimes the benefits of participating are just helping someone out. There’s something really satisfying about doing something for someone else.

My latest test drive has been the Healthcare IT Question and Answer site on Stack Exchange. I’ve used Stack Exchange a bunch before when I needed some programming help. However, I’m guessing that most people in healthcare IT (unless you’re a programmer) probably aren’t that familiar with Stack Exchange. Well, they created such an interesting community around question and answers that they got a whole bunch of VC funding and they’ve been growing their network into all sorts of new niches. Thus, the launch of the Healthcare IT Stack Exchange community.

You can go and check out my techguy profile on the HIT Stack Exchange site if you want to see what I’ve done. I’ve already got a reputation of 46 (whatever that means). I’ve already answered 9 questions on the site and a few people have been nice enough to vote up my answers.

For example, if you are a MUMPS lover, you can see my answers on this MUMPS replacement question and this NoSQL in Healthcare IT one. I couldn’t resist answering a question about CCHIT. I also took a swing at the PHR question, but I’m sure I could have dug a little more on that one to mention some other PHR software. Instead, I opted for the two most popular ones. I even hopped in the chat room, but it wasn’t that exciting since I was the only one there. You can check out the chat room, but you won’t be able to chat until you have enough reputation. Keeps out spammers, but makes for a boring chat room until you get some critical mass.

Of course, the real challenge with any site like this is the standard chicken and egg problem. You need a large number of people to ask and answer questions. However, in order to get a large number of people asking and answering questions, you need a lot of good questions and answers. I guess we’ll see how it evolves over time. The sidebar of the site says they’ve had 113 questions, 241 answers, 319 users and 147 visitors/day. A pretty small community, but a pretty good response rate considering the number of users. I just wish there was more discussion of EMR & EHR on the site since that’s what interests me most.

Let me know what you think and if you see any good questions or answers on the site that you think I should see. I’ll be keeping an eye on it to see how the community develops. I’d hate to have my 46 reputation points go to waste.

I’ve been really intrigued lately by the changing media landscape. Things like Blogs and Twitter are providing opportunities for basically anyone to be able to share a message with the world. Certainly, many of the blogs don’t get read and a tweet on Twitter falls off people’s radar very quickly. However, some of the better or more interesting ones rise to the top and provide an interesting and sometimes dissenting voice to the conversation. Personally, I think this type of open discussion around topics is valuable and beneficial as long as people maintain a certain level of respect and decency.

My question to you then, is what would you say to a Healthcare IT audience?

As I considered on this difficult question myself, I decided the message that I would want to deliver: You can resist all you want, but the future of healthcare will require IT.

Pretty much every day, someone comes on this site to talk about the benefits and challenges associated with EMR and EHR in their office. As I’ve listened to the various challenges that people have posted, I’m sympathetic to them. However, almost all of those I’ve heard boil down to poor EMR selection or poor EMR implementation.

To me, the EMR selection is the absolute most important part of the EMR implementation process. Far too many doctors and clinics don’t take the time and effort that’s required to really go through a proper EMR selection process. I’m very sympathetic to them for a lot of reasons (ie. It’s not their job or interest, there are 300 EHR vendors, there aren’t great resources for differentiating EHR, there are a lot of perverse incentives, etc). However, it’s worth the cost to do it right. Otherwise, you should wait until you can do it right.

However, I believe that EMR is still only one small part of how healthcare IT is going to impact healthcare. Just last night I was at a local event and someone who use to work in the casino industry has been working for the past year or so on an app that helps improve doctor to doctor communication. Fascinating stuff.

Personally, I see us just at the very begging of a revolution in healthcare IT. IT is going to start invading every part of healthcare and will pretty much be impossible to avoid.

Certainly there will be some (possibly many) who continue to resist the adoption of technology in their clinic. However, I’m seeing more of a shift by patients and doctors that are interested in finding more ways to integrate technology into their healthcare. Most of the doctors aren’t sure what to do next, but they’re looking.

I can certainly understand and appreciate those that say that the current EMR and healthcare IT offerings aren’t up to snuff. The fact is that many of them aren’t. However, that doesn’t change my belief that IT is still going to change how healthcare is provided. It just may mean that healthcare will be changed by an IT offering that most of us don’t know about today.

My greatest wish would be that we could close the case on whether healthcare IT is important and/or it can change healthcare. Instead, let’s put our energy into finding the ways that it can change healthcare IT for good. All of us focused on using healthcare IT and EMR for good in healthcare would produce some amazing results.

I remember when I first started blogging about EMR and health care IT about 5.5 years ago, I searched out whatever EMR and healthcare IT blogs I could find. The first three blogs that I can remember finding (and loving) were Neil Versel’s blog, Shahid’s Healthcare IT blog and Will Weider’s Candid CIO blog.

I loved reading Neil Versel’s blog because he was actually a professional journalist in the healthcare IT arena. I learned a lot by watching what he did. In fact, I think some of my writing style came from reading his blog. Along with his blog, Shahid provided HITsphere where I could see the posts from other bloggers. Plus, in the early days the traffic from HITsphere to my blog was really great. It’s hard to have a blog that no one reads. I loved the Candid CIO. Partially because the writing was so good and Will is a really smart guy. Partially because I was completely intrigued that the CIO of an organization was blogging. At that time I think I also aspired to be a CIO like Will. Funny how life changes and I prefer to be a blogger now. I’ll leave the stress of CIO to Will. I’m happy to say that all three of these bloggers are still wielding their blogging sword and I still enjoy reading their work.

Needless to say, the EMR and Healthcare IT blogging community has gotten much larger than it was 5.5 years ago when I started. Like many things, with that growth a lot of things have changed. Some for the good and some for the bad. One thing that I miss is all the interaction we use to have as bloggers. Certainly some of that interaction has moved to Twitter and other social media sites. However, I wish we had more interactions with bloggers like we use to do when there were only 5 of us out there.

I personally like to call it blog sparring. Basically, you take someone else’s post and provide the opposing perspective or at least you add to the conversation that they started. I love these types of interactions with other bloggers. Plus, I love the deep dive into a specific topic that happens when you do this type of blogging. As a reader, I think it’s fun to read the various blogger’s perspective on the topic.

So, on that note, I’m going to make the next week, Blog Sparring Week. I’m going to find interesting posts from some of the best EMR and healthcare IT bloggers out there and I’m going to write a post in response or in addition to the comments they made. This way, you’ll get to know some of the other interesting bloggers out there, but you’ll also get the chance to read some interesting in depth commentary.

Hopefully, the bloggers I write about will join in on the fun by either replying to my blog posts or blog sparring with other EMR and healthcare IT bloggers.

If you have posts you think I should consider, let me know in the comments.

Since it’s Friday and most of you have already headed home for the weekend, I figured I’d write about something that I’ve been thinking about lately. It’s the interesting balance of being well connected versus bias.

First, I should start off by saying that I think everyone is biased. We all have biases in everything that we say. The work we do, the people we know, the experiences we’ve had, the way we were raised, the person we marry, etc etc etc all biases and/or influences who we are and what we believe.

Since I believe everyone (yes….everyone!) has a bias, the important thing for me is to be aware of the biases people have.

Honestly, that’s one of the things that I love about the conversations on the Healthcare Scene LinkedIn group (Hint: You should join). The LinkedIn group is great because when someone makes a comment you have basically their resume attached to their comment and you can learn about them and their potential bias. No doubt users can clearly see why I’m so fond of the HealthcareScene.com family of websites.

I try to offer readers the same disclosure on these blogs. While you could certainly see any possible biases I have in the right side bar, I also fully disclose any time I write something about an advertiser on my site. Not only is that an FTC rule, but it’s also the right thing for me to do. You should know about any potential biases I have.

The same goes when it comes to talk about EMR adoption. I have a bias towards EMR. From first hand experience, I have little doubt that an EMR in a doctors office can be a benefit to that office. Although, I offer that bias for everyone to read and I add in the caution that it has to be done right and you need to choose the right EMR. Of course, that’s my bias as well. I think the EMR select matters. Although, that won’t necessarily stop me from arguing the other point on occasion.

One of the interesting challenges of writing well is balancing connections and bias. Certainly it’s a great thing for your writing to be well connected to a lot of different people. Those people provide interesting information, interesting perspectives and information about trends that you might not have known otherwise. Although, those connections can also be considered a bias to the things that you write.

My method to combat this is to just know everyone. Assuming you know everyone, then your bias is spread across a large group and the power of crowds should help to balance things out. My mother would likely tell me (as she did when I was younger and wanted to do everything) that I can’t know everyone. Much as I did as a little kid I say, “She’s right [never good to argue with your mom]. Although, that doesn’t mean I can’t try.” Needless to say, I have a long way to go.

I think the problem I have with much of the health IT and EMR related press out there is that they’re often working for a paycheck. A paycheck bias might be the worst of all bias. Then, your bias is to write something that will 1. keep your paycheck and 2. not get you in trouble. Ok, that’s a bit cynical of me. Certainly there are plenty of great journalists out there that really want to cover the important angles of the story. They really want to get the story right and provide value to the readers. However, let’s just not believe that your paycheck isn’t its own bias.

Why do you care? Well, maybe you don’t, but it’s Friday, my wife’s out of town and I felt like getting this off my chest. If nothing else, now you get to know some of my bias. If you ever want to know my bias, just ask. I’m always happy to share. In fact, don’t be surprised if you ask and I share it with everyone. I’ve got nothing to hide.

You know on the weekends I love to through in a little round up of some interesting things said about healthcare IT, EMR and other topics on Twitter. Hopefully, they’ll educate, entertain and inform. If not, tomorrow’s another edition of Meaningful Use Monday.

T2: I used to read 4 newsletters, now I don’t. I’ve chg’d to read tweets & blog post – so much more current. #hcsm

April 24, 2011 5:26 pm via TweetDeckReplyRetweetFavorite

@Colin_Hung

Colin Hung

I’ve been talking about this quite a bit lately on this blog (see my post about social media EMR information). However, I love how the described their shift from newsletters to tweets and blog posts since they’re more current. I obviously agree. Although, if you subscribe to the EMR and HIPAA email you can enjoy the convenience of an email newsletter with the current info of a blog.

Rock Health Launches –The First Seed Accelerator to Promote Interactive Health http://dlvr.it/PZc58

April 24, 2011 11:37 am via dlvr.itReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

I saw this announcement a while ago. I’m really excited to see what Rock Health is able to do. They definitely have a number of big names. I wish that I was some way involved with them since I love their approach. Plus, I’m really excited to have my brother, David, participating with me on the Smart Phone Healthcare website I recently launched. Mobile healthcare is a really hot area of the market and I think together we’re going to bring some interesting perspectives to the mobile area of healthcare.

E-Prescribing Incentive Program Comparison: http://bit.ly/hAjVe5 #healthit #medicare #meaningfuluse

April 23, 2011 6:22 am via webReplyRetweetFavorite

@richelmore

HealthcareTechNews

I usually hate PDF’s and a tweet in a blog post that leads to a PDF is probably even worse. Although, it has an interesting format for considering the multiple e-Prescribing incentive programs. Of course, if you’re a regular reader of the site, then you already have started ePrescribing right?

LOL! RT @WilIFerrell: Facebook is like jail, you sit around & waste time, you write on walls & you get poked by people you don’t know.

April 23, 2011 5:17 pm via webReplyRetweetFavorite

@Colin_Hung

Colin Hung

This just made me laugh and so I had to share it. Although, if you Like EMR and HIPAA on Facebook, then it will be so much better than prison. Well, maybe not much better, but it will make me smile.

I’m interested to hear how others use social media to consume healthcare IT and EMR information. As most of you probably know, I’m a pretty avid user of social media. For me, it’s a combination of marketing my websites, getting new content and information for my websites, connecting with smart people, and just keeping a finger on the pulse of what’s happening in healthcare IT and EMR.

For example, many of you probably know about my two popular twitter accounts @techguy and @ehrandhit. My @techguy account is really my twitter account for everything and anything I feel like using Twitter to accomplish. It’s an interesting (at least to me) mix of healthcare IT/EMR, television, entrepreneurship, technology/social media, ultimate frisbee, and my other adventures in life. I love the freedom of that account since I’ll do and talk about most anything that I care to tweet about or people I care to connect with. @ehrandhit on the other hand is strictly EMR and Healthcare IT focused. I probably should give it a better voice than what it is now including more connecting with people and more thoughtful comments. Although, most of my best thinking becomes blog posts and then gets linked to that Twitter account.

I’ve also started this EMR and HIPAA Facebook page (You should all Like it). It’s seen some growth over time, but nothing like I expected that it might see. I’m not sure what people think of Facebook. Maybe most people go on Facebook to hang out and not necessarily talk shop. I can appreciate that. Although, when I see the number of people that have “Liked” other sites, I wonder if I’m just missing something about how I’m using Facebook.

I’ve become a big fan of LinkedIn. In fact, that’s why I recently started the Healthcare Scene LinkedIn group. I really love how people’s profiles are attached to the comments that they make. There’s something really refreshing about that approach. Plus, I love the conversations that happen after initially connecting in the group in a discussion about a specific topic. LinkedIn makes it really easy to connect with someone who you’ve been chatting with and extend a business relationship with them. It makes sense that the conversation is great on it since it’s such a business focused website.

While I love the above social media for finding and interacting with healthcare information, I’m still a bit surprised by the thousands of people who’ve signed up to receive the EMR and HIPAA email newsletter. Email isn’t technically social media, but it’s quite clear to me that email still plays a major role in our consumption of information and our interaction with others. Email is something we all use pretty much every day. So, I guess that makes sense why so many people want good information sent to their email. It’s convenient.

Then of course, I have a blog or two under the Healthcare Scene brand (check out the new headers I made for each site). Someone recently commented on my blog about the volume of misinformation that is out there. When I look at the list of blogs that I write and that I’m partnered with, I’m really happy to see the quality of independent information that’s being created to guide people in th EMR and healthcare IT industry.

I love how something as simple as blogging software can empower people to share their unique voice. Add in the above social media tools and the power of search on the internet and I think we can have a real impact for good on healthcare IT and EMR.

What tools do you use to consume information online? Are there tools that I haven’t listed that you love? How do you use those tools to make your and other’s lives better?

Casey Quinlan wrote a really fantastic article about why “What’s the ROI?” is only half the question in healthcare IT. She quickly identifies the real challenge with putting an ROI on an EMR implementation by acknowledging that an ROI discussion quickly leads to a financial discussion. Indeed! The financial side is only have of the EMR ROI question.

I’ve written about the EMR ROI up down backwards and forwards. You have the camp that wants EMR software saying that it provides a great ROI and you have the camp that doesn’t want EMR saying that it doesn’t. The correct answer is that they’re both right. Your EMR ROI is often what you make of it. Not to mention that what you make of it starts with your EMR selection.

In any ROI discussion, I quickly point people to this list of EMR benefits. In EMR presentations, I like to divide that list of benefits into “Guaranteed Benefits,” “Possible Benefits,” and “Debatable Benefits.” In fact, I should probably do the same on that page when I have some free time.

However, Casey, in the article linked above asks a very important additional question, “What will it cost to do nothing?” Then she suggests, “The answer to that question shows the way forward.”

I very rarely republish items on EMR and HIPAA. However, every once in a while something is so good that I think it’s worth sharing so that more people can read. The following is one such case. I loved reading Dr. Rowley’s perspective on the Japan disaster and potential radiation health risks. The article was originally published on the EHR Bloggers site. As Dr. Rowley, our thoughts are with those in Japan who are suffering amidst this terrible disaster. Hopefully the following thoughts will clarify a confusing situation.

The horrific events we have seen unfold in Japan as the result of the recent earthquake and tsunami, and subsequent instability of a large nuclear facility in the disaster zone with (at least) partial melt-down of the uranium fuel, raises questions of health risks from radiation exposure.

Granted that the West Coast of the U.S. is some 7000 miles away, and disbursement of any radiation leaked into the air in Japan, carried by the jet stream eastward, would expose people here only trivially. Even close to the reactor, as nicely illustrated by a New York Times graphichere, the amount of ambient radioactivity is less than the average annual dosage experienced from all sources by Americans in a year, though spikes in exposure can be higher. The potential for a full meltdown with much larger escape of radiation still exists, with differences of opinion as to the probability of this.

The more likely health issues related to radiation exposure from this catastrophe is from people who were nearby, and leaving the highest-risk areas (see BBC article here). Because of crippled infrastructure and shortages of food in many grocery stores in a widespread area, people have been not only leaving the area, but also leaving the country. And those exiting the country may end up in the U.S., seeking medical attention.

What should practitioners do? Are there any precedents to a situation like this?

Historical experience from 35 years ago
I am reminded of an experience in the mid 1970s, when I was a medical student at UCSF. I was part of an organizing effort that included UCSF and several local community organizations, which helped with outreach to local hibakusha – survivors of the Hiroshima and Nagasaki atomic bombs, now living in the U.S. The atomic explosions (one was uranium-based, like what is now used in nuclear power plants at much lower levels; and one was plutonium-based) killed over 200,000 people and injured 150,000 more. Many of these survivors remained in Japan, but some 30,000 of them were American-born and many returned to the U.S. (see an in-depth article that appeared in People in 1990 here). They were often Japanese-Americans visiting Japan when the war broke out, were trapped there unable to return during the war, survived the Hiroshima and Nagasaki atomic bombs, and afterwards came home. During the 1970 outreach campaign I was involved with, there were about 400 hibakusha living in the Bay Area.

Nuclear survivors were often afraid to make their history known, partly due to social stigma, and partly dueto fear of losing health insurance coverage for radiation-related illnesses – an increased risk of thyroid disease and thyroid cancer was seen in this population (long-term effect), with increased risks of multiple other cancers seen (medium-term effects), and blood and immune system suppression (acute effect).

Besides the actual health risks, there was also fear and discrimination – a stigma of being “exposed” – with the unfounded belief that those exposed to radiation were themselves radioactive, and would expose others to ill effects of this imagined “radioactivity.” It took education to overcome these mistaken beliefs.

Post-war, Japan had enacted specific government-funded programs for hibakusha, and periodically assessed their health and treated their illnesses. This included sending teams from Hiroshima that would travel to the U.S. to reach out to survivors here – this was the program I was involved in. UCSF hosted the Hiroshima team, and a variety of community groups helped reach out to hibakusha, and bring them to “Hiroshima clinic day” in San Francisco.

Modern-day lessons
In the context of history, the scale of radiation exposure, and how to take care of people significantly exposed, is nowhere near what has been seen in the past. However, the issues of exposure to radioactivity from a compromised nuclear power plant should not be minimized – the risks are real, particularly for those living nearby.

Hawaii and the West Coast of the U.S. may experience some measurable increase in background radiation levels, not unlike a solar flare, or flying in an airplane at 30,000 feet. Our instruments for detecting such radiation are very sensitive. This is not likely to be the source of impact on the health care system.

More likely, practitioners may face the issue of taking care of someone who was near the disaster zone in Japan, who has now left and is in the U.S., and is concerned about radiation exposure. There is (unfortunately) much experience in dealing with such issues at orders-of-magnitude higher levels of exposure.

Based on the hibakusha experience, monitoring of blood counts (CBCs), thyroid functions and a comprehensive metabolic panel (which includes liver function tests) are about all that is indicated. For practitioners looking to code for such encounters, the ICD9-CM codes E926.8 (exposure to other specified radiation) or E926.9 (exposure to unspecified radiation) can be used.

The larger issue is reassurance and adding the calming effect of reason on a situation of fear and rumor. Unless one ingests a radioactive substance that remains in the body, being exposed to external radiation does not render one “radioactive” and there is no risk of “contaminating” others. The levels of radiation seen, even right at the nuclear power plant during times of reactor explosions, have remained less than that experienced by someone undergoing a full-body CT scan (compare the levels in the New York Times graph here).

The impact of modern health IT
Another difference in the world since the 1970s (now-vs.-then) has been the emergence of health information technology (HIT), including web-based Electronic Health Records (EHR) systems. This kind of technology is capable of capturing clinical encounter data from practices in all settings, and identifying issues among those with radiation exposure. Reporting these findings – whether to the CDC or to Japanese health authorities – can be done more systematically, and much more quickly than was ever dreamed possible in the 1970s.

In addition, the source of the health information can be much more grass-roots. Modern web-based EHR systems are used by local ambulatory clinicians in their private practices, and not necessarily affiliated with an institution. The need for travelling teams, university-to-university, is not as much of a requirement as it was in the 1970s, given modern HIT.

Our hearts go out to those who have suffered tremendous loss and upheaval in Japan. Assisting with the rebuilding of a devastated infrastructure is something everyone who can should do. The health effects seen outside the immediate area, however, should be put into their proper perspective – those leaving the disaster area will need our help. But the risk to U.S. populations – even those on the West Coast (7000 miles downwind) – is not where our attention should be.

Robert Rowley MD
Chief Medical Officer
Practice Fusion EMR

Trent Peters from Umbrella Medical Systems added an interesting comment on my previous post about Domain Controlled Networks and HIPAA that I thought really added to my original post. Plus, Trent goes into a nice list of other benefits of having a “Management” server in an office. It gets a little technical for some of my readers I’m sure, but is valuable if you’re office is embarking on this adventure.

Here’s Trent’s comment:

This is an interesting question and can be argued either way, but again it comes down to what’s “reasonable and appropriate”. A little background, my company is a IT Consultant group that works specifically in the healthcare arena offering services to medium-sized and small healthcare organizations, we have plenty of EMR implementation experience. Over 95% of our clients are in a domain environment and we always push for an Active Directory environment if one is not present. However, in the small offices (1 – 2 providers) this can be difficult because of the initial cost and the fact it’s “server” based. Many small offices will choose a “hosted” emr solution for the low up front cost and adding on the extra 5 -7K is not a valid option as the cost outweighs the benefits (from their perspective). The other 5% simply do not have the same security and manageability as the domain environments.

Any networks Security solution is only as strong as the weakest link. While not having a domain controller doesn’t necessarily equate to not being HIPAA compliant, it sure helps secure the environment to IT best practices. We call the Domain / Active Directory server the “Management” server because it provides more functions than just AD. For instance, WSUS patch management to make sure all computers have the latest security patches and don’t have the updates that may conflict with the EMR (some EMR software are not compatible with IE8 or SQL 2005 SP3, etc), centralized backup and client folder redirection for non-EMR critical data, centralized monitoring platform for servers (hardware + software), workstations, UPS, networks, VPN, etc, centralized AntiVirus protection is also important to notify the support team of malicious software and vulnerabilities. Group Policies is a big part of the overall security that can manage (if properly configured) all aspects of the network including password policies, computer and user permission rights, power setting, audit controls, etc. There are many benefits to a DC / Management and is the choice to achieve IT best practices (I believe MS recommend 3+ computers to be on a domain environment, although this is aggressive).

It’s nice to be able to bundle server roles (such as SQL or FAX) in order to justify the management server, but generally it comes down to cost. We hold our HIT practices to the highest standard, so our rule is that if the organization has +5 computers, you must have a Domain Controller / Management Server in order to qualify for our full support program. We can’t justify the extra effort required to properly manage the environment without it. In those rare cases where a small organization choses to not invest in a Domain Controller when we feel it’s required, then unfortunately we wish them the best of luck and turn down their business.