Time again for my weekly round up of healthcare IT and EMR related tweets. Plus, a few thoughts from me about the various tweets.

@Craigley
Craig Bradley
I need a Watson robot in the room to be my knowledge/evidence coach & also EMR scribe while I listen/touch/care. @SeattleMamaDoc #chc11

The good news for Craig is that I’ve seen the people from IBM that did Watson working with the people from Nuance (most famous for Dragon Naturally Speaking) working on this. I don’t think it’s that far away.

@nickgenes
borborygmi
First real recommendation: have good backup plan when #EMR goes down; one makpractice case was lost by inadequate downtime system #SA11

This was pretty interesting. I’d love to learn more details about this malpractice case. No doubt you have to work on a proper system to handle EMR down time. I’ve written before about all the ways you could have EMR down time and the cost of EHR down time. It’s not a question of IF you will have EHR down time, but WHEN.

@JBikman
Jeremy Bikman
I’m very excited to see what Orion can become w/ Amalga HIS. My hope is that they emerge as a legit EHR/EPR/HIE player globally. Very cool.

This is interesting news since Orion is focused on the Asia Pacific market. Coincidentally, I’m just finalizing the details of me attending a Healthcare Informatics Conference in Thailand in March 2012. I’m interested to learn a lot more about Asia. You can read more about the Orion Health Deal for Amalga here.

@EMRDailyNews
EMR Daily News
Over 60 EMR / #EHR Apps Now Available in the iTunes App Store su.pr/1tfhMG

64 iPhone EHR apps on the app store. In February there were only 5 EMR apps in the Android marketplace. I’m sure there are a whole lot more now. Plus, the number of apps in the app store is a bit flawed since it’s not like people purchase their EHR software on the app store. However, it’s interesting to see how many are putting it there.

I’m sure like many of you, I was completely intrigued by the demonstration of the Watson computer competing against the best Jeopardy! stars. It was amazing to watch not only how Watson was able to come up with the answer, but also how quickly it was able to reach the correct answer.

The hype at the IBM booth at HIMSS was really strong since it had been announced that healthcare was one of the first places that IBM wanted to work on implementing the “Watson” technology (read more about the Watson Technology in Healthcare in this AP article). Although, I found the most interesting conversation about Watson in the Nuance booth when I was talking to Dr. Nick Van Terheyden. The idea of combining the Watson technology with the voice recognition and natural language processing technologies that Nuance has available makes for a really compelling product offering.

One of the keys in the AP article above and was also mentioned by Dr. Nick from Nuance was that the Watson technology in healthcare would be applied differently than it was on Jeopardy!. In healthcare it wouldn’t try and make the decision and provide the correct answer for you. Instead, the Watson technology would be about providing you a number of possible answers and the likelihood of that answer possibly being the issue.

Some of this takes me back to Neil Versel’s posts about Clinical Decision Support and doctors resistance to CDS. There’s no doubt that the Watson technology is another form of Clinical Decision Support, but there’s little about the Watson technology which takes power away from the doctor’s decision making. It certainly could have an influence on a doctor’s ability to provide care, but that’s a great thing. Not that I want doctors constantly second guessing themselves. Not that I want doctors relying solely on the information that Watson or some other related technology provides. It’s like most clinical tools. When used properly, they can provide a great benefit to the doctor using them. When used improperly, it can lead to issues. However, it’s quite clear that Watson technology does little to take away from the decision making of doctors. In fact, I’d say it empowers doctors to do what they do better.

Personally I’m very excited to see technologies like Watson implemented in healthcare. Plus, I think we’re just at the beginning of what will be possible with this type of computing.

Katherine Rourke, on my sister site EMR and EHR, wrote an interesting piece on Adding Genomic Info to the EMR. Here’s a short excerpt from the post. You should go and read the rest of the post as well.

As the author notes, some specialties have already begun to tailor drug treatments to individual patients based on their genomic profile. For example, DNA sequencing of tumors in non-Hodgkin’s and Mantle Cell lymphoma can lead to personalized cancer vaccines that can produce great results, notes writer Gerry Higgins of the NIH.

Such data can also be used for a growing number of clinical situations, such as tailoring Coumadin doses to specific patients and providing psychiatric patients with the appropriate drug.

I’d been meaning to write about genomics and EMR for a while and so I’m glad that Katherine did. In one of my more interesting discussions at HIMSS with CMO of Nuance, Dr Nick (sorry, his last name is too hard to spell), we talked about the future of EMR and the possible benefits it could provide to patient care, diagnosing, etc. Nuance had partnered with IBM’s Watson project (the famous Jeopardy Watson) to apply the Watson technology to healthcare. At its core is using technology to crunch a lot of data and provide some meaningful (sorry I had to use the word) results or information.

As this discussion progressed, I casually suggested that one day we’ll need the same sort of processing across things like a person’s genome. The genome project isn’t quite a consumer commodity, but it’s getting there. One day, it won’t be at all surprising for us to bring our PHR info along with our personal genome to the doctor’s office. The lady at the front desk will ask you for a copy of your genome. Pretty crazy to consider, but probably much closer to happening than we realize.

Imagine trying to somehow process the information found in a genome in a paper based world. Exactly! The thought is so unreasonable you have to just laugh. I don’t follow the science of using the genome in healthcare that closely, but the examples in the above article by Katherine are quite interesting.

Plus, I think we’re still in an old world mentality where the world is still flat when it comes to understanding the data that’s available in the human genome. One day some remarkable humane genome Christopher Columbus is going to discover a new world that nobody knew about before. EMR software will be the tool used by most doctors to tap into that new world of healthcare based on the human genome.

This is why I’ve argued for so long about the possible long term benefits of having an EMR. The integration of a patient’s genome into their healthcare is just one of those potential long term benefits of having an EMR in your office.

In a recent Healthcare IT News article, they wrote about a KLAS research study that found that the speech recognition market is ready to grow. Here’s a small portion of the article:

Providers report a demonstrable return on their speech recognition dollars, according to a new report from KLAS. Participants of the study indicated benefits of speech recognition such as staff reductions, improved report turnaround times and increased physician satisfaction.

“The speech recognition market is ripe for healthy growth,” said Ben Brown, author of the report. “Currently, less than one in four hospitals use the technology, however, in light of meaningful use and the benefits providers point out in this study, we expect it will assume a more prominent place in the role of clinical documentation.”

It seems like a bit of journalistic spin to say that speech recognition provides a “demonstrable return.” My personal experience tells me that users either love or hate speech recognition. The article does aptly state that it requires some up front investment to learn voice recognition and access the long term benefits that voice recognition provides.

The other obvious part of the report is that Dragon still dominates the voice recognition landscape. I recently also got an email from Eric Fishman of EMR Consultant, EHR Scope, EHR TV, etc fame (and also an advertiser on this site) about a new voice recognition, dictation and transcription software they’re distributing called Frisbee.

They have a bunch of videos showing Frisbee transcription software in action on EHR TV. I found the one called Frisbee, Dragon Medical and EMR Workflow pretty interesting.

I could see this type of software providing the platform for the future of the transcriptionist. Neil Versel recently posted the news that the Medical Transcription Industry Association (MTIA) will be changing their name to the Clinical Documentation Industry Association. No doubt transcription companies are looking at ways to survive. One of those ways will be for the transcriptionist to go beyond just transcribing to assisting with the clinical documentation (including the complicated ICD-10). Seems like Frisbee’s voice recognition into the EMR with the Frisbee routing capabilities for doctors approval and sign off could be an interesting workflow.

I’m not quite as bullish on voice recognition as the report linked above, but there’s no doubt that voice recognition will continue to play a role in healthcare. Especially as it continues to improve its recognition ability and becomes integrated with mobile devices.

Many of you might remember that one of the most interesting things I saw at HIMSS this year was the natural language processing that was being done by MModal. In case you don’t know what I’m talking about, check out this video interview of MModal that I did at HIMSS. I still think there really could be something to the idea of retaining the narrative that dictation provides while also pulling out the granular data elements in that narrative.

With that background, I found it really interesting when I was on LinkedIn the other day and saw Dr. Nick van Terheyden,the same guy I interviewed in the video linked above had switched companies. Nick’s profile on LinkedIn had him listed as working for Nuance instead of MModal. I guess this shouldn’t have been a surprise. Nuance has a lot of skin in the natural language processing game and it seemed to me that MModal had the technology that would make it a reality. So, now Dr. Nick van Terheyden is the Chief of Medical Information Officer for Nuance.

I’d say this is a really good move by Nuance and I’m sure Nick is being richly rewarded as well. Nick was one of the most interesting people that I met at HIMSS this year. I’ll be certain to search him out at next year’s event to hear the whole story. Luckily, I also found out that Nick is blogging about voice recognition in healthcare on his blog Voice of the Doctor. I always love it when smart people like Nick start blogging.

I previously posted about the EHR stimulus tour (no link since I don’t want to promote them). Today I saw what seems to amount to a press release that talks about the “EHR Stimulus Alliance” and their tour to “educate 500,000 U.S. physicians about opportunities aligned with the American Recovery and Reinvestment Act (ARRA) of 2009.”

This type of puffery just makes me sick. No. Not the educating 500,000 physicians. That’s a good thing and part of the motivation for this blog. The thing that makes me sick is this seems like just a big marketing campaign for Allscripts. Sure they have a list of other partners, but they’re basically partners of Allscripts. Check out the list: Allscripts, Cisco, Citrix, Dell, Intel, Intuit, Microsoft Corp., and Nuance. The press release calls it a “broad coalition of healthcare and technology companies.” Too bad Allscripts is the only true healthcare company in that list. All the others are technology companies that sell some healthcare products.

I just don’t like when an “education tool” is really just being used as a marketing tool for a certain EHR company. If they really wanted to help adoption, they’d sponsor a tour with a whole variety of EHR vendors where they can help doctors to be able to see the wide variety of EHR vendors that exist.

Someone recently emailed me about any conferences that exist for a doctor to be able to evaluate EHR companies all in one place. I know there have been a number of other ones in the past that no longer exist. The only one I know is still going is HIMSS. Does anyone else know of other places where doctors can see a bunch of great EHR? I ask this knowing that many really great EHR just haven’t seen the benefit of these types of shows.

Also, if anyone has a chance to go to one of these EHR Stimulus tour stops, I’d love to have you do a guest post on the experience. I sent them a tweet asking if they can stop in Las Vegas so I can check it out.

Turns out the fish are starting to feed. Check out this website that talks about the “EHR Stimulus Tour: Educating the Nation.” Ok, I don’t really want you to check out the website, since I think it’s kind of sad. At the bottom it lists the “EHR Stimulus Alliance.” The following companies are listed in this EHR alliance:
Allscripts
Cisco
Citrix
Dell
intel
intuit
Microsoft
Nuance

What a group of large companies trying to sell a bunch of product. I guess we should have expected something like this, but maybe I’m just a little surprised that they made a website for an EHR stimulus tour and everything. Interestingly the twitter link on the site goes to an Allscripts twitter account. I think we can clearly see who’s behind this website.

Honestly, this reminds me of an Amway or other MLM convention. Is it any wonder the type of information that will be given at this type of tour? I guess $18 billion is a lot of motivation to market your EHR software. I just wish they were stopping in Las Vegas so that I could go and check them out.