As is often my Sunday tradition, I love to post some healthcare IT related polls. Today’s poll is prompted by this tweet I sent out earlier this weekend:

I want to spend some time thinking about the motivation for a healthy individual to become an active patient. #PHR #ePatient

February 25, 2011 11:15 pm via HootSuiteReplyRetweetFavorite

@techguy

John Lynn

On that note, I’d love to see how many of my readers use a Personal Health Record (PHR) and more specifically if you update your PHR or not. Of course, this poll will be completely bias since it’s industry people right. Which is why if the results say that few people in the healthcare IT industry are updating their PHR info, then maybe PHR has some issues to be dealt with.

I was looking through the HIMSS session titles and saw one about the Usability of PHR, which prompted me sending out the following tweet:

Usability of PHR? First, shouldn’t we address the reason to use PHR?

January 14, 2011 1:53 pm via webReplyRetweetFavorite

@techguy

John Lynn

Then, a smart HIT journalist named Neil Versel sent his comment on my tweet:

Amen! #healthit #PHR RT @techguy: Usability of PHR? First, shouldn’t we address the reason to use PHR?

January 14, 2011 2:55 pm via ÜberSocialOrigReplyRetweetFavorite

@nversel

Neil Versel

Something to think about this weekend.

I recently got a message from Jerry Theis of MyCrisisRecords. He sent me a story that I thought was a great way to start off the new year. It talks about the value of health care data interoperability and in this case a device and PHR with a person’s health information. Enjoy the story!

Yesterday, one of my members called me to tell me she was taken to the emergency room suffering combinations of complications caused by a rare condition, Polymorphous along with a flare up of fibromyalgia which caused to her go into cardiac arrest. The ER doctors were able to effectively treat her because she had her digital device which provided them all of her medications, conditions, allergies (she is allergic to latex). Because of this rare condition and her acute distress she was told by the doctors had she not had this device there would have been adverse events, medical errors and it would have been fatal.

The ER doctors read the article I had downloaded in the device about Polymorphous. She, the patient educated the doctors who said they had never treated or seen this rare condition. The ER doctors consulted with Mayo Clinic and an expert on Polymorphous consulted with them and spoke to the patient while reviewing the transmittal of her PHR sent to him. She consented to be injected with a drug that had to be sent from Mayo (2hrs). It relieved her of the severe pain and swelling in her throat.

I share this with you because it meant so much to me to hear her testimonial and how thankful she was and how grateful she said the doctors were about what I created. I am a psychotherapist and she is a patient of mine who has a Bi Polar condition. The doctors said they may have had discarded her presentation because of her psychiatric condition had they not had the complete PHR. Another primary reason why I relentlessly developed this technology, for the special needs populations.

While I admit that I’m much more suited to comment on other people’s prognostications and predictions for EMR and health care IT in 2011, I decided to throw caution to the wind and try and make some predictions for the EMR world in 2011.

Few EMR Vendor Acquisitions – I predict that acquisitions of EMR vendors will actually slow down in 2011. Certainly there needs to be some EMR company consolidation with 300+ EMR companies out there right now (and it seems more coming every day). However, I think 2011 will be a wait and see period where companies want to see how the various EMR companies perform for their clients interested in getting the EMR incentive money. The only thing that might ruin this prediction is that if many of the 300+ EMR companies have issues selling product and then have to basically sell off their assets in a fire sale. We might see some of those, but I believe even those will wait until 2012.

EHR Incentive Numbers Down – We’ve all heard the $36 billion in EHR incentive money. Of course, this is just the projection of how much EHR incentive money they’ll have to give out. I expect that when we get the total amount of EHR incentive money paid out in 2011 that it will be much lower than the projected targeted. Especially if many of them sit out 2011 and wait for 2012.

Health Information Exchange Success Stories – There are so many people working on the health information exchange issue that in 2011 we’re finally going to start seeing some breakthrough stories about the exchange of health information. Although, it won’t likely come from where we expect it. Watch for some unique approaches by companies and communities to finally make the exchange of health information a reality. It won’t be across the US in 2011, but we’ll see the signs of what could be in 2011.

Reimbursement for Online Visits – I’m far from an expert on reimbursement and trends in health insurance so this might be a stretch, but I think we’re going to see the first insurance reimbursement for some sort of online visit. The first draft will be a bit cumbersome and restricted, but it will be the start of the online doctor visit in earnest.

Portable Doctor’s Offices – A few years back I started hearing about some doctors who were going back to the old days. Not the old days of medical care, but the old days of the doctor visiting the patients in their homes. When I think about this, I always think of Little House on the Prairie and them calling for someone to go and get Doc Baker. In 2011, I bet we see a lot more doctors eschewing the traditional doctor’s office and visiting patients in their homes. With a hosted EMR and the portable laptops and iPad like technologies that we have today, it makes running an office out of your car pretty reasonable. Certainly it won’t work for all specialties, but it is a service that I think many patients would pay to have from their doctor.

PHR Adoption Will Continue to Lag – I just see no signs that PHR adoption is going to take off this year.

First EMR Lawsuit – I predict 2011 will bring the first HIPAA lawsuit where EMR is at the center of the lawsuit. It will be an important one to watch since it will likely set precedent for future EMR related lawsuits.

There you go. A few little 2011 predictions. I’d love to hear any predictions you’d like to make and which predictions I’ve made that you think are wrong and why.

An interesting discussion happened in the comments about HIPAA secure fax services in regards to the security of email. Being a tech person who formerly managed a few different corporate email systems, sometimes I forget that many people don’t understand some of the details about the security (or lack of security) that’s provided by email.

The short story is: Email is NOT HIPAA Secure (at least in 99% of cases)

There is a way to encrypt email sent between 2 email systems, but so far a standard and mechanism for encryption between all the vast number of email providers has not been established. I won’t go into the details of why this is the case (cost of encryption, standards for encryption, etc), but suffice it to say that almost none of the email systems send encrypted email that would satisfy the HIPAA requirements.

In fact, most times when an EMR, PHR or other patient portal wants to send a secure email/message to someone they send an email which contains a link to an encrypted website that has a unique login. The reason they do this is because there’s no recognized and adopted standard for encryption of email. However, presenting Protected Health Information (PHI) through an encrypted webpage where someone has a unique login is HIPAA compliant and doesn’t require the receiving email system to understand the encryption. It’s a pain, but it’s the reality of privacy of health information right now.

One of the major reasons that many people think that email is secured is that a number of email providers (Gmail being the most famous for this) turned on encryption for all of their users. The misunderstanding is that this encryption is just for users logging in to check, read and send their email. It does not encrypt the email as it it sent from Gmail to the destination email system. Aleks, from Sfax described it similar to a postcard. It’s open where anyone listening can see what’s in the email with no traces left behind.

The only security email partially offers in this manner is the volume of emails that are sent. There’s such a huge volume of useless emails that there’s some security by obscurity benefits. Although, that security doesn’t meet well with the HIPAA requirements. Plus, remember that one thing that computers are great at doing is crunching large amounts of data.

One minor exception that I might make is that if you’re sending email in an internal email system, then it’s possible to set up email encryption. This is possible because you control the email system for the sender and the receiver and so there are ways to do this. However, I know very few people that have actually set this arrangement up. Probably because if they are on your internal email system they usually have access to your EMR and all the PHI can remain in the EMR instead of your email system.

Now many have said that you shouldn’t use the free email providers like Gmail. After reading this it should be clear. You shouldn’t use ANY email provider for sending PHI. So, whether you use Gmail or some other free email provider it shouldn’t matter since I’m sure you won’t be sending any PHI through email any more.

Of course, I’d recommend you use the free Google Apps version of Gmail since DrSmith@yourpractice.com is so much more professional than DrSmith985373@gmail.com. Although, that’s kind of a topic for a different discussion.

I recently sat down with Jeff Donnell from NoMoreClipboard. We had a fascinating all around conversation, but one of the most fascinating things he told me was the story of his last visit to his doctor’s office. I’ll do my best to recount what he told me.

When he decided he needed to go see the doctor for a visit his wife suggested that he call the doctor to make an appointment. Of course, Jeff “eats his own dog food” and decided that instead of calling for an appointment, he’d request an appointment through NoMoreClipboard. So, he logged into his account and sent off the request for an appointment with his PHR attached. Pretty interesting idea no?

Don’t ask me why, but when possible I’d much rather request something through my computer. Maybe it’s sitting on hold while you wait to talk to someone that’s turned me off to the phone call, but the idea that I could request an appointment online even if the doctor isn’t on NoMoreClipboard is a pretty attractive feature for a PHR.

Of course, since Jeff’s doctor wasn’t on NoMoreClipboard, his appointment request and health record were faxed to his doctor’s office. He got a call from the doctor and scheduled his appointment. The story certainly doesn’t end there.

When he arrived at the doctor’s office he wondered if they’d have his record or not. They handed him the standard clipboard to fill out all the paperwork. He still said nothing and dutifully filled out the paperwork. No one said anything about the record he’d sent until he was with the doctor and the doctor realized that Jeff was the one that sent in his PHR. I guess it was the talk of the office when that fax came in.

Obviously, the idea of requesting an appointment and faxing in your health record using a PHR still has a ways to go. In fact, NoMoreClipboard’s goal is to work with doctor’s offices like these so that the office gets the person’s health record on the forms that the doctor’s are use to getting it on. I think that’s a smart strategy. Not to mention the idea of the patients driving their doctors to use and work with a PHR provider. I think they call that Word of Mouth advertising right?

I’ve been thinking about this for a while when I recently talked with someone from Microsoft’s HealthVault division. I quite frankly asked this gentleman why I should use a PHR. Obviously, if I was a patient with a chronic or complicated illness I could see a compelling use case. However, what’s the use case that will drive and motivate healthy individuals to use a PHR. So far I really haven’t heard a good answer.

Requesting an appointment and not having to fill out that same lengthy cumbersome paperwork is the closest I’ve thought of.

In this Sunday’s HUH? news we have a report by Healthcare IT news that Google may be considering using their Google Wave technology for EHR. Of course, I think the writer at Healthcare IT news must have had a deadline or something since the paper written by Google engineers Shirley Gaw and Umesh Shankar about representing “Individual Health Records” that are aggregating from “multiple sources” which sounds a lot more like a PHR to me than an EHR

That minor verbiage aside, it’s hard for me to imagine Google Wave used as a PHR or an EHR. Ok, I get the idea that it would be interesting to see all the clinical data elements added to a patients history in real time (basically what Google Wave does). This is an innovation that is needed. I just think that re-architecting the very consumer focused Google Wave product isn’t going to get us there.

Not to mention, Google has chosen to stop supporting Google Wave. I think Google probably has enough to do with health with Google Health. I’ll be very surprised if we really see the Google Wave technology used in healthcare.

I just finished reading a 2800+ word post talking about e-Patient Dave’s experience transferring his patient record from his hospital PHR to Google Health. If you’ve ever been to the doctor, I think it’s worth a read to learn about how doctors are charting and a little bit about where we are in patients’ owning their own health record.

I will just share a couple quotes from his experience that really stood out. First a look at why the EHR billing centric software we have now is a major problem for the future of PHR:

The really fun stuff, though, is that some of the conditions transmitted are things I’ve never had: aortic aneurysm and mets to the brain or spine.

So what the heck??

I’ve been discussing this with the docs in the back room here, and they quickly figured out what was going on before I confirmed it: the system transmitted insurance billing codes to Google Health, not doctors’ diagnoses. And as those in the know are well aware, in our system today, insurance billing codes bear no resemblance to reality.

For the love of insurance billing codes. Nice way to ruin valuable data.

Another nice quote is about the data integrity of what’s being put into the EHR system:

And you know what I suspect? I suspect processes for data integrity in healthcare are largely absent, by ordinary business standards. I suspect there are few, if any, processes in place to prevent wrong data from entering the system, or tracking down the cause when things do go awry.

And here’s the real kicker: my hospital is one of the more advanced in the US in the use of electronic medical records. So I suspect that most healthcare institutions don’t even know what it means to have processes in place to ensure that data doesn’t get screwed up in the system, or if it does, to trace how it happened.

I know this is a major challenge for our clinic. Our medical records staff have been doing regular EHR chart audits of our providers and sometimes we’re just amazed that someone would electronically sign something in the record. I don’t know how many times we’ve said, “What were they thinking?” Certainly the same thing happened in the paper world, but it is often much harder to “fix” errors like this in an EHR.

What other methods are people using to ensure reliable data being added to their EHR system?

The more I consider what Google Health and Microsoft HealthVault are doing, the more I think that they just might have found the real solution to interoperable health records. I’m still holding out final judgment, but I’m really impressed with some of the things there doing.

For example, Techcrunch reported that Google Health just recently partnered with CVS for Google Health to connect with CVS to try and create a comprehensive pharmacy history. Considering Google had previously signed up Longs Drugs and Walgreens, Google is making good head way towards this goal. No doubt Google Health is also in discussions with Wal-Mart and Target, two of the other major players in this space.

Of course, the next step is to get patients to actually start adopting this technology. I can’t see many pharmacists pushing this feature. In fact, I’m guessing this might be an annoyance for them to have to support. Patients are going to have to force the issue if they want to use this. At least until there’s widespread adoption.

We’ll also leave the privacy issues of these connections for another day as well. Either way, these types of partnerships are like gold for Google Health. It creates a good foundation to build their product. I just still like to see more connections with EHR software vendors. I haven’t seen as many of those happening as I’d like to see.

I just came across a few interesting tweets where Howard Luks, Web 2.0 and HC 2.0 savvy Orthopedist fascinated by Social Media and influence on healthcare delivery, posted his 100 patient “poll” on PHR. His first question was how many people were interested in PHR. The second one was how many patients would want their healthcare data online (cloud). Check out the responses.

66/100 not knowing what a PHR is seems high. I would have guessed more like 95/100 wouldn’t know what a PHR was. The split for those interested in their HC information being online seems pretty representative. Over half of the people don’t care or don’t know. So far no PHR vendor has really given us a reason to care.