Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and HIPAA for FREE!!

E-Patient Update: Sometimes Tech Gets In The Way

Posted on September 22, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Being such an enthusiastic tech user, I tend to assume that adding technology to the healthcare equation is a plus in almost any situation. Why not automate scheduling?  Data gathering? Pharmacy?

To me, it’s always seemed like a no-brainer that tech adoption works to my advantage as a patient. The more I can avoid going through basic motions manually, the better processes work, giving me more time to spend with my clinicians. Right?

Apparently, not so right. When you take patients into account, sometimes doing transactions the old-fashioned way may actually be more efficient – or at least more flexible – than running things through an automated process. If nothing else, it may be easier to accommodate patients if you don’t have to run them through your workflow.

That, at least, is the lesson I’ve gleaned from studying the day-to-day flow at Kaiser Permanente, where I get all of my healthcare. After watching Kaiser employees work, and asking a few unobtrusive questions, I’ve come to believe that going offline may actually be better in some situations.

Tech-friendly, but not tech-dependent

Now, make no mistake: Kaiser isn’t in the stone age technically. For example, it seems to build most of its clinical operations around what is reputed to be the mother of all Epic installations. (Back in the day, it was rumored that Kaiser spent roughly $4 billion to roll out Epic, a massive sum even by national organization standards.)

Throughout my care process, the fact that clinicians and support staffers are all on Epic has played to my advantage, particularly given that I have a few chronic illnesses and see several specialists. I’ve also benefited from other Kaiser technology, such as kiosks which automate my check-in process for medical visits.

In addition, I’ve gotten a lot of benefits from using Kaiser’s robust web portal, which offers the capability to exchange email messages with clinicians, set appointments, pay premiums and co-pays, order and track prescriptions and check test results.

All that being said, I’ve encountered manual processes at many steps in my journey through the Kaiser system. While some of these processes seem wasteful – such as filling out a standard pre-visit form on paper – others turn out to be more useful than I had expected.

‘People forget their card’

One situation where technology might not be needed is taking people into the doctors’ suite for consults. In theory, Kaiser could set up an airport- or DMV-style ticker letting people know when their doctor was ready to see them, but having nurses yell last names seems to work fine. I’d file this under “if it ain’t broke don’t fix it.”

The pharmacy is another area relying on a mix of low- and high-tech approaches. Interestingly, the pharmacy offers an airport-like board displaying the names of patients whose meds are ready. But when it comes to retrieving patient info and dispensing drugs, the front-line staffers enter the patient numbers by hand. I would have expected there to be a barcode on the membership card, but no dice.

According to one pharmacy tech, it has to be this way. “People forget their [Kaiser member] card all of the time,” she said. “We can’t assume members have It with them.”

These are just a couple of examples, but to me they’re telling. I may be missing something here, but it seems to me that Kaiser’s approach is practical. I’d still like to automate everything in my healthcare world, but obviously, that doesn’t work for everyone. Clearly, offline patient management models still matter.

Public Health Agencies Struggle To Integrate With HIEs

Posted on September 21, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

New research by ONC suggests that while public health agencies might benefit from connecting with HIEs, there are still some significant barriers many need to address before doing so.

Public health agencies at both the state and local level collect information from providers as part of conducting disease surveillance activities and maintaining data registries. Though some of these registries are common – notably those focusing on childhood immunizations, birth defects and cancer—the agencies’ technical infrastructure and data formats still vary. This makes sharing data between them difficult.

One alternative to cumbersome data matching between agencies is for the agencies to integrate with an HIE. According to the ONC report, public health researchers have begun to find that at least some of the time, the data they get from HIE organizations is richer than data from clinical systems. Not only that, when public health agencies integrate their information systems with HIEs, it can help them conduct many of their functions more effectively. However, it’s still unusual to find HIE-connected agencies as of yet.

In its new report, ONC outlines what it learned about what the agencies hoped to accomplish with HIE integration and how they moved ahead with integration. To find this out, ONC contracted with Clinovations Government + Health, which participated in discussions with eight entities and analyzing more detailed information on 10 others.

Virtually all respondents had two goals for HIE integration: 1) Minimizing the number of connections needed to link providers, HIEs and agencies and 2) Helping providers meet public health requirements for Medicare and Medicaid EHR incentive programs. A small subset also said that over the longer term, they wanted to create a sustainable platform for clinical and public health exchange which could support enhanced analytics and quality measurement.

Not surprisingly, though, they face considerable challenges in making HIE integration actually happen. In most cases, technology issues were possibly the toughest nut to crack, and almost certainly the most complex. To connect with an HIE, agencies may confront incompatible transport and messaging protocols, standards problems, data classification and coding issues, inconsistent data quality, and their often-inflexible legacy systems, to name just a few of the many problems ONC cites.

As if that weren’t enough, the agencies may not have the funding in place to take on the integration effort, and/or lack a stable funding stream; don’t have the kind of cross-functional leaders in place needed to integrate their systems with HIEs; grapple with complicated patient data privacy and security issues; and bump up against state laws limiting data sharing methods.

However, through its research, the ONC did gather some useful feedback on how the agencies were coping with the long list of HIE integration challenges they face. For example, to win over the support of policymakers, some agencies have emphasized that they’ll be able to use HIE data for higher-level analytics and quality measures. The respondents also noted that HIE integration got more internal support when they got buy-in from top leaders and second-tier leaders have project management, technical and policy skills.

Given these odds, it’s little wonder that the number of public health agencies successfully integrating with HIEs is still small. That being said, there’s good reason for them to keep pushing for integration, so their number is likely to grow over the next few years.

Will Medical Device Makers Get Interoperability Done?

Posted on September 20, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Most of the time, when I think about interoperability, I visualize communication between various database-driven applications, such as EMRs, laboratory information systems and claims records. The truth is, however, that this is a rather narrow definition of interoperability. It’s time we take medical device data into account, the FDA reminds us.

In early September, the FDA released its final guidance on how healthcare organizations can share data between medical devices and other information systems. In the guidance, the agency asserts that the time has come to foster data sharing between medical devices, as well as data exchange between devices and information systems like the ones I’ve listed above.

Specifically, the agency is offering guidelines to medical device manufacturers, recommending that they:

  • Design devices with interoperability in mind
  • Conduct appropriate verification, validation and risk management to ensure interoperability
  • Make sure users clearly understand the device’s relevant functional, performance and interface characteristics

Though these recommendations are interesting, I don’t have much context on their importance. Luckily, Bakul Patel has come to the rescue. Patel, who is associate director for digital health the FDA‘s Center for Devices and Radiological Health, offered more background on medical device interoperability in a recent blog entry.

As the article points out, the stakes here are high. “Errors and inadequate interoperability, such as differences in units of measure (e.g., pounds vs. kilograms) can occur in devices connected to a data exchange system,” Patel writes. Put another way, in non-agency-speak, incompatibilities between devices and information systems can hurt or even kill patients.

Unfortunately, device-makers seem to be doing their own thing when it comes to data sharing. While some consensus standards exist to support interoperability, specifying things like data formats and interoperability architecture design, manufacturers aren’t obligated to choose any particular standard, Patel notes.

Honestly, the idea of varied medical devices using multiple data formats sounds alarming to me. But Patel seems comfortable with the idea. He contends that if device manufacturers explain carefully how the standards work and what the interface requires, all will be well.

All told, If I’m understanding all this correctly, the FDA is fairly optimistic that the healthcare industry can network medical devices on the IoT with traditional information systems.

I’m glad that the agency believes we can work this out, but I’d argue that such optimism may be premature. Patel’s assurances raise a bunch of questions for me, including:

  • Do we really need another set of competing data exchange standards to resolve, this time for medical device interoperability?
  • If so, how do we lend the consensus medical device standards with consensus information system standards?
  • Do we need to insist that manufacturers provide more-consistent software upgrades for the devices before interoperability efforts make sense?

Hey, I’m sure medical device manufacturers want to make device-to-device and device-to-database data sharing as simple and efficient as possible. That’s what their customers want, after all.

Unfortunately, though, the industry doesn’t have a great track record even for maintaining their devices’ operating systems or patching industrial-grade security holes. Designing devices that handle interoperability skillfully may be possible, but will device-makers step up and get it done anytime soon?

The Impact of HIEs in Natural Disasters – #HITsm Chat Topic

Posted on September 19, 2017 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’re excited to share the topic and questions for this week’s #HITsm chat happening Friday, 9/22 at Noon ET (9 AM PT). This week’s chat will be hosted by Brian Mack (@BFMack) from @GLHC_HIE on the topic of “The Impact of HIEs in Natural Disasters.”

On August 29th, 2005, Hurricane Katrina, a category 3 storm, made landfall in SE Louisiana. Torrential rain and sustained winds exceeding 110 MPH quickly overwhelmed the protective measures in place, and the subsequent storm surge breached levies and flooded huge swaths of New Orleans and surrounding areas. Mass-devastation across Louisiana and Mississippi contributed to the deaths of nearly 1,500 people, forced tens of thousands more from their homes, and caused an estimated $108 billion in property damage. At that time, only 10% of physicians were actively using electronic medical records, and electronic health information exchange was still was in its infancy. An incalculable number of paper health records were lost forever. The lack of access to patient information during and following the storm significantly hindered medical response efforts, and required years to replace.

Fast forward to Aug. 24th-26th, 2017, when Hurricane Harvey, an even larger (Cat. 4) storm struck Southern Texas, and dumped more than 40 inches of rain on the greater Houston area. While Harvey has been described as “Houston’s Katrina” in terms of its intensity and impact, the story was significantly different for the healthcare delivery system. Two health information exchanges in the region, the Greater Houston Healthconnect (GHHC) and Healthcare Access San Antonio (HASA) worked together to assist both those who stayed through the storm, as well as those who were evacuated. GHHC staff actually shuttled between shelters in the Houston area, overseeing the set-up of HIE portals, to help clinicians provide care for patients. Providers were able to maintain access to patient records, even from remote locations, using laptops and WiFi to access EHR systems in the normal way. As a result, the response to medical needs, and continuity of care for the population impacted by Harvey across Texas was seamlessly maintained at a very high level.

This week’s #HITSM Twitter chat will discuss the opportunities, challenges, and value of community-based Health Information Exchange in connecting the “last mile” of interoperability, particularly in emergency situations.

Some additional reading:

Here are the questions that will serve as the framework for this week’s #HITsm chat:
T1: What lesson(s) should we, as participants in the healthcare ecosystem, take away from events like Hurricanes Katrina & Harvey? #HITsm

T2: What roles do/should stakeholders: government (local, state, federal), HC providers, private sector, citizenry play in assuring adequate preparation for disasters? #HITsm

T3: What responsibilities do health IT infrastructure vendors (EHR), and Health Information Exchange have in supporting successful emergency response? #HITsm

T4: How do community based HIE’s differ from national interoperability efforts and/or vendor based solutions in emergency situations? #HITsm

T5: What examples from your own local communities can you share where community-based health information exchange either made a difference, or COULD have made a difference in responding to a public emergency? #HITsm

Bonus: Aside from the basic task of networking disparate healthcare providers, how could Health Information Exchange contribute to better connected communities? #HITsm

Upcoming #HITsm Chat Schedule
9/29 – Condition Management vs Episodic Care Management
Hosted by Brian Eastwood (@Brian_Eastwood) from @ChilmarkHIT

10/6 – After Death Data Donation – A #hITsm Halloween Horror Chat
Hosted by Regina Holliday (@ReginaHolliday), Founder of #TheWalkingGallery

10/13 – Role of Provider Engagement for Improving Data Accuracy
Hosted by @CAQH

We look forward to learning from the #HITsm community! As always, let us know if you’d like to host a future #HITsm chat or if you know someone you think we should invite to host.

If you’re searching for the latest #HITsm chat, you can always find the latest #HITsm chat and schedule of chats here.

Searching EMR For Risk-Related Words Can Improve Care Coordination

Posted on September 18, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Though healthcare organizations are working on the problem, they’re still not as good at care coordination as they should be. It’s already an issue and will only get worse under value-based care schemes, in which the ability to coordinate care effectively could be a critical issue for providers.

Admittedly, there’s no easy way to solve care coordination problems, but new research suggests that basic health IT tools might be able to help. The researchers found that digging out important words from EMRs can help providers target patients needing extra care management and coordination.

The article, which appears in JMIR Medical Informatics, notes that most care coordination programs have a blind spot when it comes to identifying cases demanding extra coordination. “Care coordination programs have traditionally focused on medically complex patients, identifying patients that qualify by analyzing formatted clinical data and claims data,” the authors wrote. “However, not all clinically relevant data reside in claims and formatted data.”

For example, they say, relying on formatted records may cause providers to miss psychosocial risk factors such as social determinants of health, mental health disorder, and substance abuse disorders. “[This data is] less amenable to rapid and systematic data analyses, as these data are often not collected or stored as formatted data,” the authors note.

To address this issue, the researchers set out to identify psychosocial risk factors buried within a patient’s EHR using word recognition software. They used a tool known as the Queriable Patient Inference Dossier (QPID) to scan EHRs for terms describing high-risk conditions in patients already in care coordination programs.

After going through the review process, the researchers found 22 EHR-available search terms related to psychosocial high-risk status. When they were able to find nine or more of these terms in the patient’s EHR, it predicted that a patient would meet criteria for participation in a care coordination program. Presumably, this approach allowed care managers and clinicians to find patients who hadn’t been identified by existing care coordination outreach efforts.

I think this article is valuable, as it outlines a way to improve care coordination programs without leaping over tall buildings. Obviously, we’re going to see a lot more emphasis on harvesting information from structured data, tools like artificial intelligence, and natural language processing. That makes sense. After all, these technologies allow healthcare organizations to enjoy both the clear organization of structured data and analytical options available when examining pure data sets. You can have your cake and eat it too.

Obviously, we’re going to see a lot more emphasis on harvesting information from structured data, tools like artificial intelligence and natural language processing. That makes sense. After all, these technologies allow healthcare organizations to enjoy both the clear organization of structured data and analytical options available when examining pure data sets. You can have your cake and eat it too.

Still, it’s good to know that you can get meaningful information from EHRs using a comparatively simple tool. In this case, parsing patient medical records for a couple dozen keywords helped the authors find patients that might have otherwise been missed. This can only be good news.

Yes, there’s no doubt we’ll keep on pushing the limits of predictive analytics, healthcare AI, machine learning and other techniques for taming wild databases. In the meantime, it’s good to know that we can make incremental progress in improving care using simpler tools.

Willingness To Invest In Outpatient EHRs and PM Solutions Grows

Posted on September 15, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

While the ambulatory EHR market remains somewhat stable, the number of organizations preparing to get out of their existing system has climbed over previous years, along with an increase in the number of organizations prepared to upgrade their practice management solution, according to new data from HIMSS.

To conduct the 9th Annual Outpatient PM & EHR Study, HIMSS Analytics reached out to physicians, practice managers/administrators, practice CEOs/presidents, PAs, NPs and practice IT directors/staff. A total of 436 professionals responded to its web-based survey.

The survey concluded that 93% of hospital-owned outpatient facilities had a live, in-operation EMR in place. Meanwhile, 70% of respondents representing free-standing outpatient facilities said they had an EHR in place, down from 78% last year.

As part of its survey, HIMSS Analytics asked respondents whether they planned to purchase an entirely new ambulatory EHR system, replace the existing system upgrade the system within the next two years.

The responses suggest that there’s been some new movement in the ambulatory EHR market. Most notably, 10.6% of respondents said they plan to replace their current solution, up from 6.4% in 2014. This is arguably a significant change. Also, 23.8% respondents said they were upgrading their current ambulatory solution, up from 20.8% in 2014.

In addition, the number of respondents with no investment plans fell below 60% for the first time in four years, HIMSS Analytics noted.

Though the practice management system market seems to be a bit more stable, some churn appears to be emerging here as well. Eleven percent of respondents said they plan to upgrade their current PM solution, down from 20.8% in 2014, and 9.3% said they plan to replace their current system, up from 6.4% in 2014.

All in all, there’s not a great deal of replacement activity underway, though the data does suggest a small spike. That being said, I was interested to note that respondents’ willingness to invest in a new system was higher than their willingness to upgrade a system they have.

The question is, why would ambulatory providers be ready to junk their existing EHR and practice management solutions now as opposed to three years ago? Are we reaching the end of a grand health IT replacement cycle or is there more going on here?

One possibility is that with MACRA kicking in, outpatient providers have been forced to reevaluate their existing systems in terms of their ability to support participation in QPP. Another fairly obvious possibility is that ambulatory providers are choosing to systems they feel can support their movement into value-based care.

From what I can tell, providers choosing new systems for these reasons are actually a bit behind the curve, but not terribly so. When their peers attempt to push forward with their three, four or even five-year-old systems, then you may see a replacement frenzy. Sometimes you just can’t afford to stick with Old Faithful.

Create Happier Healthcare Staff in 3 Easy Steps

Posted on September 14, 2017 I Written By

The following is a guest blog post by Chelsea Kimbrough from Stericycle Communication Solutions, as part of the Communication Solutions Series of blog posts. Follow and engage with them on Twitter: @StericycleComms
Chelsea Kimbrough
Creating excellent patient experiences is the focus of nearly every healthcare organization. To do this, providers are increasingly turning to new patient engagement tools and technologies. It’s important to note, however, that patient experience woes cannot be mended with technology alone. The healthcare professionals facilitating communications and care will always play an integral role in patients’ overall satisfaction and loyalty.

Unfortunately, those providing in-person care are often distracted from important patient-facing responsibilities by front office tasks. Thankfully, many modern engagement tools are able to create more seamless operational workflows for healthcare professionals in tandem with enhanced patient experiences. But with the market growing increasingly competitive, it’s important to pick the tools and technologies that best serves both populations.

Outlined below are three steps healthcare organizations can take to create a more enjoyable workplace for their staff and what key capabilities are necessary to ensure the greatest ROI.

  1. Lessen the number of phone calls
    If the phone isn’t demanding attention, healthcare professionals are better able to focus their talent and effort on the patients and people in more immediate need of their expertise. This ability drives better health outcomes, operational efficiencies, and patient experiences.

    Telephone answering solutions and technology help achieve these results. However, it’s important whoever is answering your phones is prepared to handle any question, task, language, or call volume. Unfortunately, many internally-run call answering solutions are unable to swiftly manage fluctuating call volumes. By partnering with a third-party telephone answering service, healthcare organizations can ensure every call is met with exceptional care.

    When searching for a call center solution, healthcare organization should seek:

    • Flexible call answering solutions
    • Multilingual live agent support
    • Control over call flow & scripting
    • Proven experience & expertise
  1. Automate appointment reminders
    Patients crave convenient experiences – and so do healthcare professionals. Automating informational messages to patients, such as appointment reminders, population health notifications, and relevant event announcements, removes part of this communication responsibility from staff, directly enabling them to focus on in-person care.

    It’s important, however, that this particular service is able to integrate with the health systems’ EHR or EMR. This ability enables the health system to target a patient’s contact method of choice when sending automated messages, seamlessly enhancing their experience. And by communicating every interaction with the health system, staff members are kept informed and prepared to meet patients’ needs should they choose to reach out.

    When searching for a messaging solution, healthcare organization should seek:

    • Email, voice, and text messaging capabilities
    • Patient-specific customization
    • Easy message deployment
    • EHR/EMR connectivity
  1. Optimize patient scheduling
    Patients of all ages can benefit from a smoother appointment scheduling processes – and for many patients, online scheduling is the answer. By eliminating the need for a timely phone call, online scheduling better fits into the digitally-driven lives of today’s patients.  And when implemented properly, online scheduling can directly benefit both telephone answering and automated messaging, too.

    Because scheduling an appointment should be a pain-free process, healthcare organizations should simplify it by sending an automated reminder with a unique, secure link to digitally schedule an appointment from their phone, laptop, or other internet connected device. By choosing a tool that automatically communicates this information with the health system’s EHR, patients can call about their appointment and receive consistently accurate information no matter what healthcare employee answers the phone. What’s more, this particular patient engagement tool lessens the appointment scheduling burdening from staff, enabling them to provide better in-person care.

    When searching for an appointment scheduling solution, healthcare organization should seek:

    • Intuitive, user-friendly tools
    • Accurate appointment availability
    • Easy message deployment
    • EHR/EMR connectivity

When the right communication tools and technologies are implemented, entire healthcare organizations thrive. With the above three strategies and the technologies associated with them in place, healthcare professionals can better focus on patients with the reassurance their phones are answered by trained professionals, important messages are promptly delivered, and schedules are being filled.

Healthcare organizations that implement communication tools and technologies that benefit both patients and staff are better positioned to have happier, more satisfied team members. And with a happier staff tending to patients’ healthcare needs, organizations can better safeguard patient loyalty for years to come.

The Communication Solutions Series of blog posts is sponsored by Stericycle Communication Solutions, a leading provider of high quality telephone answering, appointment scheduling, and automated communication services. Stericycle Communication Solutions combines a human touch with innovative technology to deliver best-in-class communication services. Connect with Stericycle Communication Solutions on social media: @StericycleComms

Better Tech is Here for Healthcare

Posted on September 13, 2017 I Written By

The following is a guest blog by Brandt Welker, CTO at MedicaSoft. This is the second blog in a three-part sponsored blog post series focused on new HIT for integration. Each month, a different MedicaSoft expert will share insights on new and innovative technology and its applications in healthcare.

What are some of the common complaints doctors and nurses have about their EHRs?

“I have to click too much.” “Information is buried.” “It doesn’t follow my workflow.” “It’s slow.”

“I feel like a data entry clerk.” “*insert your favorite gripe here*” There is no shortage of commentary on the issues irking clinicians when it comes to technology. What there is a shortage of are ideas to fix it.

Better technology is out there serving other industries … and it can be applied in healthcare. Technology should ease administrative loads and put clinicians back in front of patients! I’ve talked about some of this previously and how we keep clinicians involved in our design process. When it came to building an entirely new EHR, the driving force behind our team researching and adopting new technologies was to imagine a clean slate.

Most of our team came from backgrounds with the Department of Veterans’ Affairs (VA’s) world of VistA. We learned a lot about legacy systems over the years – both beloved and maligned – and asked ourselves what a system would look like if it was unencumbered by the past. How would that system look? What could that system be? What technology choices should we make to simplify things? How could it play nicely with other systems and encourage true interoperability? How could it support users’ clinical workflow?

From the beginning, we decided that the most important thing was to get the platform right. Build the platform and build it right and things will work together. Build it to play nicely with other technology and interoperate. Make it fast. Make it easy. Make it open. Make it affordable. All of these needs were a part of our system “wish list.”

So, how’d we do it? We researched technology working in other fields and also elected to use HL7® FHIR® to its fullest extent. By now, you’ve probably heard a lot about the HL7® FHIR® standard. Many companies are using HL7® FHIR® to build APIs that are doing amazing things across the industry. We decided to use the HL7® FHIR® document data model as the basis of our platform – it simplifies implementation without sacrificing information integrity. We coupled it with a very powerful database and search engine – Couchbase & Elasticsearch. These are two high-performance tools used across industries. When you need a whole lot of data to move fast, you use Couchbase and Elasticsearch.

Couchbase is our NoSQL database. Couchbase is open-source and optimized for interactive applications. It provides low-latency data management (read: lots of data very quickly) for large-scale applications (like an EHR!). It lets us store records as documents and it’s really good at data replication. You might recognize Couchbase  — many other industry giants such as ebay, LinkedIn, and Verizon use it. It is an open-source database optimized for interactive applications. We selected Elasticsearch as our search engine. Some of your favorite sites and services use Elasticsearch – Netflix, Facebook, LinkedIn, and Wal-Mart, to name a few.

On top of Couchbase and Elasticsearch are FHIR APIs. These interactions are managed by type. We also use a Parser/Assembler Service that lets us combine, rearrange, and augment documents. Data is placed in the proper JSON format to be sent through the FHIR API into Couchbase. Our Community Health Record sits on top of this and everything described here is a part of our open platform – the one we built from scratch and architected to be interoperable and easy. Pretty neat, huh?

Once you have the platform, you can build all kinds of things to sit on top of it. The sky is the limit! In our case, we have a Personal Health Record and an Electronic Health Record, but we built it this way so you can use a wide range of technologies with the platform – things like Alerts or Analytics or Population Health or Third Party Applications, even custom built items that folks may have developed in-house will work with the platform. Essentially, using the platform means we can integrate with whatever you already have in place. Maybe you have an EHR with some issues, but you don’t have the time or budget allotted for another huge EHR implementation. No problem – we can help you view your data with a modern interface – without having to buy a whole other EHR. Revolutionary!

There are several other technology choices we made along the way, too – Node.js, NGINX, Angular.js are a few more. Angular.js allows us to be speedy in our development process. We can develop and build features quickly and get changes in front of clinicians for their feedback, which results in less time between product builds and releases. It means folks don’t have to wait months and months for changes they want. Angular is also web-based, which means user interfaces are modern and just like the interfaces everybody uses in their day-to-day lives. Angular.js was created by Google and there are many large companies you’ll recognize who use it to develop – PayPal, Netflix, LEGO, YouTube, to name a few.

I believe healthcare is lagging in adopting new technologies and there are a lot of excuses around why user interfaces in healthcare are generally horrible – they range from the software being written before Web 2.0 to users accepting that it is how it is and finding a way to work around their technology. The latter is probably the saddest thing I see happening in hospitals and clinics. Tech is there to make work easier, not more complicated.

There was a great quote from Dale Sanders, Executive Vice President of Product Development at Health Catalyst in MedCity News last week:

“Every C-level in healthcare has to be a bit of a technologist right now,” he said. “They need to understand this world. If you’re not aware of technology, it puts you … at a strategic disadvantage.”

I can’t emphasize how true this statement is. If you’re not paying attention to where technology is going, you’re not paying attention to where healthcare is going and you’re going to get left behind.

About Brandt Welker
Brandt is a HIT architecture and software expert. He calls Reading, Pennsylvania home. He has architected software systems and managed large IT and innovations programs at the U.S. Department of Veterans Affairs (VA) and the National Aeronautics and Space Administration (NASA). He’s also trained astronauts at the Neutral Buoyancy Lab. He’s currently the Chief Technology Officer at MedicaSoft. Brandt can be found on LinkedIn.

About MedicaSoft
MedicaSoft designs, develops, delivers, and maintains EHR, PHR, and UHR software solutions and HISP services for healthcare providers and patients around the world. For more information, visit www.medicasoft.us or connect with us on Twitter @MedicaSoftLLC, Facebook, or LinkedIn.

The First Ever “Unchat” – #HITsm Chat Topic

Posted on September 12, 2017 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’re excited to share the topic and questions for this week’s #HITsm chat happening Friday, 9/15 at Noon ET (9 AM PT). This week’s chat will be hosted by…

That’s right! The #HITsm chat is going rogue this week. The #HITsm chat on Friday, 9/15 at Noon ET (9 AM PT) will have no agenda, no host, and no organization. It will be an hour long #HITsm free for all where anyone can propose any topic, thought, idea, meme that they want. You can share a link, a picture, a thought, a question, or anything else you feel like sharing.

Where this will end, no one knows, but that’s what makes it so exciting! If it falls flat, we’ll blame workflow and never do it again.

This chat was inspired by @burtrosen who asked for a chat where the #HITsm community can have a chance to “blow off steam.” I loved the idea and the “unchat” was born. There are so many great people in the #HITsm community, I’m sure that some amazing conversations will happen in this chat and likely on unexpected topics. Not to mention that random conversations are a great way to inspire new relationships.

To be clear, this is a true unchat. Those that join and participate will start the topics, extend the topics, ask questions, etc. The topics don’t even have to be related to health IT. If you want to talk about your holiday vacation plans, go for it. Is there a part of healthcare IT that’s really bothering you or has you really excited, let’s hear it. If you like cats as much as Brian Eastwood, share a cat photo. If you’ve fallen in love with your healthcare chat bot and want everyone to know it, share away. Of course, this is a community, so just be respectful and appropriate the way you’d be if we were hanging out or having dinner.

Given that this is an unstructured #HITsm unchat, there won’t be any formal questions for the chat. The threads will start and extend however the community sees fit. However, we will throw out this first question to get things started and the community thinking:

T1-5: What’s on your mind? #HITsm

We hope you’ll join us for this new #HITsm Unchat. Let’s get to know each other in new and unique ways.

Upcoming #HITsm Chat Schedule
9/22 – The Impact of HIEs in Natural Disasters
Hosted by Brian Mack (@BFMack) from @GLHC_HIE

9/29 – Condition Management vs Episodic Care Management
Hosted by Brian Eastwood (@Brian_Eastwood) from @ChilmarkHIT

10/6 – After Death Data Donation – A #hITsm Halloween Horror Chat
Hosted by Regina Holliday (@ReginaHolliday), Founder of #TheWalkingGallery

10/13 – Role of Provider Engagement for Improving Data Accuracy
Hosted by @CAQH

We look forward to learning from the #HITsm community! As always, let us know if you’d like to host a future #HITsm chat or if you know someone you think we should invite to host.

If you’re searching for the latest #HITsm chat, you can always find the latest #HITsm chat and schedule of chats here.

The Healthcare IT Field is Unique, Yorktel Discovers

Posted on September 11, 2017 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Health care professionals love to vaunt the uniqueness of the medical industry, and tend to demand special, expensive treatment on that basis. Reformers tend to discount this special status. (For instance, the security problems in health care are identical to those in other industries, and are caused by the same factors of insufficient investment and training.) Yet telecommunications in hospitals and clinics really is special, and video giant Yorktel has spent the past five years adjusting to that reality. On September 5, Yorktel announced that it has enhanced its solutions for patient telemedicine with Univago HE that includes robust video connections, monitoring, and analytics as a service.

To learn how the company enhanced their video teleconferencing for healthcare, I recently talked to Peter McLain, Senior Vice President of Healthcare, and John Vitale, Senior Vice President of Project Management. They disassembled the various features of Univago that deal with hospital environments, which require reliable 24/7 connectivity, deal with a good deal of noise (both audible and electronic), and demand fast, faultless authorization to protect privacy.

Directional audio

The triangular table-top sets, familiar to so many of us from business teleconferencing, are omni-directional in order to facilitate use by people seated around the table. In a hospital, they pick up the whirr of carts going by, the chatter in the hallway, and the beeps and gurgles of machines in the patients’ rooms themselves. So Yorktel had to substitute directional microphones.

Camera positioning

Remote monitoring requires much more detail than talking heads in a teleconference. For instance, a remote nurse may want to check whether an IV bag is getting empty. So the person on the remote end of the video connection can direct the camera at particular points in the room and zoom in. Originally offering joystick-like controls for this purpose, Yorktel found them too confusing and cumbersome, so they created a system where a user can just double-click on her own screen to focus in on the place she indicated.

Infrared cameras

Remote monitoring takes place continuously, including when the room is dark. The staff don’t want to wake the patient while monitoring him, so Yorktel cameras support the display of scenes scanned from infrared light. A mild alert, such as a soft buzz, lets an awake patient know that he’s being monitored, without disturbing a sleeping patient.

Integration with dashboards

Yorktel software can be seamlessly integrated with other applications so that staff can see vital signs and other data while in a video call. The developers have made the systems adhere to relevant standards, including Skype, Web RTC, and H.323.

Robustness

Conventional business teleconference systems are used for a few hours each day; hospital systems are used 24/7 and must promise long mean times between failures. Yorktel addressed this on both a hardware and a software level. In hardware, they broke down large, integrated components into modules that would be easy to replace. In software, they built a custom operating system on Unix, feeling that would offer maximum reliability. They use artificial intelligence techniques to detect whether the camera has frozen (a common failure) and reboot the system before it interferes with a video session. Components can still fail, but McLain says they can be replaced within 15 minutes instead of 3 to 6 hours.

Security

Yorktel has hardened its authentication and authorization process to make sure that no one at random can dial into a system and see a patient in his bed. At the same time, they have integrated that process into mobile devices so the physician can check in from home or the road in case of an emergency.

The systems follow industry best practices, as specified by the ISO 27001 security standard and HIPAA. In order to expand into UK’s National Health Service and the European Union, Yorktel achieved Privacy Shield certification. They also get penetration testing from a third party expert, and incorporate anti-microbial technology into their systems. The systems are pending approval as Class 1 medical devices (the most reliable level of use) by the FDA.

Following security by design principles, Yorktel maintains no information for a patient. A physician finds the right room through an external service and calls that room. (If the patient wants to be called, he presses a button by the bedside, and a message is sent through some appropriate alert, such as a text message or a flashing screen.) No information on the traffic is preserved, and the call records have no personally identifying information.

Specialized services

Each department in a hospital has different needs, and Yorktel has provided specific enhancements to make their systems more useful in various settings.

For instance, family visits are an excellent use case for videoconferencing. A session can be shared with family members who can’t get in to the hospital. It can also be recorded and saved by the hospital (as mentioned earlier, Yorktel does not preserve session traffic) so it can be viewed again or brought out to prove that the hospital fulfilled its responsibility. To enable family visits, Yorktel allows the staff to designate members of the call as guests. The visitors are called “guests” because they have no control over the systems, but can see and hear what goes on during the session.

For general use in medical settings, Yorktel also allows sidebar conversations. The patient can be put on hold while physicians discuss treatment candidly and privately among themselves.

Via these enhancements targeted at hospitals and clinics, Yorktel has expanded its business in health care. It started with a common application, remote monitoring in the ICU, but expanded to telestroke care, family health, behavioral health, and translational services. They also knew that hospitals already have expensive, dedicated systems for many of these tasks, and don’t want to throw them away, especially if the outcome is to be locked in yet again to some proprietary system. Hence Yorktel’s dedication to standards.

Currently, video conferencing in the hospital is so expensive that it tends to be restricted to ICUs and a few other applications. Ultimately, Yorktel’s subscription plans should offer systems at a low enough cost that they can be deployed universally in hospitals and clinics.

What can other technology developers, outside of two-way video, learn about health care from the Yorktel experience? Most of all, go into the environments where you want your systems used and get to know the needs and workflows of the participants. Systems must be flexible, because each user is different. The systems must also be secure from the ground up, robust, and conformant to standards. Cost is also an important issue in most settings, particularly given the cuts in reimbursement that are widespread.

As it designs systems to interact along standards with other vendors, Yorktel’s strength in software has grown exponentially. This parallels trends throughout many industries, from manufacturers through retailers. Marc Andreessen famously said in 2011 that software is eating the world, and along these line, many analysts say that all companies will soon be software companies–or be drowned by their more agile competition. In this sense, we can all learn from Yorktel.