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Request an Appointment and Send Your Record Using a PHR

Posted on October 29, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

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.

Providers Awareness of EHR Certification Bodies

Posted on October 28, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of my readers recently linked me to an article from back in July that talks about providers lack of understanding of EHR certification and the possibility of EHR certification bodies beyond CCHIT. Here’s an excerpt from the article:

The Office of the National Coordinator for Health Information Technology has made it clear that it wants multiple EHR certification bodies, but that message apparently has not made it out to many physician practices. According to a survey by Burlington, Vt.-based consulting firm CapSite, 69 percent of healthcare providers are unaware that there will be alternatives to the Certification Commission for Health Information Technology in terms of certifying ambulatory EHR systems.

Additionally, 52 percent of the 850 providers surveyed incorrectly believe that CCHIT certification is a prerequisite to receiving Medicare and Medicaid bonus payments for meaningful use of EHRs. In reality, ONC will designate authorized testing and certification bodies, which then will test and certify EHRs on behalf of vendors.

As most of you know I have a real disdain for misinformation. I’m all about exposing the truth and spreading the knowledge as far as possible. So, you can imagine my reaction to providers not understanding that there are multiple EHR certification bodies and that all of the EHR certification bodies can provide doctors access to the EMR stimulus money.

The only problem is that I’m guessing that most readers of this blog already know this information. I like to think that readers of this blog are smarter and more informed than those who don’t. I was going to do a poll to see who knew what. Only problem is that reading above you’d know the answers.

Either way, if readers of this blog work to inform the people around them that there are multiple EHR certifying bodies (Drummond Group and InfoGuard with others on the way) and that it doesn’t matter which EHR certifying body you use then I think we’d have some impact for good on the EHR world!

Hospital Breach by Job Applicant

Posted on October 27, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

During a bond hearing Thursday in Superior Court, Wheeler’s Macon attorney Reza Sedghi described his client’s actions as a job application gone awry with “no criminal intent or compromise of sensitive patient information.” Sedghi said Wheeler had obtained access to the database with a password and access codes obtained while working on a Macon physician’s connectivity problems with the hospital.

The attorney said Wheeler uncovered seven flaws in the hospital’s system and sought to use the discovery to land a job with the countywide medical complex, spending several hours with Rhodes and David Griffin, the hospital’s security chief.

“They asked for and received a copy of his resume and a written report of his findings,” Sedghi reported in court. “Then they walked out of the conference room and returned with two Warner Robins police officers.”

Wheeler’s acts were stupid, the Macon attorney conceded, but “he had no malicious intent. He was the one exposing the flaws.” –source

I must admit that I’m a bit torn by the story of this kid who I believe didn’t have any malicious intent when he breached the hospitals security system. The crazy thing is that if he’d had malicious intent they wouldn’t have likely known that there were these security holes and that he had breached them.

Certainly the kid is dumb to have done it, but the reaction by the hospital system is terrible. Here’s a quote from the same article excerpt above:

“I condemn any effort of any party to justify his acts,” Rhodes [CIO] said in an exclusive Warner Robins Patriot interview. “This is a criminal act and he did not do Houston Healthcare or its patients any favors. His actions were illegal and we will support the authorities in prosecuting this to the full extent of the law.”

Talk about a major overreaction. Of course his condemnation of efforts to justify his acts makes people more interested in doing so. Honestly, Robert Rhodes, chief information officer for Houston Healthcare, just sounds like an angry CIO whose security efforts were torn to shreds by a 21 year old. I’d be angry too if I were Robert Rhodes. Mostly because Robert Rhodes is the one that should be fired for having such porous security and they should hire Christopher Wheeler to help them actually implement some real security.

Of course, the CIO is quick to point out that “He did not breach our internet security. He got in through a stolen pass word. He didn’t discover a breach. He was the breach.”

This is just wrong. It wasn’t stolen, but given to him as part of his duties to help the doctor connect to the hospital. That’s not a breach. What’s insane is that a doctor’s password would have the ability to create all these back doors and expose seven flaws in the hospital’s IT systems. The CIO should be held accountable for that. So much for only giving users the access that they need. Or maybe the doctors at Houston Healthcare need that ability. Yeah, right.

I don’t want to give the impression that security isn’t important. It is and what this guy did was wrong and he’ll be punished in the legal system for what he did. Although, it does seem that it wasn’t with malicious intent and so some leeway should be given there. However, the CIO accepting a c-level executive salary with responsibility over a network with so many security flaws that could be exposed by a 21 year old using a doctor’s password sounds much more inappropriate to me.

Cookie Cutter vs. Customizable EMR

Posted on October 26, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Honestly, this is one of my favorite discussions to have about an EMR system. The only hard part is that it’s an endless debate with no clear resolution. However, the choices that an EMR vendor makes in regards to their cookie cutter vs. customizable approach is really important.

For those who aren’t as familiar with the issue, the challenge lies mainly in out of the box utility vs. ongoing improvement.

The first part of that challenge is that most doctors think that when they spend their hard earned money on an EMR software, that it should be able to just work out of the box. I think many of the other software programs and other things we buy have created this culture of things just working. For example, it’s amazing how few things you have to do to setup a new computer when you buy it. The computer manufacturers have done a great job making it dead simple to get your computer and be using it shortly after pulling it out of the box.

Most people want this same type of thing to happen with an EMR. Sure, they realize that there will be some customization and entry of their clinic specific data. It’s understandable to have to create some users, add in your address and phone number and a few things like that. However, there’s this expectation that I should be able to just start using the system. Many are surprised when they start documenting their first patient to realize that there are no templates (or insert other EMR feature) available to them for that patient.

Of course, in the EMR vendors defense it’s a challenge to pre-load the information in a way that it just works out of the box. Certainly an EMR vendor could load it up with every template imaginable. However, then they’d hear the complaint that the pediatric doctor had no need for those GYN templates and what kind of silly EMR vendor would make that simple mistake. Of course the EMR vendor knows this fact, but how do you build a software that can take this into account. Much easier said than done.

Of course, some EMR vendors have approached these challenges by providing a real cookie cutter approach to EMR. The complaints then come that the EMR system isn’t customizable enough for the doctor. Of course, these are the same people that would have complained about all the customization they would have had to do if they were just given a really bare bones EMR software install.

The reality is that every practice is different and so it’s a major challenge for EMR vendors to balance these two competing interests.

At its core, the EMR software needs to be as setup as possible right out of the box. However, it also needs to provide as much customization as possible so that when the out of the box features aren’t right for a particular practice it can be changed to fit their needs. It’s a funny little balancing act that has more basis in art than science. However, when done right it makes a huge difference.

What types of things do you do or have you seen to solve these challenges?

Paying Doctors for Quality

Posted on October 25, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I recently was listening to a doctor about the reimbursement movement that’s happening in healthcare towards paying for quality instead of procedures (pay for performance or other names). He said, “It’s the right direction, but we need more research on how to measure the quality of a doctor.” Then another doctor colleague said, “In fact, in many cases the outcome that you want is that NOTHING happens. It’s harder to measure and pay nothing.”

I must admit that I’m far from an expert on pay for performance and other possible changes to physician reimbursement, but I found these two comments really insightful. I think they do a good job of describing the challenge of paying doctors based on performance is going to have in the future.

One of the major challenges is with the time needed to measure the performance before you pay the doctor. Often you can’t judge the performance until months later and reimbursement months later isn’t a good motivational model.

One thing seems clear to me about pay for performance. We’ll never even be able to really consider going to a pay for performance model without broad EMR adoption. The data we’ll need to change the reimbursement model will require the data that an EMR software can produce.

I’d love to hear what other challenges people see with the pay for performance model of reimbursement.

Speaking at WordCamp Las Vegas (A Blogger’s Conference)

Posted on October 22, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

My apologies for not having time to write a post today. It’s been a pretty crazy week with the Mobile Health Conference in Las Vegas and today I had a ton of things to get caught up on. Plus, tomorrow I’m doing a presentation at WordCamp Las Vegas which has kept me busy today. At the conference, I’ll be telling my story of how I went from being a “hobby blogger” to being a full time blogger and the lessons I learned along the way. Obviously, EMR and HIPAA & EMR and EHR play a large role in my successful switch.

WordCamp is a blogger conference for WordPress users, so I focus a fair amount on the various WordPress items I used along the way, but if you’re interested in my story there’s a live stream tomorrow at 10 AM PST. It will be the first time I’ve told my story in a venue like this, so it will be interesting to hear the attendees reaction. Hopefully they get some good takeaways.

We’ll be back this weekend with our regularly scheduled EMR programming. In fact, looks like I’m going to be hitting the airwaves on the physician focused XM radio station ReachMD soon. I believe I’m just going to do a few interviews for them. I mostly look at it as a good opportunity to have a cool experience. We’ll see how it goes. I’ll let you know more details and link the recordings once they go live.

Expanding the Definition of Mobile Devices

Posted on October 21, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I think it was Wayne Gretzky that said that the reason he was so successful as a hockey player was that while everyone else is playing with the puck at their feet, he would instead anticipate where the puck would be and that’s what made him so special.

I think we see far too many companies in the healthcare IT industry that are just “working with the puck at their feet” instead of anticipating where the puck is going.

I’ve seen that to some extent this week at the Mobile Health Conference. Everyone seems to be talking about the smart phones and then they casually mention the iPad also. Both of these technologies seem to be the puck at our feet.

I haven’t seen many people really looking at where the “puck,” mobile devices, is going to go.

For example, I’ve regularly argued that the iPad is a really interesting device and will likely be a game changer. Although, it won’t be the iPad specifically that’s going to revolutionize everything (since it’s the puck at our feet). Instead, the iPad’s features and concepts are going to be widely adopted and provide the innovation for the future of mobile healthcare and mobile EMR.

One feature is the mobility of the iPad. It seems to be the right form factor for it to be reasonably portable. It also uses 3G network connectivity that makes it portable. These types of changes are what’s going to really take healthcare mobile. Certainly the iPad isn’t the only one. There’s plenty of Netbooks which do this also.

However, the iPad did something that the Netbooks don’t do and that is changing the input method to a touch based system. Combining the mobility of the form factor, the 3G connection and the touch interface and now you can see the innovations that make the iPad interesting.

These features are the innovations behind the iPad. Soon we’re going to have a few hundred device options which innovate on top of these main innovations. For example, the touch input ability is really just getting started. Watch for it to become mainstream as more and more companies adopt and improve the technology.

My point being that mobile devices won’t just be smart phones and iPads. Those are just the start and we’re about to see a whole wave of mobile devices that need to be considered by those working in mobile healthcare.

Ensuring Patient Compliance Using Text Messages and a PHR

Posted on October 20, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

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

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

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

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

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

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

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

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

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

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

Wireless 2G, 3G and 4G for Healthcare Applications

Posted on October 19, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today I’m attending the Mobile Health Conference (mHealth) conference in Las Vegas. So far it’s been a pretty effective conference for me already. Although, I’ve gotten most of the value from the people and vendors I’ve met and talked with. Although, is that really any surprise at a conference. More about those meetings later.

In this morning’s keynote conversation, they had executives from T-Mobile, AT&T and Sprint that spoke and then did a short panel discussion. I must admit that I’d hoped for more from the panel discussion and I probably would have rather just had the whole thing a panel discussion. With that said, the most interesting topic they discussed was the 2G, 3G, and 4G topic.

Of course, they didn’t really dig into the different wireless signals like I would have liked to see. However, the executive from T-mobile said both in his speech and in the panel discussion that they’re committed to supporting 2G for 10 more years. Then, he offered this whopper: that most mHealth applications work perfectly fine on 2G and don’t actually need the higher 3G and 4G speeds.

He’s actually right that most health applications do work fine on 2G. However, I can’t help but wonder if that’s a function of there just not being enough 3G and 4G coverage to make it reasonable for a company to make an app that will only work on those faster networks.

From what I’ve seen in the internet world, applications will grow to use whatever resources they are given. Plus, there’s some applications that never get built until they have the resources to make it a reasonable reality.

So, while it may be true that the health applications of today generally work well on 2G, it’s worth asking what applications would we have if 3G and 4G were more widely available? I think we’re getting close to the point that we’ll find out. I imagine most EMR software would be happy to use whatever bandwidth you give them. Not to mention it would improve the user experience.

A few other quick hits:
-The AT&T executive (I believed) argued that they’re getting 4G speeds with 3G technology. So, why should they move to 4G?
-The Sprint executive nailed it on the head when he said that time is the economy of today. Higher speeds and better applications will save people time and that’s valuable.
-I can’t help but wonder where Verizon is. 3 out of 4 isn’t bad though.

Free EMR Selection e-Book

Posted on October 18, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I think that many of you have heard of my e-Book on EMR selection. I’d been selling the e-Book for a while now with some ok results. However, as I thought about it, I wanted to get the information contained in the e-Book out to A LOT more people than were getting it as of now.

On that note, I just made downloading of my e-Book on EMR selection called “Selecting the Right EMR” a free download. You can read more about it and download it on my EMR Selection e-Book page or click the book image at the bottom of this post and it will download a PDF file.

Feel free to distribute the PDF file to all of your friends, colleagues etc. I want to get the information on selecting the right EMR out to as many people as possible. I just ask that you link back to EMRandHIPAA.com if you promote the free e-Book somewhere. Also, if you found something useful in the e-Book I have put a donation button on the page, but there’s no requirement to contribute. Although, all contributions are appreciated.

Now that many more of you will be able to see this e-Book on EMR selection, I welcome your comments on ways that it could be better. I really hope that it helps many doctors in their EMR selection process.


Selecting the Right EMR$149.99 FREE Download
If you find this e-Book beneficial to your EMR selection, please consider making a donation to support the creation of future e-Books.