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Texting Program Helps Patients Give Hospital More Immediate Feedback

Posted on May 31, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Recently, Neil Versel wrote about a truly horrible hospital experience his father had before his passing over on Meaningful Health IT News. It got me thinking, how many patients have terrible experiences like this, and, does the hospitals’ staff even realize it? Most hospitals give their patient’s a form to fill out toward the end of their stay to evaluate their care. A situation I was in a few months ago makes me wonder, however, how accurate those are in determining the care the patient actually received.

When my son was in the hospital during his second week of life with RSV, I was very disappointed with the care he received overall. Yes, there were a few good nurses, but for the most part, my husband and I felt several times like having our son there was an inconvenience to the hospital. One time, when I left for a few hours and my sister stayed with my son, a nurse tried to discharge us (despite the fact that my son was still on oxygen, and was being suctioned every few hours) without even consulting us. At one point, we were told they wanted more room for “more sick” patients, so they might send us home, even though our baby was still very ill. I voiced my concerns a few times but they were dismissed and I was basically told I didn’t have much of an opinion in my son’s care. However, when the time came to fill out the “confidential evaluation form” I was hovered over by the nurse as I filled it out and was given very little time to actually fill it out. What the nurse came away with was a form that would have probably insinuated that our stay was fine, seeing as I hastily finished it without much thought. I planned to complain later, but time got away from me, as it usually does with a newborn baby. I knew I wasn’t the only one to have a poor experience in the pediatrics/mother and child floor at the hospital, as everyone I spoke to who had delivered here said they had a terrible experience. However, the walls are full of notes from mothers staying how wonderful the hospital is. If nurses are hovering over patients as they fill out comment cards or are “encouraged” to fill out a thank you note, how accurate are the results? And even if the patient isn’t watched while filling it out, a piece of paper is very easy to misplace or be forgotten about.

So when I read this article about a texting program implemented at Park Nicollet Health Service in the Minneapolis-St. Paul area, I was intrigued. The program, which is called CareWire, sends text messages to patients before and after their stay, sends appointment reminders, and asks questions about the patient’s stay in the hospital. The program was implemented to increase patient satisfaction. According to this article at MedCity, the part of the texting program that proves to be most useful is a “post-discharge” text that patients receive within a few hours after the patient leaves the hospital. The patient is asked to rate their experience on a 0 to 10 scale, and then Carewire “uses an algorithm to parse of the reason for any low scores, such as the type and time of the visit, which doctor the patient saw, and other relevant data. Customer Service reps then can follow up immediately on any low scores.”

Apparently, the hospital said that the program has helped to raise the satisfaction of patients and is being offered to other facilities in the area.

I love the idea of having a texting program like this. There is no risk of being rushed to fill out a form, or being eyed by an intimidating nurse as you teeter between putting a low score on one of the questions. Many hospitals have a company call patients a few weeks after their stay to answer questions, but this texting program allows for immediate, and more than likely, honest feedback. The fact that CareWire can determine facts such as the time of visit, which doctors (and hopefully, nurses) gave care, etc. during the patient’s stay make this program even better, as it can pinpoint where specific problems may be.

While it would seem that people should be able to voice their concerns and receive immediate reconciliation of the problem, it isn’t always that easy. Sometimes it can be intimidating, especially when in the hospital, which is likely not the most uplifting situation to be in. At least, that is how I feel.

The article I first linked to talks about how other hospitals are implementing other ways to get immediate feedback, such as administering a survey through a tablet right before the patient leaves. While this is somewhat similar to filling out a piece of a paper, I feel like more people would actually fill it out because, unlike a piece of paper that can be thrown away or misplaced and never filled out, there isn’t really a  risk of that happening. The information would then be uploaded immediately to a computer, and hopefully one of the hospital’s employees could review it and help to reconcile any potential problems.

Having this immediate feedback is essential, in my opinion, for increasing patient satisfaction and helping to identify problem areas. This may increase some costs at the hospital, as Healthy Heartland, the vendor for MedCity, said it would potentially add $3 or $4 per visit to use the texting program. However, if patient’s are able to receive better care in the long run, I feel like this cost is well-worth the cost. I mean, if someone’s experience at a hospital is mediocre at best, they may not feel the need to complain or fill out a satisfaction form. However, if their response to a text indicated they could have received better care at a certain time, it might eliminate certain problems before they spiral out of control, and the horrible experience that Neil Versel’s father had could be prevented. Just something to think about.

What do you think? Do you think that this type of immediate feedback would increase patient satisfaction and, hopefully, the quality of care given at hospitals? Would you take the time to respond to a text?

Will Growth In Mobile Use Compromise HIPAA Compliance?

Posted on 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.

There’s little doubt that giving doctors mobile access to data via their personal devices can be valuable. We’ve probably all read case studies in which doctors saved a great deal of time and made the right clinical call because they reached to via an iPad, smartphone or Android tablet.

And this is as it should be. We’ve been working to push intelligence to the network for at least the two decades I’ve been writing about IT.

That being said, we haven’t yet gotten our arms around the security problems posed by mobile computing during that period, as hard as IT managers have tried.  Adding a HIPAA compliance requirement to the mix makes things even more difficult. As John wrote about previously, Email is Not HIPAA Secure and Text is Not HIPAA Secure either.

According to one security expert, healthcare providers need to do at least the following to meet HIPAA standards with mobile devices:

  • Protect their private data and ePHI on personal-liable (BYOD) mobile devices;
  • Encrypt all corporate email, data and documents in transit and at rest on all devices ;
  • Remotely configure and manage device policies;
  • Apply dynamic policy controls that restrict access to certain data or applications;
  • Enforce strict access controls and data rights on individual apps and services;
  • Continuously monitor device integrity to ensure PHI transmission;
  • Protect against malicious applications, malware and cyber threats;
  • Centrally manage policies and configurations across all devices;
  • Generate comprehensive compliance reporting across all mobile devices and infrastructure.

Just a wild guess here, but my hunch is that very few providers have gone to these lengths to protect the ePHI on clinicians’ devices.  In fact, my sense is that if Mr. Bad Guy stole a few iPads or laptops from doctors at random right now, they’d find a wide open field. True, the thief probably couldn’t log into the EMR(s) the physician uses, but any other clinical observations or notes — think Microsoft Office apps — would be in the clear in most cases.

Being a journalist, not a security PhD, I can’t tell you I know what must be done. But having talked to countless IT administrators, I can definitely see that this is a nasty, hairy problem, for many reasons including the following:

–  I doubt it’s going to be solved by a single vendor, though I bet you will be or are already getting pitches to that effect  — given the diversity of systems even a modestly-large medical practice runs.

– Two factor authentication that locks up the device for all but the right user sounds good, but add-ons like, say, biometrics isn’t cheap.

– Add too many login steps to doctors already tired of extra clicks and you may see mass defections away from EMR use.

– Remotely managing and patching security software on devices with multiple operating systems and network capabilities is no joke.

If you feel your institution has gotten a grip on this problem, please do chime in and tell me. Or feel free to be a mean ol’ pessimist like myself. Either way, I’d love to hear some of your experiences in protecting mobile data.  Maybe you have a good news story to tell.

Should EMRs Force Workflow Changes?

Posted on May 30, 2012 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.

Today, I was lurking in the EMR and HIPAA Facebook chat where some readers and publisher John Lynn were talking of things EMR-related.  During that chat, one exchange really brought home to me how far we have to go in even agreeing on how the ideal EMR should work.

During the discussion, one chatroom member said that the biggest problem with EMRs is still that they force doctors to break their workflow.  Another stalwart chatroom member, the insightful @NateOsit, retorted that EMRs should break workflow patterns, as this would promote healthy change.

Well, there you have a conundrum,  if you look closely enough. While people seldom speak of the issue this directly, we’re still arguing over whether EMRs should fit doctors like a glove or change their habits for the (allegedly) better.

This isn’t just an academic question, or I wouldn’t bore you with it. I think the EMR industry will be far more wobbly if the core assumption about its place in life hasn’t been addressed.

At present, I doubt EMR vendors are framing their UI design discussions in these terms. (From the looks of some EMRs, I wonder if they think about doctors at all!) But ultimately, they’re going to have to decide whether they’re going to lead (create workflow patterns that follow, say, a care pathway) or do their best to provide a flexible, doctor-friendly interface.

I’d argue that EMRs should give doctors as many options as possible when it comes to using their system.  Perhaps the system should shape their workflow, but only if the users vote, themselves, that such restrictions are necessary.

But the truth is that when a hospital spends a gazillion bucks on a system, they’re not doing it to win hearts and minds, no matter how much they may protest otherwise.  And when a practice buys a system, they’re usually doing it to meet the demands of the industry, not give their colleagues their heart’s desire.

So let’s admit it.  Though I don’t argue that they’ll ultimately be put to great uses in some cases, ultimately, EMRs are about dollars and bureaucratic face-saving.  So, today’s workflow will just have to take a back seat.

Mobile Health App Ratings by Kaiser

Posted on May 29, 2012 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 had the chance to sit down with Kaiser’s mobile group at the Health 2.0 conference in Boston. We had a really interesting discussion where I was able to learn a number of interesting things about Kaiser’s approach to mobile healthcare. As everyone knows they have a really unique environment with a number of incredible opportunities, but also with their own unique challenges. I’ll be discussing a number of these items in future posts.

Although one opportunity came to my mind in my discussion with Kaiser: A Mobile Health App Rating service by Kaiser.

Many people might remember my previous post about the atrocious idea of an mHealth App Certification. I think this is a really terrible idea and will do nothing to help physicians and patients be able to weed through the overwhelming number of mobile health apps.

With that side comment, I love the idea of Kaiser using its vast network of doctors and patients to rate various mobile health apps. Sure, there are some issues with this model as well, but the benefits of having so many valid doctors rate mobile health apps could be tremendous.

The challenge with most rating services is that you have no way of knowing if the person rating the service is actually who they say they are. For example, Sermo is supposedly a physician only forum. However, I know a lot of non-physicians that are on the forum. One advantage Kaiser has is that they could know if the person in their network is a Kaiser physician or not.

One key question is whether Kaiser would be open to making their physician mobile health app ratings available to the public. I’m sure this will be a tricky question for them to answer. No doubt they already kind of do some of this already in their internal network. Maybe it’s not totally codified into a website with a formal process, but it could be. Plus, the benefits to healthcare in general could be great.

What do you think of Kaiser physicians rating mobile health apps? Are there other better ways to filter through the volume of mobile health apps that exist out there?

PocketHealth Raises the Bar for mPHRs

Posted on I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

On May 1st, Cognovant, a Missouri-based startup, announced in a press release that the initial funding for their smart phone app, PocketHealth, was complete. With this announcement, Cognovant also revealed that the app would be released for both Android and Apple operating systems this month.

PocketHealth is the latest mobile personal health record (mPHR) available for smart phones. This isn’t the first mPHR; other popular ones are mPHR 2 and My Medical. However, PocketHealth appears to be one of the first of its kind. It is untethered, which essentially means it isn’t tied to just one insurance company or healthcare provider. While untethered mPHR’s often make the user key in their own data manually, this isn’t necessarily the case with PocketHealth. What also sets this mPHR apart from others is that it was built following CCD standards. Dr. Joseph Ketcherside, the President and CEO of Cognovant, said in an interview with Mobi Health News:

 From the user interface standpoint, it might look like every other PHR. But the guts of our PHR are comparable to what you would find in the parts of an electronic medical record.

This is essential, because in the future, if medical providers have to be able to give copies of patient medical information in CCD format. PocketHealth is designed to be able to import that format. This also gives PocketHealth an advantage over other untethered mPHRs because doctors and hospitals that have EMRs integrated into their systems can simply upload the CCD, rather than having to take time to log in to a website or deal with a USB drive to read the patient’s mPHR.

One of the issues with some mPHR is whether or not the information is secure. PocketHealth tries to overcome that problem by having PocketHealth encrypt the data and be password protected.

PocketHealth is a free app, though there will be a 3.99 version that a user can upgrade to if they monitor the health of more than one person or have a complicated medical history. The free version seems good enough, however, and tracks information like immunizations, medical conditions, family and social history, information on providers, and more. In addition, the information can be exported as a report or a CCD.

Because PocketHealth has been released for the Android OS, I decided to download it. This was my first experience with mPHR. I was impressed with all the information that could be recorded, and I can definitely see the benefits of it (well, just the idea of an mPHR to begin with). Because I have no idea where my family will be in a year from now, it would be helpful to have this information available at the tip of my fingers when we visit with a new doctor wherever we move. I also see it being handy if someone is admitted to the hospital in an emergency situation and information needs to be quickly accessed.

However, I see some potential problems, such as if the information wasn’t totally correct. What if someone thought they were O negative blood type, so that was entered into the “vital stats” section, but they were actually A negative? Granted, I’m sure a medical professional would test a blood type, and not just trust the PHR, before doing something like a blood transfusion, but there is always the chance for incorrect information. I do like that PocketHealth is created on the same foundation as an EMR, so information can be directly exported from a doctor’s office. I also was a bit concerned about privacy, but the fact that PocketHealth is password protected and encrypts the data made me feel better.

One thing I didn’t like about the app was that it seemed a bit sluggish. I had to press my selections a few times before it would work, which was kind of annoying. Overall, I think I will probably upgrade to the 3.99 version, so I can track the health of my family and me and have a lot of information readily available.

The Android version can be downloaded here. The version for the iPhone is still in the works but the release is expected to occur in the next few weeks.

A Memorial Day Message from Smart Phone Healthcare

Posted on May 28, 2012 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.

A big thanks to all our military! We’re lucky to have so many brave people who fight for our freedoms. I found a series of Memorial Day Cartoons which each share a message of the real importance of Memorial Day. I’ll post them across the Healthcare Scene network as a way to honor and remember those people who sacrifice so much.

A really special shout out to David who’s the force behind Smart Phone healthcare. This week he’ll be given his wings in the Air Force. A well deserved honor and I thank him and his family for their sacrifice for our country!

Have a great Memorial Day and enjoy time with your family as I will do also!

A Memorial Day Message from EMR and HIPAA

Posted on 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.

A big thanks to all our military! We’re lucky to have so many brave people who fight for our freedoms. I found a series of Memorial Day Cartoons which each share a message of the real importance of Memorial Day. I’ll post them across the Healthcare Scene network as a way to honor and remember those people who sacrifice so much.

Have a great Memorial Day and enjoy time with your family as I will do also!

EMR Jobs, Olympic EMR, EMR O/S, EHR Dictation, and EMR Purchasing

Posted on May 27, 2012 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.

You can see we have a jam packed weekend Twitter round up. There were a lot of interesting topics being discussed this week in healthcare social media. As usual, we’ll do our best to provide some of the more interesting tweets. Not to mention we’ll add a bit of our own commentary to provide some background and understanding about the tweets as well.

Now without further ado, a few EMR and healthcare IT tweets for your reading pleasure:


I saw this job tweeted. I didn’t necessarily find this job all that unique, but it’s an interesting contrast to see all the EMR jobs tweeted out, posted on the EMR and EHR Job board, and posted to the Healthcare Scene LinkedIn group. Compare that with experiences like this one posted on EMR Thoughts. It’s such a conundrum that so many don’t have jobs while many can’t find qualified EMR talent.


GE Centricity has been the choice of the USOC for a few years now. I’d love to go to London to see it in action first hand. Anyone want to sponsor that? I do LOVE watching the Olympics!


Does operating system really matter anymore? I’m finding that the operating system is mattering less and less. Ok, with most client server products you need a certain operating system, but with most well done SaaS EHR it doesn’t matter. I’ve reinstalled a few computers recently myself and all I do is reinstall my browser, hook up dropbox and I have probably 90% of what I need.


The sub head on the article describes the link of EHR and dictation better: “Doctors who dictate their clinical notes before they’re entered into an EHR have lower quality of care scores than those who type or enter structured data directly into the EHR, according to Partners Healthcare researchers.” I’m always suspect of these studies. Particularly because they usually have a much narrower focus, but provide for a great headline.

Plus, I think it’s still early on NLP (natural language processing) and CLU (clinical language understanding) technology that will extract more data from unstructured text in real time to support quality care measures. Let’s look at this in 3 years and we’ll see if voice and narrative text is common place or gone the way of the dinosaurs.


I’m sure that this number is lower than many ambulatory EMR companies expect. It’s certainly much less than ONC would predict. I personally predict the number is a bit low. I expect we’ll see a few more EHR purchases than 7-8%, but probably not more than 15%.

ACOs Inhibit Neighbors from Talking

Posted on May 25, 2012 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.

A comment by Naveen in my post about the Health IT and EHR Bubble, caused me to stop and think:

HIE will eventually become the new necessity in the light of the development of regional ‘community’ systems of care (aka ACOs) – in the same way that EHR’s enable a system to talk, they inhibit neighbors from talking.

I had to think this over a little bit to understand that final part about inhibiting neighbors to talk. If I understand him correctly, the challenge is that if I’m in ACO A and my neighbor is in ACO B, then I actually don’t want to communicate with my neighbor.

This is a bit troubling when you think about the value that can be gleaned from exchanging healthcare data. If we aren’t careful as we build ACOs we might be building in more perverse incentives for doctors to not want to do the right thing. This is a huge problem in healthcare now. We don’t need to make it any worse.

Congressmen Ask FDA and FCC to Answer for Delays in Regulation of mHealth

Posted on I Written By

Regulation of mHealth Apps is one of the biggest ongoing hot topics in healthcare.  Earlier this week we posted about regulation, and how it may very well be warranted in some areas, but may be less necessary in others.  Apparently, this is something that is even catching the eye of Congress.

Just last month, members of Congress sent a letter to the FDA and FCC asking them to clarify what exactly they are currently doing with regulation, and what they are planning to do in the future.  The letter expresses their concern that excessive regulation may slow the growth of this developing industry, which grew by 250% on iTunes alone last year.

I think it is great that Congress sees the value of this industry and is concerned with not creating any unnecessary hoops for developers to jump through.  That being said, I also don’t understand how Congress sticking their nose in everything does anything but slow the process down even more.

Is writing a response to their letter a big deal?  Probably not, but who honestly thinks that these congressmen will be satisfied with a simple response?  They will naturally want regular updates of exactly what is being done.  They will likely want to insert their two cents about every little decision that is being made.  Given the chance, they will probably try to use this as another way to create jobs for their constituents, even if it makes no real sense to do so.

I agree with Katie’s article earlier this week that there is some definite value to regulation in many cases; which is ultimately where I think the FDA will end up.  What scares me, is that Congress will force themselves into the process which will only make it that much slower and create the very delay that they are trying to avoid.