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!!

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.

Why Do We Settle in Healthcare?

Posted on August 22, 2017 I Written By

The following is a guest blog post by Monica Stout, Marketing Director at MedicaSoft. This is the introductory blog in a three-part sponsored blog post series focused on new Health IT for integration. Each month, a different MedicaSoft expert will share insights on new and innovative technology and its applications in healthcare.

Imagine your typical Friday night. You’ve worked hard all week and now you’re ready to watch Netflix. You’ve picked the perfect movie. You’re ready to watch. You hit a button and your movie is right there, available and on demand. But what if it didn’t work? You’d be annoyed. You’d hop on social media to complain or see if Netflix is down. Someone somewhere would hear you.

On Black Friday or Cyber Monday, you might visit Walmart.com to search for some holiday deals. These are the busiest shopping days of the year. What if the website didn’t work? Or, what if you had to enter your shipping and billing data every single time you viewed an item? You’d be outraged. You might hop on social media to complain or see if others are experiencing the same problem. Someone somewhere would hear you.

Now imagine it’s the middle of winter and you’ve caught the latest bug du jour. You call your doctor for an appointment. When you arrive, you’re handed a clipboard and asked to fill out the same repetitive paper form with your health information that you fill out every time you visit. You’re certain they have this information already, but you’re required to fill it out yet again. You might wait 30, 40, or 60 minutes past your appointment time before you’re called back to a room.

Once you’ve made it to an exam room, a nurse comes in to take your vitals. The nurse will ask questions about what medications you are on. Nine times out of ten, the medications the nurse repeats back to you are outdated or entirely incorrect. You wonder where that data came from and are sure you’ve told this particular office the same thing the last four times you’ve gone there, so why is it wrong? Again, you wait in the exam room for the doctor. Your doctor comes in and spends more time looking at a laptop screen and clicking than making eye contact with you. Do you hop on social media and complain? Probably not. Does anybody hear you? No, because you’ve accepted that this is just how it is. In fact, you were grateful to receive a same-day appointment instead of waiting at home in misery.

The technology exists today to make things work and work fast. Other industries have intuitive UIs that people use every single day – we use them so much we don’t think about them. So, why do we settle for what doesn’t work in healthcare? Why do we accept a system that isn’t operating in ways that are beneficial or efficient to us as patients or to our doctors or nurses? Shouldn’t health information technology and the systems that support our health, well-being, and in certain situations, life or death, work more efficiently than our television subscription services or retail websites? Technology can do better in healthcare.

The technology on the back-end of Wal-Mart’s servers was robust enough to handle Black Friday and deploy with over 200 million users online THREE YEARS AGO. Amazing, right? But it’s that way because people won’t accept something that doesn’t work. If Wal-Mart’s website wasn’t available come Cyber Monday, consumers would vote with their dollars and move on to another retailer’s website that did work. That retailer would get all the business. Yet in healthcare, we keep revisiting a system that’s broken – where our health records are disjointed, incomplete, exist in duplicate (or many, many more), and just don’t work well together across practices, hospitals, or health systems. We don’t have a one centralized record with our health information serving as our source of truth. Sharing data across our providers is broken.

I realize that healthcare is more complicated than simply voting with our dollars and moving on, but why is that? The Wharton School Economics Professor Eric K. Clemons wrote a great piece on why healthcare is complicated. The technology is there to help advance healthcare to be what humans need it to be, so when will we stop accepting less? When will we demand more?

There is technology that’s easy to use and access, makes your information available, and centralizes your health information into one record. In our subsequent guest blogs, our experts will talk in more detail about these best of breed technologies and how they can be applied to healthcare to capture, exchange, and share data.

About Monica Stout
Monica is a HIT teleworker in Grand Rapids, Michigan by way of Washington, D.C., who has consulted at several government agencies, including the National Aeronautics Space Administration (NASA) and the U.S. Department of Veterans Affairs (VA). She’s currently the Marketing Director at MedicaSoft. Monica can be found on Twitter @MI_turnaround or 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.