One Texas physician leads a global healthcare mission from Moscow, supporting thousands of poor and underserved Russians, while maintaining a full-time practice in Midland, Texas.
Part 1 of a two-part series.
For more than 10 years, Dr. David DeShan has been traveling between Midland, Texas, and Moscow, Russia. DeShan is a physician and a missionary — serving patients at Midland Women’s Clinic in Texas and providing needed prescriptions, exams or treatment to hundreds of indigenous Russians.
The contrasts between the two worlds in which DeShan lives are stark. Here in the United States, he’s connected to his patients through electronic health records and secure web-based practice portals that allow him to communicate, share records and provide consultative services. Likewise, his patients can connect with him through any web-enabled device from anywhere in the world where there’s an Internet connection. His practice, which is building a new state-of-the art clinic, provides 21st century medical care.
In Russia, he is the president of Agape Unlimited, an international Christian medical mission program. Through Agape he visits people that are often secluded in very remote villages far removed from first-world creature comforts. Sometimes, as part of his medical mission work, he travels days into the lost wilderness of one of the world’s most vast and remote regions.
Four to five times a year he ventures outside of Midland, Texas, for up to four weeks on each trip. The majority of his travels are to Moscow where he oversees the nonprofit and its network of clinics. His involvement with Agape includes both the oversight of the organization in addition to traveling to the countryside to administer medical care. Despite being half way across the world he is able to effectively take care of his patients and colleagues in Texas.
In 2002, when Dr. Deshan first started his missionary work in Russia, he was completely detached from his practice in Texas. Needing to reach his patients, he eventually secured a satellite phone. Today, with the help of his EHR, he is fully connected irrespective of his location. Dr. Deshan has access to patient charts and tracks their progress remotely. Occasionally, he will use the information from the EHR and Skype his clients if a face-to-face conversation is warranted. Either way, when he returns to his patients in Texas, he never misses a step.
“None of what I’m now able to do through the ministry and the practice would have been possible without our EHR,” Dr. DeShan said recently. “I run the ministry over there, provide medical education over there, conduct outreach in Siberia and bring doctors here to the U.S. to train. The EHR really allows me to stay connected, in a fashion not available just a few years ago. It’s nice to have the opportunity to live in two worlds at the same time, and the EHR technology really makes it possible.”
Empowering an impassioned dream
Being a full-time physician and president of Agape is highly demanding and Dr. Deshan works up to 90 hours a week.
He has been on 14 expeditions into central Siberia and has made another 16 trips to Russia working in Moscow for a total of 30 trips since 2002. Outside of the expeditions to the countryside he does not practice medicine in Russia. “My role with our organization is to administer, encourage and enable our Russia staff to do the work and to invite others to join us,” DeShan said. “I have also been spending more time in medical education working with the medical schools and hospitals in Russia.”
Healthcare is different there than in the United States, as would be expected. The system is more socialized and less open compared to the U.S. Technology is also limited and use of such tools like EHRs are minimal. In fact, DeShan says there are just a few EHR-like systems in place in Moscow at elite practices.
Each workday, he logs in remotely to his EHR, reviews the pap smears, lab work and patient calls that need his response. His nurse highlights any abnormal mammograms and scans them into the system for his review, and he reviews the physician assistant encounters with his patients. The only things remaining when he gets back home is to go through the mail and review the bone density exams and normal mammograms, usually taking about 30 minutes.
“The EHR is truly what enables me to work in Russia yet still stay caught up. Since I can do this from Russia, it greatly reduces the burden on my partners and most of my patients really don’t miss me while I am gone because everything is still answered in a very timely fashion,” DeShan said.
From Midland to Moscow
DeShan said he’s always been drawn to serving his faith through medicine.
“I’ve always been very interested in Christian outreach, and I see medicine as a tool to this end. I wanted to find an organization for Christian doctors and I went to Russia once and kind of got hooked. I just felt like I was supposed to do more. It called to me,” he said.
He leads a handful of international volunteers from Germany, Canada and the U.S. and a staff of 10 in Russia working on the ministry and 40 working at Agape’s clinic. About 50 serve on expeditions each year. Despite resources, these folks see more than 365,000 patients a year at the group’s clinical network throughout Moscow and provide more than 2,000 pairs of eyeglasses to people throughout the country. Outside Moscow, more than 70,000 consultations have been given since DeShan became involved with the mission.
Though Russia is considered a first-world country, more than 75 percent of its rural residents don’t have plumbing. Without running water, medical infrastructure is not just impossible, it is a wishful hope.
“There’s a tremendous need for care, especially in rural areas out there, for medicine, and things like glasses,” he said.
What is Agape Unlimited?
Agape goes where no others go, taking action to improve the health of people who may have never seen a physician. This takes the organization to remote areas in Siberia and beyond, as well as to Moscow, meeting the needs of the medically underserved in the capital city, DeShan said.
Since 1993, Agape has been providing medicine, medical consultations and assistance to those who have little or no access to medical care in Russia. Agape sends teams to areas where the need for medical help is urgent , focusing on both the most remote and isolated people in the Arctic and Siberia, as well as the poor and overlooked in rural and urban areas,.
Agape’s medical expeditions always work in conjunction with a church within the region; this way the work continues in the community after the medical missionaries leave.
Agape provides everything to its patients for free. There’s no cost for the consultation, for medication or for the glasses received. Because of the care provided for the folks in the rural areas, sometimes this is the only medical treatment they’ll receive for years. Word of mouth spreads and people come for miles. In one instance, a group of patients rode on a reindeer-pulled sleigh for more than 24 hours for a visit with an Agape physician.
For more about Agape Unlimited, visit www.agaperu.org.
For example, video tape and video stores are virtually gone already. Watches, paper maps and newspaper classifieds are on their way out; and perhaps newspapers, too.
Wired phones are hard to find (though my children will probably see a land line in my house because of their benefit in hurricanes and other natural disasters.)
Printed encyclopedias (some of the last were printed this year) and, likewise, encyclopedia salesmen are history. Printed phones books I still get, and use, but they will one day stop coming to the door; CDs, film and fax machines are all but obsolete, though, there are still enterprises trying to make their livings peddling their wares to help organizations send secure faxes.
I don’t consider myself to be old by any means; just part of a transitional generation. I remember paying $1 for a gallon of gasoline and I remember protestors picketing gas stations in Southern California when the prices topped $1.50 a gallon.
I was introduced to the web via dial-up Internet and wondered when its value would be achieved, as it was difficult to imagine a life lived through the web one AOL minute after another.
Now, the Internet is considered one of the most innovative advancements of all time. Healthcare, and nearly every other business sector, will never be what it once was because the technology allows for continuous advancement and the development of tools like EHRs, patient portals, HIEs and mobile devices.
Why all the reminiscing, then, about all of the gadgets that my children will never know?
Simple. My primary care physician uses paper charts. She has no plans to change and is unapologetic about it. Her patients sometimes ask her why and she shrugs it off like it’s not important, an overly hyped issue. One that she’d rather not discuss and one she might wish went away.
The wall of charts behind the reception desk is a symbol of her success. They represent patients she’s treated, conditions faced by the people she cares about, meetings with those of us she’s counseled. Perhaps that wall of record is her trophy case, a testament to her professionalism, outstanding demeanor and nature, and the trust she’s earned with all of us.
She doesn’t want to be forced into any kind of decision that affects her business – that’s how she sees her practice, as a business — even if she’s ultimately penalized because of it.
Though she’s got the paper to sift, she claims to be organized and just as efficient as any machine could make her. The notes enclosed are her own and won’t be shared with anyone. The only incentive for paper these days is the recycle bin.
But, she carries on. For now.
In the end, though, she’ll probably close shop, shred the records and move on to retirement if her decision not to implement an electronic health record means she can’t continue to do what she loves – practice medicine and provide care.
She has that luxury. She’s of a certain age. She remembers things that many of us have never experienced. She grew her business on typewriters, dial telephones and paper records.
And soon, she will become one more thing my children will never know.
In an effort that could revitalize the EHR space (at least the mainstream market), the Veterans Affairs Department’s classic and still heavily used VistA (Veterans Health Information Systems and Technology Architecture) system is getting the open source EHR treatment.
In a move that is revolutionizing other technology sectors — like manufacturing, gaming and the device world and because of the success of such sites as Kickstarter (I know because I represent clients in this space and have seen their success first hand), which is a haven for open source projects, allowing volunteer programmers who are passionate about code and perhaps even passionate about healthcare, is really a pretty swell idea.
From the VA’s perspective, how else could it possibly bring a beleaguered and somewhat bemoaned product like VistA to the modern area after more than 30 years in use? Certainly, the government didn’t seem to have the funds or the necessary experience to overhaul the system by itself.
According to Rick Baker, chief information officer for the VA, even though there is a contract with a firm to make changes to VistA’s code to make it less complex and more readable, the open source community will be involved directly, day to day, with the EHR’s refresh.
The success of involving the open source community in healthcare, and in the development and maintenance of EHRs, is showcased at Oroville Hospital in Northern California, which recently passed on some of the mainstream vendors like McKesson and Meditech for a personalized, customer version of its.
Leaders at the hospital wanted the flexibility to make changes to its EHR system, and they wanted to ensure they received the attention they felt they deserved from their vendor of choice. Ultimately, they wanted total control over the hospital’s electronic health record.
The best solution to the problem for the hospital? Build its own EHR.
In addition to gaining every advantage over the creation and implementation of the home-grown system, Oroville Hospital plans to save a bunch of money by not purchasing a commercial system even though it is building a complete EHR soup to nuts.
The hospital chose to build the system with the help of the same open source folks who are working on the VistA system; the same folks the VA is using to update VistA. Once done, Oroville Hospital’s EHR was even certified for meaningful use and the hospital received more than $5 million in meaningful use incentives.
What all of this seems to suggest is that custom solutions are viable options in a sea of corporate technology offerings. With open source now breaching the professional world of electronic health records, this may only just be beginning of a wave of technology innovation, especially as hospitals and practices seek more efficient solutions and more control of their EHR technology.
Given the time, patience and buy in of leaders, healthcare facilities may be closer to independence than we’re used to in the regulated and oversight-driven world that has become healthcare.
Patients are not the only ones who will become more engaged as mobile devices continue to infiltrate healthcare; physicians, too, are reaping the so-called rewards.
As the debate continues to rage about the efficiencies created when EHRs are used in a practice setting, there seems to be little argument as to whether tablet PCs, smart phones and even applications like Skype actually improve the business of communication and interaction with patients and their physician partners and physicians with their colleagues.
A physician whom I very much respect, Dr. David DeShan, is one such physician who communicates with patients and colleagues via Skype from his mission outpost in Moscow, Russia.
Spending weeks at a time in Russia each year, he also maintains his status as a partner and practicing physician at a growing OBGYN clinic in Midland, Texas. As an early adopter of the virtual visit, DeShan is able to maintain contact with his patients if they need a consult, and he’s also able to maintain his connection to his practice so he can check labs, review diagnosis and provide counsel to his practice mates should they request it.
By his own admission, he works a full-time practice schedule from abroad in addition to his full schedule as the leader of a major international mission. By partnering Skype and his EHR, DeShan is essentially a full-time practicing physician without a need to be restricted by the brick and mortar location of his practice. At the same time, he’s able to dedicate himself to his medical mission work in Russia and serve individuals throughout the world’s largest country in places that would never receive even the most primitive of care without him and his network of medical volunteers.
But, I digress. I’ll save DeShan’s story for another day.
The point I’m trying to make is in support of CDW Healthcare’s article “Momentum Surges for mHealth,” which cites a recent IDC Health Insights observation that shows clinicians use more than six mobile devices in the care setting each day.
Accordingly, as the mobile world continues to open new opportunities in all aspects of life, physicians, like all of us, know that they will come to rely more on these devices to practice, communicate and collaborate.
Clinicians and practice leaders continue to embrace the devices in the care setting, and they expect practices to allow them in their work. When technology delivers upon its promise and actually makes life easier, it is obviously going to be supported and used, like DeShan has done with Skype.
The technology helps him bridge gaps and essentially eliminate a half-the-world-away gap between himself and his practice. But, in some places, there are policies in place to inhibit this type of care offering. (Policies in opposition to this type of approach should be considered archaic and simply regrettable.)
The CDW piece goes on to state that according to a University of Chicago School Medicine study, providing tablet PCs to residents actually reduced patient wait times in hospitals. Likewise, the study found that the same residents did not have to look for an open computer for medical charting and actually allowed the residents to spend more time with patients.
Novel concept. Technology working as promised. Not so unbelievable when spelled out so clearly as this.
As I said, mobile health will continue to grow in popularity. If internal policies are not supported and encouraged, you’ll quickly find yourself in a BYOD environment, which is not such a bad thing.
In fact, if it develops or if you’re unable to support your own internal mobile device initiative, set some rules and let it bloom.
According to CDW, “You need to establish and enforce policies for mobile users including setting up passwords, separating personal from corporate data on devices … and you need to educate users on how to securely use mobile devices.”
When managing a population that’s more likely to use or own a mobile device like a tablet PC than the rest of the consumer population, the infiltration is well underway so it’s time to begin reaping your mobile rewards.
In continuing a series based on HealthIT.gov’s “How to Implement an EHR,” now seems like an appropriate time to seek additional insight into how to prioritize your implementation plan and identify critical tasks to perform when putting your system in place.
As the HIT world continues to reel from continuous change – meaningful use stage 2, ICD-10 postponement and mobile health among the biggies – like any commercial market, there’s bound to be some constant ebbs and flows.
Selecting, and changing, an EHR are bound to happen no matter what else is going on in the market. So, though much of the market may be focused on regulation and reform related to EHRs, there are still practices who haven’t yet implemented, and there are practices that are looking to get out of their current solutions.
According to the Office of the National Coordinator (ONC), “Building an EHR implementation plan becomes critical for identifying the right tasks to perform, the order of those tasks and clear communication of tasks to the entire team involved with the change process.”
Implementing an EHR is really about implementing a change management process: new rules, new ways of doing things and new things to learn. That’s an oversimplification, but it essentially hits the mark.
Setting up an implementation plan (the plan should be in place before the implementation begins) first starts with segmenting tasks into three categories, according to ONC:
What new work tasks/process are you going to start doing?
What work tasks/process are you going to stop doing?
What work tasks/process are you going to sustain?
The three categories help determine the future work environment of the practice; how things will work after the change.
Obviously, if you are moving from an existing EHR, you’re probably going to be more familiar with how things will work once the system is in place, with a few exceptions. However, moving from paper to electronic records means there are going to be a great number of changes that, if not accounted for, may cause some initial hurdles along the way.
Your next steps should include:
Mapping your current workflow and analyzing how you get things done
Mapping how the EHR will affect your workflow, and how you hope it will enable you to perform certain tasks or functions like how you plan for them to create more efficiencies and reduce duplicate processes?
Creating a backup plan to address issues that arise during implementation. This is crucial as issues beyond your control will come up and if you’re not prepared for them, they could derail your process and set you back. Think of worst case scenarios and plan for them to happen then hope for the best. No implementation is ever the same as another; each are there own experiences.
Building a project plan to blueprint the transition then appoint a team member to manage the plan.
Identifying data that must be transferred to the EHR either from paper or from the previous EHR (charts are the most obvious example here)
Finally, find out what can be transferred to the new system like patient demographics and schedules.
Once this point has been reached, you can bring other parties into your plan, like consultants and vendors, to get the plan rolling and potentially start the implementation.
Fee, fees are everywhere, and not all EHRs are similar. But when purchasing an EHR, there’s much more to consider than just the amount of cash you’ll have to spend for the actual system you want. More than the sticker price of the system alone, you have to account for all the other functional pieces — like support, training and licensing — that need to be bolted on.
So, let’s hear it for the Maryland Health Care Commission. The Commission provides some great insight into all of the things you need to consider before making an EHR purchase and some intangibles that, when addressed, may determine your long-term happiness or misery with the tools you decide to implement.
The Commissions’ list is succinctly published by AmericanEHR Partners, which also makes a fine and sincere recommendation to take into account during the pricing of any EHR: “Price of the system alone should not be used as the primary determinant for the system, but rather one single factor to help make the decision.”
Licensing and Subscription Fees
Check to see how licensing and subscriptions work with the vendors you are shopping: Do you pay per clinician or per user, and do you pay more for more “seats” at the table if you need them? Is your payment all inclusive, meaning, are getting a fully integrated EHR with practice management system or are covering for additional features?
The Commission makes an interesting point here: Client server systems are usually licensed based upon a one-time fee with maintenance costs.
I’ll add the following: Hosted, cloud solutions are less expensive than client server to implement; typically fees are paid on a monthly retainer; and they often are less robust systems than on-site server-based counterparts.
Practicing with Your Practice Management System
If purchasing an EHR that includes and PM system, be cautious of paying extra for the practice management capabilities. With continued integration of the systems and requirements brought on by regulation, such as meaningful use, there really should not be any additional fees for the capability.
Vendors may offer a full version and a light version of PM. Make sure the light version can meet your practice’s capabilities if you decide to take that option.
It goes without saying, but make sure that the PM, like the EHR, is meaningful use compliant.
Paying forPatient Portals
According to the Commission, “Vendors may have tiered pricing for portals based upon level of functionality.”
Make sure you have an understanding the portal’s functionality, how it fits with your system and if it’s part of the EHR or an add on. It could go either way, but from experience, you’ll be paying extra for it. Don’t forget to budget for it if you plan to meet meaningful use.
Support, Training and Maintenance
No surprises here, vendor support costs vary significantly based on the level of service you need and when the support can be accessed. You’ll pay more for support at certain times like nights, weekends and holidays.
To budget for training, you have to account for the trainer’s time, travel expenses and the amount of training you want. Plus, there may be a flat fee built in to cover it with additional hours sold in blocks.
The most important thing with training is to clarify how much you’re going to get for the price paid. A word of advice: Log your own hours. Track how much you’ve actually used and compare it to the amount that you’re billed.
Another cautionary tale from the Commission is to be prepared for any training initial fees and should be priced out separately.
Finally, the maintenance. Maintenance fees are generally included as part of your software agreement. If not, proceed with caution and read the agreement carefully.
And, according to the Maryland Health Care Commission, maintenance fees for client-server systems are generally 20 percent of initial licensing and interface fees.
Hopefully, some of the preceding information helps as you price and shop for your EHR. If you have additional tips or insights, please post them in the “comment” section.
When someone says, “It’s just like riding a bike,” they typically mean that once you learn how to do a certain thing, you never forget. There’s something about the task or the ability of your body and mind to remember how to effortlessly accomplish the goal that just brings it back.
The same can be said for breathing; perhaps even driving or swimming.
Okay, point made.
But, remove the training, the time spent rehearsing or the practice attempts (you know, the fall on your head and the scars on your knees) and the whole process begins to make a lot less sense than it would had you put in the time to understand how to accomplish said task.
In fact, in the example of the bike, without the practice many never get to experience the exhilaration of reaching the peak of the hill after fiercely pumping on the pedal and finally zipping like a bullet train down the other side. In that instant of wind-rushing joy, all the hard work on the first half of the hill was worth the effort of being able to experience the second half of the hill.
I can’t imagine life without having learned how to ride a bike, or learning how to disappear into the pages of a favorite book because I knew how to read. Frankly, I can probably say the same thing about a few pieces of technology and software that I have been trained to use or that I have taught myself to use. Had I not learned how to use them properly, life wouldn’t be so rich.
Perhaps electronic health records don’t fall into the category of technology that enriches users’ lives if used properly, but there’s apparently a connection between the level of experience one has when working with the systems and the success they’ll have using them to track health outcomes and build efficient practices if they have received proper training of the systems.
According to AmericanEHR Partners, the results of a study it issued shows that user satisfaction was lower for clinicians that used an EHR but received less training than their counterparts who received more training of the systems.
Essentially, the more training and experience using the systems the more likely users are to get more out of the systems. Likewise, clinicians who received less training of the systems perceived their experiences with systems as less than positive.
According the study, five findings were discovered, none of them all that shocking, but certainly very telling.
AmericanEHR Partners found that the more training a survey respondent had with the EHR, the happier the respondent was. Secondly, three to five days of training on the EHR was typically required to achieve the highest level of satisfaction. Fewer than half of those surveyed said they received at least three days of training. The report’s other findings suggest more training leads to happier users.
In addition, according to the finding, those who had a hand in selecting the EHR were generally happier when using it than those who did not help select it.
So, there are some obvious questions here, which Steve Ferguson of Hello Health asks pointedly in his blog post on the same topic. In summary, Ferguson asks: are doctors not getting sufficient training? Why? Do vendors not offer enough training? Is it too expensive? Is the doctor at fault?
Well said; questions deserving of answers.
In some cases, though, no one is really at fault. Vendors, looking to finalize a sale add the fewest number of training hours to the deal so as not to scare new clients away. Training hours are expensive and typically not a free service provided by the vendor. The number of training hours vendors require their clients to buy have been know to cost vendors some deals. Too many training hours can cause some practice leaders to run.
In some cases, there’s often not a lot of margin in selling the EHR systems. Some vendors have even given them away to lure customers.
For vendors, the EHRs are a lot like gasoline at gas stations. The stations make next to nothing by selling the gas; it’s all the convenience store items you purchase while you’re filling up that keeps them in the cash. Same can be said for movie theaters. Theaters make little profit on the movie tickets; their dough is made selling you candies, popcorn and Cokes.
The point is that practice leaders are often scared by the often high prices of vendor’s training hours. Vendors sell systems so they can lock in lucrative annual maintenance and service agreements. They’ll forgo the training hours to close a deal to get to the monthly or annual client stipends.
Practice leaders are sometimes like moviegoers who buy the ticket, but bring their own sandwiches and sodas from home. They think they can get by on their own or will ask for free assistance from colleagues using similar systems.
In the end, it seems quite a few folks are standing around looking at the bike rather than getting on it and taking it for a spin, even though the practice and the inevitable falls is where the real value is at.
Electronic health records can build patient loyalty. And using them within a practice and letting patients know about them and their uses, it is more likely that patients will return for service again in the future.
At least that’s the latest news from Kaiser Permanente.
Also according to the health plan/care provider is that patients are more loyal to a practice using an EHR if the practice is also using a patient portal for the patient to access their personal health records.
Accordingly, people using Kaiser’s personal health record to track their health, manage their care and access records through Kaiser’s My Health Manager (the organization’s patient portal) were more likely to stick with the Kaiser health plan than not in future plan years.
Though I maintain my fair share of skepticism about the study featured in the American Journal of Managed Care because Kaiser members are incredibly loyal (I know because I’ve worked with Kaiser members as a benefit plan communications director for a major government program in the region where the study was conducted) and they probably would not have switched plans regardless of the patient portal (and because the study seems somewhat self serving of Kaiser), there may be a nugget of truth here.
Apparently, according the study, Kaiser plan members who used the portal to view their medical records, make or change appointments and communicate with their doctor or other health provider electronically, where more likely to continue to pick the same plan in subsequent plan years.
The results are derived from more than 160,000 Kaiser Permanente Northwest members enrolled in a Kaiser plan between 2005 and 2008. Members who used the portal were more than twice as likely as nonusers to stay with the health plan during the period studied. “The only greater predictors of retention likelihood were more than 10 years of plan membership and a high illness burden,” the study authors wrote.
Essentially, the authors of the study suggest that EHRs integrated with a patient portal are more likely to create loyal patients.
Really, though, the findings of this Kaiser study are nothing new. As have been reported numerous times before, patients continually perceive healthcare technology positively, at least according to my perspective.
In the survey, patients said they felt more comfortable with physicians that used an EHR system, and more importantly, patients felt that the information contained in the medical record was more accurate when they physically saw information being entered electronically. Physicians using EHRs in front of their patients said they felt the most comfortable with the accuracy of the information contained in their records.
Additionally, in the survey I conducted, 45 percent of patients had a “very positive” perception of their physician or clinician documenting patient care with a computer or other electronic device, and patients believe that using an EHR will actually improve care outcomes in the long term.
Physicians and patients also agreed on the benefits of using electronic devices to document patient care during an encounter. The most important benefits of EHRs, as agreed upon by the two groups, were
They give physicians access to patients’ medical records and history in real time.
When appropriate, EHRs help the physician securely and seamlessly share information with other doctors, pharmacies and payers.
EHRs help physician make good decisions about patient care, ultimately driving the quality of patient care.
To put it bluntly, yes, there appears to be a great deal of patient loyalty for physicians using an EHR. Kaiser’s data only seems to strengthen this claim, and, certainly, it appears that integrating technology that’s “interactive,” such as a patient portal, helps foster this connection.
If nothing else, using an integrated EHR seems to generate greater patient engagement and may create more loyalty toward a practice, which ultimately builds stronger practices and potentially more word-of-mouth customer referrals, which help businesses grow.
Given the increasing popularity of mobile devices that continue to proliferate all areas of our personal and professional lives, clearly personal devices are going to show up in business settings and will be used to disseminate information with internal and external stakeholders.
Even if not an official piece of technology authorized for use in the workplace, their ease of use and availability make them attractive and affordable tools in the professional setting. Though most personal mobile devices not provided by an employer are allowed by employers because organizational leadership believes they lead to more productive employees who are “always on.”
Healthcare is no different. Mobile devices allow physicians to stay connected to their practices, like employees of all other businesses, and where available (as in, practices with systems that support mobile integration) connected devices allow care to be virtually administered from nearly anywhere. In the very least, notes and patient records can be reviewed while the care giver is out of the office or on call giving said care giver a head start on the case should a call come in.
On the other hand, savvy practices are realizing that some patients understand the value of mobile health. Practices are encouraging their employees to interact with patients using portable devices in the care setting. Patients who value mobile technology consider their providers innovative and ahead of the proverbial curve. Sometimes personal mobile devices may be used to accomplish this goal.
However, there are clearly inherent risks involved with blindly and openly accepting the use of personal devices in the workplace that many small businesses simply choose to ignore or overlook. Not because they feel invincible, but most likely because they just don’t know or understand the risks.
Jerry Irvine, CIO of Prescient Solutions — an IT consultancy — points out in a recent editorial for Firmology.com that the most prevalent security risk of mobile devices is that they will be lost or stolen.
According to Irvine, if a smart phone, for example, is stolen, all of the information on it is available to whoever holds it. In most cases, the personal phones don’t have identity-related security benefits to protect the information meaning all personal and business information can be accessed.
As Neil Versel tells in his recent piece, the devices, at some point will go missing. When they do, most affected organizations have little or no plan to prepare for the possibility that the information will be used maliciously. The obvious risk here, in healthcare, is the exposure of patient’s personal health information, cases we hear lots about when they occur.
Offering advice to businesses without a BYOD policy, Irvine provides a nice succinct list of musts that organizations allowing employees to BYOD must consider. Picking some of the high points here, you can see the complete list at the link above.
First off, Irvine suggests requiring and maintaining complex passwords to access the devices.
Next, create a separate encrypted container for business applications and data and don’t allow the same email application to access both personal and business emails.
Set up a registration and provisioning system for the devices that allows for monitoring, remote application installation, locating and wiping of company data. Irvine says, “Use the system to remotely install all company applications as well as mobile device systems updates, patches and security fixes.”
Also, make sure to install antivirus and malicious application scanning solutions keep the devices clean, and disable its ability to access public Wi-Fi networks. Hackers can pirate networks and surf for information though unprotected devices of unsuspecting users. “Allow only known secure networks to include the user’s home network and the company network,” Irvine says.
Perhaps one of the most important steps is to require that all maintenance, updates and disposal of devices be done by the company or authorized vendors who follow specific security requirements. More information than you’d like to think gets swiped while your device is in the shop and you never know.
Finally, don’t allow enterprise data to exist on a personal device, and educate all users on the secure appropriate use of mobile devices. Once you’ve done so, get them to acknowledge and sign an appropriate usage policy.
These steps may not protect you from every incident, but they do create a foundation for what may be an otherwise unscripted and unregulated program. And, putting these steps in place lets your employees know you encourage an environment where initiative and innovation are accepted, and perhaps even rewarded.
The adoption of electronic health records continues as more physicians and practice leaders either realize the benefit of the technology or chase meaningful use in an effort to secure some cash or to avoid the soon-to-be enforced penalties for those without the systems.
However, adoption of the systems isn’t without its roadblocks nor is it as simple as plugging and playing as some might like us to believe.
In an insightful entry featured on EHR Intelligence, Dr. Kyle Murphy nicely summarizes what he labels as the top 10 reasons EHR adoptions stall, according to interviews and conversations he’s had with other physicians.
Some of the reasons cited are what we might expect. For example, at the top of his list is cost. Few can afford the cash required and the initial investment. Practice leaders know that to do it right, they have to buy the right system, as well the training, support and other required bells and whistles.
Two and three on the list are time and preparation, respectively. Typically, implementing an EHR takes a good deal of time and a great deal of preparation. Without the proper commitment, neither will come out right, which can result in less than desirable outcomes for practices.
According to Murphy, practices fear the downtime that can come with an implementation and they know that any good transformation requires total buy in from everyone at the practice. Perhaps the top concern for physicians, concerns that I’ve heard personally, has to do with the EHR implementation preparation.
Next, at No. 4 on the list, is “rollout strategy.” Ah, the choices: to implement all at once or one piece at a time. To each his or her own, but the decision remains and it’s a hard one for many to make while remaining un-conflicted.
At No. 5, is availability of vendors, or lack there of. More specifically, he recommends taking greater ownership of the process and not giving every crucial part of it to your vendor partner. Like everyone else, they are taxed and their resources spent, especially now as the rush to get in on full meaningful use reimbursements is upon us.
At six and seven are training and communication. Do away with one and you’ll likely do away with the other.
Interoperability comes in at No. 8. The system must work with the practice’s other systems. They’ve got to speak the same language and work together. Easier said than done, but at the heart of it, practice leaders are asking, “Can’t we all just get along?”
Skipping ahead to No. 10, data migration rounds out the list. The system, according to Murphy, must do more than its paper-based predecessor. It has to do more than replicate the past, but help power the future.
Perhaps the most important, and somewhat obvious, hurdle practices face, though, lies at the heart of the practice: its culture.
Culture, at No. 9, truly affects every aspect of the implementation. For example, if the culture of the practice is one that embraces change or technology, there’s a greater likelihood that finding the cash to make the investment will happen. Likewise, preparing for the change and developing a rollout strategy will seem much easier with buy in versus having to fight most of the employees who have their heels buried in the sand in resistance to the change.
Finally, with the right culture in place the practice is much more likely to get the most out of its training, even if it’s only a small amount, because there is more acceptance and will to learn on the practice employee’s part. They are more likely to communicate with all partners – vendors, consultants, even patients – because they want to ensure the greatest, most successful process from start to finish.
When the culture of a practice is one of a winner, the list of hurdles faced during this or any other change is greatly reduced and nearly everything, at that point, can be accomplished.