Tag: electronic health records
Death by PowerPoint: Overly used templates filled with a variety of bland information that does little to emphasize the point of the presenter. In this scenario, slides are often filled with generic information that could have been excluded the presentation in the first place had the speaker actually taken the time to time the point he was trying to make.
Likewise, there’s “death by a thousand clicks.” Pretty close to the term “death by a thousands cuts.”
The oft used phrase is usually mentioned by physicians, practice leaders, members of the health IT community and nearly everyone to interact with a template-filled electronic health record. It’s derived from the seemingly endless clicking as a user navigates the encounter note in the respective system, or so the story goes.
Click after click after click of the same, repetitive information in case after case, even if two patients present with the exact same conditions on the same day. No matter, when using a template system, you’ll be forced to re-key every piece of detail and click the exact clicks as the previous encounter, no way around it.
All the clicking reminds me of a cartoon I saw recently. It goes something like this: a doctor goes to his doctor for an exam. “What seems to be the problem,” the presiding doctor says to his doctor patient. The doctor patient replies, “Well, doc, I think I’ve developed a case of carpal tunnel syndrome from too many clicks in my EHR.”
I recently met Dr. Bob. Those of you with a Praxis system know who I’m talking about. In actuality, Dr. Bob is nothing more than a mascot for Praxis, which is the maker of template-free EHRs.
After ridding his practice of paper, Dr. Bob celebrates because of his decision to implement some technology. However, he quickly finds himself boxed in by templates and non-customizable data fields populated by click after click. “The templates soon bogged him down. Everything was a drop down menu or pick list. His thoughts had to pick one of the options. There was no flexibility.”
Templates slowed Dr. Bob down. Dr. Bob felt more like he was becoming more like a data entry clerk than a physician.
Sound familiar?
I thought so.
The Praxis system is written by its users in free text. The more it’s used, the easier the system is to use, remembering data from an earlier note and it essentially begins to auto populate certain data that can then be customized and changed given the varying scenarios encountered during the visit.
The system allows you to enter a few minor details like condition or medication as you to build a case. The system remembers the details of each encounter and when you enter similar details again in the future, it helps you populate the field.
And the “thinking” the Praxis system does on behalf of the user is essentially the same as what you’d find when using Google to search the web. For every search conducted, Google remembers your past searches and auto populates what it thinks you are attempting to find. And, as you type, Google offers suggestions for what you might want to see.
From the demo, it’s clear the template-free system has its advantages and certainly would alleviate the some of the click, click, clicking. For some users, though, they may not enjoy the freedom the system seems to provide as it seems to provide the exact intuitiveness that so many EHR users seem to crave.
All in all, it’s intuitive, fast, and – in my opinion – pretty slick.
So, for those of you seeking more flexibility in your system and wanting to do away with the endless clicks and data administration, the Praxis system seems pretty cool.
And for the record, Praxis had nothing to do with this post; the company didn’t know I was writing it.
This one is on the house. Enjoy.
While the final 50 or so percent of ambulatory physicians decide whether to implement electronic health records and others re-evaluate their technology plans, which may include switching the systems they use, it seems like as good of a time as any to continue the series I started about the steps that need to be considered when selecting an EHR.
At this point in the process, you’ve obviously gained the understanding that it’s an arduous process and requires a great deal of planning. But, you know that. You’ve done the planning and you’re beyond examining how implementing the system will affect your practice’s workflows.
So, when you’re gearing up to finally take the plunge, or if you’ve decided to get out of the water and dive back in, the Office of the National Coordinator provides the following guidance for moving forward with these EHR implementation tips.
Here’s a concise breakdown:
- Get to know as quickly as possible how vendor and its products will help you accomplish your goals. Test drive the product and never take the word of a salesperson without vetting it with other professionals using the product. You might also shy away from vendor-provided references as they tend to receive incentives from the vendors for giving them. And, according to ONC, “Provide the vendor with patient and office scenarios that they may use to customize their product demonstration.”
- Clarify pricing of the entire implementation prior to signing the dotted line. You want complete pricing for all things including: hardware, software, maintenance fees and upgrade costs, interfaces for labs and pharmacies, cost to connect to health information exchange (HIE), customized quality reports, etc. If it’s offered, ask for the price and get it in writing. Every time the deal changes, get a new written quote.
- Like pricing, define implementation: amount of time, schedule of completion, and availability of trainers and what’s included in the training.
- Ask lots of questions about data migration and how much it’s going to cost. Ensure a structure for the data rather than simply allowing for a dump of information. “Clarify roles, responsibilities and costs for data migration strategy,” the ONC suggests. The amount of data you need to transfer, the more complex the process will be.
- Know whether you’ll be better off with on-site server or a hosted, Saas solution.
- Can the system be integrated with other systems easily? If so, ho much does it cost?
- Privacy and security capabilities and back-up planning: are there any?
- Is your proposed vendor stable? Will it be sold or divested? Does the vendor have a strong local presence? Are those practices leaders in the local market? Do you hear good things about said vendor?
- Can the system connect to an HIE? How much does it cost?
- Is the length of the initial contract much too long – like a five or seven year lock in – and does it potentially keep you from exploring alternative options should you need to make an earlier exit?
- Finally, according to the ONC, though it may seem a little off topic, “Consider costs of using legal counsel for contract review verses open sources through medical associations.” Nevertheless, seek legal counsel before accepting the vendor’s agreement.
The best time to protect yourself from a poor decision involving the vetting and purchase and an EHR is during the shopping and review process. Take time at the beginning of the process to ensure you know what you’re getting, what you’re paying for and, ultimately, what type of vendor partner you’re going to get once the ink on the contract has dried.
Some of the most concise, yet useful, information about health information exchanges must come from Medicity. In a “primer” page (that might be written for the HIE novice) there’s quite a nice bit of information about the importance of the technology.
Obviously, Medicity is biased, as HIE is what it does, but I admit that after reading some of the points Medicity makes about the importance of HIEs, I’m sold (though I already was).
Let’s dig in.
As we know, health information exchanges help connect healthcare providers with information they likely would not have through paper records, and in many cases, not even with electronic health records as the EHRs are often fragmented or don’t depict the entire health scenario of a patient.
As noted by Medicity, HIEs help create efficiencies in the care setting in many ways, primarily by helping make information available across many platforms and even across many care locations.
Additionally, and I’m paraphrasing here: HIEs help reduce duplicate testing of patients; help create a more complete picture of a patients’ care and prior treatment protocols; and they help eliminate costs and fees associated with redundancies.
The best case I can make for an HIE (probably for an EHR, as well) is a story from a former colleague. Her mother was diagnosed with an aggressive form of cancer. At best, she was given months to live. However, after multiple specialist visits, redundant tests, labs and scans delivered the same information as the previous test, the woman died just a few weeks after initial diagnosis.
Moral of the story is this: according to my colleague, for every specialist she and her late mother visited, each one requested the same tests as the previous doc because the doc didn’t have an accurate, or complete, record. To make matters worse, the records were paper. My former colleague said the task of trying to assemble a complete care record was beyond arduous, not to mention difficult to construct given the red tape each practice had in place as the gate keeper of the records it kept.
If only the information had been in a single repository, perhaps her mother wouldn’t have wasted so much time on taking the same tests and she could have received the care she needed, my colleague said. I agree.
So does Medicity, which operates on the belief that HIEs change all of that. Simply and clearly put, HIEs “break down silos and make information available” to providers at virtually any location that’s connected to the HIE when the information is needed and required.
HIEs, like EHRs I suppose, can change and possibly save lives. Interestingly enough, at least to me, is that HIE’s lag in favor or in the very least have a history of not being able to generate the support they need to thrive (perhaps survive?).
As the government continues to place more importance on the availability of health information through exchanges and electronic records, the market will find a way to monetize HIEs (probably the biggest hurdle vendors face when considering whether to develop technologies to support them).
There are now, though, several vendors with their own HIE-like devices that can function within their EHRs the same way their patient portals work. They are able to trasmit data to other users of their company’s specific technology.
As these vendors continue to develop their own HIEs, and try to sell them, it will be interesting to see which technology – private or public – will be adopted by the healthcare community.
When I go to the doctor for a check up of another ailment, I understand that the record kept regarding my care is ultimately mine. Not because I’m told, not because I’ve asked (though I have on some occasions), but because the information collected comes from me. Without my providing it, my physician would not have it to keep it.
Maybe it’s my make up, but I pride myself on knowing what others often consider trite and trivial. For most, knowing who owns their health record is exactly that, trivial.
Interestingly, though, is that for every person with a health record, there are the same number of people with a care provider to tell them that the record is theirs. So why then doesn’t everyone know that their health record is theirs?
I don’t think the answer to this question lies in the patient apathy or the population’s potential indifference toward their health outcomes. Innately, I believe people do care.
The point I’m making here is that I think the ONC’s latest effort to market direct-to-consumer (DTC) information is well intentioned but perhaps the burden for doing so is misplaced.
Do we think physicians and their practice colleagues should be spending their time doting on the ownership of their patient’s health record? Is anything other than patient health and outcomes a priority they should be focused on? The ONC thinks so, and given meaningful use and the increased pressure providers face to record and provide results of meaningful health outcomes, physicians are being arm twisted to ensure this level of grassroots marketing provides the ends to the ONC’s means.
Certainly, we as consumers must continue to receive information and education to keep us informed about the world of health IT. It’s true that very few actually understand just how far back healthcare technology is from the mainstream in regard to use of technology. But, as I’ve said before in this very forum, should all of the responsibility for this lie on the providers’ shoulders?
Not so, in my opinion. Sure, physicians and care givers can be advocates to consumer enlightenment, but more of the responsibility really should go to the health IT vendors. After all, they are the ones selling the products to the physicians. It behooves them, and enriches them, the educate consumers to the value of the systems’ worth and how help improve health outcomes.
Sending this message to consumers, and helping to educate them of the benefits of these systems, will go a long way toward convincing them that their physicians need the systems. If consumers find value of these systems, they’ll let their wallets do the talking and give their business to physicians and practice that employ health IT.
And, if the physicians are truly going to be “the sales force for health IT,” perhaps it’s time the vendors started incentivizing these walking billboards the ONC wants them to be.
In speaking with a CEO of a major EHR/PM vendor recently, the conversation about the future of health IT kept coming back to money. Not necessarily the money saved by practices because of the implemented technology, but the money being flushed into the space by the government.
Though the money is flowing and the incentives are pouring into the economy and getting freely spent, there are obviously some still inside the vendor (and probably the practice) space that remain concerned about the viability of the government’s financial involvement in health IT in the long term.
The federal government’s money has created the structure of what we now know as health IT. Because of the push – the money, or the carrot and the stick, if you will – there’s now a deeper foundation set; there are studs and rafters in place, and even a few pieces of siding in some cases.
With roughly half (being generous) of the ambulatory market currently using some sort of an EHR, ground has obviously been gained in the market. It would have come eventually, the advancements, but the federal incentives no doubt hastened the proliferation of the technology. But, for the sake of argument, let’s say the federal money drives up or is re-appropriated. What happens then? Where does that leave the market, as my CEO colleague hypothesized?
I hadn’t exactly thought of it that way, especially now at this late stage in the program. But the man does pontificate an interesting point.
Given all of the money flowing into the health IT market, it’s one of the few booming economic segments, and given the number of parties staking claim to it hoping to make monumental returns on their investment, the scenario actually brings another very similar boom to mind.
From early 2004 though 2005, the profits were record breaking. Ad sales were way up, circulation was expanding into new markets and staffs were being bumped up to counter efforts made by the competition.
However, by late 2006, as a cautionary note, hiring slowed and expansion stopped. At the beginning of 2007, the layoffs began. Reporters, editors and production staff were cut. The newspaper chain I wrote for shuttered offices and cut more costs. Another round of employees was let go. Ad revenue hit the floor; newspapers stopped circulating, the market shrank and even more people were laid off. The business entered a tailspin that even now, five years later it hasn’t recovered from.
It never will.
The boom times went bust, and for newspapers, caught up in the seemingly never ending flow of cash from advertisers, who happened to be home builders and contractors, little planning for the future was done and any thoughts of a rainy day fund seemingly were little more than thoughts.
In Florida, at the time, you couldn’t spit or throw a stone without hitting a new housing development or condo conversion. There were housing starts everywhere. Houses, in all phases of development, were being erected. The building was constant. There was no end in sight. Contractors were hiring employees everyday, banks were lending, people were fighting, literally, over houses that were for sale.
When the boom was booming, everything even peripherally related to the market was booming. But when the housing market busted, well, I don’t need to tell you about how that affected each one of us.
So, my friend the CEO asks an interesting question. One that was probably asked thousands of times during the great housing bubble of the middle of the 21st century’s first decade: What happens if, God forbid, the money suddenly runs out of Health IT?
Come down to South Florida and see. I’m sure you could get yourself a pretty good deal on one of the thousands of properties sitting half built and empty.
Sure, they’ve got a good foundation, walls, rafters and, in some cases, a bit of siding, but they sure aren’t much to look at much less much better to live in.
In honor of the first ever National Health IT Week, here’s a gem of a story that seems to voraciously support the need for more integration of electronic health records, and technology in general, to find their way into more medical practices.
According to an article published by Referral MD, in a report issued by Health and Human Services (HHS), despite all of the attention surrounding the security of electronic health records, in actuality, between May 17 and June 17, there were 45 security breaches involving paper health records – 42 more than with EHRs.
I shouldn’t be surprised by this, but I guess I am. Perhaps I’m programmed to think about EHRs exclusively, but paper records are still the majority of records kept, at least in the smaller ambulatory practices where EHRs haven’t been implemented, so security breaches in environments like this are quite likely.
According to the report, the following fit the definition of a “breach,” including theft, unauthorized access, improper disposal and loss.
Some of these I understand, to a point. Loss. That’s easy. It’s one of the most common complaints about paper health records. They get shuffled about the office, from room to room. With the library of other records, it’s surprising that more don’t end up getting misplaced. Getting found is another story, though. If they’re found, what happens to them? Are they then stolen? Five-fingered discounted from the crevice in which they’ve been laid? And, truly, if practices are losing copious volumes of paper records – I’d think losing records would be somewhat of an ongoing problem because of internal procedures and record keeping – then I don’t want to patronize the practice.
Improper disposal. Well, that doesn’t take too much imagination, either. In fact, I once remember not too long ago that the state of Oregon disposed of thousands of Medicare patients’ records improperly by simply tossing them in a dumpster behind the state’s office building, in the same dumpster shared by the state’s capitol newspaper, The Statesman Journal.
If an organization as large the state of Oregon improperly destroys paper records, I’m sure countless others do so as well.
Unauthorized access. Okay, sure. Unwanted eyes get their mitts on the occasional (I assume it’s the occasional) record and potential danger ensues. I’m not sure how one goes about getting his mitts on someone else’s records since I’ve never thought of wanting to see someone else’s record, but I assume it has to do something with hurdling the records desk and making a mad dash for the shelves with the millions of cream-colored folders.
I jest. Obviously, info thieves aren’t jumping over counters. Perhaps one of you can set me straight, but I imagine it happens as a passerby passes someone’s record that’s sitting in the pocket outside the exam room door or something similar; just a passing glance at someone’s record as they scurry on by.
The hard one for to understand, though, is record theft. How are these records getting stolen? From a doctor’s car as he runs into the convenience store for a soda? Are they misplaced in some unfortunate public place? Are they scattered to the winds by disgruntled employees?
How on earth do they disappear?
And, perhaps more importantly, could any of these breaches been avoided with the use of an electronic health record?
Happy National Health IT Week. Enjoy.
As you know, the Centers for Medicare & Medicaid Services (CMS) issued final requirements for meaningful use stage 2 on August 23. Since then, it’s clearly been one of the most discussed topics in healthcare technology circles, perhaps this site aside.
While the dust finally settles, the nuances of the regulation are being turned over and devoured. Providers and practice leaders are examining the 17 core (required) measures and wondering which of the three menu items will allow them the clearest path to overcome the hurdles of stage 2.
Successfully meeting the meaningful use measures aside, for me the meaningful use exceptions for noncompliance are what stand out here.
Let’s have a look.
CMS established hardship exceptions to the penalties practices and providers will face for noncompliance of meaningful use. Exemptions are available for physicians who:
- Have insufficient Internet access for any 90-day continuous period between Jan. 1, 2013, and July 1, 2014.
- Are new to Medicare.
- Encounter extreme circumstances outside the physicians’ control, such as practices closing, natural disasters, EHR vendors going out of business and similar scenarios.
- Practice in multiple locations and have a lack of control over the availability of EHR systems.
- Have a lack of face-to-face visits or other patient interactions, or the need to provide follow-up care.
I’d love to know your favorite exception. Feel free to let me know in the comment section below. What caught my eye, though, is the third exception. Specifically: “EHR vendors going out of business.”
Perhaps I’m giving this single point more importance than it deserves, but I find this to be wonderful foresight on the part of CMS. Kind of like the nation’s forefathers providing exceptions to the success of the United States; a caveat to hedge against the Constitution’ failure.
Here, tucked in with acts of God and insufficient Internet access, CMS ensures that physicians need not worry about their EHR vendor putting plywood over the windows in the middle of your attestation process.
Clearly, contraction in the vendor market is going to happen. It’s a matter of time. Those of us in the vendor space have speculated on this very fact for several years. Analysts have provided their opinions and they agree, as do my counterparts.
Perhaps the next year won’t bring a dramatic change to the EHR vendor landscape, but we all know it is coming. The fact is, there’s just not enough physicians and care providers to support between 400 and 600 vendors.
Stage 2 is most likely going to prove too complex for many of the smaller shops. Those without a tool that’s robust enough to make the meaningful use push or companies without a sizable enough footprint to be an attractive acquisition target are going to fold. Their clients may expect them to weather the storm, but a ship without a sail is nothing more than a lost vessel without direction.
So, with all the other exceptions that can cause a set back, and given the level of commitment required to meet stage 2, the easiest exception to avoid may in fact be making a vendor switch now. Given the set backs a vendor collapse could cause your practice, I might prefer taking my chances with an act of God because at least I might be able to pray my way out of it.
When looking forward, it sometimes helps to look back; sometimes.
Though the past is not always an indicator of things to come, sometimes we’re able to find a little guidance in the hindsight.
Much is being written by folks like myself in response to HIMSS asking the question of where Health IT is going to be a year from now, on the anniversary of second annual National Health IT Week.
Unlike several of my counterparts — perhaps I’ll be considered less of a forward thinker because of it — but instead of fast forwarding one year, I’d like to go back one year to formulate a response.
In May 2011, I had the pleasure of helping draft a column for my then boss for Imaging Economics magazine. The piece, one of my favorites, seemed to strike a chord, even if just with my office colleagues.
Nevertheless, this piece essentially answers the very question asked by HIMSS, a year before the asking.
And so, as we wrote back then, I’ll begin here again, with an encore of the piece as a response.
“Here’s how I see it: Healthcare is a world of major transition. Like life, there is some unpredictability, and most likely, there always will be.”
We continue: “Yet, during this time – call it one of change, progress, upheaval — we must continue focusing on creating a more mobile and connected place in which physicians and their patients share tools. We need to encourage a greater, more vested conversation, where health information exchanges and practice and patient portals are used, secure messaging and 24-hour access to records and patient data for the patient and their physician.”
This observation, according to my best estimate, couldn’t be any timelier.
We continue again:
“I see a healthcare environment that mirrors the rest of the world. Where, as a patient, I can see my labs at 3 a.m., can query my doctor and request refills; if I’m up for it, pay bills anywhere there’s a connection. I see this as accepted and practiced, in the practice of medicine. Always. Any time. Now.”
Perhaps we’re there now; perhaps not. Regardless, we’re talking about it and, given another year, I might be able to more profoundly announce, “Always. Any time. Now!”
If I remember correctly, in helping write this next section I spoke for myself: “But, here’s what I know: Patients are demanding greater ownership of their care and records (I was). They (I) want the always, any time, now. I also know that physicians – along with constant pressure of requirements and reform – need solutions they can trust; technology tools that are intuitive that help them provide the highest quality of care, all while meeting their patients’ needs.”
It seems nothing has changed in more than a year. I suspect little will change in another. Reform continues as we move past Stage 1 and into Stage 2, which are more rigorous than their predecessors. It will consume hours of healthcare professionals’ time. They will toil and try, and try and toil.
Despite the continuing and conflicting headlines, patients do want to get more involved in their care, but they need a reason to buy in; and physicians need tools that are going to improve their lives. They need more efficiency, more powerful and intuitive solutions. They need to start responding to survey that asks “What is the best system to use?” rather than “What is the least complex system to try to operate?”
Let me jump ahead now. “Physicians realize their sway within the healthcare market, both as practitioners and consumers, and they realize – like their patients — how technological connections enhance their experiences in other areas of their lives (read: paying bills online, online banking, booking appointments with the DMV through a website, purchasing movie tickets through a phone, etc.). This understanding of using technology as a tool is helping them improve and streamline their practices and, ultimately (for the better), engage their patients in care. “
Finally, here we get to the heart of the matter: “Technology by itself won’t improve patient care. Physicians know this – we all know this – and physicians play the key role in providing higher quality of patient care, but using technology as a tool to improve care improves outcomes, according to the physicians and patients I speak with. And, to me, that means improved outcomes equates to improved quality of care.”
“So, it makes sense that the practice of medicine is changing with technology, which calls for an adjustment of its perceptions in the space.”
And, to the tune of Paul Harvey, here’s the rest of the story:
“Because, as more attention flows into the market – with reform and regulation – it’s time to decide where the future of healthcare is going to be. Connection and interoperable features that drive ownership of patient care may be rooted in the patient-centered medical home and accountable-care organizations, but for that, more needs to be done. We have to be able to share data – again, that’s where connectivity comes in — and we’ll have to be able to move records quickly and efficiently, all while trying to remove the shackles from providers attempting to do what they sought the schooling and expertise for: To practice medicine.”
“All of this begins with the electronic record – other tools are essential, too, including patient portals; physician referring portals with the ability for images and notes to be accessed from anywhere there’s a connection; labs; refills and appointments through one interface, a seamless integration between practitioner and patient – is where I think we need to be, so we can move forward with the rest of the marketplace (meaning: banks, media and communication segments). With the value perceived in being able to share and communicate endlessly and with ease socially, we have to reach these heights in the practice of medicine.”
“Technology helps make lives better. Though, as noted above, technology doesn’t make doctors (or people of all kinds, for that matter) better, it just makes it easier for them to do their jobs (and live their lives). It won’t happen overnight, but I can see even better healthcare attained.”
And so, the encore performance may actually be a sign of things to come.