The Healthcare IT Guy

The nice folks from Ohio State University Center for IT Innovations in Healthcare sent me a note that they are holding their second annual “Healthcare IT Innovation Summit” on November 17 in Columbus, Ohio. It seems like a very interesting gathering and I might be attending.

They are inviting thought leaders to explore questions such as:

• What effect does consumer-driven healthcare have on leveraging technology resources?
• What are the strategies behind unleashing the true power of technology innovation in health care?
• What do patients really want tomorrow and how can technology respond?
• What effective models foster academic and industry collaboration in consumer-driven healthcare IT innovations?

These all seem like great questions and well worth putting together a special conference to discuss them.

See you at the conference.

As most of us in healthcare realized long ago, pen and paper is a very difficult technology to replace and compete with. It doesn’t matter how fancy our computers get, how nice tablets become, or how good the voice recognition features are, most healthcare workers spend a majority of their time on paper.

The IOGear Mobile Digital Scribe is probably the closest device I’ve seen that may allow doctors to switch to a non-traditional pen/paper technology. The device captures/digitizes your handwriting on almost any normal paper surface and then allows it to be saved on to your computer. You can also hook the Mobile Digital Scribe directly up to your computer and record your handwriting in real time.

By the way, Office Max has the IOGEAR Mobile Digital Scribe for $60 until October 18th so it’s cheap enough for anyone to try out. Give it a shot.

If you’ve already tried it, share your thoughts about it here. What other tools like this do we all we use that others might not know about?

A friend of mine sent me a note to take a look at Make Mine Paper by a blogger who calls himself "#1 Dinosaur, MD". It’s a well written article that explains why there are some physicians who will never use an EMR. Some choice words:

Until there is a single, interoperable system in wide use, EMRs will never have the portability and versatility of paper. Just imagine the chaos that would result if doctors’ offices used 8.5-in by 11-in paper for their charts, but hospitals all used legal-sized paper; labs reported their results on 4-in by 6-in cards, and x-rays were reported on 5-in by 8-in slips. Trying to keep all of those different sizes and shapes of paper together in 1 folder would be a nightmare. Now multiply that several hundred-fold.

He’s certainly right and I like his explanation of lack of interoperability; in fact, it’s one of the best analogies I’ve read. He goes onto say:

The fragmented market of EMR suppliers isn’t just as simple as PC vs Mac; there are hundreds of vendors selling different systems, each of which works differently and none of which are capable of interacting with each other. The only way to transfer records from one system to another is to print it out on paper and then scan or manually re-enter the information into the other.

This is where I disagree — the reason that systems aren’t interoperable and can’t interact with each other is because customers are willing to accept vendors who don’t work well with each other. It continues to surprise me how easily healthcare IT customers accept mediocrity from their vendors and sign contracts and make purchases that are only good for vendors.

With HL7 we have some a "good enough" interoperability solution and there are tons of tools and many vendors out there that will connect disparate systems.

How many of you out there are being held hostage by their healthcare IT vendors?

A friend of mine sent me this link - "Beware of the EMR ‘Ponzi scheme,’ warns physician leader" — earlier this week. The article starts off by saying:

Healthcare IT does not necessarily make life easier for primary care physicians, says a leader in the movement to make medicine more efficient and patient-centered.

"When you put an EMR into a primary care practice, your life is hell for the next year," said L.Gordon Moore, MD.

"EMR vendors aren’t really giving us what we need. We have to make a distinction between a robust EMR with decision support tools, and one that is just being marketed as a way to improve coding. And we really need to get out of the E&M coding game."

Yikes. I’ve been in the healthcare IT market for a while and that’s probably one of the strongest anti-EMR statements I’ve seen publicly.

I know I have many readers who are physicians — how many of you concur with Dr. Moore?

The nice folks over at RNCentral.com have posted their list of the top 50 Health 2.0 blogs. This humble blog is listed in their Health and Technology section and I thank them for their consideration.

The folks at SoftwareAdvice.com recently published EHR vs. EMR - What’s the Difference?

It’s a good, but at times too high-level and could have been a bit more substantive in terms of real problems and potential solutions (but I suspect this was "landscape" summary so I can’t fault them too much). It talks about what is an EMR, EHR, and PHR from a definitional perspective and goes on to give a good summary of how often each term is used (with Google stats) and why vendors are still calling themselves EMRs.

I think the general debate of whether it’s an electronic health record (EHR) versus an electronic medical record (EMR) or a personal health record (PHR) is really silly. It’s like saying that your bank records kept at the bank versus the copy they give you at home via online banking versus what you see at the ATM versus what you put into Quicken are all somehow different records — they are not. They are the same financial record (yours!).

EHRs, EMRs, PHRs, are all views of a single person’s health record that doesn’t really exist anywhere in totality — they are simply slices. Thinking that we’ll ever have a comprehensive record for anyone is like saying there’s one comprehensive financial record for a person that would include their taxes, bank statements, 401k statements, etc. There are aggregators like Mint.com and Yodlee.com that do financial data aggregation because there is no single source for a financial record and there never will be (too many players).

Healthcare data is far more detailed and even more volumnious and far harder to aggregate. Good luck trying to unify these definitions.

Caring.com is an excellent example of how to use Web 2.0 for improving patient care — by targeting not just those affected by illness but actually helping those that are caring for the patients. Caring.com’s focus on eldercare (adult children caring for aging parents) is a good one and should prove profitable. I really like their "to do list" ideas that give actionable advice and specific steps for how adult children can care for their elderly patients.

Seems like a good start. I’d like to see more "calculators" and tools added (like how much time should be spent on specific ailments, how often there should be doctor visits, a scheduler that might send out reminders, etc). I think the eldercare industry is going to explode and Caring.com seems to be in a good position to take advantage of the opportunity to help.

George over at Patient Centric Healthcare blogged about using mobile phones’ texting capabilities to get insurance company deductibles and other information. Nice idea, worth reading — somebody will make some money off of it. He says:

Imagine texting your plan for an immediate response on:

• Your deductible
• Your FSA balance
• Your copay on a specific drug
• Whether a provider is in network
• The status of your prior authorization
• A list of formulary alternatives

Neil Versel recently wrote about Medicine 2.0 here and here. Check out the postings, it looks like there was some nice stuff going on there.

The proceedings of the conference are freely available.

This is an article I wish I wrote. It’s about how to demonstrate your startup or business idea to a stranger on the phone or in an audience. Since people pitch me their products (which I enjoy, of course), I see lots of demos every month. At then end of each demo I almost always give advice on how the demo could have gone better and the folks at TechCrunch have captured it quite nicely. Check it out and learn from both Part I and Part II.

The folks over at Health Content Advisors talk about the business side of online consumer health firms. With big firms like Revolution Health not doing well, it’s getting a little scarier if you don’t have deep pockets to make the advertising model work.

As a blogger whose been around the block and online for a while I get lots of new ideas pitched to me from all the various healthcare technology companies and I get excited about new consumer plays but by the time I’ve finished interviewing and talking to the firms about their business models I’m less enamored because many of the firms have no clear path to profitability. It reminds me of my old dotcom days.

An important observation from Health Content Advisors that I’ve been speaking about recently includes:

while many of the new players rely on advertising dollars from pharmaceutical companies, pharma advertising hasn’t migrated to the Web as quickly as most analysts had predicted.  

This of course puts may companies’ business models at risk and those without supplementary sources of income have a issue during the short term at least.

Their conclude by indicating: 

We regard the current shakeout as a correction, not a collapse. Too many companies are chasing the same customers and advertisers.  The survivors will have done their homework and will bring technology and editorial experience to bear to solve an information overload or scarcity problem that someone is willing to pay for-either directly via paid content or indirectly via advertising or sponsorship.

I still think there is tons of money to be made in consumer health "done right" (meaning useful to people). But it’s clear nobody has struck the right chord (yet).

It has been some time since I last wrote about XTS, a rapidly growing virtualization management vendor focused on the Citrix market. In my recent interview with Eric Spiegel, CEO, I found out that XTS has had many important changes this year. On the product side, they launched a new, more powerful version of their analysis and reporting solution and renamed it Introspect for XenApp. Although it’s not designed for it, Introspect is a very useful tool for performing HIPAA compliance checks and audit reports of which users have been accessing specific applications and servers that might contain patient data.

Last week they released a free utility that enables Citrix administrators and architects to easily create configuration reports for their Citrix farms. These configuration reports are the first step to documenting application usage for HIPAA compliance reports.

Unlike the full product Introspect, which is focused on usage data captured in the Resource Manager summary database, the free configuration report generator utilizes the ubiquitous Citrix data store and features the same flexible, easy to use interface that they have always had in Introspect for quickly creating reports exactly the way you need them.

I see it as being useful for the following tasks:

• Documenting implementations and upgrades
• Creating baselines for troubleshooting, audits and disaster recovery
• Identifying incorrect server configurations, either to solve a problem or proactively reduce help desk calls
• Ensuring consistency of hotfixes across a Citrix farm

Additionally, integration with Active Directory can be leveraged for better insight into user and application assignments. Other bells and whistles like automated scheduling, report distribution via email and the ability to customize look and feel of report output can also be found in this robust piece of free code.

Anyone can download the free configuration report generator from the XTS website. It is currently packaged as a fully functional virtual machine and includes a sample Resource Manager summary database so you can try Introspect’s starter templates to evaluate the historical usage reporting and analysis capabilities as well. Please also note that they recently simplified their pricing model and now base it on the number of Resource Manager summary databases, which makes Introspect very affordable in my opinion.

If you are a Citrix administrator or architect I suggest checking out this free utility from XTS which will probably help you save time and possibly some headaches in the future.

If you’ve already downloaded a copy and tried it, drop us a line here and let us know how it’s working out.

I introduced Phreesia on my blog back in December 2005. I was impressed by the company back then because they took a real problem — improving the patient check-in process — and solved it using some deceptively simple technology that would actually be used.

They definitely haven’t rested on their laurels; since then, Phreesia has continued to improve the patient experience. Phreesia remains the Patient Check-in Company but they’re just getting even more deeply embedded within the physician office workflow. The new PhreesiaPad has had a total makeover in its user interface and external design; a new, friendly orange PhreesiaPad now sits in doctors’ offices across the country (see image below). This non-intimidating design helps even the most techno-phobic patients ease into using it for check-in.

The team at Phreesia is dedicated to creating a functional interface and maintaining patient satisfaction. The data collection ranges from basic identifying information to reason for visit, family medical history, insurance provider and current medications – even adding a comprehensive list of name brand and generic meds built-in to avoid remembering or confusing prescriptions. One of the newer and most innovative controls I’ve seen on the PhreesiaPad was a custom signature capture feature where patients can electronically sign doctor-uploaded HIPAA and other agreement forms, not only does it capture an accurate signature, but also allows one to switch the side of the line depending on whether they’re right- or left-handed. Rest assured that all of the Patient Health Information captured, is secure and safe and since Phreesia is committed to the ideals of HIPAA, docs remain compliant by using the pad. You can view all these features in a demo of the new PhreesiaPad here.

Doctors across the country have clearly seen a need for the PhreesiaPad; the company has grown exponentially since it started. The fact that docs in a number of specialties, not just primary care physicians, get specialty specific and fully modifiable interviews makes it easy for any type of physician to serve their patients. Phreesia draws on the advice of a really comprehensive medical advisory board with a broad range of specialties from some of the top hospitals in the country, which helps the team become completely engrossed in various medical fields including: Neurology, Cardiology, Internal Medicine and Obstetrics among others.

Phreesia recently launched Spanish-language functionality so patients can conduct the interview in Spanish. Chaim, Evan and team are responding to physician offices’ requests by enhancing applications to conduct real-time, patient triggered eligibility and benefits checks and enabling a patient self service co-payment process. Phreesia will integrate with any existing and future technology in your office

With such success so far, Phreesia has also contributed to the ‘greater-good’ by launching clinical initiatives that aid in the prevention and awareness of stroke, medication wear-off in Parkinson’s Disease patients and the early identification of women at risk for postpartum depression. Since I last recommended giving Phreesia a chance, it has grown at a rapid pace and docs in almost every state are reaping the benefits. I still stand behind Phreesia, and if you’re a doctor and haven’t done so already, please take the opportunity to learn more and get this technology into your office. It’s well worth the effort.

The folks at MyFamilyHealth.com have combined online genealogy, social networking, and basic personal health record management for a single and eminently useful purpose: learning more about your family’s medical history to help improve your own health by better understanding your genetic risks. It will be fascinating to see how people use it over the next few years.

I built my own family history account this morning and found these important benefits:

• Create a social network of your family members and share your medical history with them. It would be interesting to see if they make a facebook application soon to tie in with other social networking tools.
• Discover and learn about the health problems that run in your family – including conditions that might not otherwise be considered by your physician.
• Discover if you or your family members could benefit from specific diagnostic, genetic or screening tests.This is probably the area they are making money so it’s good to see a viable business model.
• You can share your family health history with your physician and receive better guidance to delay, improve or even prevent bad health. This is a good way to promote the service, too.
• Although I didn’t try it, they claim they can Import your family tree from genealogy sites like geni.com and ancestry.com.

A surgeon friend of mine, who’s been a great proponent of practical healthcare IT solutions, prepared this nice little parody of a fictitious HIT/HIS vendor named Extormity’s press release . Here’s what my friend wrote after some bad experiences with a few healthcare IT firms at his hospital:

Health care information systems provider Extormity, Inc. (NASDAC:EXTRT) announces a product class action law firms have been developing in concert with Extormity corporate leadership.  Extormity Litigation Aggregator (ELA) helps by bringing together thousands of plaintiffs from Extormity installations nationwide for focused legal action, or threats of legal action.  Often with the help of ELA, an experienced legal firm can bring a settlement provider organization (SPO) to its knees, without having to let the actual injured plaintiffs become aware of the potential for legal action.  Hospital billing records and clinical data are scoured for use of products outside the confines of the FDA approved list, or for impossible to disprove potential adverse effects (IDPAE) for presentation to the SPO (a pharmaceutical firm such as makers of Vioxx, or a professional organization (e.g., the American Society of Neurosurgeons), who refuse to staff emergency rooms 24/7 as plaintiffs arrive in medical need.  While kickbacks to hospitals for such legal actions are illegal, complex contracting for Extormity’s clinical suite can conceal incentives to install ELA by extending our Extormity contract, free of additional charges, for a decade or more.  We expect the product to provide an immediate return on investment for Extormity, since the usual delay in litigation can be avoided, and settlement terms hammered out quickly as data is presented on a real-time basis.  Our legal team assures us that trial lawyers won’t delay product roll-out, as spin off suits can be identified and passed to smaller local or regional firms, allowing ELA’s legal clients to go after only the best litigation targets.

TechCrunch posted today about MedPedia:

MedPedia is a new project, currently in development, that will offer an online collaborative medical encyclopedia for use by the general public. In order to keep the content accurate and up-to-date, content editors and creators have to have an MD or a PhD. Several highly-esteemed medical colleges will be contributing content to MedPedia, including Harvard Medical School, Stanford School of Medicine, UC Berkeley School of Public Health, and University of Michigan Medical School. Medpedia is also receiving support from the National Institutes of Health (NIH), the Centers for Disease Control (CDC), the Federal Drug Administration (FDA) and many other government research groups. The content from these organizations will then be edited by MedPedia’s community of medical professionals.

When the New England Journal of Medicine speaks, people in clinical circles listen. In the most recent issue of the Journal, in an article entitled "Electronic Health Records in Ambulatory Care — A National Survey of Physicians" the authors report the following results from the survey:

Four percent of physicians reported having an extensive, fully functional electronic-records system, and 13% reported having a basic system. In multivariate analyses, primary care physicians and those practicing in large groups, in hospitals or medical centers, and in the western region of the United States were more likely to use electronic health records. Physicians reported positive effects of these systems on several dimensions of quality of care and high levels of satisfaction. Financial barriers were viewed as having the greatest effect on decisions about the adoption of electronic health records.

They formed the following conclusions:

Physicians who use electronic health records believe such systems improve the quality of care and are generally satisfied with the systems. However, as of early 2008, electronic systems had been adopted by only a small minority of U.S. physicians, who may differ from later adopters of these systems.

While neither the results nor the conclusions from the results are surprising (that money is the biggest impediment) , they are well documented and give a much better picture given the general rigor of the survey and excellent attention to statistical analysis.

I especially liked their closing remarks:

In discussions about health-information technology, our study informs the debate by providing benchmark information about the levels of adoption of electronic health records by U.S. physicians as of late 2007 and early 2008. Further studies that use clear, similar definitions of electronic health records and representative samples of physicians will be necessary to inform the development of policies with regard to electronic health records in our health care system.

Life hacks are productivity strategies that solve everyday problems — especially problems related to information overload. Joshua Schwimmer, a Physician, recently put together and presented Life Hacks for Doctors (as a slide deck, not a paper). It’s a nice presentation and I recommend all Physicians take a quick glance — it will only take a few minutes to run through it.

Fred Trotter sent out this note to several health IT bloggers recently.

Recently slashdot referenced two uninformed comments on Google Health offering.

http://science.slashdot.org/article.pl?sid=08/05/23/0520223

The problem here is that HIPAA should NOT cover Google Health or HealthVault. This issue now dominates this debate, and I wanted to specifically point out some of the problems with this thinking.

http://www.fredtrotter.com/2008/05/23/in-all-fairness/

Fred does a great deal of wonderful healthcare and IT writing. His latest argument for why HIPAA does not cover Google’s or Microsoft’s PHR offerings makes a lot of sense and is well worth reading. Vendors of technology are generally not covered entities unless they are somehow participating in the care process and I think everyone’s making a big deal about "Google is not HIPAA compliant" or "Microsoft has privacy problems" for very little reason.

Normally I write about Healthcare IT but today’s Why Doctors Are Heading for Texas article in the Wall Street Journal caught my attention. Here’s why:

Today obstetricians, surgeons and other doctors might consider reviving the practice. Over the past three years, some 7,000 M.D.s have flooded into Texas, many from Tennessee.
[Why Doctors Are Heading for Texas]
Corbis
Sam Houston.

Why? Two words: Tort reform.

In 2003 and in 2005, Texas enacted a series of reforms to the state’s civil justice system. They are stunning in their success. Texas Medical Liability Trust, one of the largest malpractice insurance companies in the state, has slashed its premiums by 35%, saving doctors some $217 million over four years. There is also a competitive malpractice insurance industry in Texas, with over 30 companies competing for business. This is driving rates down.

The result is an influx of doctors so great that recently the State Board of Medical Examiners couldn’t process all the new medical-license applications quickly enough. The board faced a backlog of 3,000 applications. To handle the extra workload, the legislature rushed through an emergency appropriation last year.

Now many of the newly arriving doctors are heading to rural or underserved parts of the state. Four new anesthesiologists have headed to Beaumont, for example. Meanwhile, San Antonio has experienced a 52% growth in the number of new doctors.

The article goes on to cite many other benefits of tort reform in Texas, especially in Asbestos cases. It’s a great example of how a simple change in the rules governing physicians and malpractice can fix problems like:

• Lack of medical professionals (Doctors want to practice in a state where medicine is more important than lawyers)
• High healthcare costs (when malpractice insurance premiums go down, so do healthcare costs)
• Availability of healthcare support for charity care (when healthcare costs go down, hospitals can afford to do more charity work)

I grew up in Houston, TX but now live in Washington DC. I still have fond memories of Texas and really do enjoy seeing stories like this. Perhaps some of the presidential candidates should increase their support of tort reform.

I loved what the author, Mr. Nixon, said at the end of the article:

Texas recently became home to more Fortune 500 companies than New York and California. Things are trending well for the Lone Star State. Anecdotally, we can see that while doctors are moving in, trial lawyers are packing up and heading west. They’re GTC — Gone to California.