Smartphone interfaces for EHRs will one day outstrip use of Tablets or Laptops or Desktops when it comes to using them!
SmartPhones are the most convenient devices when it comes to doing things at the “Point of Action”. In individual Physician Practices, Smart Phone interfaces may not be needed as much as they are needed in Hospitals and Emergency Rooms.
In some hospitals, they have been using desktops or laptops mounted on litle desks with wheels to be wheeled along or set in a corner. They are tethered to the Hospital backend systems with Wireless or Wired connections. They seem clunky and inconvenient to use but never the less seem to be used.
Tablets or Laptops may be convenient also but not as convenient as a small form factor computer like an iPhone, iPodTouch, BlackBerry or Android phone! These are especially handy when used in Emergency situations like in an ambulance while taking in vitals and other readings and sending them ahead to the hospital emergency room. This can enable the hospital to be ready for the patient and speed up a lot of communication that happens only when the ambulance arrives at the hospital.
Even in the Hospital in-Patient rooms or the Operating Room, SmartPhones are easier to deal with than a laptop or a desktop even with wireless connectivity.
The problem with EHR SmartPhone interfaces is to come up with natural, easy to use interfaces. With a small form factor it is quite a task to fit a lot of what goes into an EHR interface into such a small space. Even with large LCD screens EHR interfaces take up a lot of the screen real-estate. Compressing a lot of that into a small screen like that of a smart phone is quite a task!
Quite a challenge but very useful if someone does it!
Today I had my Flu Shots done at Kaiser Permanente’s facility here in the Bay Area.
There was a line that was 200 long but they had 7 or 8 nurses doing the flu shots and the line was moving fairly quickly.
But the amazing thing that was made possible, courtesy of Electronic Health Records was what happened at the end of the line after you had your flu shots. They did a quick scan of your membership card and checked on outstanding or overdue health checks. In my case, they found that a test for Colon Cancer was not done and so they set it up with thier lab to have it done immediately!
All of this was made possible, only because my health records were electronic and they were able to see what was overdue for my preventive care with a swipe of a card. As long as I was there for the flu shot, they could as well have me do my preventive health checks also!
I cannot imagine any healthcare facility delving into Paper files for each member who shows up for a flu shot, digging out tests that were done and Preventive Healthcare tests that were overdue, especially when the line is 200 long! They did this because they could, with just a swipe of a card!
We keep talking about moving from an illness based healthcare system to one of Health and Preventive healthcare. From a practical point of view, you need to encounter situations like these to see what a leap of healthcare Quality, just making healthrecords electronic, enables!
Just Preventive Healthcare alone will save any payer – the Medicare/Medicaid ones or the Insurance Companies, in spades, money they dole out in treating patients after they get too ill! What a shame!
So when someone talks about Preventive Healthcare saving money and EHR enabling it, believe you me, they are little things like the one that make them possible!
Some deadlines like the Year 2000 are not movable! Ready or not, here they come!
EHR Adoption and tthe current deadlines like 2010 and 2014 are all artificial deadlines. With just a bill they can be postponed again and again, till things like Meaningful Use, Certification of EHR Software are all worked out completely!
We have seen this movie before with the Sarbanes Oxley Act and Compliance with the act that is needed. The Act was passed in 2002 and a number of extensions for compliance were issued time and again!
I have a feeling that the longer we go with a lot of uncertainties about what meaningful use is or imprecision around how EHR packages will be certified, I am afraid that deadlines will be extended again and again!
I hope that this does not happen, but given past experiences with anything the Federal Government does on a scale that it is trying to do with the Stimulus Package and EHRs, it is very likely that deadlines get extended!
This can have a lot of profound consequences on a lot of companies and people. EHR companies may not see the same kind of rampup they would experience if the deadlines are not extended. In some sense, these are not deadlines but only announced dates. Nevertheless moving them could affect a lot of companies and people!
That way Year 2000 was better. You didn’t have a choice. It came whether you were read or not!
Talking to someone very experienced with EHR rollouts, especially with Small and Medium Sized Physician practices, I got a very pessimistic view of what might happen to EHR Adoption. He thought in such practices it would not be that great, ARRA Stimulus payments not withstanding!
Having gone through many hype cycles like Year 2000, Artificial Intelligence, Dot Com, etc I am a bit jaded when everyone is optimistic! That’s the time you need to break out your cynical evaluation of what’s being said. That’s the time everyone starts believing their own Kool-Aid when some level of skepticism is healthy and good.
During the Dot com boom, everybody had bought into the idea that Brick and Mortar stores were dead and every business in the world would be done online!
Did not happen that way; even though some things changed many things still remained the same. Of course, there were hundreds of businesses that changed for ever and online shopping is here to stay.
Something similar is likely to happen in the EHR adoption space also, most likely! Physician practices that were anyway postively inclined to automate their Health Records will go at full speed, Stimulus Payments or not, if they have not already! There will be many that will try it without a lot of planning and thought and fail as a result. This may be as much as these practices not being fully prepared with the right expectations of cost and time to successful implementation as the quality of people doing the implementation.
The Dot com boom attracted to technology, people who did not have any business doing technology just because of the demand for such people. The same may happen in 2010 and 2011 with great demand for people with EHR experience or NOT! This is where many things can go wrong and Physician practices may become even more jaded than now.
However, over the long run they will see success but it will be a quick upward curve in demand and adoption followed by a quick fall and then a gradual rise!
Electronic Health Records will buy all stakeholders incredible ROI but they may not see it immediately! That’s where discontentand disillusionment may set in. Hope it’s a short phase.
Clinical Decision Support (CDS) systems seem to form a large part of the needs of EHR, a number of physicians seem to have a lot of use for it, but it does not seem to be big part of “Meaningful Use”, at least not yet!
Clinical-decision support gains attention at AMDIS – is an interesting article summarizing this situation. It appears that current Clinical Decision Support systems come in the form of articles released as Best Practice Guidelines or Evidence-Based Medicine articles that are peer reviewed and published. These help physicians help in their Diagnosis and Treatment Plan designs at the end of each visit.
It appears that in Hospitals, they would need actual proof of physicians having used these articles or Clinical Decision Support systems in the form of statistics.
Clinical Decision Support systems, especially, if they incorporate formal studies of treatment or process efficacies, can reduce medical errors and adverse drug events to a large extent. WHO found that if a simple 20 point surgery checklist is followed in every surgery, morbidities and mortalities are reduced drastically.
Clinical Decision Support systems when combined with EHRs properly stand a very good chance of achieving the now seemingly elusive goal of moving healthcare more towards prevention and wellness rather than illness!
Many EHR adoption failures can be laid at the feet of User Interfaces at the Point Of Care. Many physicians and nurses never get used to doing their work somewhat differently from the way it was done before with pen and paper!
I was a member of Kaiser Permanente, before EHR rollout and after EHR rollout! Forget the caregivers, I was very disturbed as a patient when my Physician kept turning away from me every two minutes to type something into the EHR on the desktop that was suspended from the ceiling! I can understand how the Physician can feel that this has changed the way they deliver medical care!
This is where small form factor devices could come in handy and could solve some of these problems but they are totally underestimated today!
Devices like the iPhone and iPod Touch are very easy and natural for physicians and nurses to use and it’s only a matter of time before these devices take over a lot of the EHR functions piece by piece!
If you are a nurse taking a patient’s vitals you just need that screen where you type in the details and record them. You don’t need the whole kit and kaboodle of the EHR user interface!
iPhones, iPodTouches and other SmartPhones may already be replacing pagers in healthcare! With processors becoming faster, these devices becoming less expensive, it’s only a matter of time that they get adopted quickly!
If these are woefully inadequate, there are always these rumors of a midsize iTablet device from Apple!
Small form factor devices are coming! Good EHR software vendors seem to be working on these small form device interfaces already!
One of the Physicians I was talking to about EHRs said that he joined a practice when they had already implemented EHR and rolled it out to everyone already.
He said that he was ready to quit the second day! He persisted and by the end of the first week, got so used to the system, would not go back to paper anytime soon!
That seems to be the problem. The initial hump of adoption!
I don’t blame physicians. If I have been doing my job for years and years one way and I were to change it overnight, I would be upset and ready to quit also! But Physicians see the expense, delay and the downstream problems associated with paper records, they don’t want to go back to the way it was!
Pen and paper are very easy to use, painless from day 1 and that’s probably the way they were taught for years and years. This is like changing horses in midstream. More like swapping a horse for an automobile. Both have horsepower and that’s probably where the comparisons stop!
It may be better for consultants and EHR vendors to describe this process honestly in the beginning rather than oversell the ease with which the transition will happen! I am sure Physicians readily see the downstream advantages and are ready for it but the initial hump of adoption may be the one that scares them!