Archive for the ‘Practical EHR’ Category

SmartPhone Interfaces for EHRs

October 15, 2009 1 comment

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!


Want Preventive Healthcare? EHR is needed first!

October 6, 2009 Leave a comment

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!

The Pitfalls of Overblown EHR Expectations!

September 21, 2009 Leave a comment

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.

Initial Hump of Adoption

August 31, 2009 Leave a comment

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!

EHR Adoption is Business Process Change: Not Technology Adoption Alone!

August 26, 2009 Leave a comment

EHR adoption or Non-adoption as I see it, is not because of Physicians alone! Lots of other people need to change the way they practice medicine, not just the Physicians!

Success or Failure of EHR adoption is often laid at the feet of Physicians. They are technology-averse, they are not comfortable with computers, etc. However it appears that everyone from the Office Manager or the person at the reception at the practice, to the Nurses and Physicians’ Assistants, to the backoffice billing persons or third party billing companies are all affected by an EHR implementation.

Paper records are so easy to use that not much attention is paid when they are used by these different people during a visit to the doctor’s office. However, when the same practice starts using EHR, you have a single Electronic Visit or Encounter record that gets started up by the person at the front office, the nurse may update the vitals section of this visit,  and then the Physician fills out the rest of the information up to diagnosis, prescriptions or tests to be performed. Then others may take over and complete the rest of the visit and the information goes to billing.

Now you can see that the entire business process needs to be mapped and addressed properly with training for everyone involved. They all need to buy in, be comfortable with the new way of doing things on the computer and start doing all of these in a coordinated manner.

The tough thing is that ANY of these interested parties can cause the failure of the whole system if they do not do their part properly in the EHR but it takes ALL of them to do it properly for it to be successful.

Thinking of EHR rollouts, especially in smaller and medium sized practices as a technology rollout is a disaster in the making! If the whole thing is not considered a fundamental change in the way business is done and then ALL the parties trained properly in doing their part with the EHR, the whole thing will fall apart!

Physicians Use of EHRs – Tug-of-War Between The User Interface and Practice of Medicine

August 24, 2009 Leave a comment

One of the big reasons that Physicians abandon the use of Electronic Health Records is the constant tug-of-war between Physicians’ need to practice medicine Vs getting things done quickly, efficiently and more importantly, completely for accurate billing.

 I loved reading Dr. Stephen R. Levinson’s book Practical EHR – Electronic Record Solutions for Compliance and Quality Care.  Dr. Levinson talks in detail about the various minor things that add up to large irritations on the part of Physicians while using EHR software and at the same time practice their medicine, looking the patient in the eye, asking questions and evaluating the responses!

It is sort of understandable! Before EHR packages, doctors used to talk to the patients without anything like a tablet PC or a desktop or a laptop coming in between them and the patient. This seems like a small thing but seems like a major irritant in EHR usability.  They used to take care of note taking and dictation after the patient visit is over or at the end of each day.

The new way of using an EHR package requires them to change fundamentally, their way of doing their job. That, and the fact that they have limited time for each patient places a lot of stress on the time they can realistically spend navigating the quirks and peculiarities of the EHR package they are implementing!

However, once they get used to the new way of doing things, they have gone over this learning curve and they are converts. One of the Physicians I talked to, had joined a medical practice after they had chosen an EHR package and completed its implementation also. He was ready to quict after two days! But he got used to this package after the third day and now would not do without the same package in other practices he visits!

Interesting tug-of-war between the User Interface and the Practice of Medicine!