Sunday, December 23, 2007

EMR Video demos

Here are some demo video clips of EMRs in action. The industry is going to have to produce more of these real life examples of technology in use. With the proliferation of the internet sharing and collaboration, customers will want to see such examples before making a purchase of an IT system.

Medications and History:

Using Dragon with eClinicalWorks

Ink-able Forms


Ordering Labs

Reviewing Labs

Tuesday, December 18, 2007

Finally a National Patient Identifier ?

FierceHealth had an interesting commentary on a proposal by a non-profit group, the National Alliance for Health Information Technology, on promoting the use of a national patient identifier (see their position paper).

Finally someone has has the guts to challenge the assumption that a national patient Identifier is not possible. Currently, we are forced to do algorithmic gymnastics in order to match a patient correctly, and even then, are at best 90% effective. This has led to the dependence on high priced MPI solutions.
The problem will only get worse as more health IT infrastructure is deployed. From a safety standpoint, 90% is not acceptable. Allowing patients to "opt-in" for use of a national patient Id is a great way to address any possible privacy concerns.

Tuesday, December 11, 2007

PHR Standards

FierceHealthIT had an interesting link to an article on PHR standards development:
Health insurers, HL7 team to create portable PHRs

Its nice to hear that HL7 is developing a PHR standard, however, I wonder if companies like Microsoft (see HealthVault) will the ones to create a de-facto, practical PHR standard that one can actually implement using existing tool sets. From my own experience with HL7 v3, I don't have much confidence that standards committees can put together something that is practical in implementation. See my previous post on HL7 v3 implementation.

Sunday, December 9, 2007

Telemedicine Provider: Interactive Care

As part of my ongoing work in telemedicine and Health IT, I come across innovative companies that I think are worth looking at.

Recently I had the opportunity to speak to Michael Z. Jones, CEO of Interactive Care, a telemedicine company that "provides Internet-based, software-only service to extend care to under-served patient populations". They have a model that greatly reduces the cost of telemedicine over traditional systems by providing the service on a hosted, "software-only service" model.
They provide the complete package: the technology as well as the actual telemedicine care services.
I like the impressive demo that they have on their website. One of their key strengths is their integration to EMRs.

Health Information Technology in Massachusetts Forum

Health Information Technology in Massachusetts: Private/Public Partnership? What Should the State's Role Be in Facilitating HIT Adoption?"

I recently attended this forum held in downtown Boston last week. The purpose of the form was to discuss the states role in health information technology adoption. There was an impressive panel made up of the top Healthcare IT leaders of the state, who also happen to be leaders at the national level as well. This panel included John Glaser, Ph.D; John Halamka, MD, Micky Tripathi and Janet Marchibroda.

The full list of speakers included: Secretary JudyAnn Bigby, MD; David Blumenthal, MD; Ray Campbell, Chris Gabrieli; John Glaser, Ph.D; John Halamka, MD; Jay Himmelstein, MD; Phil Johnston; Janet Marchibroda; John McDonough; Sen. Richard Moore; James Roosevelt, Jr.; and Micky Tripathi.

Here are some points made by the speakers at the forum which I found relevant:

Chris Gabrieli, Chairman of the Board Massachusetts Health Data Consortium
Chris worked for an EMR company in 1981 as part of a pilot. This system actually had decision support and clinical alerting. However when the pilot was completed, the medical clinic did not want to pay to have the system. As a result, the EMR equipment taken out of the clinic and the project was scrapped.

He spoke about the importance of patients being able to have a seamless transition when moving between healthcare providers. He compared it to how we can switch seamlessly from one cell phone provider to another while maintaining the same phone number.

John Glaser, Ph.D, CIO Partners HealthCare
Spoke about the need to broadly adopt healthcare IT technology.

The digital divide that is developing between the large hospitals/physician groups and the smaller healthcare organizations.

Partners Healthcare’s Telehealth programs and the benefits realized in managing CHF patients.

The need to get healthcare data exchanges up-and-running by aligning financial incentives between organizations.

Mentioned that MA-SHARE has gone as far as it can go and that now it needs broader support

Mickey Tripathi, CEO Mass eHealth Collaborative

EMR is a seen as a pure cost currently. The actual return on investment is seen much later.

Benefits of an EMR play out in a complicated manner over time. This is the reason why it's hard to establish a return on investment for EMRs using conventional methodologies.

John Halamka MD, CIO CareGroup Health System, and Dean for Technology at Harvard Medical School, CEO MA-SHARE

Spoke about the difficulties faced in trying save waste from the healthcare system by eliminating redundancy: "One man's redundancy is another man's country club".

Spoke of the problems of sustainability for RHIOs. He talked about how health-care providers will not pay if there is no infrastructure. In other words healthcare providers do not see the health information exchange as an investment. The challenge is how to build the infrastructure without the capital. John implied that the providers would see value and pay if there is a live health information exchange.

Janet Marchibroda MBA , Chief Executive Officer of the eHealth Initiative
The greatest challenge to RHIOs is building sustainability.
She mentioned that based on a recent survey on health information exchanges, the largest source of revenue is now coming from hospitals, not government grants.

The health information exchanges that are operational are exchanging Lab data, emergency department and outpatient clinical summaries.

Byron Byfield has written about the event on his blog.

Tuesday, December 4, 2007

Nursing homes will be facing greater scrutiny

CMS cracks down on poor performing nursing homes
There has been a lot of attention paid to quality of care in hospitals and outpatient settings with the use P4P and HEIDIS performance measures, and this has led to a proliferation of IT in these care settings. Unfortunately, nursing homes have lagged in adoption of technology. What is needed at the nursing homes, is the implementation of technology in order to improve the quality of care. I believe the time has come.