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Category : EMR/PHR
Healthcare in the future…a scenario worth striving for?
What would the future of healthcare look like if we could connect provider and patient using technology on an even greater level than we currently do? What if patients were more engaged in their own care through increased access to their personal records? What if providers allowed for greater collaboration between themselves and their patients when making decisions? What if patient ‘consumerism’ was the norm? What if patients actually started taking care of themselves? These are all ideas posed in the recent issue of HealthLeaders under the title The Patient of the Future.
A patient enters the waiting room and is greeted warmly by her personal navigator, who hands her a tablet-sized computer preloaded with her personal demographic information and health records. She answers a series of questions and the computer compiles a list of possible diagnoses for her physician.
In his office, the physician is reading an e-mail from a patient who has forwarded an interesting study about his particular medical condition. The physician forwards the study to the rest of the patient’s care team, including the patient’s acupuncturist.
In the exam room, a specialist and patient sit together in front of a computer—the physician is showing the patient which sites have the most reliable medical information that she can use to learn more about her recent diagnosis. Next door, a physician is talking to a patient who has unusual symptoms; the doctor consults her PDA, which is loaded with a decision-support application.
Down the hall, an employee e-mails to a prospective patient a detailed, itemized list comparing the costs of hip replacement surgery at a number of area hospitals.
And, by the way, everyone in the waiting room is fit and trim. Nobody smokes anymore. People with diabetes check their blood sugar regularly. Everyone shows up for their colonoscopy appointments. People are knowledgeable about their health, empowered to participate as partners in their care, and engaged enough to comply with their physicians’ directives.
Electronic health records: Panacea or problematic?
I’m a big supporter of electronic health records (a.k.a. EHR, electronic medical records, EMR, personal health records, PHR, and on and on). The benefits are too many to do it justice in this short post, but efficiency, error control, speed, automation, and interconnectivity are among some of the most desirable aspects of the technology.
But is EHR / EMR all it’s cracked up to be? Are there reasons NOT to adopt? Are electronic health records for everyone?
The answers to these questions depend on who you ask, but in an effort to persuade you that I am [attempting to be] unbiased in my opinion, let me disclose to you that our company is, in fact, in the EHR business – yes, we provide EHR / EMR solutions for healthcare practices. And, no – we don’t think it’s for everyone (at least not right now).
First off, electronic health records can be expensive. And while the long term savings associated with EHR / EMR implementation overwhelmingly pencil out very much in favor of the technology, cash flow is undisputably a more real issue over the short term. Hence, regardless of the long term advantages to EHR / EMR, if the numbers don’t support it over the short term, it simply won’t work.
Now, this is not to say that many web-based and/or software-as-a-service (SAAS) models out there don’t mitigate this issue quite effectively – they do. But you get the point – if you don’t have the cash, you can’t benefit from the technology.
Second, and perhaps much less understood, electronic health records can be painful.
What, you say? The Obama Administration has included greater than $20 billion for EHR adoption in the stimulus package, and EHR’s are painful?
Yep, absolutely.
EHR / EMR use is different than using paper. It’s better in a number of ways, but for anyone who’s ever made the quick decision to write a phone number down on a Post-It Note rather than logging into their smartphone, navigating to the contacts menu, creating a new contact, and then punching in the number on tiny little keys, you’ll know what I’m getting at.
Using EHR / EMR in many circumstances – especially those in which the provider has to peek over the top of a computer screen in a cramped little office just to make eye contact with their patient – is awkward. It’s often not as fast as jotting down a note, and it’s certainly not as natural. Hence, it’s often difficult to get buy-in from providers. And hence, the pain.
If not managed well, the transition to electronic medical records can be an outright disaster. In my opinion – the opinion of a web-based EMR provider – if the transition is not going to be managed correctly, EMR / EHR is not for you…at least not now.
Managing the transition correctly means educating the staff on which aspects of care WILL be different, getting buy-in from EVERYONE in the office, and having the technical support AVAILABLE to deal with issues as they inevitably come up.
OK, enough of my short little rant on the topic. Here is an insightful post from the Wall Street Journal that takes a look at the issue, citing other problems with EMR / EHR usage, including mention of a study that explored a rise in the death rate for certain patients after the adoption of an EMR / EHR system at a pediatric hospital. Scary, but true.
At the risk of sounding contradictory, I’d like to end with this thought – electronic health records ARE our future. We will all have them, use them, and rely on them more and more each year. Are they a panacea? No – not in my opinion. Should we adopt them now? Yes – if we can find the financial and operational resources required to keep the doors open to our practices while administering a safe and organized transition to the technology. EMR / EHR has too many benefits to count, but it MUST be done correctly.
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Tannus Quatre PT, MBA is a private practice consultant and principal with Vantage Clinical Solutions, Inc., a nationwide healthcare consulting and management firm located in Bend, OR and Denver, CO. Tannus specializes in the areas of healthcare marketing, strategy, and finance, and can be reached through the Vantage Clinical Solutions website.
Massachusetts healthcare policy gets a shot in the arm – actually, it gets three
How’s this for a healthcare policy trifecta? – Gift bans for pharma reps, $25 million in EMR incentives for private practices, and university requirements to boost primary care graduates. Three big issues in healthcare today…one clean law to deal with them.
Tackling major issues in healthcare policy isn’t easy, and tackling three large ones with one fell swoop is quite ambitious. Pushed forward by Senate President Therese Murray, the new Massachusetts law was signed into law yesterday by Governor Deval Patrick.
The law is just the beginning however, and much more planning will be required to achieve what the law intends over the coming years. Read more about the law at the Boston Globe.
Patrick’s Human Services Secretary JudyAnn Bigby said that while universal health insurance is an important goal, the current system is lacking if everyone cannot get access to quality care, or premiums and out-of-pocket costs become too costly for patients.
“We have to make sure that people have access to high quality care and that we are being efficient in the way we pay for that care and that we are paying for the right things,” Bigby said in an interview. The law Patrick signed yesterday “puts the challenge to those of us who have to implement it to do more planning.”
Standards: The answer to widespread adoption of personal health records
As much as electronic medical records (EMR’s) have been the topic of conversation in the healthcare profession over the last 10 years, most of the buzz has been around the “potential” rather than “impact” of the technology.
One of the main reasons for this is that there exists a lack of standards that allow for the transfer of information between EMR systems. There are some great EMR systems out there, but for EMR’s to really catch on, they need to be both cost effective and efficient for providers. For all users of EMR’s to achieve this, one of two things needs to happen: (1) Everyone needs to get on board with the same system, or (2) we agree to, and abide by development “standards” that will allow systems to communicate with each other. Since getting all providers on board with one EMR platform is unrealistic, the answer to widespread adoption likely lies with the development of standards that will allow systems to integrate together, and that will lower the switching costs associated with moving from one system to the next.
With regard to personal health records (PHR’s), the same is true, and the battle between Microsoft and Google to become the preferred PHR system by consumers and providers has recently brought the issue of “standards” to the forefront. This article from WashingtonPost.com discusses how Microsoft, Google, and some other PHR developers have agreed to move forward with privacy standards in the development of electronic personal health records – an important step toward widespread adoption by healthcare consumers.
In a move designed to prompt more people to store their medical records online, Microsoft (NSDQ: MSFT), Google (NSDQ: GOOG) and several others have agreed on privacy standards to protect patients’ information. The list includes WebMD (NSDQ: WBMD), MedicAlert, AARP,Consumer Reports publisher Consumers Union, BlueCross BlueShield, and other insurers.
Kaiser pilots Microsoft HealthVault
In a big nod to Microsoft HealthVault, the software behemoth’s independent, online personal health record (PHR), Kaiser is rolling out a pilot of the HealthVault system by allowing its 159,000 employees to trial the online PHR. Employees will be given the option of transferring data between Kaiser’s online PHR and HealthVault. A successful pilot may mean a roll out to Kaiser members, a member base of 8.7 million insured.
This leap of faith between Kaiser and Microsoft’s HealthVault marks an important acknowledgement of the value of an independent PHR to insurers, providers and patients. This article from the Mercury News explains.
Launched by Microsoft in October, HealthVault is designed to give people a place to store all of their health information, from prescriptions to X-rays and lab reports. While insurers such as Kaiser, Aetna and WellPoint offer their members access to online databases, HealthVault provides people a way to pull that data together on an independent site.
“Without an independent third party, health records are not portable; they are not owned by the consumers,” Doty said.
Google Health is here
After a successful pilot project at the Cleveland Clinic, Google Health is finally available for use by the public. Will this change the tracking of medical conditions, reduce drug interactions and improve the overall quality of healthcare communication between patients and physicians? We’ll find out shortly.
Google enters the field of personal health records with a leading online brand, deep pockets and a wealth of technical skills. In a two-month trial this year, the Cleveland Clinic found that its patients were eager to use the Google health records.
The pilot project, limited to 1,600 patients, was quickly oversubscribed, said C. Martin Harris, the Cleveland Clinic’s chief information officer. Dr. Harris also said that when the clinic’s online health records, introduced in 2004, were linked to the Google record the clinic’s records were used more frequently by patients. “It positioned our personal health record more into an activity that they use every day,” Dr. Harris said.
The Google record, he said, allows the user to send personal information, at the individual’s discretion, into the clinic record or to pull information from the clinic records into the Google personal file.
Choosing the right practice management software for your practice
I wrote this article for the April 2008 issue Impact magazine, a professional journal that is read by owners of private practice physical therapy clinics throughout the U.S. The information is applicable to all types of healthcare practices with regard to choosing a practice management software package that is the right fit.
We all know that practice management software is here to stay. And while this is the case, there are still challenges associated with the use of management software in today’s physical therapy practices. It is not inexpensive to implement a comprehensive software or service, and practice owners can be left with a feeling of buyer’s remorse if expectations are not fully met.
Having a clear understanding of the benefits and exactly how they will affect your practice is of paramount importance when choosing practice management software or service that is right for you.
This article will focus on (1) the benefits of using practice management software, (2) a process that can help determine if a software or service is right for your practice, and (3) recommendations to consider in your personal pursuit of the right practice management solution for your facility.
Change Management Key to EMR Implementation
I have assisted with Electronic Medical Records (EMR) roll-out into a number of small to medium sized healthcare clinics. Careful planning and management of these projects is important for successful EMR implementation and seems to become even more critical as the number of employees in a practice rises. I came face-to-face with this recently as I assisted with the implementation of an IT infrastructure and a software package into a 7 physician practice with 33 employees. Planning, management, and communication at all levels of an organization is a lot simpler when you are dealing with a handful of employees – you can actually get them all in the same room for at least a short period of time. But, increasing this number to a clinic the size of 33 employees is quite another thing to plan for and manage. Communication has to be more formally planned out so that it reaches all levels of the practice. Furthermore, the skill sets and culture of the entire organization needs to be carefully analyzed (i.e. you can’t assume that everyone knows basic computer skills or that they even want to know).
Peter Polack, in his recent post on Medical Practice Trends, offers that applying the principle of “change management” will make EMR implementation much more successful. He includes ten principles that should be considered for anyone that will be managing the implementation of a new EMR system. These principles include such things as “addressing the human side”, “involving every layer”, “creating ownership” and “communicating the message”. Glancing through these principles one might think that they are simple common sense considerations. They are. However, omiting any or not creating a plan to effectively use these principles could be the difference between success and failure.
Many “failures” of EMR systems have as much to do with poor planning and implementation as with deficiencies in the software itself. This is especially true when it comes to the changes that occur on the human side. Planning how a new EMR system will integrate within a specific practice before actually installing the software will be time well spent and, ultimately, will benefit the bottom line.
Finding doctors (and appointment times) online
Free market enterprise is daily finding more of a home in the healthcare industry. Of recent note are moves by Microsoft and Google to become big players in the personal health record (PHR) market, but it’s not just the big guns that are bringing consumer-friendly tools into the heart of medical practice operations.
The Massachusetts eHealth Collaborative blog posted recently about an innovative approach to the online scheduling of physician and dentist appointments using a tool very similar to the type commonly used to make restaurant reservations online.
The market won’t stand still. While a bunch of us are futzing around with patient portals, PHRs, patient kiosks, and other tools to add convenience to health care delivery, along comes ZocDoc (http://www.zocdoc.com/) which allows online scheduling of physician and dentist appointments for participating providers. Physicians pay for the service and it’s free to patients.
Online scheduling has been around on the web for awhile. Booking tickets, for example, for everything from movies to airplanes. And www.opentable.com allows free restaurant reservation booking in a number of cities. Like opentable, Zocdoc also allows patients to review their physicians on the site.
EHR’s: We’re on the right track, but it is going to take a while
Electronic health records (EHR’s) are of obvious benefit to the long term plan for reducing costs and improving delivery of healthcare services worldwide. To achieve the ultimate end result of a healthcare record system that will facilitate communication between providers, allow for quick entry of data, and that will be provided on a large enough scale to impact the healthcare industry as a whole is going to still take some time however.
Currently, EHR consumers (hospitals, medical practices, physical therapy clinics, and dental offices) benefit from significant competition within the EHR market which has been effective in bringing the price of such systems down over recent years. This is of obvious benefit, however the market is so ripe for competition that the lack of unified standards that allows for communication between systems has posed implication to practices that have made leap into EHR’s, but whose systems don’t necessarily communicate well with other providers in their community.
This article from Ars Technica refers to this issue as illegible handwriting in the digital age, and comments on some of the main players involved with bringing forward the standards necessary to make EHR a safe, effective, and cost-efficient tool for private practices and hospitals in the United States.
Doctors’ poor handwriting might be a cliché, but being able to accurately read medical records can often be a matter of life and death. The ubiquity of the personal computer has allowed the clinic to enter the digital age, and given that computers excel at managing information, the development of electronic health records (EHR) has been a no-brainer. Despite this, EHR adoption in the US and elsewhere has been slower than some might like, and at least one presidential candidate has made their widespread adoption a healthcare policy platform plank, promising widespread savings through increased efficiency.
Unlike other software markets, where a single player controls the market (such as Microsoft with Office), or where there are but a few solutions, the EHR field is one of byzantine complexity. There are dozens of different software packages and competing products. In this article, we’ll look at the state of the EHR field, along with some of the benefits and problems associated with their use.
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