Credit cards have been around for a long time.  They’re easy to carry, pack a lot of information, and allow you to complete transactions quickly when at a supermarket, bank, or restaurant.  It makes a whole lot of sense, which is why just about all adults (and some children) have more than one.

And what about the kiosks that are now present at most airline ticket counters?  I’d be hard pressed to count the number of times I’ve been “trained” in the last year by ticketing agents on how to use the kiosk to speed up my check in time.  The kiosks work (most of the time) and I actually like the convenience of anonymously speeding through the terminal without having to talk to the ticketing agent.

So why not in healthcare?  I mean, credit cards and kiosks probably aren’t for everyone, but I bet they would work for a lot of people, especially when you’re trying to speed up the amount of time you spend in a place like a hospital or medical clinic.  Imagine a small credit card that stored all of your insurance and general information, and allowed you to check in by simply sliding it through a terminal - no clipboards, no rotten strings holding slightly chewed pens, and no waiting in line twice (once to get the paperwork, an once to turn it in).

Probably has a ways to go, but I bet it’s where we’re all headed.  Check out this Indianapolis-based healthcare system that introduced it’s card and kiosk system this month in an effort to put it’s patients in more control of an efficient and error-free check in process.

The service, unveiled Wednesday, offers a variety of free tech tools to patients who sign up to receive a credit-card-sized “myCommunity” card. The service features express check-in kiosks (similar to those at airports) to be installed at Community North first, then throughout the system eventually. Patients will swipe their myCommunity cards and use touch screens to complete the inpatient and outpatient check-in process.

“It involves the way people are going to interact with health care in the future,” said Daniel Rench, vice president of e-business for Community Health Network, which operates five hospitals and numerous other health facilities in Central Indiana.

If the “it” is e-medicine, and the “they” refers to patients, the “build it and they will come” strategy doesn’t necessarily apply - not without a bit of work, that is.

Readers of this blog will know that we support efforts to challenge normative business models in the practice of healthcare, including those that incorporate the use of the Internet to communicate and interact with patients (here are some posts about Jay Parkinson and the use of e-communication in medicine).  We don’t know exactly what the practice of healthcare is going to look like in 20 years, but the Internet will definitely play an increasingly important role in the future - and we will be there to greet it.

Many of the healthcare providers that are using the Internet to provide care to patients today will someday be acknowledged as pioneers that helped to shape the evolution of the industry, regardless of whether or not their efforts were immediately successful in today’s healthcare economy.  One of these pioneers, Dr. Ben Brewer, has developed a savvy and secure electronic interface for patients of his Illinois medical practice - one that helps define “cutting edge” e-medicine in today’s largely status quo healthcare economy. 

The problem is - patients aren’t interested.  It’s a common problem in business, where great products in the absence of interested markets do vastly worse than decent products in ripe markets.  Dr. Brewer likely has a great service, but if patients aren’t interested in (more likely, not ready for) it, it’s not going to sell, and the doors will have to close if changes aren’t made.

The key to selling “cutting edge” services, especially in healthcare, is to make sure a market exists that will demand the service, and if no market exists, create the market yourself through a combination of customer education and market hype.  This takes a lot of work to do, and though it may be too late to pay off for Dr. Brewer, there will likely be no shortage of opportunity to introduce cutting edge services into the healthcare market in the coming years.

The Wall Street Jounal’s Health Blog recently commented on the fate of Dr. Brewer’s practice:

Brewer counts himself among the minority of doctors willing to take the online plunge. “Most doctors I know seem unwilling or unable to make even email part of the way they practice medicine,” he writes. Legal worries and data overload are the deterrents.

At Brewer’s office the technical end works as promised, but patients don’t really seem interested. They don’t want to pay the (usually unreimbursed) $30 for the online visit with Brewer, and they’d rather just send a regular email, even though it’s vulnerable to snooping.

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.

On April 23rd I wrote about the benefits of using email in physician-patient communication, and how trends in this area are inevitably going to change the standards of communication in years to come.  I’ve also written about Dr. Jay Parkinson and the company, Myca, who are pushing the use of technology to improve the efficiency and cost effectiveness of the physician-patient relationship through the use of instant messaging, video-conferencing and email.

Email and other efficient modes of communication are undoubtedly in our near future as healthcare providers.  Now if we could just get the payers to notice…

Well, it looks like they are starting to notice.  As part of the medical home model, Capital District Physicians’ Health Plan is entering a 2 year pilot program which will, among other things, pay physicians for using communications such as email to improve the efficiency of interaction with patients.  This article from Times Union explains.

Currently, doctors are paid only for face-to-face visits. There’s little incentive for busy doctors to explore other types of interactions, said Bruce Nash, chief medical officer and senior vice president of medical affairs at CDPHP.

“The rest of the world’s used e-mail for a decade,” he said. “It’s been limited to a physician, because it hasn’t been paid for.”

It appears that physicians entering the work force these days are looking for more than good pay and desirable working conditions.  They want a good work-life balance, too.  At least they do in Canada, anyway.

A 2007 National Physician Survey reported that 60 percent of medical students and 52 percent of residents felt that work-life balance will be the most important factor for them when choosing their professional landing spot following school.

This is viewed as a good thing by Shaheed Merani, president of the Canadian Federation of Medical Students, as it holds the potential to make for the delivery of improved care by more well-balanced physicians.  This article from CTV explains how changing the physician culture and the use of technology may play an important role in achieving this desired balance.

“I think the medical students, the medical residents and doctors alike will tell you that a good life-work balance is important in not only maintaining a healthy family, maintaining a healthy physical ability and maintaining a healthy mind, but it’s also important in the work you do and the quality of care you deliver to patients,” Shaheed Merani, president of the Canadian Federation of Medical Students, told CTV’s Canada AM on Monday.

“So I think that the focus that medical students and residents are taking towards their own work-life balance is very important and will result in better care offered to patients across Canada.”

For many of us, email has become a primary means of building relationships, conducting business, and keeping in touch.  It is very effective in doing so, and while it isn’t a full replacement for phone and face-to-face interaction, it does provide a very efficient means by which to communicate.

In business, email has another important benefit; it provides a document trail that can be used to record activity and conversation, creating a transcript of all that is said (and not said) via electronic format.  Along with other benefits, the efficiency of use and ability to document in real time provides some obvious appeal to those who communicate with clients on a regular basis.

Enter physicians, dentists, physical therapists, and other healthcare providers that interact with clients (i.e., patients) on a daily basis.  While drawbacks exist in the use of email as a means of communicating with patients, we are finding that patients like it and doctors are on the verge of getting reimbursed for it; both important drivers for the regular use of email in the near term.  There will be many pitfalls to avoid for the physician and patient alike, but we will soon be seeing more and more use of email between provider and patients in the years to come.

This article in Modern Medicine explains in detail the key benefits associated with the use of email between physicians and patients, and speaks to the trends that are currently underway in this important area of medical practice.

If you haven’t yet begun using e-mail to communicate with patients, there are plenty of reasons to start. First is the increasingly loud patient clamor for e-mail, as indicated in one survey after another. The latest is a Harris Interactive/Wall Street Journal poll in which three out of four respondents said they should be able to schedule medical appointments via e-mail or the Internet, and e-mail their doctors as part of their overall medical care—at no extra charge.

Ironically, that proviso is precisely what has discouraged many time-pressed doctors from giving their patients e-mail access. But as patient demand rises, the “no extra charge” barrier is slowly but surely coming down.

Late last year, Aetna and Cigna HealthCare announced that they would dramatically expand programs that reimburse physicians for “virtual visits.” Until recently, only a handful of health plans paid doctors for this service, and the news has sparked speculation that other insurers will soon follow. Not surprisingly, the number of physicians who communicate with patients electronically is also on the rise—going from 19 percent in 2003 to 31 percent in 2007, according to a Manhattan Research survey of more than 1,300 doctors. Among physicians who did not yet use a secure online messaging service, one in four said they intended to start in the next 12 months.

I’ve been reading more in the press about the use of remote technologies used by physicians to communicate and monitor patients.  The technology exists, so using it for this purpose makes perfect sense.  I’ve even learned of some companies building this type of technology into their core business models which I believe to be a very exciting development in medical care (more on that in a future post).

In this post from Peter Lucash at the Medical Practice Business Blog, Peter reports on the use of wireless networks and video communication for just this purpose, and draws a very good parallel to the introduction of a now standard piece of office technology to the development of improved communications between physicians and patients in the 1990’s: the fax machine.

Wireless networks have the ability to carry voice, data and video. The latter becomes particularly interesting when we realize that a camera can be brought to the patient, regardless of where they are. This very portability is what makes this technology so powerful. In rural parts of Japan, nurse practitioners are using cell phones to transmit fetal monitor tracings to Ob’s at the nearest hospital (in one case, 200 miles away) for review and guidance before moving a patient several hours. AT&T offers a service dubbed “AT&T Video Share” where users can take and send live video from their mobile device – allowing another mobile phone user to see exactly what they are seeing.

This is where we’re headed.  A medical malpractice insurer in Oregon is now providing physicians with discounts for using electronic tools that will reduce errors and thus the opportunity for malpractice. 

You’ve heard of the tools before: computerized health records and e-mail.

As these tools are shown to effectively reduce errors and improve overall efficiency within the healthcare system, we’re going to see more and more insurers (both malpractice and 3rd party payers) providing incentives to use them.

Under the new program, 2,600 physicians insured by the company will receive patient safety discount points for connecting online with their patients using an online service called iHealth, which includes a practice Web site for physicians and secure e-mail and patient personal health records for patients. The service also includes safety messages for patients, including same-day patient notification if their medicines are subject to FDA recall or warnings.

“We are seeing increased market demand for these types of online services and we want to help our insured physicians adopt and use these tools to better and more efficiently connect with patients,” said Dieter Zimmer, vice president for patient safety and practice support for Northwest Physicians.

On March 13th I posted about the use of the iPhone for e-prescribing.  Here is a great commentary on the benefits of e-prescribing from the perspective of a physician CIO at CareGroup Health System and Harvard Medical School.  Seems that the benefits are real, resulting in a significant impact on the bottom line for medical groups and hospitals.

Time and Resource Impact:
1. Prior to full implementation of e-prescribing, Medical Assistant call-in of prescriptions averaged 350 prescriptions per day. We’ve reduced this to 80/day and we’ll further reduce this to 30/day by next month when all residents go live with e-Prescribing.

2. Each call-in averages 4 minutes per prescription and this equals 23 hours or 3 FTE worth of work per day, approximately $96,000.00 of salary. This has been reduced to 0.66 FTE of Medical Assistant work per day or $21,000.00 salary.

3. The Medical Assistant staff are now available to more consistently perform the core work required to support the patients, providers, and practice. In the past, the lack of control over the daily volume of prescriptions resulted in unpredictable exam room support.

4. We experienced significant improvement in efficiency and patient satisfaction in the time for prescriptions to reach the pharmacy. With e-prescribing, prescriptions travel quickly to pharmacies versus up to 2 days for the rx to be called to the pharmacy.

5. We have also seen a decrease in medication errors, in terms of wrong patient, wrong medication, wrong dose since e-prescribing has decreased the potential for “communication errors”

6. We are able to track prescriptions more efficiently. With the paper call-in system, rxs were being called in by many people. Now we can look in our EMR and quickly determine where a prescription is in the process (i.e. in queue, transmitted successfully, transmission failed, etc)

From today’s CNN.com: “Stolen Laptop Contains Personal Info of 2,500 Patients.”  What’s more…this was a government laptop and there the data was not encrypted.

Laptops get stolen, so if they’re being used in patient care they MUST NOT store accessible PHI.  Here are a few ways to address this:

1. Don’t store PHI on laptops.  This is the absolute best way to prevent the loss of patient data if a laptop is stolen.  To do this, use a web-based software backbone for management of patient records.  The actual patient information is always stored in a secure location (usually in multiple secure locations) behind lock and key that dwarfs any security possible on a mobile computer.
2. Encrypt the PHI on the laptop.  Use medical record software that encrypts PHI so that it is not in a usable form unless proper passwords and authentication have been entered by the owner.  It is possible for this information to be hacked, but not as likely as leaving it wide open for the world to see.
3. Secure your data.  Use bios-level security that prevents entry to hard disk information without proper passwords and/or fingerprint authentication.  The same applies here…this prevents the novice from getting in to the information, but someone who really knows what they are doing may be able to gain access.

The best alternative is to keep all PHI off of mobile computers and away from any vulnerable software applications such as unsecured email, IM, or electronic files.

WASHINGTON (CNN) — A government laptop computer stolen last month held unencrypted medical records of 2,500 participants in a government study, Susan Shirin, deputy director of the National Heart, Lung and Blood Institute (NHLBI) told CNN Monday.

The incident prompted the NHLBI to issue a statement saying it would no longer store patient medical information on laptops.

The lack of encryption violated federal guidelines dating back to 2006. Shurin told CNN the stolen laptop “fell through the cracks” and should have been encrypted. A thorough review of other laptops containing sensitive information is under way, she said.

The computer was stolen on February 23 from the trunk of a senior employee’s car, Shurin said. It contained the names, birthdays, medical record numbers and diagnoses of patients who participated in a heart disease clinical trial study conducted by NHLBI from 2001 to 2007.