To be clear, I’m not phobic when it comes to social media – I have an online profile myself with Facebook and Twitter.  I just think online socialites need to think things through and have a bit of a filter – especially if you’re a healthcare professional. 

Imagine that there was a technology that would allow the entire world access to what you think, see, and feel, but only when you let the world in.  Wouldn’t you want to maybe clean up your act a bit – at least when the door to the world was open?  I would. 

Amazingly, the technology exists, yet many refuse to acknowledge its power to crush even the most sturdy of reputations when used carelessly.  The technology is called Facebook, Twitter, LinkedIn, and every other social media platform out there, and its right there for the taking – to either make or break you regardless of your economic status or social circle.

By all means, connect with friends online – connect with strangers.  Just know that anyone may be watching, including your employers, patients and community.

Here’s a good article from HealthLeadersMedia.com on some of the issues that can accompany social media use by hospital employees.

Social networking Web sites and modern communication media, such as text messaging, e-mail, and smartphones, are a part of our daily lives. Although such technologies have a place in society, they are taking a toll on the professional image of tomorrow’s physicians.

In fact, 60% of medical schools that responded to a recent survey reported incidents of students posting unprofessional content online, according to a study published this month in the Journal of the American Medical Association. Medical schools also reported finding frequent references to intoxication (39%) and sexually suggestive material (38%).

Medical students are not the only Gen Xers or Yers divulging too much information online. A 2008 study in the Journal of General Internal Medicine found that residents are also posting information that they may not have otherwise shared with patients.

This is a huge HIPAA violation, and should serve as a reminder to make sure procedures are in place to verify and cross-check fax numbers and all other addressed material for all patient-related communications.

“This is a total breach of privacy,” Keith said. “This is supposed to be confidential, and it just so happens we have some scruples here and wouldn’t do anything with that information. We’ve shredded them, but you can have a file an inch thick in no time.”

via Doctors mistakenly fax patients’ data to Indiana company | The Tennessean.

A blog can be a powerful way to get a hospital’s message out to the public, says Mark Whitman, vice president of digital marketing at Ohio-based brand consulting firm Northlich. “A big advantage of blogs is that information can be shared quickly among all stakeholders,” he says. “Quick response and sharing of information can help stop misinformation and rumors that can be very damaging during times of crisis.”

via Hospital Blogs Can Help During Times of Controversy | www.healthleadersmedia.com

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.

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.

_________________

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.

I have a dirty secret. I’ve never cleaned my computer. Sure, I’ve dusted my monitor, but I haven’t taken off the cover or tried to reach the crumbs lurking inside my keyboard.

“Your computer could fry if you don’t keep it clean,” says Jonathon Millman, chief technology officer for Hooplah Interactive.

Dust clogs the vents behind your computer, which causes your CPU to heat up-and heat is the biggest cause of component failure in computers. Regular cleaning could save you costly maintenance fees down the road.

Keep your computer in tip-top shape by following Millman’s guide to a spotless computer system.

 _________________

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.

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.

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.

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.