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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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Are Physicians Really Dissatisfied With EHRs? Should We Be Concerned?

Are Physicians Really Dissatisfied With EHRs? Should We Be Concerned? | EHR and Health IT Consulting | Scoop.it

Microsoft Office was first introduced by Bill Gates at COMDEX, Las Vegas, in August, 1988.


Here we are almost exactly 27 years later, and if you plug the words ‘hate,’ ‘Microsoft’ and ‘Office’ into Google, you’ll get more than 4 million results. Remove ‘Office’ and Google returns more than 33 million results.


Clearly, some people don’t feel like Microsoft has perfected products to their satisfaction.


The perpetual unhappiness with a monolith like Office comes to mind as I read reports on the most recent surveys of physician satisfaction with electronic health records (EHRs). Let’s sum up, for those unfamiliar with the reports


First, reporting on survey data from last year, the American Medical Association (AMA) and American EHR, a division of the American College of Physicians (ACP), recently published “Physician Use of EHR Systems 2014.” Among other findings, the reports includes these nuggets:


  • 42 percent thought their EHR’s ability to improve efficiency was difficult or very difficult.
  • 72 percent thought their EHR’s ability to decrease workload was difficult or very difficult.
  • 54 percent found their EHR increased their total operating costs.
  • 43 percent said they had yet to overcome the productivity challenges related to their EHR.


Contrast those figures and levels of satisfaction with a survey of large physician practices released last week by market research firm Black Book that shows significant increases in physician EHR satisfaction. In particular, physician experience satisfaction has risen from 8 percent to 67 percent in the last three years. Physician documentation satisfaction went from 10 percent to 63 percent over the same time period, while practice productivity enhancement satisfaction has gone from 7 percent to 68 percent.


Worth nothing is that, with the AMA/ACP surveys, “Each society was allowed to select the population of their members to receive the survey. Information about EHR use by individual society members was not available. Therefore, the survey went to both users and non-users of EHRs.”


Also important: A similar ACP survey from five years ago showed significantly higher levels of satisfaction among the physicians surveyed.


The cognitive dissonance over EHRs continues, giving rise to theories on the Interwebs about the actual source of this disconnect.


At Healthcare IT News, contributing writer Jack McCarthy wonders if the constraints of Meaningful Use are antagonizing doctors, or if increased expectations and more sophisticated technology that fails to improve the daily challenge of patient care (in effect, a mashup of the two ideas) is creating dissatisfaction.


“Now, however, we have a lot more users who were forced to adopt EHRs meaning their tolerance for poor performance or usability will be lower,” notes health IT expert Shahid Shah in the article’s very interesting comments section. “I think it’s pretty easy to see why clinicians are less satisfied — if it was their choice they would be more tolerant. Since it’s not their choice in many cases, they’re less tolerant.”

Adds O’Reilly Media editor Andy Oram: “They [doctors] could be more familiar with the advantages computers offer in other areas of life … In short, having seen what a good interface can do, doctors become more demanding of the sub-par interfaces on EHRs.”


Expanding on the ‘why’ question, Michelle Ronan Noteboom (formerly ‘Inga’ of HIStalk fame) offers similar theories—MU forces doctors to use EHRs a certain way, compared to Facebook and Amazon most EHRs are clunkers, EHRs don’t deliver the ROI they promised—for the ACP survey results and asks if we should care whether or not physicians are happy.


“I’m of the opinion that physician satisfaction matters, but not nearly as much as improving the quality of patient care,” she writes at Healthcare IT News. “Patient care will be enhanced when all providers have access to thorough and accurate documentation. Ideally the patient records from one provider will integrate with records from other providers to create a single longitudinal record that is easy to decipher and provides a full picture of the patient’s health history.”


That sounds like a worthwhile goal. And Noteboom also has an explanation for the ACP survey results, pointing out “a direct correlation between physician satisfaction and the number of years a physician used his/her EHR. For example, among physicians on their system for three years or less, only 25 percent reported any level of satisfaction; satisfaction jumped to 50 percent among physicians that had used their EHR for five or more years.”


Sure, the differences between the two cited surveys could be attributed to methodology. But we know too much about how EHRs are influencing clinical culture to leave it at that. Physicians are human and subject to the same impulses—resentment when forced to do something; envy and confusion when seeing technology function well in other contexts; fear and consternation when learning something new—we probably faced when Microsoft started to become a rather sizeable part of our lives.


And, let’s recall, we’re really not that far into the ongoing transformation of American health care. Only now are we on the leading edge of value-based care as a replacement for fee for service. As EHRs evolve to improve quality, increase revenue, ensure patient safety, etc., instead of just meeting the contrived requirements of Meaningful Use, they will become the essential tools we envisioned at the beginning of this long and complex dance.


So it’s encouraging when both surveys show that physicians who’ve had their system for a while are happier with it. Indeed, while we continue to ask the specific question, “Are you happy with your EHR?”, maybe we don’t consider often enough the general frustration of digitizing processes that were once manual.


Also, it appears that plenty of hospital and health system administrators didn’t get the memo about creating buy-in before selecting and implementing an EHR. As David Whiles, former CIO at Midland Memorial Hospital said of their EHR journey, “Implementing an EHR is definitely an organizational project, not an IT project.”


And even though we are dealing with computers, this isn’t a binary choice of EHRs OR physician satisfaction. No one thinks computers are going anywhere, even if the Meaningful Use program ends. And physician satisfaction, to a reasonable extent, must be a high-level consideration for all clinical organizations. Over time, EHRs will improve and doctors will become more satisfied with them, perhaps will even depend on them, as essential clinical tools.


In the meantime, plug ‘hate’ and ‘EHRs’ into Google from time to time and see what you get. When we get over 30 million results, we’ll know we finally achieved Microsoft-ian levels of influence.

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New Medical Tech Not Hard to Swallow, Just to Implement

New Medical Tech Not Hard to Swallow, Just to Implement | EHR and Health IT Consulting | Scoop.it

The "always on" smartphone world of today matched with personal digital diagnostic technologies in development by the likes of Microsoft, Apple, Google, and other digital powerhouses promise to revolutionize chronic disease management and empower population health to stratospheric levels.

The development initiatives using data created and transmitted via smartphones using wearable, clothing embedded, ingestible, and other personal sensors are limited more by imagination than technology.

Just one little problem: The ability to convert another tsunami of new patient data into usable and actionable information for physicians using existing EHR technology is more than a decade in the rearview. The existing system platforms are static warehouses, not digital highways.

Further, each EHR's warehouse is an island unto itself because it uses a different layout, nomenclature, and even language designed to make changing to a competitor as difficult as possible by making data migration to a new system an expensive and daunting process. Until Congress stepped in, exorbitant ransoms imposed by some EHR companies to translate the data into the standard language are effectively bad memories.

The Wall of Interoperability

Still, federal law, which prescribes that all EHR data is to be contained in a standard format called a CCDA (Consolidated Clinical Document Architecture, if you must know), to be certified. The law, however, has more loopholes than grandma's knitting.

That makes the new healthcare information highways, population health, and similar programs that convert EHR warehoused data into usable information for physicians and other healthcare providers (among a host of other enabling and time-saving features), the ultimate solution hobbled by that EHR industry manufactured wall to data called "interoperability."

Circumventing EHR companies by automating removal of the CCDAs out of EHR systems has been solved by a very clever few, as has even making them interactive, but it comes at a cost because each version of each EHR has to be done separately.

To achieve a single-keystroke model (inputting data only one time), which is not only desirable but the only way to get people to use it, tons of EHR data has to be machine translated into a common language, delimited, mapped, parsed, validated, and, finally, populated into a common platform so that it can be made into something useful for providers. Every day. That takes lots of time, money, and skill, which can be undone by EHR companies at will every time they issue an upgrade, new version, or even a simple update — and expensively redone.

In return, providers get useful, time-saving tools that can allow them to do much more in much less time, which is the key to a reasonable quality of life for physicians.

That makes effective population health, let alone enhancing it by new wireless, personal smartphone app-enabled diagnostics, equivalent to baking a cake by having to get and process the raw ingredients from farmers and dairies instead of a cake mix from the supermarket.

The obvious solution, of course, is to pull the data directly into the information manufacturers' systems, circumventing the EHR warehouses, which will be hoisted by their own petard in the open ocean without a paddle because information systems cannot be EHR-specific to be effective.

In the end, there is a bright future for developers, physicians, healthcare providers and, especially, patients.

EHR companies? They took a different road. The survivors will join the program, and the time to do so is so very close.


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Do We Need Patient Relationship Management (PRM) Systems? | The Health Care Blog

Do We Need Patient Relationship Management (PRM) Systems? | The Health Care Blog | EHR and Health IT Consulting | Scoop.it
As a primary care doctor in San Francisco and Silicon Valley, I have been searching for the holy grail of patient engagement for over 15 years. My journey began with alpha-numeric pager and a medical degree. I shared my pager number with my patients along with a pledge to call them back within 15-minutes, 24-hours a day. My communications evolved into email and texting, with the predicate that by enhancing communication, I could carefully guide my patients down the byzantine corridors of healthcare – with a high probability we could avoid mistakes – if they would agree to share the ownership of their treatment plan. My life’s work has been where the rubber meets the road; where doctors interface with patients: office, hospital, home or smartphone.

Technology has washed over almost every industry and transformed it, radically. Healthcare is on the precipice of destiny. The wave is here.

Over the past three decades healthcare has lurched from one existential crisis to another; often manifested by an acronym solution: HMO, ACO, PCMH, P4P, PQRS; each a valiant attempt to reign in costs and solve for aligning incentives. However, we can’t have hospitals, doctors, health systems and payers accountable to healthy outcomes if the 300,000,000 people (patients) are not paramount to the equation.

If you haven’t been paying close attention, ‘patient engagement’ is a white-hot topic in healthcare these days. It wasn’t sexy 5 years ago. In fact, at the keynote speech at HIMSS 13 (the national Health IT conference), it was announced that the “The blockbuster drug of the 21st century is Patient Engagement”.

While the mantra is strong, the industry seems to conflate “patient engagement” with “consumer engagement”, which in my view are two distinctly different propositions. Consumer engagement is predicated on the fact that there is choice, a free market and low barriers. As consumers, we can swing by the Apple Store and pick-up a Jawbone bracelet to monitor our exercise activity and sleep patterns, perform an in-home ECG screening with AliveCor’s iPhone Heart Monitor, or self-assess symptoms and find an appropriate doctor using the BetterDoctor service..

These products represent the innovative eye-candy that dominates the headlines, but I’m here to tell you that none of them are the killer app for patient engagement. They are all important pieces of the puzzle but the kernel of transformation lies in tapping into one of the most under-valued assets in health care, the doctor-patient relationship. Consumers, who strap on monitoring devices and crawl the web for solutions without the guidance of a doctor, are heading down a path towards anxiety – and likely more questionable consumption of healthcare resources. The always available Dr. Google enables anyone to self-diagnose, but what consumers don’t realize is that Dr. Google is an oncologist that often lists cancer as one of the possibilities….more anxiety.

Patients engaging with themselves are a noble aim, for sure, however coupling a patient to their doctor throughout their healthcare journey is simple, elegant, and necessary: essentially we need a Clinical CRM (or PRM – Patient Relationship Management). On the surface this may seem like an improbable proposition, as many doctors are already suffering from Chronic EMR Fatigue Syndrome, overloaded schedules and diminishing payments. They don’t want yet another solution.

Taking human physiology as a metaphor for complex systems (in the spirit of biomimicry), excess sugar in our food supply causes metabolic syndrome and ultimately diabetes – which extracts a huge drag on the body in terms of aging and pathologic opportunities. Our healthcare system is no different; excess technology and proprietary solutions have caused a digital opacity syndrome and ultimately a health care system of balkanized cash vacuums, people suffering unnecessarily and finger pointing. Healthcare is the diabetes of our GDP.

When technology understands what people want from healthcare, our system has a chance. This is not about what the system wants for itself and it’s not about what ‘consumers’ want for themselves; it’s what makes the most sense to achieve the ultimate outcome: a healthy population at the most efficient cost.

We need a new angle, a new dimension, something simple and human that provides demonstrable value; both in the short term and the long run. The good news is that we’re at a once-in-a-generation moment in time where great change is upon us….and where there is great change, there is great opportunity.

We need a new Healthcare Operating System; one that enables shared ownership between all parties and where innovative ideas fit together like Legos.

The four walls of medicine and the millions of telephones that occupy the space between doctors and patients must evolve.

It has failed to scale. Grab the eraser and let’s start all over. Please.

I have a few ideas…perhaps the next blockbuster drug of the 21st century is Physician Engagement…(wait, what?). Yep, if we do not get physicians involved and engaged in a new model and we try to commoditize them, we will have failed to appreciate the important role they play. There is plenty of talk about “the algorithm will see you now”. Meh.

People have always lived in tribes and relied on other people for help; physicians are people, too. While we (and I believe I speak for many physician) are as frustrated as patients about the oligopolistic and opaque healthcare system, we really just want to help people…and we need technology to work with us, not around us.

Jordan Shlain is a physician in San Francisco and a founder of HealthLoop.
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Google Glass links to EHR

Google Glass links to EHR | EHR and Health IT Consulting | Scoop.it

Look, Ma, no hands! EHR company drchrono is incorporating Google Glass in its platform. The idea is to create the first wearable health record -- one that is always mobile. Drchrono offers its EHR free on the iPad, iPhone and cloud. Adding Google Glass to its platform would enable physicians to work hands-free, its officials say.
 
"The iPad was a new consumption device that changed the world, and now we are seeing that doctors want to use more and more hands-free technology,” drchrono CEO and Co-Founder Michael Nusimow said, in a news release. "Glass is one of the first of its kind to do this. A physician wants to practice medicine and not be burdened with all of the paperwork that goes on in the practice. We knew this would be an important app to integrate into our EHR platform, and we're excited to now offer this to doctors using drchrono."


Nusimow imagines a future where the doctor has an iPad, iPhone, laptop and Glass all connected through a mobile EHR platform so they can operate efficiently and spend more one-on-one time with patients instead of processing paperwork.

Some use-case scenarios from drchrono:


  • Taking pictures in any setting by just saying, "OK, Glass, take a picture," e.g. during surgery a doctor can take a picture that will be pulled into the patient's medical record without his having to touch anything that could get his hands infected;  
  • Recording videos of patient encounters or medical surgeries to document, so that medical staff and scribes can code in asynchronous time offline, and view the video to add codes after the encounter;
  • Real-time data streaming of patient encounters so that doctors can have other physicians, patients' family members, or scribes watching anywhere in the world while the physician can focus on the patient 100 percent;
  • Flipping through patient profiles on the heads-up display -- with the tap of a finger, physicians can quickly preview a list of all of the patients they are seeing for the day;
  • Getting real-time notifications about who has come into the office with alerts about patients coming in or needing help;
  • Reviewing medical data about patients hands free.


"This is a game-changing device," Bill Metaxas, DPM, who recently started using drchrono and Glass in his San Francisco practice, said in a press statement. "I am amazed at how well drchrono and Glass help the documentation process during patient encounters. It's a big time saver. I can see Glass becoming an integral part of the norm in a physician's workflow."

Drchrono is also expanding its platform integration with Box by enabling medical data captured with Glass to be available on Box's cloud content platform. 


"Doctors want better workflow for capturing clinical documentation," Missy Krasner, managing director of healthcare and life Sciences at Box, said in a statement. "Glass provides faster alternatives to standard data collection and capture. By partnering with Box, drchrono can broaden its data-sharing options by allowing relevant medical content to be securely shared with patients, family members and other providers involved in patient care."


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Moolahonly's curator insight, April 28, 2015 2:32 PM

These are the types of wearable devices we would like help get funding on our crowdfunding platform www.moolahonly.com

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Google on board for DoD contract bid

Google on board for DoD contract bid | EHR and Health IT Consulting | Scoop.it

Google is a key contender – part of the PwC team – bidding on the massive 10-year federal contract to build an electronic health record system for the Department of Defense. PwC announced the collaboration with Google Thursday.

Google had been part of the team from the start, Dan Garrett, PwC's health IT leader, told Healthcare IT News.

"They were part of our submission in our original proposal," he said. "Since the proposal, we've also cemented a broader relationship between the two firms. And, we thought it was appropriate now to make the rest of the world aware of the submission that we had made."

"Google provides us with another whole layer of options from an infrastructure perspective." Garrett said. "You have everything from work management, storage, search engines, security, cloud – a whole level of infrastructure that we can pick from as the industry changes and innovation continues to come into the space."

Besides Google, the main players on the PwC team include General Dynamics Information Technology, DSS Inc. and Medsphere, whose commercial OpenVista EHR, an open source offering, was derived from the VistA-EHR, built by the Department of Veterans Affairs.

The other three teams that submitted bids are:

  • IBM and Epic
  • Computer Sciences Corp., partnered with HP and Allscripts
  • Cerner, Leidos, Accenture Federal and Intermountain Healthcare

Formally named the Department of Defense Healthcare Management Systems Modernization Electronic Health Record contract – DHMSM, for short, the DoD award could pay as much as $11.3 billion over 10 years. DoD is expected to award the contact this June.

As the clock ticks toward the anticipated verdict, the contenders have released more information on their bids. Epic, typically silent about any of its doings, last week joined its partner, IBM, to reveal it had assembled a team of advisors from some of the most recognizable health system names in healthcare, among them Kaiser Permanente and Partners HealthCare.


The PwC proposal is called the Defense Operational Readiness Health System. Garrett refers to it as DORHS.

PwC's interest in Google is not limited to the DoD contract. PWC and Google also recently forged a business relationship in which they will team up to help companies use the cloud and build trust in it.

“Google is known for its expertise in innovative, secure and open technologies, and the power of Internet scale, Scott McIntyre, PwC’s clobal and U.S. public sector leader, said in a statement. “Google can assist us in delivering a cost-effective and efficient solution to serve the healthcare needs of our military.”

“Our solution is engineered to provide flexibility, cost effectiveness and a platform that will stand the test of time, and does not rely on unproven technologies or proprietary computing platforms,” said Garrett. "Consistent quality is what we were looking for, true open systems, true interoperability and true open source systems."

DORHS’ flexibility, he added, would  help prevent the federal government from being locked into a single technology, avoiding “vendor lock” and “innovation lag” which can occur with proprietary EHR and technology companies.

"Google is a great example of how we're going to prevent that," Garrett said. "With Google on our team, the DoD will be able to tap in to the latest and greatest infrastructure innovation for the duration of those 10 years,."

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5 things EMRs should learn from social media

5 things EMRs should learn from social media | EHR and Health IT Consulting | Scoop.it

1. Likes. Health care providers should be able to “vote up” an excellent note in the medical record. Let’s face it, not all doctors are equally good at documentation. Untold hours of our time are spent trying to cull through pages of auto-populated, drop-down-box checks to figure out what’s actually going on with a patient on a particular day. Once in a while you stumble upon some comprehensive free text that a physician took the time to type after a previous encounter, and suddenly everything becomes clear. If there were a way to flag or “like” such documents, it would help other readers orient themselves more quickly to a patient’s history. A “liking” system is desperately needed in EMRs and would be a valuable time saver, as well as encouragement to physicians who document notes well. Hospitals could reward their best note makers with public recognition or small monetary bonuses.

2. #Hashtags. Tagging systems are sorely lacking in medical records systems, which makes them very difficult to search. Patients make multiple visits for various complaints, often with numerous providers involved. If physicians had the ability to review notes/records unique to the complaint that they are addressing, it would save a lot of time. Notes could be tagged with keywords selected by the author and permanently recorded in the EMR. This would substantially improve future search efforts. Even if the EMR generated 10 search terms (based on the note) and then asked the physician to choose the 3 most relevant to the current encounter, that would be a step in the right direction.

3. Selfies. Medical records would benefit from patient-identifier photographs. In a busy day where 20 to 30 patients are treated and EMR notes are updated after the patients have gone home, a small patient photograph that appears on each documentation page will serve the physician well in keeping details straight. Patients should be able to upload their favorite portrait to the EMR if the standard one (perhaps taken during the intake process) is not acceptable to them. In my experience, nothing brings back physical exam and history details better than a photograph of the patient.

4. Contextual links. All EMRs should provide links to the latest medical literature (on subjects specifically related to the patient’s current diseases and conditions) in a module on the progress note page. UpToDate.com and other reference guides could easily supply the right content (perhaps based on diagnosis codes). This will help physicians practice evidence-based medicine and keep current with changes in recommended treatment practices.

5. Microblogging. Sometimes there are important “notes to self” that a physician would like to make but don’t need to be part of the official medical record. EMRs should provide a free-text module (like a digital sticky note) for such purposes. These sticky notes should not be admissible in court as part of the medical record, and should not be uploaded to the cloud. Content included in these notes could include social information (patient’s daughter just had a healthy baby girl), hunches (patient looks slightly pale today — will check H&H next time if no change), and preliminary information (remember to review radiology result before calling patient next Tuesday).

It is my hope that EMRs will slowly adopt some best practices from top social media platforms. After all, if millions of users are effectively using voting, tagging, linking, searching and imaging in their daily online lives, it only makes sense to capitalize on these behaviors within the constraints of the medical environment. Maintaining strict confidentiality and appropriate professional boundaries (often missing in the social media world at large) is certainly possible with EMRs. Let’s build a better information capture and retrieval process for the sake of our patients, and our sanity.



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