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.

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.

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.

For large healthcare organizations employing hundreds, if not thousands of staff, it is clear that there must be in place the ability to audit what staff see in regard to patient medical records.  In small private practices HIPAA requirements are the same, so shouldn’t the ability to audit the eyes of curious staff be the same?  Certainly.

Borrowing from the hype caused by the recent snooping of Britney Spears’ medical record by UCLA staff and physicians, this article from MedBlogger.net provides commentary on the audit trail capacity of EHR systems, and how it can deter and detect unauthorized entry into the medical record - regardless of practice size.

An EHR must be able to create an audit trail to comply with the security requirements of HIPAA. Accordingly, the Certification Commission for Healthcare Information Technology, or CCHIT, won’t certify an EHR unless it has this capability.

Audit trails play less of a security role in solo offices, where a handful of trusted employees eyeball virtually every record, notes Marlene Jones, vice president for group operations at the consulting firm PivotHealth in Brentwood, TN. However, as practices grow in size, says Jones, the need to police recreational record-reading increases.

Your patients may not include a headline-making entertainer, but it’s likely that you have some lower-level VIPs whose records might tempt a nosey employee—the mayor, a partner’s wife, or a high school football star. If you use an EHR, you can detect snooping by checking the audit trails of select records on a monthly or quarterly basis. Some EHRs even allow you to study the audit trail of a particular employee across multiple records, as opposed to zeroing in on a particular record.

I believe the most recent statistic I read regarding the number of medical clinics in the U.S. that have adopted EMR was between 30-40%.  Considering the push toward full adoption of EMR from government agencies and from third party payers with deadlines in the next 2-7 years, we have quite a ways to go in a short amount of time.

For the minority that have already converted to EMR, we can learn a lot from their stories - both positive, negative, and often a mix of both.  Here is a recent post from a physician that speaks to some of the ups and downs that she experienced during the process.  Ultimately, she feels that the positives outweigh the negatives; the outcome was worth the bumps and bruises along the way.

It’s been 21 months since I was forced to convert to an electronic medical record, and I have just now reached the point where I can say that the EMR has had a positive impact in my practice.

Converting to the EMR is not easy. This conversion is not like getting dunked in the river and seeing the light. It’s more like going through Dante’s Inferno. It’s taken me almost 2 years to ascend through the Circles of Hell and I am in Purgatory right now - things aren’t perfect, but I can see Paradise in the distance, and I’m glad I’m here.

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.

More often than not, a medical practice will hire the IT “guru” or “specialist” down the street to handle their information technology infrastructure, deployment and ongoing maintenance.  In addition, they may rely on this person to help make decisions for a new electronic medical records system or a clinically-related piece of electronic hardware.  What often is missing in these processes is the person (or group) that has knowledge of efficient, integrated IT systems AND understands provider needs, medical practice workflow issues, cost-effective purchasing, cash flow analysis and long-term business strategies.  These things are all tied together and should be handled as such in the decision making processes - whether it be to purchase all new workstations for the clinic or to roll out an entirely new electronic medical records system.  This is where the decision to hire an IT consultant with medical facility experience can make all the difference.  Yes, this person may be more expensive than the IT “guru” down the street, but wouldn’t you be willing to pay $10,000 more now to save $50,000+ in the years to come.

Just as a layperson is impressed by someone introduced as “Dr. Jones”, who may be anything from a neurosurgeon to a chiropractor to an economist, an “IT specialist” may be a high-school graduate (if that) who has decided to hang his computer shingle out for business. And don’t rely on someone with no technical training who is considered “computer-savvy” by friends or colleagues.

In his article, Peter Polack lists some additional thoughts for consideration in finding the right IT consultant.

The iPhone is a great invention.  My brother-in-law, Preston was one of the earliest adopters of the device, and I spent most of my Thanksgiving and Christmas holiday draining his iPhone battery while watching YouTube videos.  I have a Treo 700wx, and still prefer it to the iPhone in some ways (especially in regard to networking with our server), but the iPhone does have a huge advantage over other smartphones in that the internet really is the internet.  Not scaled back, just smaller and more mobile.

In this post from the Independent Urologist, we are introduced to a great use of the iPhone to improve the efficiency of private practice through mobile e-Prescribing.  I just love to see technology in action…

…I was in the OR today and forgot my Rx pads. I did several cases on patients, all of whom had different pharmacies and I had have to call in some scripts for them. Now with hold times and phone trees and formulary related call backs etc, calling in prescriptions to pharmacies can be a royal pain and not something that I relish. Instead, I asked to borrow my friend Mike’s i-Phone. With it, I logged onto my e-RX network, located my patients’ profiles, selected the meds and doses from drop down menus, selected their pharmacies, hit approve all and voila’, done.