EHR Bloggers

A few comments: Version control - Another thing t...

2010-03-09T15:00:16.845-08:00

A few comments:

Version control - Another thing that SaaS allows is for the host of the SaaS to be alerted in near-real-time for errors that happen. This allows for customer satisfaction. Think of this: you click on something, you get an error. That sucks. A minute later your phone rings or you get an email from the customer service folks at the SaaS who let you know that they know and they'll work on it. All software has bugs, but isn't it great to hear, pretty quickly, that the bug is acknowledged and understood and you shouldn't worry?

UI - People seem to compare SaaS to "native apps" in that SaaS can't compare to the responsiveness and feel of a regular app. This is true with poorly designed web-applications, but you CAN have great design elements on the web via AJAX/UI libraries (jquery), Adobe AIR or Flash. I think that "great" graphic designers tend to work more on the web than in traditional applications so a SaaS that understands that UI matters will spend on making sure that a UI is going to fit the clientelle.

Learning curve - As above with the UI, the right information architecture makes this easier and easier to do. Study how people click on things, eliminate clicks. Study the business-process people have and map your application to that. Even better, build your app in "pieces" so businesses can drag-drop the components into the workflow they desire. This makes the learning curve much more shallow.

SaaS also has advantages in that they tend to be centralized so that information sharing with people outside of your "network" becomes possible for a much lower cost than having to bind networks.

I couldn't agree with you more about remote and po...

2010-03-08T05:22:44.626-08:00

I couldn't agree with you more about remote and portal devices, especially if the much-hyped GE ultrasound works as well in person as in the commercials. My family knows from personal experience how much time/money/possibly lives such a device would save.

However, you bring up a question I'm not sure everyone agrees on the answer to: "Do we care that such innovations widen access disparities to the highest quality healthcare in our country?" I'd say the answer depends on whether you have medical insurance or not, and if you do, the answer is probably "No."

Alturism is usually only skin-deep. People are very willing to donate money to a TV special on Haiti at little cost or risk to themselves. Actually giving up something (even if it's only in appearances rather than substance) is a much tougher pill to swallow.

I can't agree more with your comments. Let the fed...

2010-03-07T13:45:32.694-08:00

I can't agree more with your comments. Let the federal government release as many open source services, gateways and adapters so everyone can plan in the EHR/HIE/NHIN sandbox. It still allows commercial and open source developers the opportunity to come up with great new web apps/services, middleware, etc.

This is in contrast to the smoke and mirrors that exists with many HIT/EHR vendors, in terms of price transparency. Open it up to good old American ingenuity!!!!

Bob

The thought that was profound to me was that there...

2010-03-05T20:15:11.703-08:00

The thought that was profound to me was that there was this undertone at the conference that the bigger your booth was the more substantial you are as a company and the more likely you will be around 5 years from now and therefore a good place to surrender your millions for legacy solutions. Oddly google's booth and yours were about the same size. It seems if you have the right business model you dont need such a booth.

meanwhile i like your comments.

How about the equivalent of a PHRMA Code for HIT? ...

2010-03-05T05:34:49.876-08:00

How about the equivalent of a PHRMA Code for HIT? No useless trinkets, federal reporting of meals, etc.

The concept of "certification with contingencies" ...

2010-03-04T12:09:59.435-08:00

The concept of "certification with contingencies" sounds like the best idea I've heard so far to help make HITECH more flexible, far less complicated or problematic than the ones I heard debated during both the HIT Standards and Policy Committee meetings last month. It would address a multitude of issues, including the one you raised about how to handle those who don't quite meet the bar set by the previous NPRM and IFR. I'd be interested in seeing this concept brought up at the Certification and Adoption Workgroup next Friday.

The post-market clearing house concept is interest...

2010-03-03T06:25:14.136-08:00

The post-market clearing house concept is interesting, and certainly would provide more information on overall medical safety. I wonder, though, how it would work legally, in terms of establishing "fault" for an accident. For example, could this information potentially be used in a malpractice suit that included both the provider and the vendor? Would that require the results to be "unanonymized?" While moving toward better patient safety should be the number one priority, these concerns will certainly need to be addressed for the medical field to support any comprehensive safety procedures.

The "load tested" requirement is an excellent one:...

2010-03-02T09:41:15.591-08:00

The "load tested" requirement is an excellent one: we've all expierenced problems with technology when the server's busy or heaven forbid, down. The difference with EHRs is that such down time could result in extremely harmful reactions, rather than just getting your email late (which, come to think of it, could also cause extremely harmful reactions, albeit of a different nature).

The danger in mandating usability is not that things will get worse, since I think most products on the market today could benefit from a usability overhall. It's in staying stuck with a model that won't adapt to new conditions. The best way might be to pattern usability after the improved coding rules the HIT Standards Committee talked about last week, with a base-level requirement the market could use to springboard into even better designs over time. Now that would be exciting.

Excellent post! You folks are definitely a talent...

2010-02-26T18:17:17.222-08:00

Excellent post!

You folks are definitely a talented group of people that have come together to improve healthcare through the use of technology!

The EHR Guy

Say, what hardware does Dr. Rowley's practice use?...

2010-02-22T05:37:56.767-08:00

Say, what hardware does Dr. Rowley's practice use?

Dragon Dictate is available for the iPhone OS, just need to plug a cheap microphone into a device that doesn't have it. As for running out of iPad battery power? If you're on the cloud, they're so cheap in comparison to the Intel MCA's that you simply pick up another unit and keep on going.

There are already a couple of EHR apps, Epic and Life Record, already running on the iPhone, so I wouldn't count the iPad out just yet.

I always think it's a little short-sighted to gues...

2010-02-22T04:39:42.660-08:00

I always think it's a little short-sighted to guess about any product this far in advance. Who REALLY knows what the final product will look like? Maybe it'll have a camera?

As far as the "must haves" that it doesn't:

Resistance to dust and liquids: how long before the ipods had resistant covers in all shapes and colors? 2 months after the product was released?

Medical Software: That's up to the software makers. Surely brower/cloud based software can write a native app that interacts well with their site with savvy use of authentication and structured data. Given that interfaces with EMRs have taken flak, maybe they need a gesture-based interface to really shine. And wouldn't that be a cool value-add to an EMR? It's risky, but doesn't SOMEONE have to try to see if gesture-interfaces are what this market needs?

Fingerprint access/Barcode scanning/Camera: This one's tricky, I'll admit. My belief is that a savvy hardware maker will use the Bluetooth abilities of the iPad (or the competing Android/Chrome platform that will surely emerge) to create all sorts of pluggable devices. So then all sorts of functions are possible and in the pocket and portable.

Voice-to-text: It exists on the iphone. Should exist on the ipad. Once again, this is up to the software people to do and Dragon's voice-to-text already works fairly well on iphone (at least as well as its traditional tablet counterpart).

Battery stuff: I use a Palm Pre for most of my phone stuff. One of the cool things about it is that it DOES store stuff locally, but it also continually backs-up to a central point. I could get another Pre tomorrow and all of my stuff would be there for me when I turn it on. There is plenty of synchronization software for iPhone. We're entering a cloud world (and you're surely betting on that proposition). Who cares if the device runs out of juice? Just get another charged one from the stack, turn it on, and there you go! Hospitals already do that with batteries (stacks of charging batteries). Just have stacks of charging ipads.

I agree that Apple was likely not thinking about the HIT vertical, but in my experience in the Legal Services vertical, Apple tends to go after a vertical after the fact and then make sure subsequent versions of a product can work with that vertical if it proves to be promising.

I'm not an Apple Fanboy. I barely use their products. But gesture interfaces might be really good in the healthcare IT world. With complaints of "it takes me 10 clicks to do what I do in 10 seconds with a pen/paper" maybe gestures are a way to really change the EMR world. It would be a shame to not have someone try it out.

I have 3 levels of username/password for the 3 lev...

2010-02-08T08:17:27.017-08:00

I have 3 levels of username/password for the 3 levels of websites that I use. They are all based on one of 3 phrases that I have in my head and then plying a first character from the phrase. So long as I remember the phrase, I can pretty much always remember my password. An example which I often used while instructing the lawyers who used our legal software was: "We the people of the united states in order to form a more perfect union." became wtPotU5mpU or something like that. As long as its over 10 characters, has a nice mix of stuff in it and isn't dictionary recognizable, it's a decent password.

But the onus of protection is on the website itself. There are many layers of protection to use, but I think a great thing to do (and we did this on our legal website which required high-levels of security) was to publish a 3rd party report of a penetration test of our security. A double-edge sword, to be certain, but it showed that we took security seriously and were proactive in that.

It's one thing to say, "I'm secure". It's another to actually show it.

Additional

what about the system calling patients with teleph...

2010-02-04T08:40:57.478-08:00

what about the system calling patients with telephone reminders or at least do you integrate or have a solutions partner?

also is there a way to get smaller labs integrated? e.g. we need hunterlabs.com support.

"though flash is not an information deliverer. It ...

2010-02-01T16:07:32.310-08:00

"though flash is not an information deliverer. It is a graphics engine, and basically the only one."

Which (unfortunately) makes it an information deliverer. We're not getting our information in XML format and then coding your own apps to accommodate... unless you're me. We're getting our information in whatever form the provider gives it to us. HOPEFULLY, there will be APIs and RSS feeds that let us get our info in any form we want, which will allow us to use a variety of apps, but as it stands now, we're at the mercy of receiving our information in whatever mechanism the provider wants to give it.

Flash IS an information deliverer, whether we like it or not. And it's the "standard" even if the mechanism of creation is corporately owned. It's not corporately controlled.

As long as developers continue to display stuff in Flash, Flash is honestly required to view the Internet as many developers intend. However, I DO think HTML5 will change things. I also think really really clever Jquery (or dojo or whatever) programmers can do almost-Flash things and can get around that.

Sorry Bernz; I appreciate your extending my somewh...

2010-02-01T15:55:22.687-08:00

Sorry Bernz;
I appreciate your extending my somewhat hasty remark, though flash is not an information deliverer. It is a graphics engine, and basically the only one. Sure the engine certainly conveys information through its graphic representation but it basically functions like an accessory; simply added onto the browser like a piece of jewelry.

So if you want to criticize apple for taking a cut, why not throw your liking of adobe out while you at it, because you would need to spend $500 to author content under their system. Simply: flash is smoke and mirrors.

Apple is making a huge statement, one that will likely change the economy of the internet. Sure they take a cut for what a developer charges, but they have infrastructure to support. I think this is fair, you pay for bottled water? They also have invested interest, so I also think its fair that they control services that compete with their identity.

People are free to knock the socks off apple products (if they can), some certainly do within perspective, but you can't honestly say that a completely free-open internet isn't the best one?

You say "de facto", I say deficit technology. Flash is bloated, far too bloated for mobile computing.

2b: Flash is the way that much (certainly not all)...

2010-02-01T12:31:29.346-08:00

2b: Flash is the way that much (certainly not all) of information is delivered on the Internet. HTML5 might change that, but for NOW, that's the way things are. By leaving out Flash, Apple is forcing one of two things:

1. Web browsing to be crippled for many sites.

2. Those sites writing iphone/pad apps that have to go through an approval process and Apple gets a 30% cut of each one of them (unless they're free). The Internet, as I see it, shouldn't require special software. I understand that Flash is special software, but with 90%+ installation, I hardly call that "special". Flash is the defacto (currently, though this will change) mechanism for handling various forms of media.

If the iPad is truly meant to be a cloud device, then it should, in my opinion, be able to handle the various forms of the Internet, not only what Apple deems safe.

You've got to be kidding me! Get ready for a wave ...

2010-02-01T11:37:10.265-08:00

You've got to be kidding me!
Get ready for a wave of flame, because you hate more than hexmurda.

1) Apple did not falsify the browsing of the new york times site.

2) Flash will not exist on an apple mobile device until it can do the required 5,000,000 situps required to handle the daily grind of our mobile device lifestyle. Would you carry walmart with you where ever you go? Okay thats dumb, and bad form.

2A) Besides is obesity, another reason flash will not be on the ipad, and shouldn't be on the ipad is its very much unneeded.. The internet is information, and flash is so much an extra layer of unneeded rendering. Furthermore, not only is it another layer of computation, but that extra layer has so much extra functionality/baggage that it really simply unneeded and doesn't fit into our lean technological functional ecosystem; much of the iphones/ipads single serving success.

2b) Flash is designed for graphics, motion, and a bit of sound. The Iphone can already do a lot of that through quicktime, or it can atleast succeed in very functional modes, plus its gaming functionality... Why should apple incorporate this essentially new form of there painful rosetta (from another company though) into this sterile environment?

We will find out when the first jailbroken ipads a...

2010-02-01T05:46:50.433-08:00

We will find out when the first jailbroken ipads appear with Flash.

Officially Flash isn't supported on most Linuxes, yet here I am, using it on one of the unsupported Linuxes. And there's several choices; a reverse engineered version, the "real" version with a wrapper and more.

So the moment that the iPad has Flash on a jailbroken iPad, then we'll know that it's just Apple implementing some strategy as opposed to something technical.

Dear Anonymous: Re: fax integration--we've explor...

2010-01-29T13:46:11.728-08:00

Dear Anonymous:

Re: fax integration--we've explored a number of fax options, but they all require a monthly fee. In this instance, we think it's best for users sign up for their own e-fax accounts that deliver faxes to their email inboxes as PDF attachments. They can then upload the PDF files into Practice Fusion's document management center, as Dr. Costley had pointed out.

Re: Mobile--Every EHR company sees this opportunity, and every EHR company also knows that the new HHS certification criteria for EHRs necessitate redeployment of development resources to meet the regs. So it's a race for 2 prizes, not just one. I like our chances in both instances, but I'm not saying more than that right now.

Thanks for writing in,
Glenn

Is fax integration anywhere on the roadmap? That w...

2010-01-29T06:18:58.710-08:00

Is fax integration anywhere on the roadmap? That would be handy.

Mobile platforms as well? I see that Adobe is beta-testing a Flash app builder for iPhone/iPad, as well as Flash for Android and WebOS.

All those practices need to be thinking about comp...

2010-01-25T09:16:07.321-08:00

All those practices need to be thinking about compliance with the privacy and information security provisions of the HITECH Act or they could face fines that would far out weigh the stimulus funds.

I have heard people say that as much as 75% of lab...

2010-01-22T08:00:26.237-08:00

I have heard people say that as much as 75% of lab results come from local providers. How many years do you think it will take to standardize the industry? Does the government have any levers to get labs to migrate to the appropriate standards?

I'm also impressed with the work so far. However, ...

2010-01-06T21:20:32.267-08:00

I'm also impressed with the work so far. However, I still have some concerns. In conversations with rural small practices there is still apprehension that these plans are going to favor big vendors and large health systems while leaving them high and dry.
I also have concerns that the criteria for meaningful use could be watered down after the upcoming comment period, and rather than actually improving the system using health IT, we end up pushing adoption at the expense of true improvement in quality and clinical outcomes. So I remain guardedly optimistic...

Robert, I find the wording in federal document t...

2010-01-05T15:54:30.043-08:00

Robert,

I find the wording in federal document to be pretty ambiguous re: whether, when and how certification of EHR modules will occur.

Don't get me wrong -- I think certification of modules is a good idea and will advance innnovation in the marketplace.

Look at the wording on pp. 37–38:

“While the use of EHR Modules may enable an eligible professional or eligible hospital to create a combination of products and services that, taken together, meets the definition of Certified EHR Technology, this approach carries with it a responsibility on the part of the eligible professional or eligible hospital to perform additional diligence to ensure that the certified EHR Modules selected are capable of working together to support the achievement of meaningful use. In other words, two certified EHR Modules may provide the additional capabilities necessary to meet the definition of Certified EHR Technology, but may not integrate well with each other or with the other EHR technology they were added to. As a result, eligible professionals and eligible hospitals that elect to adopt and implement certified EHR Modules should take care to ensure that the certified EHR Modules they select are interoperable and can properly perform in their expected operational environment.”

Hospitals and docs have the burden to determine whether “certified” modules actually work together? What good is that? That’s like electronics manufacturers saying: “We ‘certify’ that this box is a DVD player and that that thing over there is a HDTV, but you have to figure out whether they actually work together.”

Further, on p. 104 the document reads: "We believe that during meaningful use Stage 1, approximately seven types of EHR Modules will be practical given the current state of the HIT marketplace. We assume that EHR Modules will most likely be prepared to be tested and certified to provide the following types of capabilities:…”

“Approximately”? “Assume”. Why doesn’t HHS say “The modules will be A, B, C, D, E, F, G” or even “by such and such date we will delineate the definitions of specific modules?”

Is HHS suggesting that the market should determine evolution of modularity, rather than a specific delineation and definition of modules by HHS? or if HHS is indeed going to certify modules, what’s the timeline?

This ambiguity could have the unintended consequence of further stalling the EHR market while vendors wait to try to fit their capabilities into specific modules and buyers sit around and try to understand what modules they will have to piece together on their own.

I’d appreciate your and others perspectives on an important topic that I read as being very mangled in this first draft.

I admire you for wading through 500+ pages of gove...

2010-01-05T12:36:09.737-08:00

I admire you for wading through 500+ pages of government literature and thank you for posting a user-friendly summary.