Mobile Technology in Healthcare: Can You Hear Me Now? Mobile technology, and specifically the mobile phone, has become the new global platform of computing. This is creating significant sociological changes that will greatly impact the practice of healthcare. The unprecedented computing power available to billions in their coat pockets can be leveraged to improve medical practice and consumer health. However, the explosive growth of this modality also creates the potential for growing pains.
Because healthcare providers have a disproportionately higher rate of smartphone ownership, these devices are now increasingly finding their way into the highly regulated environment of hospitals and clinics. This has the potential to threaten patient privacy and the security of information, which are governed by Federal laws such as HIPAA – and violations already have made headlines with multimillion dollar fines. Despite this risk, the majority of hospital Information Technology departments don’t even have robust mobile device use policies.
Trending Topics in the Acute Care Continuum. I try to make it a point to find medical blogs that stay up to date on the latest emergency medicine developments. You may be especially interested in two articles. One discusses strategy and technology architecture issues associated with the future development of EMR. The other is a study about how to curtail the overuse of the ED by frequent users. What is happening with the $19 billion stimulus aimed at modernizing EMR? In this Forbes article by contributor Dave Chase, Health Systems Spending Billions to Prepare for the “Last Battle”, Chase talks about how designers of the next generation EMR will have to create a system that is more nimble, affordable and person centric. Study suggests new ways to slash ED Overuse. In this article by Kevin B. Compliance Risks Don’t Increase With Medical Scribes. Recently, the Report on Medicare Compliance (from Atlantic Information Services) published an opinion article about the use of scribes in healthcare.
The premise of the article was that hospital executives and physicians should re-examine the benefits of scribes because compliance risks grow when scribes are allowed to make entries into electronic health records. Furthermore, the article questioned the gains in physician productivity from scribe utilization. Are these authors practicing physicians themselves?
Do they understand the growing clinical pressures and demands placed on healthcare providers today? I believe that the authors are not only misinformed, but that their article will hinder the advancement of EMRs and the modernization of the healthcare workforce. Compliance risk is inherent in all forms of medical documentation. Scribes generate the medical record during the patient encounter, contemporaneously. ‘A’ is for Apple, ‘H’ is for Healthcare? “Daddy, I want an iPad.” This is a common request heard by parents, but this one was coming from my daughter in medical school, who already possessed a MacBook and an iPhone! Just beginning her clinical rotations in her 3rd year, she noticed many of her peers using iPads to look up questions they had on a medication, the pathophysiology of the disease the attending was lecturing on at the moment, or even to study a lecture or required reading.
It is no secret that physicians have flocked towards the iPad for both work and play, with multiple surveys showing high penetration rates in this demographic. Mobile technology is clearly overtaking healthcare with the term “mHealth” achieving buzzword status. But, is the tablet the right tool for the job? The word “tablet” itself has gone through its own evolution. While iPads were not built from the ground up for healthcare (then again, some might say neither was EMR software), they have been adapted quickly for the healthcare setting. Scribes: A Brief History, Current Boom and Impact on Acute Care Metrics. By Jim Strafford Scribing, particularly in Emergency Medicine (EM), has been something of a phenomenon during the past decade. Scribes are typically employed by third party vendors such as Scribe America as well as directly by provider groups. Scribe America has experienced phenomenal growth and now employs over 2500 scribes; physician group CEP America employs over 600 scribes for their ED and Hospitalist Practices.
What accounts for the scribe boom, and how do we measure the impact of scribes on the Acute Care Continuum? A Very Brief History Scribes appear throughout ancient history as “record keepers” who copied legal texts and other documents. Scribes also appear many times in Scripture. What accounts for the phenomenal increase during the last decade? Scribe Impact on the Continuum of Acute Care Anecdotal evidence indicates that scribes improve the quality of providers’ work experience. An EHR System Without Scribes Is Like a Jaguar Without Tires. By Jason Ruben, MD Imagine yourself buying a luxury car — for argument’s sake, a Jaguar XKR-S convertible.
It's got a 385-horsepower, 5-liter V8 engine. It's got plush leather seats, OnStar and Blue Tooth for your iPhone. But there's a problem. The tires are missing. The dealer apologizes and offers to put some new ones on for $300. "Are you kidding? " So what does this absurdist little sketch have to do with healthcare reform?
Proprietary EHR systems — the kind used by a majority of hospitals — are notoriously pricey. Unlike a Jaguar, EHR systems aren't luxuries. There's another important way that EHR systems differ from Jaguars: engineering. So where do the tires come in? Some evidence demonstrates that EHR use can indeed improve healthcare quality, but even that's debatable. So how much have things improved since 2004? Well, here's what some physicians are saying about EHR utilization today: "Documenting a full clinical encounter in an EHR is pure torment. " — Steven J. An EHR Workflow Analogy. COMMENTARYWilliam A. HymanProfessor Emeritus, Biomedical Engineering Texas A&M University, w-hyman@tamu.eduRead other articles by this author A theme I and others have addressed is the impact of EHRs on workflow, and whether having to adopt the workflow to the EHR is always the optimum thing to do.
Associated issues are whether the designers actually knew anything about clinical workflow, and whether if they had such knowledge did they use it well, or at all, in creating the system. Also recently addressed is whether the Meaningful Use imperative is driving bad design. A related issue is did the people who selected the EHR have effective workflow in mind, or did other issues drive their decision. This may be especially relevant in large organizations where the selectors are not the users, yet even in smaller settings users may not know how to adequately analyze a candidate EHR with respect to workflow issues. Tags: Featured, William Hyman, Workflow Category: EHR Adoption. Patient Portals and EHRs: Generating Reports. Some of the details of Meaningful Use Stage 2 are proving to be quite tricky. This week we’ll be going over how to handle reporting when a practice employs custom solutions for their patient portal.
When the software that patients engage with isn’t supported by the EHR, figuring out the right figures to report for each measure can get complicated quickly. Let’s dig in a little deeper to see what’s the best course of action. My practice uses a patient portal, not associated with our EHR. As we prepare for Stage 2 of Meaningful Use, specifically the Patient Electronic Access Measures, the numerator and denominator information comes from two different systems. How would we generate an accurate report?
There is one MU Stage 2 objective and two associated measures that address an eligible professional’s (EP) ability to engage patients to view online, download, and transmit their health information within 4 business days of the information being available. Electronic Health Records Linked to Improved Care for Patients With Diabetes. Study part of Kaiser Permanente’s ongoing work to better understand how EHRs affect clinical care The use of electronic health records in clinical settings was associated with a decrease in emergency room visits and hospitalizations for patients with diabetes, according to a study published today in the Journal of the American Medical Association.
Researchers examined the medical records of 169,711 diabetic patients over 1 year of age in the Kaiser Permanente diabetes clinical registry before and after the implementation of Kaiser Permanente HealthConnect®, the organization’s comprehensive EHR system. They found that patients visited the emergency room 29 fewer times per 1,000 patients and were hospitalized 13 fewer times per 1,000 patients annually after the implementation. Researchers found that annual emergency room visits declined 5.5 percent, from 519 visits per 1,000 diabetes patients before electronic health records to 490 visits per 1,000 diabetes patients afterward.
Pennsylvania Patient Safety Authority Examines EHR Errors Related to Default Values. Data Analysis Shows How to Avoid Certain Types of Errors When Using EHRs “Default values are often used to add standardization and efficiency to hospital information systems,” Erin Sparnon, MEng, patient safety analyst for the Pennsylvania Patient Safety Authority said. “For example, a healthy patient using a pain medication after surgery would receive a certain medication, dose and delivery of the medication already preset by the healthcare facility within the EHR system for that type of surgery.” The preset medication, dose and delivery are known as a default value. Default values for time are often put into medication and lab orders to coordinate staff resources. Automated stop times are used to end drug orders after a certain amount of time unless a doctor or healthcare provider renews the order.
However, EHR event reports show that patient harm can sometimes occur if these defaults are not used appropriately. Category: Industry Press Releases. Who Will Rescue Healthcare and Solve The EMR Debacle? We Need Another Steve Jobs. Today we announce the third most popular blog of 2012. We congratulate Jason Ruben, MD. Steve Jobs knew that the key to Apple’s success was simplicity. Apple products are painstakingly designed for simplicity. Updated Apple products are always better than their predecessor. If you question this, visit an Apple store at the release of the next iPhone or iPad. Quite the opposite is true in the EMR-healthcare arena. The result: hospital executives are pressured to buy systems that “fit” into their existing IT platform regardless of physician usability. The merits of the HITECH Act, the EHR Federal Mandate, and The Stimulus Package have been greatly discussed. I want to know who will save physicians, hospitals and patients from the existing, pathetic breed of EMRs available today?
If the deep pockets of Google failed—What’s next? Who will be the Steve Jobs of the electronic medical record era? I doubt it. We need an innovator who can develop a disruptive technology in EMRs that: 1. 2. 3. Data Capture: Devil in the Details Confronting All Meaningful Users in 2014. By Robin Raiford and Anantachai (Tony) Panjamapirom, iHealthbeat.org To meet many of the meaningful use requirements, providers must capture, store and share clinical data mostly in a specified electronic, structured and coded format.
Having undergone a major ramp-up data capture in Stage 1, providers will continue to experience the increased pressure and intensity in both quantity and quality of required data elements. Providers should view this mandate, as an opportunity to transform their data collection process and develop plans to sustain providers’ agility needed to successfully demonstrate meaningful use as the future stages will only bring additional data elements and more complex requirements. Devil in the Details — More Data To Capture In Stage 1, providers were able to meet key objectives of meaningful use with a single piece of data. Starting in 2014, this is no longer the case. Major Workflow and Change Management Implications Click image to enlarge.
Getting More Health Out of Health IT. COMMENTARYby Jane Sarasohn-Kahn Twitter: @healthpopuli How can we get more health out of health IT? Getting more patients involved in their own health will help maximize providers’ investments in health IT. Let’s call this ROH (return on health). Notwithstanding roughly 100,000 mobile health applications available in mobile phone stores, several dozen activity-tracking devices unveiled at the 2013 Consumer Electronics Show and the availability of patient portals built into the top-selling electronic health record systems in the nation, it’s hard to find the health return on investment in health IT in America.
Moving From ROI to ROH Through Patients Evidence on the ROI for EHRs is mixed at best. Researchers at the Mayo Clinic armed 149 heart patients with a Fitbit activity monitor once they moved from the cardiac unit to an acute inpatient bed. Venture Funding for Remote Patient Monitoring Grows … … And More Consumers Are Engaging More in Health With Technology Come Together. Responsive Web Design Patterns | This Is Responsive. Responsive Patterns A collection of patterns and modules for responsive designs. Submit a pattern Layout Reflowing Layouts Equal Width Off Canvas Source-Order Shift Lists Grid Block Navigation Single-Level Multi-level Breadcrumbs Pagination Images Responsive Image Techniques Media/Data Video Fluid Video Iframes Tables Charts & Graphs Responsive Chart Forms Basic Forms Text Lettering Fittext Footnotes Responsive Footnotes Modules Carousel Tabs Accordion Messaging Lightbox.
The Case for Agile in Healthcare Software. Before I joined Atomic and learned the ways of agile and TDD, I spent several years working in the software industry. So from time to time I reflect on the other industries where I have experience, and I consider how the techniques we use might benefit development in those domains. One area I have quite a bit of exposure to is healthcare software. The more I think about it, the more the distinctive traits of healthcare lend themselves to agile methodology. Healthcare has a critical need for their software to work flawlessly.
Every time a bug is discovered that may affect patient care, a tremendous amount of time and energy must go into fixing the bug for all affected versions of the software. Within testing, of course I would advocate the usual battery of unit, integration, and system tests. Just having a huge array of tests is not sufficient, though. Where have you seen a need for Agile in an industry where it isn’t generally applied?
Healthcare Experience Design.