Intelligent Healthcare Information Integration 3/4/10

Meaningful Views

“Meaningful Views” is a grand conglomerate term (not to be confused with the “Meaningful Ewes” from a prior posting.) It encompasses graphical user interfaces (GUIs) and workflow efficiencies and the minimization of “clicky-clicks.” (Props to Jonathan Bush for that term; it says so much in such a cutesy, snarky way!) Meaningful views are something we all seek, every day, whether via digital dazzlery or paper and pen.

Consider the ultimate goal of medical information: to lead to better heath. My goal, as a physician, is to help my patients lead better quality lives via better health choices and illness management optimization. To accomplish this goal, I need to: obtain data; aggregate, assimilate, and evaluate that data; add interpretive value to that data; and deliver the data’s meaning and true usefulness to the patient. Whether it needs to come from the patient, from a lab test or radiology exam, or from a textbook, professor, colleague, or website, the data I need to digest must somehow be “viewed” in order to be shared and used.

While auditory “viewings” of data are important, more and more in our modern world we are turning to visual information sharing portals. Televisions, faxes, lab/radiology printouts, computer screens – these are increasingly diminishing the verbal-auditory transfer of information.

The exponential growth rate of medical knowledge has long ago exceeded the mental capacity of mere mortals. Thus, how data is presented has become increasingly pressing. We need data views that facilitate our data comprehension. If we were not mere mortals – and perhaps the ultimate goal of all this techno-data-collaboration is to allow this – we could share knowledge via some form of Vulcan mind meld or Borgian collective consciousness. Until that time, in order for us to share the information we seek or need, the presentation of that data must improve.

Face it: we all only have so much time in a day. We need data delivery which is as fast as possible, as efficient as possible, and as easy to assimilate as possible, because we have a lot of things we need to do with that data. Personally, I also want to get home to see my family on occasion. (OK, I also want to have time to catch the latest Mythbusters.)

I want data “views” that make sense. I want data views where I have to do as little as possible to assimilate said data. I want views that allow me to do the things I really want to do, not views that require me to alter what I do in order to accommodate the viewing. If I have to learn how to view the data, if I have to work to visualize the data because it comes in a difficult format, if I have to constantly seek the data I need because it comes in non-standard views, then the data viewing becomes a barrier to my goals.

Workflow efficiency is enhanced by standardized patterns. In my office, for example, each exam room is set up identically and all of the necessary supplies are stored in identical locations within each room. I don’t have to spend any mental energy deciding which room I’m in and where the tongue blades are stored. I can spend that energy thinking about and talking with my patients. It’s little, but it adds up.

When I seek data from a lab report or from a radiology report or from the exam notes of a previous physician, you know where most of my time is spent? Yep. Looking for the data I need. Why? Because the “view” is either non-standard, sub-standard, or, sometimes, flat out crappy.

I recently learned of an initiative to provide cross-platform standardization of laboratory data. This means that whenever I look at a lab report, from whichever institution or provider or EMR or HIE, the data is presented in a regular, logical, and consistent format. The “view” is optimized. Time is spent in understanding the data, not in finding the data. (If you’ve ever had a new lab reporting system thrust upon you where you had to relearn where to look for lab data in the new system’s report forms, you’ll understand). If you can easily see it, you can use it. If you can easily see it, you won’t unnecessarily repeat it. If you can easily see it, you can make meaning from it.

Meaningful use, in my humble opinion, should always revolve about what helps us help patients. Help me spend less time looking for what I need, help me focus less upon data entry functions and clicky-clicks, help me make better decisions for helping more people faster, help me get home to see my wife, sons, and Survivor more often – that is meaningful use for a trench grunt. This standardized look for lab reports, one form of “meaningful views,” would be a great step in that direction.

From the trenches…

“Know where to find the information and how to use it. That’s the secret of success." – Albert Einstein

Dr. Gregg Alexander, a grunt in the trenches pediatrician, directs the “Pediatric Office of the Future” exhibit for the American Academy of Pediatrics and is a member of the Professional Advisory Council for ModernMedicine.com. More of his blather…er, writings…can be found at his blog, practice web site or directly from doc@madisonpediatric.com.

Intelligent Healthcare Information Integration 3/3/10

While the Gettin’s Good

Here I sit, 6:10 AM, leaving the 2010 HIMSS conference, riding the shuttle toward Gate D25 here in ATL. (Typing that, I feel like Kenny Tarmac; respects to “The Bob & Tom Show.”) As I write this, I realize how freakin’ psychic I am, planning to leave just after one day of show. Not because of anything related to the HIMSS event; rather, because the last time Atlanta had a half an inch of snow, I was speaking to a friend there who was just about in a panic, as was pretty much the rest of lovely Atlanta, at the sight of frozen water. Wouldn’t you know, after arriving back at the hotel last night after a phenomenal HIStalk reception and excellent Eclipsys party with the still-spectacular B-52s, the local newscasters were abuzz with the news of, yup, snow.

Two to three inches was being forecast to hit starting just after my departing plane arrives safely away in Charlotte. Now, being from the frigid north, this piddly dusting doesn’t begin to worry me. However, if a half an inch frightens Atlantians into rolling up the sidewalks, I can’t imagine what enough to cover their shoe tops might do.

My post-HIMSS first-to-mind thought? As a mere grunt from the small town trenches, you might think the colossus into which HIMSS has morphed might be overwhelming. Would be, I suppose, if:

a) I hadn’t been watching all this HIT hubbub bubbling away for over a quarter century;

b) I didn’t know a bunch of really good people involved in this work who attend HIMSS who;

c) Keep introducing me to even more really good people.

Speaking of really good peeps, perhaps the most intriguing – and, perhaps, telling – comment I heard this year came from Pat Downing, one of those nice folks met via another nice folk. Pat, originally from Maryland, has now lived for over ten years in Thailand – Bangkok, to be specific. He’s the original brain behind what has since become Microsoft Amalga. Not being daily immersed in the U.S. HIT world, he notes how his infrequent visits allow a unique perspective upon what’s the haps here when he does make the rounds at HIMSS. This year, his take was disturbing, if not downright ominous.

To wit (paraphrased): I always find that walking the periphery of the HIMSS exhibit hall(s) gives me a view for the new, the innovators, always positioned around the outskirts of the show, those small guys who are bringing along the next big “pops.” This year, though, nothing popped.

Maybe it’s the scramble to address “meaningful use” (whatever that truly is.) Maybe it’s the ARRA funds which seem to have stalled – at least temporarily – the EHR purchase decisions of many potential adopters. Maybe we’re just out of idea men and women who can even pretend to wrap their minds around this ginormous, dysfunctional beast we call healthcare here in America.

But, maybe, just maybe, it’s the lull before the next great storm of disruption which will actually engage the masses of healthcare providers into actualizing the real horsepower of IT. Not technology for technology’s sake, nor technology for the sake of a carrot or the threat of a stick, but technology uptake based upon technology which excites and enthralls, technology which needs no incentives other than its own inherent value. Sort of like my palm Pre. (OK, sort of like the iPhone for the rest of you.)

The fun of the HIStalk reception still lingers, so I’m going with the latter, glass half full possibility.

Best of luck with the “blizzard,” y’all.

(On my way back to where I’m) From the trenches…

“The optimist proclaims that we live in the best of all possible worlds and the pessimist fears this is true” – James Branch Cabell

Dr. Gregg Alexander, a grunt in the trenches pediatrician, directs the “Pediatric Office of the Future” exhibit for the American Academy of Pediatrics and is a member of the Professional Advisory Council for ModernMedicine.com. More of his blather…er, writings…can be found at his blog, practice web site or directly from doc@madisonpediatric.com.

News 3/4/10

I’m back at home after an exhausting, fun, and educational few days at HIMSS. I have a ridiculous number of e-mails to wade through, but as far as I can tell, there were no earth-shattering announcements, such as company mergers or the like. However, many new product releases, new partnerships, and client success stories were shared. Over the next few days I will digest it all a bit and post more highlights.

In terms of offerings of interest to physicians, I had the chance to look at a few of the EMR vendors. The big name vendors had heavy traffic the whole time, but I have to wonder if the HIMSS experience is worth it if you are a small vendor in one of the small booths and low traffic areas. A lot of those folks looked lonely.

I got a quick peek at SRS and I finally understand its appeal. It does not offer every bell and whistle that you might find in a NextGen or Allscripts product. However, it’s very intuitive, the screen is not cluttered, and navigation is simple. If you want to chart the complete note at the point of care, this is not the product for you. But if you want something that gets your charts electronic, it’s not a bad option. It’s not the option if you want to do complicated data searches since it relies heavily on scanning and transcription. There are limited discrete fields, which also means you don’t have a whole lot of point and click in the documentation process. I knew the product had these limitations before seeing it, but it is strong enough in its design to be an attractive alternative for certain types of providers (especially specialists).

I didn’t see the Sage product in great depth, but it looks like one of the more comprehensive EMRs in terms of its ability to be customized and to accommodate a totally paperless workflow. However, it is not the prettiest EMR out there and a little window dressing might improve its appeal.

If you are a smaller start-up vendor, here’s a recommendation: hire an industry veteran to help you define what is different and unique about your product. This is 2010 and there is no need for a vendor to begin a pitch saying that what makes his EMR great is that it makes patient information available from anywhere and saves on transcription costs and reduces paper. I’m pretty sure that just every HIMSS attendee is aware of that every EMR has that same potential.  When a vendor starts telling their story in this fashion, their credibility is blown and their lack of experience in HIT is exposed.

Here is what seems to be a hot trend: products that can be bolted on to core practice management and EMR programs. The hospital world has been doing this for years, but not so much the ambulatory space. Of course there have long been claims clearinghouse that work with PM solutions, but now vendors are offering easy-to-use and customizable front-end solutions (like Salar) to work with EMRs, all sorts of RCM tools (RelayHealth is big in this area), and business intelligence tools to help doctors with PQRI reporting and the like.

Despite this not so pretty picture, VisualDX was a  pretty sexy product and one of dozens of applications that are newly available for use on a smartphone. VisualDX includes a database of images so a provider trying to identify a particular skin rash, for example, could search through a library of thousands (with pretty precise search options.) A consumer version is also available for all those nervous moms.

For me, the HIStalk party was the ultimate highlight. If you were there, thanks for attending. And endless thanks to Encore, Evolvent, and Symantec, our gracious hosts. If you missed it, I hope we’ll see you next year!

Short post tonight as I get caught up on life! I’m be sharing more, so keep reading.

E-mail Inga.

Intelligent Healthcare Information Integration 2/26/10

Hi Ho, Hi Ho, It’s Off to HIMSS We Go

The setting: Outside of a small, storybook cottage in fairy-tale woods.

Camera zooms in, from a group of frolicking woodland creatures, through a too-cute cottage window to the hand-carved, kitchen table where four elfin men sit sipping steaming mugs of morning blend.

Sleepy: (yawning) I just can’t seem to get excited about this whole HIMSS thing.

Happy: What!?! How can you say that? This will for sure be one of the best events ever!

Doc: I concur. Not only is the whole country abuzz with HITECH fever, but the world is watching to see if the U.S. can actually mend its fractured and dysfunctional healthcare system, especially the informational component thereof.

Dopey: Hyuck, hyuck. I never quite know what you’re saying, Doc, but it shore sounds fancy!

Grumpy: (walking into the kitchen with a gruff and grumbly tone) You fellows never let a guy sleep in!

Happy: (with just a tad too much cheeriness) Good morning, Grumpy! Aren’t you excited about our trip to the big city in the land of peaches and Coca-Cola? Even you must be keyed up with all of the hubbub surrounding ARRA monies and HIT investment that’s brewing.

Grumpy: Harrumph! I most certainly am not. I don’t think those promised dollars will ever hit the hands of the physicians…sorry, Doc.

Doc: Oh, Grumpy, that’s not what this is all about. That money is designed merely to flow THROUGH the hands of the physicians into the hands of the vendors and developers to stimulate the growth of our digital healthcare information system.

Sneezy: (entering, with an ACHOO!) That’s not what everybody thinks, Doc. (sniff) I saw Dr. Doolittle on my way to the mine yesterday and he said he was heading down to Woodland Bank to arrange his new EMR system loan because (sniff) his vendor swore he’d make a bunch of money by adopting now.

Happy: (with his chronic big smile) Either way, don’t we all benefit if healthcare goes electronic? Isn’t the goal really about the benefits to us, the patients, and not who gets what piece of which pie?

Sleepy: (wiping sleep from his ever half-closed eyes) Pie? We’ve got pie?

Happy: (chuckling) No, you silly, sleepy little elf. We’re talking about the big EHR vendor ARRA/HITECH “pie.” I was thinking about what Snow always said, (in a girlish voice) “If your palm itches, you’re about to come into money.” (grinning ever bigger) I’ll bet there will be a lot of palm-scratching CEOs walking around the Georgia World Congress Center!

Doc: Well, I don’t begrudge them a nickel if they can actually create systems to make treating Bambi’s bunions easier and my days in AR dwindle.

Grumpy: Well, I think that is yet to be determined, Doc. Hey…how can a hooved creature have bunions?

Doc: Figure of speech, my dear dwarf.

Happy: Well, regardless, HIMSS will have lots of parties and lots of freebies and lots of happy people excited about the future. I hear even Eric Fishman will be there filming for EHRtv.com. Hope I get interviewed!

Sneezy: I just wish more HITECH money was going (ACHOO!) to big pharma. None of my nasal sprays help anymore. (sniff)

Doc: With all the great data we’ll soon be able to accumulate, aggregate, analyze, and share, Sneezy, I’m sure we’ll figure out better ways to circumvent your rhinitic condition.

Dopey: Hyuck. There you go talking all purdy again, Doc!

Bashful: (standing in the doorway, sheepishly twirling his big toe into the earthen floor) Aww…I’m just thinking about Monday night at the HIStalk reception. You think there’s any way I might meet Inga?

From the woodland trenches…

“From now on, Snow White and the Seven Dwarfs will be known as Person of No Color and the Seven Vertically Challenged Individuals.” – Argus Hamilton

Dr. Gregg Alexander is a grunt-in-the-trenches pediatrician and geek. His personal manifesto home page…er..blog…yeh, that’s it, his blog – and he – can be reached through http://madisonpediatric.com or doc@madisonpediatric.com.

News 2/25/10

No single EMR vendor is a clear leader in sales to physicians, according to Kalamora’s EMR 2010 Report. The study names Allscripts, Epic, eCW, athenahealth and NextGen among the top vendors but says no one company has even one fifth of the entire market. Kalamora also notes that brand recognition for EMRs is fairly low and no particular brands stand out when doctors are surveyed. That’s a disappointing observation if you are an EMR marketeer. In my experience its always difficult to figure out the best way to connect with ambulatory care physicians, so I suppose not much has changed.

Capario releases a new Web-based portal designed especially for physician billing services. The portal that includes real-time dashboard reporting, customizable work queues, and tools to manage parent-child relationships among customers.

KLAS launches a new HIT Buyers Guide just for HIMSS and it is free to providers, though not vendors nor consultants. The guide includes letter grades on over 700 software products and services that are offered to acute and ambulatory providers. If you are a provider and have downloaded a copy, let me  know your impressions. The KLAS folks will also be distributing the guide during HIMSS.

Island Orthopaedics & Sports Medicine (NY) purchases SRS hybrid EMR for its seven provider practice. According to one of the doctors, earning ARRA stimulus money is not a top priority:

“I am confident that the economic benefits we will receive from this system will far exceed any government subsidies that may be forfeited in just a few years.”

Thirteen of the country’s largest radiology practices form Strategic Radiology, an entity designed pool bargaining power with insurers and equipment dealers, as well as share expertise and best practices. The organization represents over 750 physicians.

This study finds the average number of hours worked by physicians fell 7% between 1996 and 2008, from 55 hours a week to 51. Physician residents decreased their hours even more, averaging 10% less work time over the time period analyzed. Coinciding with the decreased hours were physician fees, which fell 25% between 1995 and 2006.

Pulse Systems is one of the many companies launching new products to spotlight at HIMSS. Pulse is introducing an integrated patient portal and a self-service patient check-in solution which will be available stand-alone or integrated with Pulse’ Patient Concierge Suite.

PrimaCare Medical Centers (TX) claim that since installing MedInformatix’s practice management and EMR solutions, their insurance collections about increased about three percent. The 11-location urgent care network also uses ZirMed for electronic claims processing. So, is a three percent improvement in collections that significant? Doesn’t sound very dramatic to me, but perhaps collections weren’t too bad pre-MedInformatix.

Just published by The Huffington Post Investigative Fund: FDA is “moving closer” to regulating EMRs after receiving reports of six patient deaths and 44 injuries related to system malfunctions. Examples included an OR system whose lockups forced nurses to re-enter data from memory and another that didn’t display allergies correctly. An FDA official admitted that the agency has steered clear of regulating HIT, but says, “In light of the safety issues that have been reported to us, we believe that a framework of federal oversight of HIT needs to assure patient safety.” Reaction from vendor executives at the recent hearings was interesting: Epic’s Carl Dvorak was quoted as saying regulation wouldn’t necessarily ensure safer products or encourage innovation, while Cerner says it supports making voluntary safety reports mandatory because it’s “the right thing to do.” It’s not clear if the FDA is looking at all EMR’s or just inpatient systems.

I’m heading out to HIMSS this weekend so my next update will come direct from Atlanta. On the top of my list is checking out some of the lesser known EMR products, so stay tuned.

E-mail Inga.