Navigating Healthcare – Patient Safety and Personal Healthcare Management

Joining the MedicAlert Board

MedicAlert

I am excited to be elected to the MedicAlert Board joining Jessica Federer, head of digital development at Bayer. As Barton Tretheway, CAE, chair of the MedicAlert Foundation Board pointed out

Their collective experience aligns with our priorities and will be immeasurable to us as we look to leverage the power of new technology to expand the mission of MedicAlert Foundation, which is designed to help save lives

Which succinctly captures my feelings around this additional role. I personally experienced the value of the MedicAlert solution, brand and promise when I practiced as an Emergency Room physician in the United Kingdom. It was part of the standard procedure for any patient who arrived unconscious or confused to look for the signature bracelet

Traditional Medical Alert Bracelet

 

With its iconic Caduceus (similar but different to the Rod of Asclepius) which was the traditional sign of the God Hermes and became established as the symbol of medicine in the United States in the late  19th Century.

History of MedicAlert

The Original MedicalAlert User – Linda Collins

The history of MedicAlert dates back to the Early 1950’s developed by parents of Linda Collins who had an who had an anaphylactic reaction to tetanus anti toxin (which in her instance she only received a small scratch test as was the practice in 1953) and had a severe reaction. She survive but her parents Dr Marion Collins and his wife Chrissie realized that she was at risk and made a paper bracelet and note that was attached to her coat detailing her severe allergy.

 

 

 

 

 

In fact the original MedicAlert Bracelet is now in the permanent collection of the Smithsonian Institution in Washington, D.C. Today

The Original Bracelet stored in the Smithsonian in Washington DC
The Original Bracelet stored in the Smithsonian in Washington DC

From these modest beginnings things have developed with early recognition by “Peace Officers”. The California Peace Officers magazine even ran an article back in January 1957 highlighting the MedicAlert bracelet to their members. In the era before mobile phones and always on communication it was a reliable way of identifying individuals and providing immediate access to a 24- hour phone line linked to critical and life saving information for that individual. This function continues today with a live 24/7 Emergency Response Service

I worked on one of these switchboards as a Medical Student many years ago

 

 

with full health and personal information including your personal health record and emergency contacts information and available in other countries including Australia, the UK, Canada and South Africa to mention a few through affiliates and partnered with many groups including AAFP, Alzheimer’s Association, ACEP, Autism Association, Philips LifeLine, National Alliance of Mental Illness, Food Allergy Initiative – to mention but a few

The age of computing brought new innovations and the ability to more readily store and retrieve more information for members and track and follow membership and presidential recognition dating back as far as April 9-16, 1978 when then President Jimmy Carter commemorated the occasion of MedicAlert and their contribution to Medic Alert week in April. Even Hollywood got in on the act with appearances of the MedicAlert in everything from the Today Show and Good Morning America to CHiPs

and Columbo

Peter Falk in Columbo

 

Moving into the Digital Age

The organization is moving into the digital age with solutions around stored medical records, moving to digital mobile formats and storage solutions and even exploring the potential for RFID enabled solutions and in partnership with the American Medical Association has a joint venture on advanced directives.

Back in 1956 Dr Marion Collins commented that

“I think I can save more lives with MedicAlert that I’ll ever save with my scalpel”

Which is much like my own perception of medicine and the opportunity of Digital Health that I saw 30 years ago and continues to be the case. It’s this combination of a storied brand and concept from MedicAlert as a foundation and the opportunity to update for the new Digital world we live in that presents such an exciting opportunity. We are facing a Silver Tsunami of people who struggle to age in their homes and technology and solutions that help them do so, safely and with the support of their relatives and the health system will be in high demand.

I’m looking forward to working with my fellow board members and the MedicAlert team to continue the tradition and build on the brand with a Digital update and twist

 

 

 

 

 

 

Joining the MedicAlert Board was originally published on Dr Nick van Terheyden, MD

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Digital Health for the Undeserved

A recent report published by Jane Sarsohn-Kahn for the California Health Foundation: Digitizing the Safety Net Health Tech Opportunities for the Undeserved offers some deep insights into reaching the population most in need of help but often left out in the discussions of the latest and greatest technology to break into the news cycle.

As pointed out low-income households have access to mobile technology with 8 out of 10 sending and receiving text messages – in fact mobile phone usage and ownership mirrors the experience in Africa where many of the communities have little choice given the paucity of existing infrastructure and have bypassed the traditional communications systems in favor of mobile networks
Adults who own a cell phone, Africa

and gave rise to a whole innovation of mobile banking that originated that pre-dated, is more flexible and is more widely used than anything developed in the west (The M-Pesa system) – servicing the unbanked people of Africa without requirements to have a smart phone nor to use an app. I’ve written about the opportunity we have of learning from our African friends in the past)
In the case of the undeserved here in the US many of these people mirror these experiences and providing easy access using simple tools is effective not just from a cost standpoint (as Healthcrowd showed $1 for mobile messaging vs $34 for paper mailing) – and that’s even before you consider the engagement/response rate we find with mobile applications and interactions…think about it, when you want to reach your children do you send them an email or text them

Textpectation

 

Take the time to read about the multiple projects that are reaping big benefits and doing so cost effectively. These are real working projects with a range of technology that has demonstrable impacts and could be applied to many more groups and environments. The extensive piece takes you on a journey from everything as simple as text messaging from Healthcrowd to the medication adherence and tracking concepts of Proteus Digital Health of digestible sensors that track your pill from manufacture to ingestion.

There are a few guiding principles to help steer you to success

  • Meet people where they are – widely varied and none are typical
  • Build Trust – under promise, over deliver; everything is fragile for this community and failure can be far more catastrophic for them than “average” users
  • Address social determinants of health – just providing a ride to get to the clinic could mean the difference between success and failure and an Uber Ride is a lot more cost effective than an ambulance required for the crisis that could have been averted
  • Consider the cost of data service – data is expensive on many plans treat it like memory used to be in the days of 640K
  • Recognize the many layers of health literacy – not just comprehension but basic literacy and even language
  • Speak in the Vernacular – and make it culturally sensitive too

As Aman Bhandari said

“The new sexy is scaling what can work”

Proven solutions that have been effective provide great opportunities for those looking to make that impact on their own area.

 

 

 

Digital Health for the Undeserved was originally published on Dr Nick van Terheyden, MD

7 Tips for the Best HIMSS16 Experience

Posted in #hcsm, education, HealthIT, HIMSS, HIT, social media by drnic on February 5, 2016

 

This year will be my 19th year at HIMSS – things have grown significantly since 1997 when HIMSS was held in San Diego with a record number of attendees – 15,800 and 408 exhibitors (you can read more of the history going back as far as 1961 here). At the time I remember being overwhelmed adn that was before things had grown to the most recent statistics for 2015 now at over 43,000 attendees

 

HIMSS16 SMA BadgeThis year I am part of the HIMSS Social Media Ambassador program joining my 19 colleagues to help provide a guide that was not available back in 1997 to help guide you through the landscape of the HIMSS conference and get the best experience possible

If you do nothing else – follow my friends and colleagues on the list at the bottom. Their feed and content will keep you up to speed on the latest news, events and any last minute gems to keep you getting the most from the events and activities

 

 

 

As part of this opportunity I also the present the following 7 rules/suggestions things to help you get the best from HIMSS 16 in Las Vegas

 

Rule 1: Have Fun

HaveFun

Rules 2: Hack your Conference Badge to Include your Social Media Handle

This used to require some clever editing of the name in the system but it has gotten easier – all you need to do is put you Twitter handle in Nickname field

HIMSSHackBadge
Rule 3: Look up

SocialMedaiEverywhere
Don’t bury your nose in your phone and technology the whole time – part fo the value is the exchange with real people and real activities. When you get in the inevitable line for a taxi or shuttle at Las Vegas airport talk to your fellow travelers – you never know who you might meet and what they might share about their business, news or the conference. You might even be able to shorten the wait and share a ride.

Rule 4: Prepare and Plan and then Adapt

Your plans will change but if you come with no plan you will end up missing more. Depending on your organizational preferences either fill your gmail calendar with your plan or download the Apple or Android HIMSS16 App and use it to checkout the daily sessions and listing of keynote speakers, exhibitor listing, maps and the social media activity feed which will have the latest news from the show floor

Look for the sessions you really want to attend and grab the details and add to your schedule now – you may not make it but you stand a better chance of making it if its on your plan.

Rule 5: Enjoy the Parties but Don’t Stay Late

How you manage this may depend on what time zone you came from but be warned the days are long and can be physically and mentally exhausting

Celebrate but my advice is enjoy the parties and social activities but don’t burn the candle completely – get to bed especially so you can get up early to exercise before hitting the show floor. You may get your steps just walking the floor but even if you do 30 minutes in the gym will energize you to cope with the busy days on the show floor

Rule 6: Leave the Laptop in the Hotel Room

I know a full sized keyboard is great to have but the additional weight of a laptop will weigh heavily on your shoulder. If you can use your phone as your main device and carry a spare battery or a Portable Battery Charging device like this one and/or charging cable and plug

Like this 10ft cable

An extra long one would be helpful when accessing difficult and hard to reach ports)

If you really need the larger device – go with the tablet format but bear in mind the bigger the device the more weight you are carrying around every day

Rule 7: Stay Connected Socially

Use social media to stay connected and find out the latest adn greatest things going on at the conference. You can use Social media just as a lurker and to access information but this is a great opportunity to ascend the social media ladder of engagement

 

SociaMediaLadder

Use your phone to take pictures – post your experiences and things you see and tag everything with the official #HIMSS16 hashtag. But its not just twitter – there are other channels and some can help you share to a wider audience. If you set up your instagram account to link to twitter and facebook you can post from here and populate both your twitter and Facebook feed.

For short videos (less than 6 seconds) – Vine is great for capturing and sharing across multiple channels

Facebook has been rolling out a live streaming feature and if it is available in your newsfeed you could try this for any exciting presentations or interactions

And expect some addition of live streaming from Twitter’s Persicope and the more recent interactive streaming from Blab

Enjoy the conference – it presents a host of opportunities to learn, meet new people and renew old friendships. You are in Las Vegas – you never know you might win some great new friends – to start you off here is a list of my colleagues and friends who are also Social Media Ambassadors

 

 

7 Tips for the Best HIMSS16 Experience was originally published on Dr Nick van Terheyden, MD

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Why All Doctors Should be on Twitter

Posted in #hcsm by drnic on October 28, 2015

The title on the article is actually “Why all Retina Doctors Should be on Twitter” – but i think should read all doctors source
Social media is an open forum for learning, sharing and engagement and is where the patients. It offers a concise (140 characters or less) which helps with speed and especially useful for busy people like doctors
It comes with a great infographic and listing of the basic jargon on twitter that would help anyone just entering this space
Time to get on board – here’s a pathway

Why All Doctors Should be on Twitter was originally published on DrNic1

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The Problem with Celebrity Medical Advice

Posted in #hcsm, #HITMC, HIT, Pharma, science by drnic on August 26, 2015

The challenge with taking advice from celebrities is you never know what the underlying drivers are. FDA Responds to Kardashian Post

In this case the FDA has to respond to social media posts from Kardashian who has 35 Million followers and 45 Million on Instagram and offers up Diclegis for pregnancy associated nausea. Pharma advice from celebrities and other non-scientific sources is an increasing problem especially given the increasing influence of these individuals with large followings of people who might not see the counter points of science and the FDA post (The FDA Twitter handle (@FDA_US) has not even broken 110,000 followers – that’s less than 0.4% of the direct influence.
Aside from the fact this is based on a data set of on, it transpires Kardashian is a paid spokesperson for Duchesnay. This is not independent advice.

The Problem with Celebrity Medical Advice was originally published on DrNic1

New Horizons for me at Dell

Posted in #hcsm, Dell, Healthcare Technology, HealthIT, HIT, HITsm, Innovation, Technology by drnic on July 20, 2015

I am excited to announce I am joining Dell Healthcare and Life Sciences 

as their Chief Medical Officer. Dell has been ranked number one in Healthcare Provider Services for six consecutive years by Gartner and continue to expand their presence in healthcare space with an incredible range of solutions and services that are combined with extensive experience offerings of hardware and infrastructure.

This was such an exciting opportunity with a dynamic company with a focus on healthcare that is driven by a guiding principle from Michael Dell:

Technology has always been about enabling human potential

The opportunity to apply this principle with the assembled first class talented team that have a wide range of skills and deep industry knowledge is empowering and exciting. Healthcare is personal and struggling to deal with technology that has in many cases hindered the personal realtionship between the doctor and the patient. Clinicians want to focus on the patient and not the technology and while patients like technology to be used to improve the quality and safety of care while helping to reduce the costs they also want to doctor to pay attention to them not the device(s) as I have said on many occasions – here in this AMDIS presentation on documentation:

and Healthcare Technology need to include Patients

When I looked at the breadth of what Dell already offers its customers, the range of amazing talent, and some of their innovation projects that included

  • An impressive healthcare cloud and a focus on Interoperability
  • Patient engagement, predictive analytics, population health management
  • Social Media and mobile solutions
  • Working on Genomics Cloud Storage and analysis that included the recent announcement of the Dell and Translational Genomics Research Institute that is supporting the fight against Pediatric Cancer and helping clinical researchers and doctors globally expand the reach and impact of the world’s first Food and Drug Administration (FDA)-approved personalized medicine trial for pediatric cancer.
  • This all felt like a perfect match and one that offered me personally an incredible opportunity to have a positive impact on healthcare delivery system here in the US but also around the world.

Amongst the many bonuses of this opportunity was my friend becoming a new work colleague – I am excited to be joining Mandi Bishop (@MandBPro) – social media guru, #HealthITChick and innovator in data management and analysis.

The big draw for me was that Dell already has a vast amount of products, solutions and data along with insights that they are already integrating across multiple platforms, facilities and technologies. I can’t wait to share more on some of the projects the Dell team are working on soon.

 

 

New Horizons for me at Dell was originally published on Dr Nick – The Incrementalist

MasterChef in Healthcare: Integrating Social Media

Posted in #hcsm, #mHealth, Healthcare Technology, HealthIT, HIT, HITsm by drnic on April 15, 2015

Social Media is rapidly becoming an integral part of our lives. Despite the pervasive nature of the communication channel healthcare remains a technology laggard. This presentation from HIMSS15 Wednesday Apr 15) will offer insights to help understand why healthcare professionals should join the community, participate in the discussion and how can do so successfully.

gordon_ramsayNickasGordon

I presented this topic at HIMSS15 on Wednesday Apr 15 – you can find the listing here. As promised I am posting a summary of the points as well as a link to the Slideshare for that presentation

You can find the presentation on my slideshare (nvt) here

Master chef in healthcare- integrating social media – @DrNic1 from Nick van Terheyden

 

 

DontKNowWhichDoctor

Technology is all pervasive in our lives and Social media is everywhere – in fact in a recent survey of 3,000 people conducted in the US, UK and Germany to help counter the limited time with their physicians, patients are seeking information and embracing technology outside of the doctor’s office to come to appointments prepared. Approximately 80 percent of patients feel engaged in their own health:

  • 68 percent of patients bring a list of questions to each doctor’s consult;
  • 39 percent have checked WebMD or another online source in advance; and
  • 20 percent bring personal health data from outside monitors.

PatientsEnteringWithDigitalInformation

 

You can see some 87%o f US adults are online in this Pew internet research so if you are not on board you are missing a huge opportunity but more importantly your patients are forming an opinion about you before they meet you

 

PatientsFormedOpinion

 

 What is Social Media

  • It’s a conversation, not a lecture
  • It’s an extension of everyday interactionCollaboration
  • It’s group driven, not top-down
  • It’s messy, disorganized & hard to control
  • It’s a tool, not an end-point
  • But most of all…

 

 

If you have not already – go to twitter and sign up for an account

What to Tweet

  • What you have read that you want to share with others
  • When and where you are speaking
  • Something you post on your blog
  • A link to a Web site that you find interesting
  • Listen to conversations happening online using keywords (hashtags, lists and searches) – learn from your colleagues, friends and patients
  • Befriend people – and then earn their trust by solve problems, answering queries, helping and providing useful information
  • Share information, valuable content with them
  • Questions and Requests for information and help – crowdsourcing answers
  • At a minimum – Lurk, Listen and Learn

There are many HashTags to follow and starting by assign friends and colleagues what they follow is a a good start but then get involved – join an online chat and community and take a look at the listing of healthcare hash tags from symplur. Listed below are a few of the healthcare hash tags I follow:

#hcsm (h/c social media)
#HCLDR (healthcare leaders)
#HITsm (health IT social media)#MedEd (medical education)
#mHealth
#eolchat (end of life/elder chat)
#BCSM (breast-cancer social media)
#LCSM (lung-cancer social media)
#BTSM (brain tumor social media)
#S4PM (Society for participatory medicine)

But I received a aggregated list when I polled my followed that included all these:

Others

#QuantifiedSelf
#KareoChat
#HITChicks
#HIT
#healthIT
#hcrefor
#ACA
#ONC
#HL7
#Interop
#IoT
#HIMSS15
#POWHIT – People & Organizations improving Workflow w/HIT
#RareDisease
#foodallergy
#rheum
#bcsm
#gyncsm
#medx
#BlueButton
#patientengagement

Chats

#JACR 4th Thurs 12pm EST
#LCSM Every other Thurs 8pm EST
#BCSM Mon 9pm ET
#HCLDR Tues 8:30pm EST
#MedEd Thurs 9pm EST

and

@twubs @hashtracking or @tweetreachapp

 

My thanks to all my twitter friends who contributed

@HealthcareWen @HIMSS @lsaldanamd @sjdmd @HealthcareWen @DrJosephKim @dirkstanley @dlschermd @Docweighsin @RossMartin @CraigJoseph @RobertWahMD @ishakir @SteltsMD @JenniferJoeMD @StevenChanMD @CIBR_News @Jim_Rawson_MD @aussiclydesdale @ACRselect @AdamFuhriman @Gregmogel @ruthcarlosmd @techguy @MandiBPro @HITshrink @ahier @RandaPerkinsMD @motorcycle_guy @wareflo @susannahfox @Lygeia @ePatientDave @CMichaelGibson @Colin_Hung @annelizhannan @MelSmithJones @Paul_Sonnier @JennDennard @HIStalk @JohnNosta @2healthguru @lsaldanamd @lisagualtieri @EricTopol @ShahidNShah @DanMunro @Daniel_Kraft

 

Put yourself somewhere on the Social Media Adoption Curve

SocialMediaAdotpionCurve

 

Add LinkedIn and Facebook – they offer a different channel and voice – Facebook tends to be more social and LinkedIn tends to be more professional/business orientated

There are some good examples already out there

The Mayo Clinic has several properties and their own published guide book to social media and the University of Maryland Medical Center that has blended many channels

What Not to Do

The JAMA 2012 report Online posting of unprofessional content by medical students highlighted a high proportion of violations and problems and there are plenty of examples of people who failed use basic common sense – I personally like the 12 word Simple Social Media Policy from the Mayo

Don’t Lie
Don’t Pry
Don’t Cheat
Can’t Delete
Don’t Steal
Don’t Reveal

 

Conclusion

  • Social Media for Physicians is a Game Changer
  • Social media, when effective, will establish a physician’s brand and connect him/her with those in need of their services
  • With increased deductibles, more consumers will “shop” using social media sites.
  • Social Media will Expand the Physician’s Role with Patients
  • Social media is shaping patient encounters with physicians and that impact is expected to increase significantly
  • Extending the patient experience will foster existing patient relationships and improve patient outcomes, especially for long-term chronic conditions.

 

Where are you on the social media ladder and are you going to climb higher?

SociaMediaLadder

 

 

MasterChef in Healthcare: Integrating Social Media was originally published on Dr Nick – The Incrementalist

Connected Health and Accelerating the Adoption of #mHealth

Posted in #hcsm, #mHealth, bigdata, EMR, Health Reform, HealthIT, HITsm, Medical Devices by drnic on November 7, 2014

I attended the Connected Healthcare Conference in San Diego yesterday Accelerate mHealth Adoption: Deliver Results through Data Driven Business Models for End-User Engagement

Never has there been so much to play for in the mobile health landscape, a revolution is just round the corner with key players from the health care and consumer markets coming together to develop the mHealth industry. This Connected Health Summit will create a bridge bringing together hospitals, clinicians, providers, payers, software and hardware innovators, consumer groups and the wireless industry.

You can find the agenda here and the organizers will be publishing the presentations – there were many interesting insights

Andrew Litt, MD (@DrAndyLitt) (Principal at Cornice Health Ventures, LLC) opened the conference with a great overview of the industry and a slew of challenges and opportunities.

He sees our industry in Phase 1 – the Capture and Digitization of records and we have yet to really move and explore Phase 2:

Move and Exchnage Data AND Analyze and Manage Data that is linked to Information Driven decision Making

And Phase 3:

Managing Patient Health

In our need to move from data to analysis and information he cited a statistic from a white paper: Analytics: The Nervous System of IT-Enabled Healthcare that sadly puts 80% of data in the EMR unstructured. This is a fixable problem today with Clinical Language Understandingand we are seeing some results and a change in the industry to stop looking to doctors to be data entry clerks He also cited Hospitals:

Technology offers tremendous scope to not only fix these problems but get ahead of the problem (as is done in other industries like the Airline industry that has rebooked your flights before you even land and miss your connection). As he suggested could we use data to understand who is likely to develop a heart attack in the next 2 hours and try and change this outcome

But integrating mHealth into our workflow requires an mHealth Ecosystem:

mHealth needs an ecosystem that improves workflow and integrates data to reduce clinicians workload. This is why doctors and clinicians are resisting mHealth – they don’t like the change to the workflow that has little if any positive effect (for the doctor – they may have a positive effect for the individuals health) of reducing clinicians workload

Interesting comment on wearables and the perspective of doctors on these devices:

What bothers the doctor – mostly the people who are buying and using wearable fitness/activity trackers are the people that are young healthy fit and want to prove to (themselves/others) that they are young fit and healthy?

His graphic on Security and privacy was on the money:

Essential to balance Privacy of Health with interoperability but trust is the imperative The stats he presented were troubling (at best)

  • 96% – Percentage of all healthcare providers that had at least one data breach in the past two years
  • 18 Million – Number of patients whose protected health information was breached between 2009 and 2011
  • 60% – Proportion of healthcare providers that have had 2 or more breaches in the past 2 years
  • 65% – Proportion of breaches reported involving mobile devices
  • $50 – Black market value of a health record

The healthcare industry is under attack and is the most attacked industry today:

You might find these figures of the value of Healthcare data as it is valued on the black-market

Another interesting data point:

HIMSS records a total of 11,000 Healthcare Technology companies – less than 100 are large size and the balance of 10,900 are small business that are essentially capturing and scattering your data across many systems and data repositories…

Multiple other presentations and panelists that were all insightful. As always Jack Young (@youngjhmb) from Qualcomm Life Venture fund had some great insights – impossible to capture all of them but here are some:

Healthcare is moving out of the hospital into the home for many reasons but cost is a big driver:

and he suggested there was at least $1.5 Trillion in economic value as the industry shifts (shifting vs replacement?)

 
 

Many were surprised by his stat that users check their smart phone at least 150 times per day (just looking around my world this seems low) – in fact a quick check online suggests this is no longer valid and it is probably 221 times per day. Given this device is the one thing we will not leave home without and it now contains a range of sensors including:

  • Accelerometer
  • Gyroscope
  • Magnetometers
  • GPS
  • Cameras
  • Infrared
  • Touchscreen
  • Finger print
  • Force
  • NFC
  • WiFi/Bluetooth/Cellular

We have the potential for more passive compliance with our patients (and as many stated in their presentations likely more accurate as self reported data is notoriously inaccurate) He predicted a a 10x growth in wearables from 2014 – 2018 with 26% of this growth attributable to smart watches (I know hard to believe at this point but I think if you looked back 4 years ago the iPad had nothing like the level of penetration it does today) iPad Growth Rate

I liked his assessment of the werable market place by researching the eBay Discount against the price of the new device:

and even worse for Smart Watches

I also presented “mHealth Reimbursement – Who Will Pay: You can see it here at Slideshare or below:

mHealth Reimbursement : Who Will Pay? from Nick van Terheyden

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Getting Value from the EHR – Yes it is Possible

Posted in #hcr, #hcsm, Art of Medicine, EHR, EMR, Healthcare Technology, HealthIT, HIT, HITsm by drnic on July 18, 2014

I have the privilege of spending a lot of time on the road interacting with clinicians around the country (and world). I hear with too much frequency many doctors complaining about the Electronic Medical Record and how it fails to help them and in many cases makes their work harder. Some of this is a hangover from the past and the inadequate technology and in some cases hardware at the time In fact I’ve told this story a number of times that I can date to around 1995/6 and in this piece: Clinical documentation in the EHR

Many years ago, an excited friend who worked for one of the electronic health record (EHR) vendors at that time — it was really more of a billing and patient tracking and management system than an EHR — was desperate to show me some of their latest applications. In particular, a new module they had developed to capture clinical data. My friend pulled out his laptop, fired up the application, selected a patient and proceeded to enter blood pressure (BP). Some 20-plus clicks later, he had entered a BP of 120/80. While he was excited, I was dumbfounded. When it comes to patient care, doctors didn’t have time for 20 clicks to record BP years ago and they definitely don’t have that luxury in today’s demanding medical environment.

There is still some of that going on and not enough focus on the User Interface design and turning the technology into a barrier – this is the focus of the Art of Medicine campaign we launched some weeks ago

This article on Government HealthIT Are electronic health records already too cluttered? highlights a rising problem and one I hear about frequently. This is not just a healthcare problem and it is the focus of the work by Edward Tufte an American statistician and professor emeritus of political science, statistics, and computer science at Yale University who is well known for his books on information design which are bets acquired by attending one of his frequent courses on data visualization Here is a recent overview of visualization on the iPhone

He has a section on healthcare but many of his principles apply

For Brian Jacobs the problem was even more acute working in a Pediatric ICU:

The ICU is a very toxic and tech-laden environment….because of that, it offers the opportunity to make a lot of mistakes

As he points out much of the cutter derives form the multiple notes entered into the EHR every day. “It’s not uncommon in teaching hospitals to have six to seven notes per day on one patient, by the time the attending physician, residents, consultants, other doctors and fellows check on the patient.” So they instituted a policy of One Note per day

Actually its

It’s actually one note per team per patient per day; one giant multi-contributor note. They still may be all writing their components, but it’s one note

With a template to hold the content generated each morning by the resident and then everyone contributing to that one note, adding and amending as necessary

So in addressing the issue clutter they also addressed usability and design turning the note into a living breathing document that is updated and maintained by the team that now takes care of patients But he addressed some other important issues – especially when it comes to quality of care and the quality of the medical note

Copy Forward is subject to some warranted scrutinyfrom a billing and audit standpoint. Much of the repetitive and “clutter” in the note comes form the copying forward of past information. But:

These notes should never be the same

And as part of that message they moved to an “End-of-day note” that was a fresh summary of the patient. Add to that an updated and well maintained Problem List and integration with the billing system to allow doctors to select their code for the work carried out that day and they moved to a valuable addition to the healthcare team in delivering quality healthcare with their EHR

EHRs are: more complete, legible, accessible and can be auto-populated and searched. They can provide diagnosis codes and they’re good for billing. On the other hand, they can sometimes lack quality information and are by far, too cluttered.

I said this back in 2003 (yikes!) – The Future of Technology is already here – Who’s on Board the train and who’s left at the station. I still believe it and understand that the technology does need to get better and be more integrated into the existing workflow

The next generation of health care technology is here, with visionaries and futurists pushing the envelope to enhance, create and generate the newest cutting edge in health care delivery. Advances in technology, like advances in medicine, are a shared entity that enhances life expectancy and the quality of life.

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Patients Prefer Electronic Documentation

This Survey: Do Patients Really Care if You Use Your EHR in the Exam Room? was very revealing. It turns out contrary to the perception that the intrusion of EMR’s in the office patients prefer electronic documentation to alternatives

Most Patients Don’t Mind Electronic Note-Taking During Exams

In each case, more than 80 percent of respondents indicated they would not be bothered. On a sliding scale, patients indicated the least concern for doctors using tablets during the exam.

What was more surprising was the push back by patients on having scribes

But worst of all – recording devices

Ultimately, over one-third of patients said they’d be bothered by doctors using tape recorders to assist in charting medical notes. Specifically, patients at the furthest end of the spectrum—those who chose “would bother me a lot”—were more prevalent when it came to tape recordings than with any other method of charting during an exam.

There was a big preference to Electronic documentation at the point of care

They asked about reasons for dissatisfaction

Its not the technology that causes the dissatisfaction but in order of importance (for patients)

  • long wait times at the doctor’s office,
  • unfriendly staff
  • short duration of visits with the doctor
  • Trouble Scheduling Appointment

And coming in with a sliver of dissatisfaction at 5% “Doctor using a Computer in the exam room”

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