There is one way to measure the popularity of an EHR.
If you look at the section of Google ads on the right column of our meaningfuluseok.com website, you will see a bunch of EHRs companies advertising their goods and services.
The way Google ranks those ads gives you an idea of the popularity of the product. Google gives the first place not to those companies who pay more but to those companies whose ads attract more clicks.
I have been following the ranking of the ads for the last 2 months and there is one clear winner in popularity: PRACTICE FUSION, the free Web-based EHR that claims to have 65,000 physicians already using its free product.
Now, of course if you go to their website: www.practicefusion.com, you will learn that they have been chosen as number 1 in customer satisfaction in several categories. Not an unusual claim for a home page, but then they cite the Brown-Wilson's annual Black Book Rankings, which is a very respected survey company.
So I am inclined to believe that PRACTICE FUSION is a wavemaker.
What does this mean for the future? Will doctors be able to achieve Meaningful Use without spending a penny? Will more companies copy the model? Will ads be enough to support the model? After all pharmamoney is over 1 trillion dollars per year. That amount can certainly buy a lot of ads in free ad-based EHRs.
I don't have answers. I just have questions.
Barnaby Jara
Monday, February 21, 2011
Thursday, January 27, 2011
NEW CONCEPT - history of HIT, why?
WHY IS THE HISTORY OF H.I.T. IMPORTANT?
By Barnaby T. Jara
Capitol Community College, H.I.T.
Health Information Technology is no different than any other human endeavor. Therefore
the reasons why its history is important are the same.
The history of H.I.T. is important because:
1-We learn from our mistakes: By learning how the implementation of systems went
wrong or by learning the resistance of physicians and other personnel to some aspects
of an EHR, we will avoid those errors in the future. One excellent book that deals with
this aspect is: H.I.T. or Miss: Lessons Learned from Health Information Technology
Implementations, by Jonatha Leviss, MD.—which is a “collection of case studies of HIT
implementations that didn't go as planned, offering expert insight into key obstacles that
must be overcome to leverage IT and modernize and transform healthcare.”
2-We share a common experience that binds us together: For example we all share
experiences of how paper prescriptions were issued in the past. How sometimes those
pieces of paper were lost from the doctor’s office to the pharmacy, and the good feelings
we got when we experienced our first ePrescription.
3-We learn about our roots and why we are where we are now. When we learn about how
patient care improved in facilities where EHR was implemented, we feel proud about our
profession. We feel we are contributing to the betterment of mankind.
4-We build upon past accomplishments. Quality improvement is based on analyzing
data, and data is another word for historical facts. Whether the facts occurred years ago,
or minutes ago, data is always a representation of the past. The analysis of these data on
EHR is used to improve the products of the future.
5-We speculate about the future. By studying the changes in technology and how it has
affected healthcare, we can predict how healthcare will be in years to come. For example,
we all remember the bulky data storage of the past, and how we have evolved to the very
small data storage of the present, such as EHRs on flashdrives, by the same token we can
speculate that the data storage of the future will be no wider than the diameter of a hair,
and we can envision the possibilities.
For these reasons, studying the history of H.I.T. will help us tremendously in designing,
implementing and maintaining good electronic health records, which would provide
better care for patients, keep us employed and made us feel proud of our contribution to
society.
Barnaby T. Jara
Hartford, January 13, 2001
By Barnaby T. Jara
Capitol Community College, H.I.T.
Health Information Technology is no different than any other human endeavor. Therefore
the reasons why its history is important are the same.
The history of H.I.T. is important because:
1-We learn from our mistakes: By learning how the implementation of systems went
wrong or by learning the resistance of physicians and other personnel to some aspects
of an EHR, we will avoid those errors in the future. One excellent book that deals with
this aspect is: H.I.T. or Miss: Lessons Learned from Health Information Technology
Implementations, by Jonatha Leviss, MD.—which is a “collection of case studies of HIT
implementations that didn't go as planned, offering expert insight into key obstacles that
must be overcome to leverage IT and modernize and transform healthcare.”
2-We share a common experience that binds us together: For example we all share
experiences of how paper prescriptions were issued in the past. How sometimes those
pieces of paper were lost from the doctor’s office to the pharmacy, and the good feelings
we got when we experienced our first ePrescription.
3-We learn about our roots and why we are where we are now. When we learn about how
patient care improved in facilities where EHR was implemented, we feel proud about our
profession. We feel we are contributing to the betterment of mankind.
4-We build upon past accomplishments. Quality improvement is based on analyzing
data, and data is another word for historical facts. Whether the facts occurred years ago,
or minutes ago, data is always a representation of the past. The analysis of these data on
EHR is used to improve the products of the future.
5-We speculate about the future. By studying the changes in technology and how it has
affected healthcare, we can predict how healthcare will be in years to come. For example,
we all remember the bulky data storage of the past, and how we have evolved to the very
small data storage of the present, such as EHRs on flashdrives, by the same token we can
speculate that the data storage of the future will be no wider than the diameter of a hair,
and we can envision the possibilities.
For these reasons, studying the history of H.I.T. will help us tremendously in designing,
implementing and maintaining good electronic health records, which would provide
better care for patients, keep us employed and made us feel proud of our contribution to
society.
Barnaby T. Jara
Hartford, January 13, 2001
Tuesday, January 4, 2011
W00_24f: DOWNTIME - RESPONSE TIME - DATA SECURITY - ENCRYPTION
DOWNTIME:
Downtown period is aggravating. There are studies that show that the IT professionals don’t understand that the impact of 1 minute of downtime during the middle of the day percolates through the system throughout the day. In one example, a system went down for a minute, and the alert system did not work so the wrong medicine was given to the patient. This is important because no system has been created that does not go down. We have all kinds of solutions: buffers, redundancy, go to another server; but even with those safeguards, systems still go down. Also remember when you become totally electronic, suddenly you don’t have paper.
RESPONSE TIME:
When you hit the click button, the response time that physicians want are seconds. This problem is accentuated in remote locations where you don’t have broadband and you are still using telephone lines. In some rural counties, they had to install T1 lines at a huge cost, which, by the way, could also use the funding money. CT got 90 million dollars for broadband (don’t know why because the northeast corner is the only area not connected.). Just think what California got, with all its rural counties. Research shows that CPOE systems take 6 more minutes than by issuing orders by hand, and one of the main causes for this is low response time.
DATA SECURITY:
The cost of securing your data could be bigger than the cost of implementation. However, advances in technology are creating cheaper protection. There is a way to lay out your network for it to be secured, that’s why security is cheaper if it is included from the beginning, in your plans of network design. It is very important that infrastructures in which you put the electronic health record be secure. Although nothing is 100% secure, mainly because of human folly. The administrator goes on a one-week vacation and he writes the ID’s for the servers so they can be updated. That is a breach of security.
ENCRYPTION:
Sharing of information is protected by the TPO clause in HIPAA. To be able to run a healthcare organization, information must be shared. They use the encryption process to protect that data. Encrypted data over the lines means that only the ones who have the key are able to decode the data. The claims data that is paid both in Medicare and Medicaid also uses this encryption software. Both physical security and technical security is implemented. But even with encryption, data still can be compromised, for example by losing a laptop or with a disgruntled employee. You can’t turn humans on and off. You can increase the threshold but you cannot eliminate the risk. But on the other hand, if the information is so difficult to access it (because of so much encryption) then it loses all its value. It is a balancing act.
Downtown period is aggravating. There are studies that show that the IT professionals don’t understand that the impact of 1 minute of downtime during the middle of the day percolates through the system throughout the day. In one example, a system went down for a minute, and the alert system did not work so the wrong medicine was given to the patient. This is important because no system has been created that does not go down. We have all kinds of solutions: buffers, redundancy, go to another server; but even with those safeguards, systems still go down. Also remember when you become totally electronic, suddenly you don’t have paper.
RESPONSE TIME:
When you hit the click button, the response time that physicians want are seconds. This problem is accentuated in remote locations where you don’t have broadband and you are still using telephone lines. In some rural counties, they had to install T1 lines at a huge cost, which, by the way, could also use the funding money. CT got 90 million dollars for broadband (don’t know why because the northeast corner is the only area not connected.). Just think what California got, with all its rural counties. Research shows that CPOE systems take 6 more minutes than by issuing orders by hand, and one of the main causes for this is low response time.
DATA SECURITY:
The cost of securing your data could be bigger than the cost of implementation. However, advances in technology are creating cheaper protection. There is a way to lay out your network for it to be secured, that’s why security is cheaper if it is included from the beginning, in your plans of network design. It is very important that infrastructures in which you put the electronic health record be secure. Although nothing is 100% secure, mainly because of human folly. The administrator goes on a one-week vacation and he writes the ID’s for the servers so they can be updated. That is a breach of security.
ENCRYPTION:
Sharing of information is protected by the TPO clause in HIPAA. To be able to run a healthcare organization, information must be shared. They use the encryption process to protect that data. Encrypted data over the lines means that only the ones who have the key are able to decode the data. The claims data that is paid both in Medicare and Medicaid also uses this encryption software. Both physical security and technical security is implemented. But even with encryption, data still can be compromised, for example by losing a laptop or with a disgruntled employee. You can’t turn humans on and off. You can increase the threshold but you cannot eliminate the risk. But on the other hand, if the information is so difficult to access it (because of so much encryption) then it loses all its value. It is a balancing act.
W00_24e: CLOUD COMPUTING - ONC - GOLD RUSH
CLOUD COMPUTING:
Cloud computing could solve the problem of interoperability, costs and upgrades. Providers don’t buy the system, just the access to it, and the cloud computing company takes care of the problems. This is America, where free competition is king. The cheapest and the best technology should win out. If cloud computing is the answer, we will see more in the times ahead.
ONC:
The money from the stimulus was available on February 9, 2009. 2 billion went to the ONC to help with implementation of EHR technology. We’ve had this technology for 10 years and we kept saying, oh doctors will adapt it because it is the right thing to do, but they did not. Research shows that only 4% of physicians adapted the EHR technology, and those were usually in university settings. University physicians and hospitals are always ahead of the ballgame because they have funds for research. The goal of ONC is to change that.
GOLD RUSH:
1 out of every 5 dollars of the stimulus money is going to Health IT. You are never ever going to see such amount of money coming to IT as it has come right now. This is what some people are calling the gold rush in health IT: Stimulus funding dollars. This is the industry to be in today. 25% of the GDP in America is healthcare. It is the only industry with potential for job growth. Besides, the adoption of technology will not eliminate the need for people. They will be needed for training because technology changes every 5 years, so people will always be needed for implementation. For example: Portland has a good system. Providers go to a portal to use it but it is not being used enough because of lack of training.
Cloud computing could solve the problem of interoperability, costs and upgrades. Providers don’t buy the system, just the access to it, and the cloud computing company takes care of the problems. This is America, where free competition is king. The cheapest and the best technology should win out. If cloud computing is the answer, we will see more in the times ahead.
ONC:
The money from the stimulus was available on February 9, 2009. 2 billion went to the ONC to help with implementation of EHR technology. We’ve had this technology for 10 years and we kept saying, oh doctors will adapt it because it is the right thing to do, but they did not. Research shows that only 4% of physicians adapted the EHR technology, and those were usually in university settings. University physicians and hospitals are always ahead of the ballgame because they have funds for research. The goal of ONC is to change that.
GOLD RUSH:
1 out of every 5 dollars of the stimulus money is going to Health IT. You are never ever going to see such amount of money coming to IT as it has come right now. This is what some people are calling the gold rush in health IT: Stimulus funding dollars. This is the industry to be in today. 25% of the GDP in America is healthcare. It is the only industry with potential for job growth. Besides, the adoption of technology will not eliminate the need for people. They will be needed for training because technology changes every 5 years, so people will always be needed for implementation. For example: Portland has a good system. Providers go to a portal to use it but it is not being used enough because of lack of training.
Sunday, January 2, 2011
W00_024c: User friendly - Alert fatigue - VistA
USER FRIENDLY:
The nurses like the COWS (Computers on Wheels) better instead of the in-rooms. Provider takes time away from the face-to-face interaction. There are clinicians who don't want to do anything with the computer, but they must be motivated to incorporate it on their workflow. It all depends on how user-friendly the program is, because if it takes too much effort to use it, you better change it to an easier one. Programmers and physicians are different kind of people, so programs won't be used if not user-friendly. At University of Virginia, physicians took 6 more hours to enter the info into a CPOE, they went on strike. As technology advances, user-friendliness increases. Pretty soon doctors won't have to type in information, just talk and computers will automatically type it. But the human interaction won't ever go away, for checking the facts.
Errors by omission: you forgot to do something you should have done. Errors by commission: you knowingly did not do something.
ALERT FATIGUE:
About 5 years ago, they computerized everything and the system would tell you the interactions you are not supposed to do. But the computer kept giving alerts when doctors were working, and they were alerts that doctors did not need, so they starting switching off the alerts. That is alert fatigue. What you need to do is discern what should make the alarms go off and what shouldn't.
Technology is 10% of the problem, people is 90%.
Research indicates that with technology, doctors ask more questions and make better decisions, so the level of healthcare improves.
VistA:
Most hospitals went electronic quite a while ago, 10 or 15 years ago. But now we are talking certification, so they might be changing the system. And the hospital has to absorb that cost. These vendor-based systems come at millions of dollars. However, the VA has a free EHR system called VistA. It was created by federal dollars, therefore it is open source or free to whoever wants to use it. Mexico adopted that system, and now it is their only EHR system. And this solved the problem of interoperability. The certification takes away some of those stumbling blocks but there are still problems, which we would not have if everybody used the free VistA system, as in Mexico.
The nurses like the COWS (Computers on Wheels) better instead of the in-rooms. Provider takes time away from the face-to-face interaction. There are clinicians who don't want to do anything with the computer, but they must be motivated to incorporate it on their workflow. It all depends on how user-friendly the program is, because if it takes too much effort to use it, you better change it to an easier one. Programmers and physicians are different kind of people, so programs won't be used if not user-friendly. At University of Virginia, physicians took 6 more hours to enter the info into a CPOE, they went on strike. As technology advances, user-friendliness increases. Pretty soon doctors won't have to type in information, just talk and computers will automatically type it. But the human interaction won't ever go away, for checking the facts.
Errors by omission: you forgot to do something you should have done. Errors by commission: you knowingly did not do something.
ALERT FATIGUE:
About 5 years ago, they computerized everything and the system would tell you the interactions you are not supposed to do. But the computer kept giving alerts when doctors were working, and they were alerts that doctors did not need, so they starting switching off the alerts. That is alert fatigue. What you need to do is discern what should make the alarms go off and what shouldn't.
Technology is 10% of the problem, people is 90%.
Research indicates that with technology, doctors ask more questions and make better decisions, so the level of healthcare improves.
VistA:
Most hospitals went electronic quite a while ago, 10 or 15 years ago. But now we are talking certification, so they might be changing the system. And the hospital has to absorb that cost. These vendor-based systems come at millions of dollars. However, the VA has a free EHR system called VistA. It was created by federal dollars, therefore it is open source or free to whoever wants to use it. Mexico adopted that system, and now it is their only EHR system. And this solved the problem of interoperability. The certification takes away some of those stumbling blocks but there are still problems, which we would not have if everybody used the free VistA system, as in Mexico.
Saturday, January 1, 2011
W00_024b: US healthcare system - CPOE - CDS - data security
US HEALTHCARE SYSTEM:
The quality of healthcare in the US is not good. One of the studies that was done in 2004 by Rand Corporation-Elizabeth McGlynn (http://www.rand.org/pubs/research_briefs/RB9053-2/index1.html) reports that people only get recommended care half of the time. That's like tossing a coin: will I get good care today or not? And we spend the most of any developed nation. Our per capita expenditure is over $6000, which is at least 3 times what the closest developed country spends. In quality we are at the bottom of the developed world. And also we have 40 million people who are uninsured. After 2014, hopefully everybody will have coverage. In 1965, when Medicare was passed, the Congress was very close to actually approving universal healthcare, but they backed down and only granted healthcare for the elderly (over 65 years).
Even when technology can do a lot of things, what makes healthcare difficult is people. Human errors when putting information in, like transposing a number. CDS. Data security.
CPOE & CDS:
After a provider enters information into a certified EHR, using a CPOE (computerized provider order entry system), what if the clinician doesn't know about everything? And they don't, because the amount of information that they have to keep up with, yearly, is phenomenal. So the CDS (clinical decision support system) lets the clinician know that he should do something. For example, they are entering an order for a medication, and because there is a history of the patient in the system, an alert flashes up: THE PERSON IS ALLERGIC TO THIS DRUG. The clinician has the power to override it, but he has been warned. This technology makes care safer.
DATA SECURITY:
The data that is collected electronically can be compromised if it is not securely hosted. Technology is a good place for securing data but people who are responsible often are the weakest link. How many times how you been told not to give your password ID to anybody? Have you complied?
=================
The quality of healthcare in the US is not good. One of the studies that was done in 2004 by Rand Corporation-Elizabeth McGlynn (http://www.rand.org/pubs/research_briefs/RB9053-2/index1.html) reports that people only get recommended care half of the time. That's like tossing a coin: will I get good care today or not? And we spend the most of any developed nation. Our per capita expenditure is over $6000, which is at least 3 times what the closest developed country spends. In quality we are at the bottom of the developed world. And also we have 40 million people who are uninsured. After 2014, hopefully everybody will have coverage. In 1965, when Medicare was passed, the Congress was very close to actually approving universal healthcare, but they backed down and only granted healthcare for the elderly (over 65 years).
Even when technology can do a lot of things, what makes healthcare difficult is people. Human errors when putting information in, like transposing a number. CDS. Data security.
CPOE & CDS:
After a provider enters information into a certified EHR, using a CPOE (computerized provider order entry system), what if the clinician doesn't know about everything? And they don't, because the amount of information that they have to keep up with, yearly, is phenomenal. So the CDS (clinical decision support system) lets the clinician know that he should do something. For example, they are entering an order for a medication, and because there is a history of the patient in the system, an alert flashes up: THE PERSON IS ALLERGIC TO THIS DRUG. The clinician has the power to override it, but he has been warned. This technology makes care safer.
DATA SECURITY:
The data that is collected electronically can be compromised if it is not securely hosted. Technology is a good place for securing data but people who are responsible often are the weakest link. How many times how you been told not to give your password ID to anybody? Have you complied?
=================
W00_024a: Training grant, textbook, informatics, US healthcare system, EHR
These are random notes from the first class (Introduction to Health Care and Public Health in the U.S./The Culture of Health Care) of the federally-funded course on HEALTH INFORMATION TECHNOLOGY, which is part of the HITECH Act.
==========
HITECH TRAINING GRANT:
You are our pilot class, this is the first time we're running this class through the Federal funding. It is the same curriculum offered nationally that every State in the nation is receiving. There is a competency exam being developed by Federal Government; not ready yet. This course has been put together by the OHSU, which is the Oregon Health Science University in Portland Oregon.
You are our pilot class, this is the first time we're running this class through the Federal funding. It is the same curriculum offered nationally that every State in the nation is receiving. There is a competency exam being developed by Federal Government; not ready yet. This course has been put together by the OHSU, which is the Oregon Health Science University in Portland Oregon.
There are three grants: 1-Training. 2-Development of the curriculum 3-Development of the competency exam. You will get a certificate from the college, once you finish your courses. We don't know how the Federal Government will recognize your education.
The goal of the grant is to have 10000 new HIT professionals until 2012.
One of the kind of jobs that health IT might be generating is to assist in the selection of EHR.
TEXTBOOK
One of the kind of jobs that health IT might be generating is to assist in the selection of EHR.
There will be a group presentation because working in groups is one of the things you will need to learn if you want to be a successful HIT professional. That's why the group will be graded collectively.
TEXTBOOK
The textbook we will use is: ELECTRONIC HEALTH RECORDS, A Guide for Clinicians and Administrators by Jerome H. Carter, MD. Read it from cover to cover. You'll get standards, terminology, hardware, software. Gives you an introduction on HIT.
INFORMATICS
Informatics is just a fancy name for changing data that we collect into information, so that you can act on.
US HEALTHCARE SYSTEM
All of you have knowledge about the US Healthcare System but you may not have the lingo. The reason why we are having discussions about the US Healthcare System is because it doesn't work well for everybody. The areas we will cover are: 1-How is healthcare organized in the US. 2-How is healthcare delivered 3-How it is financed 4-Regulated, and 5-The culture of the healthcare system.
EHR:
Definition of an Electronic Health Record: The longitudinal collection of information about a patient, covering a lifetime.
Definition of an Electronic Health Record: The longitudinal collection of information about a patient, covering a lifetime.
Only 4% of the general care practices now in the US have an EHR, and 13% have something that it is close to an EHR but not there yet.
Since 2009, just having any EHR is not enough. You have to have a certified EHR. When you talk about certification, regulation is coming in. These EHRs must meet standards.
IF WE HAVE A PAPER RECORD AND WE SCAN IT, IS THAT AN EHR ALREADY? No. It is not structured data that can be searched or analyzed. It is just an image. However, there are modern scanners that can structure the documents.
==========
Barnaby
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