EMR Implementation Training

One of the things that always surprised me was the level, or lack thereof, of basic computer skills that existed within most providers’ offices. This low level of computer skills existed not only with office personnel, but also with doctors and nurses. Therefore, when implementing new computer software a lot of time was spent providing basic computer training in addition to software specific training.

With EMR implementation it’s highly critical that both medical and office personnel are trained on EMR systems. If they are not properly trained they will become frustrated, and possibly, unproductive. An unproductive doctor and/or nurse in a clinical setting is not a good thing. If that happens it could sabotaged the best of EMR implementation projects.

Keep in mind that no two providers are alike and work flow processes differ from one provider to another, here are a couple of training recommendations when providing EMR training that are applicable across the board. First, access the computer skills of everyone that will be using the new system. If basic computer training is needed, include it in your training curriculum. When providing basic computer training take nothing for granted, heck, you may have to teach keyboarding, how to operate a mouse, etc., just be prepared to get the users up to speed on the most basic of computer skills. Secondly, provide one-on-one training when feasibly possible. I found one-on-one training works best for this set of users, especially for smaller to medium sized providers. If this is not possible, try to have at least one experienced (or a well-trained user) to support every two doctors during the initial days of “go live.” And thirdly, require ALL medical personnel to attend training, even if it means night and/or weekend training sessions. This may require flexibility on your part to accommodate everyone’s schedule, but it will be time well spent to have trained doctors/nurses using the system on day one of “go live” versus doctors/nurses doing OJT on the day of “go live”...

Remember the best way to eat an elephant is one bite at a time, so save yourself a headache by implementing EMR in phases. Implement only one process at a time before turning up the next process. Because if glitches are caused by implementing an EMR system, i.e. billing, clinical, prescriptions, etc., the emergency system just may get activated (see cartoon)...

EMR Costs, Just Like Hens in a Hen House

On the heels of my last post, EMR APP for iPhone, I mentioned the cost of the EMR iPhone app was less than $200. Keep in mind EMR deployments can cost millions. In a report by the Free Library, “EMR: one hospital that got it right,” Dr. James Leo, associate chief medical officer for Long Beach (Calif.) Memorial, stated "EMR [systems] can cost hospitals $20 million to $200 million due to implementation, vendor and hardware costs, staff training, and upkeep." Smaller providers’ can expect to spend from $25,000 to $60,000 per physician to deploy an EMR system. For smaller providers this projected cost doesn't cover consulting, training, add-on-software, and upkeep.

Despite the availability of EMR iPhone apps, EMR deployment is still a costly project. For this reason, a good case can be made for EMR implementations to hire an external EMR consultant, which is not employed by the vendor, is money well spent. Go ahead, laugh. Coming from an IT professional, this is like the rooster telling the farmer he needs more chickens in the hen house, right? But for a project of this magnitude, whether it’s for a small provider’s practice or a large hospital institution, having someone on board that’s not affiliated with the vendor but has rolled out one of these systems is money well spent.

Just like the farmer will be ecstatic with the additional hens in the hen house once all of his hens are producing more eggs, providers will be happy that a set of non-partisan eyes are part of the project team when implementation challenges are encountered. As IT professionals, we know that implementation challenges will be ecountered.

Click here to read the entire article from Free Library.

EMR App for the iPhone

In a previous blog entry, “A Gadget Kind of Day” I blogged about Sling Box finally releasing the Sling Player Mobile app for the iPhone and iPod Touch. Because of my excitement to finally get a chance to watch TV on my iPod Touch, I proudly stated the blog entry had nothing do with HIT, other than possibly up selling a techno-geek physician that had to have the latest gadget. Thanks to blogger Fred Pennic of Healthcare IT Consultant Blog for his blog post on an EHR app for the iPhone.



A company in California, Caretools, have developed an award winning app, iChart, specifically designed for the iPhone and iPod Touch platforms. In addition to the charting, iChart also includes prescription, billing and lab report modules. Basically, all patient data is entered on the iPhone app, or from a web based desktop computer. Once new information is added to a patient’s record via the iPhone, the data is first stored on the iPhone and then synchronized to an iChart Web based account.

So in a nutshell, iChart is a SaaS EMR with an iPhone front-end. Therefore, the same risks identified when evaluating a SaaS EMR must be taken into consideration when evaluating this app. Also, because patient data is stored on the iPhone, in order for this app to be HIPAA compliant the dreaded iPhone password must be enabled. Honestly, do you know anyone with an iPhone that has their password enabled? However from a price standpoint, Cartetools have competitively priced the iChart app. The basic product is priced at $139.00 for the first year with an annual renewal subscription fee of $99.

Here again, for the techno-geek type provider, this app can’t miss, its way cool!! For the bread and butter type provider, a desktop anchored down in the examination room or a nice size handheld tablet is more in line.

Click here to visit Caretools' website.

Read Fred Pennic’s complete blog article here.

Healthcare Reform Noise

Since there is so much noise in the system about the troubled waters President Obama’s overall Healthcare reform package is facing, let’s not forget that Healthcare IT reform is still on pace. The previously approved federal stimulus package included about 10 billion dollars in net Medicare and Medicaid incentives for EHR adoption.

In a recent interview, the National Coordinator for Health IT, David Blumenthal, discussed timetables for electronic health record adoption with American Medical News. Blumenthal said officials are still promoting EHR adoption in an effort to meet the President’s goal of providing all U.S. residents with an EHR by 2014. He also added that his office is still working under the guidelines of the federal economic stimulus law, which imposes penalties on health care providers who do not adopt health IT tools by 2015. However, Blumenthal acknowledged the challenges facing his office and physicians to make this happen but he believes his office and the physicians are up to meeting the challenge.

EHR adoption is alive and well, so now is not the time to let up on pushing EHR solutions. When presenting to clients and the user community it’s imperative that IT professionals deliver a clear and concise message that the current noise in the system does not affect the federal requirement for EHR adoption by 2015.

Read the complete American Medical News article here.

MJ, A Case For EHR

Could EHR have prevented Michael Jackson’s allegedly abuse of prescription drugs? Saying EHR could “prevent” prescription drug abuse may be a bit far reaching, but it definitely makes it more difficult for prescription drugs to be obtained fraudulently. Before you close your browser session, navigate to another web page, or write me off as having drank the “EHR Kool-Aid,” hear me out.

There's basically only one of three ways, or a combination thereof, for a person to easily obtain and abuse prescription drugs. The abuser must either visit several different physicians to obtain several prescriptions, enlist the help of others to obtain unnecessary prescriptions written in their name that eventually gets passed on to the abuser, and/or find a physician that would write fraudulent prescriptions.

The first scenario, one person visiting several doctors, currently physicians depend on the patient to self identify their past medical and medication history. What makes scenario one plausible is that a patient can see several doctors and conveniently forgets to inform the other physician of their current medications. With EHRs, all doctors will have access to the patients’ history as reported by the patient’s providers. Since the overwhelming majority of doctors are honest, this scenario is unlikely to contribute to the abuse of prescription drugs under an EHR system.

The second scenario, multiple people obtaining unneccessary prescriptions to be later passed on the abuser. Under EHR would someone really want to risk getting a prescription for someone else, to later be possibly denied this prescription when actually needed? Or worse yet, run the risk of altering their future treatment plans because of fraudulent prescriptions in their EHR?

The last scenario a dishonest provider writing uneccessary prescriptions. Although EHRs cannot prevent a physician from writing fraudulent scripts, but because EHR captures the patient’s history, and the visibility of EHR records by other providers may deter some from being dishonest. Similarly to home alarms, if a burglar wants to break into your specific house, a home alarm system would not stop it. Just like EHR doesn’t stop a dishonest physician from writing fraudulent scripts. However, a Rutgers University study, using five years of data, scientifically proved that burglars tend to avoid homes with alarm systems. So the fear of physicians being exposed by EHR’s historical prescription data, individuals not wanting to risk their own health and treatment with fraudulent data in their EHR, and physicians would have an accurate picture of a patient’s current and past treatments would inherently would reduce the number of fraudulent scripts written hence reducing the opportunity to abuse prescription drugs.

Maybe I did have a sip, or two, of the “EHR Kool-Aid.”

Read the complete Rutgers press release here.

Click here to see HIMSS definition of HER.

For Everything Else, VistA

I haven’t hid my affinity for open source code, especially as it relates to HITECH’s requirement for providers to implement EMRs. I’ve come across an interesting article from Washington Monthly, "Code Red," that does a nice job articulating my viewpoint. This article contrasts two EMR implementations, one institution uses the much touted open source system initially written for the Veterans Administration hospitals called VistA and the other institution implemented a proprietary solution developed by Cerner Corporation.

In a nutshell, the institution that used the open source system achieved dramatic positive results, i.e. the number of medical errors and deaths decreased drastically. Whereas the institution that installed the proprietary system, experienced disastrous results, i.e. in some cases two doctors were required to attend to a patient whereas previously only one was needed and the mortality rate for certain patient populations more than doubled. Although I’m sure a similar contrast could be made extolling the virtues of using a proprietary system, however, I think this article does a good job of articulating my position overall for open source code EHR.

In addition, this article also shed light on other possible unintended outcomes resulting from HITECH requiring providers to implement EHR a such a fast pace.

Read the complete Washington Monthly article here.

A Healthy Discussion on EHRs

Medscape reported although physicians agree with the potential advantages of electronic medical records (EMRs), they are taking issue at the current administration push for EHR’s on three fronts:

1. the incentive program for providers to implement EHRs;
2. quality of existing EMR systems; and
3. the drive to put EHR on every doctor’s desk.

In the words of President Obama, there’s nothing wrong with a healthy discussion on the issues. Although I don’t agree with all three of the physicians’ reasons (reason number 2 is a valid concern), I do believe this dialogue with physicians, bureaucrats, and the IT community will yield a better solution. However, the question becomes can all of the stakeholders stomach a painstakingly long “healthy discussion?” Or will everyone pick-up their marbles and go home, then in 2012 healthcare reform will be the bat used to beat up those that supported it?

Read the complete Medscape report here.

EMR Usability, Leapfrog or IBM OS/2

I stumbled across an interesting article this afternoon on FierceHealthIT by Anne Zieger, “HIMSS says poor usability cuts EMR adoption.” In her article she basically reports that HIMSS published a paper outlining usability as one of the key reasons that will prevent EMR adoption. In their paper, HIMSS proposed that usability should become a part of the EMR certification process. HIMSS EHR Usability Task Force chair Jeffery Belden, MD stated that if certified EMRs were guaranteed to be user-friendly, decision-makers would feel more confident in selecting such systems.

What concern me are the diverse computer skills among the provider community. Some providers take to technology like a fish to water, and there are others where it’s more like forcing a kid to eat spinach. Usability testing in its purest form is generally done using black-box testing techniques, whereas the aim is to observe a random set of people using the product to discover errors and areas of improvement. If the usability test group is skewed towards the technology adverse providers, the resulting interface could end up resembling a Leapfrog educational gadget. Or if it’s skewed towards the technology favorable providers the interface could end up resembling IBM’s ill-fated OS/2 operating system, a PC operating system that was only appreciated by the most technical savvy of technologists.

Yes, I have over simplified the issue of usability certification. Surely the random collection of usability testers (providers) would be a fair representation of the skill set in the provider community. However, the criticality of assembling a “fair representation” of the provider community does give me reason to pause on the idea of usability certification for EMR applications to "guarantee" user-friendliness.

Read the complete HIMSS paper here.


Read FierceHealth IT article here.

Open Source EHR, Back On Main Street

As I’ve stated many times before in this blog, I’m a proponent of open source software. Unfortunately, the required certification needed from Certification Commission for Health Information Technology (CCHIT) in order for providers to receive EHR stimulus put open source EHR on life support. Much to everyone’s delight, well open source advocates' delight, CCHIT recently announced they were modifying the EHR certification process.

To understand why this recently announced EHR certification modification could possibly put open source EHR back on Main Street, you must first understand why the original CCHIT’s certification process impacted EHR open source. In a nutshell, the impact boiled down to two major reasons. First, the cost for CCHIT certification is significant. By nature of open source software, no one particular entity owns the source code, so the issue is not only the cost, but also who pays for the certification, providers (users) or the developers? If providers are required to pay CCHIT certification is open source EHR really free? In addition, if the provider had to pick up the CCHIT certification fee, it would be easier to justify implementing a certified proprietary EHR package. Secondly, the current certification approach supports the certification the “end-to-end” solution versus integrated solutions that could be implemented to support the “end-to-end” business process. This could force some providers into needlessly retiring previously installed proven software in favor of a CCHIT certified “end-to-end” solution.

CCHIT announced they were replacing the single certification approach with multiple certification paths. One of the new certification paths would have a simplified, low cost site-level certification path. In addition, a path was created to allow for modular certification. This would be welcomed from providers who prefer to integrate technologies from various certified sources.

Once the details are ironed out for the new CCHIT EHR certification, this has the potential of putting open source EHR back in play for smaller providers.

Read the official CCHIT announcement article here.

EHR, All or Nothing

American Medical News reported that doctors are pushing back on penalties for not implementing EHRs. The reason for this push back is because they feel it unfairly punishes physicians who can’t afford the up-front cost of adopting an electronic medical record system.

Although their reason has some validity, let’s not lose site of the end goal, nationwide EHRs. If the penalties are removed, physicians would no longer be on a timetable to have an EHR system implemented. This would slow down the nationwide adoption of EHRs which could force the nation into two separate systems. One electronic system, whereas patient’s medical information could be shared only if all providers in the patient’s vertical supply chain have EHRs. Otherwise, the analog system would be engaged, which is what we have now.

Surely at some point in your career you’ve had the misfortune of being involved with a project that has kept, or attempted to keep, the legacy system functioning while the new system makes it through one cycle of processing. Whether that’s a daily, weekly, monthly, quarterly, or annual cycle, what one quickly learn is after the new system has been operational for 4 or more hours, falling back to the legacy system is virtually impossible (riskier), or worst yet, its quickly discovered that the legacy system can NOT be turned off. Either scenario is not pretty.

The lesson that physicians must learned, that most IT professionals probably already know, is that negotiating to remove the penalties for providers that do not implement EHRs will be a zero-sum agreement, nationwide EHRs will not happen. When it comes to implementing EHRs, unfortunately you can’t “have your cake and eat it too.”

Read entire American Medical News article here.

Electronic Record Keeping?

Just like in any good corporate vision statement, marketing plan, and/or program a bare minimum requirement for a successful campaign is for everyone to speak the same language. To quote a former client, “everyone must sing from the same hymnal.” In a CNN article by John King (Cleveland Clinic pushes into future), he quoted the CEO of Cleveland Clinic, Dr. Toby Cosgrove, saying “he believes electronic record keeping—and sharing—will lead to few duplicative tests and other cost savings....” What is electronic record keeping? Surely he meant EHR, electronic health records.

“Why am I nitpicking, why is this important” you asked. First of all, Cleveland Clinic is not just some provider in obscurity in the Midwest. This clinic is often cited as a model of what healthcare reform would have other providers to do. President Obama quite often cites the Cleveland Clinic when talking about his healthcare reform package. The doctors and executive management team at Cleveland Clinic are frequently consulted by lawmakers, industry experts and others. So if anyone should have been up to par on the correct terminology for the administration’s reform package, Dr. Cosgrove should have been. Secondly, as President Obama’s healthcare plan gasps for air, it’s important that a consistent and clear message is articulated if his plan is to succeed. And thirdly, referring to EHR as electronic record keeping marginalizes the impact and complexity of electronic health records management. Just like the term “book keeping” does to “financial analysis.” The next time you see a financial analyst or an accountant for that matter, refer to them as a bookkeeper and see what happens.

As information technologists, whether you agree with the proposed healthcare reforms or not, you must be clear and consistent when addressing the topic of electronic health records. Now is not the time to cause confusion, it will come back to bite you. As you know, if systems are implemented when confusion is in the air IT is the function that usually suffers, or is blamed.

Read entire CNN article here.

The Best and Brightest

Over the weekend, I attended Yale commencement exercises to see my daughter graduate (the reason I haven’t updated my blog in a while as we prepared for family & friends from several states attending her graduation, her celebration activities, moving her out of the dorm into an apartment, etc.). I was surprised at the number of graduates that were continuing on to get their MPH, Masters in Public Health, degree. During my college days, obtaining a MPH automatically meant you aspired to be a hospital administrator or work for a state agency, not exactly a “glam” job that attracts the young, best, and brightest minds.

According to my daughter, a graduating senior that’s continuing on to get a MPH degree, the increased interest in this degree begin during the past presidential election campaign, healthcare reform was at the top of each candidate's list of issues that must be addressed my the next President. In addition, the sparkle of Wall Street was becoming dull. As promised, the current administration made healthcare reform a top priority. Now that the current administration is widely popular, young, cool, and hip, "public health" is now vogue.

Albeit, most of the young and talented minds have dreams of working in the Oval office, walking on the Whitehouse lawn with a slight swagger, and riding Air Force One advising the President but for now if the “best and brightest” could just settle the debate on what “meaningful use” means in the ARRA stipulations for receipt of funds for EHR implementation would be “cool” enough for me. But who knows, I may have unknowingly met our next Health and Human Services secretary this past weekend.

A Gadget Kind of Day

In the words of Ice Cube, "today was a good day." One of the most anticipated apps for the iPhone was finally released, SlingPlayer Mobile [read complete story in InfoWorld]. I've had my SlingBox since Decemember 2007, about 10 months later I purchased my iPod Touch for one reason, and one reason only, so I could Sling live TV on-the-go (a Wi-Fi connection is required). I'm giddy because today is the day that my “tech-toys” can finally merged. Prior to today, the only way to get SlingPlayer mobile on my Touch was to jailbreak it. Since I'm not one to "jailbreak" anything, I had to wait it out.

What does this have to do with Healthcare IT? Not a doggone thing! Wait a minute, maybe I spoke too fast. I remember my days as a system integrator when I supported small physician’s practices. There appeared to be a level of envy, or maybe jealousy, that existed among them. Such that if one brought a new BMW, the others would buy a new Mercedes or Lexus. If one hung a $5,000 piece of fine art in their office, the others would put pieces of fine art into their office. When we installed a wired network with Internet access in one doctor’s office, the others followed suit soon thereafter. You see where I going with this, right? If you're a system integrator, show off this "way cool" app to the doctor that must have all the latest gadgets, trust me, he will want this. Of course, you offer to set this all up for him. Then once he shows it off to his physician pals, the others will follow….cha-ching!!

If you have no idea what a SlingBox and/or SlingPlayer is check out the YouTube video posted by PhoneDog.com.

Open Source, Un-American

I’ve said in several blog posts that I’m a huge fan of Open Source apps, but the bill introduced by Sen. Jay Rockefeller of West Virginia on April 24 to fast track open-source electronic records, is not a good idea. Not that the use of Open Source code is bad, but to nudge everyone into using Open Source code is not the answer. The benefits outlined for using Open Source code is right on the money, but capitalism is still king in the American marketplace. To force an Open Source solution seems inherently, un-American. All the government needs to do is define the standards and then let the providers choose which vendor and/or application to implement those standards. Read more..

The only thing that’s more ridiculous than this is the legislation introduced by Rep. Joe Barton of Texas that would prevent the NCAA from calling a game a national championship unless it’s the outcome of a playoff. As much as I would like to see a NCAA football playoff, I’m sure the country has more pressing matters to be concerned with.

IT, it rolls Downhill

I was having lunch with one of my more technical savvy, or so she thinks, doctor friends the other day. Just like most physicians, she’s contemplating implementing an EMR application for her family practice. After visiting with several EMR vendors, she decided that she was going to implement an open source EMR solution because of its cost effectiveness, plus she has a longstanding relationship with her current system integrator.

Since our last discussion, someone, another vendor, had convinced her that a software as a service (SaaS) solution was the way to go. It's quite possible that a good financial case can be made for an EMR SaaS solution as opposed to other EMR solutions. But what surprised me was that she was not aware of the inherent risks of implementing this type of solution. I reminded her of when her web site hosting company closed. The frustration it caused and length of time it took to get her site back online. Actually, the bulk of the frustration came from her trying to get the source code for her site (she never had a copy). I warned her that experience would be very similar if her SaaS provider tanked, only it would be MUCH worst. After our discussion, she realized she had more work to do before coming to decision.

I begin to wonder who responsibility is it to outline the risk of the various EMR solutions to a potential customer? Should each vendor outline the inherent risk associated with their solution? Or should a physician research and understand the inherent risk involved for each possible solution? For large clinical practices and hospitals, this is not an issue because this falls squarely on the CIO, IT Director, or to the most senior ranking IT executive. However, an IT executive would be aware of the inherent risk in each solution platform and would carefully and thoroughly explained the risk to all stakeholders ;)

As the healthcare IT reforms begin to be implemented, vendors, software developers, and system integrators will merge, disappear and possibly default. "Things" will begin to roll downhill and IT will be sitting at the bottom of the hill. If the magnitude of this problem is great, that hill will be Capitol Hill. We all saw what happened to the last industry execs that visited there.

CPT Code for Computer Support

The Los Angeles Times ran a story Sunday, “Electronic Medical records have people abuzz. What’s the reality?”

“Primary care physician Matt Handley believes that information technology enables him to provide better patient care. So much so that he recently spent an afternoon hooking up a computer and DSL line at the home of a patient so he can contact him more frequently.” Click here for the complete article.

I found this to be a very good unbiased article because here lately there has been some negative chatter in the press for electronic medical record applications by a few in the medical profession. So it’s refreshing to see a “real-world” physician publicly profess their support for healthcare IT in a major news publication.

BTW, what’s the CPT code for in home visit for computer support? Dr. Handley may need it..

Demand for Healthcare IT Consultants, Bust or Boom?

In my previous blog, I stated now is a good time for HIT Integrators to align with one of the open source EMR solutions. I ran across this article from Healthcare IT News “Healthcare IT companies prepare IT consultants for EHR implementations”. Basically they are highlighting the contrasting views on what the future holds for HIT consultants.

COO Rick Jung from Medsphere, a open source provider of OpenVista – an EHR product, is “...seeing a “glut” of interest [from potential business partners that want to get certified on their open source product], which he attributes to the economic recession and the attraction of open source’s value proposition-paying for services and not tools.”

John Hummel, CTO of Perot Systems’ Healthcare Group had a different twist, “The number of people who have completed successful electronic medical record implementations is few and far between….. Perot Systems created its Healthcare Academy a few years ago to train college graduates around the globe. The program has achieve a 100 percent placement rate….”

I’m not sold they have polar opposite opinions, heck I'm not sold they even have different opinions. My read on this article is if you’re a college graduate with a desire to learn about EMRs, there will be opportunities galore for those individuals. However, if you’re an experienced EMR professional and possibly an independent consultant, you may have a difficult time landing a contract because of competition in the marketplace. One exec addressed the employment landscape from a college graduate perspective and the other exec addressed it from an experienced professional point-of-view. They each addressed different segments of the market, not so much that they have different views of what the impact the demand of EHR will have on the marketplace.

Once the government establish the timeline for EHR implementation, the demand for HIT consultants will definitely increase. However, will the marketplace have a gluttony of EMR skills or will it have a shortage, no one knows. However, increase demand does bring about new opportunities.

Opportunity Awaits, Open Source EMR

Linux, MySQL, PHP, Joomla, Audacity, the list goes on. I love open source technologies and applications. The lure of an open source medical practice software package is its price, FREE and there are several packages to choose from:

OpenEMR - a free medical practice management, electronic medical records, prescription writing, and medical billing application.
MirrorMed - a web-based application that is capable of running a healthcare practice. MirrorMed shares code with FreeMED, and OpenEMR.
FreeMED - GPL-licensed Electronic Medical Record and Practice Management system for medical providers that runs in any web browser in multiple languages. It provides an XML-RPC backend and multiple import and export formats, as well as reporting and other features.

The concern, or opportunity, with open source EMR applications for small physician practices is ongoing support. During the early 90s in my professional career as a regional IT Integrator we installed Linux running SAMBA fileserver in small offices. At that time, if a small business wanted to install Windows NT server along with the appropriate license fees cost an “arm and leg”, so to say the least we did VERY well. What I learned during this time was most small businesses had a brother, brother in-law, a kid in high school, nephew, or some other family member that provided basic computer support, i.e. adding users, shares, etc. However, Linux wasn’t a OS that was being discussed in A+ training classes, nor discussed in basic networking classes and only the most geeky of brother in-laws even knew how to pronounce Lin-us, oops, I meant Linux. So after implementation, these small offices had to contact us, or should I say contract with us, for ongoing support. In most cases, even with the ongoing support fees, the Total Cost of Ownership (TCO) was still much less than the TCO of Windows NT Server and the appropriate license fees over a 3 year lifespan. This was a WIN/WIN scenario for both the supplier and client.

But we did have a subset of clients that were upset their TCO were more than the intial cost of implementing the solution because of ongoing support costs. Although the ongoing support fees were explained upfront prior to implementation, this subset of clients believed their “family hackers” would be able to give them free support as they have always done. When their displeasure with our support fees drove them to seek another vendor there was none in the area that was familiar enough with Linux to support it, and there was no manufacturer to call because it was an open source product, so in a way we were the only ones that could assist them.

In any case, as the face of Healthcare IT radically changes, and with the federal government stimulus package earmarking loans and grants for providers to deploy e-health records, now is the time for savy IT Integrators to develop a niche market using open source EMR applications.

Healthcare IT War Games

Over this past weekend, MIT, Columbia, Northwestern, and Penn business schools competed in Fuld and Company War Game simulation. This year’s theme was “The Battle for Healthcare Information.” One of the predictions, among several reached during the war game, was that most prominent companies in the healthcare information technology and healthcare delivery industries, including Microsoft, McKesson, Kaiser-Permanente, and Allscripts, will quickly move to create alliances and in certain cases merge with their rivals—to take advantage of the government push to adopt EMRs. Click here for details.

The last time I checked, Microsoft doesn’t merge with anyone. Once Microsoft set their sight on a company, they will either buy the company (i.e. Visio) or squash the company (i.e. Netscape). My concern is if Microsoft becomes one of the major players in shaping the new healthcare IT paradigm, would the best solution emerge? I’m not bashing Microsoft, but Microsoft is responsible for creating value for its shareholders and they have the clout and resources to bully everyone in such an alliance. Basically for me what it balls down to is, can Microsoft be trusted to act in the best interest of the greater good in such an alliance?

$51.80 A Day For Internet Service

For the long Easter weekend, I took team Henderson on a little road trip to Niagra Falls. We stayed at Embassy Suites Niagra Falls – Fallsview, not a five star hotel brand, but a solid brand for a family retreat. So I never would have thought getting an Internet connection, correction, a wireless Internet connection, at an Embassy Suites would have been problematic. However, among other issues (a condescending front desk clerk, wireless connection only in the atrium area of a 42 story hotel, just to name a few of the other issues), the hotel's procedures does not allow for a guest to connect more than 1 device wireless without ponying up an additional $12.95 for the additional device. So for my family of four traveling with 3 laptops and an iPod Touch, the cost for Internet service would have set me back $51.80 per day ($12.95 per device per day to allow for simultaneously wireless connection), if I allowed everyone to have wireless Internet access. So is $51.80 the going price for wireless Internet access when a family of 4 travels? If so, I'm in the wrong business.

If you think the $51.80 Embassy Suites was asking me to pay for my family of 4 would never happen for a business traveler, not so quick, Grasshopper. Let say two healthcare professionals attend an out-of-town training class. Because of their institution's travel policy, they room together. In addition, each employee has a laptop and an iPod Touch loaded with medical apps. That’s 4 devices among the 2 of them needing wireless wi-fi access. If this training class is taking place at Embassy Suites Niagra Falls, it would cost them $12.95 per day per device, in other words, $51.80 per day for Internet service the same as I would have paid for my family of four to have wireless Internet service.

Yes, I know there were ways I could have circumvented the process and got everyone wireless Internet service with only incurring the $12.95/day charge, i.e. an Apple Airport Express would have worked nicely in this situation. The point here is, currently in healthcare IT we’re fighting over EMRs, EHRs, and PHRs standards, Google and Microsoft fighting the government over HIPPA privacy laws for their PHR apps, which mobile healthcare apps really add value, and the list goes on. However, the real question is, is the basic infrastructure needed in place and easily accessible to fully utilize and leverage the things we're currently debating? I understand what happened to me at Embassy Suites isn't the typical "textbook case" of broadband inaccessibility, and my theoretical scenario is just that, theoretical. But what it does highlight, broadband Internet service is far from being a commodity service. In order for healthcare IT to deliver on the projected efficiencies in the healthcare industry, broadband must be easily accessible under all, except the most far-flung, scenarios just like broadcast television and telephone service is today. Do you really want to receive a call every time a physician and/or other healthcare personnel you support needs help setting up an Apple Airport Express in their hotel room?

It's EHR, not EMR, To The Rescue

While sitting in the dentist office the other day, I perused an April 6, 2009 issue of Time magazine. The article that got my attention was “Wrong Prescription” by Scott Haig, M.D. He made a couple of points, if not totally inaccurate, they were a far stretch from practicality. So much so, that I finally decided it was time for me to start my Healthcare IT blog, an idea that I've been tossing around for about a year.

In his viewpoint article, he ascertains “that the Obama administration thinks it has discovered a magic bullet in the drive to lower health-care costs: electronic medical records (EMR).” Firstly, the current administration plan calls for the implementation of Electronic Healthcare Records (EHR) not EMRs. The media toss these two terms around interchangeably however there is a difference. Electronic Medical Records vs. Electronic Health Records: Yes, There Is a Difference, a HIMSS Analytics white paper by Garets and Davis described it best, “the EMR is the legal record created in hospitals and ambulatory environments [or any provider's environment] that is the source of data for the EHR. The EHR represents the ability to easily share medical information among stakeholders and to have a patient’s information follow him or her through the various modalities of care engaged by that individual. Stakeholders are composed of patients/consumers, healthcare providers, employers, and/or payers/insurers, including the government.” The EMR is for a specific provider's entity and EHR is to be shared. This ability to share a patient’s EHR among the various stakeholders is where efficiencies are gained, hence lower health-care costs.

Secondly, Dr. Haig suggested that an EMR will make it easy for a physician to create hyped-up diagnoses and inflated bills. An EMR will not make it any easier for a physician to create a hyped-up diagnosis than a blank prescription pad does. For providers that want to partake in fraudulent activities, an EMR application will not stop it, just like a copy machine doesn’t stop a person from producing fraudulent documents. So should progress in this area be stopped just because of what a small minority of sinister providers may do? I think not.

Basically, the majority of research does suggest implementation of EHR will lower health-care costs. In 2005, Health Affairs published a study, “The Value of Health Care Information Exchange and Interoperability” by Walker, Pan, Johnston, Adler-Milstein, Bates and Middleton which summarized net savings from national implementation of a fully standardized interoperability between providers and five other types of organizations [EHR] could yield $77.8 billion annually.


The bottom line is this, if we are to deliver higher quality, safer, health care at reduced costs, digital records are needed to help both providers and suppliers achieve this lofty goal.