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“According to the Deloitte 2008 Survey of Health Care Consumers, over 70 percent of consumers want their hospital to provide online access to an integrated view of their medical information, including test results, doctor visits and hospital stays. Yet the percentage of hospitals that have deployed a true patient portal is still in the single digits.”
Article
Peter Kuhn, Acumeme, 8 October 2008
“Chilmark Research published a “PHR Market Report, Analysis and Trends” - the Executive Summary is available for free (with sharing of your details). In their blog commentary they make an relevant point.”
Article
Nick van Terheyden, Accelerating Adoption of Healthcare IT, 6 October 2008
“You might find your electronic medical record to be an efficient way to store patient data, but is that record legal? If it were subpoenaed, would it help you or hurt you in court?
These kinds of questions are emerging as more physicians go electronic. Federal Rules of Civil Procedure, approved by the U.S. Supreme Court in December 2006, not only make any electronically stored data discoverable in a trial, but also open up physicians to several new liabilities inherent in the detail electronic data provides.”
Abstract
Pamela Lewis Dolan, AMNews, 13 October 2008
“Large medical systems generally have implemented EMRs while small, independent practices have not. It’s not a government or socialism thing. That 13% EMR penetration statistic masks a huge disparity between the bulk of physicians in 1-3 person practices and the minority of physicians in large practices (or at hospitals).
The EMR problem reflects on a larger problem of fragmentation in the US medical sector that serves no purpose for the larger public interest. The Mayo clinic manages to offer some of the highest quality care in the US, does cutting edge research, has some of the lowest rates of unnecessary resource utilization, and pays its doctors a salary. Those things are not accidentally connected (well, the cutting edge research part is).”
Article
The Health Care Blog, 6 October 2008
“This recent comment about information technology implementation by a reader named Rob was so excellent it deserved re-running.
I’m a technologist. I’ve been implementing information technology professionally for 25 years. I’ve been doing EMRs for the last five. There are lots of ways this can go wrong, large or small.”
Article
The Health Care Blog, 5 October 2008
“I have published a number of previous notes about personal health records (PHRs) including a recent one about Health Vault with a reference to Google Health (see: Some Clues About the Microsoft Healthcare IT Strategy). I have come to the conclusion that there is very little future for the so-called untethered PHRs, which is to say web-based stand-alone PHRs. The only ones that will thrive are those with links to hospital EMRs such that some of the medical information contained in the hospital electronic records can be replicated to the tethered PHRs. It is impractical to suggest families will assume the onerous task of hand-entering even a small portion of their health records to a web-based system.”
Article
Bruce Friedman, Lab Soft News, 3 October 2008
“Despite the fact that we can complete our taxes and perform complex financial transactions digitally over the Internet, medical records have faced an impasse preventing a transition to the digital age. Patient charts are still paper-based in most doctors’ offices across the country.”
Article
Kevin Pho, USA Today, 1 October 2008
“I recently received a comment from a healthcare blogger, Dr. Peter Kim, in response to my note about Microsoft’s EMR product, Amalga (see: Amalga Makes Inroads in the EMR World). It raises some interesting points so I reproduce it below. You may want to take a look at Dr. Kim’s blog (see: The EMR/EHR Show). He has also blogged specifically about Google’s role in EMR development (see: Is Google The Answer To EMR?).”
Article
Bruce Friedman, Lab Soft News, 30 September 2008
“My colleague in pathology at the University of Michigan, Dr. Ulysses Balis, has taken to referring to EMRs as data shredders. What does he mean by this? The use of the term simply reflects that fact that after an LIS transmits test results to an EMR as an HL7 stream, they are reformatted based on the rules and constraints of the EMR system. The sad part about this daily scenario is that pathologists and lab medicine experts have been perfecting lab result formatting for many decades and the EMR support personnel frequently have little or no understanding about this knowledge domain. They thus turn to lab professionals for help in formatting the data that had been optimized in the LIS prior to transmission but which were then shredded by the interface and the EMR.”
Article
Bruce Friedman, Lab Soft News, 26 September 2008
“A federal panel will soon recommend that field usability be a primary goal for an electronic medical record system now in development for use in federal disaster response efforts.”
Article
Kathryn Foxhall, Government Health IT, 25 September 2008
“With the dawn of electronic medical records (EMRs) and patient portals, there is an unprecedented opportunity to provide truly collaborative patient-centred care. These tools can promote communication between healthcare providers and patients, improve chronic disease management and enable patients to become active members in the healthcare delivery system, but only if the tools work for everyone involved - including patients. Without patient consultation and input, there will be limitations in the ways in which physicians and patients are able to capitalize on these tools. Decision-makers must begin to enact their commitment to collaborative patient-centred care by engaging patients in discussions related to EMR design, implementation and use.”
Abstract
Rebecca L. Mador, Nicola T. Shaw, Stephen Cheetham and Robert J. Reid, Electronic Healthcare, 7(2) 2008: 90-92
“In Canada, the measurement of quality of healthcare has historically focused on specialized hospital-based care. Considerably less is known about the quality of care provided in the offices of primary care physicians. Primary care research has relied on data collected manually from physicians’ offices or from administrative databases. Manual data collection from paper-based patient charts in primary care physicians’ offices is costly and time consuming, and often only a small portion of the information in the charts is useable due to the lack of uniform documentation. Although data from administrative databases are more readily accessible and encompass the entire population, they are limited in their depth of clinical information.”
Article
Tezeta F. Mitiku and Karen Tu, Healthcare Quarterly, 11(4) 2008: 23-25
“At a Live Chat today with Dr. Jason Hwang co-author of The Innovator’s Prescription: A Disruptive Solution for Health Care, (Sponsored by the World Healthcare innovation and Technology Congress) I asked him how he saw the recent and fast paced developments in mobile phone applications and technology having an impact on health care.”
Article
Fred Fortin, AJFortin.com, 23 September 2008
“If one looks at the evolution of the physician’s office electronic medical record (EMR) in Canada, it is clear that the industry was spawned with an eye towards the administrative aspects of running a physician practice. It began with electronic billing which delivered the benefit of greater revenue and/or reduced costs; always a critical consideration for any business endeavor. It then evolved to include scheduling of patients as an extension of the billing process, or as a general office function.”
Article
Alan Brookstone (Eric Gombrich), CanadianEMR, 21 September 2008
“Background Web-based personal health records (PHRs) have been advocated as a means to improve type 2 diabetes mellitus (DM) care. However, few Web-based systems are linked directly to the electronic medical record (EMR) used by physicians.
Methods We randomized 11 primary care practices. Intervention practices received access to a DM-specific PHR that imported clinical and medications data, provided patient-tailored decision support, and enabled the patient to author a “Diabetes Care Plan” for electronic submission to their physician prior to upcoming appointments. Active control practices received a PHR to update and submit family history and health maintenance information. All patients attending these practices were encouraged to sign up for online access.
Results We enrolled 244 patients with DM (37% of the eligible population with registered online access, 4% of the overall population of patients with DM). Study participants were younger (mean age, 56.1 years vs 60.3 years; P < .001) and lived in higher-income neighborhoods (median income, $53 784 vs $49 713; P < .001) but had similar baseline glycemic control compared with nonparticipants. More patients in the intervention arm had their DM treatment regimens adjusted (53% vs 15%; P < .001) compared with active controls. However, there were no significant differences in risk factor control between study arms after 1 year (P = .53).
Conclusions Previsit use of online PHR linked to the EMR increased rates of DM-related medication adjustment. Low rates of online patient account registration and good baseline control among participants limited the intervention’s impact on overall risk factor control.”
Abstract
Richard W. Grant; Jonathan S. Wald; Jeffrey L. Schnipper; Tejal K. Gandhi; Eric G. Poon; E. John Orav; Deborah H. Williams; Lynn A. Volk; Blackford Middleton, Arch Intern Med. 2008;168(16):1776-1782,
“Healthcare IT does not necessarily make life easier for primary care physicians, says a leader in the movement to make medicine more efficient and patient-centered.”
Article
Richard PIzzi, Healthcare IT News, 19 September 2008
“Though a relaxation of the so-called Stark law was expected to spur hospitals to help physicians buy electronic medical records, a new study finds hospitals are moving slowly and cautiously on that score.”
Article
Bernie Monegain, Healthcare IT News, 19 September 2008
“While hospitals are evaluating strategies to help physicians purchase electronic medical records (EMRs) following recent federal regulatory changes, they are proceeding cautiously, according to findings from the Center for Studying Health System Change’s (HSC) 2007 site visits to 12 nationally representative metropolitan communities. Hospital strategies to aid physician EMR adoption include offering direct financial subsidies, extending the hospital’s ambulatory EMR vendor discounts and providing technical support. Two key factors driving hospital interest in supporting physician EMR adoption are improving the quality and efficiency of care and aligning physicians more closely with the hospital. A few hospitals have begun small-scale, phased rollouts of subsidized EMRs, but the burden of other hospital information technology projects, budget limitations and lack of physician interest are among the factors impeding hospital action. While it is too early to assess whether the regulatory changes will spur greater physician EMR adoption, the outcome will depend both on hospitals’ willingness to provide support and physicians’ acceptance of hospital assistance.”
Issue brief
Joy M. Grossman, Genna Cohen, Center for Studying Health System Change, September 2008
“Because of the burden of other ongoing hospital information technology projects, budget limitations and lack of physician interest, hospitals are not significantly taking advantage of the relaxation of federal physician self-referral and anti-kickback regulations to subsidize physician purchases of electronic medical-record systems, according to a Robert Wood Johnson Foundation-funded study released today by the Washington-based Center for Studying Health System Change.”
Article
Andis Robeznieks, Modern Healthcare, 18 September 2008
“A GP who has pioneered record sharing between GP and community teams wants to see local service providers giving interoperability a higher priority.
Dr Kambiz Boomla’s practice was the first surgery in London to trial EMIS Web, the common clinical record system from GP IT supplier EMIS. But he says plans to interoperate with hospital systems have so far failed to happen.”
Article
e-Health Insider Primary Care, 16 September 2008
“The folks at SoftwareAdvice.com recently published EHR vs. EMR - What’s the Difference?
It’s a good, but at times too high-level and could have been a bit more substantive in terms of real problems and potential solutions (but I suspect this was “landscape” summary so I can’t fault them too much). It talks about what is an EMR, EHR, and PHR from a definitional perspective and goes on to give a good summary of how often each term is used (with Google stats) and why vendors are still calling themselves EMRs.”
Article
The Healthcare IT Guy, 16 September 2008
“EMR Rankings are now available for all EMR products listed on CanadianEMR that have verified raters.
Until now, only rating information for EMRs has been published for each product. The Rankings now take into account the number of verified raters, and produce a 1 to 10 ranking based on both the average rating score and the number of raters.”
Article
Alan Brookstone, CanadianEMR, 15 September 2008
“An electronic medical records initiative will link more than 100 independent physicians affiliated with Mountain View, Calif.-based El Camino Hospital.
New Jersey-based ITelagen will provide El Camino with information technology and EMR support and services as the non-profit hospital implements EMR systems and solutions that are designed for smaller medical practices.”
Article
Molly Merrill, Healthcare IT News, 11 September 2008
“Background Web-based personal health records (PHRs) have been advocated as a means to improve type 2 diabetes mellitus (DM) care. However, few Web-based systems are linked directly to the electronic medical record (EMR) used by physicians.
Methods We randomized 11 primary care practices. Intervention practices received access to a DM-specific PHR that imported clinical and medications data, provided patient-tailored decision support, and enabled the patient to author a “Diabetes Care Plan” for electronic submission to their physician prior to upcoming appointments. Active control practices received a PHR to update and submit family history and health maintenance information. All patients attending these practices were encouraged to sign up for online access.
Results We enrolled 244 patients with DM (37% of the eligible population with registered online access, 4% of the overall population of patients with DM). Study participants were younger (mean age, 56.1 years vs 60.3 years; P < .001) and lived in higher-income neighborhoods (median income, $53 784 vs $49 713; P < .001) but had similar baseline glycemic control compared with nonparticipants. More patients in the intervention arm had their DM treatment regimens adjusted (53% vs 15%; P < .001) compared with active controls. However, there were no significant differences in risk factor control between study arms after 1 year (P = .53).
Conclusions Previsit use of online PHR linked to the EMR increased rates of DM-related medication adjustment. Low rates of online patient account registration and good baseline control among participants limited the intervention’s impact on overall risk factor control.
Abstract
Richard W. Grant; Jonathan S. Wald; Jeffrey L. Schnipper; Tejal K. Gandhi; Eric G. Poon; E. John Orav; Deborah H. Williams; Lynn A. Volk; Blackford Middleton; Arch Intern Med. 2008;168(16):1776-1782.
“Background: There is a lack of tools to evaluate and compare Electronic patient record (EPR) systems to inform a rational choice or development agenda.
Objective: To develop a tool kit to measure the impact of different EPR system features on the consultation.
Methods: We first developed a specification to overcome the limitations of existing methods. We divided this into work packages: (1) developing a method to display multichannel video of the consultation; (2) code and measure activities, including computer use and verbal interactions; (3) automate the capture of nonverbal interactions; (4) aggregate multiple observations into a single navigable output; and (5) produce an output interpretable by software developers. We piloted this method by filming live consultations (n = 22) by 4 general practitioners (GPs) using different EPR systems. We compared the time taken and variations during coded data entry, prescribing, and blood pressure (BP) recording. We used nonparametric tests to make statistical comparisons. We contrasted methods of BP recording using Unified Modeling Language (UML) sequence diagrams.
Results: We found that 4 channels of video were optimal. We identified an existing application for manual coding of video output. We developed in-house tools for capturing use of keyboard and mouse and to time stamp speech. The transcript is then typed within this time stamp. Although we managed to capture body language using pattern recognition software, we were unable to use this data quantitatively. We loaded these observational outputs into our aggregation tool, which allows simultaneous navigation and viewing of multiple files. This also creates a single exportable file in XML format, which we used to develop UML sequence diagrams. In our pilot, the GP using the EMIS LV (Egton Medical Information Systems Limited, Leeds, UK) system took the longest time to code data (mean 11.5 s, 95% CI 8.7-14.2). Nonparametric comparison of EMIS LV with the other systems showed a significant difference, with EMIS PCS (Egton Medical Information Systems Limited, Leeds, UK) (P = .007), iSoft Synergy (iSOFT, Banbury, UK) (P = .014), and INPS Vision (INPS, London, UK) (P = .006) facilitating faster coding. In contrast, prescribing was fastest with EMIS LV (mean 23.7 s, 95% CI 20.5-26.8), but nonparametric comparison showed no statistically significant difference. UML sequence diagrams showed that the simplest BP recording interface was not the easiest to use, as users spent longer navigating or looking up previous blood pressures separately. Complex interfaces with free-text boxes left clinicians unsure of what to add.
Conclusions: The ALFA method allows the precise observation of the clinical consultation. It enables rigorous comparison of core elements of EPR systems. Pilot data suggests its capacity to demonstrate differences between systems. Its outputs could provide the evidence base for making more objective choices between systems.”
Article
de Lusignan S, Kumarapeli P, Chan T, Pflug B, van Vlymen J, Jones B, Freeman GK, J Med Internet Res 2008;10(4):e27, doi:10.2196/jmir.1080
“Officials of Ochsner Medical Center say the hospital system remained open throughout Hurricane Gustav and fared better due to lessons learned from Hurricane Katrina. Officials kept the hospital’s electronic records system powered throughout Gustav’s visit.
Article
Diana Manos, Healthcare IT News, 3 September 2008
“One of the areas getting ready to grow dramatically in the near future is self monitoring. As countries face physician resource crises, patients are unable to find family physicians and chronic diseases become a greater burden on already overloaded healthcare systems, new processes and sytems will evolve to deal with the demand for care. A significant amount of chronic disease care is provided through hospital based ambulatory clinics and through other specialty clinics. However, there are only so many hands on board and providing increased face-to-face services is not always the best option.”
Article
Alan Brookstone, Canadian EMR, 28 August 2008
“Providence Healthcare Network in Waco, Texas, has completed implementing San Diego-based IntelliDOT’s Bedside Medication Administration system and has integrated it with its Epic EMR.
According to the company, this is the first implementation where IntelliDOT BMA has been integrated with an EPIC HIS.”
Article
Healthcare Informatics, 25 August 2008
“This is a Getting Started resources discussing the Slow Adoption Rate of EMR.
This discussion between Robert Gleeman and Mark Anderson, CEO of the AC Group, Inc. discusses the slow adoption rate of EMR and delves into some of the reasons behind why Doctors are not using EMR as actively as they could. This interview is also provided as a written transcription below.”
Article
Nick Harrington, EMRUpdate, 23 August 2008
“The road to connected health care is paved with complex conversations. Hospital leaders strategize with the board, bargain with vendors and negotiate with physicians, all with the goal of using information technology to improve the quality, safety and efficiency of care. To introduce an ambulatory electronic medical record, hospitals and physicians often need to talk their way from conflicting agendas to common ground. And when working with a vendor, honest communication about expectations and deliverables is needed to lay the foundation for a fruitful partnership.”
Article
Jane Jeffries, HHNMostWired, 20 August 2008
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