Besides the obvious, social media seems to have many ways inside healthcare institutions. Is that good thing or not?
Strong popularity' of social media seen at U.S. providers
http://healthcareitnews.com/news/strong-popularity-social-media-seen-us-providers
Though many people are utilizing social media, "one-third use it as a part of their professional obligations."
As the article points out, "one-third of institutions do not allow access to social media for employees, typically due to security issues and concerns about employees’ productivity. The majority of institutions that allow access to social media employ some policies to control that access."
I always state that without a clear and define security policy, social media utilization would be high. Now, I am not saying that social media is bad but rather institutions should set parameters so that it is beneficial for all stakeholders (including the institution; the article points out about marketing and name recognition through social media).
At the end, social media is a double edge sword. It could help as well as hurt a company depending upon how it is used. At the end, I have to keep a policy definition of how social media would be used.
Saturday, September 10, 2011
Friday, September 9, 2011
Physicians Could be Graded!!!
One new update from one vendor caught my eye.
How would it be nice to see your doctor's grade?
http://healthcareitnews.com/news/vendor-notebook-athenahealth-launches-real-time-physician-performance-dashboard
"Athenahealth has launched a new online dashboard to provide clear visibility into the performance of physicians on the athenahealth network against meaningful use criteria.The regularly-updated dashboard offers insight into how the thousands of providers currently participating in athenahealth’s reimbursement program are progressing toward meeting Medicare meaningful use measures. Through its cloud-based EHR, with providers sharing a single instance of software, athenahealth has a real-time view into how its providers are performing, enabling the company to identify client pain points and focus its array of client services on addressing these challenges for all clients on the network."
The only issue is how the performance is measured. As long as the definition of measurement are clear and concise, it will help us hold physicians "accountable" in taking care of their patients (proper diagnosis, time waiting, repeat visits, etc.)
How would it be nice to see your doctor's grade?
http://healthcareitnews.com/news/vendor-notebook-athenahealth-launches-real-time-physician-performance-dashboard
"Athenahealth has launched a new online dashboard to provide clear visibility into the performance of physicians on the athenahealth network against meaningful use criteria.The regularly-updated dashboard offers insight into how the thousands of providers currently participating in athenahealth’s reimbursement program are progressing toward meeting Medicare meaningful use measures. Through its cloud-based EHR, with providers sharing a single instance of software, athenahealth has a real-time view into how its providers are performing, enabling the company to identify client pain points and focus its array of client services on addressing these challenges for all clients on the network."
The only issue is how the performance is measured. As long as the definition of measurement are clear and concise, it will help us hold physicians "accountable" in taking care of their patients (proper diagnosis, time waiting, repeat visits, etc.)
Wednesday, September 7, 2011
Preparation is Key!
I enjoy this article and how the world needs to expect when they are getting set to deploy a project.
The 7 Deadly Sins of EMR Implementation
http://www.healthcareitnews.com/news/7-deadly-sins-emr-implementation
As the article points, signing the dotted line and going forward with eMR (or eDR) is not the final step but just the beginning. Understanding the process will help achieve a smoother transition and deployment.
Key Points the articles makes of being a deadly sin:
1) Not doing your homework:
As the article points out:
"Avoiding supplier problems means background research and thorough evaluations of vendors and products. And beware: vendors tend to make promises they can't keep."
I hate overpromises but no delivery. So you should check with your association of professionals on "reputation" and success.. It is always know the strength and weakness of the software
2) Assuming the EMR is a magic bullet
I always state that it is not the end all of everything. As the article points out, it is change of doing business. Not necessarily an improvement.
The best quote I got:
"Most people think an EMR solves problems," he said. "But an EMR will only amplify problems that already exist in the practice."
3) Not including nurses in the planning stages
Stakeholders!!!!
4) Not participating in training
Big one that they read the manual and just do it
5) Thinking you can implement the same processes as paper
I get this the most that why can't we do it in paper? I state that you could but do not expect it to be efficient nor optimal (especially if one employee who is critical on the process get sick)
6) Not asking for extra help
Doctors are smart but they got a mentality that they know everything. They are doctor in their field but not necessarily in computers. They have "pride" to not ask... It is important to know your limitation and ask. The problem could be a quick fix instead of a longer, time consuming solution that could save you more money
7) Being short sighted
As the article points out, "(according to Waldren,) it's important to find an EMR that supports not just the current healthcare industry, but what the industry will soon become."
I have seen doctors go with the cheaper solution only to purchase another solution and pay twice for the same thing (let alone time lost and utilized)
At the end, you need to know what you are buying.. You get what you buy...
As for me, I focus on these pitfalls for the doctors and most of our solutions have been successful.. Not only knowing the strength but the limitations.
The 7 Deadly Sins of EMR Implementation
http://www.healthcareitnews.com/news/7-deadly-sins-emr-implementation
As the article points, signing the dotted line and going forward with eMR (or eDR) is not the final step but just the beginning. Understanding the process will help achieve a smoother transition and deployment.
Key Points the articles makes of being a deadly sin:
1) Not doing your homework:
As the article points out:
"Avoiding supplier problems means background research and thorough evaluations of vendors and products. And beware: vendors tend to make promises they can't keep."
I hate overpromises but no delivery. So you should check with your association of professionals on "reputation" and success.. It is always know the strength and weakness of the software
2) Assuming the EMR is a magic bullet
I always state that it is not the end all of everything. As the article points out, it is change of doing business. Not necessarily an improvement.
The best quote I got:
"Most people think an EMR solves problems," he said. "But an EMR will only amplify problems that already exist in the practice."
3) Not including nurses in the planning stages
Stakeholders!!!!
4) Not participating in training
Big one that they read the manual and just do it
5) Thinking you can implement the same processes as paper
I get this the most that why can't we do it in paper? I state that you could but do not expect it to be efficient nor optimal (especially if one employee who is critical on the process get sick)
6) Not asking for extra help
Doctors are smart but they got a mentality that they know everything. They are doctor in their field but not necessarily in computers. They have "pride" to not ask... It is important to know your limitation and ask. The problem could be a quick fix instead of a longer, time consuming solution that could save you more money
7) Being short sighted
As the article points out, "(according to Waldren,) it's important to find an EMR that supports not just the current healthcare industry, but what the industry will soon become."
I have seen doctors go with the cheaper solution only to purchase another solution and pay twice for the same thing (let alone time lost and utilized)
At the end, you need to know what you are buying.. You get what you buy...
As for me, I focus on these pitfalls for the doctors and most of our solutions have been successful.. Not only knowing the strength but the limitations.
Tuesday, September 6, 2011
Apple iPad Becoming more Universal
As Apple iPad become more mainstream, the application of utilizing it seems to be the norm..
Patient Check-in Moves to iPad
http://www.healthcareitnews.com/news/patient-check-moves-ipad
As the article writes, iPad is becoming the primary device for sign-in machine in hospital.
"Just three weeks after its iPad-native EHR made news for gaining ONC-ATCB-certification, drchrono has launched an iOS app to replace paper-based patient check-in."
As the article states, it is to optimize the sign in by letting the patient "do it themselves" and update their profile according like their photo profile and changes to their medical history.
Instead of it being on paper to write, they would take the information in. Again, the article states it best:
"That saves "time and money" says Nusimow. "Putting in insurance info and all that minutiae takes a lot of time." With medication and allergies pre-entered, "the next time [patients] go to the doctor, they can just engage with the doctor."
As for me, it is important to see how any device could apply into any client or business. Then it was the handheld device. Now, it is the iPad. Lastly, it is important to understand the capability. I do not think the iPad could do tremendous amount of calculation but it could be utilize for certain aspect of the practice.
Patient Check-in Moves to iPad
http://www.healthcareitnews.com/news/patient-check-moves-ipad
As the article writes, iPad is becoming the primary device for sign-in machine in hospital.
"Just three weeks after its iPad-native EHR made news for gaining ONC-ATCB-certification, drchrono has launched an iOS app to replace paper-based patient check-in."
As the article states, it is to optimize the sign in by letting the patient "do it themselves" and update their profile according like their photo profile and changes to their medical history.
Instead of it being on paper to write, they would take the information in. Again, the article states it best:
"That saves "time and money" says Nusimow. "Putting in insurance info and all that minutiae takes a lot of time." With medication and allergies pre-entered, "the next time [patients] go to the doctor, they can just engage with the doctor."
As for me, it is important to see how any device could apply into any client or business. Then it was the handheld device. Now, it is the iPad. Lastly, it is important to understand the capability. I do not think the iPad could do tremendous amount of calculation but it could be utilize for certain aspect of the practice.
Monday, September 5, 2011
Open Source for Patient Records
This is the great question of eDR and eMR... Will it ever be open source? At least it seems like it is going that way to a point.
http://www.healthcareitnews.com/news/va-cio-when-we-get-it-done-it-will-be-open-source
VA Offices state that they will be open source after their implementations.
"VA is developing an open source track to modernize its VistA electronic health record and will incorporate the approach with DOD in the joint system. DOD has become more excited by open source and “sees it as a strong contributor as we move ahead,” said Roger Baker, VA CIO.
How did they reach the objectives? By making the vendors comply with the institutions.
"VA and DOD are also requesting that vendors with proprietary standards move them into the public domain or assure that they are publicly available if they want to be used so that both departments can rely on them to communicate and exchange information."
That is a big step but the question is to what extent with vendors do that? Will the private sector head that direction? I believe once a mandate has been established, records will head to that direction.
One thing of concern is that my selection of technology to apply into offices have to be thought out. My analogy is getting BetaMax instead of VHS.. Token compare to Ethernet. Trying to ensure that the technology gets it ROI and minimize re-investment of technology into my clients and my company.
VA CIO: 'When we get it done, it will be open source'
http://www.healthcareitnews.com/news/va-cio-when-we-get-it-done-it-will-be-open-source
VA Offices state that they will be open source after their implementations.
"VA is developing an open source track to modernize its VistA electronic health record and will incorporate the approach with DOD in the joint system. DOD has become more excited by open source and “sees it as a strong contributor as we move ahead,” said Roger Baker, VA CIO.
How did they reach the objectives? By making the vendors comply with the institutions.
"VA and DOD are also requesting that vendors with proprietary standards move them into the public domain or assure that they are publicly available if they want to be used so that both departments can rely on them to communicate and exchange information."
That is a big step but the question is to what extent with vendors do that? Will the private sector head that direction? I believe once a mandate has been established, records will head to that direction.
One thing of concern is that my selection of technology to apply into offices have to be thought out. My analogy is getting BetaMax instead of VHS.. Token compare to Ethernet. Trying to ensure that the technology gets it ROI and minimize re-investment of technology into my clients and my company.
Saturday, September 3, 2011
Is Centralized Patient Record the Solution?
As I go back to the importance of Patient Records, the question were addressing the critical question as shown in the title...
We see the benefits but there comes a lot of concerns:
One Medical Journal speaks of the matter and centralized or non-centralized (or they call demand aggregation).
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068075/?tool=pubmed
Some of the concerns and issues are:
1) Security in terms of access, modification, and lost
"For many years, the authorities have understood the risk of losing all of the data of a centralized system if the system is destroyed."
Meaning that if he destroy the brain, the body will be lost. Their analogy of comparing the ARPANET and the defense mechanism was to have a "independent but heads" network. So if one head is out, they still have other heads to execute objectives. In laments term, there is no one central spot if destroyed would place the system below life support. Also, the question is authority (Security, privileges) and who has access becomes a great issue since the user level is on a national level.
Another note is what about changes to the data... Concurrency issues are increased since there are more users who could access, modify, and write.
2) Lack of flexibility and maintenance
Since most organization has the standardization of terminology, does the coding have to be "standardization"? That is the question... Some would argue it would make everything easier but when there are many various organization, groups, and associations that dictate the standardization for their industries. When there is a conflict, who dictate the standardization? Since a platform has to be universal, cost of upgrade, maintenance, and performance could be extremely high. This is why I believe universal interface will be emphasized (and pay as a service like cloud computing services)
3) The infrastructure investment is higher. The argument (the journal) is that dedicated service is not better than on-demand.
"Finally, to maintain the completeness of the EMR, every single actor has to be connected to the centralized system to notify it of every single operation he makes. Regarding the case of drug prescriptions, for example, the regulation of traffic load and security could be very difficult to manage."
The workload to change instantly, would require a bigger investment in capital, human capital for performance and maintenance, and protection and monitoring
The other listed are in addition to the article that came up when thinking and analyzing
4) Operational and Procedure issue. Will the data generate locally and poll into the database? Instantly? You see the issue on how the national EMR database is utilized with produce another set of question (as well as contingency plan issue when a disaster occurs). Added the issue of HIPAA and how the data is made, sent, or changed is questionable.
5) Unwarranted access and cost to the patient (like insurance). With a complete patient record, insurance and other parties could charge a higher premium because they could base it on your whole record. (See it like credit report could generate a higher premium even if the information is right or wrong. Another example, higher premium because you are in higher incidents though no fault of your own.) There are a lot of ethical question in have a patient profile and potential denial of service (higher concern and liability though treatment might be crucial).
These are some concerns and the importance is how important that data is, who has access, how they utilize the data, and checks and balance. If those could be addressed, some of the issues could clear itself out. But they are not defined nor explained and this "quasi" standard will not resolve the issue at hand.
We see the benefits but there comes a lot of concerns:
One Medical Journal speaks of the matter and centralized or non-centralized (or they call demand aggregation).
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068075/?tool=pubmed
Some of the concerns and issues are:
1) Security in terms of access, modification, and lost
"For many years, the authorities have understood the risk of losing all of the data of a centralized system if the system is destroyed."
Meaning that if he destroy the brain, the body will be lost. Their analogy of comparing the ARPANET and the defense mechanism was to have a "independent but heads" network. So if one head is out, they still have other heads to execute objectives. In laments term, there is no one central spot if destroyed would place the system below life support. Also, the question is authority (Security, privileges) and who has access becomes a great issue since the user level is on a national level.
Another note is what about changes to the data... Concurrency issues are increased since there are more users who could access, modify, and write.
2) Lack of flexibility and maintenance
Since most organization has the standardization of terminology, does the coding have to be "standardization"? That is the question... Some would argue it would make everything easier but when there are many various organization, groups, and associations that dictate the standardization for their industries. When there is a conflict, who dictate the standardization? Since a platform has to be universal, cost of upgrade, maintenance, and performance could be extremely high. This is why I believe universal interface will be emphasized (and pay as a service like cloud computing services)
3) The infrastructure investment is higher. The argument (the journal) is that dedicated service is not better than on-demand.
"Finally, to maintain the completeness of the EMR, every single actor has to be connected to the centralized system to notify it of every single operation he makes. Regarding the case of drug prescriptions, for example, the regulation of traffic load and security could be very difficult to manage."
The workload to change instantly, would require a bigger investment in capital, human capital for performance and maintenance, and protection and monitoring
The other listed are in addition to the article that came up when thinking and analyzing
4) Operational and Procedure issue. Will the data generate locally and poll into the database? Instantly? You see the issue on how the national EMR database is utilized with produce another set of question (as well as contingency plan issue when a disaster occurs). Added the issue of HIPAA and how the data is made, sent, or changed is questionable.
5) Unwarranted access and cost to the patient (like insurance). With a complete patient record, insurance and other parties could charge a higher premium because they could base it on your whole record. (See it like credit report could generate a higher premium even if the information is right or wrong. Another example, higher premium because you are in higher incidents though no fault of your own.) There are a lot of ethical question in have a patient profile and potential denial of service (higher concern and liability though treatment might be crucial).
These are some concerns and the importance is how important that data is, who has access, how they utilize the data, and checks and balance. If those could be addressed, some of the issues could clear itself out. But they are not defined nor explained and this "quasi" standard will not resolve the issue at hand.
Friday, September 2, 2011
Let's talk about Adaptive Diaster Recovery
Coming into Thursday, I had a full load of appointments to run some updates and upgrades. Then the dreaded emergency call.. The 7:48am call and voicemail that abruptly woke my wife and I up.... Checking out, the call was from one of my clients in Albany (2.3-3.5 hour drive).
Add Murphy's Law with my Internet being down, it seems like today is not going to be a good day.. Luckily, the disaster was not as much of a disaster after executing an actual disaster recovery plan..
Though the disaster recovery took 3 hours (most of my recovery go from 15 mins to 5 hours depending upon the type of back up solution, type of disaster, and amount of data that needs to be restored), we had a partial recovery... Well, it was more like 99.999% because the software corrupted one data file and the last time stamp on CDP backup was on 11:00am (so we lost all the data changes on that file from 11:00am to 4:00pm).. Talk about griefs of all the data entry changes that was lost for that file (it is one of the most heavily used files). Secondly, why was there no other updates or changes?
So we went back to our DRP plan (though this was not a drill, they have experienced and tested it out)... And here we get to the article and additional notes to consider the disaster plan:
Do You have a Disaster Recovery Plan (DRP)?
http://netsecurity.about.com/od/disasterrecovery/a/Do-You-Have-A-Disaster-Recovery-Plan-DRP.htm
Add Murphy's Law with my Internet being down, it seems like today is not going to be a good day.. Luckily, the disaster was not as much of a disaster after executing an actual disaster recovery plan..
Though the disaster recovery took 3 hours (most of my recovery go from 15 mins to 5 hours depending upon the type of back up solution, type of disaster, and amount of data that needs to be restored), we had a partial recovery... Well, it was more like 99.999% because the software corrupted one data file and the last time stamp on CDP backup was on 11:00am (so we lost all the data changes on that file from 11:00am to 4:00pm).. Talk about griefs of all the data entry changes that was lost for that file (it is one of the most heavily used files). Secondly, why was there no other updates or changes?
So we went back to our DRP plan (though this was not a drill, they have experienced and tested it out)... And here we get to the article and additional notes to consider the disaster plan:
Do You have a Disaster Recovery Plan (DRP)?
http://netsecurity.about.com/od/disasterrecovery/a/Do-You-Have-A-Disaster-Recovery-Plan-DRP.htm
Like my previous post, the article hits the same detail with a little more in depth of defining the critical files, how to backup, your plans, downtime, etc. For some, it might be enough. But even with a decent thought out plan, there some things you can't control..
What was the problem was the application software actually generated a corrupted the file but was still accessible and "functional". But due to the corruption, it was not write-able on the backup at 6pm (though I am trying to figure how it was read, access, and modified).
Like GIGO (garbage in, garbage out), the corrupt could be updated into your data set and you have a problem (depending upon type of backup). Also, since the application did not warn of any problem, the error on the file could potential crash the software at any time....
As the article points:
"Whichever method you choose, make sure you set a schedule to backup all your files at least once weekly, with incremental backups each night if possible. Additionally, you should periodically make a copy of your backup and store it off-site in a fire safe, safe deposit box, or somewhere other than where your computers reside. Off-site backups are important because your backup is useless if it's burned up in the same fire that just torched your computer."
Even with the setup, we would have to go back to the last "complete" backup (which would have been the day prior). But all the entry on the other aspect of the software is lost... So you see the issue at hand... What would you do?
The amazing thing that is forgotten in all disaster plan is Know your tools at hand.. The software has an amazing audit trail of all entries (update/delete) and since that file did not get damaged.. You could "duplicate the error". Could we go back 1 day prior? Yes, with just one file, it was not worth going back 1 whole day. It was best to back half-day and "rebuild and data enter" the data set to the current.
As the article states:
Additionally, there was a contingency plan to consider how the office will function without data. Luckily, they are keeping some form of hard copy and they have electronic journal in the software. Both would have worked and they were able to back track the information.
Lastly, they had accounting tools at hand from the day prior, and the audit trail verified the numbers and was no issue. The software support added the last tools to ensure the data is not corrupted in other aspect and the team confirmed the entries were correct. Though a lot of mental and time-consuming validation. They were up in 3 hours!!!!! Added this involved multiple stakeholders.
What impressed me was that the CDP provided all increments and differential on the file (except the time of corruption). They do not back up every second but they update 1-2 hours or no activity.
Though I was not back for my whole day appointment til 9:00am (yes, I had a 24 hours work day schedule), I am glad that the office had a disaster, respond to the disaster, and execute their plan flawlessly... Lastly, any out of control matter... We just managed it and develop a solution with some thought and executed it... That is adaptive and creative thinking..
"Whichever method you choose, make sure you set a schedule to backup all your files at least once weekly, with incremental backups each night if possible. Additionally, you should periodically make a copy of your backup and store it off-site in a fire safe, safe deposit box, or somewhere other than where your computers reside. Off-site backups are important because your backup is useless if it's burned up in the same fire that just torched your computer."
Even with the setup, we would have to go back to the last "complete" backup (which would have been the day prior). But all the entry on the other aspect of the software is lost... So you see the issue at hand... What would you do?
The amazing thing that is forgotten in all disaster plan is Know your tools at hand.. The software has an amazing audit trail of all entries (update/delete) and since that file did not get damaged.. You could "duplicate the error". Could we go back 1 day prior? Yes, with just one file, it was not worth going back 1 whole day. It was best to back half-day and "rebuild and data enter" the data set to the current.
As the article states:
- Support phone numbers (for ISP, PC manufacturer, network administrators, tech support)"
Additionally, there was a contingency plan to consider how the office will function without data. Luckily, they are keeping some form of hard copy and they have electronic journal in the software. Both would have worked and they were able to back track the information.
Lastly, they had accounting tools at hand from the day prior, and the audit trail verified the numbers and was no issue. The software support added the last tools to ensure the data is not corrupted in other aspect and the team confirmed the entries were correct. Though a lot of mental and time-consuming validation. They were up in 3 hours!!!!! Added this involved multiple stakeholders.
What impressed me was that the CDP provided all increments and differential on the file (except the time of corruption). They do not back up every second but they update 1-2 hours or no activity.
Though I was not back for my whole day appointment til 9:00am (yes, I had a 24 hours work day schedule), I am glad that the office had a disaster, respond to the disaster, and execute their plan flawlessly... Lastly, any out of control matter... We just managed it and develop a solution with some thought and executed it... That is adaptive and creative thinking..
Subscribe to:
Posts (Atom)