Boy…that sounds boring.
I suppose it could be for those not interested in the Electronic Health Record (EHR), and for those who are interested, innovations to what Document Management is, its value in treatment, and what it could mean in the future, this is a pretty good topic. Consumers and professionals need to be aware of the consumer’s record and how information becomes part of that record.
Recently I shared about Health Information Exchanges (HIEs) (see my last post). HIEs and Document Imaging can be viewed as two sides of the same coin. HIEs share data electronically without a document ever having to be printed, while Document Imaging is generally an electronic copy of a printed document.
John Mancini, president of the Association for Information and Image Management, has opinions about the insufficiencies of the EHR based on personal experience, as well as his own expert opinion. I love to take exception to an expert opinion, and still I’ve seen tremendous movement toward scanning outside documents into a consumer’s EHR. Most mental health and addictions treatment software manufacturers have or plan to have built in technology to include scanned documents from outside sources like labs and other professionals. They even interface to document imaging systems created for multiple departmental environments like hospitals. I imagine it is common enough for a private practice to rely on the paper chart, and certainly our industry hasn’t become fully acclimated to the EHR. Implementation of the EHR has, however been on the increase, and there’s a deadline. The commandment is for professionals to be operational on the EHR by 2014. Originally envisioned in the Bush era as a primary task that would be nothing but good for healthcare in the United States, this goal was reiterated by president Obama when he took office. Both Document Imaging and HIEs contribute to a consumer’s electronic record.
Along with document imaging capabilities, I commonly see software interfaces to labs and pharmacies required as part of the purchase of an EHR. Interfaces to electronically share data are big business, and can be expensive. Without stimulus funding in the form of Meaningful Use incentives, professional organizations in our industry can lag behind the requirement, simply because they can’t afford it. In our sector of healthcare, some professionals rely less on labs and pharmacies than others, so they may not have enough data volume to justify an interface…in some cases the cost outweighs the benefit. Other professionals may see the value in having the data on the computer, and can’t see that interfacing to these ancillary providers will even be used when they have a printed lab report that all the professionals in the organization are used to.
One thing is certain; searching for a paper document can slow down service for the consumer, and is where document imaging comes in handy.
In a computer, each consumer is assigned a number, and that number is likewise associated with the lab results and pharmacy orders or other document when scanned into the computer’s secure database.
If a consumer comes to a professional with a referral from another facility, or an existing consumer returns with a discharge summary after a stay in the hospital, the associated documentation can be electronically attached to the consumer’s record number, with a link or command button available in the consumer record that pops the lab results or list of currently filled medications to the screen.
My last post discussed how Health Information Exchanges (HIEs), which eliminate the need for a provider to scan and attach these types of data to the consumer’s record by making them available electronically: • Current demographics • Diagnosis treated • Services rendered • Medications prescribed • Admission and Discharge summaries
Whether or not professionals and the organizations they work for will profit from interfaces or HIEs to electronically share data, or be better able to justify a document imaging system, either as an added stand-alone system or one that’s built into their (EHR), is a decision that needs to be made with the consumer’s treatment experience in mind. It’s never a bad idea to chat with a consultant when it comes to determining the better value of multiple technological choices.
Read more →The number one trend in my business, according to Healthcare Technology News will be the growth of Health Information Exchanges (HIE).
We’ve known the importance of electronic sharing of patient data for decades, and these days the hesitancy we felt in the past has become an obsolete emotion. With the advent of HIPAA and its embracement by forward moving legislation as well as new technologies, confidentiality is better assured than ever before.
In mental health and addictions treatment, there are a number of elements of patient data that can be shared that provide a number of benefits. Mistakes are fewer and efficiency is increased on the data entry side of recordkeeping. Treatment can be improved with a broader knowledge of the consumer’s healthcare events and who’s been treating them lately. Conceivably, when a billing address changes, the HIE could assure all professionals in the neighborhood treating the consumer have the most recent information. Professionals have dreamed of having access to few key types of data that multiple agencies treating a consumer might need in order to effectively treat the patient: • Current demographics • Diagnosis treated • Services rendered • Medications prescribed • Admission and Discharge summaries
Now, these elements are available through HIEs..
I am increasingly impacted by the success of HIEs When I was hospitalized a few years ago, and after discharge treated by a couple specialists within the hospital’s network of associates. I was very happy not to have to fill out so many pieces of paper, so somebody else could enter that data into the computer. It was already verified as correct while I was in the hospital, and immediately available to the specialists as soon as I’d signed a Release of Information (ROI).
This is the essential nature of other sorts of consumer data exchange networks, like a Regional Health Information Organization (RHIO). There are many examples as this model is based on a local network of providers….there tend to be a bundle of different solutions where the need seems to support them, and that’s the case with sharing health information. Usually providers pay to become a member of the RHIO, and they will be able to see other local providers’ information like the elements listed above for a specific consumer. I share the opinion of some experts in the field that eventually all these networks will be joined together by the states, and ultimately the feds to finish creating the National Health Record that was mandated back in the Bush era.
I also agree with Adam Gale, president of KLAS, that with all that availability of data we should wonder what it’s being used for…Is the HIE matching patient addresses with their diagnosis in order to sell a list to a major anti-depressant manufacturer? It’s not likely, and that line of questioning is certainly valid for providers joining an HIE.
Conceivably, the value of the access to patient data should exceed the cost of belonging to an HIE. Will the government mandate for all patient care to be recorded in the EHR include the HIE? Testing the wind and laying out an opinion, I’d say it’s a great goal to have the consumer-authorized availability of information among providers, and for the most part that’s happening…it may take a few extra years get the EHRs connected, simply because the technology to make the secure connection, the mapping of the data from an existing EHR to the format needed by the HIE, and other technical concerns add up to a significant price tag.
Read more →Crime runs rampant! If a hacker has my health information, chances are high they can get yours, too. Frankly, if they have mine, I find that less disconcerting than somebody having access to my credit card and bank accounts. Perhaps if I were a senator or a member of the president’s cabinet, I might feel differently…as you may feel also. I may not care who knows I have three stents in my heart or that I have a history of being treated for anxiety. That senator or cabinet member, however, may have a very unpopular disorder and want that knowledge guarded zealously.
The idea behind hacking computers to get data is to turn it into money, and people are pulling down big bucks for sharing certain data with certain people! Apparently, holding data hostage is getting to be a popular pastime these days. I ran across a bundle of opinions about what the future holds recently in Healthcare Technology News for we who are interested in Electronic Medical Records (EHRs), and the article on healthcare hacking by Mark Kadrich set my imagination wandering. How can we improve security to healthcare systems?
In this industry, we need to make no mistake about it, consumers’ health information need to be secure, and it’s the professional’s responsibility to make sure security measures are in play…their tools are stringent password security and all that magic software that runs in the background to keep hackers out of systems. Electronic Health Record (EHR) software is currently regulated by some pretty stringent laws, and I’ve thought we had done pretty well in guarding healthcare data against hackers. HIPAA, data encryption, complicated schemes for patient Release of Information (ROI) and other measures combine into quite a net of security, right?
One hospital I worked with required me to negotiate three different security systems to get to the database I needed to work on. Even with all those levels in place, they recently suffered a virus attack that took a couple months to recover from. The good news is that from the recovery, they ended up with better EHR protection. It was, however, quite an expensive way to earn wisdom. A visit from a security expert and a system security tuneup might be a better solution. It pays to hire the professional, and a couple years ago a friend of mine graduated from a professional education program as an expert in system security; it’s a very specialized and valuable vocation…he got a job within weeks of graduating, and earns his tremendously increased salary
Healthcare Professionals are being encouraged to protect their consumers’ data with yet more security measures, even to the PC level and for SmartPhones. There are a ton of solutions out there. Without a careful analysis of your needs, what’s been effective and ineffective, which companies have a good track record of improving their products when a customer’s data is compromised, and a number of factors, who can say what’s best for you? The salesperson? Perhaps.
I am occasionally put in the uncomfortable position of recommending products and services like this, and frankly, I recoil as from a hot flame…there are plenty of security experts out there (like my friend), so I bring one of them into the equation. Technology changes by the minute, and I have enough work to do keeping tabs on EHR products and development. It’s like laundry…I hire a professional because if I handle it myself, I’m bound to end up with an irremovable stain.
Read more →Perhaps I have been proven wrong…
Recently I looked into SmartPhones in medical use, and commented that I felt the applications were not ready for prime time due in part to questionable security (passwords and a secure connection). If it was my mental health data being broadcast across the planet, I’d want to be sure that the distance between the server and the SmartPhone being used by the professional helping me was a secure connection, and my confidential healthcare data would not be intercepted by somebody else.
Well, the proof arrived from Andrew Isham, the director of development for A-CHESS. That’s the SmartPhone app being developed for treatment facilities by the University of Wisconsin. Data coming from and going to the fileserver, whether it’s from a workstation with a secure network, internet connection or SmartPhone, is forced to a login page that sets up the VeriSign security certificate, assuring data encryption. VeriSign is an old hand at this sort of work. I’m not a real tech nurd, however I am pretty tech-savvy, and the explanation satisfied me that the security concern I mentioned in conjunction with SmartPhone connections is no cause for anxiety attacks. All is well. Breathe.
I heard on the radio (one of the wonderful news programs on National Public Radio (NPR) that SmartPhone app development is the fastest growing segment for jobs in the tech industry and looked into it. It turns out that it’s so popular that the traditionally required experience and education is being ignored in the search for people to do this sort of work for software companies. It’s a big deal. My marketing and sales background tells me that even though we’ve seen this sector grow with leaps and bounds lately, we are at the tip of the iceberg.
The question of how appropriate EHR products are to deploy on the SmartPhone and other hand-held devices has come to my attention for a number of years. At least 20% of the organizations I’ve talked with over the past 5 years have a professional on staff who asks about this technology. A friend of mine who runs a mental health and addictions treatment oversight agency has been so serious about using hand-held devices for EHR purposes he developed his own application for this purpose years ago. He was ahead of his time, and I’m certain he’s happy to see this trend.
As I implied above, a commercially viable SmartPhone product needs to synchronize with an agency’s EHR housed on a server. That way the data is available to others treating the consumer, provided the consumer has signed off a Release of Information for them to see the treatment documentation. ACHESS is the product closest to deployment I’ve seen, and most professionals in this business are not likely to develop their own apps like my friend mentioned above. I predict a well-researched app for SmartPhones could be a small part of an enterprise EHR system that will make or break system sales to new agencies very soon. Now that I know security is not a problem, I’m eager to see how they work in scheduling appointments and collaborative development of assessments, treatment planning and progress notes with consumers.
Let me know if you see any mental health and addictions treatment EHR’s that have this sort of functionality working for professionals and consumers in the field. I, for one, am very happy to see some movement in this direction; and my interest was prompted by the silliest thing: learning to send text messages to my kids on my SmartPhone.
Read more →I like new gizmos. I think most of us do, evidenced by the rocketing success of the Apples’ iPod, iPhone, and iPad.
These American products are taking over the world. Unfortunately, in medical technology, the trend is putting us behind the worldwide curve for the availability of innovative and exciting medical gizmos and medical technology in general. Price Waterhouse Cooper says this is a product of good, old-fashioned capitalism. American companies are seeking worldwide for medical solutions that can be marketed quickly and effectively. The fear of releasing products that are not approved by a government agency makes it hard for companies to market medical technologies.
Naturally, we’ll get the goodies eventually, and American professionals can be the last ones to get new technology, so American consumers could be the last to benefit from innovative gizmos and technology. It seems the increasing wealth in emerging nations and Europe is enabling these markets to pay the freight for the cool stuff.
Why is this so?
It’s simple, really. There’s a long history of medical technology being released in this country with negative effects, Medications like Ephedra (a base chemical for crystal methamphetamine, or speed) and Avandia for treating diabetes have their troubles, and Americans are frightened. Medication side effects, X-Ray or other electronic emission exposure, and gizmos manufactured and marketed with flaws have led to government intervention and a hyper-vigilant attitude toward medical innovation. This leads to more testing and a slower release curve, which looses time that can instead be spent marketing the product in other countries. Evidently, the rest of the world is not as careful (fearful?) of things going wrong as Americans are.
Combine this with the idea that the rest of the world is getting rich enough to afford new medical technology, and it’s easy to understand why the rest of the world is getting access to gizmos and medications before us.
In mental health and addictions, gizmos may be less of a factor than with other health concerns, like deteriorated knees that can now be replaced with artificials, however consumers can still benefit from technology, mostly in the area of diagnosis, like with brain scans.
It’s hard to tell what other technology can benefit mental health and addictions treatment when we aren’t clairvoyant, and still, it’s on the way. I guess the point of this meandering discussion is that as Americans, if we’re seeking a new solution to our mental health or addiction problems, technology may be on the way, however, in order to use it, we may need to take a European vacation. Provided we could overcome the fear of side effects and make the bold move to seek offshore solutions, the manufacturer of the gizmo would be happy, and we might end up with improved mental health.
This brings another factor to light…will insurance cover solutions a consumer seeks outside the United States, like use of a gizmo to bombard some brain malfunction that leads to depression or anxiety with newly discovered, healing electronic emissions? I bet they’d want to wait till the item was approved by the government for use in the United States (by the way, I made up this example).
If you’re intrigued about the prospect of an offshore solution to a mental health problem, keep your eyes open and keep surfing the web for new, innovative technology that’s becoming available elsewhere in the world. It’s a good idea to know what we’re getting into when we make bold moves, so check with your insurance company to understand who’s paying the bill, and understand possible side effects of any new treatment.
Read more →I hope I have been proven wrong…
Recently I looked into SmartPhones in medical use, and commented that I felt the applications were not ready for prime time, and that I hoped that somebody could prove me wrong as to the reason why: security. If it was me, I’d want effective security that my communications over the SmartPhone were going to the person I directed them to, and would not be intercepted by somebody else.
Well, the proof hasn’t come to me yet, and I must share that it may be on the way in the form of ACHESS a SmartPhone app for alcoholism and addiction treatment. A study is under way for ACHESS that will test its features from “panic buttons” to GPS locators helping consumers get peer and professional support when they are experiencing cravings or have wandered into the wrong place to stay clean and sober.
ACHESS, or Addiction CHESS, is being tested in the field right now, and we’ll know the outcome in a few months.
I like the ideas that form the foundation of the app and how it’s used.
Still, I wonder about security. I reviewed the ACHESS web site, discovering that current iterations of the product are primarily for the home computer, for which SSL and a few quite good security solutions like Citrix are about as effective as you’re going to get. The problem with the SmartPhone is that it’s wireless, and if your messages go out into the ether without some sort of scrambling called encryption, there is a high likelihood they could be intercepted. Addiction treatment has long been concerned with protecting the identity and treatment records of consumers in treatment, and that’s not about to change.
I looked, I called, and I Emailed, and still have no answer to this concern…then again, the test is just beginning, and the answer to that question is forthcoming.
…more to come.
Read more →I admit it. I text. Almost everybody does these days.
Texting on your Smartphone is not a far cry from a professional in a behavioral health hospital or outpatient addiction treatment center keeping notes or other treatment documentation on the device. In fact, companies like New Mexico Software are developing medical record solutions for these devices at a record pace. I thought I’d investigate products that have been sold to professionals, are effectively being used and proven in the field.
I prefer the thumb-driven phone keyboard as opposed to the touch screen, probably because I’m used to it, and don’t want to get used to the new device. I’ve actually improved to the point that I can write a pretty detailed Email with fair speed. This gives me hope that using the small-screen environment to do real work is not just a pipe dream. Somewhere, it’s already happening, I’m sure professionals are writing their notes on their devices and somehow getting the note transferred from their phone to the Electronic Health Record (EHR) resident on the server of the agency they work for.
This prompts me to immediate suspicion…consumer confidentiality is a huge issue in our business, and I asked myself if HIPAA rules were being broken with this technology strategy? HIPAA is a rule that protects privacy of health information and is enforced by the US Office for Civil Rights.
I became quite frustrated looking into possible SmartPhone solutions, I found nothing conclusive. I ran across so many open ended arguments about the iPhone and iPad’s HIPAA security compliance, I decided to concentrate on the one I use, the BlackBerry. I ran across a fair source for the basics in the HIPAA Compliance Journal. Since Email is the foundation of electronic data transfer in the mobile environment, it seems a logical place to start exploring to determine whether the Smartphone is a secure enough device on which to keep or share consumer information. First of all, there may be no way to assure outgoing Email from a BlackBerry will remain secure, especially if it is forwarded to other treatment team members or to the consumer. Consumer information that’s quoted in Email is probably breaking HIPAA rules. This means the IT staff needs to be very savvy in order to assure the information makes it to the EHR without having to pass through public air space in an unsecured state if this technology is to be used.
The simplest thing to do is assure the entire Blackberry mobile network is set up in a secure fashion, to avoid insecure transmissions of data. This is just a matter of configuring the Blackberry with the Secure IMAP selection.
So, you say, that’s Email…what about documents like progress notes written on the Smartphone?
In a general sense, many mental health EHR software manufacturers offer mobile solutions. These are usually a service available on the Internet instead of software that’s installed on a mobile device, and come with secure methods of access. Using the software could be as simple for the user as launching an Internet browser on a Smartphone. The problem comes in with real estate. The Smartphone’s screen is too small for most professionals to find the environment effective to do any real work in the program.
Unless there is an App, a special, small program that installs on the Smartphone to deliver a screen that’s limited enough to perform a practical task like writing a note. I’m not aware of companies who have this capability up and running as part of their product, and would really like review the feature/functionality. Companies like New Mexico Software (above) are working on that.
So, if a mental health or addiction treatment professional wants this capability, it may come down either waiting for technology to catch up, or selling the idea to the folks they work for to develop it, simply because it falls into the bucket of software out there that’s “not ready for prime time” Hope somebody proves me wrong.
Oh, and about texting patient information? Make sure you have a secure environment that meets the HIPAA rule if you’re doing this.
Read more →I remember odd stories of people being referred to professionals and treated for conditions they didn’t have because they were mistaken to be somebody else with an entirely different problem. Wrong medications can be delivered or professionals can act under false assumptions when working with the consumer. Confusion like this can be avoided with positive identification methods available to the Electronic Health Record (EHR).
A little over a year ago, Rand Corporation said that the Unique Patient Identifier would cost $11 billion, and pay off nationwide in reducing these sorts of medical errors, and in simplifying the nationwide effectiveness of the Electronic Health Record (EHR), which in turn can introduce a high level of efficiency, and a way to enforce patient privacy. Thank you, Rand. In the EHR manufacturing world, we’ve been selling these ideas for many years. Hopefully Rand and other high-profile companies will help make the nationwide Unique Patient Identifier a reality.
One important result of the nationwide Unique Patient Identifier for consumers would be patient confidentially, or so we’ve said for over a decade. Patients deserve to have control over who knows their mental health diagnosis or any information about their stay in an addiction treatment center. Typically, we’ve accepted we will be identified by a number, so what number do we use? The Veteran’s Administration uses the social security number, identifying VA Hospital patients by last name and the last 4 digits of their SSAN. I don’t know if that’s good or bad, but it certainly seems effective.
Occasionally we hear of breaches in confidentiality like the loss of a Veteran’s Administration laptop in May of 2007 with a gazillion veteran’s names and numbers on it…like social security numbers. That single event woke me up to how important it is for me to maintain the confidentiality of that particular number.
Let’s use my old pal Kenny as an example of how this “secret” and private number has been spread around. Who has Kenny’s social security number? Oh, everybody, it seems.
In short, that secret number isn’t very secret, but it’s the closest thing that we have to an identifier. In my book, it’s time to abandon the idea of the social security number as a single identifier…it’s too compromised.
The solution for me seems to be technical. What’s done is done, and Kenny can’t do much about it. Perhaps you can. You don’t have to share your social security number with anybody…Verizon and the banks might argue about that, but it’s a law. These companies may not let you use their services and products as a result. No phone and no mortgage could be an inconvenience.
Signature pads have been in use for many years to validate consumer identity. A common software technology ties the signature to a patient ID. If consumer data needs to be shared with others, the patient signs for it, validating his Unique Patient Identifier. This assures the consumer is in control of who sees what. Without the signature, these entities who have your information can’t share it, and if they do, they are at great risk. Somebody could be open for a law suit or jail.
Voice technology, face identification, and retinal scans are a few other methods that can be used to validate Kenny is who he says he is, which is handy in the case of identity theft. Most of the organizations like credit bureaus and medical providers (probably your friendly neighborhood Community Mental Health Clinic) simply pair the SSAN with the date of birth, name and/or address, which is simple. Is that secure enough for you?
A solid, durable signature pad costs around $200 (the $100 model wears out quickly in a production environment and the $400 model with LED screens and interactive technology may be overkill). The other solutions cost a bit more, but so what? Technology is a pretty reasonable solution to assure nobody else is using a consumer’s ID, and confusing a person’s diagnoses and treatment with somebody else or spreading it across town or across the country without that person’s permission.
The simple point is, when it comes to treatment, maintaining confidentiality is tough and getting tougher as the National Health Record becomes a reality, and in the end, every citizen needs to take responsibility for the security of his ID. Keep your eyes and ears open, campers!
Read more →Years ago, while vice president of a small Electronic Health Record company, the dream of speaking into a microphone and having progress notes magically type themselves came up in every presentation, and the answer was similar to today’s answer: “That’s not part of the product, and it’s very possible using a product like Kurzweil Speech Recognition software”. We considered integrating speech recognition into our product.
Even back then, it worked great once you got it set up. The software needed to know your speech patterns, your voice and such. Any idiosyncrasies brought into the mix like dentistry or an injured tongue or a strong accent really threw the software for a loop. Like I said, the software worked fine, it was the setup and changing patterns of our voices that could throw a monkey wrench in the works. Consequently, speech recognition software was seldom used…Oh, I almost forgot, you could have bought our company for what the voice technology cost, so we declined to integrate the product.
The technology is much better now, and still in our field, seldom used. There are a number of high quality systems on the market that are available for a reasonable cost, like Dragon software, (and I imagine Kurzweil, too). You don’t have to go far for examples of how the technology has advanced. Most automated telephone systems with voice recognition do a good job, and the system that bowls me over is the Long Island Railroad system at 718-217-5477. Sometimes on a cell phone under less-than-optimal conditions, you might need to wait a while the system “thinks” about your response, but it picks up from that point well. Voice technology seems to no longer need much coaching or training to deliver what ‘s needed.
In mental health and substance abuse facilities, people ask about this technology for the benefit of those who don’t type. I learned to type in high school. I was a healthy boy and that’s where the girls were. I liked being there and over the years typing became a stream-of consciousness phenomenon. I don’t touch a writing implement often these days. My suggestion throughout the years has been to learn how to type if the effort and price tag is too high for voice technology. In this age of texting, select boxes, templates and drop-down dictionaries, that opinion has to go. The technology seems to have arrived, and by purchasing Voice Technology software for a PC, speaking notes and having them automatically type into memo fields us usually a snap.
Traditionally doctors have been the ones who used voice technology, historically that means Dictaphones. Today, it means software like those mentioned above. Most EHR software will accept input from the software. As I understand, the computer changes the voice input into typed characters, and they look like standard keyboard input to most software when your cursor is focused on a memo field.
It’s only rocket science, and we’ve been doing that since the Chinese invented fireworks rockets, long, long ago.
Once a doctor or other mental health professional uses the software, the text will still need to be edited, since we don’t write like we talk…not a big deal once we get the hang of using it, and that usually means the person using the software has to do the editing. This eliminates the drudgery and expense of having somebody listening to the recorded message and type the notes into the EHR.
Call me old-fashioned. I like to type. If you know professionals who don’t, suggest they look into voice technology; it’s a new world.
Read more →