The digital health space refers to the integration of technology and health care services to improve the overall quality of health care delivery. It encompasses a wide range of innovative and emerging technologies such as wearables, telehealth, artificial intelligence, mobile health, and electronic health records (EHRs). The digital health space offers numerous benefits such as improved patient outcomes, increased access to health care, reduced costs, and improved communication and collaboration between patients and health care providers. For example, patients can now monitor their vital signs such as blood pressure and glucose levels from home using wearable devices and share the data with their doctors in real-time. Telehealth technology allows patients to consult with their health care providers remotely without having to travel to the hospital, making health care more accessible, particularly in remote or rural areas. Artificial intelligence can be used to analyze vast amounts of patient data to identify patterns, predict outcomes, and provide personalized treatment recommendations. Overall, the digital health space is rapidly evolving, and the integration of technology in health
Showing posts with label ehr. Show all posts
Showing posts with label ehr. Show all posts

Friday, May 6, 2016

Mental Health Data Missing from Electronic Health Records

Mental Health Data Missing from Electronic Health Records


The article in HealthLine underscores the issues of developing a total electronic health record. 

Despite federal desires (CMS & HHS )to totally wrap medical records into an electronic format there remain several critical issues important to guarding privacy of patient mental health information. The Federal Definition of an EHR is extends beyond the aspects of recording patient data. They define an EHR with a broad pen including capabilities of meaningful use capturing data for analytic purposes.

By convention, and a long ethical history, providers have always guarded the privacy and protection of patient’s medical records, especially for emotional disorders. The physician has always been the health information collection agent in a fiduciary manner.  If the emotional and behavioral aspects were put into the EHR it would greatly endanger patient’s reputations, employment, and even  discrimination by health plans.  The Affordable Care Act  has markedly reduced the risk of non insurability by law. The other issues have not been addressed.



There is a spectrum of behavioral disorders ranging from severe organic brain disease resulting in schizophrenia and bipolar disorders to mild neurosis and anxiety disorders.  It is a gray playing field and somewhere in the middle it crosses over from ‘medical disorder’ to ‘behavioral disorder" in the reimbursement system. (What's in an ICD code?)



Health Plans discriminate between the two on a reimbursement basis as well. Co-pay for visits to a psychologist are higher than medical visits. In some cases even when an MD psychiatrist is involved the visiit is not treated as a medical visit even if medications are managed by the psychiatrists.

Often the staff at a ‘behavioral clinic’ do not discern the difference and bill improperly.



The federal government is interested in interoperability for purposes of data analytics. The experts who advise congress and HHS are misguided and naive, positing that developing this system will improve the quality of health care.  

Mental health issues should have a higher level of privacy protection. Not every provider should have access to the mental health record of every patient. That is a shot gun approach prone to much collateral damage. Mental health records should only be in the EHR in a higher level of protection with additional access granted only by the patient. The level of emotional dysfunction will be a major determinant in the importance of the information.

In a time when medical care has become patient centered the patient will have the final word on release of potentially harmful behavioral information. It is now established that the patient owns his own data even while it resides in the EHR program. He owns it and no one can take it without the patient's permission. (case precedence ?)


There was a time when public figures could enter a hospital and/or a provider's office and be certain the visit would not be made public. . Politicians, celebrities and other high level people expected this as the normal course of the day.  So too should it extend to all patients with equanimity. Placing this information in the EHR in an unrestricted fashion is not a good thing to consider.

Neither can a metric be applied in this gray zone. Most of it is ‘judgment’  The word that EBMers do not have in their vocabulary.

Unexpected release of protected information either medical or emotional can result in a serious alteration of a patient’s life, and/or employment. Employers like to have this information to determine suitability for employment. Allowing employers or any non medical person not directly involved in the patients health care would be akin to opening Pandora's box.

The Feds are wrong about this, as they have been in most health quality and reimbursement issues. There is no real necessity for inclusion in the EHR the Feds would like it but they are not going to get it unless providers cave in and are once again blackmailed and extorted by another carrot and stick scheme so common to our corrupt system of governing.


Thursday, July 2, 2015

A Review of the midyear progress of mHealth


A Review of the midyear progress of mHealth focuses on several mHealth IPOs,  specifically Fitbit and Teladoc.



They serve two separate niches, fitbit in the area of mhealth wearables, and Teladoc as a provider-patient centered application allowing remote video patient encounters with physicians.

Several transformative shifts are occuring between mHealth and EHR integration. In some cases mHealth is driving EHR integration.

Our blog today offers a quick centralized source for progress in mHealth application development.

Will mHealth's rise signal the end of the EMR?


 EHRs and wearables - their time has come?]



The convergence of two industry titans, Apple and Epic portends another swift sea-change fueled by adequate capitalization of IPOs and equity funding. Does this mean the EMR is becoming obsolete? Or is it evolving into an EHR?
Much of the conversation between a doctor and a patient focuses on what the patient is doing outside of the doctor's office – in other words, the doctor is looking for data that today's health and fitness wearables are collecting. This means that all that information in the margins is now being pulled into the record.
Providers say they don't want all that extra information coming into the medical record, but they can't deny the value of health and wellness data in developing a care management plan for their patients. They're worried about validity – is data entered by the patient reliable enough to be included in clinical decision support?

At this point, the answer is no, and mHealth vendors and EMR providers understand this. As Navani points out, the data has to be curated first – collected, sifted and organized into something that a provider can trust and ultimately use. Some EMR companies tackle this issue by shunting consumer-entered data into a PHR or similar silo; the consumer then grants permission to the provider to parse over that data and determine what can be pulled out and ultimately entered into the medical record.
f that's the case, then this truly is a health record, not a medical record.
The proliferation of consumer-facing apps and devices has also given rise to a dichotomy in how mHealth data is collected. On one side stand platforms like Apple's HealthKit and ResearchKit, which gather consumer data for use by healthcare providers. On the other side are platforms like Qualcomm Life's 2net hub, which takes data from reliable devices – not the consumer – and goes to great lengths to ensure that such data is "medical grade."

Can both data streams share space in the same record? That depends on how EMRs and EHRs are defined.




EHRs and Medical Students: How to educate Medical Students


Practicing medicine today means interacting not just with patients, but also with computers. As of 2013, nearly 80% of office-based physicians were using electronic health records. But medical schools have been slow to keep up with the trend. There's no national standard yet for how med students should be trained on EHRs. Some are using computer systems from day one of their education. While others may be forced to sink or swim once they start to practice. This is a report for iHealthBeat, a daily news service of the California HealthCare Foundation.


<Audio Transcript>

I'm Ali Budner Priyanka Chilakamarri is a fourth-year medical student at the University of Vermont. From very early on, she and her fellow students were expected to engage with their lessons through computer screens. (Chilakamarri): "When I first started medical school ... they gave all the students laptops." They also immediately started using computers in their interactions with patients. That meant learning how to use an EHR system. But EHRs are complex and notoriously hard to teach. (Jemison): "Because inevitably the computers are attached to walls, your back is to a patient, there's a lot of physical reconfiguring you have to do in order to take notes." Jill Jemison is the director of technology services at UVM, Chilakamarri's school. (Jemison): "We're teaching them how to do a good note, how to put all the information in it, how to collect the right thing." The third year of med school is when students would typically be exposed to EHRs, when they start clinical rotations. But in her very first year at UVM, Chilakamarri was already practicing on what's called a "dummy EHR," a system that's been stripped of identifying personal information to protect patient privacy.

Comments:

Harold Lehmann
Consider constructing a curriculum around a virtual (or multiple virtual patients). Cases should be created in the training environment, not only for the purpose of training in the use of the EHR per se, but also for teaching how to practice medicine in this machine-centric environment. Hopefully, one can teach how to be efficient, yes, but also, how to *think* in multiple screens that are not designed necessarily to aid cognition.
Lauren La Barge
Many of my friends and colleagues are medical students, and I was fortunate to live with many medical students at a top ranked institution. They are interested in curious about EHRs generally, but lose interest as they are unable to interact with them. Suddenly when they are in a clinical setting using EHRs for the first time, there is a lot of frustration and confusion. My friend, a first year anesthesia resident, used to take hours of work home on Epic! Teaching EHR use in the medical curriculum needs to be a part of the medical school experience.
Michael Warner
Medical students are in a tough position today as they are hands-off when it comes to the EHR. I was not allowed to write in the chart either, when I was a nurse's aid. I realize the legal ramifications, but patients are now able to view their records on patient portals and enter information. Why not allow the student doctor to partner with the patients and construct the History component of the encounter note? In research study that just concluded, patients where able to "co-author" their health record by writing a Pre-History. Imagine if medical student partnered with a patient to document her or her story? This might lead to a future where patients and providers get closer - while using the EHR as a tool.

July 2, 2015
Gary Levin M.D.
The clinical practice of medicine is changing rapidly. Advances in basic and clinical science challenge praactitioners as well as neophyte trainees. Today a new curriculum is developing in medical school focused on health information technology. Electronc health records and eRX are just two of the niches.

Today pre- medical students have a computer, pc tablet or are given one when they enter medical school. Much of the curriculum and even examinations are offered via this tool. Medical students enter school with considerable exposure to computer technology and operating systems.  They are facile with the hardware.  This is not so for EHR software.

Some thought is being given to  training students to use EHRs. However hospitals, and clinics may use different EHRs, and training students to use one does not necessarily translate to using another one.  In fact studies have shown it is easier to teach a student an  EHR if they have never used one.  Changing EHRs requires unlearning the original EHR to use the new EHR.

In general it may be more important to teach  adaptive skills, such as where to place a computer monitor or keyboard to minimize visual isolation from a patient. Digital health space believes that tablet PCs are the most user-friendly in the clinical environment.  It can be used much like a classical paper progress note... The addition of touch screen functionality is even more useful.

Wednesday, June 17, 2015

Most EHR Buyers Want To Replace Current Systems

Most EHR Buyers Want To Replace Current Systems, Report Finds - iHealthBeat


Percentage of Office Based Physicians with EHR (U.S.A. 2001-2013)



In  a previous blog I discussed the reasons for upgrading or replacing a users electronic health record.

Small and medium sized physician groups are faced with an overwhelming number of EHR solutions. There are several groups for medical practice defined by their size and history of EHR usage. Large medical clinics and integrated health systems  have adequate HIT resources to study this question. Unfortunately small practices do not have adequate HIT resources, and must outsource this to a consultant or their software vendor. - 

In a report from iHealthBeat from June 16th 2015, Most EHR   users want to replace their current systems.

The number of electronic health record purchasers who want to replace their existing software increased by more than 59% between the first quarter of 2014 and Q1 2015,according to a new report by Software Advice, Clinical Innovation & Technology reports (Walsh, Clinical Innovation & Technology, 6/15).

Report Findings

For the report, the company analyzed 385 randomly selected interactions from U.S. EHR purchasers during the first quarter of 2015.
Overall, the report found that 60% of EHR purchasers in Q1 2015 were already using EHRs, up from 40% in Q1 2014 (Software Advice report, 6/12).
In addition, the report found 37% of EHR purchasers were looking to replace paper records, marking the first time the number of clinicians seeking to replace current EHRs outpaced the number of clinicians purchasing their first EHRs (Leventhal,Healthcare Informatics, 6/12).
Meanwhile, the report found purchasers' motivation for buying new EHR software varied. For example:
  • 24% said their current software was faulty or cumbersome;
  • 20% said they were opening a new practice;
  • 13% cited regulatory compliance;
  • 12% were seeking to improve organization and efficiency;
  • 9% were seeking to go paperless; and
  • 8% reported poor support for their current software vendor (Software Advice report, 6/12).
In addition, the report found that billing was the top-requested EHR application among prospective buyers, which the report attributed to the upcoming ICD-10 transition.

U.S. health care organizations are working to transition from ICD-9 to ICD-10 code sets to accommodate codes for new diseases and procedures by Oct. 1 (Clinical Innovation & Technology, 6/15).
Meanwhile, the top five requested EHR functionalities were:
  • Patient tracking;
  • Customizable templates;
  • Regulatory compliance;
  • Electronic prescribing; and
  • Tablet/mobile integration (Software Advice report, 6/12).

Thursday, March 5, 2015

Healthcare.Gov Insurance Exchange Allows 3rd Party Access to Your Data

Electronic Health Records are becoming the 'Black Hole" of  Digital Health IT.

Enormous amounts of data are  orbiting the the universe  ready to be annihilated or swept into unknown hands.


Those who  know are warning what is coming and what is already happening.

Ducknet, published by Barbara Duck,, a well known algorithm pundit warns us,

"There are a number of 3rd parties connected to the website (Health.gov) and they can mine and secure data just like any other website.  The data once secured can be queried and re-matched and sold.  This is a huge oversight from the government.  Here's a clip from one of the number of articles on the web on this topic... , MORE......

"It works like this: When you apply for coverage on HealthCare.gov, dozens of data companies may be able to tell that you are on the site. Some can even glean details such as your age, income, ZIP code, whether you smoke or if you are pregnant. 

HealthCare.gov contains embedded connections to multiple data firms that the administration says generate analysis to improve the consumer experience. Officials say outside firms are barred  from using the data to further their own business interests.

Do we know if these 3rd parties sell this information, of course not.  Breaking the law today with computerized algorithms is an area where law enforcement has been very weak as so many don't understand it.  Would it benefit HHS to know the license numbers (if this was in place) of those who sell data and connect to the Healthcare.Gov site?  You bet it would.  


 Scroll on down and watch with the Killer videos and links

What Happens to your EHR records when a building or other infrastructure fail ?

A recent post on Healthcare IT news brings to the fore-front about trusting, but verifying what EHR vendors promise.

While electronic record keeping gives great advantage in operations; at the same time a small failure quickly expands to total systems outage.

A recent 'blackout' of a hospital's  medical records points out the inherent weaknesses of a 'systemic failure' of an offsite data source providing infrastructure for a medical or hospital practice.

A Northern California hospital has acknowledged that its electronic health record system went dark for about a week, which resulted in clinicians unable to access patient medical records and even having to postpone serious medical treatments. 

The two-hospital health system recently implemented the McKesson Paragon platform, but Chason emphasized that the EHR system was not at fault. Rather, HVAC units contained in an off-site data center were to blame after one burned out, and the other overheated soon after. Rideout Health officials did not respond to Healthcare IT News' inquiries for further details on the incident.

Who's at fault?                                   





Cloud Servers

Despite Chason assuring reporters patient medical care was notaffected by the outage, he did acknowledge it resulted in many patients having to postpone their radiation treatments. What's more, clinicians had no electronic access to portions of their patients' records. "We talked about whether to transport and transfer patients for a long period of time," Chason was quoted in the Appeal Democrat. "There were some records that were not accessible for a period of time, but we tried to get them as quickly as we knew about them."


A patient had a nuclear heart stress test at the health system when the computer outage occurred, and as a result the test didn't get to her cardiologist until two weeks later. After examining the test results, Ferreira said clinicians determined she potentially suffered a minor heart attack and would require additional cardiac intervention efforts. This EHR outage is far from an isolated incident.

Just in August 2013, the 24-hospital Sutter Health system in Northern California reported that its $1 billion Epic electronic health record crashed due to a software glitch in the system that manages user access to the EHR. The outage lasted an entire day, with nurses saying they were unable to access medication orders and patient allergies, among other things. 

Then there was the IT network failure at the three-hospital Martin Health System in Florida, which in January 2014 reported its $80 million Epic EHR also went dark, an outage that lasted nearly two days. Clinicians at the hospital had to resort to manual charting and documentation.


Setback for Sutter, $1B EHR goes black

‘Meds were not given for the entire day for many of the patients.’

The 24-hospital Sutter Health system in Northern California was the talk of the town late August after a software glitch rendered its $1 billion Epic electronic health record system inaccessible to nurses and clinical staff throughout all Sutter locations. 
On Aug. 26 at approximately 8 a.m., the Epic EHR system failed, at which time nurses, physicians and hospital staff had no access to patient information, including what medications patients were taking or required to take and all vital patient history data, according to reports from the California Nurses Association, part of National Nurses United, the largest nurses union in the U.S. 



"Many of the families became concerned because they noticed the patients were not getting their medications throughout the day,” 




Monday, October 13, 2014

Why the Government Prejudice regarding Specialty Electronic Medical Records

The past decade saw the development of electronic medical records, both in number and level of sophistication During this decade there was a steep learning curve by vendors with frequent and arbitrary regulations regarding EHRs.

Successfully Choosing Your EMR: 15 Crucial Decisions 



                                                                   Purchase on Amazon

EHR development has been overly influenced not by it's functionality but by parameters of HHS and CMS in regard to data structure and interoperability.

The regulations included a mandate for interoperability and items called 'meaningful use'.. The term 'meaningful use' is a misnomer.  Meaningful use in their terms only had to do with it's utility in garnering information from an EMR which may or may not be useful for it's designed purpose.

The following statement from Ophthalmology Management specifies some items:

"Switching electronic medical records (EMR) systems is a big decision, even if you feel like throwing your existing system against a wall. So don't ditch your EMR system before you download the paper that includes an eight-question assessment to help you decide - and to protect you from making the same mistake twice.  (this statement is from Ophthalmology Management and is a quote from EMA, a specialty EHR for ophthalmology.)"

In many specialties there are fields and specific information unique to that specialty. Clinical work flow must be considered, since a poorly designed software can radically alter efficiency and disrupt the clinic volume and income. Numerous studies have revealed that efficiency can be reduced for several months by a factor of 20-30%.

Medical practices chose to accept incentive payments for consenting to meet meaningful use criteria with their EHR.  This occured by an angst of 'not being left behind' despite serious reservations and advice for HHS and ONCHIT. Several deadlines have been delayed and doubts remain about the implementation of MU Stage III.

Many medical practices have invested in EHRs. Some installations were obsolete at the time of purchase.

Some medical practices decide to purchase a new system despite the added costs, preferring to write off an older system with accelerated depreciation. These decisions are supported by a record of decreased patient volume.  Most physicians report an additional hour of work each day and a reduction in patient volume.

Many physicians have expressed their extreme unhappiness with their electronic health records. Management surveys continuously confirm dissatisfaction. Despite this, EHR use has grown.  Imagine using a defective hammer to drive in a nail. Regulators have taken their eyes "off the ball" ignoring patient care, and equating paperwork with 'quality of care'.  This has become a fundamental failure of the entire American health care system.  Poor patient care can easily be disguised if all the information which is entered is designed to thwart the 'required entries' to proceed, or satisfy an algorithm for a complete medical record.

There are several certifying standards, the most onerous are those mandated by CMS and regulated by  

Adding to this frustration is that many large organizations will select a vendor whose reputation has been built upon usability for primary care and/or internal medicine/pediatrics.  Population Health has become a new 'buzzword" in the HIT workspace.  A large or medium sized multispecialty group may select a system which their specialists can not use.  Interoperability has become a deserved design requirement.

When designing or selecting an EHR, every department must have input on decision making. Some IPAs and loosely organized primary care groups have offered to 'give' an EHR to their specialists t
o encourage acceptance of a group EMR.  This in many instances has been disastrous.

Their are other choices.

1. Utilize a specialty specific EHR based upon:

     User testimonials
     Site visits
     Demonstrated user functionality and efficiency in actual operations.

2. The requirement for interoperability are clearly defined by ONCHIT which should make disparate systems interoperable.

3. The realities however are quite different from a vendor point of view, leaving users holding the proverbial 'bag'.





Does your EHR need a tweak or a trashing?

How to tell if your system is already in need of a major goose.

BY ROBERT N. MITCHELL



Need an EHR plan?

Whether it’s your practice’s first foray into EHRs or your practice is upgrading to a new version of the software or a new system, the HealthIT.govwebsite provides ophthalmology practices valuable insight. This includes these six steps:
    1. Assess your practice readiness
    2. Plan your approach
    3. Select or upgrade to a certified EHR
    4. Conduct training and implement an EHR system
    5. Achieve Meaningful Use
    6. Continue quality improvement

On the www.HealthIT.gov website, each step is a link that users may click on for a detailed explanation.




Tuesday, December 24, 2013

Accountable Care Organizations and Health Information Exchange



No surprise here.  Accountable Care Organizations are going to require massive amounts of data sharing between the hospital, it's medical staff either as a whole or by  specialty.

Electronic health records and health information exchanges are an early beginning to having meaningful data, although the true nature and scope of HIE is limited by the fields that are interoperable and visible to users. Many health information exchanges only allow sharing of limited data....ie diagnosis, medications, and perhaps a discharge summary.  That in itself would be a helpful and very useful study.

Accountable Care Organizations will be searching for information systems to accomodate the needs of an ACO.

Hospital EMR & EHR reports

With accountable care becoming the standard for providers, more and more are seeking out best-of-breed vendors that can fill in the gaps in their health IT lineup and meet expected ACO requirements. It seems that just having it EMR in place doesn’t do the trick by itself. 

Management of an ACO is an entirely new industry, one that is very immature and the availabliity of experienced ACO  CEOs is very limited.  I am not sure what 'best of breed vendors means in such an immature market, nor how to compare or rate vendors.  This sounds much like a repeat of EHR software or Health Information Exchange offerings.

KLAS, a large consulting firm describes its mission, helping healthcare providers make informed technology decisions by reporting accurate, honest, and impartial vendor performance data.  The Best in KLAS Awards for Medical Equipment report is published June 15 and the Best in KLAS Awards for Software and Professional Services report is published December 15. 

 KLAS spoke with 73 organizations – mostly medium- to large-sized IDNs and hospitals –  to gauge where they are in their migration from volume to value and accountable care. The goal is to eliminate reimbursing for procedures to eliminate or minimize the 'do more' to gain  income mindset that has been embedded in the economics of medical reimbursement.

That's the conclusion from the newest KLAS report, "Accountable Care Timing 2013: Migration from Volume to Value Speeds Up," which shows that more than 65 percent of providers interviewed are looking to niche vendors to address the critical areas of population health, health information exchange and business intelligence.


We’ve known all along that the ACO game was going to be an expensive one. If KLAS is right, it’s going to be a whole new independent marketplace, in which providers shop for calls that fill in huge gaps in their existing ACO toolkit. If I were CIO, however, I’d be pretty annoyed that the huge investment made situation made in an EMR can’t get the job done all by itself.
Now the question is which health IT areas hospitals and medical practices will take on first; after all, there’s lots of ways to attack the question of how to prepare for the new, bold ACO world. My guess is that tools supporting population health measures will be particularly popular, as population health management is a key capability ACOs bring to the table that health systems alone may not.
The end game is complex, how to extract the data for analysis and merge it with population health measures, comparing expense with outcomes and maximizing better outcomes while holding expense flat, or decreasing it.
Some early ACO organizations are claiming some success in managing this goal, and it would be useful to survey what vendors and/or software combinations they use. Is it done in real time, or does it require separate data entry? 
The other big question is much like the analysis of ROI for EHR and HIX.  If the ACO will require new software, it will certainly be very expensive and no one can tell for certain what the ROI will be.
Several hospitals and INDs have lost considerable sums adopting well known EHR systems such as EPIC and/or Cerner. The failure of a central software infrastructure would be a fatal blow to a young ACO.  One that would rival the near catastrophic rollout of the national health benefit exchange in October 2013.
"This is a major shift from what we are seeing in most healthcare IT areas," said report author Mark Allphin. "What we are seeing in many areas is a migration toward integration. The fact that providers tell us that they will be looking to niche vendors over their EMRs tells us that the ACO market very likely is still up for grabs.”
So, this post raises more questions rather than answers. , 
Those early IDNs and early Pioneer ACOs may be ahead in discovering the answers to our questions.

Becker's Hospital Review lists 100 early ACOs, and CMS listed  32 initially, now down to 20 due to ACO dropouts.

Much of this information is open to question, a term which I call  "Truthiness'. CMS is claiming how successful their model is working.




According to CMS Nine of the 32 Pioneer ACOs are leaving the program, but the majority will continue. It is not surprising that some health care systems would re-evaluate their participation and choose to move on. The program does not guarantee that it will be the right fit for every health system. That’s the nature of innovation. And no model may be right for every population in every community.  It is important, however, to examine these departures for the lessons they offer.

Further commentary from CMS:

"We remain optimistic. ACOs represent one innovative model with the potential to improve care coordination, ideally leading to improved quality and lower costs. Testing of that model should continue, and we are pleased that the Medicare ACO program has given a boost to the development of ACOs, which are now proliferating among private health plans and provider groups"

Is this the message of idealogues, who will forge forward no matter the variability of success or failure.

We have seen the early missteps of Health Benefit Exchanges and there should be no reason to trust  CMS plans and/or statements.

Digital Health Space will be watching this niche carefully.