Augmented Reality, Google Glass, and the Holideck

Ok, be forewarned… I am about to reveal my geekish side.

Growing up, my mother use to tell me that anything we can imagine can be done – maybe not today, but as we advance, anything imaginable can be done. You are probably thinking, wow, she has a cool mom… and yes I do. Few adults can brag that their mom is more tech savvy than they are. I suppose she is why I am so fascinated with tech today.

In light of the ‘anything imaginable can be done’ mentality, I grew up a Star Trek fan, wondering when (not if) the holideck would become a reality. For those not familiar, the holideck was a place on the Starship Enterprise where crew members could go for a virtual reality experience. The holideck created an entire virtual world of sight, sound, smell, and touch, designed according to the user’s preference.

Fast forward to the early 2000s and introduce sites like Second Life where a person can create and “live” in a virtual world through their computer. I admit that this was an interesting concept, but still weak in comparison to a holideck. Fast forward again to present day and introduce augmented reality.

Of late, I have become fascinated by Google Glass. Imagine it, walking around with glasses that fill in the gaps, connect people, and explain things.


While Google Glass is still in its infancy, I see so many possibilities for how technology such as this will transform the way we interact with the environment and the people around us.

I think, from this point it is only a matter of time before mainstream implantable devices create constant, bigger experiences; experiences that include sight, sound, touch, smell, and even emotion, as it collects data to continuously refine the experience.

Think about big data for a second. Think about all the places from which data is collected and how many more data sources will be collected in the future as more and more devises and people connect. This may include information about the population in aggregate as well personalized information, even real-time health monitoring. Think about how that information could be used to augment individual reality.



Not only would this change every person’s reality but something like this could have a huge impact on healthcare. Connected doctors and nurses may be able to receive real-time, individualized instructions for patient care. Doctors would have access to deeper, more detailed patient records including life-style information. How about real-time, personalized care instructions for patients? How about if a patient being able to know about predispositions to and/or extremely early signs of illness?

My mother was right; anything that can be imagined, can be created. I know that this could start a huge debate of the good versus the evil of such technology, but this post is just pointing out the interesting factor – not discussing the philosophical debate…So, those are my thoughts for today...

Healthcare Marketing

As technology evolves and HIT demand drives more and more people to start their own businesses, i thought it would be nice to talk about advertising for small businesses. Over the years I have worked with many small healthcare businesses and found that advertising is a huge challenge for small business. The reason for this is simple, advertising is expensive. Still, there are ways to affordable ways to advertise.

Now, I am going to start this post by saying something shocking – but don’t be turned off…wait and here me out. Here is the shocking statement: Contrary to  popular opinion, services like Google Ad Words alone are not likely to produce a return on investment. This is not to imply that you can ignore Google Ad Words, but rather to say that Ad Words ALONE will not work and investment in Ad Words when finances are limited can be disastrous.

First, I will give a brief blurb on Ad Words for those not familiar. Search engines, like Google, have advertisements at the top and sides of the page. These ads are produced based on the words a person searches compared to the advertisement’s purchased keywords. For example, if I search the word ‘tomato’, at the top and sides of the search page, I will see advertisements for businesses who have ‘purchased’ the word ‘tomato’. Each time a person clicks on one of those advertisements, the business that advertised by purchasing the word ‘tomato’  is charged for the word’s use.

So, if people are clicking on an advertised term, one can assume that the person wants that item. Why would that be disastrous? There is one single reason and it is return on investment (ROI). Let’s say a click on your advertisement costs $0.50. Over the course of a month, 1,000 people click on your ad. That will cost you $500. Your tomatoes sell for $0.50 each. Of that 1000 people, only 1 person bought a single tomato. So, your revenue was $0.50 and your advertising cost was $500… where is the ROI?

It can be argued at this point that getting your name out there - in front of the consumer - is worth that loss of $499.50 in the long run. Unfortunately, for a small business this absence of immediate RIO is the primary reason why the marketing/advertising budget is the first thing cut when finances are tight. So, there has got to be a better way and there is.

First, let’s think about why only 1 person out of 1,000 bought tomatoes from you.  There are a lot of possible reasons but two reasons stand out as things you can control and I will discuss both at length in two posts (to keep this from getting too long). The first possible reason is that your website is terrible. The second reason is your brand recognition which I will explain in this post and give tips for improving it in another post.

Let’s start with your terrible website. A terrible website can be defined in two ways. One is a website that is confusing. There are ‘rules’ for good user interface (UI) design. If your website breaks the rules and people cannot find what they want –they will not buy from you. If you don’t know the rules, you can research that but before you rush off to do that finish reading here first. 

The next thing about terrible websites are ugly, homegrown, unprofessional websites.  In many ways an ugly website is WORSE than breaking good UI design rules. If your website it ugly, people will leave the site immediately and your reputation will sink. It does not matter how good a business you have, how affordable your prices, how fabulous your service, etc…if your site is ugly – you lose business. 

Face it, most people like shiny objects – attractive websites, modern websites, innovative-looking websites will take your business away. Don’t depend on your own judgment about your website – you are bias. It is like children’s artwork – to a parent, that piece of artwork hanging on the fridge is comparable to any Van Gogh. To everyone else, it’s just ugly. The best investment a small business will EVER make is in professional web design.

Now, understand professional web design is not a homegrown thing done by a relative who claims to know something about it. You need to hire a consultant who is wholly objective. Interview a LOT of companies or independent designers before choosing who will do your website. The person/company  you choose should understand good user interface design, user experience, and search engine optimization (SEO, search engine optimization is the art of designing a website so search engines can effectively catalogue your contents and product web search results).  

Do your research on these terms before interviewing – understand the topics so you are not deceived by someone who claims to know more than they do. Then spend quality time reviewing the designer’s portfolio. Ask a lot of questions. You can also ask many designers to create a sample page for your website so you can see what they are capable of. Keep in mind many designers will charge for such custom samples (as a precaution). Above all else, don’t be cheap in website design! Spend the money on your site and hold off on the expense of Ad Words for a bit. Once you have a good website, you can start driving traffic for free or relatively inexpensively.

The next reason you only sold one tomato may be your brand image. As a small business, how can customers know you are reputable? Who are you? Before Ad Words can have a positive impact on your sales, you need to build your brand. A brand is the combination of your name, what you do, how you do it, what you stand for, etc. Before people will trust to buy from you, they need to know your brand or at least not be afraid of it. Your website is a major part of your brand, make sure it is professional-looking! Additionally, branding activities can be used to generate website traffic. That, however, is the subject of the next post. 

EHR & Good User Interface Design

I think I have mentioned before that I read the Kevin MD blog. Today, I read an interesting article. I did not agree with the writer’s ideas, but it made me think and that is a bloggers whole purpose. So while, my opinion is widely different from the author’s, I think the ideas are well worth consideration… then after reading my opinion, you can form your own.

The article was called The UserInterface for EHR Should be Uniform by Roheet Kakday.  In a nutshell the article discusses the challenges physicians face in learning to use multiple EHR systems such as their office EHR and the EHR for the hospital. The author believes that this is one of the problems slowing adoption. With that in mind, the author proposes that EHR user interfaces be uniform and even recommends a mandatory adoption of a single EHR vendor by region.

Again, I do not completely agree with this idea. Over time reading my blog the reader may begin to learn a little about my personality… but for the sake of this article, I will tell you flat out – I am very pro-capitalism – even when it comes to healthcare. In the article, Roheet Kakday says that capitalism leads to product diversification and stratification. I cannot deny that to be a fact. The difference between our opinion is the value of diversity and competition. I thoroughly believe that competition is the single most powerful driver of innovation. If healthcare providers, HIT vendors, etc. are constantly struggling to gain market share – they are bound to be striving toward better products and thereby better healthcare.

I believe that it is competition and the resulting innovation that makes the American Healthcare system the best in the world.  Think about it… people come to America from all over the world for healthcare. If you or a loved one were diagnosed with a terrible disease, perhaps a life threatening cancer, where would you go? I doubt Zimbabwe or New Guinea were the first places to came to mind.  Why is our healthcare better? Simply, we have the best resources – designed, built, and marketed because of competition.

Still there is a problem. If diversity is in fact preventing adoption, providers are therefore not sharing the benefits of capitalism (referring to superior technology created because of competition). Therefore the benefit is lost and capitalism is of no value in healthcare, right? NO, the value is still there but HIT vendors need to shape up and get it right. The problem is NOT related to diverse user interface, the problem is stupid user interface.

Before I go on, I want to back and explain user interface. I know that some of my readers are not overly technical and I hate when people speak jargon without considering clarity. So, allow me to explain in English. Everything computerized is made from a combination of hardware and software. Hardware is comprised of the tangible, mechanical parts. Software, however, is a little less tangible.

Software is an ‘instruction manual’ that tells the computer what to do. Software (as an instruction manual for the computer) is written in code that the computer can understand. Computer programmers are experts in code and ‘speak’ it as a another language. Most other people, however, cannot understand code. So, to make software so that non-programmers can use it – programmers and designers arrange pictures or simple (common language) words on top of the code.

These pictures are the buttons, links, and things you see and click on in any software program. For example, when you click on a button in a software program (like the save button or icon) – you are actually clicking on a picture that lays on top of an individual instruction that tells the computer what to do in response to your click. Since what you see on a software or website are all pictures on top of code these pictures, including all of the button, icons, etc. are called the graphical user interface or just user interface (sometimes also referred to as GUI or UI). 

Now that all readers are on the same page, we can go back to the point at hand – whether UI should be completely uniform. Personally, I do not think such a measure is fair to competition and I don’t think it is necessary. What I do think is necessary is that EHR vendors follow basic and generally accepted  in user interface design. Allow me to explain using an example.

Like most people, I do some shopping online from a variety of websites. Each website looks different or has a different user interface. When I started using these websites, no one came to my house to do a formal implementation or training. I just figured out how to use the websites myself. Also, like most people, I access several bank websites, for my mortgage, car, personal banking, and credit cards. Yet, again, no one taught me how to use these sites. So why is it that most of us can use so many websites without training, but EHR software are too hard to use?

The answer is simple. Shopping sites, banks, news sites all have common elements and a common arrangement. They are not uniform – but they share similarities that help us navigate easily. These commonalities are simply good user interface design. As an example of this, think about a shopping website – any one – what do you look for when you are ready to pay for your purchases? The shopping cart icon, right? Now think about how you search for something that is not immediately visible. Where is the search? Isn’t the search usually toward the top of the web page? Menus are often in a bar along the top of the page or to the right side.

With good UI design there is no inconvenient left to right scrolling and the most often used or most important things are visible toward the top of the page. Colors and shapes are also sometimes used as indicators or to draw the user’s eyes to a particular location. For example, red and bold attract the eye and hyperlinks are often blue until the user clicks on them and then they are purple to indicate that they were previously viewed. Further, think about a shopping web site… when was the last time you chose shipping options before selecting merchandise? Never. Why? Because websites are supposed to be designed to move in a rational order.

The problem with EHR is that vendors often ignore the virtues of good user interface design and user experience. We don’t need total uniformity. We don’t need to have our choices and competition limited. What we do need is for EHR vendors to adhere to good user interface design principles.  Here’s a clue to the EHR vendors… you are wasting time, effort, and profit on training and support. A little effort and time spent during the design process will benefit all parties far more and improve adoption. 

Can Mobile Health and Social Media in Healthcare Improve Patient Engagement?

With Meaningful Use stage 2 looming and healthcare payment models gravitating toward value and outcomes, mobile health and healthcare social media are all the rage. So, I figured I would jump on the bandwagon.

Everyone knows patient-centric healthcare apps and websites have been around for a while. Sites like WebMD, Patients Like Me and  others have been in use for years and web-based personal health record abound. Still, patients are seemingly not as engaged as they could be. Why?

Last year, I decided that I wanted to drop a few pounds. To guide that venture, I downloaded an app called My Fitness Pal. It was nice and easy because I could log calories by scanning bar codes on food. I used it religiously for a couple of months, lost some weight and haven’t touched it since. Why?

When I or someone I care about is sick, I might do a web search to find out about the condition or ways toward relief – usually finding what I am looking for through someone like the Mayo Clinic and confident that their information is trustworthy… but that interest is over in a flash. Why?

Clearly, I am not an engaged patient. The reason is simple. I am not sick all the time. In general, I am quite healthy, but for the occasional head cold. At the same time, I have known people with more serious conditions like diabetes, cancers, etc. The funny thing is, those people are not sick all the time either or at least they don’t want sick all the time.

Even though I work in healthcare and am immersed in healthcare daily, I don’t find personal healthcare interesting. It is terrible to say, I cannot even recall the last time I had a physical. It’s not that I have any aversion to taking care of my health, but amid work and day-to-day life things – I just don’t think about it. As for doctors, well… to be honest, I have seen the business side of healthcare so long that I cannot be engaged with someone when I know he/she is not engaged with me.

All these healthcare apps and websites are great when I need them, but when I don’t – I forget them. Initially one might say that’s ok. If you don’t need it, don’t use it. That, however, is wrong. Prevention and a healthy life style are key to controlling healthcare costs.

So, if people like me are not interested enough to seek information – the powers that be should send it to me, right? Wrong! Currently, my email inbox has 8,498 unread emails (no, I am not exaggerating). I scan through the senders, read very few subject lines, open even fewer emails, and ignore the rest. My email is a black hole for junk mail (haha spammers, I just ignore you!).

Twitter, perhaps? The messages are delivered in a timely manner. They are short..perfect, right? I don’t think so. I don’t read about 90% of what I follow on twitter. Now, I do scan the tweets from just about everyone I follow (from time to time), but not frequently enough to really learn much. Further, a lot of it just isn’t pertinent to me – so I ignore a lot. Heaven knows what I overlook in my rush to get through it all.

I have mentioned before that I am a HIT product manager.  As a product manager, I love challenges like I described above. So, let’s dissect my disinterestedness product manager style and see if we can find a solution that will bring patient engagement to fruition for unengaged patients like me.

1.       I am not always sick and I have other important things to attend that often supplant the importance of my own healthcare

2.       I am bombarded with messages that I don’t have time or inclination to read

3.       I am willing to seek health information when I want it

4.       I am only interested in things that I consider important to me or those I love

5.       I do not believe that my healthcare is any more important to my doctor than it is to me (and that is not very much)

Based on this, I see that the way to engage me is as follows.

1.       Combine healthcare information in a meaningful and organized way with my other interests.

2.       Don’t overwhelm me

3.       Make the information specific to my interests, but give me the option to search for other things when I want it

4.       Deliver it to me but not by email

5.       Make me believe healthcare providers actually care about me

Perhaps now it seems we are no further than we were before. Isn’t this what most sites are already doing? No, I don’t think so. For most things, I have to go to them or if the site sends me things it is irrelevant, untimely, or just too much. So, I go back to the age old principal in innovation– KISS (keep it simple stupid).

There are two non-health related technologies that are simple and from which I think healthcare could take some lessons.

First, think about text messaging. It is simple. People, like me, read text messages. I don’t have time for yet another overdone website. Texting could be a great way to remind patients about preventative visits, reminders to follow up, reminders to fill medication, or simply how are you feeling messages that build the patient-doctor relationship. Clearly, there are some doing this already – but why so few? The right HIT vendor could automate texts creating ‘personalized’ messages based on criteria pulled from the doctor’s EMR.

Another fabulous idea is Pinterest. It exceedingly well organized collage of the often disconnected things I like – from architecture to healthcare. Like I said above, people are not sick all the time. A site like Pinterest has the potential for making healthcare part of the other things I do rather than something I have to seek out. While pictures may not be the best way to do it – the basic idea of ‘boards’ or organized groupings of my diverse interests is simple yet brilliant.

I think the basic idea here is that in order to successfully improve patient engagement through mobile technology, HIT providers are going to have to find ways to include healthcare in patient’s other interests. Further, simplicity rules. No one has the time or inclination to be overwhelmed by more information that is already required of us. Patients don’t have time to log health stats in disconnected locations.  Lastly, patient engagement will only come when patients feel that our clinicians are engaged with us in return – that we patients are more than dollar signs. 

How to Learn More About the Healthcare Industry

I got the following comment on the resources page and like several other questions, I thought the answer may be of interest to others as well so I decided to answer it as a post. Here’s the question:

“I would like to start by saying that I really do appreciate you taking the time to share your wealth of information and creating this reservoir of knowledge for the all of us.

I am 25 years old, just out of graduate school. I work for a firm that provides IT medical billing solutions to the medical industry and I am looking to understand the nuances/intricacies of medical billing as a whole. Reading your blog posts has been very informative to me.

I've been in the business for two and a half months now and I have gotten a head start into understanding some of the details. I was wondering though, if there was a starting point from where I could incrementally add to my understanding or if you just grasp things as you go along? I eventually do want to end up in the healthcare consulting industry. Please advise. Thank you once again for all your help.

Regards

Yash”

Yash, thank you for the question and congratulations on both the new job and finishing grad school.

The healthcare industry is growing at a tremendous rate and your work in HIT (healthcare information technology) will be a huge asset in working to achieve your goal of healthcare consulting. You are absolutely right to want to learn more. Any knowledge you add to this experience will be a benefit.

Obviously, you have already visited the resources page.  Still, since this is a post, I will remind other readers that the resource page is full of great websites to help you learn more about the healthcare industry.

Yash, as you noted best way to learn anything is by hands on experience. Still, you can add to that knowledge by studying. Of course, this blog is the best place to start. If you have not done so already, go back through the archives. There is a lot of information in here!

You should also consider spending some quality time with Medicare. While there are a ton of different insurance companies around, Medicare is (as a general rule) the standard for most things. I find, that once you have a firm understanding of Medicare, other insurances policies and procedures are relatively similar.

The website CMS.gov  (the website for the Centers for Medicare and Medicaid Services) is a wonderful place to start. Here is a link to their education pages: http://cms.gov/Outreach-and-Education/Outreach-and-Education.html

You can also take online courses in medical billing and/or coding through the AAPC. Here is a link to their educational programs: http://www.aapc.com/training/index.aspx

The most important thing is to keep up on changes in the industry. There are several websites that I read frequently and I highly recommend them as sources to learn more. Check out:

Capture Billing Blog

Kevin MD

Healthcare IT News

Now, you will note the last one is an IT website. This is important. While there is a lot to learn in medical billing, HIT is the next big wave… be ready to ride it! You should be knowledgeable about things like EMR, Meaningful Use, health information exchanges, and new applications (apps) for healthcare.  Also, you should make an effort to learn about new business models in healthcare such as medical homes and ACOs (accountable care organizations).

Lastly, please, please do not limit yourself to billing only. I know that initially sounds counterintuitive, but hear me out. By studying other industries and various business methodologies, you can develop new ideas that apply to healthcare. A breadth of knowledge in many areas will make you far more successful than just billing alone.

For example in methodologies, Six Sigma has many ideas that apply to healthcare insofar as streamlining operations and reducing waste. Lean methodology has fabulous ideas for developing a business (product) that customers love while keeping costs in check. You should also do some study on Total Quality Management which provides metrics by which you can assess quality and implement positive and profitable changes in an organization. I cannot say any one of these methodologies is better than the other; they all have applications and benefits regardless of industry. 

In summary, read everything you can get your hands on! You will be surprised how you can apply that knowledge and what creative ideas emerge. 

I hope that you feel I have sufficiently answered your question. If you have follow up questions, please feel free to post them. I am very glad you like my blog and I promise to try to keep going with relevant, useful, and educational content. And again, thank you for the question.

Has AllScripts Hit a Home Run in EMR Innovation?

I spoke too soon! In a recent post, I said that someone needed to design an app sytle EMR. Well, I should have known… AllScripts to the rescue! On April 5, 2012 AllScripts announced the release of the Wand, an iPad application that gives doctors mobile access to the most commonly used features of their EMR.

While I have not seen the Wand myself, the concept is GREAT and the company’s press release interviews an end-user who is quite pleased with the product calling it “elegant”. Most impressive, is how AllScripts designed the product and this design is why I am convinced that Wand is going to be a home run! Finally, an EMR company is taking user experience seriously. The Wand was designed, according to the press release, incorporating user-experience concepts and Human Performance Modeling.

For those not familiar, Human Performance Modeling is a performance modeling technique that incorporates both behavioral psychology (in other words, how people move and why) with best practices from concepts like Total Quality Management and Six Sigma. Human performance Modeling not only helps to make software usage more convenient but also (and most importantly) more efficient by eliminating performance gaps.

Like I said before, I have not had the pleasure to see the Wand, but if I get the chance you can be guaranteed I will revisit this topic in another post to tell you everything I learn about it. In the mean time, you can see the press release by following this link: http://www.healthcareitnews.com/news/allscripts-ipad-app-waves-wand-over-ehr-functionality

Or you can check out AllScrtipts website at http://www.allscripts.com/

Healthcare Apps: Great Ideas in Text Messaging

Now, let’s go back to looking at some great innovations in healthcare IT. Since my last post was about apps in healthcare I thought I would spend some time talking about a really great idea for an app for physicians and hospitals.

The first app I want to mention is called Tiger Text and it brags HIPAA compliant and completely secure provider to provider text messaging. To guarantee security the app works on a closed network meaning that is it not standard SMS messaging but rather a member to member chat. Further, messages are not permanently stored on some random server, but rather passed directly from sender to recipient then deleted after a specified time period.

Considering that text messaging is quickly moving in to the number one spot as a means of communication, I am glad to see that someone thought to develop a system that doctors can use for exchanging protected heath information securely. Traditional text messages through phone networks are not totally secure, yet I have seen providers using text quite often. 

For those providers who are texting in un-secured environments, this is a great opportunity to do it right. For those providers who are not, Tiger Text is a chance to enjoy the convenience of texting without fear of the HIPAA police coming after you.

Another nice thing is that the service can interface with existing software and it can be accessed from a desktop computer and/or a smart phone.

So, for example, the nurses in the hospital can send a text to a doctor about a change in patient status from the patient’s bedside and quickly receive a reply directly to their phone. Now, one could argue that it is equally easy to just call the doctor and while that is true think about the way many people use text messaging for personal business. If calling is easier, why do we all text so often? Texting is quick, easy, discrete, and if the recipient is not available, texting waits until the recipient is available. Further, texts get better and more frequent responses than voice mail.

I’m not sure if Tiger Text is able to send attachments and pictures, but it just makes sense that it should be able to. Even if it cannot, I definitely this app belongs on my list of very useful healthcare business tools and great innovative concepts in HIT. 

Apps and Healthcare

I was just reading a great article on the KevinMD.com blog about how an ER physician uses her smart phone to facilitate care. For example, the author called a specialist from her smart phone, received a return call on her smart phone, looked up medical information on her smart phone, and even took a picture of an EKG and emailed it through a secure network from her smart phone. None of this is really new. In layman’s terms a user makes a call, gets a call back, looks up information on Wikipedia, takes a picture something and sends it to a friend. Most of us have been doing this for years.

I think people need to be told about the obvious applications of technology and I am so glad that this article spelled out the value of technology in simple, real life terms. Still it makes me think. Why does healthcare require laws like HITECH and ARRA and government incentives to do what other industries have been doing for years? Apple’s iPod and iPhone hold over 80% market share and there were no laws requiring its usage; yet, EMR is still (despite laws and incentives) struggling to convince doctors about the value. Maybe, EMR needs to take a closer look at the ‘value’ they are providing.

One big problem in healthcare IT adoption is the use of uncommon technology platforms, formats, languages, etc. None of the various healthcare technology solutions can talk to each other with ease. With that, information has to be entered again and again into different places or providers have to pay for expensive fees to link the software through interface. Given there have been some improvements with CCR, CCD, HL7, etc. but it is not enough.

Still, I am not sure this is the whole problem either. Think about Apple again. For a very long time Apple had compatibility issues in this Windows dominated world. Yet, iPod, iPad and iPhone dominate and even the Apple computers have become popular enough that Microsoft has had no choice but to create Apple compatible versions of many products. So, can we really say compatibility is the problem? I’m not so sure. I wonder what would happen if someone came up with something as good as iPhone for healthcare. Would adoption and perceptions change?

I think the bigger problem is cost versus value. Healthcare providers struggle to find a single affordable system that doesn’t milk every penny out of the provider’s pocket. Very often it seems that every feature in healthcare technology is an additional cost and every interface to develop connectivity between systems or between healthcare providers is another fee. Another aspect of cost is the money lost in long implementation times resulting from software that is just too hard to use and/or inconvenient. These are problems that smart phones don’t have. Features (apps) are cheap or free and I only need to pay for the ones that I use. Also and perhaps more importantly smart phone apps are easy to learn and easy to use. Why does EMR have to be so complicated?

The answer – it doesn’t! I think that over the next few years we will begin to see some dramatic changes in this as life becomes more and more app driven. We are eventually bound to see an app style EMR emerge. In the mean time, I hope more and more providers will begin using the technology that is already at their disposal.  

What's Next in Healthcare?

For those interested in the future of healthcare technology, this video is fabulous! Technological advances give us a lot to look forward to. 

EMR Innovation Should Be Spelled KISS: Keep it Simple, Stupid

In a recent post, I talked about an innovative EMR idea. I thought for this post I would back up and talk about innovation. Perhaps I can discuss my definition of innovation because the more I look around the less innovation I see.

The dictionary definition of innovation (according to the all-knowing Google)  is a create something new. I don’t like that definition. I think that is weak and limiting. Something can be new and completely useless or just plain badly designed. Would that be innovative? If it is, then I think innovative is a very sad word. To be innovative, something needs to be better, but not necessarily new.

For example, if we look at the iPod again, it was not a new concept, really. The iPod was a portable music player. That was not innovative. Walkmans were portable music players long before iPod existed. The innovation came in the fact that iPod was better than what came before it.

With that, I’d like to recommend a better definition of innovation. Innovation is a way of doing something that is better than anything that already exists. Innovation, therefore, can be an improvement on an existing concept and not necessarily something entirely new… it’s just better. An innovation should meet an unmet need, improve function, communication, and/or operations, etc.

In the healthcare IT world, there is very little innovation. For example, all EMRs do the same thing and generally that same thing is burdensome in many different ways. That is why healthcare information technology (IT) adoption is still relatively low – even with government incentives. The biggest problem in all of healthcare IT is that the current technology is not innovative (e.g. it is not an improvement). 

Now, I am not contradicting my previous posts here. There are some great ideas out there but I think the execution is still WAY off. I will share a story with you so you can see why I would say such a thing.

Some time ago, I did a site visit with a client where I shadowed my product’s end-users for a full day. The purpose of a site visit is so that I, as the product manager, can see what users need (because often they cannot really explain it clearly). During this visit, something very important happened and I had an epiphany. The nurse I was shadowing stopped her work to ask me how to perform a task on the system. The solution to her question was easy for me and the nurse was a little embarrassed so, she excused her question by saying “I am just no good with technical stuff”. What happened next struck  me.

Then, the nurses cell phone vibrated and she picked up her iPhone to answer. A few second in to her call she said let me check the bank and I will call you back and let you know. After hanging up, she used her iPhone to log on to her bank account. Then, she logged in to her email from her desktop computer, clicked on a hyperlink led to a product on Amazon.com. She proceeded to buy the product online, then return the call to say that she had bought the product. In a matter of 3 minutes, she used multiple technologies. Not tech savvy, hu???

As a good product manager, I had answer some very painful questions. For example, why is my software harder for her to understand than iPhone, email, bank, and Amazon.com? Then the really important question – the expensive question in the software world…. Why does my software requires weeks of end-user training and ongoing support when non-tech savvy people download and use apps, bank websites, and online retail with little to no training?

The answer is simple. Healthcare IT has forgotten about intuitive end-user design. I will admit, healthcare is complicated…but so is banking. If we want to improve adoption of IT in healthcare we need to simplify. That's right KISS, keep it simple, stupid. To do that, healthcare IT needs to include non-tech savvy users in the design and development process and in usability testing. I completely understand that such a proposal can be expensive to implement initially, but is it really more expensive weeks long implementation, ongoing support, and redesign after redesign in hopes of eventually getting it right?

Poor design in healthcare software is the problem preventing adoption. If we want to move healthcare in to the 21^st century in terms of technology, we really need to take a good long look at the technology that the self-proclaimed non-techie people are using. When a healthcare IT vendor finally comes up with a software that does not take months to implement  or years to really understand, technology adoption in healthcare will skyrocket. Remember, innovation is not necessarily something new.. it is something better. Simplifying something that is complicated is better… it is innovation.

(As an amusing side note… I keep referencing iPhone in posts but I am an actually Andriod user haha.)

HIT - Healthcare Information Technology

Technology is a great thing. It simplifies our lives and gives us the ability to do things we could not have done otherwise. Remember when people carried personal CD players around? They could play an entire CD and were relatively handheld. But then… the IPod came and we could play thousands of songs hundreds of different CDs.  Have you ever wondered where these things come from? How does this evolution happen?

Really, it is simple. These ideas come from paying attention and watching people closely. This is one of my favorite parts of product management. As a product manager, it is my job to constantly pay attention to everything. For example, I watch what is happening in the market, what competition is doing, and how end-users use my product. From that, ideas are generated. For example, I may see a person doing a particular task over and over and I’d ask myself – ‘can’t we make that easier for them?’ or ‘how can we do that better?’ Many times, the changes or development are not massive, sometimes a little goes a long way at making the customer happy.

Other times, a new development is a disruptive technology (translation = disrupting the status quo). For Apple, someone saw people stuck with just one CD at a time and said ‘can’t I make that better? What if you could have thousands of songs from many CDs all in one place.’ As we see now, that person hit a home run for Apple.

These improvements can take many forms. The change can be related to a new business model, a new marketing or positioning strategy, a new look, improved technology, or a combination of many things. The most important thing is to make sure that the customers want the change. The customers are a company’s most valuable asset.

Now, perhaps, you are thinking “this isn’t about healthcare, this is about technology. What is she doing?” Well technology is HUGE in healthcare and it is only going to get bigger. Think about the insurance website you log in to when you check if a doctor is in network… technology. Think about robotic surgery … technology. Think about EMR and medical billing software…technology. Electronic claims submission…technology.  And the list goes on and on.

In this evolving world of healthcare, you had better be (or become) tech savvy. With that, let’s start talking about technology. 

Successful EMR Implementations

I decided to skip the next obvious topic about choosing an EMR because, I think that topic has been exhausted everywhere. On the other hand, I can offer some practical advice on the best way to implement an EMR in a medical office.

The very first thing you must realize when you decide to move to an EMR is that your workflow will change. Don’t be deceived by any vendor who tells you otherwise. Still, that is not a recipe for disaster – it is one for improvement! You must be prepared to change the way you do things and you need to be ok with that. The change from a paper record to an EMR is a little like when we all began moving from typewriters to Microsoft Word. It was weird, right? It took a some adjustments, but soon you realized how much easier typing had become.

Once you are mentally prepared and understand that things must change (for the better) you are ready to go.  Having worked in healthcare for years both as a consultant and working with EMR, I have found that the best implementation practice is to have a staff cheerleader. The staff cheerleader needs to want the change and needs to drive the change. The staff cheerleader should also be what some people call the ‘super user’.

EMR vendors will either offer to do your implementation in person or virtually using web conferencing technology. Either way can be successful if you have a cheerleader/super user. That super user should be the first person trained directly by the EMR vendor and will not only drive the rest of the users to implement the EMR successfully  but also become the on-site ‘go to person’ for the rest of the staff. So, how do you find the right person to be the super user?

The super user must be a person who embraces change. This must be a person who is flexible and willing/capable of learning new things. A super user must be comfortable with technology. The best super users are those who are not afraid to play with a new software, even without or before formal training. Super users are by nature inquisitive and have a clear vision about how technology improves workflow.

Again, the super user is the cheerleader. This person has to be a leader who can encourage and motivate others to see the improvement ‘vision’. You can help the super user to be successful by giving that person clearly defined goals and authority. Without authority, the super user will not be able to drive change. This is not to indicate that the super user should become a dictator, but the super user needs to be able to set goals for the rest of the staff and offer positive reinforcement as needed.

Once you have identified the super user and the EMR vendor. Make sure that super user is an expert on using the software first – then he or she can train the rest of the staff. If you have a large practice, you may need multiple super users, even perhaps super users for specific segments (like billing, clinical, front desk, etc.) regardless having a super user(s) on staff is integral to a successful EMR implementation.

When the super user is ready, he/she should define incremental implementation goals. Don’t try to do everything at once. That will just overwhelm the staff (particularly those who are not comfortable with technology). Start slowly and add new things as staff becomes comfortable using the software. For example, your super user may choose to start by teaching the front desk to enter demographics and use the new software’s calendar. Once the staff is comfortable doing that, you can teach the staff how to verify eligibility electronically.  

Of course, this is just an example. In reality, some EMR software have these features intertwined so smoothly that you may choose to implement all those items simultaneously… but you get the idea… slow and steady wins the race! Your best bet is to ask your EMR vendor for help. The vendor knows the software and they have likely done hundreds of implementations just like yours. The vendor will be able to recommend how to break up the system in to incremental implementations.

Here, it is important for you to realize that this type of implementation will take longer than jumping in to it all at once. BUT, you will find that this is more successful. When you jump in too quickly, people get confused and make mistakes that WILL impact revenue and performance. If you take it slowly, implement in bite sized pieces over the course of 3-4 months, you will minimize (or even eliminate) any negative financial impact that could have resulted from the change in workflow.  

Introduction to EMR Part II

In the last post I mentioned the government incentives for doctors who meaningfully use an EMR. For many, the term meaningful use is a bit confusing. Really, though, it is quite easy. Meaningful use simply refers to using the best features of an EMR.

Last year, 2011, was the first year of meaningful use. In that first year the bar was set pretty low insofar as usage requirements. Basically, doctors had to use an 'approved' (certified) EMR the right way for just three consecutive months. The EMR that the doctor chose to use had to be certified according to ONC-ATCB requirements. The ONC-ATCB requirements simply ensured that the EMR had the necessary features to accommodate doctors needs and government requirements.

As of 2011, there were two companies testing and certifying EMR for ONC-ATCB certification. These are The Drummond Group and the Certification Commission for Health information Technology (CCHIT). These two companies have great websites that help a physician find a certified EMR product. If you are in the market for an EMR these websites are the best place to start.

Once you are on the site(s) you will see that there are two types of certification, complete and modular. Complete means that the EMR has proven that they have all of the components a physician needs to achieve meaningful use. A modular certification simply means that the software satisfies part of the requirements. If a doctor chooses a modular EMR s/he will need to use other technologies to fulfill some of the requirements for meaningful use. 

In other words, with a complete EMR – you have everything you need in one place. With a modular system, you will need to use multiple modular systems to meet meaningful use. 

While systems with modular certification may seem to be less useful – that is not necessarily true. Modular give you the ability to mix and match according to your preferences. So, in my opinion, either modular or complete are great depending on your preference for all-in-one or mix-and-match.

Now, let’s jump back to meaningful use. As I said before meaningful use really is easy but it may require a change in workflow…. Even so, it is a change for the better in most cases. Here is what meaningful use requires the physician to do in an electronic medical record:

• Prescribe electronically
• Turn on the EMR’s drug interaction warnings
• Report clinical quality measures to the Centers for Medicare and Medicaid Services (CMS)
• Enter patient demographics in the EMR (name, gender, date of birth, etc.)
• Keep an electronic record of patient’s diagnosis history
• Record patient allergies
• Record patient medications
• Record patient vital signs (height, weight, blood pressure, etc)
• Record whether a patient smokes
• Implement clinical decision support rules (automated reminders about how to handle certain medical situations)
• Provide medical records to patients within 3 days of their request
• Provide patients with a summary of their office visit within 3 days of the visit
• Test the EMR’s ability to electronically communicate with other medical providers
• Conduct a security and privacy risk assessment
• Turn on the EMR’s drug formulary system (checks if medications are covered by a patient’s insurance)
• Enter (or receive) lab results in the EMR
• Generate a list of patients by medical condition
• Send patient reminders about preventative care and wellness
• Give patient’s timely access to their medical information
• Provide patient educational materials
• Perform medication reconciliation when patient’s transition from other care providers (this means the provider must compare his/her list of medications to a list from the other provider)
• Test the EMR’s ability to submit immunization information to the appropriate state agencies
• Test the EMR’s ability to submit electronic disease information to a public health agency (health department, Centers for Disease Control , etc.)

See, there is nothing earth shattering in that list. These requirements will, however, get bigger as time goes by. But for now, meaningful use is simply a way to get doctors to get acquainted with using an EMR. Also, as you look over that list of requirements, it is pretty easy to see how useful these requirements are in patient care. 

To learn more about meaningful use and the EMR incentive programs, go to the Centers for Medicare and Medicaid website here: Overview of EHR Incentives

Introduction to EMR (EHR)

Considering my experience in EMR, I think a good place to start is talking EMR.

An EMR, for those who don’t know, is an electronic medical record. An electronic medical record virtually replaces all paper patient charts in a medical practice or hospital. Another term frequently used is an EHR or electronic health record. EMR and EHR are technically two different things but in common usage the terms have become synonymous. For the purpose of this blog, I will call it an EMR and assume that an EMR and EHR are the same.

We’ll start with a simple introduction to EMR.  In general electronic medical records all have the same basic features such as places to enter/store patient demographic profile, patient medical history, documentation for each patient visit, scheduler or calendar, and so on. An EMR program and all the patient data contained within can either be stored on a server (computer) in your office or it can be web-based. A web-based EMR holds the same type of information, but the data is stored on the software company’s servers and you access it over the internet.  

There are pros and cons for both. For example, if your EMR is stored onsite at your office, you need to take precautions against disasters that would cause you to lose information – like flood. Web-based EMRs generally have these precautions figured out. Web-based EMR companies use a facility called a data center to house their servers (and all of your information). EMR companies have multiple copies of all the information called back ups and some EMR companies have multiple data centers which means that if one data center has a problem – the other data center can take over and continue servicing the customers. On the other hand, web-based isn’t perfect either. If your internet goes down, you cannot access the patient records.

EMR became a huge topic of conversation back in 2005 when Hurricane Katrina destroyed parts of the south. Millions of medical records were lost in that disaster and many realized that EMR, particularly web-based, would have prevented the loss of that information. In 2009, President Obama signed the American Recovery and Reinvestment Act (ARRA 2009) in to law. Within ARRA, the HITECH act dedicated billions of dollars to health care IT such as EMR.

The manifestation of ARRA’s HITECH act is known as Meaningful Use. In a nutshell, doctors and hospitals can be paid incentive dollars by the government for implementing and using an EMR. If they refused to use an EMR, government insurances like Medicare will begin cutting their payments within 5 years. This is why so many people are talking EMR these days.

Still, there is more to it. It is not just the fear of natural disaster that prompted the EMR madness – it is patient wellbeing and ever-rising healthcare costs. EMR has features that help doctors and reduce mistakes. For example, most EMRs have features that help doctors write prescriptions and send those prescriptions to the patient’s preferred pharmacy. Writing a prescription on an EMR helps protect patients and keep costs down in two big ways.

First, doctor handwriting is messy (I think they learn how to scribble in 3^rd year med school). That messy writing can result in mistakes – either when the pharmacist fills the wrong medication or the patient takes it incorrectly…just because no one could read it. Secondly, EMR prescription writing software has built in warnings that will let the doctor know if s/he is prescribing something that the patient is allergic to or if s/he prescribes something that will have a negative interaction with the patient’s other medications. This is a huge help to doctors. 

Today, we have so many medications on the market , no doctor can remember everything. So EMR helps to prevent medical mistakes and thereby reduces the cost of healthcare. EMRs are good in other ways too. They keep all of the patient’s information in one place and it is always properly filed. This too helps to prevent medical mistakes from missed information such as family history of certain conditions that can be a warning sign for things to come for the patient.

So, that was a good start to what’s what with EMR. In the next post, we will get in to some more meaty stuff and I will talk about ways to successfully implement an EMR in a medical practice (it may sound like a no-brainer… but it’s more challenging that most realize).