The Healthcare IT Guy

The folks at Phyzoom have recently released a social networking site for physicians that adds a nice twist – it’s helpful for marketing services between physicians and other parts of their healthcare ecosystem (insurance, hospitals, etc). I’ve seen and reviewed a number of physician-oriented social networking sites (like Sermo and Ozmosis) but Phyzoom seems to be the first one looking to help doctors with marketing and increasing patient visits. It’s an excellent idea.

In addition to tying together physicians, Phyzoom seems to also rope in patients to help them communicate with their physicians.

Check them out and let me know what you guys think.

Many Physicians have been asking me for what my suggestion is for e-prescribing both now and in the future. My simple answer for them is that unless you have an EMR fully functional and working in your practice and e-prescribing is built-in, you should give the NEPSI guys a shot: they are offering free and pretty decent e-prescribing nationwide to any Physician willing to sign up.

If you’re a NEPSI user, help out your fellow physicians and tell us:

1. What do you think, in general, about NEPSI and whether you recommend others sign up.
2. How well does it integrate with your patient roster and EMR?

If you’re a technical consultant or team who’s helped do some integration, I’d love to hear how you did it, what API or other documentation is available, and whether you recommend it to your physicians.

One of the biggest challenges in conducting clinical trials is recruiting the right patients. It’s an often expensive, time-consuming, and difficult process where you usually need contract firms or other specialists to do your recruitments.

This week I learned about a New York based healthcare IT startup, TrialX, which is doing some pretty innovative stuff around patient recruitment by using Google’s and Microsoft’s personal health platforms to help match patients with specific trials.

It looks pretty friendly and uses natural language processing to deal with unstructured data instead of forcing lots of data structuring and discrete data capture and analysis alone (which is how existing firms do their matching).

A neat little widget is also provided so that TrialX can also be  integrated into websites. And, while Google and Microsoft are the initial PHRs they will work iwht, they said they are looking to integrate with PHRs such as Dossia/Indivo Health and others soon.

This is a company worth watching to see how the clinical trials segment of the Pharma industry can benefit.

MedCalc is a free medical calculator for the iPhone, Palm OS and Windows Mobile. It’s pretty useful and well done. The best thing about it (other than being helpful on a daily basis) is that it’s open source so it can be expanded upon easily. Check it out.

The nice folks at NAHIT sent out a note about their new survey of about 144 CIOs that captured technology executive’s views on healthcare IT spending. The report’s key findings include (these are direct quotes from the report):

• More than half of the CFOs/VPs Finance (55%) are experiencing slight or significant delays in accessing capital and expect the financial crisis to last another 12 to 24 months.
• CFOs/VPs Finance are delaying or lengthening timeframes for completing new facilities or facility upgrades (74%,) deferring IT equipment purchases (57%) and delaying or lengthening timeframes for implementing health IT initiatives (52%).
• CIOs are responding by implementing longer timeframes for application projects (63%) and reducing spending on outsourced IT services (34%).
• One-third (33%) of CFOs/VPs Finance have cut budgets while one in four (26%) has laid off staff and/or instituted a hiring freeze.
• Almost all respondents (94%) have cut IT budgets by extending implementation time for existing projects and delaying or reducing the slate of new projects.

It goes on to say:

“While this recession is clearly impacting IT expenditures, it is encouraging to see that there is not major slashing of IT budgets; that IT projects are being generally preserved, albeit with some slowing of pace and schedules,” says Richard Correll, president and chief executive of CHIME. “The continued support for IT investments is a clear vote of confidence and recognition of its strategic importance by senior health care leadership.”

Dr. Joshua Schwimmer wrote an article earlier this year called The New 3G iPhone, Doctors, The App Store, and Medicine in which he tried to predict what kinds of iPhone (and of course iPod Touch) applications would be available once Apple opened up the platform to 3rd party programmers. This week he posted an update called Medical Applications in the iTunes App Store for the iPhone and iPod Touch in which he highlights some of the almost 100 medical apps available for the Apple mobile platform.

I’ve tried many of these applications and they are a great start. Lots of physicians are using smart phones and many are die hard fans of iPhones. iPod Touch is not really made a big impact in hospitals and other mobile uses but I think it should — it’s almost the same platform as iPhone and is actually a cheaper device for use while roaming within a hospital using WiFi.

Check out Dr. Schwimmer’s postings and let me know what applications you’re dying to see on your iPhone or iPod Touch. Are you a physician using an iPhone or iPod Touch? What are your thoughts about it as a medical applications platform for mobile use?

Fred Trotter sent out a link today to the new AMIA report entitled Free and Open Source Software in Healthcare 1.0. Fred reminded us that this is the first time he’s seen a serious count of installations of open source software in non-government institutions. ClearHealth seems to be the leader with over 3 million patient records managed at over 830 sites. Not exactly taking the world by storm but certainly good news that free stuff is being used to do important healthcare data management.

Check out the report here. It’s worth reading.

Dr. Jason Bhan is a practicing family physician and an Assistant Clinical Professor and Community Preceptor at the Medical College of Virginia and is board certified in Family Medicine. Dr. Bhan is Co-Founder and Chief Medical Officer of Ozmosis, a great physician-only online resource for sharing medical knowledge between trusted practitioners. He is regarded as an emerging national expert in the applications of social media to healthcare and medicine and writes a regular blog on these topics and more at his blog. He’s got some great ideas and always has very practical advice for physicians and patients turning to the Internet for better healthcare information. Here’s what Jason had to say about Patient Social Networks.

A recent Manhattan Research study revealed that over 60 million U.S. adults are now Health 2.0 consumers. This means that over 60 million consumers are using social media (social networks, blogs, videos, etc.) to interact and share their health experiences online. As physicians, we should be aware of the additional opportunities and resources our patients now have online.  As we, ourselves, embrace new and innovative methods to learn from one another, we must be prepared to advise our patients and practice medicine in the social media age.
The impact social media is having on medicine is most notable in four areas - patient social networks, social search, knowledge sources (wikipedia powered sites), and physician online communities.  In this and subsequent posts we can examine, with more detail, each of these and their specific impact on the way we learn, practice, and care for our patients.
Patient social networks are generally either diverse, all purpose communities, such as HealthCentral, MedHelp and RevolutionHealth or disease focused, such as Patients Like Me (neuro-degenerative diseases and mood disorders), Relief Insite (chronic pain), DiabetesMine (diabetes), and I’m Too Young for This (cancer patients from 15-40 years old).  As these sites continue to grow in popularity, patients are using these communities to share and discuss daily life struggles or to cope with rare diseases.

Patients Like Me, in particular, has made tremendous strides as it brings together over 20,000 patients who suffer from diseases such as ALS (Lou Gerhig’s Disease), MS (Multiple Sclerosis) and Parkinson’s Disease. Patients use visual tools to chart symptoms over time, rate treatments and drugs, and even track their own progress against fellow patients. Patients and physicians should be aware that the company shares data, stripped of names and other identifying information, with research hospitals, pharmaceutical companies and non-profit organizations.  Inspire and Bristol-Myers Squibb recently started the Advanced Breast Cancer Community to offer both an information source and social network (support community) for people with advanced or metastatic breast cancer. 

Online communities such as these offer the benefits of support groups to those who might otherwise be unable or unwilling to participate (including family members and loved ones of the person diagnosed). The continued innovation and growth in consumer empowerment must be both applauded and carefully balanced with improved patient-physician interaction. In addition to our existing responsibilities, we must now decide how to participate with our patients on these sites.
In recommending and using social media, we need to focus on the following:

• Become familiar with assessing the quality of patient sites - one resource is “The Wisdom Patients: Health Care Meets Online Social Media”
• Provide patients with criteria on how they can review and select appropriate online patient support groups as well as potential risks and benefits of support groups and forums
• Make sure to visit a website before recommending it; learn about the community and consider becoming a physician contributor
• Warn patients not to make medical decisions based on patient support group advice without input from their physician

Social networks provide our patients with both amazing opportunities and new dangers. With our support, we can help guide them to make wise decisions as they engage and interact with the online world.

The nice folks from Ohio State University Center for IT Innovations in Healthcare sent me a note that they are holding their second annual “Healthcare IT Innovation Summit” on November 17 in Columbus, Ohio. It seems like a very interesting gathering and I might be attending.

They are inviting thought leaders to explore questions such as:

• What effect does consumer-driven healthcare have on leveraging technology resources?
• What are the strategies behind unleashing the true power of technology innovation in health care?
• What do patients really want tomorrow and how can technology respond?
• What effective models foster academic and industry collaboration in consumer-driven healthcare IT innovations?

These all seem like great questions and well worth putting together a special conference to discuss them.

See you at the conference.

As most of us in healthcare realized long ago, pen and paper is a very difficult technology to replace and compete with. It doesn’t matter how fancy our computers get, how nice tablets become, or how good the voice recognition features are, most healthcare workers spend a majority of their time on paper.

The IOGear Mobile Digital Scribe is probably the closest device I’ve seen that may allow doctors to switch to a non-traditional pen/paper technology. The device captures/digitizes your handwriting on almost any normal paper surface and then allows it to be saved on to your computer. You can also hook the Mobile Digital Scribe directly up to your computer and record your handwriting in real time.

By the way, Office Max has the IOGEAR Mobile Digital Scribe for $60 until October 18th so it’s cheap enough for anyone to try out. Give it a shot.

If you’ve already tried it, share your thoughts about it here. What other tools like this do we all we use that others might not know about?

A friend of mine sent me a note to take a look at Make Mine Paper by a blogger who calls himself "#1 Dinosaur, MD". It’s a well written article that explains why there are some physicians who will never use an EMR. Some choice words:

Until there is a single, interoperable system in wide use, EMRs will never have the portability and versatility of paper. Just imagine the chaos that would result if doctors’ offices used 8.5-in by 11-in paper for their charts, but hospitals all used legal-sized paper; labs reported their results on 4-in by 6-in cards, and x-rays were reported on 5-in by 8-in slips. Trying to keep all of those different sizes and shapes of paper together in 1 folder would be a nightmare. Now multiply that several hundred-fold.

He’s certainly right and I like his explanation of lack of interoperability; in fact, it’s one of the best analogies I’ve read. He goes onto say:

The fragmented market of EMR suppliers isn’t just as simple as PC vs Mac; there are hundreds of vendors selling different systems, each of which works differently and none of which are capable of interacting with each other. The only way to transfer records from one system to another is to print it out on paper and then scan or manually re-enter the information into the other.

This is where I disagree — the reason that systems aren’t interoperable and can’t interact with each other is because customers are willing to accept vendors who don’t work well with each other. It continues to surprise me how easily healthcare IT customers accept mediocrity from their vendors and sign contracts and make purchases that are only good for vendors.

With HL7 we have some a "good enough" interoperability solution and there are tons of tools and many vendors out there that will connect disparate systems.

How many of you out there are being held hostage by their healthcare IT vendors?

A friend of mine sent me this link - "Beware of the EMR ‘Ponzi scheme,’ warns physician leader" — earlier this week. The article starts off by saying:

Healthcare IT does not necessarily make life easier for primary care physicians, says a leader in the movement to make medicine more efficient and patient-centered.

"When you put an EMR into a primary care practice, your life is hell for the next year," said L.Gordon Moore, MD.

"EMR vendors aren’t really giving us what we need. We have to make a distinction between a robust EMR with decision support tools, and one that is just being marketed as a way to improve coding. And we really need to get out of the E&M coding game."

Yikes. I’ve been in the healthcare IT market for a while and that’s probably one of the strongest anti-EMR statements I’ve seen publicly.

I know I have many readers who are physicians — how many of you concur with Dr. Moore?

The nice folks over at RNCentral.com have posted their list of the top 50 Health 2.0 blogs. This humble blog is listed in their Health and Technology section and I thank them for their consideration.

The folks at SoftwareAdvice.com recently published EHR vs. EMR - What’s the Difference?

It’s a good, but at times too high-level and could have been a bit more substantive in terms of real problems and potential solutions (but I suspect this was "landscape" summary so I can’t fault them too much). It talks about what is an EMR, EHR, and PHR from a definitional perspective and goes on to give a good summary of how often each term is used (with Google stats) and why vendors are still calling themselves EMRs.

I think the general debate of whether it’s an electronic health record (EHR) versus an electronic medical record (EMR) or a personal health record (PHR) is really silly. It’s like saying that your bank records kept at the bank versus the copy they give you at home via online banking versus what you see at the ATM versus what you put into Quicken are all somehow different records — they are not. They are the same financial record (yours!).

EHRs, EMRs, PHRs, are all views of a single person’s health record that doesn’t really exist anywhere in totality — they are simply slices. Thinking that we’ll ever have a comprehensive record for anyone is like saying there’s one comprehensive financial record for a person that would include their taxes, bank statements, 401k statements, etc. There are aggregators like Mint.com and Yodlee.com that do financial data aggregation because there is no single source for a financial record and there never will be (too many players).

Healthcare data is far more detailed and even more volumnious and far harder to aggregate. Good luck trying to unify these definitions.

Caring.com is an excellent example of how to use Web 2.0 for improving patient care — by targeting not just those affected by illness but actually helping those that are caring for the patients. Caring.com’s focus on eldercare (adult children caring for aging parents) is a good one and should prove profitable. I really like their "to do list" ideas that give actionable advice and specific steps for how adult children can care for their elderly patients.

Seems like a good start. I’d like to see more "calculators" and tools added (like how much time should be spent on specific ailments, how often there should be doctor visits, a scheduler that might send out reminders, etc). I think the eldercare industry is going to explode and Caring.com seems to be in a good position to take advantage of the opportunity to help.

George over at Patient Centric Healthcare blogged about using mobile phones’ texting capabilities to get insurance company deductibles and other information. Nice idea, worth reading — somebody will make some money off of it. He says:

Imagine texting your plan for an immediate response on:

• Your deductible
• Your FSA balance
• Your copay on a specific drug
• Whether a provider is in network
• The status of your prior authorization
• A list of formulary alternatives

Neil Versel recently wrote about Medicine 2.0 here and here. Check out the postings, it looks like there was some nice stuff going on there.

The proceedings of the conference are freely available.

This is an article I wish I wrote. It’s about how to demonstrate your startup or business idea to a stranger on the phone or in an audience. Since people pitch me their products (which I enjoy, of course), I see lots of demos every month. At then end of each demo I almost always give advice on how the demo could have gone better and the folks at TechCrunch have captured it quite nicely. Check it out and learn from both Part I and Part II.

The folks over at Health Content Advisors talk about the business side of online consumer health firms. With big firms like Revolution Health not doing well, it’s getting a little scarier if you don’t have deep pockets to make the advertising model work.

As a blogger whose been around the block and online for a while I get lots of new ideas pitched to me from all the various healthcare technology companies and I get excited about new consumer plays but by the time I’ve finished interviewing and talking to the firms about their business models I’m less enamored because many of the firms have no clear path to profitability. It reminds me of my old dotcom days.

An important observation from Health Content Advisors that I’ve been speaking about recently includes:

while many of the new players rely on advertising dollars from pharmaceutical companies, pharma advertising hasn’t migrated to the Web as quickly as most analysts had predicted.  

This of course puts may companies’ business models at risk and those without supplementary sources of income have a issue during the short term at least.

Their conclude by indicating: 

We regard the current shakeout as a correction, not a collapse. Too many companies are chasing the same customers and advertisers.  The survivors will have done their homework and will bring technology and editorial experience to bear to solve an information overload or scarcity problem that someone is willing to pay for-either directly via paid content or indirectly via advertising or sponsorship.

I still think there is tons of money to be made in consumer health "done right" (meaning useful to people). But it’s clear nobody has struck the right chord (yet).

It has been some time since I last wrote about XTS, a rapidly growing virtualization management vendor focused on the Citrix market. In my recent interview with Eric Spiegel, CEO, I found out that XTS has had many important changes this year. On the product side, they launched a new, more powerful version of their analysis and reporting solution and renamed it Introspect for XenApp. Although it’s not designed for it, Introspect is a very useful tool for performing HIPAA compliance checks and audit reports of which users have been accessing specific applications and servers that might contain patient data.

Last week they released a free utility that enables Citrix administrators and architects to easily create configuration reports for their Citrix farms. These configuration reports are the first step to documenting application usage for HIPAA compliance reports.

Unlike the full product Introspect, which is focused on usage data captured in the Resource Manager summary database, the free configuration report generator utilizes the ubiquitous Citrix data store and features the same flexible, easy to use interface that they have always had in Introspect for quickly creating reports exactly the way you need them.

I see it as being useful for the following tasks:

• Documenting implementations and upgrades
• Creating baselines for troubleshooting, audits and disaster recovery
• Identifying incorrect server configurations, either to solve a problem or proactively reduce help desk calls
• Ensuring consistency of hotfixes across a Citrix farm

Additionally, integration with Active Directory can be leveraged for better insight into user and application assignments. Other bells and whistles like automated scheduling, report distribution via email and the ability to customize look and feel of report output can also be found in this robust piece of free code.

Anyone can download the free configuration report generator from the XTS website. It is currently packaged as a fully functional virtual machine and includes a sample Resource Manager summary database so you can try Introspect’s starter templates to evaluate the historical usage reporting and analysis capabilities as well. Please also note that they recently simplified their pricing model and now base it on the number of Resource Manager summary databases, which makes Introspect very affordable in my opinion.

If you are a Citrix administrator or architect I suggest checking out this free utility from XTS which will probably help you save time and possibly some headaches in the future.

If you’ve already downloaded a copy and tried it, drop us a line here and let us know how it’s working out.