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Meaningful Use Is Not For Specialists

You know, I’ve been thinking a lot about Meaningful Use lately. I previously I’ve had pretty negative opinions of it, and my thoughts seem to be echoed by a lot of doctors currently in practice.

Rob Lamberts, MD, wrote an interesting post titled Ten Ways to Make the EMR Meaningful and Useful. I have to admit, his suggestions made an awful lot of sense. They started me thinking about how useless much of my own documentation is because of its origination in archaic rules for receiving insurance reimbursement money. Unfortunately, it seems that a lot of these rules stem from the medical profession itself rather than have been having been thought of exclusively by insurance moguls. For example, the family history is usually almost entirely irrelevant to what my scope of practice generally entails. The Review of Systems (ROS), which is the part of the exam where we as doctors ask the patient a myriad of questions regarding their symptoms, is typically exhaustive, unproductive and usually despised by most practicing physicians. Patients are generally very forthcoming about any active symptoms that they are currently experiencing, and a few additional questions around their symptoms typically suffices for a doctor’s purposes.

The majority of old medical records that I get from previous practices in which the patient has been involved are usually either illegible, irrelevant, or not directly related to the reason the patient is coming in to see me. If I am seeing them for the same purpose and they are just transferring their care to me, I generally will ask much of the same questions that have been asked before, rendering the review of records of even more limited value.

I think that getting meaningful use out of our own individual records could be greatly helped by an overhaul of the medical profession’s recommendations to insurance companies on the types of information that needs to be included in medical office notes for the purposes of providing excellent healthcare. In the increasingly complex and technologically-advanced society in which we live, information “noise” really should be kept at a minimum, especially in providing appropriate healthcare recommendations to patients. Medical records should not be in a habit of containing information that does not change or impact the medical management of the patient. We really need to revisit the idea of “gee whiz” type of data and cut out any extraneous documentation.

This would, of course, require that meaningful use become much more personalized and individualized to specific doctors and their specialties. The current state of meaningful use is actually fairly limited in that it applies mostly to primary care providers making recommendations for preventive health care. Preventive health care, unfortunately, is almost never the reason why patients seek the advanced medical knowledge of specialists and subspecialists in specific areas of medicine.

In summary, I agree with Dr. Lamberts that we need to overhaul meaningful use into something that is much more meaningful and usable.

October 1, 2012 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

EMRs’ big gaping hole of secure messaging

Today’s post begins a series inspired by my recent participation in a breakfast panel in Washington, DC, Doctors and Patients Bridging the Digital Divide. There were a lot of useful ideas discussed during this panel, and so I decided to capture and share some with you.

One of the biggest holes in electronic medical records currently seems to be a lack of secure messaging systems built into the software.  Although maybe not universally true, this still represents a huge problem that also represents a great opportunity for gains in technology that will enhance the doctor-patient relationship and move digital healthcare forward into the future.

Currently, my electronic medical record vendor does not supply this feature as part of its software package.  However, as part of the Meaningful Use Stage 2 requirements by the federal government, the use of a certified EMR system that supports this function will be required.  A HIPAA-compliant secure messaging system will be needed as a part of every electronic medical record going forward.

Currently, if I wanted to use secure messaging to communicate with my patients, I would have to purchase a separate third-party vendor’s online software to communicate in a HIPAA-compliant fashion.  This involves an additional service agreement between the third-party and me, as well as monthly fees they can be expensive.  This would grant me the right to not only communicate with patients but also to bill third-party insurance companies for providing such electronic health services.  However, what may people do not appreciate is the small reimbursement allowance for such services, which is quite minimal.  Thus, regardless of the demand by patients, it’s currently more financially lucrative simply to see another patient in the office for a follow-up visit rather than answer a message electronically.  If an electronic medical record vendor builds secure patient messaging into their platform, when there is already a contractual arrangement between the doctor and EMR vendor, then a third-party cost would potentially become unnecessary.  The prospect of using a built-in, HIPAA-compliant, secure messaging system suddenly becomes much more attractive and potentially fiscally responsible.

Unfortunately, many EMR systems are in still developing stages at which they do not yet have built-in secure messaging features in their PHR or personal health record modules.

But what a wonderful and potentially powerful area for future development in order to further promote patients to become more engaged in playing a more active role in their own health care.  The ability of a patient to reach their doctor through the Internet is certainly an attractive feature if done right and seems potentially better than a patient spending five minutes on hold listening to elevator music only to finally speak to a front desk staff member who will only be able to forward a message, which may or may not be forwarded accurately.

September 12, 2012 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

Guest Post: Do EMRs Cause a Mirage of Health?

This is a guest post by Ken Harrington, Practice Manager at the Washington Endocrine Clinic.

The smart phone (blackberry, android, iphone) is an icon of the postmodern age.  In my fingertips, I hold the power of the internet.  I can look up my e-mail messages in real time, search anything in the world on the web, and be socially connected to a world-wide community of people – all in the palm of my hand.  This concept is slowly being applied to medical records.

Many of the new EMR systems that are beginning to infiltrate into the physician’s office now allow patients access (even if partial for now) to their own medical record.  With a few clicks of the computer mouse, a patient can now access his or her labs, radiology, and pathology reports.  Even better, the EMR that we use at the doctor’s office in which I work will soon be available on the iPhone and iPad.  This will enable any of the patients in our office to login anywhere and have instant access to their medical chart.  No longer does a patient have to guess at what she thought the doctor said or didn’t say about her results – the patient can now have access to the official record herself.

This gives a patient a lot of new power over his own healthcare that he did not previously hold.  For example, now the patient can research online about cholesterol if his test results show he had an elevated level. Granted he still cannot write his own prescription for a medication, but he can educate himself and use that knowledge when he speaks to his doctor about the test results.  This is a game changer of sorts which will add the physician’s office to the growing list of other institutions that have become transparent in the postmodern age.

This is all good for the consumer/patient – right?  On many levels, it is.  Patient empowerment in the realm of healthcare is what doctors have been complaining about for years.  Theoretically, this should lead to the patient having greater control over the choices she can make regarding her healthcare.

To boost this empowerment, certain companies are taking all of this patient data and showing what the future could look like.  The particular EMR that we use is partnering with a start-up company called 100Plus.  100Plus is taking the data and filtering it through a computer algorithm to project what someone’s future health would look like if he did not make the recommended choices to improve his health.  A future projection might mean death 10 years earlier if he had not made the choice to start exercising and eating right when the test results began to show a problem.  The entrepreneurs behind 100Plus know they have a market-winning idea because, in the postmodern world, people want to take control of their reality, including their health, as much as possible. This is just one more way to gain a little bit more control.

But what really do you gain by having all of this control and power?  A recent news article described a doctor in California who offered himself up as a test case for a new personal human genome sequencing test.  This test would look at whether a person’s DNA sequence could foretell that the person would be more predisposed to certain diseases over others.  This particular doctor’s test result showed he had a strong predisposition in his genes for developing diabetes, despite that fact that he was in good shape and ate health-consciously. However, six months after the test results were reviewed, the doctor was diagnosed with diabetes.

This makes me wonder whether it’s possible to have ultimate control over one’s health. Will access to a patient’s medical chart cause them to make better choices – or any choice – to improve their health? One would think it would at least give them a leg-up on the limited choices their recent ancestors had and make life-changing decisions possible sooner rather than later. But sometimes empowerment leads people to think that they have ultimate control and can make all the right choices. I’m not convinced that this is the case. If it is built into my genes that I am gong to die of a disease that I cannot do much about, doesn’t this level of transparency simply cause me to worry about something I have no control over? I guess you could say, “Well, we will all die of something, and if we know what that something might be, then we might try to limit its damage with better choices now.” But, unless someone can actually change the direction of my genes, I might actually be quite limited still in what I know.

The same may hold true for open EMRs. If the patient is focused enough to make choices with the knowledge they now have on a 24/7 basis, will it cause their health to be any better? Maybe. But could patients’ thoughts that they have a growing control over their own healthcare (via knowledge of their medical records) also potentially lead to developing a culture of false security? In other words, will such thinking only lead to a mirage of health? For me, I think it might.

* Dr. West’s note: This reminds me of a book titled “Mirage of Health” by Rene Dubos, the famous microbiologist who wrote that mankind develops a false sense of security with the acquisition of technological advances over his environment.

May 29, 2012 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

Easing the Pain of Electronic Medical Records?

The Huffington Post recently had an interesting video in which an orthopedic surgeon poo-poos EHRs because they waste time and cause him to have to type up his notes.  He tries to say that dictation is the way to go, in order to ease the pain of using electronic medical records.  A word of caution that this video is a paid advertisement for Nuance, of Dragon Naturally Speaking fame, and so the “doctor” might actually be a paid speaker.

He subsequently goes on to say that, well, at least Dragon Dictation allows him to avoid typing notes.  And that he dislikes templated notes because he finds them hard to read and impersonal.  But he seems to ignore the possibility that templating your own office notes is often a far better approach than using templates an EMR company sets up on their own, and many EMR systems nowadays allow this readily.

I have to say that I found this irritating although I love Nuance’s products, especially the free iPhone app Dragon Dictation, which works very well.  It was irritatin because it was at odds with the hard work and creativity doctors need to have in order to make it though all the training hoops of learning to live digitally.  I don’t buy that they can’t or shouldn’t have to figure out the another hoop to jump through, especially after they’ve pledged in medical school and residency, over and over again, ad nauseam, that they support lifelong learning.  Templating has allowed me to move from patient to patient without leaving a trail of unfinished notes, and it didn’t take that long to get going.  It’s a very customizable process that can be just as personal as anyone likes it, depending on how many “fill-in-the-blanks” areas that you decide to set up in your notes.  Templating notes has saved me so much work and protected my patient’s information that I couldn’t pass up this opportunity to support it.

Dr. West is an endocrinologist in private practice in Washington, DC.  He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine and opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at doctorwestindc@gmail.com.

September 16, 2011 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

Going Mobile: How EHRs and Mobile Technology are Shaping One Physician’s Practice

For today’s blog post on going mobile with health IT, please join me over at EHROutlook.com!

Dr. West is an endocrinologist in private practice in Washington, DC.  He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine and opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at doctorwestindc@gmail.com.

September 13, 2011 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

International EMR, EHR — Insider’s Perspective on NeHTA

A recent reader recently commented on my earlier post, Government Sponsored E-health Initiatives, and brought my attention to his blog, Australian Health Information Technology, which focuses on the Australian government’s EMR initiative NeHTA.

David More MB, PhD, FACHI, describes himself as a ‘dissident’ who is a bit worried about this organisation.  Have to say that he sounds like a fun guy (and certainly very interesting guy) already.  You may want to poke around his site to get more information about NeHTA in general.  He posts interesting tid-bits such as noting the number of weeks late that NeHTA is in delivering their plans for what sounds like stage I of their version of the US Meaningful Use plan.  Dr. More also cites breaking news articles regarding government EHR plans from both Australia and the US.  Bon apetite!

Dr. West is an endocrinologist in private practice in Washington, DC.  He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at doctorwestindc@gmail.com.

September 6, 2011 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

Latest Practice Fusion Stats Continue to Skyrocket

Just thought I would share with my readers the continued phenomenal climb in users and patients served by my EMR, EHR provider, Practice Fusion.  They continue to impress the heck out of me in terms of their user number, which is now over 100,000 users strong.  They reportedly add to this over 500 per day and 10,000 per month.  The patient count is now up to 16,000,000 apparently.  Considering there are about 312,000,000 citizens in the US population, that’s about 5.1%.  Quoting from the above link, “the company started the year with 55,000 users (82% increase) and 6 million patients (166% increase).”

Just remember that a while ago I predicted that Practice Fusion would be the next Gmail and that eventually every doctor would eventually have an account.  Looks like my prediction may be coming true.  No wonder venture capitalists like Peter Thiel have been pumping in the dollars.

Dr. West is an endocrinologist in private practice in Washington, DC.  He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at doctorwestindc@gmail.com.

August 26, 2011 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

GE Healthcare Throws iPad into Mobile EMR Mix

iPads are getting a lot of hype in the EMR and EHR press lately, so Apple is sure to benefit financially from the EMR, EHR-rush.  Entrez vous GE’s Centricity Advance-Mobile!  Apparently, DrChrono is being joined in offering an native iPad EMR app by GE, and I believe GE’s system is also certified.  The app can be previewed here and extends GE’s certified EMR, Centricity Advance, to a mobile application.  Gotta love the iPad mania!

Dr. West is an endocrinologist in private practice in Washington, DC.  He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at doctorwestindc@gmail.com.

 

 

 

August 24, 2011 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

EMR Development, Where are the Doctors?

John Lynn, over at EMRandEHR.com recently wondered about Depth in an EMR Conference.  He recently attended the Health Tech Next Generation conference in San Francisco, where few doctors seemed to be present.  This is such a classic blunder in health IT: not checking with the end users to make sure what you are designing is on the right track.  To be honest, it’s what killed our first EMR experience and led us to fire the EMR vendor.  There was no clearly tangible evidence that a medical doctor was involved at all in programming the thing.  We felt like we were beta testing their system for them as they worked out “bugs” based on our suggestions.  Frankly, we should have requested three months worth of consulting fees in the end, but that’s a story for another time.

John also made the comment that he had never seen a true EMR conference focused on doctors, practice managers, and actual users of the EMR.  Hmm… I think Practice Fusion Connect 2010 did this to a large extent.  Lots of pics and videos from the event can be found here.  Better yet, I’ve already scheduled time to go the next one, Practice Fusion Connect 2011, which is being held in SF on 11.11.11.  It’s slated to be about  five times bigger this year according to my inside sources at the company, and they are expecting about 1,000 attendees.  When I was there in 2010, it seemed heavily focused on the end users, who seemed to make up a large portion of the audience.

John mentioned the important and puzzling question of “how do you get enough doctors together at an EMR conference?”  I’ll admit that one’s a tough nut to crack, since you are asking private practice docs to give up income to get to a conference during a weekday, on which most conferences like this are held.  If it’s held on a Saturday or over a weekend, that might help.  If the target audience is employed and salaried, then it’s not as much of a problem getting them there since they aren’t really losing any pay/income.  The problem with that is: employed docs generally don’t make buying and implementing decisions.  Those of us who do, typically are in small practices of our own.  An interesting conundrum to solve, but bring it on.  More conferences like this are definitely needed since American healthcare runs on private practice doctors, their managers, and their staff.

Dr. West is an endocrinologist in private practice in Washington, DC.  He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at doctorwestindc@gmail.com.

 

 

 

 

 

 

 

 

 

August 15, 2011 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

Practice Fusion in DC for summit on interoperability

Recently had the pleasure of spending a great night out with our friends Emily Peters and Tom McMennamin at Practice Fusion.  After serving 22 patients in a very busy day for us yesterday, we had a blast at Ris since E & T were in town for a local conference to discuss the importance of EMR and EHR interoperability with major government institutions.  Various government reps were present for this two-day extravaganza of the minds, including those from the Social Security Administration.  Turns out that PF is working on developing many things, including a bridge to communicate important medical records electronically to the SSA efficiently when patients apply for disability benefits support.  I’ve completed two such requests for records recently in the past two weeks and it’s currently all on paper.  What a pain and how inefficient!

After a long first day at the conference, Emily and Tom were still alive and bursting with energy enough to meet up with several local area docs and practice managers to discuss the latest and greatest updates.  We got to ooh and ahh at all the progress in Practice Fusion’s ongoing meteoric rise over the past several years.  They are now around 100 employees and will be moving into a fantastic new larger space in San Francisco within the next few months to better accommodate their mission to provide a great EHR, EMR system with top-notch interoperability.  Go PF!

Dr. West is an endocrinologist in private practice in Washington, DC.  He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at doctorwestindc@gmail.com.

August 10, 2011 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.