Healthcare IT Alphabet Soup — Descrambled!

Posted 29 June, 2007 in education

If you’ve been on the digital side of healthcare long, you’ve no doubt been inundated with a flood of domain-specific acronyms. If you’re new to the area, you’ll perhaps benefit from a catalog of some of the terms more frequently thrown about. I’ll add more to this list as time permits.

• EMR (Electronic Medical Record): a medical record in digital format. If you’re still using paper records in your hospital, you need to change. now. seriously. NOW.
• EHR (Electronic Health Record): a health record in digital format. (Though there might be technical differences for some, but the words EHR and EMR are used interchangeably by many.)
• HIPAA (Health Insurance Portability and Accountability Act): provides national healthcare privacy standards. It’s another reason why outsouring your EMR system is a good idea.
• PHR (Personal Health Record): a health record maintained by an individual. All good EMR systems include a patient portal which allows patients to access their PHRs.
• PI (Predictive Informatics): healthcare predictive analytics. When data mining is applied to healthcare data, useful trends can be found to modify outcomes.
• HL7 (Health Level Seven): A way of encoding medical data so it can be transmitted between different systems without losing meaning. Particularly for large hospitals, interoperability between disparate systems is a must, so a common interchange format is required.
• ICD-9 (International Classification of Diseases): a classification system for diseases, symptoms, complaints, etc, used to correctly document a medical encounter and for insurance billing purposes. “Every health condition can be assigned to a unique category and given a code, up to six characters long.”
• DICOM (Digital Imaging and Communications in Medicine): a standard for storing medical imaging data. Another aspect of a full-fledged EMR system is the ability to view, annotate and manipulate DICOM images.

HIPAA and YOU

Posted 27 June, 2007 in education

The Administrative Simplification (AS) provisions of Title II of HIPAA (pronounced “Hip-Uh”), are to the medical community what Sarbanes-Oxley is to the financial world; in a sentence, HIPAA provides national healthcare privacy standards for operations and penalties for non-compliance.

HIPAA Overview:

• Ensure the confidentiality, integrity, and availability of all electronic protected health information the covered entity creates, receives, maintains, or transmits.
• Protect against any reasonably anticipated threats or hazards to the security or integrity of such information.
• Protect against any reasonably anticipated uses or disclosures of such information that are not permitted or required.
• Ensure compliance by the workforce

What does this all mean to you? Well, before signing up, you should ask some tough questions to your hosted EHR provider, such as:

1. Are their backups encrypted?
2. What sort of physical access security do they have?
3. Do they maintain both read and write access logs at the database level?
4. Is credit card information encrypted?
5. Are passwords one-way hashed?
6. Is SSL used to encrypt data traffic?
7. Do user passwords expire?
8. When they have employees leave, what measures are in place for revocation of access?
9. Is data ever stored on non-company computers?
10. If data is transported physically, is it encrypted?
11. Do workstations auto-lock when employees step away?
12. How is media properly disposed of?
13. What server operating system is used? (if it’s Windows, you should look for a better vendor…)

Also, be sure to see their Data Backup Plan, Disaster Recovery Plan and Business Continuity plan.

Here’s a sample HIPAA Security Checklist and here’s yet another HIPAA Security Checklist

near-Future innovations in personal health

Posted 25 June, 2007 in future tech

Many EMR vendors, like RemedyMD, offer a web-based “patient portal” (e.g. MyHealthManager), which provides a handy interface for recording daily meals, activities, blood pressure, weight, glucose levels, etc. The screens are intuitive enough for the computer novice to master while remaining feature-rich for the power-users.

The problem is one of diligence. For the ADD-afflicted (such as myself), it’s hard to remember to daily chronicle my weight or calories consumed, so I find myself backdating entries, feverishly (and inaccurately) attempting to recall the events of past days.

Those times of difficultly might be soon over. It’s just a matter of time before a host of wireless devices are linked up to an intelligent and user-friendly patient portal. When they are within range, these wireless devices transmit back data to your PC which data is consequently uploaded to the web. Then, periodically you (or your physician) can review the much-more-useful data.

Wireless healthcare devices that are/soon-will-be available include:

• Scale
• Pedometer
• Meters for:
  • Blood Pressure
  • Body temperature
  • Glucose
  • Blood/oxygen levels
  • BMI/Body Fat %

EHR: here or there?!?

Posted 22 June, 2007 in tech choices

You’re a doctor and, in order to catch up with the times, you’re in the market for an EHR. They come in two flavors: software you buy and load on your own computers (aka client/server) and software you access over the Internet (aka web based/ASP.) I’m oversimplifying this a bit and there are a number of variations on those two themes (like web applications that require custom plugins etc.), but basically the question is whether the software will reside at your office or in a data center somewhere else.

Some people will give you big lists of PROS and CONS. Not I. Hosting your own EHR is dumb and I’ll tell you why. YOU’RE A DOCTOR. You’re supposed to be practicing medicine, not worrying about server uptime and security and maintenance patches. You should let a competent EHR company manage your data and the program upkeep. Client server programs were great in the early 90s before the Internet, but they are something much less than intelligent now. Here’s the reality: everyone is online nowadays. If you’re not online, you need to buck up and get online. It’s a necessity in today’s world. Your patients need to be online. They need access to their own medical records, too. The client server approach doesn’t provide that. ASPs do — they allow you to access your data anywhere in the world at any time. That’s the power of the Web and you should be leveraging that.

Some will argue that a web approach isn’t as “rich” a user experience as the client/server. Those people were right several years ago, but with AJAX, Flash, and Java they are now WRONG; everything you can do in a client/server graphically, you can do in a browser. Others will say that ASPs are slower. Again, this is simply an antiquated view. Bandwidth is cheaper than an in-house IT staff. If you want to be ensured of constant connectivity, buy several DSL lines from different vendors and aggregate them together. You will save money.

Don’t be fooled by 80s era companies living in the dark ages. The ASP model is the right one. Choose it and be happy.

Some releated links for further reading:

http://emruser.typepad.com/canadianemr/2004/06/is_asp_vs_clien.html
http://businessweek.buyerzone.com/software/electronic-records/buyers_guide6.html
http://www.emrexperts.com/emr-ebook/client-server-vs-asp-comparison.php

Hanging the meat on the bones (the search for better organized data)

Posted 21 June, 2007 in future tech

Thankfully, many hospitals and physicians are beginning to store their medical data into electronic medical records system which, in turn, use a relational database such as Oracle or MSSQL. Relational databases are powerful tools because they provide fast access to non-redundant, consistent data.

And the real advantage of all that data is the promise of data aggregation: being able to extract useful information over a range of different databases in difference practices. Relational databases alone, however, fall short when you’re trying to integrate disparate systems. The problem is the lack of a structure of meaning (what researchers call an “ontology”) which ties data together in meaningful relationships and then back to a universal set of medical terminology and hierarchy. When a carefully constructed ontology is employed, particular information can be combined with other matching pieces of information.

The data (meat) alone is useful, but when combined with an agreed-upon structure (bones), suddenly we begin to have real possibilities for integration and collaboration.

You Can’t Improve What You Can’t Measure

Posted 21 June, 2007 in solutions

That’s a tagline that RemedyMD uses on their promotional trade show give-aways. To be perfectly accurate I suppose you can’t measurably improve what you can’t measure, or maybe it’s that you might be able to improve it but how would you know? The point, of course, is that metrics act as signposts to verify that you’re proceeding in the right direction.

With healthcare, that means that it’s easier to track the progress of a patient if the patient is frequently entering data points (like weight, calories consumed, medications taken, exercises, etc) into a personal health record (PHR.)

Elements of a good PHR include:

1. User-friendly; simple to create and update information
2. Single location (so discrepancies don’t creep into multiple copies)
3. Confidential
4. Controlled by the user (who grants permission to doctors/hospitals to see/modify the data)
5. Universal format (so other systems can interact seemlessly with it)

The PROBLEM with healthcare

Posted 21 June, 2007 in problems

Or rather some of the problems. Here’s one possible scenario:

Virginia is for lovers, or so they say, so you and your wife make a beeline to Virginia Beach for a relaxing weekend. No vacation is complete without good food, and diets be damned, you eat a fair amount of everything. Now you’re not feeling well. You’ve ingested something that turned in your stomach and suddenly you begin vomiting. A lot. You’re losing fluids fast. Hours pass and you’re becoming severely dehydrated and delirious. A quick ambulance ride later and you are admitted to the nearby Sentara Bayside Hospital’s emergency room. You’re not from the area, so Sentara is neither your hospital, nor is it in your hospital chain.

Time for paper work. Lots of forms: Insurance. Consent. Previous Medical History. Allergies. Of course, this is the worse time to be asking you to think about anything, let alone the details of your previous medical history. You mean to check the box beside penicillin allergy, but you are distracted by your wife, who is on the phone with her mother. You also missed an entire page where, under better conditions, you would have mentioned that you suffer from mild epilepsy.

Your stomach suddenly seizes and you throw up in the waiting area, which is just enough incentive for the triage nurse to quickly move you to a private room.

A nurse arrives and takes your vitals. Minutes later the physician shows up and, after a brief inspection, concludes that you have a bacterial stomach bug. He prescribes Benzylpenicillin (penicillin G) as the antibiotic. An injection later and you start to feel better. Then, without notice, the epileptic seizures caused by your allergic reaction begin…

This situation would have been much different if

1. Your hospital had an electronically accessible, universal format of your electronic medical records to which Sentara Bayside could be granted access
2. The medical record system had a Internet “patient portal” so you could have thoroughly reviewed your information before an emergency requires it