2005-10-21 00:00:00

medGadget reports on UCLA’s new mobile clinical aggregation technology implementation

Clinical data aggregation has been around for a long time but given near-ubiquitous availability of thin client computing devices across hospitals, it has been picking up steam for some time now. medGadget reports on UCLA’s recent implemenation of GCQ’s technology in its hospitals.

Filed under: — @ 2005-10-21 00:00:00
2005-10-20 00:00:00

Application-focused healthcare IT needs to give way to service orientation

Health/medical informatics is a 55 year old industry; in fact, some of the first applications written for computers in the 1950????????s and 60????????s were for managing healthcare data. Throughout that history, thousands of applications have been written, rewritten, and thrown away. What always remains, though, is data. Databases of healthcare information created decades ago are still available and some are still in use.

The traditional approach to healthcare software development, which continues to this day, has been application focused: a need was identified and a program was written to address that need. This stove-pipe (disintegrated) process continued for the wide variety of needs within the healthcare space to such an extent that today, on average, U.S. hospitals have more than forty distinct information systems, handling information for different departments and divisions, and fewer than 25 percent of these systems regularly share information with other systems. And, any information that is not shared needs to be recreated or duplicated in other systems, all of which require roughly the same patient, organization, prescription, charts, and other data.

With each application acting as a silo and without the information tools supporting integration of data, users are left to fend for themselves, resulting in lost information, difficulty finding what is needed, creation of ???????dirty?????? data, error-prone duplication of entry, and, perhaps worst of all, a system where the lack of information sharing for drugs or clinical information jeopardizes human lives.

Consider a typical healthcare organization with typical information management requirements: people (care providers, patients), organizations (clinics, hospitals, departments), relationships between people and organizations, characteristics and attributes of people and organizations, etc. If we cataloged the information management requirements, even for fairly diverse constituents in the healthcare industry, the majority of the requirements would be similar if not identical. What this means is that each application that manages patient data would duplicate that data and not work with a master database of patients. An application that managed drug inventory would duplicate patient data again just to track prescriptions. An application that managed schedules would duplicate patient data just to manage appointments.

The problems with the application-focused approach become clear in a practical operating environment. The typical healthcare user must interact with a number of different applications. For example, a private practice physician must interact with applications for scheduling to check on patient load, managing an electronic medical record, writing orders, dictating a transcription, reviewing claims submissions, patient emails, and continuing medical education. A nurse will have to maintain the schedule, handling the ICD/CPT coding, billing, intake and out-processing of patients, phone calls, medical record management, follow-ups, and her own continuing education. It is obvious that their jobs and responsibilities require that they access information that crosses the boundaries of each of these applications. And each time they have to move from one application to another (or from a paper-based way of doing things to the computer), they waste time in reentering information or retrieving duplicate information.

To integrate data and keep from duplicating functionality and information capture what is needed is a way to model and create common services instead of applications. Services in this context are referring to pieces of computer code that are small, reusable, and focused granules of functionality instead of large monolithic applications. For example, any application that needs to register a patient or edit patient demographics would use a common patient registration service; an application that needed to discover what prescriptions a patient have would use a common patient medications service; and, an application that needs access to a care provider????????s credentials would use a centralized credentialing service. These are all examples of healthcare services that been written as computer code once and then reused across dozens of applications.

Modern patient-centric service-oriented applications will need to orchestrate and deliver end-to-end business processes across multiple users and channels by leveraging existing legacy systems. Such applications enable healthcare companies to convert existing IT assets into business Services and orchestrate these Services into business processes.

Filed under: — @ 2005-10-20 00:00:00
2005-10-18 00:00:00

National conference on mobile health and EOE

In an attempt to answer the question “How will mobile communications change healthcare in the future?” and make some big bucks in the process, The Medical Records Institute is hosting a conference on mobile healthcare in San Diego December 12-14. According to their website the conference will focus on the following:

* e-Prescribing: experience reports, successes, time comparisons, the e-prescribing challenge, point-of-care computing and order management
* Interoperability: sending messages and documents between medical devices, EMR systems, phones, and other communication devices
* Device Communication
* Strategies For Telecommunications: Understanding the options for a hospital to select a communications partner
* Analysis Of The Current Mobile Healthcare It Market: WiFi vs. Broadband and Blue Tooth; how to integrate them; what is the best strategy?
* Areas Of Growth In The Healthcare It Market
* Mobile Healthcare It And Workflow

Filed under: — @ 2005-10-18 00:00:00
2005-10-18 00:00:00

Good healthcare IT books that will boost your knowledge

Most of my clients and friends who want to get into healthcare IT often ask me about which books I would recommend. Given that the healthcare landscape is so vast and broad, it’s hard to answer that question so I’ve come up with a brief list to get people started.

Electronic Medical Records: A Guide for Clinicians and Administrators (Communications and It) Electronic Medical Records: A Guide for Clinicians and Administrators (Communications and It) Implementing an Electronic Health Record System (Health Informatics) Implementing an Electronic Health Record System (Health Informatics) Electronic Health Records: A Practical Guide for Professionals and Organizations Electronic Health Records: A Practical Guide for Professionals and Organizations Clinical Data Management Clinical Data Management Managing Healthcare Information Systems with Web-Enabled Technologies Managing Healthcare Information Systems with Web-Enabled Technologies Strategies and Technologies for Healthcare Information: Theory Into Practice Strategies and Technologies for Healthcare Information: Theory Into Practice Information Technology Solutions for Healthcare (Health Informatics) Information Technology Solutions for Healthcare (Health Informatics) Designing Healthcare Solutions with Microsoft Biztalk Server 2004 (VertiGuide) Designing Healthcare Solutions with Microsoft Biztalk Server 2004 (VertiGuide) Information Systems for Healthcare Management, Sixth Edition Information Systems for Healthcare Management, Sixth Edition Clinical Informatics Clinical Informatics Clinical Knowledge Management: Opportunities and Challenges Clinical Knowledge Management: Opportunities and Challenges Clinical Information Systems : A Component-Based Approach (Health Informatics) Clinical Information Systems :A Component-Based Approach (Health Informatics) Introduction to Clinical Informatics (Health Informatics) Introduction to Clinical Informatics (Health Informatics) Cancer Informatics Cancer Informatics
Filed under: — @ 2005-10-18 00:00:00
2005-10-17 00:00:00

Family Medicine Digital Resources Library

The Society of Teachers of Family Medicine has just unveiled the Family Medicine Digital Resources Library. They say the purpose of FMDRL is:

To support and enhance the sharing and collaborative development of educational resources among family medicine educators through Digital Library that will include resources for all levels of family medicine education.

Filed under: — @ 2005-10-17 00:00:00
2005-10-17 00:00:00

Open Source Software for HealthcareCourse

Dr. Mohammad Al-Ubaydli, a Visiting Research Fellow at NLM (NIH), is teaching a course entitled Open Source for Healthcare on November 2-3 from 10a to 12:00p. If you’re in or around NIH you should definitely drop by. Dr. Al-Ubaydli did a one hour lecture at Johns Hopkins in June covering biomedical uses of open source software and it was videotaped and the stream is available.

Filed under: — @ 2005-10-17 00:00:00
2005-10-17 00:00:00

HealthLine medically guided search unveiled

HealthLine, a new search engine that translates regular language into medical terms and helps refine broad terms into more specific ones, launched today.

As any good search engine architect knows, searches that returns too many terms can be improved with visualization so the HealthLine folks have come up with a nice HealthMaps feature that displays related information visually.

You can take a tour to learn more.

Filed under: — @ 2005-10-17 00:00:00
2005-10-16 00:00:00

Should we care about EMRs?

Electronic Medical Records (EMR) are getting much press these days, especially since the Bush Adminstration is pushing them as a core of the NHII (National Health Information Infrastructure) in the second term agenda. HHS set aside $50 million for EMR projects in 2004 and included $100 million for such projects in its 2005 budget. Everybody seems convinced that we could save billions of dollars and thousands of lives if only we had electronic medical records in place. While there is some truth to the fact that creating electronic records from patient data would have significant benefits, my roughly 10 years in the healthcare IT industry leads me to believe that the numbers people have come up with are not only unproven but may be dangerous to cite because they imply that information technology somehow creates better healthcare (and not better doctors, more experienced nurses, better management of secondary infections, etc).

Nevertheless, given that there’s so much interest in EMRs these days I figured I would jot down some variations of EMR definitions.

  • One definition of an EMR is the traditional paper chart (clinical information) moved into some electronic form.
  • Another definition of an EMR is a reworked healthcare workflow where doctors and nurses enter orders and notes in a computer instead of on paper.

Ultimately, the proper definition is meaningful if we try to figure out what an EMR is supposed to do:

  • A clinical data repository - pull together clinical data from various sources, consolidate it, organize it, convert all the disparate meanings so that they are semantically similar or identical, and then provide an easy way for clinicians to use it to make better clinical decisions and have the computer help them do they couldn’t do before.
  • A physician or caregiver workflow tool that helps them gather more meaningful and actionable medical data than they could before they had access to an EMR.

Most EMR firms forget that they’re not just a medical database - they are responsible for ensuring that doctors don’t forget to gather important data, that their system can provide alerts to prevent mistakes, and allow data to be used to make better medical decisions in the future. There are a million reasons cited in literature and the press for why doctors don’t use EMRs. I think there are two simple reasons: they’re not useful enough to invest their time yet and they have no way of being reimbursed for all the extra work of maintaining an electronic record.

Filed under: — @ 2005-10-16 00:00:00
2005-10-16 00:00:00

Beware the SOA hype in healthcare

The healthcare sector represents the largest single industry in the world, representing nearly $4 trillion globally. Moreover, this industry manages more information than does any other, with a greater volume and complexity per transaction and series of transactions than seen in other sectors. There are an estimated 90 billing healthcare transactions taking place globally; unfortunately, more than 90 percent are happening via phone, fax, or postal mail.

The complexity of efficiently managing health and clinical information has magnified exponentially during the last decade. As the number of healthcare industry constituents has grown and the relationships between them have increased in complexity, the information management requirements for efficiently managing medical data have become significant. Moreover, the healthcare field is spending much less on IT infrastructure and solutions than most other industries. Roughly 40% of companies spend less than 1.5% of their operating budget on IT and 35% of them spend 2% to 4%.

Although some countries have nationalized healthcare and are able to provide government IT systems for health information management, no single system or even small group of systems can manage the complexity inherent in the United States???????? healthcare sector because the US does not have a single payer system. It is common for medical services to be rendered to patients by one organization (a hospital or clinic) and paid by a third party (an insurance firm). In order for healthcare organizations to better manage their new information technology requirements, they require modern tools that are designed to work with legacy infrastructures in a service oriented approach/architecture (SOA) where middleware is able to get information to and from multiple systems and applications that have likely been around for decades.

Even though SOA makes a good deal of sense in the healthcare IT industry, beware of the hype and existing vendors simply “SOA” enabling their existing software suite. It’s not going to be easy to convert closed legacy healthcare systems into open service oriented applications and databases. Cerner or IDX won’t be able to become “service oriented” by slapping on a label. Epic and Meditech can’t become service oriented given that they couldn’t even make the move to object oriented quickly. Eclipsys and Seimans can’t just put in a messaging system and tell you that they’re now service enabled because they can pass messages between systems. Before your existing vendors come to you with their SOA message, have them explain to you what they think about SOA, why they think you should care, and why systems that they’ve had around for years are now, suddenly, service oriented.

Filed under: — @ 2005-10-16 00:00:00
2005-10-16 00:00:00

Patient-centric Customer Relationship Management

Specialized Customer Relationship Management (CRM) software has been in use (mainly outside the healthcare sector) for over a decade now and has provided organizations a sophisticated means to track customer information to help improve satisfaction and service. Although some forward thinking healthcare companies have customized and adapted traditional CRMs to help manage patient-centric data, managing patient information in CRM software is difficult due to the large volume of information tracking required and the fact that patient privacy is often difficult to protect in current CRM software.

What is needed in our healthcare industry is patient-centric CRM software, or Patient Relationship Management (PRM) systems. PRMs are not widely deployed at this time because of legacy software connectivity requirements and the fact that it????????s difficult to come up with software that can adequately track, and keep private, thousands of pieces of medical, clinical, and demographic data elements.

Filed under: — @ 2005-10-16 00:00:00
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