In an earlier post we examined how health care organizations are increasingly investing in clinical information systems( aka EMR) and, the benefits from such a system. As these systems have evolved, vendors(like with other application software) are increasingly migrating to a web based or online EMR systems. For as little as $500/month some vendors offer a full featured EMR system for physician offices, providing advanced features such as charting, drug interactions,  etc.

While some  physician offices and provider groups have bought into this (partly because they require considerably lower investment than  desktop based EMR software), there is still a lot of skepticism. Just as with any other new technology questions are being directed at the security of data on such systems. This is amplified due to sensitive patient data and, payment information residing in such systems.

Houston Neal at SoftwareAdvice, recently told us about his article on the double standards that exist in healthcare when it comes to evaluating the security of web based Electronic Medical Records (EMR) systems. He notes that vendors of such web based EMR software put in considerable resources and efforts to secure data exchange, data storage and, data integrity.

How Vendors secure medical data in web based EMR

To protect data transmitted between a physician office and the server, vendors use HIPAA-compliant data encryption technologies, the standard being 128-bit secure socket layer (SSL) encryption. The servers are powered with firewalls to block illegitimate traffic, and intrusion detection systems to monitor when someone tries to hack the system. In addition, vendors safeguard the data center where the server exists, storing the server in a highly secure compartment with un-interruptible power, air filtration and advanced fire suppression systems. At the physician’s office, software will have permission settings for each user, allowing them to access the EMR only during specified hours and days of the week.

While there are definitely some valid unanswered questions about security and HIPAA compliance of such systems, it does look like many of the questions are being answered by the top quality software vendors.

Now, we wonder how many exisiting health care providers or even large acute care hospitals currently have such sophisticated secure data centers ?  We will leave that question as food for thought.

Sermo, the largest online physician social networking site founded by Dr. Daniel Palestrant, recently launched FluMonitor to help track the spread of Influenza in the US.  FluMonitor(see pic above) lets physicians submit flu cases they might encounter with a few clicks.

HealthCare Management spoke with Sermo’s chief medical officer Adam Sharp. According to Dr. Sharp, the FluMonitor provides near real-time access to physicians on the spread of influenza across the United States.

This is definitely the first of its kind in tracking the spread of disease in real time exclusively through an online social networking platform for physicians. FluMonitor can give doctors the ability to track and predict outbreaks and, share notes on treatment and trends. Specifically, it can provide granular details such as, Patient breakdown for vaccinated vs. not vaccinated Age distribution- which age is most affected Symptom breakdown- which symptoms are presenting more than others voracity of outbreak- how many per day/week/month, etc.

If doctors know the flu is coming, it helps them to know that flu likelihood is much higher so they can be confident to base a diagnosis solely on observations in patients vs. having to use a Rapid Flu test- which is quite expensive. This will also help them avoid taking other, expensive, tests in order to rule out other ailments/diseases because they know it’s likely to be the flu.

HealthCare Management was recently informed of a product launch that could potentially, help hospitals lower their inventory costs, improve tracking of medical devices, and positively impact patient care.

The new RFID technology enabled system is being launched jointly by Wavemark: a market leader in real-time inventory management (RTIM) solutions for the healthcare supply chain, and Lumedx, the market leader in developing end–to-end cardiovascular information and imaging systems.

Florida Hospital Pilot

A strategic customer to WaveMark and LUMEDX, Florida Hospital Orlando facilitated the development of this interface by becoming the pilot site. The  goal was to achieve accurate and timely inventory data that would enable the department to reduce its device and equipment inventory by $30,000 to $40,000. According to the RFID journal, the system allowed the department to post a savings of $65,000 at the end of the pilot.

From a patient care standpoint the system is expected to enhance the level of care and, the accuracy of their medical records while at the same time improving the billing process.

HealthCare Management plans to talk to WaveMark-Lumedx and, Florida hospital to bring you more details on the technology in future posts. Stay tuned!.

We had previously featured an article on this site on the Smart patient room innovation at the Univ. of Pittsburgh Medical Center. Since, then we have talked to David Sharbaugh(DS), the leader of the smart room project and,  a senior director at UPMC’s center for quality improvement and innovation and, Lucy Thompson(LT) one of the team members.

Today we bring you this exclusive interview.

What is the vision behind the smart room project ?

DS:  We believe this technology will enhance patient safety, allow clinicians to spend more time at the bedside, simplify the jobs of health care workers and improve overall patient satisfaction

Who are the people behind the smart room?

DS: The core development team consisted of 5 people. Working anywhere from part time to full time to complete most of the development. In addition, over the past six months a team of clinicians and medical technologists have worked on this.

Where does the ultrasound technology for Smart Rooms come from ?

DS: the system uses ultrasound tracking devices to identify the numerous caregivers whom a patient might encounter on any given day. UPMC used Sonitor technologies, as the vendor for buying the ultrasound tracking devices.

How much did it cost to build the smart room system?

DS/LT: Since it was internally developed, it mainly cost UPMC man-hours (or FTEs in health care parlance). But,  the total cost to the system would be approximately $2 per patient/day.

What clincal metrics does smart room system impact?

DS/LT: We are currently still compiling the metrics and observing the impact, but it is estimated that this system has reduced the time spent searching for allergies, demographics, since there is a visual cue provided to the care giver on the items that need to be completed. Medication safety is expected to impacted and patient safety, and, fall rate are some other metrics that are expected to improve. Currently, smart rooms are in the medical surgical floor.

How long did it take to train staff on this system?

LT/DS: There was minimal training for this, since the screen interfaces that staff and, physicians need to use are very intuitive.

Future enhancements to the Smart patient rooms system.

The Smart Room went live in early October and is being tested in six patient rooms at the UPMC Shadyside campus .They, told us that they are currently working on releasing the second version. The new version would include code information that will automatically display to the relevant care giver when a code is called.

In addition patient will be able schedule tests, get test results, and other information. Another possible enhancement is informative emails to patients!

We think this is innovative and will keep bringing you more information on future enhancements. So keep watching this space.

Survival of the fittest!

It is very well know that in today’s healthcare business, cash flow is the life blood of any business, specifically in the healthcare industry.

The healthcare industry has become much more competitive over the years. Hospitals proclaiming that they have a state of the art cardiology center, with nurses that put the patient first. I am sure that hospitals across the country put their patients first, it’s just that they do it better, the ad claims.

We see the messages on billboards lining the streets, on TV. from shows like Big Medicine and such. Walk thru a mall and see the ad’s from doctors who are specialist in plastic surgery, weight control, and various other procedures.

One would ask why a doctor, hospital does, emergency service need to advertise, don’t they receive their patients from word of mouth, one doctor recommending another?

One would think so, but the game has changed for ever. In the near future the family doctor will no longer be. We will all be seeing a“specialist” for what ill’s us. You may ask yourself “so what’s wrong with that?” well there is nothing wrong, but if you work in the healthcare industry and run a practice, hospital, emergency care center and such, well you need to make sure that your business has steady cash flow and has a competitive edge, and in today’s world the edge is CASH!

Medicaid and Medicare set the stage for what will be paid on claims. As we know, HMO’s and PPO’s and other insurers follow suit and try to under pay claims as well. You the healthcare provider are providing services on a daily basis and do not receive payment on the claim for 45 to 90 plus days, and that is if it is coded correctly.

The point that I am trying to make is that there is much more competition for each dollar that is out there and a lot of energy is spent to collect that dollar. Separating yourself from you competition is important. Having the steady cash flow for working capital to grow is imperative!

The number one key factor in a provider’s fiscal downfall, or lack of growth, is the lack of working capital. A solution to prevent this lies in the provider’s accounts receivable, an asset often wasting away accumulating dust on the balance sheet that becomes lost revenue due to the time value of money.

Many “C-Suite” healthcare executives are choosing medical accounts receivable (MAR) funding as an important tool in their business financing strategies. MAR funding’s flexibility and immediate cash infusion reduces their dependency on debt-incurring bank loans and lines of credit as their sole forms of financing. It provides a predictable and steady cash stream and the amount of medical accounts receivable funding is not limited by a bank’s often under-valued assessment of the provider’s assets

Bank credit lines are often insufficient to meet a provider’s working capital needs and monthly cash flow plans, especially when a conventional bank determines a line based on a significantly “under-valued” valuation of the provider’s assets. Additionally, the bank may be quick to disqualify that collateral once the aging reaches 90 days. This often happens because most conventional banks do not have the deep understanding and working knowledge of the healthcare business, its industry specific regulatory requirements and cash flow challenges.

I challenge you to take a look and see if your business can survive?
How “fit” is your business?
Who are your competitors?
Do you have cash on hand to handle the ups and downs or to expand your business, to be competitive?

Editor’s Note: James Hill is the author of this article and, Vice President at Choice Med Consulting. You can check out his profile on linkedin

Emergency Room incident at King’s County hospital

The King’s county hospital in Brooklyn, N.Y. has several claims to fame; It was the site of the first open-heart surgery performed in New York State; Kings County physicians invented the world’s first hemodialysis machine, conducted the first studies of HIV infection in women and produced the first human images using magnetic resonance imaging (MRI). In addition, Kings County was named the first Level 1 Trauma Center in the U.S.

It is ironic then, that the hospital became the center of all media attention for a negligence death in their waiting area in the Emergency Room. Esmin Green, a 49 yr old psychiatric patient had been waiting in the emergency room for more than 24 hours before she toppled from her chair and fell on ground. Although the waiting room was occupied by other patients, a security guard, and a staff member, no one cared to help Green until more than an hour after her fall (Check out the Associated Press report for further details on this).

Isolated incident or alarming trend?

HealthCare Management decided to do some research of our own and here is what we came up with.

• An archived article in New York times talks about Federal regulators reprimanding cook county for serious flaws in how it decides who should receive emergency care and for treatment delay
• The king’s county hospital’s emergency room sees about 116,000 patients a year
• In 2007, Kings County hospital deployed, MediKiosk software solution, that automates patient registration and helps emergency department staff prioritize treatment based on medical urgency
• According to a recent survey conducted by the American College of Emergency Physicians (ACEP), 80% of the 328 emergency departments surveyed board psychiatric patients
• 30% of ACEP surey respondents said they board patients between 8 and 24 hours

Before, we conclude it is a dead end, let us look at some other facts that might present solutions

• 85% of the doctors in the ACEP survey said that wait times for all emergency patients would improve if there were better psychiatric services available.
• More than 80 % agreed that regional dedicated emergency psychiatric facilities nationwide would work better than the current system for dealing with psychiatric emergency patients.

Maybe, it is time to redesign the Emergency care ? We rest our case, now you decide!

In a previous post we talked about electronic health records, and how hospitals and providers are embracing it to improve patient safety. With the introduction of the new iPhone3G, electronic health records are now going beyond the computer and into the iPhones. Hand held devices are always popular with physicians (tablet pcs and pdas). Now, consumers and providers can access health records on their phones.

Some current applications available at the online apple store

Medfile - Developed by Kaplan design lets users create and manage their personal medical records. Information such as blood type, allergies and emergency contact etc can be stored and retrieved.

ADAM - An application that lets the users identify health symptoms.From a simple sprain to fever, and upset stomact, ADAM gives users access to up-to-date medical information that is expert-reviewed. The tool also provides information on what the symptoms mean and when to seek professional medical attention.

These applications are fairly new, and are surely going to generate debate amongst medical professionals within and outside the blogosphere. Also, it remains to be seen, how popular these applications get with consumers.

We at HealthCare Management will keep a tab on this. So keep watching this space.

There has been a lot of activity in the Health 2.0 world recently. There are already two major Health 2.0 related conferences. Atleast a dozen new health 2.0 applications in the first half of this year and the launch of Google Health and Microsoft Health Vault. As usual, we at Healthcare Management will help you keep upto date with what is going on. But like with our previous articles, we intend do our research before we publish. Soon we will be talking with Google Health development team and folks at Aetna to get an understanding of what their Health 2.0 plans are. But before, we get too far ahead let us examine the basics.

What is Health 2.0 ?

Health 2.0 aka Medicine 2.0 aka eHealth, can be broadly defined as ” applications, services and tools are Web-based services for health care consumers, caregivers, patients, health professionals, and biomedical researchers, that use Web 2.0 technologies as well as semantic web and virtual reality tools, to enable and facilitate specifically social networking, participation, apomediation, collaboration, and openness within and between these user groups.

The idea is simple. Health 2.0 is about interactive Web services,that, will arm individuals with information, tools and supportive online communities so they can take charge of their own medical care — and in turn transform the U.S. and other healthcare systems by demanding better service and lowering costs.

Watch this space in the future as we profile some emerging health 2.0 applications and services.

Star Trek at Bedside

Imagine a hospital room, which recognizes doctors and nurses as they enter. Their name flashes on a flat panel screen for the patient and family to see. At the same time, a second monitor, shows the clinician exactly what they need to know at that moment to care for the patient. Information displayed includes: medication due, patient’s vital signs, and allergies. Does this sound like futuristic technology too good to be true? Well, it is not.

The smart room idea has already been developed and tested at the University of Pittsburgh Medical Center(UPMC). They have been testing this since early October at their Shadyside campus. The idea for the Smart Room came about two years ago when a UPMC nurse wearing latex gloves unknowingly went to place an IV in a patient with a latex allergy, causing an allergic reaction

Effective Technology

According to the UPMC , the system uses ultrasound tracking to identify the clinicians that might come to advance the care process for a patient. Each worker is assigned a unique tag—smaller than a pager—that emits ultrasonic sound waves, when the person wearing the tag first enters the Smart Room. The ultrasound detector in the room reads the tag and identifies the caregiver by name and job title, displaying the information on a flat-screen monitor at the foot of the patient’s bed. When a caregiver leaves the room, the information disappears from the screen. In this pilot phase, tags have been assigned to doctors, nurses, nursing assistants, phlebotomists and dietary hosts and hostesses.

Benefits

The biggest benefit of this innovation is in helping improve patient safety. Patient identification is a key factor in the care process and numerous errors can result from not verifying patient id. Smart rooms can help minimize that. In addition medication errors can be greatly reduced. Less obvious benefits can include, improving workflow and minimizing redundancy. The amount of time wasted in communication between care givers to gather information can also be impacted with this system.

**Picture courtesy UPMC media kit

Increasingly, healthcare organizations are investing in clinical information systems. According Kalorama Information – the publishing division of MarketResearch.com, hospitals in the United States would be spending close to $4.8 billion on Electronic health record(EHR) or Electronic medical record systems(EMR). Despite the brouhaha, there is a lack of understanding of what an EHR can do and can not do.In this post, we will attempt to peal the layers.

What is an EHR/EMR?  Simply put, the EHR  is an electronic record of a patient’s medical history. This electronic record includes important information like test and imaging results, medication history, Emergency department visit summaries, doctors’ notes and general health history – from childhood allergies to surgeries.

All of this exisits currently, (in most hospitals).But, in paper charts and in some cases in databases behind applications that do not talk to each other . For Instance, the Emergency department diagnosis, might reside in EMSTAT(a popular ED application) , while the same patient’s Inpatient treatment notes resides in another application such as Affinity. 

An EHR ultimately replaces the paper chart currently used to store the same information. The electronic version of the record can be made available to the patient’s caregivers in different locations, more quickly and efficiently. And when done well, it minimizes data redundancy (the need to enter the same information over and over) . So for instance, information captured during an emergency visit can be retrieved by an inpatient care giver, if the patient goes on to recieve care as an inpatient. 

How does EHR help hospitals ?

The EHR can help hospitals and health systems make improvements in three major areas.

1. Improved quality of medical decision making

It provides doctors with immediate access to a patient’s health information.Whether it is an Emergency Physicain, or a nurse that needs to phone an on-call physician in the middle of the night, the patient’s chart can be accessed to support important treatment decisions. In addition, in most cases the EHR is connected to a robust library of medical information that can help physicians in making diagnoses and treatment plans based on the latest research.In some cases, it can generate automatic reminders by mail or e-mail to notify test result availbility, critical values and other useful medical information.

2. Improved Patient Safety

Because doctors’ orders and prescriptions are entered into a computer rather than in handwritten orders, pharmacists and other caregivers have no trouble interpreting the information. This greatly reduces the possibility of transcription errors and other medical mistakes. Thereby reducing adverse drug events and increasing patient safety.

3. Improved efficiency

Caregivers will no longer need to search or wait for your patient chart. In addition, lab results and X-rays can be sent electronically to your doctors as soon as they are completed, for immediate analysis, diagnosis and treatment.

In addition to the major areas listed above, there are other advantages including cost savings from an EHR implementation.  In a recent article that  Houston Neal, (Director, Business Development, SoftwareAdvice.com) shared with us, they talk about how EMR can help reduce medical malpractice insurance premiums, reduced downcoding and even revenue gains by participating in pay for performance time programs (Medicare Care Management Performance (MCMP) ).