Category Archives: EHR

How Apple iPad can revolutionize Health Care?

When Steve Jobs got on stage Wednesday, to release Apple’s latest creation the iPad, he described the iPad as a magical and revolutionary device. Whether it is truly revolutionary from a technology standpoint or not, is a debate best reserved for the tech pundits like Endgadget. But we are are more interested how it can revolutionize health care. So here is how we think the iPad can do this.

1. Accelerate electronic medical records adoption in hospitals- eMR and eHR have been talked about for a while but there is still a lot of resistance and inertia in the healthcare community. We think the popularity of the iPad can help change that in a way tablet pcs never could.

2. Apps for health care- There’s an app for that. Imagine what web 2.0 did to the airline and restaurant business. Reviews, reservations, social networking. We think iPad will serve as a platform for all those innovative app developers (App developers are you reading this ?).
Everything from scheduling a doctor’s visit to viewing your x-ray (yes on that gorgeous AMOLED 9.7 inch screen ).

3. Paperless for real – Remove clutter and Free up space in Emergency departments and urgent care clinics- There is no need for a registration desk with a big clunky desktop. No paper work to deal with for Reg and insurance staff.

4. More time at bedside and with the patient – If you have ever been to an Emergency department or urgent care, the word waiting has new meaning for you. We think that the iPad adoption in hospitals can reduce the time doctors and nurses spend walking to a nurse’s station or desk to wait for results or write orders and spend more time at bed side. Which means that they can focus more on taking care of you working on the iPad. Research has shown that this can improve outcomes and improve quality of care.

5. Improve communication and entertainment options – Remember the last time you were at your Dentist or Doctor’s office. What did you do in the waiting room? Now imagine reading that Cosmopolitan, the Healthcare Management blog or whatever else you like to read. And while you are reading that your screen flashes with an update on your wait time, test result or even a prompt with some information on your illness. Same if you are in the waiting room of a surgery center eager to hear about your loved one. The possibilities are endless.

Magical or not, the more popular the iPad gets we believe it can revolutionize health care delivery and, without the tedious debates on Capitol Hill.

Cleveland Clinic’s Low Cost Health Care Model

With the health care debate looming on the horizon on Capitol Hill, there are some compelling arguments on what should and should not be included in the health care bill. One thing that everyone agrees on however is the cost of care. The current rate of increase in cost of care in America is unsustainable. And, a low cost health care model is the need of the hour.

Some of the key features of their model are that they are highly integrated according to their CEO Dr. Toby Cosgrove. The doctors and hospitals are all part of one organization. Here are some highlights of their model.

1. The Clinic’s doctors are all on salary

2. There is no concept of fee for service -whether a cardiac surgeon performs one surgery or ten they get paid the same.

3. EMR (Electronic medical records) have been available since May 2008

4. An emphasis on preventive care that goes beyond health and wellness bulletins – A heart healthy cafeteria and a fully functional gym.

Now, we should also point out that they are yet to realize a return on investment on the electronic medical records. Also it is now well known that they were also the test site for Google’s health records application roll-out.

While it is clear that the Cleveland Clinic is always ahead on the technology curve it is their unique approach to practice of medicine that has helped them become a leader in low cost health care.

Health Records-Now on your iPhone!

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.

Introducing Smart Patient Rooms


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.


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

Demystifying Electronic Health Records


Increasingly, healthcare organizations are investing in clinical information systems. According Kalorama Information – the publishing division of, 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, 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) ).

Are Web Based Electronic Medical Records Secure?

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.