The Laszlo Letter

What's Wrong With EMRs

Short Rant

The following is a quote from a recent article by Guy Boulton of the Milwaukee Journal Sentinel newspaper. Read it and weep.

Hundreds Of Physicians At ProHealth Care Hospitals Switching To EMR.

"In the next year, several hundred physicians who practice at ProHealth Care's hospitals in Waukesha and Oconomowoc will move from paper to electronic medical records [EMR], enabling them to improve the coordination and quality of care for patients." These "physicians will lease software that ProHealth uses at its hospitals and clinics." This "will allow the doctors to work from a single medical record on a central database, as opposed to each practice buying different software with little or no ability to share information."

Bold and italics above were inserted by me.

On the surface, one would be happy to read that more physicians and practices are finaly adopting EMR's. Unfortunately, the last sentence in the quote points to a serious problem with EMR adoption, namely the lack of data interchange standards. More specifically, the legislation that is busy throwing billions of tax dollars at healthcare providers for 'meaningful use' of EMRs does not also put a strict requirement on interoperability. Thus, we have hundreds of software companies and service providers who are competing for the EMR business but have little inclination or incentive to focus on the ubiquitous exchange of the data being collected. So, as more and more practices/hospitals implement EMR systems, the problem is going to snowball and the promise of electronic health records will not be met. 

Message to Obama and the Administration: A focus on data exchange standards should be the #1 priority for meaningful use. Throwing money at adoption is putting the cart before the horse. Change it now or wait for inevitable failure.

Can Frog Design figure out Healthcare?

If you have not heard of Frog Design, it's worth checking out what they have done over the years. I won't talk about that here and let you do the research. I promise, it will be fun!

But, I would like to get your opinion on what Frog Design and Microsoft are dreaming up to solve the ills of Healthcare with technology. Even Homer Simpson is in on the act (though not of his own free will). You can get a glimpse of that by clicking here to get to the video on the Forbes Video Network. It's less than 3 minutes long.

Do you like what you see? Are they on to something or are they nuts? Send me your comments and share them with my other readers.

I will hold back with my own opinions until I've heard from you.

Update: Software for Clinical Development - 2010 Edition

The updating of this software list is still in progress. Several new software categories have been added and the list of vendors is growing and shrinking at the same time. In other words, some companies have gone out of business, others have been assimilated and new ones have also been born. At the moment, I am optimistic that the list will be ready to share sometime in November. Your patience is appreciated and hopefully rewarded fairly soon. 

Electronic Health Records (EHR) coverage at HIMSS

The annual meeting of the Healthcare Information and Management Systems Society (HIMSS) took place last week in Chicago. While there are many publications out there covering this meeting, ChannelWeb had an especially good series of articles on it.

Those of you who are not yet familiar with ChannelWeb, it is a web site focusing on companies that sell computer and communication based solutions (i.e. hardware and software.) In other words, the sellers ARE the channel.

As you will see from these articles, the most popular topic at HIMSS was the Obama stimulus package and its implications for health care. As you can imagine, vendors had a Pavlovian reaction about the potential to make a lot of money.

How well the money will be spent remains an open item. Once thing is certain. A lot of it will be wasted.

Read on...

HIMSS: Moving From Stimulus Hope To Real Health-Care IT Projects
ChannelWeb , April 10, 2009
At HIMSS, VARs, CIOs and vendors look past the initial round of stimulus excitement to gauge what's coming next.

20 Scenes From HIMSS 2009
ChannelWeb , April 09, 2009
The annual HIMSS conference brought more than 27,000 attendees to McCormick Place in Chicago, to hear from each other and from the likes of Dennis Quaid and Alan Greenspan as they place their bets on the future of health care IT. A strong pulse? You bet--and Channelweb was there to check it.

HIMSS: Greenspan Says Economy 'Will Turn, But Not Yet'
ChannelWeb , April 08, 2009
At HIMSS, Alan Greenspan addresses technology's role in health care and the broader economy.

HIMSS: Dell, Perot Systems Unleash Health Care IT Salvo
ChannelWeb , April 06, 2009
Dell announces partnerships with Perot Systems and others and virtualization and social networking solutions for health care

HIMSS: Dennis Quaid Calls On Health-Care Modernization To Eliminate Errors
ChannelWeb , April 05, 2009
Actor Dennis Quaid said at HIMSS keynote that health-care IT technology is the only way to reduce medical errors.

HIMSS Preview: Health Care Tech Revs Up As Stimulus Begins
ChannelWeb , April 03, 2009
Electronic medical records and health care IT funding from the federal stimulus package are on everyone's minds as HIMSS gets under way in Chicago.

Health Care IT: 25 Solutions To Check Out At HIMSS
ChannelWeb , April 02, 2009
A sampling of products and solutions to see at the 2009 HIMSS Conference in Chicago.

Obama, Healthcare IT and the FDA

Today is day 2 of Obama's presidency.

While I do not expect him to even think about the FDA just yet, his inauguration led me to speculate about the possible changes that may come about for Healthcare IT in general and the FDA in particular. Somewhat coincidentally, these thoughts came out on inauguration day in the now weekly magazine Pharmaceutical Executive Europe. If you don't yet subscribe to this wholly electronic publication, consider doing so.

Click here to read the article which begins on Page 8. Your own thoughts on these topics are welcome.

Obama's Healthcare Team

Next week the USA gets a new President!

Anyone who is interested in what Obama will do with Healthcare should be interested in the colorful cast of characters that he has (and will) assembled to tackle this monster. One of them is Peter Orszag who will now be his budget director.

An Economist by training, Mr. Orszag already knows a thing or two about healthcare. He's got the facts on the spending front and has a few ideas about putting healthcare on a diet.

If you want to know more, there is plenty of that on the Internet. Here is one pretty good review (The Number Cruncher in Chief) about Mr. Orszag. Skim it first and then decide what parts you want to read.

Patient (Self)Recruitment

Notes from the 23^rd DIA CDM conference

Sometimes we tend to forget that everything we do is for the patient.

I was reminded of this when listening to a talk by Laura Esserman of the University of California Medical Center at San Francisco. Dr. Esserman described her clinical work in the area of breast cancer and the recognition that patients themselves could be the source for electronic health records (EHR). Once collected, these records could be used to match patients to clinical trials. In other words, the EHR becomes the source of data for patient recruitment.

DIA Euromeeting: Impressions and Recommendations

I’m writing this on the plane to New York from Barcelona having just attended the 2008 DIA Euromeeting. As a veteran of many DIA annual meetings in the USA, I must admit that this year’s Euromeeting was like a breath of fresh air. A key reason for this may be the calculated risk that the meeting planners took by redesigning the program around themes and sessions.

Suggestion: Click here to see a phenomenal set of Barcelona photos!

Bedside Portable Computer

Motion Computing has announced the availability of their Motion C5 Mobile Clinical Assistant (MCA) tablet computer. This flash demo gives a good overview of the device.

The device was created in collaboration with Intel Digital Health Group. While currently intended for hopital use, the tablet could be used for other purposes such as EDC.

It should be noted that the device is primarily a hardware solution and does not come with healthcare application software. A good example of the way the device can be adapted for bedside use is described in this field study by Intel. In this case, the tablet was integrated with the Eclipsys Sunrise Clinical Manager platform.

The unit uses the Intel Centrino processor, runs on either MS Vista or XP and includes a bar code reader, RFID reader and digital camera. It also supports wireless and bluetooth connectivity.

Healthcare Standards and Healthcare IT

The (re)use of patient data in the form of the electronic medical/health record (EMR/EHR) will be discussed in three separate sessions at the annual DIA meeting and is an emerging topic within our industry.

Two key uses within clinical research are 1. patient recruitment and 2. encounter based clinical data collection. There is also great potential for using EMR/EHR data for signal detection in pharmacovigilance. These examples only begin to scratch the surface of potential uses.

From my point of view, our industry is still in the learning phase when it comes to the potential impact of EHR/EMR on the way we conduct R&D or deliver better care. So, what better way to learn than read what our colleagues in the healthcare provider world have written about EMR/EHR and related issues.

To that end, I'd like to recommend that you look at a multi-part essay written by Steve Beller Ph.D. on the Trusted.MD web site. Since that site makes getting to all the parts a bit mysterious, I am giving you the link to each part below:

• Part 1 - Better care delivery through knowledge reuse
• Part 2 - Types of standards
• Part 3 - Issues related to healthcare standards
• Part 4 - HL7 messaging
• Part 5 - Problems with healthcare standards
• Part 6 - Use of innovative technologies