Florida Board Member Recommends Statewide Warning on EMR Errors

Here’s an interesting story from Florida:

A Florida Board of Medicine member wants the board to issue a statewide warning about EMRs, following an incident in which an OB-GYN missed an abnormal Pap smear and blamed the EMR. The OB-GYN punished the EMR by replacing it, while the Board of Medicine punished the OB-GYN with a $20,000 fine, a risk management review, and 100 hours of community service. The board member, a dermatologist, said “”I think the Department of Health needs to put out a warning to physicians that they need to look at their programs’ default settings. This year we have seen as many if not more medical records violations from electronic medical records as we saw from hand-written records violations.”

I’m not sure what benefit the Department of Health issuing a warning would do. I know I’ve never personally seen a warning from the health department (outside of the major news ones). One thing is clear to everyone involved with EMR or not. EMR isn’t the secret potion with no issues. Doctors are still accountable for the care.

Meaning of KLAS Results

I’ve had this post in the hopper since HIMSS back in early March. Unfortunately, it got lost in my other 200 or so draft posts that I work from for future posts. We’ll see if people think I should have left the idea in my drafts or not.

During one my meetings with EMR vendors I discussed the value of KLAS and why this EMR vendor was so HIGH on CCHIT (they’re booth had it plastered all over) and why they chose not to have KLAS ratings plastered beside their CCHIT marketing plan. This really smart EMR vendor marketing manager had previously described the marketing value (note that I didn’t say technical or clinical value) of having the CCHIT certification. So, why not KLAS?

This EMR vendor had obviously done their homework and had considered getting the KLAS rating. The reason they didn’t go that direction was he asked an interesting question of KLAS. He wanted to know how many people actually went to KLAS and downloaded the ratings from their website. Obviously, if they had hundreds of thousands of doctors downloading the ratings from their website, then it could be a great marketing tool for the EMR vendor to sell more product.

Turns out only 5000 people actually downloaded the KLAS ratings. When you add in the EMR vendors and other people who don’t purchase an EMR, that’s such a small footprint. I’ll admit that I’ve seen the KLAS name around a lot of places, but I’ve seen it less and less lately. Does anyone care about KLAS anymore? I’m going to Utah later this month. Maybe I should stop in and say Hi. Seems like there’s such an opportunity in the EMR space right now and they might be missing out.

Lost in Italy for a Bit

Well, as you can see my blog hasn’t gotten much activity lately. I wish I could say that things were going to get better, but the fact is that you probably won’t see many posts from me for the next 2-3 weeks. I’m going to Italy with my wife. I will give you a little look at where we’re headed in Italy.

Rome
We’ll be flying into Rome arriving about 10 AM. We’ll spend most the afternoon going around Rome. I think that Trevi Fountains, and the spanish steps are tops on my list of places to see in Rome. I also love going to St. Peter’s and watching the painters.

Napoli
After touring Rome we’ll hope on a train and head down to my friend’s place in Napoli. She is the sweetest lady. She said she’d have dinner waiting for us and a key to her house so we can just come and go as we please.

The next morning we’ll be touring some of Italy and I definitely have to hit Piazza Garibaldi to get me a suit and some other Sunday clothes for church. I was also told that there will be a baptism Saturday night. This happened last time I went to Napoli (truthfully Pozzuoli). It’s so much fun, because I get a chance to see a bunch of the members all at once. The next morning I’m sure we’ll enjoy church in probably the most beautiful chapel I’ve ever seen. Well, at least the view from the chapel is the best.

Amalfi
Monday we’ve got a nice hotel lined up in the beautiful town of Amalfi. We’ll probably check in to our hotel as early as possible and then head up for a little hike to the waterfalls just above Amalfi where they use to make paper. It’s an incredible hike that feels like you’ve gone into a completely different world. Got to love Valle Dei Mullini.

Positano
After spending the night in Amalfi, we’ll be taking an early morning “chicken bus” up to my favorite place in Italia:Sentiero degli Dei(Trail of the Gods). It’s about a 4 and a half hour hike. At the end of the hike there are 1000 steps to reach the beautiful city of Positano below. We’ve got a hotel lined up in Positano which will be a certainly welcome relief.

Napoli – Pompeii and Vesuvius
The next morning we haven’t decided exactly what we’ll do, but we’re considering heading to Pompeii since it’s in the area. However, if we’re too tired we might head back to Napoli and go to Pompeii later. I would love to take the boat from Positano back to Napoli. The boat is a lot of fun and a nice soothing ride.

Venice
After spending a couple days with friends in Napoli, we’ll be heading for a romantic weekend in Venice. I can’t say anything about Venice. It’s absolutely the most unique place I’ve ever been. It’s Romantic. It’s incredible and I can’t wait to stroll the streets with my wife. Not to mention a nice gondola ride.

Bologna
I’ll be meeting a friend of mine in Bologna. We’ll be attending church in Bologna which should be interesting since we’ve never been there. I’d rather go to church somewhere else, but I really want to see my friend Maria Rosaria so we’ll do what we have to do. Sunday after church my friend will pick us up and after eating some of her mother’s fine fine Italian cooking we’ll be heading to Florence.

Florence
We haven’t decided how many days we should spend in Florence. We’ll stay at least a day and up to 4 days. I must admit that my wife and I aren’t that into art and so I’m not sure how long we’ll want to stay in Florence. I think we’re probably going to want to head back to Napoli to spend more time with friends.

Well, that’s the general round up of our trip through Italy. Most things are subject to change, but it doesn’t really matter. No matter where we go or what we do we have nothing to worry about, because the best part of Italy is….

THE FOOD!!

Hopefully I’ll be able to at least blog a little from Italy, but if I can’t then we’ll see you after our trip.

Benefits of EMR Software to Consumers

One of my readers emailed me about a presentation he was looking at doing about EMR software and consumers. I was really intrigued by the idea of presenting on the benefits of an EMR to the consumer (Translation: Patients). I’d spent quite a bit of time thinking about the benefits of an EMR to doctors, but I hadn’t put as much thought and effort into the benefits of an EMR to patients.

Here’s our initial brainstorm on the benefits of an EMR to patients. Feel free to add to the list in the comments:
-Online Appt Scheduling
-Online Prescription Refills
-Online Patient Information
-Online Forms (possibly pulled in from a PHR)
-e-Visits (this is a controversial one)
-Secure communication with doctor
-Recall/Reminders Electronically
-Patient participation in health record (ie. diet journals)
-Better point of care
-Clinical decision support
-Better access to your health records
-Less errors
-Lower cost
-Better collaboration and communication between primary care and specialty Drs

No doubt some of these benefits should have a ? mark by them. Although, I like the idea of looking at the EMR from the patient perspective. I do after all think that consumers might be the key to “forcing” broad EMR adoption.

EMR Permissions

It’s always interesting to talk with someone about the permissions they should set in their EMR. Pretty much every EMR that has any footprint has a broad set of permissions available to restrict the access of your end users. It can often be a pretty significant task to set all of these permissions. Thankfully, it’s a project that you do once and then don’t have to go again (except for maybe some minor changes). Also, many EMR vendors have good templates for giving you a starting point for permissions.

What usually happens is that users end up with ALL sorts of restrictions on user accounts. I can’t say this is such a bad thing. Users should only have access to the information and features they need for the job. However, in the application of this rule, people almost always go overboard. Shortly after an implementation, the permissions are eventually opened up.

Since this is bound to happen, it’s important to make this part of the EMR implementation plan. Don’t make your nursing staff beg you for access to something. Give them a way to ask for access without making them feel like they are doing something they shouldn’t. Instead, encourage them to ask you for access to things that would make their life easier. That doesn’t mean that you’ll always give access, but from what I’ve seen, most people don’t want more access than what they need.

Remember that the rule is that people should only have access to the information that they need. If they’re asking for access to certain information to make their (and often your) life easier, then they probably do need it and should have access.

EMR Question and Answer: Domain Controlled Networks

I got the following question from Brandon about the need to have a domain controlled network in order to comply with HIPAA.

I am currently trying to implement an EMR system in a small practice. I am trying to convince the parties involved that it is necessary to transition to a domain controlled network for security reasons even though this type of network is not required for our EMR system or its server. My understanding of HIPAA is that simply having a firewall does not qualify as a “secured network”. Am I right on this?

Brandon,
You are correct that just having a firewall does not likely qualify as a “secured network.” However, that doesn’t necessarily mean that you need to have a domain controlled network to meet the HIPAA security standards. You could still manually apply the domain security policies on to individual computers and achieve the same level of security.

Of course, the key word in that statement is the word “manually.” If you have less than 10 computers, then this probably isn’t a huge deal and can be done manually. Once you pass 10 computers (or somewhere in that range) you probably want to consider using active directory to manage the security policies on your computers. It’s much easier to apply policies on a large number of computers using active directory. Plus, you can know that the policy was applied consistently across your network.

You also shouldn’t ignore the other benefits of a domain controlled network. I’ve written previously about the benefits of things likeshared drives as a nice companion to an EMR. Active Directory makes adding these shared drives trivial. It’s also a nice benefit to have a universal login that’s managed by the domain and can work on every computer in the office.

Plus, if your EMR runs on SQL Server and you buy a nice but inexpensive server with Windows Small Business Server, then you already have the software for active directory. So, it’s really an easy decision to use it. I’ve implemented it at a site with 5 computers and it’s been a great thing to have even if it’s a bit of overkill.

New Healthcare Blog Announcement I Received

Ingenix today announced the launch of “The Leary Report on PPS,” an interactive blog designed to help facilitate discussions about the important changes taking place in Medicare reimbursement.

“The Leary Report on PPS” is dedicated to discussing Prospective Payment System (PPS) issues, intially focusing on the severity-adjusted reimbursement changes proposed by the Centers for Medicare & Medicaid Services (CMS). CMS intends to implement a new method for classifying patients for inpatient reimbursement based on a severity-adjusted DRG model that will modify CMS’ existing Inpatient Prospective Payment System (IPPS), allowing Medicare to pay hospitals for inpatient services based on the severity of a patient’s condition.

“The industry’s input is needed because CMS has yet to finalize many details of its severity-adjustment system,” said Robert J. Leary, vice president of Ingenix. ” ‘The Leary Report on PPS’ provides a dedicated forum where industry professionals can collaborate among peers, evaluate alternative ideas and formulate feedback that will help CMS shape the final details governing how hospitals and other organizations are paid for services.”

The above is the “press release” I got a while ago. I just checked the blog and it hasn’t been updated since October 9, 2006. All I can say is that it isn’t easy to keep a good blog going. It takes commitment and passion. I will say that it is a good idea to interact in a community of bloggers. HITSphere is the best one I know for Healthcare IT bloggers.

On a personal note, my wife is due with our second child on Wednesday. Don’t be surprised if I’m not on here for a while.