Japanese Philosophy and EMR Implementation Work Hand-in-Hand

With thoughts and prayers headed towards our friends in Japan, I thought it would be a good time to focus on their contributions towards work flow and process analysis, the cornerstones of health care consulting and EMR implementation.  

As many of you know, EMR implementation is more than buying a software package and a few machines and hitting the ‘on' button.  Prior to any of these investments, there are processes and efficiencies that must be identified and implemented such that an office, group or hospital can maximize the use of EMR to improve patient outcomes.  Several organizational methodologies exist to conduct such analysis and implementation: Sigma 6, Lean Thinking, Deming Cycle, etc.  One specific Japanese philosophy, 5S,has received a lot of attention of late as we transition towards complete EMR implementation.

5S represents a philosophy built around the principles of building an efficient workplace with standardized work procedures.  The tenets of 5S involve simplifying, reducing waste and non-value activity while improving quality efficiency and safety.   There are five words that this philosophy is built around.  They include:

1. Sort (Seiri): elimination of wasteful items around the workplace.  To do so, a process called red tagging is completed in which a red tag is placed to identify any item that is wasteful around an office.  All red tagged items are then removed and put into a central area where they can be evaluated.  Such items that are unneeded are discarded while those with occasional use are moved and organized.  This process allows for valuable work space to be freed up and clutter to be removed.
2. Set in Order (Seiton): focuses on efficient and effective storage methods.  For any given item, one must ask him or herself: What do I need to do my job? Where should I locate this item? How many of this item do I need? All shared items should have a place where employees can find it (e.g. mop, stapler, etc.) Everything has a place.
3. Shine (Seiso): Having rid yourself of waste and set in order the remaining goods in the office space, cleaning those areas thoroughly shall be the next focus.  A daily scheduled follow-up cleaning will help with sustaining such improvements while ensuring the remaining goods are looked after and kept in their best order.
4. Standardize (Seiketsu): creating a system of standardized practices is the next part of the 5S philosophy.  All employees doing the same job should be able to switch to any station with the same function and reproduce the work task.  Involving employees to participate in the process will only help make them feel invested and increase compliance with new standards.  
5. Sustain (Shitsuke): literally means implement and achieve.   While humans are quite resistant to such change, this process can and will prove to be one of the most difficult to complete.  The tendency always is to revert back to “old ways.”  Employees should always be thinking about ways to improve the work place and processes; in the event that some sort of issue arises where an improvement can be made, one must review the first 4 S’s and how they relate to the new process prior to making the appropriate change.

While sticking to the 5S principles won’t guarantee the smoothest implementation, there are some great reminders of what it takes to make a system work.  As you continue to consider EMR implementation or a career as an Implementation Clinician, Informatics Specialist, and/or Clinical Consultant, understanding work flow, process analysis and process implementation should be your highest priority.  With your solid clinical background and this framework to help guide health care facilities to more efficient results, you will begin to understand what it takes to take on such a job.  

ONC's HITECH Certificate Program: The Rewards Add Up

I have written about my many motivations to acquire a Health IT certification through the Office of the National Coordinator's HITECH program.  The advantages are numerous: a top notch education designed by industry and academic leaders, the opportunity to network with individuals in the field, tuition entirely reimbursed upon successful completion within the six months, etc.

One more advantage was announced in the last week: the American Health Information Management Association (AHIMA)  is now offering HITECH students membership at a special rate of only $50 --  a $115 discount for up to two years.  As you may know, AHIMA membership provides a world of resources, including access to more than 61,000  other health information, informatics, and technology professionals committed to advancing the industry.    

Among the advantages of membership as highlighted by AHIMA.org include:

• Access to the AHIMA Body of Knowledge online library
• Network on the Communities of Practice
• Exciting annual convention and many other events held throughout the year
• Career Assist job-search site
• Practice briefs provide professional insight
• Opportunity to grow your professional skills through online and in-person training.
• Receive AHIMA’s award-winning Journal—Available in both print and digital format
• Career-enhancing credentials
• Discounts on professional resources for career growth.

This partnership not only promotes AHIMA, but it tells me that the HITECH certificate program is headed in the right direction as far as industry adoption goes.  As of this publishing, I could not find any other Health IT certificate program that has established such a bond with AHIMA.

Click here for more information.

Android's Google Reader App Gets More Muscle

Author: Mehdi Rais, M.D.

Last week, Android’s Google Reader app received some dynamic updates that bring the app closer inline with the online experience, and in some ways now exceeds the web version.  I lean on this app to keep up with over 225 news feeds a day ranging from Health IT to technology to emerging clinical best practices to a myriad of other topics.  Among the updates to the Android version of Google Reader include:

• Unread Count Widget: any feed can be chosen within your Google Reader (labels, person, specific feeds, or all items.)  You’ll have a pulse on developments in your reader inbox as they happen.  Clicking on such feeds will send you to the respective feed.

• News Ticker Widget: any feed within Google reader can cycle through those headlines and stream on the homescreen. Much like the previous widget, clicking on a given article will take you to the article.

• Mark previous as read: this feature isn't available in the online version; currently you can only mark a time period (last day, week, etc.) as read, not everything prior.  In your reading list view, you can simply press “Mark previous as read” to mark feed listings above the screen as read.

These developments are right in line with the spirit of Google Reader's aim to streamline your online browsing experience.  Have you made the leap yet to Google Reader?

About the author:

Mehdi Rais is a physician, medical lecturer, medical writer, and self-proclaimed “tech nerd.” When Dr. Rais isn’t honing in on his trades, he spends his time scouring publications and the web for the latest trends in technology in the medical field, new applications in Health Information Technology, and emerging legislative & regulatory changes in medicine. 

Dr. Rais' interests are greatly focused in the realm of mobile computing and the use of cell phone technologies in the clinical setting.  He received his Medical Doctorate from St. Christopher’s College of Medicine after spending his undergraduate years at the University of Texas at Dallas.  

Dr. Rais can be reached on LinkedIn or followed at his blog here. Look for him on Twitter @DrMedBlog.

EMR = MSQ (A Massive Security Quagmire)

With the emergence of electronic medical records, the amount of intimate data being stored on any given patient is enormous.  This begins with identifying information such as age, race, sex, social security information, billing information, etc.  Such data is invaluable to identity thieves and marketers alike. Last week it was reported that a group of hackers broke into the Emory Health Care System and stole the records of at least 77 patients at an orthopedic clinic.  

Alarmingly, the hospital IT department did not detect nor identify any security problems.  The security breach was picked up by an ongoing case being pursued by the FBI.  In a statement by a hospital spokesperson for the Emory Health Care System, the intentions of the thieves were revealed, ”According to the IRS this information appears to have been subsequently used for the filing of fraudulent federal tax returns with the intent of collecting associated tax returns."

Despite the perception of being a secure network, I find it amazing that such security breaches could occur without any clue of its occurrence by the IT department. This event speaks volumes as to the distance we have to go to prevent the compromise of highly sensitive patient data.  

As I continue through my HITECH program, I learn every day about a new creative way hackers have accessed such sensitive data.  Creating a secure system truly is a monumental task requiring both education of health care workers, increased hardware and software resources, and a better trained more prepared IT team. Along with creating a unified language as being one of our nation's largest hurdles for system-wide EMR implementation and adoption,  top-rated health IT security will prove to have an equally immense resource cost.  

EMR: No Shortage in Standards

As we transition to a full EMR system, one of the largest current challenges to our health care model is the need to share information at different sites: hospitals, clinics, nursing homes, tertiary care centers, etc. To help facilitate this interoperability between health care sites, standards are needed to guide us towards this end.

Even to begin to set such standards and/or goals towards interoperability, there first must first be a focus to aggregate patient data towards a unified standard. In setting the stage for this ‘consensus’ standard, all stake holders who represent some specific arm of medicine must come together and define the standards that allow them to work together across sites and distances.

Many of these respective groups that create standards have a tight relationship; some have absolutely no connection whatsoever. Thus, it’s easy to see this creates an inherent redundancy in standards in some areas of gap in others. Such redundancy and scattered coverage in standards have created the need for harmonization.

 

The graphic above represents the 43 major international health care standard developing organizations (SDO's) that are working together to create seamless interoperability. Many of these organizations have a need for assistance, and are free to join and have openings for volunteer opportunities. If you are interested in breaking into HealthIT, anyone of these organizations could mark the start of your transition towards this career.

As I continue to navigate through my HITECH program, I will continue to highlight many of these organizations and give you a bird's eye view of their role in the EMR interoperability equation. If you'd like to learn more about EMR transition and the mountain we are facing, click here.

About the author:

Mehdi Rais is a physician, medical lecturer, medical writer, and self-proclaimed “tech nerd.” When Dr. Rais isn’t honing in on his trades, he spends his time scouring publications and the web for the latest trends in technology in the medical field, new applications in Health Information Technology, and emerging legislative & regulatory changes in medicine.

Dr. Rais' interests are greatly focused in the realm of mobile computing and the use of cell phone technologies in the clinical setting. He received his Medical Doctorate from St. Christopher’s College of Medicine after spending his undergraduate years at the University of Texas at Dallas.

Dr. Rais can be reached on LinkedIn or followed at his blog here. Look for him on Twitter @DrMedBlog.

EMR Transition: It's all in the Words....

Seamless care through EMR requires establishing interoperability between different systems (i.e. organizations, hospitals, clinics, networks, etc.)  The starting point for achieving this interoperability is producing a controlled vocabulary to input within a database.  Naturally, over time development organizations have created such data sets in vocabulary for the specific aim to explain a specific arm of medicine.  Gradually, these organizations have broadened their purpose to encompass all medical terminology.  With this in mind, it is important to note that none of these initial data sets were ever intended to cover all of medicine and thus the reason we have overlap in terminologies, descriptions, etc.

If one were to simply take a look at a single term/data set and the variance in definitions of this term, it would be easy to see how the transition to EMR could effectively come to a grinding halt in its attempts to achieve complete interoperability.  A recent study examined the term myocardial infarction (MI). We all have our own conceptual model of MI and a respective qualitative/quantitative description to fit this model. The study I am referring to found 60 different scientific definitions of myocardial infarction.  Take this example one step further, and imagine the EMR interoperability nightmare if the records of one MI patient had to seek care or advice from a different institution. The flow of that data set from one institution to the next would immediately be severed simply because of the differing definitions and descriptors given. Now multiply this problem by every diagnosable disease.  The thought of standardization of language and disease description becomes a staggering one, and here lies the mountain of work we must climb to achieve seamless EMR interoperability.

To put this into further perspective, the following table elaborates the choices in terminology for specific recordable data sets and the respective organizations that are attempting to develop a controlled language.  While there may be overlap in some of the language in one or two of the systems, there is by no means a consensus language. 

 '+' represents the amount of use of a controlled terminology set within the U.S.; '$' represents a respective cost to the end user.

Having said this, clinicians cannot sit back and simply think that EMR transition will be done by IT people alone.  Definitions and vocabulary are the back bone of this system. Such terminology can only be given by clinicians.  Currently the Office of the National Coordinator estimates 50,000 people will be needed to assist in this effort over the next 4-5 years to reach our goal of 100% transition to EMR.  

I for one had no idea of the scale of the interoperability problems without having started the HITECH Workforce Program only a few weeks back.  I look forward to presenting many more of the big issues that we are facing during this EMR transition in the coming months.  

About the author:

Mehdi Rais is a physician, medical lecturer, medical writer, and self-proclaimed “tech nerd.” When Dr. Rais isn’t honing in on his trades, he spends his time scouring publications and the web for the latest trends in technology in the medical field, new applications in Health Information Technology, and emerging legislative & regulatory changes in medicine. 

Dr. Rais' interests are greatly focused in the realm of mobile computing and the use of cell phone technologies in the clinical setting.  He received his Medical Doctorate from St. Christopher’s College of Medicine after spending his undergraduate years at the University of Texas at Dallas.  

Dr. Rais can be reached on LinkedIn or followed at his blog here. Look for him on Twitter @DrMedBlog.

Blood Pressure Showdown: Withings vs iHealth

You've read a few reviews on iOs enabled blood pressure cuffs breaking into the market (here, here, and here.)  I was interested in taking a closer look at the devices available and their respective hardware and user interface.  In the following chart, you'll find some pretty big differences between the offerings of the two main manufacturer's (iHealth and Withings) in terms of power, user interface, ability to share, analytical capabilities, and more....

SPEC COMPARISON

With Specs in mind, let's take a quick glimpse at the hardware package and UI.

WITHINGS BLOOD PRESSURE CUFF & APP: 

A look at the size and portability of Withing's product.

UI while acquiring blood pressure

Blood Pressure results display

Graphical results of blood pressure readings

iHealth's BLOOD PRESSURE CUFF, BASE & APP:

Despite the base station, iHealth's offering is still highly portable.

UI while acquiring blood pressure. 

Blood pressure results

Graphical interpretation of blood pressure data. 

Determining a champion in this showdown is really a matter of personal preference.  If you or your patients need a product that offers dynamic avenues to share, Withings is your product.  If you need a more robust and appealing UI and user experience, iHealth gets the nod.  At the end of the day, you can't lose with either product.  

Which one will you be advising your patients to grab?