At Montefiore Medical Center in Bronx, NY, researchers are harnessing the power of more than a decade's worth of electronic medical record data using a software program called Clinical Looking Glass (CLG). Developed by the academic medical center, the program interprets de-indentified data for entire patient populations and can be used to gauge the effectiveness of patient safety measures, identify and track public health threats, and provide data for professional articles and published studies.
Researchers, physicians, and other clinicians run as many as 2,800 queries every month using the software. Three examples: They used the program to measure the impact of Medicare regulations on rehabilitation patients, quantify the reduction in radiation exposure for emergency department patients, and track the care and progress of diabetes patients over time.
Measuring Medicare Policy
The Centers for Medicare and Medicaid (CMS) announced in 2005 a new rule that said a large percentage of rehabilitation hospitals' patients must have one of 13 specific diagnoses or the organizations could lose reimbursement. Concerned about the rule's potential impact on patients, a group of physicians at Montefiore, using CLG, performed a retrospective study of discharges from the hospital the year before the rules were implemented and discharges the year after the rules. They found that, in general, "restricting access to inpatient rehabilitation on the basis of diagnosis alone" resulted in patients being readmitted sooner and dying sooner. Their study called for broader, evidence-based guidelines to allocate rehabilitation services.
Reducing Radiation
To reduce unnecessary radiation exposure to patients admitted to the ED with a suspected pulmonary embolism, a group of radiology and nuclear medicine physicians conducted educational seminars for ED physicians. They showed the ED physicians that for certain embolism patients, a high-radiation CT pulmonary angiography (CTPA) was not necessary and that the lower-radiation ventilation-perfusion scan was just as effective. Using CLG, they showed that the number of CTPA scans performed decreased from 1,473 before the educational seminars to 920 after the seminars for an average reduction in radiation exposure of 23% percent per patient.
Improving Care for Diabetes Patients
Using CLG, physicians at Montefiore's 25 ambulatory care centers have identified 14,000 diabetes patients and tracked their care and progress over time, including improvements in blood glucose and cholesterol levels. Then they compared the results of patients in different centers and the results of those being treated by different doctors. Some Montefiore physicians practice outcome-based medicine linked to pay-for-performance incentives. The study showed that those patients being treated by those physicians had lower blood glucose and cholesterol levels.
Fostering Intellectual Growth
The organization says not every query run through CLG is as successful as the three examples above. Sometimes inquiries hit a dead end. But that doesn't mean Montefiore's investigators stop learning. They can attend bimonthly lunches to exchange ideas and share their CLG experiences. Out of those meetings, new avenues of exploration often emerge.
"CLG allows all clinicians and hospital administration to test hypotheses that just a few years ago would have been impossible to do," says Eran Bellin, MD, vice president for clinical IT research and development at Montefiore, who was instrumental in designing CLG. "It democratizes the research process. To be able to identify, within minutes, a cohort of patients, qualify them by a specific disease, medication, clinical event, race, time period or neighborhood provides a new paradigm for population-based medicine and a new level of importance for health care informatics."
(To read more about how hospitals and health systems are using EMR data to conduct research—and some of the legal pitfalls to avoid—see A Data Gold Mine in this month's issue of HealthLeaders magazine.)
I recently asked a group of healthcare workers "What's the one technology you can't live without?" It probably won't come as a big surprise that many of the answers began with the lowercase letter "i." In fact, some of the folks I queried sent their answers via devices beginning with that very same letter.
D. Elan Simckes, MD, medical director of Fertility Partnership in St. Louis, MO, nicknamed the iPad he got for his birthday his "MyPad."
"I thought it would be mostly used for fun, but really it's turned into an invaluable work tool," he says. "I now have all my online medical journals and my medical search engines at my fingertips at any time of the day. My iPad seamlessly interfaces with my electronic medical records system which I think increases accuracy in everything I do."
Even more important, the device has helped him overcome a condition common to physicians—poor handwriting. "There are those who say I became a doctor because my handwriting is completely illegible," he says. "My mother says it is nothing but pure chicken scratch."
Using the iPad and a dictation software application, he says he dictates everything from case notes to patient letters. "I even dictate messages to my staff and e-mail them right then. What's great is that the application is more than 95% accurate even with much of my medical terminology."
The practice's marketing department also use iPads. "They can build presentations and Powerpoints and I can instantly showcase them out in the field," Simckes says. "Last week I took my iPad to a live TV interview and had my notes right at hand. I was able to prep literally until the moment the cameras went live. The TV crew loved it and it made me incredibly comfortable and relaxed."
The iPhone has brought a little fun to the Indianapolis offices of Downtown Physical Therapy, says Bryce Taylor, president of the practice.
"Nobody could have convinced me three years ago that my patients would be playing video games for treatment," he says. "Here we are though—in a new tech era, when video games are no longer bad for you. The iPhone has helped his patients complete home exercise programs—one application has a printer-friendly handout function he uses to show patients the exercises.
"Technology certainly is making my clinic run more smoothly and creates a fun environment at times," he says.
"The smartphone is the new doctor's black bag," says John Luo, MD, associate director of psychiatric residency training at the Resnick Neuropsychiatric Hospital at UCLA Medical Center. "I never leave home or office without it."
Luo uses his phone to check medication dosages and drug interactions, sends refills online, and I looks up "all sorts of medical information using the web browser." He lists about half a dozen applications that provide him with health information, continuing medical education, and medical calculations—all at the point of care. "The smartphone is more valuable than a computer to me because it is always available to help; just as Sherlock Holmes had Dr. John Watson," he says.
And it has one more advantage over the Holmes-Watson relationship. It actually makes phone calls, too.
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There are so many new, cool things happening in the world of healthcare technology that it's impossible to keep up—which is why my inbox is cluttered with e-mails from PR folks who are "just checking" to make sure I got their e-mail . . . for the fourth time. So, since today is National Clean Out Your Inbox Day (OK, there's no such day—but there should be), here are a few cool healthcare technologies that hospitals are using to reduce hospital-acquired infections (HAI) and help clinicians practice safer medicine.
1. Like a really big can of Lysol, except with light
The maker calls it "the fastest, safest, and most effective method for the advanced cleaning of hospital rooms in the world today." Hyperbole aside, Xenex Healthcare's disinfection system uses patented xenon UV pulse technology to deliver high-intensity, broad-spectrum UV light to quickly kill microorganisms on surfaces and in the air without contact or chemicals.
The UV pulse of the lamp penetrates cell walls of microorganisms including bacteria, viruses, mold, fungus, and spores, and essentially fuses the DNA of the microorganisms, leading to instant damage, the inability to reproduce or mutate, and killing the organism, according to the company.
2. Taking the icky out of remote controls
I hate to touch the TV remote control in hotel rooms—so I don't even want to think about the germs on a hospital remote. Some hospitals, including UCLA Medical Center and the University of Washington Medical Center, have replaced their bacteria laden remotes in high-risk areas with a product called the Clean Remote.
The device has a non-porous flat surface with no nooks and crannies where germs can hide. It's easy to clean and resists bacteria, according to the maker, New Remotes Inc. Clinical studies at the University of Arizona found it to be 99% cleaner than any other remote tested. And they make them for hotels, too.
3. Getting all virtual on patient safety and quality
The North Shore-LIJ Health System's newly-expanded Patient Safety Institute features cutting-edge simulation technology, including an operating room, a procedure room, a labor and delivery suite, and eight critical care rooms, that help physicians and nurses hone their clinical and communication skills in a realistic hospital setting without risk to live patients.
Computerized patient mannequins can be programmed to mimic a range of high-risk medical scenarios, such as respiratory failure and cardiac arrest in a variety of clinical settings. All simulations are video recorded and reviewed during post-scenario debriefings.
4. Would you rather we brought in soap-smelling dogs?
Developed at University of Florida, the HyGreen technology can sniff out sanitizer or soap fumes in order to monitor healthcare workers' hand hygiene. The technology logs, down to the second, the frequency of hand cleaning and contact with patients in a database that clinical supervisors can review in real time.
The device's maker, Xhale, is also developing technologies that analyze a person's breath and other types of vapors for use in pharmaceutical, health monitoring, and diagnostic applications. For example, the company is developing a product that would allow remote monitoring of patients to ensure medication compliance. It can also be used to ensure compliance by clinical trial participants, improving both safety and efficacy.
5. Smart talk about hospital-acquired infections
Linguists at Xerox Corporation have teamed up with medical researchers in France to explore how language technology can help prevent HAIs. During a three-year project, researchers will use an advanced text mining tool developed by Xerox to analyze medical records, automatically identifying patients who could be at risk of contracting an HAI.
The technology reviews medical records and identifies specific terms and sequences of facts that indicate a patient may have contracted an HAI. The software not only pinpoints meaningful pieces of information, such as patient symptoms, drugs and names of bacteria but also how they are linked to each other.
When these links identify potential risk, the system automatically alerts the staff to take preventative measures. The project brings together a range of unique competencies in the fields of natural language processing, terminology, knowledge representation, epidemiological surveillance, medicine, and infection control, according to the company.
Now, if only someone would invent a product to automatically sort through your e-mails and clean out your inbox for you.
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Unveiled yesterday at Apple's annual conference for software developers, the iPhone 4 is thinner, prettier, and has a longer battery life than its predecessor. But for healthcare professionals, the big news is that it shoots hi-def video and is packed with four times the pixels. Good for Farmville fans; even better for those who use medical apps, many of which rely on high resolution and advanced sharing capabilities. A few of the latest examples:
Take a test drive
Take, for example, the app for interactive, high-res surgical procedure training. One simulation replicates the challenging laparoscopic nephrectomy procedure. Urologists can practice the procedure in a virtual clinical environment without risks to patients or recurring training costs, says maker Simbionix. Course materials include featured 3D animations and interactive quizzes to test comprehension and the company plans to release more apps for a variety of procedures and topics.
Listen and learn
Thinklabs has released iMurmur 2, which lets medical students, cardiologists, and others to learn or classify patient heart sounds. The app includes digital heart sounds recordings, phonocardiograms, diagrams, and educational content. The company also has a stethoscope app that records, documents, and e-mails heart and lung sounds from the bedside or clinic.
Examine a virtual body
University of Utah researchers recently developed two iPhone applications that allow scientists, students, doctors, and others to study the human body, evaluate medical problems, and analyze three-dimensional images. Using ImageVis3D, users can display, rotate, and otherwise manipulate 3-D images of medical CT and MRI scans and a wide range of scientific images. AnatomyLab allows students to conduct a virtual dissection on images of a real human cadaver.
Search for science
Oncologists can use the CancerTrials App to research experimental therapies in clinical trials and share them with their patients. The app, released by Glaxosmithkline and Medtrust Online, starts with 12 common cancers and narrows the search by gender, age, trial status, and location. The program maps relevant studies for the patient.
Tie an electronic string on your finger
Emerging Healthcare Solutions, Inc. is working on an app that aims to reduce medication errors. Scheduled for release this summer, it will call users daily to remind them which medicine they're due to take, the exact dosage they should take, and the exact time they should take it.
Want more? Check out these previous stories on healthcare apps:
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The patient of the future—also known as the e-Patient—is technologically savvy, information hungry, and has a sense of entitlement about the level of service and the types of services they want. They'll demand up-to-date, easy-to-understand, and easy-to-access information about the cost of care and billing, online appointment scheduling, the ability to e-mail their physicians, and hospital Web sites that have more information than can be found on Google maps. The patient of the future will put plenty of demands on healthcare organizations in general and healthcare IT departments in particular.
Donna Cryer is one such patient. A liver transplant recipient who's had to deal with multiple and complex health issues starting when she was just 13, she wants to be cared for in ways that can only be delivered with data-sharing and expedited communication.
I interviewed Cryer for this month's HealthLeaders magazine cover story, Time to Put Patients First: How America's hospitals have lost touch with their top priority—and what healthcare leaders are doing to fix it. The story is about the patient of the future—including how technology can help meet some of their needs. Unfortunately, we didn't have room to run her comments, so I want to share some of what she said here.
"Patient-centered care is individualized, personalized treatment decisions that [are] placed in the context of the patients' entire life," she says. Each person has individual goals for who they want to be, how healthy they want to be, what their own risk benefit analysis is for a given treatment, she says. For example, when Cryer was still in her teens, her surgeons recommended she have her colon removed.
"I just really wasn't able to face that . . . spending my teenage years with an ostomy bag. So we did it in my twenties," she says. "My medical team works with me and I work with them . . . It was my decision to make and they were coaching me through that calculus."
Although Cryer has good things to say about how patient-centered her healthcare provider is, she says the organization falls down in other areas, especially when it comes to technology.
"The Web site is totally inadequate—I can't get any useful information," she says. No online appointment bookings, difficulty finding parking, wait times that range from several weeks to months long waits for results of labs tests that were finally delivered via snail mail. And when she finally got them? "They weren't shared with, well, anybody."
After getting the test results, she went to an appointment with a specialist. She didn't bring the lab results or her "truckload of files" because she had heard they were finally instituting an electronic medical record.
She should have brought them.
"I am the conduit for all tests results and information to my physicians. That is my current challenge in healthcare—meaningful access to my physicians [is] supported by the most meager amount of technology," she says. "Patient responsibility—I'm a big fan, but it's too much even for me . . . it's not really appropriate for me to take on that role . . . This role as über-coordinator is beyond even someone like me who can do it pretty much full time."
Cryer, an attorney who is now CEO of CryerHealth, a Washington, DC, organization that advocates for patients' rights and to make healthcare more patient-centric, did finally find a physician that "gets" the patient of the future. The doctor works with her to solve problems, and discusses results and trends. She gives Cryer electronic copies of her medical information. She even gave Cryer her e-mail address. "It was like I discovered the Holy Grail," Cryer says.
Frankly, it shouldn't be that way. And soon, hospitals won't be able to do it that way … assuming they want to remain competitive and that they care about their patients.
For example, the demanding patient of the future isn't going to stand for the kind of telephone conversation I had yesterday with a health system billing department. When I asked if I could get a discount for paying cash up front for a procedure that's not covered by my insurance, instead of getting information I got a condescending little lecture about how lucky I am to have insurance at all and that paying for anything that's not covered is my responsibility. This despite the fact that several people within the organization told me that such discounts were routine.
(I wanted to ask the lecturer in the billing department what the organization's self-pay collection rates were, but resisted. I might send them the link to this month's magazine story by Senior Finance Editor Karen Minich-Pourshadi, Self-Pay and the Bottom Line: New approaches put patients back into POS collections.)
Like many patients would do, as soon as I hung up the phone I went straight to the organization's Web site. Not much help there—no estimates of how much the procedure would cost, and just a few vague lines stating that the hospital can help those who are uninsured or underinsured pay their bills. There was mention of interest-free payment plans. Gee, thanks. I could get the same from a furniture or appliance store—the difference is they'd tell me up front how much I'd be financing.
That inability to disseminate consistent, accurate information is a problem, Cryer says. "Communications, how you're greeted, patient throughput, everything matters," she says. "Information needs to be shared and not hoarded."
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Telehealth and remote medicine are hot topics these days, widely regarded as fields that are about to explode—from remote radiology readings to ICU monitoring by off-site intensivists, to e-visits during which the patient and physician consult via video. But perhaps the most futuristic use of these technologies is the doctor robot: a device that allows the doctor to "walk" (or, perhaps more accurately, roll) into a room and examine his or her patient.
One such device is the five-foot tall RP-7® Robot, manufactured by InTouch Health® in Santa Barbara, CA. A physician, using a control station and a joystick, can maneuver through the hospital halls, interacting with patients, family members, other clinicians, and staff via a live video feed. The doctor's face is visible on a monitor that serves as the robot's "head." A camera, speaker, and microphone allow real-time, two-way audio and video communication.
Clinicians use the remote presence devices in a variety of different applications, from time-sensitive stroke treatment, emergency room call, critical care coverage, hospital capacity management, and specialty training and collaboration.
In addition to improved efficiency for doctors, who can conduct night and weekend rounds from their home, clinic, or office, the robots can also improve patient and family satisfaction. In a study led by Louis Kavoussi, MD, chairman of urology at North Shore-LIJ, and the nation's first user of the remote rounding robot, half the patients preferred a "tele-rounding" visit by their own doctor to a "real" visit by another physician. More than 80% of the patients felt that the robot increased physician accessibility.
"Patients have been extraordinarily receptive and enthusiastic about the robot," Kavoussi, who is using one of the three robots at LIJ to check on his patients after hours and on weekends, said in a release. LIJ is also using two robots in its ICU. The hospital's intensivists use the robots from their homes and offices to provide additional patient monitoring.
Although there are benefits—especially in rural and other areas where access to specialists is limited and as a Band-Aid for the physician shortage in general—there are some critics who say some robotic-controlled procedures are gimmicks, that the price of the technology is to steep for many hospitals, and it could limit the human contact that's important to the patient-physician relationship, notes an article in the Ventura County Star in Camarillo, CA ("Robots' place in diagnostics, surgeries debated").
An anecdote I heard recently suggests the latter argument is not always true, however. An elderly woman had been seeing her physician via robot over the course of several visits. At the time of one scheduled visit the physician was in the area and decided to meet with her in person. "What are you doing here?" she asked when he walked in the exam room. "And where is my robot?"
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Hospitals are increasingly pulling their heads out of the sand when it comes to the social media activity of their employees, recognizing that they're active on sites such as Facebook, Twitter, and YouTube regardless of whether the IT department blocks access to them from work computers. Time to face facts: Employees post online comments from their computers at home and use their smart phones to update their Facebook status while at work. And yes, they're talking about your hospital online.
In last week's column, I offered up four steps to take when crafting a social media policy, including borrowing ideas from hospitals that have already begun the process. This week I'll show you some examples of policies with language worth borrowing.
1. Keep It Short
As I mentioned last week, your social media policy should be short—about one page—and should be written in the simplest possible language. Sure, legal is going to make you put some jargon in there; just try to keep it to a minimum.
Examples of policies that are downright unreadable abound. However one facility that got it right is Danbury (CT) Hospital. The introduction sets up clearly the difference between personal and professional online activities:
"Personal blogging is not a business-related activity and should be done during personal (non-work) time only.
"Company-sponsored blogging may only be done after express authorization of public relations/marketing."
Other bullet points are just as straightforward. One that I particularly like: "Since your site is a public space, we require that you will be respectful to the company, our employees, our customers, our partners and affiliates, and others (including our competitors)."
Similar language can be found in other hospitals' policies, suggesting this is one area where smart hospitals are already borrowing from each other. Mayo Clinic's policy, for example, reads in part: "Be respectful and professional to fellow employees, business partners, competitors and patients."
2. Keep It Simple
Mayo, a pioneer among hospitals in developing social media best practices, also drills down into some of the nitty-gritty of posting online—yet still manages to put it in easy-to-understand terms. Take this list, for example:
"Mayo Clinic blog posts and comments will be accurate and factual.
"Mayo Clinic will acknowledge and correct mistakes promptly.
"When corrections are made, Mayo Clinic will preserve the original post, showing by strikethrough what corrections have been made, to maintain integrity.
"Mayo Clinic will delete spam and/or comments that are off-topic.
"Mayo Clinic will reply to emails and comments when appropriate.
"Mayo Clinic will link directly to online references and original source materials.
"Mayo Clinic staff will disclose conflicts of interest and will not attempt to conceal their identity or that they work for Mayo Clinic."
3. Keep It Encouraging
I like policies that don't just tell employees what not to do, but give them guidance on best practices, as well. Vanderbilt University Medical Center's online "social media toolkit" avoids the finger-wagging tone that some policies take on and manages to make social media sound (gasp!) fun.
It asks its employees to think about their purpose in blogging and other forms of online communication with questions such as "Who are you trying to engage?" and "What would you like to accomplish?" and "What is your message?" The answer to that last question is a useful one: "Social Media is all about connecting, not pushing a message. To be a good participant, you must first be a good listener. Your online community will tell you what they want to hear from you."
There's more good advice—and encouragement—under the heading "Do you have what it takes?"
"To be successful at social media takes not only time and some strategy, but it also takes an outgoing personality. If you've been described as a people-person or friendly, you probably have what it takes. Or you may be a connector—someone who enjoys making connections and providing helpful information. In any case, you'll need to have some personal or professional experience with social media before hosting an account on behalf of VUMC."
Why take a positive tone? Because social media can, in fact, be good for your hospital and its reputation. Employees can be among your best brand ambassadors—it's better to help them succeed than to simply point out all the ways they can fail (and then mention discipline if they break the rules, to boot).
4. Keep It Educational
Whenever someone tells me I can't do something, my first question is always "Why not?" Although Kaiser Permanente's social media does have a warning tone to it, it also gives clear-cut explanations of why it's in an employee's best interest to comply with the rules. Even better, the policy references Kaiser's mission.
"Blogs, wikis, and other forms of online discourse are individual interactions, not corporate communications. Kaiser Permanente staff and physicians are personally responsible for their posts. Be mindful that what you write will be public for a long time," the policy states. "One of Kaiser Permanente's core values is ‘trust and personal responsibility in all relationships.' As a company, Kaiser Permanente trusts—and expects—its workforce to exercise personal responsibility whenever they blog or participate in any social media medium. This includes not violating the trust of those with whom they are engaging. Kaiser Permanente staff members should not use this medium for covert marketing or public relations purposes. If and when members of Kaiser Permanente's Communications, Marketing, Sales or other functions engaged in advocacy for the company have the authorization to participate in blogs, they must identify themselves as such."
OK, it's a little long-winded. But even a contrarian like me can't argue with that logic.
5. Keep It Transparent
What to do with your employee social media policy once it's done? Share it with the world. Although many hospitals do post their policies on internal sites, many are making them public by posting them online. In fact, you can find a list of hospitals with policies and, in some cases, links to the policies online, on Ed Bennett's Found In Cache blog.
If you have a social media policy, leave a comment on the post and he'll add your organization to the list. (Just make sure you follow your organization's social media policy when doing so.)
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When hospitals first started experimenting with social media, the biggest challenges they faced was how to use it, whether or not it was worth the effort, and how to explain foreign concepts such as "tweeting" to senior leaders who insisted on referring to it as "twittering." Like it or not, those days are over—social media has arrived. Even if your organization isn't officially on Twitter, YouTube, and Facebook, your employees are. Enter the next social media hot topic: the employee social media policy.
Representatives from three organizations that have begun that process spoke at the annual Medseek eHealth Client Congress in San Diego yesterday. Here are some of the lessons they've learned and four steps to follow when creating your own social media policy.
Get off the block
IT wants to save bandwidth, managers want to control how employees spend their time, and the privacy team wants to protect, well, privacy. Many organizations have tried to accomplish these goals by blocking employee access to social media sites while at work. But it doesn't work.
"Don't think just because IT blocks access, social media efforts will be stymied," said Tommye Morrison, Web site development specialist at the four-hospital Moses Cone Health System in Greensboro, NC. You can monitor the Web for misinformation and to make sure employees are acting appropriately while online, she said, but there are some things you just can't control.
Like Moses Cone, Alegent Health, a 9-hospital system in Omaha, NE, blocks access to social media sites for most clinical employees, says Matt McCahill, eHealth marketing manager, but he knows they can—and do—access the sites at work on their smart phones.
Better to set clear rules and encourage employees to be ambassadors for your brand than to waste time trying to stop them from talking at all, the panelists agreed. Alegent's solution is to educate employees in a positive way. An online toolkit is in the works that will give examples of the dos and don'ts of online communication. The organization is working on allowing all employees access to Facebook. It's scary, but it has to happen, McCahill said.
Research, borrow, and steal
There's no sense trying to create a social media policy from scratch. Several organizations have already done some of the work already. The idea for Alegent's online toolkit, for example, came from a similar one created by Vanderbilt University Medical Center.
Another good place to start: Your existing policies. For example, managers worry that employees will goof off if given access to social media sites at work. But existing policies already cover goofing off—you don't need a special one for goofing off online. Professional and personal standards of behavior apply regardless of the medium, Morrison noted. After all, you don't take away employee's access to phones because they might make a personal call while on the job or take away their paper and pens for fear they might write a personal letter. (Not that anyone writes letters anymore.)
Assemble the right team
Marketing, internal communications, HR, compliance, legal, Web development, and IT are among the groups and departments that must have a hand in developing social media policies, the panelists agreed. Legal and compliance, in particular, have helped identify potential problems at Alegent, McCahill said. The emergency management team, adept at thinking of worst-case scenarios, was a valuable member of the Moses Cone social media policy team, Morrison added.
They pointed out, for example, that the system should have administrative powers over all Facebook pages in case an employee who administers a page is fired. You don't want them walking away with the keys to the page, as it were.
It also helps to have an evangelical chief technology officer, as is the case at Texas Health Resources, said Charlie Dierker, consumer portal manager for the 13-hospital system in Dallas-Fort Worth. In-house enthusiasm can go a long way. But he also recommends bringing in outside help to woo holdouts and convince them that "this is where the train's heading."
Keep it simple
"When you write your policy, realize … that it's going to get outdated really quickly," said Morrison. "It's a very fluid process," McCahill added. That's a good reason to keep the policy document simple—the panelists agreed that a one-page policy is best. It's hard to avoid jargon, legalese, and corporate speak. But you can help keep it short by linking to existing policies and regulations instead of trying to cover everything in the policy.
Trust your employees
Texas Health Resources not only allows all employees access to social media sites from work but also encourages them to participate in social media. Even so, the organization also maintains administrative control over official sites. For example, all Facebook pages must be created with a system e-mail and although employees and clinicians can serve as administrators for Facebook pages, someone in the PR department must also have administrative access to every page.
Still, the best policy is one that is based on common sense and "treats everyone like adults," Dierker said. Texas Health Resources' policy reaffirms its trust in its employees, he said. (And, one might add, doesn't pretend that blocking social media sites means everyone will magically stop using them.)
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I had such a clever idea for this week's column: I would test a number of free online personal health record sites and write about the experience. About four and a half hours into my research—with only one prescription and a list of the vitamins I take daily entered into just one online PHR site—I realized that I would have to either abandon the project or abandon all hope of meeting my deadline.
My personal health record currently consists of a file in my home office stuffed with random papers—bills, test results, receipts for co-pays, old insurance cards, and notes scribbled on scraps of paper—from a number of different sources. My most comprehensive record is a little blue book with my childhood immunizations recorded in fading ink in my pediatrician's scrawling hand. I've moved and changed providers often enough that many of my records are likely lost forever.
Theoretically, I could share my paper file with my physician and any specialists I see. But an electronic record that can be shared via the Internet would be so much simpler. It's especially appealing if you see a number of different providers, as you could allow each of them access to the record and make sure that your primary case physician knows that your acupuncturist has recommended you take an herbal supplement that might interact with a prescription medicine—to cite just one of many examples. And for patients with multiple health issues who see multiple providers . . . well, the benefits multiply exponentially the more health issues you have.
There are many other benefits, as well. Online records have the potential to engage, empower, and educate patients in a number of ways. They can be used to share condition-specific information, teach patients how to make healthy lifestyle choices, and foster dialogue between patients and caregivers.
That's how it would be in an ideal world, anyway.
In 2009, Dave deBronkart (who would later become a patient advocate) famously tried to import his medical records from Boston's Beth Israel Deaconess Medical Center using Google's free online PHR, Google Health. Because some of the data was pulled from coded billing records, a number of conditions he was tested for showed up on his PHR as if he suffered from all of them.
"The problem is this kind of information should never be used clinically, especially if you don't have starting or ending dates" attached to each problem, deBronkart's primary care doctor, Daniel Z. Sands, told the Boston Globe. (Both deBronkart and Sands were named to HealthLeaders Media's 2009 20 People Who Make Healthcare Better list.)
As far as I can tell, not much has changed since then.
When I imported my health data into Google Health from my insurer, I got the list of every condition that I've been tested for—but no outcomes. So although I can see that I've had cholesterol tests every year, I couldn't see my year-over year results—a feature that would be extremely helpful.
Another error that popped up—when one of my prescription medications became available in generic, I switched over. But now Google Health is keen to warn me that taking the name-brand drug and its generic equivalent together could cause an adverse reaction. Terrific advice—except I'm not taking them both.
Finally, there were terms in my imported data that I didn't know. I was alarmed to learn that I have hypermetropia—at least until I looked it up and learned it just means I'm farsighted.
Online PHRs are a great idea. And they might work well—someday. But for now, the hassle factor (supplementing the raw data with details, figuring out which warnings to heed and which to dismiss, and researching what all those medical terms mean) is a huge drawback. One that will likely prevent me from completing an online PHR (let alone comparing a number of them) even though I really want one.
When I described my experience setting up my account to family, friends, and co-workers, even those who like the idea of having an online record they can share with their providers and loved ones agreed it sounded like too much effort. And many noted that even if they did do all that work to create an online PHR, the chances of their online provider actually looking at it or populating it with helpful educational information were slim.
As one person I spoke to noted, physicians barely understand patient experience—are they really ready for the e-Patient experience?
The answer in most cases, in case you were wondering, is no.
Bottom line: I would love an accurate and historical picture of my health in an online format. And I know I'm not alone. But as it stands now in order to make it happen I'm going to have to do most of the work myself. And, after all, isn't the whole point of electronic records to share information between patient and providers? As an uncle of mine said, if the online PHR were a street, it would be a one-way.
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In the 2009 film Confessions of a Shopaholic, the main character gets a job at a financial publication and finds herself in over her shoe-obsessed head. Her new boss comes up behind her as she sits at her computer.
"Did you just Google 'Finance?'" he asks her. "Yes," she admits. "I Googled."
Well, I have a confession of my own to make. Since I started covering healthcare technology, I've entered phrases beginning with the words "what is" into search boxes dozens of times.
I've never searched "What is healthcare technology?" But I have typed "What is cloud computing?" "Why are the first and last letters of SaaS capitalized when the other two are lower case?" and "Is there a difference between an electronic health record and an electronic medical record?"
I mentioned Web 2.0 in an e-mail to my editor a few weeks back and he responded with what seems like the obvious follow-up question: "What is Web 3.0?" That was convenient—all I had to do was cut and paste his question into the search box, hit return, and send him the answer as if I'd known it all along.
More recently, I searched "Can I download Apple applications to run on my computer?" Stop laughing. I was just curious if there was a way that I could test and review healthcare apps even though I don't own an iPhone. (OK, now stop laughing at the fact that I don't own an iPhone.)
I'm not embarrassed to say that I've had to ask these (and many more) questions not only over the past few months, but also throughout the course of my career. The truth is you'll never even know all of the things you don't know. But that's what makes it so much fun to be a reporter—you don't just learn one new thing every day—you learn several.
For example, now I know:
That cloud computing is a virtual server farm, except when it is something else. If Google were a "Magic Eight-Ball," the answer would have been "Reply hazy, try again."
That there is no discernable rhyme or reason to either of the two capital S's in the acronym for software as a service. And yes, to write that sentence I had to Google "What is the plural of the letter S?"
That there is a difference between an EHR and an EMR and that the damn press usually gets it wrong by using them interchangeably. I promise I will memorize the definitions in the HIMSS whitepaper, "Electronic Medical Records vs. Electronic Health Records: Yes, There Is a Difference," a title that, not surprisingly, came up very high in my search results.
That you, in fact, can not download apps onto your computer and, further, judging from the vitriol that the subject elicits when raised on tech message boards like this one, I might as well have queried "What is technology?" Or "What is an iPhone app?"
And that no one knows what Web 3.0 is yet except that it will be cooler than Web 2.0.
When I first started out in journalism, I saw a cartoon that has always stuck with me, even though I've long since lost the clipping: It depicted two scruffy-looking men wearing fedoras and throwing darts at a bulletin board that was covered with rectangles of paper. Each piece of paper had a word written on it: "economics," "education," "politics," "business," "healthcare," and (let's just say) "healthcare technology," for example. And above the board there was a sign that said "Today I am an expert in . . ."
The caption read: "How reporters start their day."
I can totally relate.
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