Here's the crowd sourcing results of the top 10 barriers to successfully deploying an EHR:
10. Usability - products are hard to use and not well engineered for clinician workflow.
9. Politics/naysayers - every organization has a powerful clinician or administrator who is convinced that EHRs will cause harm, disruption, and budget disasters.
8. Fear of lost productivity - clinicians are concerned they will lose 25% of their productivity for 3 months after implementation. Administrators are worried that the clinicians are right.
7. Computer Illiteracy/training - many clinicians are not comfortable with technology. They are often reluctant to attend training sessions.
6. Interoperability - applications do not seamlessly exchange data for coordination of care, performance reporting, and public health.
5. Privacy - there is significant local variation in privacy policy and consent management strategies/
4. Infrastructure/IT reliability - many IT departments cannot provide reliable computing and storage support, leading to EHR downtime.
3. Vendor product selection/suitability - it's hard to know what product to choose, particularly for specialists who have unique workflow needs
2. Cost - the stimulus money does not flow until meaningful use is achieved. Who will pay in the meantime?
1. People - its's hard to get sponsorship from senior leaders, find clinician champions, and hire the trained workers to get the EHR rollout done. (this was the #1 concern by far)
After we reviewed the real top 10 list, I read a more colorful top 10 list in the Letterman tradition, from a very creative student
10. You need to attend a Harvard Certificate Program to have a clue
9. Meaningful use is only meaningful to academic scholars
8. Docs keep asking - where's my money?
7. The government thinks 2011 is a decade away
6. The government says 'do it now, but I will tell you what I want next month'
5. My kids say 'hey Dad, I just discovered 10% (i.e. the inpatient CPOE usage requirement) is a passing grade'
4. You read about your security breaches in the New York Times.
3. Patients get to go home early because clinicians are busy implementing software.
2. When you ask vendors how they justify the claim that their products are 2011 certified (and the certification process has not yet been announced), they show you a Ouija Board.
1. You need Ted Williams' batting statistics to convince your Board that EHRs are worthwhile.
There you have it - the actual top 10 from the crowd and the wisdom from someone who's keeping their sanity during this time of great change with a touch of humor.
I finally broke down and bought a Motorola DROID from Verizon several weeks ago- that's the new phone that runs Google's Android 2.0.1 Operating System.
Thus far, I don't regret the decision.
AT&T's coverage where I live stinks, so as much as I like the iPhone, it just wasn't an option for me. Fortunately, the DROID does most things as well as the iPhone, and does some things much better than the iPhone.
I agree with most of the accolades and criticisms you've probably already read about the DROID.
Things I Like:
The touchscreen is large, responsive, and looks terrific.
Syncing of my Gmail contacts, my work contacts, and my Facebook contacts is pretty darn great. I always have ALL my contact information on me- and it is updated whenever Facebook, my Gmail contacts, or the Address Books at my place of work are updated.
The "open" model is appealing. Even without having a rooted phone, I have *much* more control over the device than with an iPhone. If there's any file I want on my Droid, I can put it there without jumping through any hoops. I have complete control over the file structure. iPhone/iTouch users has undoubtedly been annoyed by how strictly Apple controls what can (and cannot) be moved over the device's USB cable and have to use third party applications to move data from an iPod/iTouch to a new computer- even if that data has no DCM.
Customization-I can tweak so much about the DROID's interface that it took me several days to explore a lot of options and make some decisions about how I wanted it laid out. As my continued use of it reveals new/different/unexpected needs, I can quickly and easily make changes.
Navigation design is good- getting around the DROID takesa bit of getting used to, but it makes sense and I can customize shortcuts to almost any application, document, directory, etc- so common tasks are accomplished quickly.
The Notification Panel is GREAT. I'm never interrupted, just notified.
MPOW supported my access to my (Exchange) work email and work calendar immediately- cleverly, it interfaces through Outlook Web Access, which makes supporting the device's access to Exchange a very easy decision for the Information Systems department. I win, they win. Everyone is happy with no additional work. (Our IS department has some security concerns about iPhone access to our Exchange server and Blackberries require an enterprise server to make Blackberries play nice with Exchange.)
It is a good TELEPHONE. The sound quality is about as good as can be expected from a mobile phone.
There's a nifty little app called Call Filter that blocks calls from unknown numbers (i.e. telemarketers) or any number you tell it to block. This is especially useful if you keep getting "wrong number" calls from one particular source.
Other useful telephony apps include Phonalyzr, which analyzes your phone usage:
Dial Zero is useful little utility that lists companies alphabetically. Choose the company and it'll give you a number to click (which the Droid will dial), then tell you how to game the voicemail system to get to a human being as fast as possible.
Awesome Apps for Android
All of these are available from the Android Market.
SugarSync may remind some of Dropbox (mentioned during the #mlamobile Webcast for the iPhone/iTouch), but actually does a good deal MORE than just synch files between my DROID and folders on other computers. I can stream media files from my home computer to my DROID, if I want. More here: https://www.sugarsync.com/downloads/android.html
I have it set up to send status messages to Twitter when I get to work or when I go to my Mother-in-law's house. I'd eventually like to set up a simple status board for Liz and I so each would always be able to quickly check where the other is. Imagine that I could tap my phone and see quickly if Liz is on campus, at her mom's, or somewhere else. I also have Locale (with a WOL plugin) set up to wake up my home computer as I approach our house after work.
I also have it set up to prevent my phone from ringing when my calendar says I'm in a meeting. (Can your iPhone do that?) It also stops notifying me of new work email between 5:00 PM and 8:00 AM.
I also have it set up so if my battery falls below 30% of capacity it alerts me to plug in and shuts down all non-essential functions (don't want to miss a call from my wife because I was using it for something power-intensive, right?)
abcOrganizer is a great way to be able to manage and access a great number of applications, shortcuts, contacts, or any other objects in Android in a compressed, organized fashion. Click on the category icon and a window of the apps in that category pops up. Yes, you could do this just by using Android's native folders, too- but I like AbcOrganizer better. I get to choose my own icons.
For those who like reading comics in .cbr or .cbz format, check out ACV:
For books, I've use mostly FBreader and have read a few novels in it now. No eye strain for me, and the night display (black background, white text of adjustable brightness) keeps it from annoying my wife.
AndFTP is an awesome file explorer and FTP client for your Android device. Soooooo convenient to access my FTP server this way. Also supports SFTP and FTPS. The Estrongs File Explorer is another good client for managing media files via LAN or FTP.
Barcode Scanner is really neat. It'll scan the barcode on an item and try to find prices for you elsewhere. Even cooler for those of us who like books: If the book is scanned by Google Books, you can scan the barcode and search within that book. We live in the future.
So, thus far there aren't a ton of health info apps for Android that I find exciting.
In the meanwhile, my favorite health info destinations on my DROID are the new MedlinePlus Mobile and Unbound MEDLINE, both of which run in the browser.
Podcast interview with Zynx Health CEO, Dr. Scott Weingarten
Zynx Health is a clinical decision support company whose technology is in place at more than 1700 hospitals in the US, covering more than half of hospitalized patients. Decision support is an important part of meaningful use, and now that the detailed definition has been published, Zynx is busy working with its customers to help them check the meaningful use box and gain incentive payments under the American Recovery and Reinvestment Act of 2008 (aka the stimulus package).
In this podcast interview, Zynx Health CEO Dr. Scott Weingarten discusses the Zynx approach to achieving meaningful use, the impact of decision support on patient care, differences between hospital and physician group meaningful use definitions, and implications of health care reform.
VisualDx Mobile, that is scheduled for release on January 19th, is the fastest way for physicians to visually validate a patient’s diagnosis. It serves as a decision support tool for physicians, allowing them to either build a differential diagnosis by entering patient findings, signs, and symptoms, or search for a diagnosis by name. It combines physician-reviewed clinical information with more than 18,000 medical images from renowned physician and institutional collections that represent the variation of disease presentation in age, stage, and ethnicity.
There has been a great deal of commentary profiling medical applications that are useful for healthcare providers. However, there hasn't been much talk about how mobile medical applications can enhance the doctor-patient experience and in turn, help optimize your practice’s overall experience. In future posts, we’ll focus more on applications for medical providers, but this post will discuss applications centered around the physician-patient relationship.
We all know how busy clinic can be, and this leads to increased waiting times for patients. Understandably, patients often complain that this is the most frustrating time for them, and none of us likes walking in excessively late on an angry patient because we had to deal with another patient’s medical emergency. So how can this downtime be made more bearable and productive at the same time?
Here is where the iPod Touch comes in. It runs basically the same operating system as the iPhone, and the applications I’ll discuss work for both devices.
During a patient's waiting time in the waiting room or exam room, you could give them an iPod Touch with some of the following applications pre-loaded.
Blausen Human Atlas ($19.99)
We reviewed this application in detail a few months ago, and I still continue to find uses for it. It's designed to help providers communicate medical conditions and procedures to patients in an understandable form. The application has 3D animation videos, a medical glossary, and a vast library of pictures. Every time I use this application with patients, they’re stunned and impressed by its visual interface.
The highlights of this application are the videos. They're aesthetically pleasing and do a fantastic job of explaining medical conditions and procedures in lay terms. I’ve found patients actually enjoy watching them and feel better informed about their medical condition or procedure afterward. Primary care providers could use the videos and images to explain common conditions, such as GERD, osteoarthritis, and diabetes. Specialists and surgeons could use them to explain complex procedures such as cardiac bypass surgery, angiography, and Roux-en-Y gastric surgery. Pediatricians can show parents the mechanism of allergies and how ear infections occur. With the vast amount of information available, almost every provider can find some way to use this application.
The best way to utilize this application would be have the staff show patients the video pertinent to their current complaints before you come in to the exam room. This way your patients gain a better understanding of their condition before you even walk in. Although the videos are no substitute for your own explanations, they could still save time because patients would understand you faster. The vast library of pictures could also be used to show where specific disease pathology is occurring in the body.
Unfortunately, this isn’t a standalone application. A dedicated internet connection is required to view the videos, and the videos can only be used on an iPod Touch when you are connected to a Wi-Fi network.
I’d recommend downloading the “lite” free version of this application before paying for it. You can also buy add-on atlases that contain more detailed information about your specialty.
Merck Manual – Home Edition ($9.99)
The Merck Manual – Professional Edition has been used by physicians for ages, but this condensed and shortened version, the Home Edition, is meant for patients. We have a full review of the Home Edition on our site. The app still contains much of the vital information the Professional Edition has, but it uses laypersons’ language to get information across. It’s basically a medical reference with Wikipedia-like wording, authored by physicians.
While patients are waiting for you, they could get a better idea of their current conditions or read up on comorbidities. The best part of this application is the E-Mail out option. If you’re explaining a condition to a patient, you can easily bring it up in the app, and then e-mail a link to the online Merck Manual page. The link will take the patient directly to the section you were discussing, and patients will be able to read up on their diagnoses at a later time from this legitimate source.
The e-mail-out link requires a WiFi connection.
Lose it (Free)
This is the number one downloaded application in the free healthcare apps category. The application is absolutely fantastic, and I’ve used it on many occasions with patients when counseling on diet and weight loss. The app allows you to count your calories and keep track of your weight.
The highlight of the application is the database of foods it contains. I’m able to ask patients about their diet on a typical day and use the app to show them the total calories incurred (e.g. you can look up the caloric numbers of a Big Mac with detailed nutritional numbers). It allows you to set goals with target weight loss dates, and with motivated patients, I’ve actually sat down and set up specific weight loss programs with them just by using this application.
This is a great application to suggest to patients with iPhones as well.
Games
Yes, games. The majority of the App Store’s top-selling apps are games. The above three apps could be used by patients as a productive way to stay busy, but why not include some fun games during a patient's wait? There are plenty to choose from, and many of them are free as well. These apps could entertain an older population but they're particularly useful when dealing with pediatric patients.
So there you have it. These are just a few of the ways medical and health-related applications from the App Store can help improve your patients' healthcare experience. There are obvious barriers to implementing this plan in practice. You would probably need two or three iPod Touch devices, and they aren’t cheap (about $180). Also, you’d have to train your staff how to use these applications in a quick and efficient manner. Unfortunately, the Blausen Human Atlas App needs a dedicated Internet connection, so if you’re using it with an iPod Touch instead of an iPhone, you’ll need WiFi.
On the flip side, these mobile devices could substitute for LCD screens or other medical reference items often present in patient rooms. They could also end up saving you time. Remember, the iPhone can run all of these applications, as well, and you can use these applications while talking to patients.
At the end of the day though, these applications have the potential to improve your patients' healthcare experience, and give you a reputation as a tech-savvy healthcare provider.
December 22nd, 2009 by David E. Williams of the Health business blog
It’s interesting to be in late 2009 and see e-visits described as a “disruptive innovation” that “the medical establishment is fighting.” I first started working on e-visits almost 10 years ago, consulting to RelayHealth (then Healinx). It’s a sensible concept, fairly straightforward to implement, efficient, and effective for certain situations. Yet growth has been slow. Part of the issue is that it’s health care we’re talking about, where innovation tends to be retarded when it involves changing physician practices. Another, related problem is that there’s no great financial incentive for the physician or patient to make a change. Health plans that do cover e-visits often charge the same co-pay for patients as for in-person visits, even though they often reimburse physicians at a lower rate.
My guess is that over the next decade we’ll see e-visits become common. Why?
Adoption will follow the typical S-shaped curve, and we’ll soon get to the steep climb almost regardless of other changes
More patients and physicians will simply expect to communicate online, as they do in every other area of their personal and professional lives
Payment systems will evolve to support e-visits, rather than penalize them
Adoption of electronic systems in physician offices in general will enable e-visits
Supporting technologies will evolve and emerge. These include remote monitoring, higher bandwidth, personal health records, and mobile applications
Nanoparticles designed to mimic the clotting capability of blood platelets have been shown to quickly reduce bleeding in rodents with severed arteries. The synthetic particles, which stick to the body's own platelets, staunch bleeding more effectively than a clotting drug currently used to stem uncontrolled blood loss. Uncontrolled bleeding is a major cause of trauma-related death. Existing methods of stemming blood loss are largely limited to treating open wounds or for use in the operating room. None have proven effective in staunching internal bleeding prior to arrival in a hospital.
Attempts to mimic platelets themselves have so far been unsuccessful. Scientists have engineered red blood cells and blood-specific proteins to bind to platelets, "but those particles can build up in capillary beds, increasing the potential for [dangerous blood clots]," says Lavik. Lavik and collaborator James Bertram, a graduate student at Yale, have now developed a nanoparticle small enough to flow through capillaries unfettered. It also has a platelet's specific stickiness. The particle is about a third of the size of a normal platelet.
December 22nd, 2009 by 
David E. Williams of the Health business blog 