Re: Walmart Health: Just had a great dental visit this morning, which was preceded by helpful reminders from Epic, and…
Intelligent Healthcare Information Integration 11/30/10
Time for the Cheese, Please
“Thought provoking EMR comment. Don’t be sparing us the details of the cool features you’ve seen and which companies are providing the cool features you’ve found … show me the good stuff!”
That’s a compilation of a couple of quotes from John over at EMR and HIPAA after a recent post here where I mentioned I was starting to find some pretty cool pieces and parts amidst the waterfall of EMR/EHR demos I’ve been drenching myself within of late. I promised I would “stop the tease and show the cheese.” (John requested sharp, but it may be more along a Muenster.)
Four upfront caveats:
- I am in no way receiving any remuneration from any of the vendors I will be mentioning.
- I have really enjoyed many, if not most, of the people who have taken their time to show me their solutions. Part of me wishes I didn’t have to end up choosing but one answer / company for our office’s needs.
- While I am certainly keeping self-interest at the fore, I try to consider the needs of my heretofore undigitized colleagues and what my understanding of their needs might include.
- There’s only one of me and I have a day job (well, often a day and night job,) so I wouldn’t even begin to imply I’ve seen all there is to see – but I’m trying!
OK, here we go, and in no particular order of coolness…
Ultimate Usability
Unfortunately, there’s not a system in existence today that has this feature – yet — but the hands-down winner in my book goes to Medicomp’s CliniTalk and its yet-to-be-named Type / Write / Click cousin. Using their medical knowledge engine of “260,000 coded clinical concepts mapped to CPT®, DSM, ICD, LOINC®, RxNorm, SnomedCT®, and other billing codes and clinical reference terminologies,” this middleware allows truly smart data capture, integration, manipulation, and utilization. It’s coming very soon to some pretty good systems which it will help to make great.
I’m so enamored with this functionality that I’m doubtful I’ll be able to choose a new system that doesn’t have it incorporated – or at least one with plans to do so. Seriously, it does for clinical data what I’d always thought a computer should: it adds an intelligence and an level of association-making that a busy clinician really needs while helping to minimize the “Wow, I went to med school to become a data entry clerk for insurance companies” feeling. Unconfirmed, but I hear Sage Intergy will be one of the first to engage this hyper-enhancement.
Eye-Friendliness
This is one of my personal “gotta be there” criteria. It was a huge factor in my love at first site with Bond Clinician, the now life-support-plug-pulled Peak Practice. If my “blink” upon first view of an EMR isn’t one of “OK, that’s kind of pretty,” then I know the demo from there on out will likely only yield ideas for features or functions I might want to see in the other system I do eventually choose.
Prettiest faces in this category are all iPad-ian: Quest’s Care360 and ClearPractice’s Nimble. Right up there, too, is Dr. Chrono, but I admit to enjoying the warm feel of faux leather, even if only digital, which Care360 and Nimble use. This familiar view might even assuage some of the anxiety of docs who are still pen-and-paper bound. (I especially like the slightly askew desktop look-and-feel of Care360, perhaps because my desk is usually pretty askew, too.)
Desktop systems could learn a thing or three from these iPad implementations. I mean, really, isn’t there a whole science about HCI (Human-Computer Interaction) and how to make visual content appealing, productive, and efficient? My take: Many EMR vendors could use a few less chief marketing officers and a few more humanistic computer interface designers.
That said, I have seen a couple of desktop systems worth noting. SOAPware’s EMR has come miles from when I first remember its rather basic layout. athenahealth’s athenaClinicals also has evolved nicely since I joined Inga and John Smalling in a group demo about a year ago in an ill-fated jaunt into product demo reviews. (I liked it then; its look and feel is even better now.)
As this is a long, ongoing, often sleep-inducing process, I guess it’ll have to be a “to be continued.” But, before I go, here’s a few I’ll be discussing next time:
- We “get” the “App Me, Baby” idea: SRSsoft’s Hybrid EMR and Medicity’s iNexx.
- EHR vendor team who seems to have the most creative fun: Nuesoft.
- Most exciting new non-EMR EMR: Mitochon Systems mEMR.
- Best digital office preparation tool: Welch Allyn’s EHR Prep-Select.
- The value of views: DIS.
- Using exo-EMR stuff, mostly iPad apps, as really useful patient education and engagement tools: Blausen Medical’s Human Atlas, Pampers’ Hello Baby – Pregnancy Calendar, CHADIS, and Text4baby. (Pseudo exception to caveat #1 above: I also like start-up Health Nuts Media for whom I am the unpaid CMO). Heavy prejudice toward pediatrics, I know, but remember the source here.
- Vendor web sites: what attracts and what repels.
- “The Good, The Bad, and The Ugly” of demos and vendor/client connections.
So, while not meaning to continue the tease as I’m really trying to dole out the requested cheese, I’ll close here with the promise to grate some more fresh Parmesan soon.
From the trenches…
“The early bird may get the worm, but it’s the second mouse that gets the cheese.” – Jeremy Paxman
Dr. Gregg Alexander, a grunt in the trenches pediatrician, directs the “Pediatric Office of the Future” exhibit for the American Academy of Pediatrics and is a member of the Professional Advisory Council for ModernMedicine.com. More of his blather…er, writings…can be found at his blog, practice web site or directly from doc@madisonpediatric.com.
Greg,
Thanks for keeping us in the loop on your quest- it’s amazingly valuable to have an experienced EMR user reviewing some of the offerings! I do worry about something though… that the EMR vendors appear to be trying harder and harder “make the EMR look like the paper chart”. While I understand that is what doctors say they want because they are used to it… I worry that they are setting themselves up for failure. In other words, computers (even the iPad) will never be as good as plain old paper for certain things… but that is OK because they can be much better at other things.
However, if EMR vendors keep focusing on “making it look and act like a paper chart” rather than rethink how to use IT in healthcare… they will never reach their potential. An obvious example is the gaming industry- the best 3D action games of today look nothing like the board games of a few decades ago. They are easy to learn, very usable, and fun… if only our EMRs had those qualities!
Given that we keep hearing that total cost of ownership is the number one barrier to adoption and given that PracticeFusion has a browser-based application that is completely free (including lab interfaces and e-prescribe functionality), did you look at their offering? I realize there are 400+ EHR’s out there but I think that PracticeFusion’s business model is unique enough to put it in a class all by itself when comparing features, functionality and cost. I am not a paid consultant of PracticeFusion…just a veteran practice administrator that is attempting to help small practices in northeast Florida navigate the waters of reform.
DrLyle – I could not agree with you more, but maybe with a little different take.
Looking like something familiar doesn’t mean it has to act like something familiar. Using your great analogy, early comupter games looked anything but real; nowadays their realism is almost scary! And, as they look more real, adoption grows.
But, because they look like reality, doesn’t mean they’re limited to the rules of reality. (Think “The Matrix.”) You can do so much more within virtual reality than in real life despite the familiar look and feel.
EMRs, in my opinion, could advance adoption by looking more familiar (thus, less scary from a resisitance-to-change perpsective) while still having a ton of computer-enabled smartness/features/functionality behind the realism which “real” pen and paper can never have.
Doug – I have been looking into Practice Fusion and probably should have mentioned them, too. (My dive there hasn’t been deep enough, yet.) I mentioned Mitochon Systems which has a similar “let folks who derive profit value from this data, such as Pharma, inscos, diaper makers, etc. pay for this” model, but which has some differences I find very intriguing.
I looked at the CLiniTalk demo on your recommendation–looked reasonable until the end when the guy starts dictating the “HPI” into the HPI section and starts rattling off family history items, which the system dutifully transcribed into the HPI with a blank “Family History” section sitting down below. You’d think a “text to data” system would know which category to put stuff in. Then again you’d think a doc doing a demo for his system would know that the family history doesn’t belong in the HPI in the first place.
Thought I should share the response I received from CliniTalk after forwarding Robert Lafsky’s comment (which he had emailed me earlier):
“…we specifically did the demo to show that you can put anything you want into HPI, at the request of several docs who complained when they could NOT put a family history in their “comprehensive” HPI. Current version actually puts items in the sections below the HPI, also, so if I say mother’s history of breast cancer, it stays where the doc said it, but also puts the coded item into family history.”
They confirm the online video is old news; nose to the wheel developing and haven’t spent much time on the promo/web stuff recently.
Gregg,
Thanks for the mention of our Blausen Human Atlas iPad app in your 11/30 piece. We believe the whole subject of point of care patient education is a critical (and sometimes overlooked) complementary area of opportunity within the burgeoning EMR space. Would think that as it develops further past the current emphasis on “charts/tests” content, the “exo-EMR stuff” will begin to be integrated within it more and more. That’s why we’re expanding our Blausen Human Atlas rich media content across the spectrum of smart phones and tablet devices… http:www.blausen.com/ipad , so clinicians can quickly and effectively educate their patients about their conditions and treatments. EMR is (obviously) an amazingly dynamic space and it’s only going to get more so.
Cheese is so delicious. We can take it as it comes. No need to rush!
Nuesoft does seem to have some creative fun. I’d put Practice Fusion in the creative fun category as well. Both worth looking at.
I think you should also look at a unique approach to EMR, pay per visit: http://www.medtuity.com/