Thoughtful article on mentoring

Here's a link to a thoughtful article on mentoring by Ed Marx, SVP/CIO for Texas Health Resources.  The post appears on HISTalk as part of it's CIO Unplugged series.

Though Mr. Marx talks about mentoring in the context of a larger organization, the principles he lays out can be transferred to a medical practice of any size.  For example, where he talks about presenting at a university, maybe Rotary Club is more appropriate for your situation.

Tricking out your iPad for the tech unsavvy doctor

If you are a techno geek, gadget monster, or computer wise doctor, then this article isn’t for you.  This is for doctors who are using the iPad as a tool, and don’t really invest much time in reading about technology.  In this post my goal is to give you some helpful accessory buying tips so you can make better use of your new iPad.

Before buying any accessories, you may want to use the iPad for a few days or a week to see what your needs truly are.  Accessories are readily available at Best Buy, Apple stores, and office supply stores like Staples, so for most folks it’s easy to pick up the right accessories on a weekend or in the evening.  You can also find lots of options online.  However, since you’ll be handling your accessorized iPad daily, I suggest you touch and feel your options before buying so you can make the selections which feel most comfortable to you. 

Case

You’re going to need a case, sleeve or some sort of protection.  Let’s face it, at some point you are going to drop it,  it will slide off a stack of paper you’re carrying, fall out of a car or have some other jolting experience.  While iPads are fairly tough, they are not invincible.

Case with a swiveling hand loop

It can be awkward holding an iPad by the edges, balancing it on your palm or cradling it in your arm.  Consider trying a case that has a loop on the back into which you can slip your hand and also can swivel 360 degrees.  For standing and walking around, this can very handy.  There are lots of options in the market.  For some ideas, search online with these words: iPad case with hand swivel.

Traveling case

If you plan on throwing your iPad in your bag or briefcase (does anyone even carry a briefcase anymore?) you’ll want something to protect it from pens, paperclips and that overripe banana.  If you plan on flashing your techno bling at conferences, a nice leather portfolio with paper pad insert may do the trick.

Stylus

Some people find a stylus handy when poking at small application buttons on the iPad.  I personally don’t use one, but I know people who swear by them.  I suppose a lot of it depends on your application and how your software is presented.  If you constantly lose pens you’ll probably have the same issue with a stylus, so don’t invest too much into one unless you plan on treating it with the same care as your Montegrappa.  Some stylus’ double as pens as well.    Montegrappa does not make one of these, yet.

For stylus ideas, Google these words: iPad stylus.  Don’t get caught up in the graphic artists’ discussions, you’re just looking for a pointer, not a brush.

Screen cover for protection

Some people just seem to scratch and dent things.  If that’s you, then buy some screen protectors.  I don’t use them on my iPad, but I’ve used them on my old Palm Pilot (ok, I’m dating myself here)and they worked well.  On the iPad my only concern is how easily you can retain that nice fluid swipe feeling.  If you’re using a stylus that may not be as much of an issue. 

Keyboard

This is a surprisingly contentious issue.  I personally use the Apple Bluetooth keyboard when I’m working on a writing project on my iPad.  Otherwise, I use the onscreen keyboard for calendaring and short form items.  Some people I know vehemently protest the need for an external keyboard saying it’s all about pointing and swiping.  Well, it’s hard to point and swipe a 10 page RFP.  So, if you find yourself frustrated with the onscreen keyboard, buy one. 

An important point here is to consider where you’ll be using the keyboard.  I typically use my keyboard when I’m writing at home and don’t want to be in my office.  I leave the keyboard in the kitchen which is typically where I’ll work.  If you think you may need it to be more mobile, consider a case with an integrated keyboard.  It may not be as sturdy or robust as a separate, but will be more convenient for travel. 

If you have the chance, test out the keyboard before buying.  If you don’t like the feel of the keyboard or the size and placement of the keys you’ll be less likely to use it.

Have fun

iPads are actually pretty fun, even if they are used for work.  Hopefully I’ve given you some things to ponder as you trick out a new iPad.  Fortunately, most accessories are not very expensive, so if you don’t like something you’ve bought, you can probably pawn it off on someone and buy something else.

As always, if you have any questions, feel free to reach out to me via phone or email.

Straight ahead,

Bob

CMS National Provider Call on MU Stage 2

Today I sat in on the CMS National Provider Call titled “Proposed Rule for Stage 2 Meaningful Use Requirements.”   In spite of the name it was an interesting call.  Below are a few of the things I took away from the call and links to the CMS presentation and future audio file location.  For good measure, at the end are some links to related articles.  Enjoy.

My take aways:

• CMS is asking for comments on the definition of hospital based eligible professional (EP).   They asked for comments on situations where an Eligible Professional (EP) who is classified as hospital-based might still be providing their own Certified EHR Technology.  Currently, in this situation the EP would not qualify for incentive payments.   (slide 8)

• They are looking to make the Stage 2 Proposed Rule the Stage 2 Final Rule in Summer 2012, with a proposed start date for Stage 2 of 1/1/14 for EPs. (slide 15)

• Whenever an EP starts with Stage 1, they will have 2 years on Stage 1, 2 years on Stage 2, then Stage 3.  Each EP's timeline is based on the year they start the program. (slide 16)

• Starting in 2014, exclusions won’t be counted towards meeting one of the menu objectives. (slide 18)

• Two revised objectives depend on patient participation.  The first is an objective that  more than 10% of an EP's patients actually access online health information.  The second is that more than 10% of an EP’s patients send secure messages to their EP.  It should be an interesting debate on this, not sure if these will remain intact. If they do, looks like a good opportunity for CRM experts to get involved.  (slides 20-21)

Link to presentation

Link to audio and transcript when available

Other analysis/commentaries on Stage 2:

hint: Google the following to find more sources:  cms stage 2 meaningful use

AMA article    source: histalkpractice.com
Nice Stage 1 and Stage 2 comparison  source: histalkpractice.com 
A policy-focused look at Stage 2

Connecting devices to your EMR-Part 3

In the prior two posts in this series, we looked at the parts involved with connecting a device to your EMR, and how the data is presented in your EMR.  This post will examine things to consider when you're in the market place looking at devices.  Since I’m not a clinician, I’ll leave it to the dear reader to ponder specific medical and diagnostic issues.  In this article I’m focusing on the more technical aspects of devices. 

Let me assure you that if you get confused while shopping, you’re not alone.  There seems to be lots of chatter and unsettled matters when it comes to making EMRs and devices play nice in the same sandbox.

Start by defining what it is you are looking to accomplish by connecting a device to your EMR.  Do you want to save time, improve accuracy, save money, improve processes, all of the above? Put another way, what problem are you trying to solve?  If you can’t define a real problem, then you probably shouldn’t go any further. 

Next, determine the format the data should take.  Does it need to be discrete so you can sort and report?  Or can it be non-discrete, as long as it’s placed in the EMR?  Would it be acceptable if the device manufacture’s software held the data on a computer instead of in the EMR?  This issue is important because you may be presented with choices as you shop, and those choices may have very different price tags.  Typically, it is more complex and therefore more costly to get discrete data into the EMR from a device. 

Finally, determine how and where you would connect a new device to your computer.  For example, do you have a computer, Mac, laptop, iPad, iPhone or something else available to make the connection?  Does your computer have enough USB ports, or maybe Bluetooth if required?  Are you planning to move the device to different rooms?  Make sure you know the operating system spec (typically some flavor of Windows, with a service pack version) and the computer hardware spec for each computer you plan to connect with.  Don’t forget about memory (RAM) and hard drive space.

Once you know the problem(s) you’re trying to solve, the format you’d like the data to take, and how you’ll make the physical connections, now you can start looking at your options.  Start with your EMR vender and ask them the following questions.  I previously mentioned some of these in the first post in this series.

 

• Ask for a list of the devices for which your EMR version and build will interface.
• Ask for a list of the data fields which interface, and which are discrete, and which are non-discrete.
• Ask if these devices will continue to be supported in te next version of the EMR.
• Does the EMR vender or a third-party vender provide the interface between the device and the EMR? 
• Is there an upfront cost for the interface?  Is there an annual cost?
• Who supports the interface, the EMR vender or a third party vender?

In most cases, EMR venders will just have a list of device manufactures with which they interface and the cost (if any) of the interface. You may have to dig to find out about a specific device, specific data fields, and discrete vs. non-discrete data fields.  Regarding forward-looking compatibility, in some instances they may not be able tell you because the vender simply may not know what will happen in future builds. 

Some practices are upset if they are told they need to pay separately for an interface, especially if there is an annual fee for it.  You can try to negotiate, but interfaces are a true cost for EMR venders due to the coordination they need with the device manufacturers.  And things do change, they need to periodically do some programming and troubleshoot break/fix issues.  My personal opinion is that I’m fine paying a reasonable annual maintenance fee for an interface. 

Once you know which device manufactures and their devices are supported, you can shop for devices. 

When shopping for devices, here are some questions and considerations.

•  Is this model going to be around and supported for a while?
• Confirm with the device manufacture that the model you are looking at is in fact able to interface with your EMR. 
• How does the device connect to my computer?
• Is this device compatible with the hardware in my office?
• Does the operating system software on my computer (typically Windows) support this device?
• Can I move the device between computers?  Or does its license restrict that?
• Is there a special connection, such as a dongle, which I need to purchase?
• Does the manufacturer have it’s own software which can store data?  Is that software included in the purchase price of the device?

Once you decide on a device, you’ll likely may need to coordinate things with your EMR vender in order to activate the interface.  This may be a simple process, or a test of patience.  Which ever it is, be sure to document who you have spoken with, any ticket or job numbers they give you, and the timeframe they have committed to.  If you ever need to revisit issues with the interface, this will be handy information.

So, here’s a quick recap of today’s post:

1. Define the problem which an interfaced device will fix
2. Define your existing computer hardware and operating systems
3. Define the devices your EMR supports
4. Shop for your device
5. After the device purchase, document the interface activation process.

As always, if you have any questions or corrections on my posts, please feel free to reach out to me at (515) 249-9011 or email me.

Straight ahead,
Bob 

Connecting devices to your EMR-Part 2

In the first post of this series, we looked at the three components involved with interfacing a device to your EMR: the device; the interface; and the EMR software.  In this post, we’ll discuss the data received by the EMR.

When your EMR receives data from your device (EKG, blood pressure cuff and so on), it will usually take one of two forms, discrete or non-discrete.  So what does that mean? 

Discrete data

Within the context of your EMR, discrete data is data that will be placed alongside your manually entered data just as if you had manually entered it.  Take, for example, data from a blood pressure cuff.  If you manually enter a blood pressure (BP), you enter the systolic reading, diastolic reading, and time of day.  In the future if the need arises you can generate a report on the patient’s historical BP using these figures, and generate a nice graph if the EMR has the capability.  Likewise, if the data you receive into your EMR from your device is discrete, you can also view, sort and report on it just as you would manually entered data.

Non-discrete data

Non-discrete data, by contrast, is data which is not sortable or reportable.  In the EMR, the format into which it is placed is static.  Conceptually, think of the non-discrete data as a PDF document.  You can view it, but you can’t pull anything out of it.  Continuing with the BP example, if the data from the device is non-discrete you couldn’t search, sort or report on the systolic or diastolic data points. 

So what?

Given the choice between discrete and non-discrete data, discrete data is preferable.  Why do we care if data is discrete or non-discrete?  For starters, the ability to search, sort and report data such as BP is a great tool when tracking an individual patient’s health over time.  Second, public and private payer reporting requirements may require you to pull and report data out of your EMR, and the more discrete data you have the easier it is to report.  Third, quality initiatives will ask for reporting of various data sets, and the ability to have your EMR pull out that data instead of you having to manually type it is important.  Finally, are you now or planning to receive CMS EMR Incentive money?  If so, at some point you’ll need to sort and report data out of your EMR.

This need for discrete data is one of the primary reasons why not all devices fully interface with all EMRs.  So why don’t device manufacturers and EMR companies always interface their products?  Creating and maintaining interfaces can be expensive and time consuming in today’s market.  Venders are dealing with rapid evolution in EMR software, devices, and regulatory standards.  Plus they are dealing with a market which has exploded with implementations. 

Let me make a final point on this in defense of the device manufactures and software companies.  Manufactures know that their products must have high reliability.  Going back to our blood pressure example, the systolic data point exported by the device must be in a form and format readable by an interface.  That interface must know where to place that data point within the EMR.  That means making sure it gets into the correct patient record and the correct systolic field.  And it must happen correctly every time, without fail.  If the device software changes, it must still perform flawlessly.  If the EMR is upgraded, it must still perform flawlessly. 

Next time

So we’ve looked at the components to interfacing a device to an EMR, and the data received into the EMR.  In the next post in this series we’ll look at navigating the marketplace when purchasing a device.