First, let’s acknowledge that doctors think they want to carry a computer that is very much like the way they carried their paper records.  They want to review data in the hallway before entering the room.  They want to hold the record in their lap.  This is why EHR-on-iPad questions have been asked to every EHR vendor in America for the last three years.  Even the largest EHR companies in the US (I have one in my backyard and know a number of the people who work there) have resisted EHR-on-iPad, but have acquiesced to find ways to put some of the functions on them anyway.

We built the basis for RevolutionEHR from 2005-2007 to be the delivered through the most sophisticated User Interface that is available for internet/cloud-based software solutions.  The basis for our system’s display is called Adobe Flex, which has Adobe Flash Player running underneath it.  All of that design activity happened in the pre-iPad era.  It was also the pre-iPhone era, and iPods still had control wheels on the front of them.  Progress happens fast!

In 2010 when iPads came out, Mr. Jobs at Apple decided that he wanted to run displays that supported all kinds of software bases other than Adobe Flash Player.  Today, if you go to any website that has Flash Player videos embedded in it, you will not see the video.  So if you try to run RevolutionEHR on an iPad, you simply won’t see the application.

Today, the world of tablet systems is evolving, and so are we.  There is a brand new PC from Samsung called the Slate 7 that I’ve been testing.  It’s slightly bigger than an iPad, but it’s a truly functional computer.  It’s decent and holds promise.  On the other hand, we can eventually move our system to a new, also sophisticated UI that isn’t based on Adobe Flash Player.  We are doing this in an updated release of our RevolutionPHR patient portal, which will allow our patients at home or in your waiting room to enter their pre-examination case history through iPads.

Here’s my word of caution, however… tablets are very poor devices into which to put data.  If you have an iPad, you realize how hard it is just to type a Subject line in an email, much less three sentences.  When using EHR, you have to input data in a variety of ways — some buttons, some dropdowns, a few checkboxes, but there is always the need for text.  And in my experience, tablets are simply inferior devices for any text input.  Thus, while we want the mobility of our EHR to move from room to room and perhaps even the feel of a record on our lap instead of on a desktop, these devices are not the panacea.

Watch for more updates from us — I already mentioned the update to RevolutionPHR coming in May that will run on iPad.  We are also going to offer mobile versions of RevolutionEHR that will likely start in view mode, for both tablets and handhelds (read iPads and iPhones).  We also have done work and will continue to do so to evolve the UI that we deliver to you so we are always staying on the cutting edge of sophistication.

Mobility with tablets is the top issue, and we believe you will see that in place for RevolutionEHR users and RevolutionPHR patients in the very near future.

http://www.washingtonpost.com/national/health-science/medicare-moves-to-tie-doctors-pay-to-quality-and-cost-of-care/2012/04/14/gIQAFq3IIT_story.html

This week they posted a summary of the Stage 2 MU proposed rule making that includes a series of recommended changes to the MU program from Stage 1.  Instead of offering my views on the changes, I recommend that you might go read theirs.

Enjoy!

In pockets of the country, health systems have decided to utilize a common type of EHR product for hospitals and clinic facilities that are within a given system.  This means that patients who are seen by any number of specialists or primary care physicians or at any of the facilities within that health system will have access to pieces of their EHR data stream available within a PHR.  Many EHR companies provide their doctor-customers with a co-developed PHR for their patients, while some patients are left to explore the internet for their own PHR products.

With the increased use of EHR technology, we will see an increase in PHR technology.  But, will patients have a compelling reason to use PHRs?  That all depends on how clearly the providers spell out the value propositions to the patients.  If the patient can actually take action in a PHR, like document their pre-examination interview/case history, or schedule and reschedule appointments, or message the clinic staff or doctor securely, PHRs will become mainstream in just a few years.

For more information about PHRs from the Blue Cross/Blue Shield perspective, read here:

http://www.bcbs.com/healthcare-partners/personal-health-records/clinicians-phi-faq.html

To see a press release about PHRs from an alliance of health care organizations, read here:

http://www.acponline.org/pressroom/phr_guides.pdf

<The acting head of the CMS on Tuesday signaled that the agency will extend the timeline on ICD-10 implementation.

After speaking to attendees at the American Medical Association Advocacy Conference in Washington, acting CMS Administrator Marilyn Tavenner told reporters that the CMS will “re-examine the timeframe” through a rulemaking process. She did not say when that rulemaking process will begin but said the CMS would send details about the process in the coming days.

“There’s concern that folks cannot get their work done around meaningful use, their work around ICD-10 implementation and be ready for exchanges,” Tavenner said. “So we’re trying to listen to that and be responsive.”

Separately, Tavenner said she the CMS has had “good results” with accountable care organization applications and expects to make an announcement about selected applicants “at the beginning of the second quarter of this year.”>

Then this was published in the online publication, Health Management Technology:

<

http://ehrdecisions.com/

The topic of customer support of software is interesting from the consumer side.  Most users of software including ubiquitous ones like Microsoft Word have come to learn that support is all about FAQs, help menus, and keywords.  Essentially, it’s self-guided support… I doubt you have called Microsoft lately to learn how to change a font or an indent in a Word document.

When it comes to all-encompassing software products like QuickBooks Online the support process is a blend of self-help and opportunities to contact a Support department.  It could be that the contact phone numbers are easy to find and recommended, or they are almost impossible to find.  Some systems also offer live chat, although consumers often doubt that there is a committed support person on the other end of live chat.

EHR software systems, especially those in optometry, are mostly offshoots of practice management software programs that were available since the 1980s and the users (office managers, opticians, sometimes doctors) have a long-standing history of calling the support line to get assistance.  But as these companies have evolved to providing more complex software that every person in the practice touches, delivering support to all of these users is more complicated.

EHR vendors must abide by the last paragraph of the article — own the customer concern.  Make it clear to the customer that the issue has been heard, even if an answer isn’t available.

If you are a customer, give feedback on the support process.  Most tech-savvy companies offer support via a wide variety of avenues and you should know them and use them well.  Support teams will appreciate it if you ask for urgent support only when it’s needed.  Some may prefer instant messaging over phone calls, or emails might be appropriate if you feel you get responses in a timely fashion.

Ultimately, support of software may be more important than the product itself!

1.  MU year two — the doctors who did MU in 2011 now have to deal with MU every day, all year long.  That means attention to the details and keeping track of progress every month.  Correcting problem areas will need to happen within the first two months of the year so failures don’t go on for a half year.

2.  A house divided — I am a big believer in the value of our professional organizations especially those that provide us advocacy and representation, AOA its state affiliates.  But I’m left to believe that there is a sense (right or wrong) of inaction and poor decision-making that yesterday was defended with overly emotional commentary from an AOA representative.  Tell us the facts, and let’s work together instead of apart.  That goes for both sides.

3.  Profile of RevolutionEHR from Dr. Richard Hom — take a moment to read this profile and feel free to share it with doctors who you might believe are deciding on an EHR purchase in 2012; our company would be happy to add users to our incredibly supportive customer base:

http://grandrounds4ods.wordpress.com/2012/01/31/spotlight-on-revolutinehr-tips4eyedocs-daily-31-jan-2012-no-40/

Anyone who has ever tried to type an email on an iPad must continue to understand that the flatscreen keyboard is not an ideal text entry tool, especially when it occupies half of the screen when it pops up.  Plus, there are many EHR actions that require specific data entry that is blended with some typing, and that doesn’t lend itself well to an iPad (or any other tablet for that matter).

I made this point in a blog post last April, and now we have some proof.  Read this article.

Per the CTO of Seattle Children’s Hospital:  “Every one of the clinicians returned the iPad, saying that it wasn’t going to work for day-to-day clinical work,” says CTO Wes Wright. “The EMR (electronic medical record) apps are unwieldy on the iPad.”

This is not to say that it will never be an option to put an EHR (or a part of the EHR’s data) on an iPad… but doctors need to reduce their expectations that there will be a natural movement to tablets because they want the familiarity of carrying a record into the exam room with them.  It’s just not that easy.

Although written for the doctor who has made an EHR choice and is proceeding with implementation, this is a perfect piece for doctors who are getting ready to make an EHR decision.  Even if you only look at the first sentence each paragraph, you will find a good read and you will have been spurred to REALLY think… enjoy!

First sentence summary:

“You’ve done your homework.

Still, this is a major transition in your life and in your practice.

One thing that can help is talking to people who have lived through this transition.

You will have spent time undergoing a full self-assessment of your practice patterns and preferences so that you can identify and prioritize those functions that are critical for patient care at the time of installation and those that you may choose to implement in the near future.

You will have learned how to build and populate templates for the most common problems that you see clinically, so that these templates can be implemented and test driven before go-live.

Perhaps one of the most important things to consider is how your clinical and billing functions integrate

Lastly, don’t assume that you can do everything on go-live day.”