As a result, many observers in this field have re-examined their approach to EMR implementation. Rather than focus efforts on automating the 10% of structured HCP transactions, a more impactful solution may be to gain a better understanding of the comprehensive provider desktop and paper based workflows. Utilizing readily available, off the shelf, lower cost technology solutions to automate currently unstructured HCP communications and data exchanges has the potential to provide more benefits with less investment. This will attract more providers to the solutions and provide a smoother and faster migration strategy to full EMR adoption.

Advances in browser-based applications, virtual print drivers and dynamic form generators are all currently available technologies which help bridge the gap between structured and unstructured transactions. HCP participation in the automated community will only occur when there are both short and long-term benefits associated with the investment.

These approaches must reduce HCP operating costs, increase revenue cycles, expedite communication and information exchange, and ultimately improve patient care. Therefore, by deploying simple browser based technologies to manage HCP’s paper communication, documents and workflows, suppliers can provide an intermediate step to EMR, that has practical value and be within economic reach of even the smallest practices.

A Realistic Look at the HCP Environment

This new approach will require careful and systematic analysis of HCP workflows, communication and data exchanges. However, this may be the only way to demonstrate potential value and properly incentivize HCP’s to adopt automation on the massive scale necessary for success.

Will some of the more recent, well publicized efforts to create Personal Health Technology Platforms move us any closer to the goal of a critical mass of HCP’s in a community able to electronically exchange patient data based on industry and community standards? It remains to be seen if “consumer generated” web-based health information, storage and management systems will provide the necessary catalyst for massive provider adoption of EMR.

Some interesting players are teaming up in the E-Health space.  Here are a few developments to keep your eye on.

• AT&T, Covisint and The State of Tennessee partnered to create the Tennessee E-Health Network Exchange Zone. AT&T will provide the secure broadband connectivity via a VPN based portal available in all 95 Tennessee counties. The network is being designed to safely and securely enable a variety of applications for patient and physician access. Some of these applications include e-prescribing, imaging, labs, etc. Covisint provides the web-based storage and management system support.

• Microsoft Healthvault & CVS Caremark formed A partnership utilizing Microsoft’s Healthvault, an on-line repository for patient health information which will allow users to view their pharmacy records online and receive alerts for CVS prescription renewals.

• Massachusetts Blue Cross Blue Shield and Google Health partnered to offer MABCBS members the ability to view and incorporate their claims data in Google Health’s centralized on-line location to store medical record information.

• Kaiser Permanente and Microsoft launched a new capability in 2007 for 156,000 KP employees designed to augment an existing KP on-line facility called “My Health Manager” where KP members can already perform interactive communications with authorized providers, get prescription refills and do appointment scheduling. It is anticipated that the affiliation with Microsoft Health-Vault will widen existing capabilities and online features.

I’m sure we will be hearing about many other such relationships in the near future.

Clearly the issue of Health Privacy Standards looms large for players in the PHR space. Recently Google and Microsoft agreed to a set of privacy standards for online health records. At the moment, these players do not have to abide by HIPPA, the federal law that covers patient privacy. The new guidelines require online vendors to provide the same protection already governing medical records on paper. I doubt these voluntary guidelines will be the last word on the topic. The Federal Government, more specifically the U.S. House of Representatives, Committee on Energy and Commerce, Subcommittee on Health, recently drafted legislation and heard testimony from Janet M. Marchibroda, CEO E-Health Initiative, proposing among other items, federal leadership for a comprehensive framework for protecting online privacy and security.

To briefly summarize, until we obtain massive provider adoption, through value added incremental efforts which automate the vast majority of HCP unstructured transactions and communications, we will see very little progress towards health care community connectivity. And, until and unless HCP workflows are thoroughly examined, understood and ultimately automated, there will not be real opportunities to provide HCP’s with value propositions that make economic sense and in turn will promote massive provider adoption.

The achievement of this goal will require both public and private participation and partnership. I’d appreciate hearing your thoughts on where this technology may lead us and what it will take to tap into this great opportunity for enhanced health care connectivity. Drop me a line and let me know at gguselli@infomedics.com.

1 Centers For Medicare and Medicaid Services, 2007
2 Insight Research Corporation 2008-2013 Research Report
3 Business Now Healthcare White Paper
4 NEJM, June, 2008
5 Business Now Healthcare White Paper

Is Marcus Welby, MD, Ready to Move to EMR?

Practicing physicians make good use of technology to ensure their practice runs smoothly and they rely on the very latest technology to provide patients with diagnostic/surgical care in the hospital. So you may wonder why the majority of physicians still revert to old-fashioned pen and paper when they see a patient, document the visit in the patient’s chart, or write a prescription.

Perhaps the heart of the matter is the physician-patient relationship. Physicians desire to have good, productive communications with their patients. Many may fear that technological tools may in fact interfere with their patient interactions. I know many physicians who have begun to use laptops but struggle with the basic decision of where to physically position the laptop during the conversation. Will the screen be a barrier between us? Will the tapping of keys be a distraction?

Another barrier to their adoption of new technology in the practice is their comfort with established procedures. Physicians form practice patterns, prescribing routines, and bedside “habits,” when they find those that work well for them and their patients. Changing those “tried and true” procedures isn’t easy and may require tremendous motivation and assurance that it won’t detract from proven steps in place.

So, what will it take to get more physicians on board?

Proponents of EMR must understand the physicians’ environment, and offer tools which will allow them to adapt to the technology but not become overwhelmed by it – financially and technologically -  and not have it interfere with their primary function of communicating with their patients. If these criteria are not met, physicians can’t be expected to shift established procedures to new ones... Rather, as Gene recommends above, developers could generate genuine physician excitement by offering straight-forward, accessible tools that will quickly and easily demonstrate to the physician how it will help them communicate with and care for their patients.

A peek into medical school classrooms may hearten those who advocate for more physician adoption of advanced technology. Students use laptops and PDAs routinely and will likely be eager to integrate technology into their medical practices. The future Marcus Welby, MD, could very well marry advanced technology to good physician practice and find that it can actually improve patient communications. Until then, physician adoption will depend on providing simpler solutions.