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A Physician's Perspective: Meaningful Use of Health Technology


March 30, 2013  8:33 PM

Windows 8 in enterprise healthcare



Posted by: DrJosephKim
cpoe, dell, EHR, HP, iPad, lenovo, tablet pc, windows 8

Over the past several weeks, I had had the opportunity to test several tablets running Windows 8 Pro. Don’t get these mixed up with the consumer tablets running Windows RT. Windows 8 Pro is an enterprise operating system that actually blends two operating systems into a single device. Imagine picking up an iPad where with a swipe of a finger, you get a fully functional Windows 7 desktop experience. Well, that’s what Windows 8 is like. You get the ability to switch from a mobile OS running mobile apps to a traditional Windows desktop that can run legacy enterprise applications.

The devices I’ve been testing include the HP ElitePad 900, the Lenovo ThinkPad Tablet 2, and the Dell Latitude 10. I think most of us would agree that HP, Lenovo, and Dell are some of the leading manufacturers of PCs for the enterprise healthcare setting. These tablets are powered by an Intel Atom dual-core processor, so they are not as fast as Intel Core i3, i5, or i7 processors, but you get full-day battery life on these thin, light tablets.

If you haven’t tried Windows 8 yet, you should spend some time exploring this new OS. You’ll need to set apart some time since Windows 8 is actually quite different in many ways from Windows 7. Although you get the familiar Windows Desktop, you’re left to navigate the computer without a traditional Start button on the lower left corner of the screen. Plus, you get a lot of navigational functionality by swiping up, down, left, right, or right-left-right on the left edge of the screen.

Clinicians working in enterprise healthcare settings rely on standard PCs to run enterprise electronic health records (EHRs) and computerized physician order entry (CPOE) systems. We’re talking Epic, Cerner, McKesson, Greenway, AthenaHealth, NextGen, RelayHealth, and many others. Most of these systems do not provide full functionality on traditional mobile tablets like an Apple iPad. So, this leaves many clinicians frustrated and looking for workarounds so that they can still use a light, small tablet when they’re working around the hospital.

Well, Windows 8 is here to solve many of those challenging IT headaches. You can now run fully functional enterprise applications on a really small, light, thin tablet that has all-day battery life. Plus, you get the added benefit of being able to run touch-friendly mobile apps in a familiar mobile environment.

I admit that it took me a while to get fully comfortable with Windows 8. It takes some time to learn the ins/outs of the new OS. Plus, you have to establish your own working routine on such a device. You can rotate the device in landscape/portrait mode. You can also configure the on-screen touch keyboard so that you can type with your thumbs by splitting the keyboard. You’ll already be familiar with these features if you know how to use an iPad or Android tablet.

I’ve become a big fan of Windows 8. It’s not a perfect OS and I’m sure the next version (Windows Blue) will be better, but this is definitely a step in the right direction for Microsoft as they try to merge the computing the requirements of a legacy Windows operating system with a newer, more modern touch-friendly mobile OS.

March 11, 2013  8:04 PM

Global health, HIE, and interoperability at #HIMSS13



Posted by: DrJosephKim
clinton, EHR, global, hie, Interoperability, Interoperability and health information exchange, Meaningful use

#HIMSS13 was quite an event this year! On Wednesday, March 6, President Clinton spoke about the need to use health IT effectively to improve population health management. More aging patients are entering the health system every day and physicians and hospitals need to expand their capacity to manage all these patients who often have multiple chronic conditions. He also spoke about how health IT will allow clinicians to effective treat the growing population of baby boomers. HIMSS also announced the New Clinton Global Initiative Commitment to Action – an extension of the Clinton Global Initiative (CGI) that HIMSS joined in September 2012 to advance its work on its Healthcare Transformation Project. The Healthcare Transformation brings senior healthcare provider leaders together, with year-round events, research and networking, as they decide and act upon their own commitments to action. Established in 2005 by former President Bill Clinton, the Clinton Global Initiative (CGI) convenes global leaders to create and implement innovative solutions to the world’s most pressing challenges.

We know that clinical decision support (CDS) and the use of collaborative workflows can help members of the care team manage their patients more effectively. This year at HIMSS, we heard how some hospitals and health systems are integrating some of these health IT resources to improve patient outcomes. These things will become more important as physicians and hospitals pursue Meaningful Use Stage 2. One of the major components of Stage 2 is the collection of data on clinical quality measures (CQMs). Physicians and hospitals are identifying ways to use health IT to improve patient safety, reduce medical errors, improve care coordination, and engage the patient in their own health care. Stage 2 MU also outlines the goals around the use of health information exchanges (HIEs). While there are several states that have successfully launched and sustained HIEs, others are struggling to identify a business model that will allow an HIE to be sustainable.

Interoperability has always been a major buzzword at HIMSS. This year, a major announcement was the launch of the CommonWell Health Alliance , a collaborative effort pioneered by several electronic health record (EHR) companies including: Cerner, McKesson, RelayHealth, athenahealth, Allscripts and Greenway. The CommonWell Health Alliance is a not-for-profit organization that will support universal access to health data through seamless interoperability. They will promote and certify a national infrastructure with common standards and policies. Over the next several months, we may see other EHR companies joining the Alliance, so stay tuned for those updates.

Speaking of interoperability, another big challenge in health IT revolves around the security of patient information. Protecting patient health data is becoming more crucial as hospitals and health systems rely on IT resources to manage patient records. Information security continues to remain a high priority among the HIMSS community. Microsoft Office 365 is a major cloud business productivity solution that addresses the rigorous HIPAA regulations and offers a HIPAA Business Associate Agreement (BAA) to customers, allowing healthcare organizations to reap the benefits of the cloud without the security risk.


February 28, 2013  1:43 PM

Topics to explore at HIMSS13



Posted by: DrJosephKim
himss

Are you ready for HIMSS? It’s such a massive conference that it’s easy to get lost if you don’t create a clear agenda. There are so many sessions and meetings. Plus, I find the exhibit hall a powerful place to learn and explore what’s happening in the evolving world of health IT. Make sure to spend plenty of time in the exhibit hall.

This year at HIMSS, I’ll be exploring the following topics:

  • Interoperability
  • Mobile Health
  • Care Collaboration Strategy
  • Accountable Care
  • Enterprise Content Management
  • Consumer Engagement
  • BYOD
  • Cloud Computing
  • Public Health Disparities
  • Quality Improvement
  • HIE
  • EHR, PHR, and CPOE
  • Telemedicine/Telehealth
  • Computing Security
  • HIPAA
  • Patient Privacy
  • Social Media
  • Medical Education

Wow, that’s quite a list, isn’t it? It’s certainly not an exhaustive list, but these are the topics that resonate the most with me based on my clinical background and my experience in health IT, mHealth, telemedicine, social media, and medical education.

I look forward to seeing you at HIMSS and I hope we can connect at the SearchHealthIT and Health IT Exchange #TweetnMeet on Monday, March 4 from 5:00 – 7:00 p.m. CST.

Follow my updates from HIMSS on Twitter @DrJosephKim


February 18, 2013  1:15 PM

Tablets and Windows 8 in Healthcare



Posted by: DrJosephKim
cpoe, EHR, iPad, mobile, tablet pc, windows 8

More and more doctors are starting to use tablet computers in the health care environment. The old era of Windows XP Tablet PCs are gone. Windows Vista and 7 didn’t generate enough momentum in the slate tablet market. It wasn’t until the Apple iPad that health care professionals started to seriously re-consider the use of these digital devices in the clinical setting. So, where are we today?

The first iPad was introduced in 2010. We’re now up to the 4th generation iPad (with various rumors circulating about the 5th gen iPad). We also have the iPad mini which was launched in 2012.

Hospitals and health systems are running enterprise-level electronic health records (EHRs) and computerized physician order entry (CPOE) systems on Windows-based PCs. Yes, many hospitals are still running Windows XP. It’s hard to believe that they’ve survived this long on antiquated systems, but then again, they’re not running applications that require a huge amount of horsepower. At most, EHRs are data entry and data storage systems. You may have some clinical decision support built into the system, so you’ll see alerts and warnings pop up.

We’re living in an era of cloud-based computing, so the cloud provides us with limitless possibilities as long as you have a device that can leverage that cloud infrastructure effectively. The computing power of your native PC is becoming less relevant. However, the security features of mobile devices is becoming more important because of the high incidence of device theft or loss. Every month, we seem to see a story about a lost or stolen, unencrypted laptop that jeopardizes thousands of patient records. This is simply not acceptable.

So, where does that leave us in 2013? I believe we’ll see the newer Windows 8 tablets gaining significant momentum in the health care setting. These devices are thin, light, and they run full Windows 8. That means that they will run full EHR and CPOE applications. Physicians won’t be limited to “read-only” patient data. They will also be able to leverage the power of cloud-computing for voice recognition, data processing, and much more.

Personally, I find Windows 8 to be very exciting. I realize that it’s not a perfect operating system and that it can be challenging to blend traditional mouse and keyboard computing with touch-based computing. The landscape of mobile computing is evolving rapidly. I believe that the active digitizer stylus pen is coming back. I believe that people will become more comfortable with touch and voice-input. I believe that we’ll rely more on mobile devices and less on traditional desktop PCs.

This year, I’ll be attending the HIMSS conference and I’ll be exploring the rapidly evolving world of mobile computing, so stay tuned by following my updates on Twitter @DrJosephKim


January 23, 2013  4:42 PM

Will the revised HIPAA rule actually hurt patients? Here’s how it may.



Posted by: DrJosephKim
HIPAA, Privacy and security

So we recently heard that HHS revised HIPAA (which originated in 1996). Some of us can’t even remember what kind of computer or mobile technology existed in 1996. I remember using my grayscale MacBook along with my analog Motorola StarTac cell phone (we used to call them “cell phones” back then). Of course, I also had my trusty Apple Newton Messagepad (which was killed by Steve Jobs when he returned to Apple). Alas, I digress quickly when you get me started on gadgets.

So, the new HIPAA Privacy and Security Rules have been called “sweeping changes” and I agree. We’re seeing changes to reflect technology, clinical workflow, consumer behavior, and patient expectations in 2013. However, I remain concerned that some of these changes may backfire and ultimately hurt the patient. Here’s what I mean:

HHS has indicated (in a news release) that “When individuals pay by cash they can instruct their provider not to share information about their treatment with their health plan.” This sounds good, doesn’t it? Well, it may if you’re a patient and you don’t want to see your insurance premiums go up. However, doctors (and certainly health plans) probably don’t like how this sounds because it could lead to patient harm. Let me give you an example.

Let’s say that a fictitious patient named Jane Doe (not the unconscious unidentified patient in the Emergency Room, but a different Jane Doe) tries to “hide” her diagnosis of HIV by paying cash anytime she gets treated for her HIV. In trying to “hide” this fact from health plans, she may also “hide” this fact from her primary care doctor and her endocrinologist who is managing her diabetes. After all, she doesn’t want any of her main doctors to document that she has HIV. She’s receiving HIV care from a city clinic and she’s paying cash. They’re not sending her medical records to the health plans, and she specifically instructs the city clinic not to send her records to any of her other doctors.

This is a potential example that can occur in the real world and that could ultimately harm our patient Jane Doe because both her primary care provider and her endocrinologist may end up mismanaging her health since they don’t know that she has HIV. In fact, they may prescribe treatments for her that end up being harmful to her because they don’t have a complete picture of their patient.

In reality, most patients will disclose everything about their health to their doctors because they want an accurate diagnosis and treatment plan. However, there are some patients who will hide information because they don’t want to be judged. Others may lie to their doctors because they don’t want their doctor to be angry at them. After all, they want their doctors to think that they’re doing what they’re supposed to. Patients don’t want to be viewed as “non-compliant” or lousy patients.

So, although the revised HIPAA Privacy and Security Rules offer significant benefits for patients and the entire health care community, giving patients too much control over their health information can be disastrous to their own health.

I admit that I have not read the entire 563-page document, so maybe I’m missing something here. Maybe there’s a special provision that excludes certain conditions or diagnoses (I doubt it). Maybe there’s a line in there that mentions that patients needs to sign a waiver indicating that by withholding valuable health information from their providers and payors, they may put their own health at risk (I doubt that too). Maybe the principles of utilitarian ethics in healthcare justify these types of patient decisions to withhold information. I’m just not entirely sure.

At any rate, I respect that patients need privacy, even from their own doctors and health plans. However, providers and payors are trying to do what they can to help and treat patients. Shouldn’t they have access to all relevant information? I realize that providers and payors can’t always be lumped into the same category, but that’s what some integrated delivery systems have done and they seem to be providing efficient, high-quality care.


January 18, 2013  4:06 PM

Growing momentum in self-monitoring gadgets means more health data to analyze



Posted by: DrJosephKim
fitness, medical device, mhealth, quantified self

We seem to be hearing the term “big data” in healthcare a lot these days. After all, the use of EHR systems across the country have led to huge amounts of health data that needs to get analyzed so that clinicians can deliver more effective care. The focus will shift from collecting data to analyzing and using that data effectively.

So, while that’s happening across hospitals and major health systems, patients are going out and shopping for self-monitoring gadgets. This year at CES, we saw several new “quantified self” (QS) gadgets from major manufacturers like Fitbit, Basis, and several others. Nike is out there with their Nike+ Fuelband. You’ll see billboards featuring this device across the country. Jawbone is taking a second round at their Up self-tracking wristband. Misfit Wearables will be coming out with a waterproof metal tracking device called the Shine.

Plus, these devices aren’t simply glorified pedometers anymore. Some are incorporating biometric sensors that will measure heart rate, skin temperature, metabolic rate, blood pressure, and much more. Soon, we may see these devices incorporated into continuous glucose monitoring sensors for patients with diabetes. Or, we may track all-day blood pressure in patients who have high blood pressure (hypertension). Where will it end? More importantly, who’s going to have time to look at all this data and decipher what is clinically significant vs. background “noise” that has no significance?

We don’t have a clear answer because there is no sustainable reimbursement model supporting the QS movement right now. Early adopters who are using self-monitoring gadgets to stay more motivated to lose weight and exercise more and experiencing clinically beneficial weight loss, increasing cardiovascular capacity, and better overall fitness. However, doctors would love to jump on the QS movement and play a role if someone would be willing to reimburse them for their time.

At the end of the day, we’ll need to see IT systems that can crunch and decipher all the QS data to filter what’s clinically meaningful so that doctors and other health care professionals can provide useful advice to patients. That’s the next phase for QS. Right now, there are computer systems that can scan breast mammograms or cardiac EKGs to detect abnormal patterns. Once the system flags the abnormality, it must get confirmed by a human (usually a doctor) before the results get sent to a patient. In the same way, someone will build such an ecosystem for some of these QS devices. Of course, this means that the device will now get classified as a medical device that must get FDA clearance, so I’m sure that the majority of QS devices won’t pursue that route. On the other hand, some will explore that option, particularly if the device is specific to a chronic disease like diabetes or hypertension. That’s what I’m waiting to see. I predict that by 2015, we’ll see some of these QS medical devices in mainstream use.


December 31, 2012  8:03 PM

Future of health IT: Predictions for 2013



Posted by: DrJosephKim
EHR, hie, mhealth, social media, Telehealth, telemedicine

Here are a few health IT thoughts for 2013 as we enter the new year:

1. HIEs: We will continue to see new and evolving models support the idea behind a true health information exchange (HIE). Some models will fail. Other models will only work in a certain part of the country because of the market dynamics, politics, and the availability of hospitals and providers. Some models will be applicable across the country in various market segments. Others will get funded by a government organization. We will see many different models for HIEs that will be viable in this country, but there will still be a handful of states that won’t have HIEs by the end of 2013. Some states will have several HIEs. At least we’ll make some progress in 2013.

2. EHRs: Roughly half of the physicians in outpatient practices are using EHRs. I predict that will reach 75% or higher by the end of 2013. That number may need to get adjusted again if other prescribers like nurse practitioners and physician assistants are included. Over 95% of hospitals will have EHRs and computerized physician order entry (CPOE) systems in place. So, 2013 won’t be a year where we see any major advances in EHRs. It’ll just be a year where more providers and hospitals implement or switch to different systems. Nothing too exciting here.

3. mHealth: This will be an exciting area where we will continue to see rapid growth, innovative concepts, and increasing adoption of tools ranging from smartphones to tablets. The innovative ideas will be aimed at both health care providers and patients. We’ll continue to see startups with novel ideas and a variety of health and medical apps designed to improve patient care. I also predict that we’ll get some definitive direction from the FDA on the topic of mobile medical apps in 2013.

4. Telemedicine: Whether you call it telemedicine or telehealth, this will be an area of rapid growth in 2013. We’ll see more people using the term telehealth (but I’ll stick to telemedicine since I’m a doc). The lines separating connected health, wireless health, digital health, telemedicine/telehealth, and mHealth will all get blurred. Eventually, we’ll find some element of telemedicine incorporated into any digital health solution.

5. Social media: I’m not just talking about Facebook and Twitter. The use of social media in health care will continue to gain momentum and we’ll start getting much more sophisticated with our use and interpretation of social media. Hot themes in 2013 will include social media analytics, influence scores, reaching the right audience with your message, and engaging physicians and other health care professionals on special social media platforms that are reserved for licensed health care professionals.

That’s a snapshot of some predictions in 2013. I didn’t even get into cybersecurity, health care reform, novel reimbursement and payment models, and more. Those topics will have to wait until next month.


December 27, 2012  11:41 PM

A few thoughts from mHealth Summit 2012



Posted by: DrJosephKim
mhealth, mHealth devices, mHealth Summit

I attended the mHealth Summit in D.C. a few weeks ago.  This was the first year where HIMSS was involved as coordinator and owner of the conference. The three day event was full of excitement and energy about the rapid expansion and adoption of mobile technologies in health care. I could write pages about what I saw, but I’ll just share a few thoughts:

Global health: The use of mobile technologies in developing countries will significantly bridge health care gaps. Many patients in these countries may not be able to afford standard medical care (or they simply lack access to providers), but they can get to a mobile phone almost anywhere. You don’t have to own a mobile phone – there are local stands and huts where you can pay per minute to use a mobile phone. The technology and infrastructure is available in many areas to make remote interaction with a health care professional possible. Although this may sound fairly simple, it’s providing a wealth of value to those patients who need diagnostic HIV testing or simple treatments like antibiotics to treat serious infections, prenatal vitamins to prevent birth defects, or immunizations to prevent diseases. There are many doctors and nurses all around the world who are willing to volunteer a bit of time in front of a computer to remotely treat patients in developing nations. Mobile technology is paving the way to make this a reality.

Empowering patients: So many people have smartphones or tablets. We’re all constantly connected to the Internet and sharing information with others through social media platforms and other means of digital communication. We’re surrounded with digital technology that can educate and empower patients across all ages. Kids aren’t just playing smartphone games. They’re interacting with health apps even if they don’t know it. A great example is the Magic Vision Band-Aid app that brings Disney characters alive when a child puts a Band-Aid on. Now, a scrape or cut isn’t so bad, especially if you’re going to have your favorite character come to life to entertain you while your boo-boo heals.

More data: Health IT isn’t just about electronic health records. Patients are using self-monitoring gadgets like Fitbits to monitor their activity, diet, exercise, calories, and even their disease management. We’re swimming in so much data that we don’t know what to do with all of this information. The cloud will provide the platform for health care data analytics and every mobile device will have access to the cloud. The technology powering these gadgets will change rapidly in 2013, though many of them seem crude and rudimentary now.

The mHealth Summit was truly a blast. I enjoyed speaking about the role of social media in the context of a digital policy within a health care organization. The Tweetup sponsored by Imprivata was a great social gathering where some people learned how to tweet. The exhibit hall was full of interesting organizations, including those working in health gaming and medical devices. If you missed the mHealth Summit this year, I hope you’ll make it in 2013!


November 15, 2012  10:47 PM

The evolving world of BYOD in mobile healthcare



Posted by: DrJosephKim
cpoe, mhealth, mobile health

Bring your own device (BYOD) is still a hot mobile health care topic in many hospitals because a growing number of doctors, nurses, and students (both medical and nursing) are bringing their own devices into hospitals. Even if they don’t try to access patient data on these devices, they may be using them to send emails or text messages about specific patients. That’s a major problem because email and short message service (SMS) are not encrypted or secure ways of communicating personal health information (PHI). I doubt that most of these doctors and nurses have secure messaging apps on their personal devices.

Some hospitals are still using Blackberry as the enterprise mobile OS, which is another factor contributing to the BYOD headache. We’re now finding more doctors bringing their own iPhones and iPads into the system because Blackberry has lost so much favor among medical professionals (though they’re still carrying their Blackberry devices).

A mobile device management (MDM) solution “secures, monitors, manages and supports mobile devices deployed across mobile operators, service providers and enterprises” (from Wikipedia). There are some MDM capabilities built right into Apple’s iOS as well. According to Wikipedia,  Gartner recognized five vendors to be leaders in the “Magic Quadrant for Mobile Device Management Software” market overview of 2012. These include MobileIron, AirWatch, Zenprise, and Good Technology.

A growing number of primary care doctors no longer work in hospitals. They spend 100% of their time treating patients in an outpatient setting, so they don’t have to deal with CPOE systems or any other inpatient issues. Does this mean that they don’t need to worry about MDM solutions because they’re not accessing enterprise level data? They’ll need some type of MDM solution if they’re using their mobile devices to access any type of PHI, even if it’s through their outpatient EHR. Otherwise, all that outpatient patient data is at risk.


November 3, 2012  5:24 PM

Why the iPad mini is ideal for physicians and medical students



Posted by: DrJosephKim
hospital, iPad

I finally had my chance to play with an iPad mini at an Apple Store. I plan to buy one next month after I receive an Apple gift card for recycling an old iPhone. The iPad mini is just the right size for the ubiquitous white coat that medical students and physicians wear in the hospital (although the classic medical student white coat is a short white coat that only goes slightly below the waist).

I was impressed by the elegance and its overall performance, as I held  the iPad mini in my hand and rotated the screen. The device is well-crafted and the screen quality is exceptionally good, even though it lacks a Retina display. I admit that I’ve been spoiled by the Retina display on my iPhone 5 and my iPad (3rd generation).

Medical students and doctors working in hospitals always have access to computers everywhere, so why would they need to carry an iPad? It’s a great tool that can be used at the bedside to take notes while you’re speaking with the patient. You can do this using a stylus pen and “write” on the screen using apps that have built-in palm rejection technology so that you can comfortably rest your hand on the screen as you jot down notes.

The iPad mini won’t weigh down the white coat. It’s not too bulky (in fact, it’s extremely thin) and it’s very light. In the past, medical students and residents would develop back and shoulder problems because they were stuffing way too many books into their white coat pockets. Now, these individuals can carry a wealth of information with a single mobile device like an iPad and be connected to the Internet for cloud-based computing, for medical information searches, and more. Plus, there are so many great medical apps that are available for the iPad.

I’ve been a big fan of Apple products ever since they introduced the PowerBook and the Newton MessagePad. I used to carry my Newton in the hospital and use it at the bedside. I don’t think many people in the late 90s would have dreamed that a powerful mobile device like an iPad mini would be possible in 15 years. Computer hardware technology has come a long way.

So, what about all the Android tablets like the Samsung Galaxy Tab, the Amazon Kindle Fire HD, and the Google Nexus? Google’s Android is gaining market share among medical professionals and students, but Apple’s iOS is still in the dominant position among medical professionals and it will probably stay there for a while.

I envy all those medical students who can use a device like the iPad as they go through medical school and their clinical rotations. These digital tools are becoming more powerful every year and they are allowing students to learn in very innovative ways.


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