Posted: Fri Dec 27, 2002 2:55 pm Post subject: EMR's
this was copied from the Thanks Chris Topic. To see all related topics, please look in posts for that thread.
instead of responding to this thread (Thanks Chris), i've started a new topic called emrs. (same for anyone else. title of thanks chris was directed towards chris for setting up a DOC SIG based on the three of our answers that we'd be interested.
though i've used win ce, thats been strictly as a thin client for my citrix setup. though may sound confusing, when i opened up my practice, danny didn't have asp facility so i have my own server. as you said, any server can go down. the beauty of his new capabilities is that i would no longer have to worry about daily back ups. only reason i haven't gone with him is the 15K i spent for hardware/software 4 years ago.
i think anything that is worthwhile would require a server with an EMR rather than a home-grown solution unless you're a great relational database builder.
danny will be more than willing to go over things with you if you'd like - Sparta NJ, 1-973-726-4444.
Good points with having to maintain a server and having multiple (redundant?) backups could be very costly. I think even Amazing charts offers an online backup service for a fee. I still like the idea of a thin client if it were more capable for voice. I do think that a larger screen would be nice without gaining weight. I do feel that the active digitizer would be better for handwriting on a screen which I don't think Smart Displays have. I think my brother does work with relational databases so I will see if he is really up to the challenge of producing what I think I want as a documentation and coding tool.
Posted: Sun Jan 05, 2003 7:06 pm Post subject: What Do You Want In an EMR?
I am currently Project Manager for a company developing an ASP Electronic Medical Record package to fit with out current Scheduling, Prescription, and Medical Billing modules. Now, I am not a salesman so I'm not going to discuss the product comparisons, pricing, or my company's name. I am looking for input as to what a physician looks for in an EMR system. You ask 50 doctors, you get 50 completely different answers.
We currently plan on having an application that will provide forms for vital statistics, common exams and test (think of O in SOAP), text fields for subjective, assessments, and planning. Outside the forms, all information is presented as organized text. We then "feed" the text to a module to determine the ICD and CDF codes (including level of service). Once approved by the physician, the data is sent to a Billing package for completion by a billing clerk.
I know this is a rough explanation. Since this is an ASP applications, we would expect the medical and office staff to use Tablet PC's web browser to run the application. I purchased my own Tablet to test the functionality and I think it will do well. I'd love to get any feedback as to if we're on the right track or we've driven off the deep end.
Your product sounds interesting. The only thoughts I have are if you are using a web interface for an ASP product and the physician is trying to do everything at the point of care I think if you would require the wireless to be on the whole time it would be a major drain on the batteries. I have the TC1000 and it has one of the longest battery lives besides the electrovaya scribbler (which beats everybody by a long shot I've heard). I think as long as you can complete some of the forms offline it would be OK. The other problem would be completeing the subjective and assesment/plan area if it is a blank text field. That may be helped with voice recognition but if you are running a lot of other proccesses at the same time and using wireless it doesn't work as well as it should at least with Dragon Naturally Speaking Medical 6.1 and the TC1000. I should say I am still experimenting with this and I am a novice with computers and software. Some of the owners of the Intel processor based Tablet PC's may be able to speak if the Intel processors work well with voice recognition and having other things on like a web browser and wireless on. I think the Intel have speed step enabled on battery power that may affect the performance of voice recognition. I think you can turn it off but that would affect battery life significantly (except maybe the scribbler). Which Tablet PC do you have? Have you tried the voice recognition? Will your product work without the need for voice recognition?
Thanks for the reply. We are recomending that staff using Tablet PCs have an alternate battery charging. At least with my TC 1000, batteries charge faster than they are used. Luckily, you can put the maching in standby, swap batteries, and resume without losing anyhing.
In an effort to minimize the amount of writing, we plan on having templates of typical office sessions so if a patient is in for migranes, the template would be selected for migranes, and typical text would be entered into each section so the staff can alter and delete text with a minimum of keystrokes.
We're looking into the voice recognition software but this is so new, the results are mixed. I am continuing to test but I think we're probably one more generation away from useful voice recognition.
Sounds like a good implimentation. I have some reservations about templated Subjective and Assessment /Plan. I have a friend that uses an EMR with templated descriptors based on diagnosis or chief complaint. He does a good job of trying to personalize each encounter. However, if you look at each subsequent visit for chronic disease it looks monotonous and somewhat cut and paste. Also since every visit is different you may not do the same physical every time. It works for him, but I think I read where The Office of Inspector General may be looking at EMR's to prevent fraud by unscrupulous (sp?) doctors that are overcoding for things that aren't done but are easily manipulated by computers. I would like to think this would be a very very few "bad apples" that had gone astray. However with the way things are I would like to avoid a sounding templated just in case this is their next area of investigation. I can understand the need to prevent fraud, but all the hoops to go through to get reimbursement and documentation does make it hard to be efficient. I hope the changes in E/M guidelines that are rumored turn out to be of benefit to practicing physicians and I hope the HIPPA laws aren't too burdensome to put into practice. By the way, are you advising or going to advise clients to use a Vrtual Private Network with their wireless? I am not a HIPPA expert but is this a needed step to provide sufficient wireless security?
Posted: Mon Jan 06, 2003 8:28 pm Post subject: vpn and hipaa
if one is running citrix, be it local server or over the web with an asp or even from a satellite office to the main office server, there is really no need for a vpn. one would have to know the ip address which if behind a router makes it very difficult to say the least, and then would have to know the id and passwords of the registered users.
agree with you too about templated cc/hpi and assessments/plans. these really shouldnt be templated in my mind which is why i have the acer (convertible). though i can customize pe normals both by age and ..., there is rarely a patient who doesn't have something unique on any given day. so yest it's nice to click "all normal findings" and autofill the exam, can't do that 100% of time.
The templates we plan on using won't complete the Subjective, Assessment, etc. sections of an encounter. Instead, it will offer a short-cut to minimize the amount of typing, handwriting necessary to complete the section. Especially, medical terms that would be difficult for a handwriting recognition program.
To be honest, we haven't considered fraud in producing these templates but it will be on our agenda from now on.
As far as the wireless network goes, we aren't using any VPN's from the local wireless lan to the internet. That way our customers can acccess the system from home, hospitals, the 19th green ( ), etc. The wireless LANs have have MAC authorization to keep other devices from stealing the signal.
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