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Transitioning to Health IT Jobs

I’ve made the transition to health IT relatively recently. In May that I started doing some contract work as tech writer for a health IT vendor, then looked around for health IT related gigs – if there was a business analyst or tech writer posted in the DC/Baltimore area on Craigslist or Monster, you can bet that my resume was in there somewhere. It took me a good two months of searching to land my current job (and after two months of email after email saying “sorry, your resume didn’t make the cut”, I got three job offers in the same week – true story.) This is what I’ve learned along the way:

1) Having health-care related credentials helps: It can be anything – a degree, college coursework, actual paying jobs or volunteer positions you’ve held. In my case, I had a B.S. in pharmacy with a minor in IT, and a masters in Communication, so it seemed as if a health IT tech writer gig would be perfect for me. I believe that adding the “My undergrad major was pharmacy” in my cover letters was the phrase that opened doors for me.

2) Volunteer: I have mixed feelings about this piece of advice. It’s a well known secret that employers want certifications in vendor-specific products in the candidates they shortlist, which makes it something of an impossibility for regular IT folks looking to transfer to health IT.

On the HIMSS blog, there was a really interesting discussion from some time ago on healthcare employers not getting enough trained health IT people. The comment section was really enlightening – a commenter said “I’d like to share a little known secret: many hospital employees, IT included, are hired as a result of volunteer activities at the very same hospital that he or she volunteered at.”

Someone else commented that “An open secret in the NPO world is that they get many person hours donated with the unstated goal of being hired but no person ever actually receives employment. Especially in towns with many colleges and universities, some NPOs glean many free person hours from students and depend on the myth that all NPOs hire this way.”

So in effect: you might get a paid health IT gig after volunteering at a hospital or similar setting, but such NPOs are also the most liable to take advantage of you by dangling the job carrot before you. Also volunteering when you’re a newbie to the workforce might make sense, but I’d really love to see how that might help a mid-career IT person with a few years of experience under her belt, and with mouths to feed at home. I’m not discounting it entirely, but I’d do my research (how many volunteers were actually hired, and so on).

3) Hone up on healthcare concepts skills: HIMSS has a great repository Health IT Body of Knowledge. Read some blogs, follow the #EMR #EHR twitter feeds, or check out the thought leaders on Quora. Figure out which aspect of health IT interests you – is it the mobile apps sector, or EMR product development?

4) Learn from the greats: I really lucked out that I got some great health IT mentors this year who worked with me into turning the raw ingredients of my healthcare knowledge into something semi-cooked. And this is true of any area where you’re a learner – the more you show your enthusiasm for something, the more people are willing to teach you what they know. If there’s someone in your office or friends circle who is a walking encyclopedia of anything health IT, talk to them, and ask for their advice. If you don’t know any such person, make online relationships by commenting on blogs or following conversations on twitter. Read what the greats read, engage them in conversations. Knowledge osmosis will take care of the rest.

November 14, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now writes about healthcare, science and technology as well as traditional news features.

Life After EMR Implementation

I spent a lifetime as an IT developer before I landed my present gig as technical writer in a health IT company. I can tell you from experience, that for many development teams, the implementation date is the biggie that the developers are racing against. And yet, the real fun often starts post-implementation. It’s not that different even with EMR implementation, you’ll be happy to know, at least according to this article at CMIO.net

According to the story, here’s what happened at Hospital Sisters Health System in Wisconsin and Illinois: A couple of months after their CPOE (Computerized Physician Order Entry) and EHR went live, the CIO received a letter with listing 38 issues faced by physicians using the EMR, with an ultimatum that these problems be fixed within two weeks. Half were known issues, and another quarter were training related. But even so, “The installation team was taken aback by the letter, including the physician champion.”

Now, not every IT project is like the one described but here are some lessons worth repeating from the Hospital Sisters example:

  • Prepare, prepare, prepare: That there will be unexpected issues is a given. The problem is not that issues crop up. How prepared you are – knowing how, when, who will handle glitches – is the difference between success and failure.
  • Train Your Users: I honestly get turned off when someone utters “It’s self-explanatory, really,” when it’s related to a software product. Yes, it might be, to you, tech geek, but not everyone was born with the chip embedded in their being. Expect to spend some time training your end users. Well-structured training sessions not only impart the know-how but can also be crucial rapport-building occasions with your buyers.
  • Support Your Users: After the initial euphoria of product launch, using your product might actually bring down the productivity some as users get used to using your product on a regular basis.
November 7, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now writes about healthcare, science and technology as well as traditional news features.

PHRs – A Difficult Pill to Digest?

A report from Manhattan Research earlier this month had some interesting statistics on consumer access to electronic medical records. According to the report, 56 million Americans accessed the patient records available from their medical providers’ EMRs, and another 41 million said they were interested in viewing their medical records online. Manhattan Research gets this information from surveying 8745 adults online and by phone in Q3 2011. Assuming the statistical basis for extrapolating this survey of 8745 people to the entire US population is sound (Nielsen does something similar to arrive at its daily media numbers), that’s a good 97 million people who are interested enough to have already accessed their records or are interested enough to, if given a chance.

But you know what’s the surprising tidbit? 140 million Americans have not used and are not interested in viewing their own medical records online! Predictably enough the report attributes this massive reluctance to an older or less tech-savvy population. I’m not sure how this will play out with the less tech-savvy population. With the older generation, this might just translate to access and maintenance of personal PHRs falling on authorized proxies – caregivers or adult children. Maybe this will span an entirely new profession – personal health advisers of sorts – whose sole job is to view your online medical records, explain them in plainspeak and research and offer up options. Certainly something to think about!

October 31, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now writes about healthcare, science and technology as well as traditional news features.

Health It in New Zealand Vs US: A Comparison

I’d been corresponding with a PR person for a story I’m doing on ambulatory exoskeletons. She dug me up on Twitter, figured I dabbled in a few things health IT and asked if I would be interested in a recently published report on how health IT influences New Zealand’s healthcare. Now, unbeknownst to her, I also have an abiding interest in all things Kiwi, having lived in Wellington for a brief bit of time, so I was curious to know what this report contained.

The press release introducing the report started with an endorsement from John D. Halamka, so that was a huge plus in its favor. It outlined things that New Zealand has done right:
– It has a population the size of Colorado, and ranks 23rd among OECD countries (Organization for Economic Cooperation and Development, basically all of Europe, Aus and NZ, US, Canada, Mexico and industrialized nations in Asia) but is ranked number 1 or number 2 in several healthcare categories, including overall quality care delivery (92%), EMR use by doctors (97%), use of computerized patient care reminders (92%)
– Demographically similar to the US in terms of urban/rural population split (86:14 NZ, 81:19 US), Information and Communication Technology development index, has lower physician, nurse and dentist density per 10,000 (NZ: 87,4,10 resply, US: 27, 98, 16 resply) but spends far less than the US on healthcare (NZ spends 9.8 percent of its GDP, US spends about 16 percent of its GDP)

There are far too many of these interesting compare and contrast stats for me to do justice to them in this little space, so I’ll suggest you read the report in its entirety (Do not look at Table 5 if you want to avoid serious heartburn). There are some interesting case studies towards the end of the report and plenty to keep you busy reading for quite some time.

For me, the most interesting part of the report dealt with how far NZ health infrastructure has come since its national medical IT policy was implemented in 2005. New Zealand, as the report states, has a single layer of national government, low population size, making it easier to implement a standard health IT policy. However, it’s also interesting what they’ve been able to achieve infrastructurally, which is the establishment of the National Health Index, the Health Practitioner Index and a Medical Warnings System.

To those of us who associate indices with performance, the National Health “Index” seems clunkily named, and is not a measure of how healthy Kiwis are. New Zealand’s NHI is really a kind of health ID assigned to each patient who uses the country’s health and disability support services. The report says children born in New Zealand are automatically assigned an NHI at birth and about 95 percent of the population have their NHI. Where the NHI comes handy is in tracking of patient medical records. Whether a patient moves from hospital to community to private care or any combination you can think of, all EMR documentation generated along the way reference the unique NHI for the patient. The same concept applies to Health Practitioner Index, which is again a unique ID identifying every medical practitioner in a myriad of medical professions.

The Medical Warnings System is probably the most interesting piece of the New Zealand health infrastructure. It is a system containing details of all significant medical conditions associated with the patient. A flag against the NHI tells health workers that the patient has, say, a significant medical condition, or is allergic to some medicines.

Put together, this report paints us a picture of where we could take US healthcare over the next few years – from a logical way to collect patient data under one ID to a comprehensive electronics warnings system that takes the guesswork out of care. (One could argue that the American SSN serves pretty much the same purpose, but we certainly don’t have a system where records are organized by SSN, or used by health workers to communicate with one another.)

October 24, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now writes about healthcare, science and technology as well as traditional news features.

Gamification and Encouraging Healthy Living

There are those that swear by the Quantified Self movement and those that think its bunkum. Having grown up around a grandfather who kept a meticulous daily diary of his bowel movements and sleep patterns, I can totally relate to the pleasures afforded by such healthful navel gazing. But unless the data can be distilled into meaningful information or can be used to effect behavioral change, it is just interesting data, destined to remain the domain of card-carrying data geeks.

Social health networks might just change all that. Dr. Jan Gurley, writing on SFGate, had a great post a couple of weeks ago on the effects we can expect to see with healthcare gamification. She wrote about Mindbloom, a website in beta with about 15000 users, whose CEO wants us to not “run away from something” but to want to run towards good health. To achieve that, Mindbloom has devised a game around the a tree of life, where the actions you report (positive health related changes based on commitments you made), get transformed into virtual rain for the tree, which in turn helps it grow. You can use your good deeds to purchase seeds and raindrops for your friends, and you can collectively inspire one another . Dr. Gurley calls it the Farmville of Health, but yeah, it is pretty similar to those virtual pets (fish, gerbil) you could raise in the early 2000s. As inspiring as this is supposed to be, I can totally imagine someone gaming the system by reporting that they ate a piece of fruit when they didn’t. I think the Achilles Heel of this idea is its reliance on self-reporting. It also veers Chicken Soup for the Soul-ish and that is not really everyone’s cup of tea.

One of the more interesting pieces of nuggets in Dr. Gurley’s post was about how working towards a collective goal as a group helps one travel farther than one would on one’s own (she cites religion, tai-chi in the park and Alcoholics Anonymous as examples of real life social networks that can affect positive behavioral change). The companies Dr. Gurley cites in her blog support this thesis.

Startup Zamzee keeps kids motivated to move by giving them points for ANY movement they make. The referral rates for Zamzee were as high as 50%, and soon involved original participants’ parents and friends. Livn.it figured that while people fall off the change bandwagon very soon, they would also climb back on if the distance between the ground and the wagon was close enough. A company called Shapeup let people form teams to lose weight, increase exercise or walking. Apparently the game went viral in Rhode Island where 10% of the population participated. Shapeup also creates social health networks for employers. Now, these are programs I would love to know more about.

October 17, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now writes about healthcare, science and technology as well as traditional news features.

EMRs and Templates: How to Avoid the Pitfalls of Boilerplating

On Kevin MD, there was a recent post about the problems associated with templating and John mentioned in his weekend EHR Twitter roundup. Some EMRs provide automation for notes so that a provider can check a few boxes regarding symptoms and have a patient note generated on the fly. While such a methodology works for a wide majority of patients a provider might see, it doesn’t for the one-off cases who present to the provider with certain problems and have something different going on. The author calls for a health IT products to function as decision support systems, meaning systems that allow for templating while at the same time encourage the provider to think through how a particular case might not fit the usual profile.

This study in Health Care Management Review pretty much comes down on templating. The study interviewed 78 physicians on how EMRs affect the skills of physicians. Yes, n=78 means we need to take this study with a pinch of salt, or more research is needed, but what’s revealed is pretty fascinating.

Physicians cut-and-paste too: Hey, I’m the last person to come down on using Ctrl-C/Ctrl-V. I’m doing it each time I write a blog post (albeit with attribution.) “A key dynamic with using EMRs involved the perceived ease by which a physician could use an EMR to “cut and paste” identical assessments of patients with similar clinical diagnoses or issues into several different patient records.”

It is better to get it “written” than right: Here’s something straight out of How to Write a Novel in 5 Days type self-motivation books. “The homogeneity of different patient visit notes convinced these PCPs that some physicians… favored the basic need to complete a patient EMR in a timely manner over the care management need to say something accurate and unique with regard to each individual visit.”

There’s way too much noise: Physicians interviewed recalled how specialists provided 6-8 line summaries of patients which contained everything a doctor needed to know about the patient’s visit – “[t]here was all signal, and no noise. Now as we review what specialists do in an EMR, and even what we do in primary care, what I miss is the narrative.” What you’re getting by checking a lot of boxes is copious documentation that says precious little, and makes you wade through the mire to get to the precious nuggets.

While I’m trying to poke some (I hope gentle) fun at the study’s findings, I’ve also been thinking along the lines of what features of an EMR system would help. One clue lies in the study itself: the physicians recalled how paper records forced them to dictate “certain amount of unique verbiage for transcription into a patient’s record.”

So maybe we need EMRs that:

  • combine voice recognition, so that the physician can continue to dictate patient notes
  • have Thesaurus like features to generate verbiage that at least uses interesting synonyms and phrases to give the appearance of uniqueness
  • don’t allow physicians to generate automated notes at all

What do you think will make things easier without boilerplating patient information?

October 10, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now writes about healthcare, science and technology as well as traditional news features.

Electronic Health and the Non-Digerati

Everytime we discuss something innovative and interesting to do with our lives, my friend comes up with yet another app or game we should design and market via the App Stores and live richly and happily forever. And I, true to my vaguely creative pursuits, always state that not every problem has a solution rooted in IT or mobile phones or the next iThingamajig. While this is a strange admission to make on a blog that is titled “EMR Thoughts”, bear with me. For example, there are entire classes of problems that IT cannot solve – such as whether the water in a village well is potable, or ensuring that there is enough food for a growing world populace, our collective Farmville skills notwithstanding.

Today I was reading John Moore’s report of the recent SFO Health2Con, where I felt he addressed a health version of the same discussion my friend and I have. More on that later. First the reviews.

Moore says:
– the Health2Con demos sported cleaner interfaces, better UI,
– had more realistic business models (fewer free/Freemium models).

On the not-so-great news side:
– mobile health is cheap and the “it” technology of the moment but Moore doesn’t think anyone’s figured out how to use it,
– demos rarely give enough detail to be instructive,
– And if he cannot deal with any more demos that call for gamification or Facebookization as a way to approach health (I hear him)

Then about midway through the post, he made a comment that made me sit up and take note:

“[Health IT Vendors] want to make a difference. That passion is contagious. Unfortunately, that passion appears to be confined to the digerati [digital literati]

Maybe the most disturbing part of the event was the on-stage interview with a mother of eight kids (she was white, middle age and clearly upper middle class) showing how her family is tapped into the quantified self movement with the various Apps they use to track their health and fitness. This is not representative of the broad swath of the American populace who are the ones that will drive our healthcare system off the proverbial cliff. It is that grandmother in Indiana who is caring for her diabetic, overweight husband, two grandchildren, a daughter suffering from an addiction and a son-in-law who is unemployed and has no health insurance that we need to talk to, have up on stage to tell us what they need to better manage their health and interaction with the healthcare system.”

Another post on iHealthbeat clearly examines the motivations behind our health IT thrust.

EMRs/EHRs will make healthcare efficient and reduce costs. Engaged, empowered patients will take charge of their own health and again bring down health costs. These are some assumptions we hold to be true.

The problem with these assumptions that they don’t take into account the non-IT savvy grandmother problem. How do we reach her and others like her? A particularly trenchant comment from commenter Kim Slocum on iHealthBeat says:

We know that half the US population consumes essentially all the nation’s health care resources.

I’m guessing that a large proportion of high car(sic) utilizers are also off-line and currently unreachable via this medium (e.g. dual eligibles and substantial fraction of the Medicare population). If that’s true, a lot of the “Health 2.0″ buzz is misguided if it is thought to be a vehicle to bend the cost curve via “consumer engagement.”

Something to think about. John Moore’s post is here, and the iHealthbeat post is here.

October 3, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now writes about healthcare, science and technology as well as traditional news features.

Who Owns Patient Data?

Recently, on The Healthcare Blog, there was a really interesting post by Dr. Marya Silberberg about why patient lab data should be liberated. She recommends lab results be sent to patients at the same time that they’re sent to doctors. Dr. Silberberg does an admirable job of looking at the patient data issue from both sides. From the patient’s perspective, it is really not that hard to understand. If you’ve ever transferred your (paper) records from one doctor to another, or you’ve spent a month or more waiting for your doctor’s office to call you with their interpretation of lab test results, you’ve known the pain. It’s your data, about your body, your health, and you really have no way to access it if you have something of a grinch gatekeeping the records at your doctor’s office.

I’m no doctor, but I get you too. There are way too many paranoid, entitled people in the world, and chances are they’re your patients. Handing patients their lab records is the best way to make sure your office is inundated with callers demanding to talk to the doctor right now, and many of them will just be non-emergency calls.

Having said that, I wasn’t a huge fan of commenter Dr Mike’s response to the post:

“If I ordered the test, the results should be returned to me first, if you ordered the test, the results can come to you. So go order your own lab tests and then you won’t have to wait for me to get through that mountain of paper on my desk. Not sure your insurer will want to play along as you play doctor though

Part of the problem is that patients don’t understand that I am not on retainer for them. In the good ol’ days the docs cared for their friends and neighbor’s and community, and had a personal and financial interest in each individual. But today I don’t have a contract with you, I have one with your insurer, and together the two of us have pretty much locked you out of the decision process, and you have allowed this to happen.”

 

Whoa, them’s fighting words. Patient data access doesn’t have to be an adversarial experience. If you, the doctor, are spending an inordinate amount of time explaining lab results to patients, it’s only fair you be compensated for your consultancy in some way. And you, the patient, must stop thinking of access to patient data as a zero-cost right you can exercise. A tiered insurance plan offering could very well take care of phone-consultancy and patient-lab-reporting costs. If I or a loved one had a condition that required me to look over lab reports and such, I would happily pay a few dollars extra a month for that privilege. And for all the concerns about how the average user can’t understand what the lab results say, it’s surely not impossible in this day and age that lab reports sent to non-medical recipients be in human readable form.

Check out the post here.

September 26, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now writes about healthcare, science and technology as well as traditional news features.

EMR Systems Spawn Cottage Industry: Scribes

One of the limiting factors when it comes to EMR systems is that it requires some amount of training to use an EMR system. Doctors are in the habit of writing down notes, or dictating them into dictaphones for transcribing later. So the idea of an EMR system that requires typed input can easily face some resistance, just based on the process change it requires. And hence the rise of a new class of health IT worker – the scribe.

Having a scribe taking notes at hand would’ve seriously helped me like my doctor better at my last appointment. This was someone whom I was meeting on account of a referral – I didn’t already have an established relationship with the doctor. The doctor and an assistant spent about a third of their time figuring out how to enter my scans into the EMR system. I don’t know what was at fault – the newly acquired iPad or an EMR they didn’t know how to use. They were effusive with their apologies but I couldn’t help feeling that I got the short end of the stick when the doc rushed through the rest of my visit and quickly ushered me out. A competent scribe, well versed in their EMR of choice, might have really helped.

 There have been a slew of articles about the rise of scribes in health IT. They started sounding really promising to me, especially when I considered how one could tail a doctor on his/her rounds with patients, and gain some insight into the business of being a doctor from the ground up. I checked out a couple of companies (ScribeAmerica, EM Scribe Systems) that train medical scribes and source them out to ERs. EM Scribe Systems’ application form states that it requires a one or two year commitment, wants to know what your future med school plans are. The pay anywhere is between $8-$16/hour (scroll to the bottom of the page). The higher end of that range gets paid with scribe experience.

(Seriously? If medical transcription can be outsourced to India and Philippines, why set the bar so high for medical scribe jobs? Or alternatively, if the bar is so high, why not pay better?)

I guess the pre-med scribes are approaching it from a different aspect – the real payback for them comes from understanding the medical aspect. The EMR system is merely a tool to an end.

September 19, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now writes about healthcare, science and technology as well as traditional news features.

EMR in the Age of Skype

The physician community has something of a split persona. Doctors are probably the only community still dedicated to using pagers to communicate with their offices. And yet, it’s no secret that the medical establishment is among the fastest growing segment among smartphone and tablet users. A widely quoted statistic from Manhattan Research stated that 81 percent of doctors would own a smartphone. Manhattan now states that the 81 percent rate has already been reached in 2011, while average America is at 40 percent adoption, according to Nielsen.

So, the medical establishment is clearly ahead of the curve in some ways.

But you just have to juxtapose pagers and smartphones against each other to understand the real advantages of the smartphone. If you have an iPhone and your doctor has one too, you’re going to probably take it to the next level, right? Yeah, FaceTime. (Surprisingly enough, that’s not what the statistics show. A full 78 percent of respondents said they didn’t want to chat or IM with their doctors, according to this recent article on Technology Review.)

For this kind of face to face interaction to work, it really depends on how good a rapport you have with your doctor, but if there’s a good doctor-patient relationship, you might just consider making the move. Let’s be clear, doctors are not taking to video-conferencing via Skype or Face-Time in droves (or rather, there are no published statistics from the bean-counting firms about the trend), but there are some anecdotal stories on blogs like Dr. Brian Goldman’s on CBC.ca. But it’s interesting to think ahead to how video consultations might change EMR.

The Pros:
Direct connection with your doctor, in an instant: Great for the patient, furthers doctor-patient relationship but could be something of a double-edged sword.
Show, don’t tell: For those times, when you don’t know whether a symptom needs an in-office visit, or when you’re not in town and some conference magic and ePrescribing can save the day.
No more Lost in Translation: The paging process has that additional office staff layer in between, who convey your message to the doctor. It’s tempting to think that you can axe the middleman with Skype.

The Cons:
Direct connection with your doctor, in an instant: How long before patients are calling at all hours of the night demanding FaceTime? Blackberries and iPhones might simply be another way to tether yourself to your business (Next time you see 24-7 IT support, know that there is a person dreading the Blackberry ping somewhere in the world)
Too many interruptions spoil the day: Pagers let the doc put off calling till she’s done with the task at hand, not when the patient demands.
Privacy issues: From an EMR perspective, this is the big kahuna. There are several nuances to consider. The doctor-patient line has to be securely done, with HIPAA in mind. For CYA purposes, video-cons will probably need to be recorded.

Microsoft’s main intent behind its purchase of Skype might be its conferencing features for business, but wouldn’t it be awesome if Skype also showed up in HealthVault (which only has image saving capabilities so far, according to this Q&A on MSDN forums)? Or if any advice dispensed via Skype could be saved into your doc’s EMR system and become part of your health profile. There are several possibilities out there when you throw video into the mix, and they seem quite interesting.

September 12, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now writes about healthcare, science and technology as well as traditional news features.