Skeuomorphs, metaphors, and EMR design

For the past two decades, legions of computer users learned how to create files, place them in folders, and dispose of them in a trash can. They used their computers to send messages by placing them in a virtual envelope addressed to their recipients. The desktop and mail metaphor provided new computer users with a context and frame of reference they were familiar with and helped them learn how to make effective use of their computer. However, the days of relying on metaphors based on paper-based processes when designing software may soon be coming to an end.

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Mike

 

Is there an ROI for Health IT? It depends.

One of the most frequently and hotly debated questions that I encounter in my professional life is whether health IT offers a measurable return on investment (ROI). Various studies and opinion pieces have addressed this question but no clear consensus has emerged. Maybe there is no single answer. Perhaps the answer is: “It depends.”

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Mike

The Applification of the EMR

Perhaps one of the Steve Jobs’ greatest legacies is the iPhone and the app ecosystem that it supports.   Rather than trying to define and develop every bit of functionality that an iPhone has to offer, Apple handed the opportunity to do so to hundreds of other organizations, large and small. Apple gave up some control in exchange for unprecedented growth in market share and, ultimately, stock price.  Imagine for a moment if a similar approach was applied to the design of EMRs and other eHealth applications.  Might the same level of innovation and user adoption result?   A team led by Harvard University seems to think so and was awarded $15M by the U.S. Office of the National Coordinator for Health IT to turn their ideas into reality.

You can read the rest of my monthly Technology for Doctors column here.

Mike

mHealth Rant

Check out my latest article in Technology for Doctors, an online publication for which I write a monthly column.  You can find it here.

I’d like to hear views on whether we need yet another buzzword.  I argue that mHealth will cause more confusion among potential users and divide the health IT community at a time when it should be united.

Mike

 

 

 

Canadian EMR Adoption and Use – National Physician Survey Statistics

The 2010 National Physician Survey (NPS) offers some hard data on adoption and use of electronic medical records by Canadian physicians.  In response to a question regarding “Thinking about your MAIN patient care setting, which of these describes your record keeping system?”, respondents indicated that:

• 16.1% use electronic records
• 34.1% use combination of paper and electronic charts
• 37.6% use paper charts only
• 12.2% either did not respond or indicated that the question was not applicable to them

So, it would appear that slightly more than 50% of Canadian physicians use some form of electronic chart.  Interestingly, of these physicians, roughly two thirds still use a mix of electronic and paper charts.

The NPS does not provide detailed data on use of EMRs in physician offices.  The closest statistic in this regard is the answer to the question “In which setting do you use electronic records most often”, Respondents indicated:

• 43.1% in “Office/community clinic/community health centre”
• 38.8% in “Hospital/AHSC/Emergency Department”
• 1.5% in “University/faculty of medicine/research unit”
• 0.4% in “Nursing home/home for aged”
• 1.5% in “Other” settings
• 0.9% felt that the question was not applicable
• 13.8% did not respond

Mike

Should doctors be “forced” to use EMRs?

Tom Closson, the Ontario Hospital Association (OHA) President and CEO, created a bit of stir at the eHealth 2011 conference in Toronto when he suggested that doctors should face real consequences for not adopting electronic medical record systems such as not getting paid.   This same sentiment was expressed in a recent article in the Canadian Medical Association Journal.

Tim Wilson, a fellow Canadian eHealth blogger, explored Tom’s comments in a recent blog post.  I commented on this blog post with the following observation:

I agree that mandating EMR use is not the answer, at least not until we get more physicians using EMRs. While it might sound like the easiest path to take, forcing physicians to use an EMR casts them as technology resistors who simply aren’t smart enough to realize the benefits that EMR’s have to offer. Given their education and their use of some quite advanced technologies in other aspects of the practice of medicine, one has to wonder they aren’t pounding down the vendors’ doors to buy an EMR.

I suggested that it was perhaps a bit hypocritical of those who still use pen and paper for many daily work activities to admonish physicians for doing the same.

If we are unprepared to ditch pen and paper, what right do we have to ask physicians to do the same? Clearly there are usability issues still remaining with many EMR products and forcing physicians to use products that don’t fit how they work is not the answer. While I am not naive enough to suggest that usability is the only issue standing in the way of massive EMR adoption, I do believe it is a contributing factor.

What are your thoughts on this matter?  Head over to Tim’s blog and join the debate.

Mike

Yet another Canadian provincial EMR program

I found out this morning on MERX that Newfoundland and Labrador will soon become the latest province to put an EMR funding in place.   Interestingly, although the MERX posting date was today, the announcement document issued by the Newfoundland and Labrador Centre for Health Information is dated 4 May 2011.

According to the announcement, the purpose of the RFP is “to secure a commercial, off-the shelf product and the associated professional and managed services to implement an EMR solution.“.  Although a subtle distinction, note use of the word “product”.  Not plural but singular.   The apparent intent to tender for a single vendor is consistent with rumours I have heard from several sources.

Mike

 

Steven Huesing Virtual Debates – First Debate

About a month ago I wrote a blog post about the The Steven Huesing Debates on Digitizing Canada’s Healthcare System. This virtual debate series is intended provide a platform to engage all stakeholders in open, unfettered discussions about the about the major issues impacting eHealth adoption and use, such as:

• Measuring the return on value to the patient
• Improving quality and safety
• Data sharing to respect the privacy rights of patients
• The appropriateness of the current agenda

The debates will be conducted virtually and will include a public commenting period. The first debate took place on 12 April 2011 and the public commenting period is now open. You can find information about the debate series as well as a recording and written synopsis of the first debate here.

I urge readers of this blog to participate in the virtual debate. Please check out the virtual debate website and offer your thoughts and comments. In particular, please offer your thoughts on the topics to be discussed In future debate sessions. The currently identified topics include:

• Patients as co-creators/owners: Should the HIT agenda change to build the infrastructure that ensures personal health information rests with the patient who shares it with others? Do you want patients to genuinely become a co-creators—to share power
• Aligning business models to incent using these systems: What changes in the current approach (business model and incentives) are necessary to speed up adoption and change processes of care to drive out more value?
• The need for e-health policy: The technology roll-out is advancing before we have e-health policies in place. What policies are needed to address challenges or potential barriers?
• Regulation vs. government edict: What would be the best approach to creating a carrot and/or stick regime to speed up adoption by clinicians?
• The right balance between top-down and bottom-up to drive the agenda: Is HIT in Canada emphasizing a more grassroots agenda driven by the patient and providers rather than a top-down approache driven by governments?
• Do we need a higher sense of urgency with the HIT agenda? If the answer is yes, then what do we do to build this into decision making and implementation?

What are your thoughts on these proposed topics? Are there additional topics that should be considered? Please go here to participate. Also, please let people in your own networks know about the debate series and encourage them to participate

Mike

The Steven Huesing Debates on Digitizing Canada’s Healthcare Systems

Late last year a small group of people decided that a mechanism was needed to engage more people in active discussion regarding the digitization of Canada’s healthcare system. Until now, very little real debate about the current healthcare IT agenda has occurred. Discussions to date have tended to focus on system manager needs and not so much on health outcomes. Most key stakeholders have had little say — providers, vendors, researchers and, most importantly, patients.

The Steven Huesing Debates on Digitizing Canada’s Healthcare System provide a platform to engage all stakeholders in open, unfettered discussions about the main unresolved issues, such as:

• Measuring the return on value to the patient
• Improving quality and safety
• Data sharing to respect the privacy rights of patients
• The appropriateness of the current agenda

The debates will be conducted virtually and will include a public commenting period.  The first debate will take place at noon eastern time on 12 April 2011 and will focus.  The debates and the commenting period that follows are open to anyone who wishes to add a comment. There is no cost for participation.  You can find more details here.  I encourage you to participate in what I hope will be a lively and informative debate series.

Mike

 

Infoway turns to the “crowd” for ideas

I first heard about this idea last fall and thought it was a great way to engage a wider audience in coming with new ideas for how to use IT to transform healthcare services delivery. Infoway’s ImagineNation ideas challenges offers cash prizes for “bold, new ideas – or creative combinations of existing ideas.”

Ideas will be evaluated according to four criteria:

1. Impact on Health and Health Care in Canada (30%)
2. Innovation & Originality (30%)
3. Effective Use of Technology (20%)
4. Feasibility (20%)

A total of $35,000 in prize money is available and will be awarded as follows:

• $100 for up to 50 top ideas
• $250 for the idea that receives the most votes from Canadians (“Canada’s Choice” Award)
• $5,000 for each of up to 5 top finalists
• An additional $5,000 for the winning idea

The top ideas will be announced July 5th just after the Canada Day long weekend.   You can find more details here.

According to Infoway, they plan to “promote the leading ideas” though the exact details of how they will do so have not been specified.  As well, they are “considering future initiatives that may be informed by the best ideas“.

Overall, I think that the notion of a public “challenge” is a good way to raise greater awareness of the impact that IT can have on healthcare and to more meaningfully engage Canadians in Infoway’s mission.   The US First Lady, Michelle Obama, issued a similar challenge last year to develop mobile applications to combat childhood obesity and not only raised awareness about this growing problem but also stimulated development of some innovative mobile applications.

I do wish that the public input would have a greater impact on selecting the winning ideas.  Perhaps a more substantial cash award could be associated with the “people’s choice”.  Or, maybe the criteria could be adjusted so that public voting would factor into the choice of the top winners.

Mike