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June 2009

May 2009

The Use of Twitter to Communicate With Patients, Clinicians...

The way that the Center for Disease Control (CDC) is using Twitter during the H1N1 influenza situation has changed my perspective about the use of online social media in healthcare.  I previously wrote off Twitter as a fad or phenomenon that would fade away as quickly as it appeared.  I could not see value in communicating information in less than 141 characters. However, I found that I did gain value when I began following the CDC's swine flu "tweets" (@CDCemergency), especially during the first few weeks of the H1N1 influenza situation.  When the CDC discovered new information or developed new recommendations, they not only posted it on their website, but they also used Twitter to alert followers that there was new information or recommendations posted (with hints regarding the subject of the new content).  The "tweet", which I set up to come through my iPhone, often included a brief summary and a link that conveniently took the follower directly to the full content of the new information which was posted on their website.  This saved me time as I did not have actively look for new content on the website if I had not been alerted by Twitter.  I also did not have to surf through the CDC websites to find new information.  This spurs me to seriously consider how I might use Twitter and other social media within my practice of medicine.  I already recognize the value of blogs.  At my son's college, for instance, the dean uses a blog to communicate with his large, diverse community of students, parents, professors and so forth.  He even posts YouTube videos of some of the "happenings" at the University.  I like that as a parent.  So, it has got me seriously thinking about how I might use Twitter and a blog site to allow me to more effectively reach out to my adolescent patients who are quite comfortable with this new type of social interaction.  Perhaps there is a place for Facebook in my practice as well, but will take things one step at a time.  Certainly any large physician group or even a healthcare system could use these social media tools to more effectively communicate with patients, parents and families just as the dean at a University does.   Some are beginning to do that.  Not exactly sure how this will all work out...but I figure the best approach is to jump in with something, get feedback and continually adjust it.


Ambulatory EMR Product Side-By-Side Comparisons

Physicians who are planning to select an EMR for their practice should consider checking with their local, state and national professional organizations for any available EMR product comparison information.  Although a more detailed analysis specific to a practice is needed before selecting an EMR, these tools are helpful for physicians to learn what to ask and look for during their evaluation.

The Texas Medical Association (TMA) recently released a side-by-side comparison of ambulatory EMR products to help physicians in Texas who are in search of an office EMR.  This tool, which TMA members can access on the TMA website, compares self-reported information submitted by the top ten most popular ambulatory EMR vendors in Texas who were invited to answer survey questions (two of these companies declined to participate).  The top ten vendors were determined according to market share as indicated in TMA technology surveys from 2005 to 2007.  The TMA's Health IT Committee facilitated the development of the survey which includes common questions physicians should ask during an EMR selection process.  The TMA articulates that it does not favor, endorse or recommend any particular EMR vendor but does want to provide physicians with some specific information that would help them select an appropriate EMR for their practice (whether it is from the top ten list or not).  A second and more important goal of the TMA is to help physicians learn what to consider during an EMR selection process. The questions and considerations that this comparison tool consolidates for the eight vendor products are:

  1. Practice size for which product is intended
  2. Practice size range of current installations
  3. Number of medical specialties currently installed by the vendor
  4. Most recent CCHIT certification
  5. Existence of a patient portal
  6. Encrypted email capabilities
  7. Ability to provide reports based on PQRI andP4P
  8. SureScripts certification (depth of e-prescribing functions)
  9. Voice-recognition functions
  10. Availability of 24/7 support
  11. Annual updates of CPT/ICD codes
  12. Cost to interface to the state's immunization registry
  13. Does the product support the Continuity of Care Record/Document ?
  14. "Get-started" costs*
  15. "Additional/optional" costs**
  16. Other costs***

*Get-started costs:  software/license, implementation/training, practice management system (interface or additional software/license), e-prescribing (module or interfaces), technical support and hardware

**Additional/optional costs:  data conversion, basic interfaces (lab, radiology, dictation), eligibility verification, patient portal, secure messaging, reporting tools/software/databases, scanning software, voice-recognition software

***Other costs:  The TMA cautions physicians that the costs listed above are mainly just the vendor's costs.  Because physicians are likely to encounter other implementation costs, it is important for them to consider performing a detailed cost analysis prior to selecting an EMR.  Examples of these other costs include additional training costs (computer-based tutorials, hired trainers), office back fill costs (while staff are in training, design or implementation), temporary labor costs (initial EMR data entry, scanning old paper records), temporarily reduced income during implementation, office construction/furniture/shelves/wall mounts/power outlets/chairs/carts/tables, technical upgrade of office infrastructure (wireless networking, upgraded connectivity to internet), consultants/project manager to facilitate the implementation, additional hardware (printers, kiosks, networking devices) and other technical services.

And finally, the TMA recommends that physicians implement the EMR's practice management system if one is available.  Alternatively, the EMR should be interfaced to the physician's practice management system.  This is emphasized because it optimizes their office's work flow.  Poor work flow redesign is a common reason for EMR implementations to result in suboptimal physician satisfaction or even to fail.

Although the information contained in this comparison tool is proprietary and only available to TMA members, the outline of EMR product considerations is valuable for any practice that is planning to select an EMR.  Some national physician professional organizations are developing EMR comparison tools for their members, including the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP).  Interested physicians should check with their local,  state and national professional organizations for EMR product comparison information.

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