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mHealth is Coming of Age

Last week I had the pleasure of attending my first mHealth Summit in Washington, D.C.

The tone and rhetoric of this year’s meeting seemed a great deal different than what I read about last year’s meeting.  Gone was the doctor bashing by keynote speakers.  Instead we heard talks like the one from NIH director Dr. Francis Collins.   His literature review showed there are only 30 published, randomized, and controlled studies of mHealth technology.  Of those studies only 6 showed that mHealth showed a statistically significant improvement in patient care. He admonished the audience to subject mHealth technology to the same rigorous, statistically relevant testing that is given to other potential advances in health care.

Bravo.  Music to my ears.  That is something everyone in mHealth needs to hear.

Other speakers and panelists shared similar views.  I was also pleased to hear several acknowledgements of the critical role physicians must take in mHealth.  Until that point I had wondered if some mHealth proponents thought they needed doctors at all.

I was delighted to meet Arthur Lane, Director of Mobile Healthcare Solutions at Verizon Wireless.  Readers of my blog may recall I (unfavorably) reviewed Verizon’s home monitoring program for congestive heart failure (CHF) patients.   After discussing with Arthur my concerns about the program I realized we were very much on the same page.  He is aware of the literature, including the Yale study showing no benefit for home monitoring of CHF patients.  He has a very grounded approach to solving the issues raised by the medical literature.  That conversation changed my opinion of the project.  I like what they are doing.

I was also a panelist in a discussion entitled “Converting to mHealth: How to Drive Change”.  We had a very spirited discussion before a standing-room-only crowd.  I was very impressed with the moderator and the other panelists as well as the questions from the audience.  Much of the discussion addressed the relationship of doctors to health IT folks and the relative role of each in driving mHealth forward.  The discussion demonstrated that this is a complex issue with emotions on both sides.  I’ll have more to say about this in a future post.

It was gratifying to come home with my faith as least partially restored.  mHealth has matured over the past year.  And perhaps my own feelings about mHealth have matured as well.

 

 

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December 11, 2012 I Written By

Dr. Michael J. Koriwchak received his medical degree from Duke University School of Medicine in 1988. He completed both his Internship in General Surgery and Residency in Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center. Dr. Koriwchak continued at Vanderbilt for a fellowship in Laryngology and Care of the Professional Voice. He is board certified by the American Board of Otolaryngology-Head and Neck Surgery. After training Dr. Koriwchak moved to Atlanta in 1995 to become one of the original physicians in Ear, Nose and Throat of Georgia. He has built a thriving practice in Laryngology, Care of the Professional Voice, Thyroid/Parathyroid Surgery, Endoscopic Sinus Surgery and General Otolaryngology. A singer himself, many of his patients are people who depend on their voice for their careers, including some well-known entertainers. Dr. Koriwchak has also performed thousands of thyroid, parathyroid and head and neck cancer operations. Dr. Koriwchak has been working with information technology since 1977. While an undergraduate at Bucknell University he taught a computer-programming course. In medical school he wrote his own software for his laboratory research. In the 1990’s he adapted generic forms software to create one the first electronic prescription applications. Soon afterward he wrote his own chart note templates using visual BASIC script. In 2003 he became the physician champion for ENT of Georgia’s EMR implementation project. This included not only design and implementation strategy but also writing code. In 2008 the EMR implementation earned the e-Technology award from the Medical Association of Georgia. With 7 years EMR experience, 18 years in private medical practice and over 35 years of IT experience, Dr. Koriwchak seeks opportunities to merge the information technology and medical communities, bringing information technology to health care.

Filed Under: mHealth  mHealth Summit  physician
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EMR Note Cloning is Scarier than I Thought

The health IT community is well aware of the dangers of cloning notes in an electronic medical record.  I include myself in that group.  Until recently I prided myself for doing a good job, both in our EMR design and in my own personal practice, of using just the right amount of automation in our documentation workflow.  Two recent events showed me that I still have some work to do.

The first event occurred a few weeks ago when I was reviewing some records.  One patient note documented an enlarged salivary gland containing a stone.  That would be fine except for one small detail – I had removed that gland one week prior to the date of the note!  My nurse had created that note.  A conversation with her revealed she thought she was doing the right thing by always clicking the “previous finding” button, which I had programmed myself.  My nurse is extremely bright; this was my fault for not training her on this issue.  I had also signed that note.  So it was my fault twice.  After a 30 second conversation with my nurse it has not happened since.

The second event was when an attorney interviewed me regarding one of my patients.  I was a treating physician in a malpractice case (I am not the defendant thankfully).  The attorney wanted to know if, in my opinion, the physician defendant had met the standard of care in treating the patient despite the adverse outcome.

This was a high-risk case for note cloning; the patient had multiple abnormal neurologic findings that were stable over time.  In reviewing my records I was satisfied that my notes were accurate, complete and original for every visit.  I avoided cloning those abnormal but stable findings by describing the same exam but using slightly different wording at each visit.  How else do you avoid cloning?  But the attorney pounced on my small changes in description, trying to establish a trend in my notes that the patient was getting worse.  I explained the cloning issue to him, and he understood…. I think.  Nonetheless I felt somewhat uncomfortable defending my documentation, and I was not even the defendant.  In trying to avoid cloning notes I had stepped right into another problem.

This issue is huge in my practice.  I have a large volume of head and neck cancer patients.  The essence of caring for them properly is to monitor them for changes in their abnormal – but stable – physical findings.  A recurrence of cancer might manifest as a subtle change in one of these findings.

How do you document that an examination is stable and unchanging, but change your wording enough to document that you actually examined the patient at every visit?  We do not yet have the cloning issue figured out.

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June 15, 2012 I Written By

Dr. Michael J. Koriwchak received his medical degree from Duke University School of Medicine in 1988. He completed both his Internship in General Surgery and Residency in Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center. Dr. Koriwchak continued at Vanderbilt for a fellowship in Laryngology and Care of the Professional Voice. He is board certified by the American Board of Otolaryngology-Head and Neck Surgery. After training Dr. Koriwchak moved to Atlanta in 1995 to become one of the original physicians in Ear, Nose and Throat of Georgia. He has built a thriving practice in Laryngology, Care of the Professional Voice, Thyroid/Parathyroid Surgery, Endoscopic Sinus Surgery and General Otolaryngology. A singer himself, many of his patients are people who depend on their voice for their careers, including some well-known entertainers. Dr. Koriwchak has also performed thousands of thyroid, parathyroid and head and neck cancer operations. Dr. Koriwchak has been working with information technology since 1977. While an undergraduate at Bucknell University he taught a computer-programming course. In medical school he wrote his own software for his laboratory research. In the 1990’s he adapted generic forms software to create one the first electronic prescription applications. Soon afterward he wrote his own chart note templates using visual BASIC script. In 2003 he became the physician champion for ENT of Georgia’s EMR implementation project. This included not only design and implementation strategy but also writing code. In 2008 the EMR implementation earned the e-Technology award from the Medical Association of Georgia. With 7 years EMR experience, 18 years in private medical practice and over 35 years of IT experience, Dr. Koriwchak seeks opportunities to merge the information technology and medical communities, bringing information technology to health care.

Filed Under: EHR  Electronic Health Record  Electronic Medical Record  electronic medical records  EMR  EMR note cloning  physician  workflow
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EMR Workflow Continues to Evolve

As we approach the midpoint of 2012 our practice will complete 7 years of electronic medical records.  Just like a musical instrument, we will never have EMR fully mastered, but our skills and wisdom continue to grow slowly with time.  Over the past several weeks one lesson is becoming clear.

To this point I have equally supported 2 types of workflow for the exam room.  The first involves the physician working solo in the exam room with a laptop or tablet computer.  The medical assistant remains at the nurses’ station to support workflow.  In our financially strained environment we can’t afford to add another medical assistant to put in the exam room with the physician.   In this model the EMR enhances the physican’s documentation and workflow control capabilities and eliminates the need for an assistant in the exam room.

In the second workflow the doc never touches the computer.  Instead a medical assistant or nurse accompanies the doc to the exam room and documents on a laptop.  After capturing the results of the physician interview and the exam findings, the assistant documents workflow in the EMR.   The doc uses the workflow engine to initiate and control workflow.  It works well but carries the expense of an additional assistant, some $40k per year including benefits.

Over the past year I have been blessed with 2 exceptionally talented RNs who are both outstanding clinicians and savvy computer users.  The first of them will be going out on maternity leave soon, so the second was hired.  For several weeks they have both been working and training together so I have had the (expensive) luxury of having an extra assistant to bring to the exam room.  Thanks to them I have come to realize there is no reason for me to operate the workflow engine.  For most patients the RN can listen to my conversation with the patient and initiate the treatment workflow via the workflow engine.

By allowing the RN / assistant to operate the workflow engine we eliminate the need to keep an assistant at the nurses station and this eliminate the additional expense.

We have also replaced our web portal vendor after several frustrating, unsuccessful years.  I am very excited about the Intuit product.  Although I have been wrong many times about similar technologies in the past I remain hopeful that that the new portal will be attractive to patients.  If that happens we will finally be able to automate several workflows and get a measurable return on investment on the portal itself.

Combining a successful web portal with a sophisticated workflow engine operated by staff holds the promise of taking our practice to the “next level” with our EMR.  This will allow us to automate data input, workflow management and patient communication.  This is very important to physicians.  As a group we docs see EMR as something we constantly put resources into but rarely get anything back out.   This would be a big step past that barrier.

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May 8, 2012 I Written By

Dr. Michael J. Koriwchak received his medical degree from Duke University School of Medicine in 1988. He completed both his Internship in General Surgery and Residency in Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center. Dr. Koriwchak continued at Vanderbilt for a fellowship in Laryngology and Care of the Professional Voice. He is board certified by the American Board of Otolaryngology-Head and Neck Surgery. After training Dr. Koriwchak moved to Atlanta in 1995 to become one of the original physicians in Ear, Nose and Throat of Georgia. He has built a thriving practice in Laryngology, Care of the Professional Voice, Thyroid/Parathyroid Surgery, Endoscopic Sinus Surgery and General Otolaryngology. A singer himself, many of his patients are people who depend on their voice for their careers, including some well-known entertainers. Dr. Koriwchak has also performed thousands of thyroid, parathyroid and head and neck cancer operations. Dr. Koriwchak has been working with information technology since 1977. While an undergraduate at Bucknell University he taught a computer-programming course. In medical school he wrote his own software for his laboratory research. In the 1990’s he adapted generic forms software to create one the first electronic prescription applications. Soon afterward he wrote his own chart note templates using visual BASIC script. In 2003 he became the physician champion for ENT of Georgia’s EMR implementation project. This included not only design and implementation strategy but also writing code. In 2008 the EMR implementation earned the e-Technology award from the Medical Association of Georgia. With 7 years EMR experience, 18 years in private medical practice and over 35 years of IT experience, Dr. Koriwchak seeks opportunities to merge the information technology and medical communities, bringing information technology to health care.

Filed Under: Electronic Medical Record  electronic medical records  EMR  physician  workflow
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The “Enthusiasm Gap” in Health IT

My next piece is published at Townhall.com:

 

Despite the success of information technology (IT) in transforming many parts of the economy, the health care sector has proven itself immune to the seduction of smart phones and iPads.  This is puzzling at first glance.  It is certainly not due to any shortage of health IT products.  The problem appears to be on the demand side.

A recent article by Olga Khazan in The Washington Post provides some explanation. She reports on the third annual mHealth Summit, held earlier this month in Washington D.C.  The event has attracted such notables as Bill Gates and Ted Turner, according to the mHealth website.  The piece laments the “enthusiasm gap” between Health IT startup companies offering dozens of miracle products and those darn stick-in-the-mud physicians who just can’t get with the program.   But meetings like the mHealth Summit actually hurt the movement of Health IT that they profess to support.

The poster child for Ms. Khazan’s article is Dr. Eric Topol, one of the Summit’s keynote speakers.  HHS Secretary Kathleen Sebelius joined Dr. Topol behind the podium.  Together they offered Health IT Utopia – where “you can take a video of a rash on your foot and get a diagnosis…without making a doctor’s appointment.”  Then they criticized practicing physicians using the same old Obamacare propaganda.  Ms. Sebelius continued, “Americans still live sicker and die sooner than many of the people in other nations…Healthcare has stubbornly held on to its cabinet and hanging files.”  Dr. Topol called the medical community “ossified” regarding the adoption of health information technology.  The author starts the online post-article comment thread herself with the question, “How do we encourage doctors to be more open to these technologies?”

This kind of meeting is common in the Health IT (HIT) community.  A bunch of self-described HIT experts get together, pump each other up about the absolute perfection of their products, and then start bashing physicians because – literally and figuratively – we aren’t buying it.  At similar meetings I have heard HIT people brag about walking out on their doctor the minute he pulled out a paper prescription pad.  Doctors are called fearful, stupid, or rich fat-cats protecting their turf.  Now thanks to our “colleague” Dr. Topol we can add, “ossified” to the list of unflattering terms.  It comes as no surprise that the government is happy to join in the sing-along.  It is a free opportunity to serve Obamacare Kool-Aid.

I am a dedicated supporter of HIT.   Our practice’s EMR implementation reached a reasonable level of maturity long before Obamacare, HITECH incentives, and Ms. Sebelius came along.  We became Meaningful Use – compliant the first of October.  I believe in the potential of HIT to revolutionize the practice of medicine by reducing costs and improving efficiency and quality of care.  But I do not believe the HIT community is on a course that will take us to that vision.

Read the rest of the article here at Townhall.com

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January 5, 2012 I Written By

Dr. Michael J. Koriwchak received his medical degree from Duke University School of Medicine in 1988. He completed both his Internship in General Surgery and Residency in Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center. Dr. Koriwchak continued at Vanderbilt for a fellowship in Laryngology and Care of the Professional Voice. He is board certified by the American Board of Otolaryngology-Head and Neck Surgery. After training Dr. Koriwchak moved to Atlanta in 1995 to become one of the original physicians in Ear, Nose and Throat of Georgia. He has built a thriving practice in Laryngology, Care of the Professional Voice, Thyroid/Parathyroid Surgery, Endoscopic Sinus Surgery and General Otolaryngology. A singer himself, many of his patients are people who depend on their voice for their careers, including some well-known entertainers. Dr. Koriwchak has also performed thousands of thyroid, parathyroid and head and neck cancer operations. Dr. Koriwchak has been working with information technology since 1977. While an undergraduate at Bucknell University he taught a computer-programming course. In medical school he wrote his own software for his laboratory research. In the 1990’s he adapted generic forms software to create one the first electronic prescription applications. Soon afterward he wrote his own chart note templates using visual BASIC script. In 2003 he became the physician champion for ENT of Georgia’s EMR implementation project. This included not only design and implementation strategy but also writing code. In 2008 the EMR implementation earned the e-Technology award from the Medical Association of Georgia. With 7 years EMR experience, 18 years in private medical practice and over 35 years of IT experience, Dr. Koriwchak seeks opportunities to merge the information technology and medical communities, bringing information technology to health care.

Filed Under: CPT  EHR  Electronic Health Record  Electronic Medical Record  electronic medical records  EMR  government  HITECH  Meaningful use  Medicare  mHealth  physician
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Why Should Doctors Trust the Government?

This article is published at Townhall Finance and was written for a Docs4PatientCare.   This is much more politics than Health IT but still a good read.

MK

Find the article here

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July 26, 2011 I Written By

Dr. Michael J. Koriwchak received his medical degree from Duke University School of Medicine in 1988. He completed both his Internship in General Surgery and Residency in Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center. Dr. Koriwchak continued at Vanderbilt for a fellowship in Laryngology and Care of the Professional Voice. He is board certified by the American Board of Otolaryngology-Head and Neck Surgery. After training Dr. Koriwchak moved to Atlanta in 1995 to become one of the original physicians in Ear, Nose and Throat of Georgia. He has built a thriving practice in Laryngology, Care of the Professional Voice, Thyroid/Parathyroid Surgery, Endoscopic Sinus Surgery and General Otolaryngology. A singer himself, many of his patients are people who depend on their voice for their careers, including some well-known entertainers. Dr. Koriwchak has also performed thousands of thyroid, parathyroid and head and neck cancer operations. Dr. Koriwchak has been working with information technology since 1977. While an undergraduate at Bucknell University he taught a computer-programming course. In medical school he wrote his own software for his laboratory research. In the 1990’s he adapted generic forms software to create one the first electronic prescription applications. Soon afterward he wrote his own chart note templates using visual BASIC script. In 2003 he became the physician champion for ENT of Georgia’s EMR implementation project. This included not only design and implementation strategy but also writing code. In 2008 the EMR implementation earned the e-Technology award from the Medical Association of Georgia. With 7 years EMR experience, 18 years in private medical practice and over 35 years of IT experience, Dr. Koriwchak seeks opportunities to merge the information technology and medical communities, bringing information technology to health care.

Filed Under: government  Medicare  physician  spying on doctors
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