Learning Your Way on EMRs & PHRs - LIVE From TEPR 2008

TEPR (Towards the Electronic Patient Record) opened its doors today, May 19, 2008 at the Ft. Lauderdale Convention Center. MDNG will be reporting LIVE with continuous coverage from meeting rooms and the showroom floor; please check back frequently for updates to our homepage Featured Story.

Here, attendees are experiencing a newly designed and expanded conference that has grown beyond the EMR/EHR program that it established nearly 24 years ago. Breaking out of this pattern that is reflected in conferences throughout the industry, TEPR 2008 will explore emerging as well as traditional topics according to major categories of interest.

The 2008 program, developed by Medical Records Institute (MRI) CEO Peter Waegemann, includes twenty-five educational tracks and roughly 500 speakers addressing topics in five major categories: Hospitals, Payers, Physicians, Health IT Professionals, and Web-based Consumer Patient Systems including Digital Health Companions. (Hear more from Waegemann and his thoughts on Regional Health Information Organizations (RHIOs) in MDNG's Podcast interview.)

TEPR's manageable size and comprehensive education program will distinguish it from the hundreds of other HIT events hosted every year. "TEPR 2008 will be known as both the most strategic and practical conference that is convenient and pleasant to attend and offers more stimulating content than any other conference" says Waegemann, who was recently named among the "20 People Who Make Healthcare Better" by HealthLeaders Magazine.

Tuesday, May 204:30PM (EST)

I spent some time on Day Two listening to Carol Teplis, MD, a pediatrician from Chicago, explain her odyssey in finding an EHR. The interesting thing about this presentation was that only one doctor was in attendance. This made for an interesting dynamic in that the rest of us were able to see first-hand how frustrating and time consuming it can be for a physician to find an EHR program that is suitable for their practice.

Teplis described her journey in intricate detail, pointing out tips along the way and instructing us on how the process could have been made easier. For instance, she explained how she was able to eliminate some programs right off the bat, as they didn’t contain specialty-specific data fields and templates that are necessary to streamline her workflow, such as pediatric dosing calculators, autism and lead questionnaires, etc. This points to a much larger issue: EMR companies have to take the time to focus on individual specialties before entering the market; there isn’t going to be any one program that applies across all of them, and, in most cases, giving physicians the ability to create templates and fields is useless because, as Templis told us, she already spent enough time searching for an EMR - she’s certainly not going to spend a great deal of time piecing one together to fit her needs. Another lingering problem is interoperability; a physician may find an EHR that suits them well, but if it is incapable of exchanging data with other programs that are frequently used in the practice, it will only create more work down the line.

Tuesday’s keynote address was given by James Mault, MD, FACS, Director, New Products and Business Development for Microsoft’s Health Solutions Group. Mault took us through the evolution of HealthVault, Microsoft’s hyped-up personal health record program. I have to admit, the program looks very cool; however, I’m not sure I’m convinced that it will be of much use outside of those patients who have chronic conditions. Sure, it’d be neat if I could view my historical health records online because, as everyone says, “you can view your bank statements online” — but the simple fact is that I need to be able to view my bank statements and regularly make banking transactions; I don’t need to check my health record as frequently. I’m really only concerned with my healthcare provider(s) being able to access my information quickly and easily. I could see, however, someone with diabetes revering HealthVault as a valuable tool. For what it’s worth, Microsoft seems to have thought of every single detail (integration, interoperability, security, convenience), and it will be interesting to see how well it is received.

I also attended an informative session with Carolyn Hartley, President and CEO of Physicians EHR, who gave a presentation entitled “The Physicians EHR Training Toolkit.” She was extremely engaging and very well-informed. Hartley broke down the physician-vendor relationship and explained that adults are not receptive to formal learning sessions; rather, they need to be involved and have things explained visually. This seems very accurate, and physicians in the audience did confirm their own personal experiences with vendors who were only concerned with their sales pitch and talking them into their EHR rather than taking the time to really get down to the nuts and bolts of the program to see if it were of value to them. Hartley essentially took her own advice, using her time to engage the audience and take questions, focusing on the barriers to implementing an EHR and offering advice on how to construct a plan where physicians could get all levels of the team on board and explained easy ways to learn EHR programs, such as Web-based training. She mentioned that the most common problem she has seen is when a practice implements an EHR too soon, and strongly encouraged taking the time to complete readiness assessments.

"Drink lots of water, rest, and sign up for an unlimited texting plan." You may be telling this to a patient soon, as there are all kinds of systems set up now for monitoring patients with chronic conditions by cell phone. I sat in on a presentation by Peter Boland of BeWell Technology, who spoke of study findings from a recent research project where patients of all ages who had asthma were reminded to take their medications by phone. Adherence rates were extremely high, and the process is very simple: patients just get text messages, answer yes or no questions, and get short instructions when appropriate. The program has been formatted for use with all cell phone brands by any carrier, and programs for diabetes and hypertension are also in place and doing well. Look for programs like this to start becoming more evident as they continue to produce positive feedback and results.

Well, those are some highlights from Day Two at TEPR. I’ll leave you with my top 10 observations from the conference:

1. Physicians are frustrated with EHR vendors.
2. EHR vendors are frustrated with physicians’ frustration.
3. "Interoperability" is the healthcare IT buzzword of 2008.
4. Aside from the presenters and speakers, I’d estimate about 100 physicians in attendance, which is very surprising given the EHR "classes," vendors, and first-hand experiences as told by other physicians all in one place.
5. There’s no shortage of mayonnaise at the Greater Fort Lauderdale Broward County Convention Center.
6. A lack of free wireless Internet at a technology conference left many physicians, attendees, and MDNG bloggers scratching their heads.
7. Patient portals are the new black.
8. Top three knick-knacks from the exhibitor floor: stress balls, yo-yos, and carabineers.
9. Any presentation with the word "Microsoft" or "Google" in it draws a crowd.
10. It is possible to stay in Fort Lauderdale for three nights and leave with less of a tan than you had when you arrived.

Monday, May 19 4:15PM (EST)

Aside from not providing free wireless internet for attendees (seriously, the whole conference is based on using technology to streamline processes), TEPR is off to a good start in sunny Fort Lauderdale. With focuses on a wide variety of clinical specialties and speakers ranging from IT think-tanks to well-reputed clinicians, there is something here for everyone interested in learning about how electronic records can better the healthcare industry.

I spent a good deal of the morning listening to Dr. James Saul discuss his experience with implementing an EHR in his Cleveland practice, which consists of his father-in-law, his wife, and a couple assistants. He woke up one day and decided that not only would it be more productive to get an EMR, but that he would most likely need to implement one in the foreseeable future. So even though he had opposition from everybody else, he saw a program he liked and went for it. It took about 10 days of hands-on experience to learn the program, and he spoke about the specific features he liked. He was especially fond of his "pick lists," which are data fields that he creates will whatever selectable answers he can input to make for a much quicker documentation of patient encounters when it comes to the typical questions that he asks each of his patients. He mentioned that the existing templates that came along with his EHR program are useful when used appropriately, but cautioned physicians against letting them mechanize patient encounters - because that can lead to changes in their otherwise normal encounter - which could then lead to missed diagnoses. Saul’s wife and father-in-law, who were initially skeptical and adverse to change, eventually took notice of how easy it could be to learn the program, saw the benefits that came along with it, and now use the program themselves. So even though the levels of acceptance and the learning curves are all different, it seems that it only takes one person to adopt the technology to really make a difference in the long term.

One of the afternoon sessions I attended focused on using technology to attract and keep patients. There was a lot of good info to be taken from this session; however, it was also a 45-minute long plug of Kryptiq. The session covered the importance of patient portals and secure messaging to keep a practice on the cutting edge, and, therefore, attract more patients. The presenter used the website www.healthyfuturepeds.com as an example (no doubt a client of Kryptiq’s), and took us through how this particular practice allowed parents to report signs and symptoms online, input the necessary data, and send over a report to the physician office, where nurse’s could immediately review the information. Depending upon the information supplied, users of the site would receive a response telling them that they should call right away to schedule an appointment (in more serious situations) or that their information had been received and they would be contacted by someone from the office soon. For the latter, they could use the site to research common conditions; having trusted, accurate information on a wide variety of conditions is also very important to drive patients to and keep them at the portal, instead of having them turn to a search engine. Users at the site could also request refills and update clinical information. The session brought to light a new generation of physician websites, and how there is a developing trend of informative and convenient patient portals to attract patients.

The latter part of this shortened kick-off day was spent listening to Bill MacLaney, president of CareNav Health Solutions, Inc., talk about how integrating personal health records is as simple as following the banking industry’s lead. After all, who has had enjoyed more growth than banking market in the US over the last five years? According to a Pew Internet & American Life Project survey, no one. MacLaney’s parallels were well-explained and even more sensible. He explained that personal health records (PHRs) must present many conveniences similar to online banking in order to be successful, and that going electronic will create benefits for everyone.

Think about this: right now, you could probably go online and acquire your banking statements from the last few years, likely for free, just to have as a reference. Now think about trying to do that with your health records. Most likely it would entail a trip to your physician’s office, asking for them, and more than likely, paying a fee. MacLaney believes that this is just one of many problems that will be solved with PHRs. He also stressed the intangible value of having people’s health records easily accessible from anywhere so that when a devasting natural disaster like Hurricane Katrina takes place, aid can be provided quickly and safely. His idea of using the banking industry as formula for success is nothing new, but it does seem to apply particularly well to PHRs.

That wraps up the highlights from Monday’s coverage.