News

Digg It Bookmark It Email It Live It ...

2007-07-13T12:10:00Z

Just added some links at the bottom of Blog Posts allowing you to

email it
bookmark it
digg it
live it

Email it pops a new mail item containing a URL to the Blog topic you're sending to a colleague or friend.

Bookmark it sends your bookmark to your account at Del.icio.us
(You need an account to use this Bookmark service)

Digg it sends the blog URL to Digg
(ditto - need an account to submit Diggs)

Live it sends the blog URL to Microsoft Live Favorites
(ditto - need an account to use the MS favs service)

Trying to get these added to Forum Posts.

If anyone wants to recommend Robert's next interview for a Digg or email to an old flame or colleague you now have the tools under each Blog Post.

Nick

To read more about Digital Docs new cellphone see here: http://www.engadget.com/2007/07/12/transformers-phone-sports-lethal-theft-deterrent-system/

Adding YouTube & Wikipedia references

2007-07-10T13:08:00Z

Support for embedded YouTube media content

In support of our planned EMR Showcase we've just re-instated support for embedding [wikipedia:YouTube] video content inside a Blog or Forum Post. This means that we can use video to show EMR demonstrations or even handy How-To videos which a poster may create to describe a fix for a specific issue.

The best way of demonstrating this support is to ... show a YouTube video embedded within this Blog post.

Using YouTube's all time most viewed video The Evolution of Dance by [wikipedia:Judson Laipply] we want to embed the ID for the video inside brackets using this syntax:

where the URL at YouTube is http://www.youtube.com/watch?v=dMH0bHeiRNg

[YouTube:dMH0bHeiRNg]

This shows the video served within this blog post.
Click the play button to watch this video.

Tagging your Post using Wikipedia entries

You can spot there are a number of Yellow Highlights over [wikipedia:YouTube] and the creator of the Evolution of Dance [wikipedia:Judson Laipply]. Hovering over these entries allows you to click for some quick information about the highlighted Wikipedia entry.

To tag one of your words with a Wikipedia reference use the following syntax where the word "TOPIC" is the subject you want displayed by a Wikipedia entry.

Create your own customized post Signature

2006-09-27T16:11:00Z

We've had a number of posters attempting then failing to create a swish functional signature for their poster profile here at emrupdate.com. Part of the challenge is that CommunityServer does massage content to remove any code likely to wreck page presentation... the exception being when I post an image that exceeds your page boundary. This is deliberate to show our "John Doe" signature: (yes, yes there's a mistake in the picture, I'm busy)

This signature is made up of

my fictional name
my email address; obfuscated to prevent spam
my web-site address; formed to open in a new window
my tag line followed by trademark ™ and registered ®

The email address obfusaction is credit to Al Borges who tracked down the following site:
http://www.u.arizona.edu/~trw/spam/spam2.htm

Enter your email address into their email obfuscator - this converts your email address to a bunch of code and characters. Thereby your email address can only be read by someone who using an ordinary browser - not an email harvester. Of course, you do not have to include your email address within your signature.

To see roughly what the above looks like, check out the following lucky posters' signatures that I fiddled with to get the right appearance:

bbchase with a post here
sanvas with a post here
Terry from DescriptMed was already way ahead of the above two posters.

If you still need help & assistance getting just the right signature - send emrupdate.com a donation and I will happily construct a winning signature for your internet EMR presence. None of the above posters were charged for the mention.
:)

Nick

Chat Room Rules and Etiquette

2006-09-13T14:52:00Z

As you surf around our Forums you may come across a Chat Icon, looks like a nice "Cup of English Tea":

Each Forum contains its own Chat icon, meaning if you want to talk Billings, visit the Billings Chat room. Once in a Room you can Jump to any other active Rooms. If there is no one in a Room, it is not active and will therefore not appear. Head over to Forums or review the picture below:

We're currently on a 30-day Evaluation of the CuteChat Software. If you would like this feature maintained and made permanent - we could do with a hand towards its purchase ($299). You can donate a few bucks here.

If you're an EMR Vendor and you're spotted in the Rooms BUT HAVE NEVER DONATED A SINGLE DIME TOWARDS THIS SITE you will be discovered and shamed. Go here first.

A word about Chat Room Rules and NEtiquette:

You're chatting with fellow Doctors or industry professionals. Be polite, civil and honest at all times.
Please, no bad language. Be imaginative and erudite in your put-down. It shows you have an education. Your Mom and Pop will be proud.
No sexist, racial or religious insults. That sort of stuff isn't acceptable here.
These are public Chat Rooms - never disclose any personal information - of any kind - within these Rooms (or anywhere else on the internet) unless this involves dressing up in ladies clothing on weekends.
IF YOU DO SOMETHING that doesn't go down well within our community we reserve the right to retrospectively create a rule to outlaw your behaviour. (Cunning)
ANY NEW RULE that we create can be applied retrospectively to any member. (Clever eh)
There is no Rule 7.
The collective decision of the Moderators is final, unless we decide otherwise.

We don't want to get heavy, but guys and gals, play nice.

All of the Chat discussions are recorded to SQL Server database with date, time, IP address and other identity information.

That donation link again in case you had already forgotten.
Go on, you won't miss $10.00. Its tax-deductable.

Active Topics

2006-09-13T10:00:00Z

Long, long time ago, we used to be based upon Snitz 2000 Forum Software (Active Server Pages). This provided an excellent Active Topics function for which we didn't find a comparable function within our current software Community Server.

Well...

Community Server did develop - but didn't publicise - the very thing we thought lacking from Community Server that Snitz provided.

If you now check the menu above, you can see the Active Topics button:

HOWEVER - there are a few issues to resolve:

I need to fix the menu code such that "Active Topics" is the "active" menu; not too important, but a valid niggly complaint.
The time period value (e.g. New since last visit) doesn't persist. (Needs a cookie or equivalent)
The Active Topics page really needs a timer to auto-refresh in X-minutes, such as Refresh every 5-mins, 15-mins, 1-hour.

Have I missed anything? I'm posting the above request at Community Server and will insert the request link (here)

Adding Digg It, Email It and YouTube movies into Blog Posts

2006-09-11T11:46:00Z

Fred Trotter along with other posters posted here a list of excellent ideas for improving our search engine site ranking and generally trying to increase our readership. I've been busy all morning adding various features to help make some of this possible.

I've added support for the following widgets and neat features:

Support for Camtasia embedded Flash Movies
(Already live on Graham Chiu's Free EMR site synapsedirect.com)
Support for YouTube embedded Movies
(Wonder which poster will love this feature?)
Support for an EMail It link under a Blog or Forum post
(Go find an interesting post, and email it to a Doctor who doesn't know emrupdate)
Support for a Digg It link under a Blog or Forum post

What is Digg?

Digg is a user driven social content website. Ok, so what the heck does that mean? Well, everything on digg is submitted by the digg user community (that would be you). After you submit content, other digg users read your submission and digg what they like best. If your story rocks and receives enough diggs, it is promoted to the front page for the millions of digg visitors to see.

What can you do as a digg user? Lots. Every digg user can digg (help promote), bury (help remove spam), and comment on stories... you can even digg and bury comments you like or dislike. Digg also allows you to track your friends' activity throughout the site — want to share a video or news story with a friend? Digg it!

Want to know more how the site works? Read our FAQ.

You Tube Test

I've added below the YouTube link to "Where the Hell is Matt"
(That guy on the internet who is filmed dancing around the world)
This is the URL to the movie: http://www.youtube.com/watch?v=bNF_P281Uu4
So we strip off the last reference after the = sign and place as the following text part

{YouTube:bNF_P281Uu4} replacing my {} parenthesis for []

[YouTube:bNF_P281Uu4]

Nick

OK! Own up, who's still using Win 3.1? (or an Executive Summary of emrupdate.com statistics)

2006-09-02T19:36:00Z

This is our executive summary of emrupdate statistics for the month of August 2006.

What operating systems are you Docs / EMR Vendors using? I have to ask WHO is still using Windows 3.1? One of Al Borges' eBay purchases? More Macs than I would have bet on! Cyath? Ducknet?

Page Views
We executed a software upgrade back in Feb - this involved a complex database migration - or a simpler new database instance. I took the latter option. I think we're seeing just a seasonal dip as our regulars take vacations, therapy, treatment and complete gender re-alignment surgery.

Historic Visits
I think these figures are quite alarming! Quite a progressive drop in our historic visits - however some of the drop is a product of an increase in RSS fed viewing.

and this as an Activity Breakdown for August 2006:

For the technical amongst you: Historic Bandwidth:

How long do you spend on site? These are our average Times Per Visit:

The increase in time per visit has been statistically proven as as result of members revisiting Al Borges Medical Picks as they ask "No. Al didn't post that, did he?"
" />

I mentioned above, an increase in RSS driven usage. This is our Page Activity breakdown:

The prior months executive summary can be downloaded from the Visitors counter or here.

Hope you all enjoyed your statistics.
Nick Harrington
"That English Chap"

Al Borges posts open letter to Dr. Robert Lowes

2006-09-02T12:23:00Z

Dr. Al Borges (alborg) has posted a detailed response to Dr. Robert Lowes article "The Best EHRs for Small Practices" in Medical Economics.

The Medical Economics article can be found at:
http://www.memag.com/memag/article/articleDetail.jsp?id=367341&pageID=1&sk=&date

with Al Borges post at:
http://www.emrupdate.com/forums/thread/54518.aspx

Thanks to Al for the research and comment in providing this response.

emrupdate Newsletter Saturday August 19, 2006 by Al Borges, MD

2006-08-19T09:10:00Z

Since the ground breaking initial emrupdate Newsletter of 5/5/2006 much has occurred on various fronts both in the world of EMRs and at emrupdate.com. (Type-setting and jockey-asides by Nick)

This Newsletter Contents

Bibliography - Newsletter Contents
Certification Commission for Healthcare Information Technology (CCHIT)
CDC: More Physicians Using Electrical Medical Records
IBM Brings Electronic Medical Records One Step Closer Through Open Technology
The British National Programme for IT vs EMR Adoption in the USA
The Rand Corporation Study
Articles Posted During the Past 3 Months at emrupdate.com
The eCHIT Process
Medical Voice Recognition and General IT, Hardware & (non-EMR) Software Sections
Editorial- The State of the IT Industry 1986 vs. 2006
Changes/Additions To emrupdate.com and Statistics

Certification Commission for Healthcare Information Technology (CCHIT)

There have been numerous milestones concerning CCHIT since the initial emrupdate.com Newsletter. On 5/24/2006 Naveen had the opportunity to participate in a ‘Town Hall’ meeting with Dr. Mark Leavitt, the headman at CCHIT, at the TEPR ’06 event. He reports on the difficulties Dr. Leavitt had with the seemingly unruly, angry audience. Check out the thread located here.

The first 24 certified EMRs were published and discussed here. Every EMR that was presented passed. Many wonder what will happen when CCHIT begins to fail EMRs that apply for certification, which at some point it must do to demonstrate a meaningful process. If it doesn't, then CCHIT may turn out to be simply a buy-in clout process for the large, powerful EMR companies. As Jason (DrMurdoch) aptly stated that this list represents "a big long list of the who's who in old school of overpriced EMRs". Here's the list:

1. Centricity® EMR 2005 Version 6.0 (GE Healthcare)
2. Companion EMR v8.5 (Companion Technologies)
3. eClinicalWorks Version 7.0 Release 2 (eClinicalWorks)
4. e-MDs Solution Series 6.1 (e-MDs)
5. EncounterPRO® EHR 5.0 (JMJ Technologies)
6. EpicCare Ambulatory EMR Spring 2006 (Epic Systems)
7. HealthMatics Electronic Health Record 2006 (Allscripts)
8. Horizon Ambulatory Care Version 9.4 (McKesson)
9. iMedica Patient Relationship Manager 2005, version 5.1 (iMedica Corporation)
10. Intergy® EHR v3.00 (Emdeon Practice Services)
11. MEDENT 16
12. (Community Computer Service)

13. Medical and Practice Management Suite Client Server Version 5.5 (Service Release 2.1)
14. (LSS Data Systems)
15. Misys EMR 8.0 (Misys Healthcare Systems)
16. mMD.Net EHR 9.0.9 (MCS-Medical Communication Systems)
17. myNightingale Physician Workstation 5.1 (Nightingale Informatix Corporation)
18. NextGen EMR 5.3 (NextGen Healthcare Information Systems)
19. Patient Records 9 (Practice Partner)
20. PowerChart 2005.02 (Cerner Corporation)
21. Praxis® Electronic Medical Records, version 3.4 (Infor-Med Corporation)
22. Record 2006 (V 3.0) (MedcomSoft)
23. TouchWorks Electronic Health Record 10.1.1 (Allscripts)
24. WebChart 4.23 (Medical Informatics Engineering)

On 8/15/2006 President Bush has put out an executive order concerning CCHIT, with the NIH Health Policy newsletter stating:

"The Bush White House is issuing an Executive Order requiring health care providers to use information technology systems certified by the Certification Commission for Healthcare Information Technology (CCHIT) and meeting federally approved efficacy and interoperability standards [if they wish to work with Medicare, Medicaid, and major insurance companies in future pay for performance schemes]."

The push is also being seen in town-hall meetings. In my neck of the woods I will be attending such a meeting in 2 weeks. Stay tuned for my thorough report on the 6 hour meeting.

The jury is still out whether CCHIT will really help or hinder the growth of the EMR industry in the United States. Although they have decreased the cost of certification slightly, the $28000.00 per year cost for certification will increase the overall costs of CCHIT-certified EMRs taking these softwares to economically unreachable levels to providers. Fritz Switzer aptly looked at Sanvas/Doctors Partner Price Matrix using the information in the "2 Year Total Cost" column and found the following data:

Average EMR/Product cost (all companies) = $18,776.50
Average EMR/Product cost (CCHIT Certified) = $30,690.80
Average EMR/Product cost (non-Certified) = $17,066.00

CDC: More Physicians Using Electrical Medical Records

Nearly one in four (23.9 percent) of physicians reported using full or partial electronic medical records (EMRs) in their office-based practice in 2005 - a 31 percent increase from the 18.2 percent reported in 2001. CCHIT advocates claim that for the 2006-2007 year certification of EMRs will bring about a 30 percent increase from the current 24% level.

URL: http://www.cdc.gov/od/oc/Media/pressrel/a060721.htm
And
“Experts Predict Sharp Rise in Electronic Medical Record Adoption”,
URL: http://www.genengnews.com/news/bnitem.aspx?name=4557625

IBM Brings Electronic Medical Records One Step Closer Through Open Technology

IBM announced on 8/9/2006 a major step in the drive toward a national electronic medical records system by contributing software technology that supports the exchange of healthcare information to the open source community (“interoperability”).

The software, contributed to the Eclipse Foundation's Open Healthcare Framework (OHF) project, might allow for the creation of an EHR network similar to the Internet that would have no central depository but would allow doctors to access patient records from anywhere nationally.

Could this be a major CCHIT competitor? It’s goal seems to be focused on interoperability, which is what will eventually really drive the growth of EMRs nationwide.

URL: http://www.forbes.com/businesswire/....63r1.html
Discussion: http://www.emrupdate.com/forums/thread/53449.aspx

The British National Programme for IT vs EMR Adoption in the USA

Electronic Medical Records (EMRs) are now a well established part of medicine in much of Europe, with as many as 90% of practitioners using recording patient histories and care electronically. Since 2001, over half of the physicians in the United Kingdom (UK) and the Netherlands used EMRs.

The UK has a socialized medical care offered through the National Health Service (NHS). No matter which part of the United Kingdom a citizen is from, they are entitled to health care through the NHS provided by the taxes they pay. The NHS has created a plan called the National Programme for IT (NPfIT), and is currently in the process of implementation. The program is stated to “connect over 100,000 doctors, 380,000 nurses and 50,000 other health professionals and give patients access to their personal health and care information”. The program is laying the groundwork to better organize Britain’s health care system by digitizing medical records and providing doctors and patients with a way to quickly connect to the health care system to view records. In addition, the NPfIT will have a service to schedule appointments to meet with doctors, to transfer prescription information, to transfer records between practitioners, and to establish a national broadband network to support these services.

On 4/11/2006 a group of 23 computer science academics from around the UK have written an open letter calling for an “independent technical assessment” of the National Programme for IT. They asked the British House of Commons health select committee for: "Concrete, objective information about NPfIT's [National Programme for IT] progress is not available to external observers. Reliable sources within NPfIT have raised concerns about the technology itself. The report is due out by the end of the year.

In the United States, President George W. Bush has introduced a plan to have a nationwide Electronic Medical Record system in place by the year 2014. This system would be similar to the United Kingdom’s NPfIT project.

The biggest barrier to the adoption of EMRs, though, is the initial capital cost required by hospitals and medical facilities to create an EMR system. Many physicians are also worried about an increased workload associated with updating and maintaining EMRs. Doctors fear that there will be a great deal of time spent performing data entry, as well as learning how to use the new EMR systems. The final major barrier to entry is one of the most critical: security.

In conclusion, only time will tell if and when these ambitious programs will be successful. In the USA the question is whether an expensive standardization process (CCHIT) or whether a simple focus on interoperability is the way of the future.

URLs: http://www.personal.psu.edu/kjs266/IST431/Utilization.htm and http://www.ehiprimarycare.com/news/item.cfm?ID=1822

The Rand Corporation Study

A Rand Corporation study published last fall estimated that only 15 percent of physicians and 20 percent of hospitals use computers to manage records. Key findings:

Properly implemented and widely adopted, Health Information Technology would save money and significantly improve healthcare quality.
Annual savings from efficiency alone could be $77 billion or more.
Health and safety benefits could double the savings while reducing illness and prolonging life.
Implementation would cost around $8 billion per year, assuming adoption by 90 percent of hospitals and doctors’ offices over 15 years.
Obstacles include market disincentives: Generally, those who pay for Health Information Technology do not receive the related savings.
The government should act now to overcome obstacles and realize benefits.

URL: http://www.rand.org/pubs/research_briefs/RB9136/index1.html

Articles Posted During the Past 3 Months at emrupdate.com

The following articles were posted in the general EMR Forum section:

State [Massachusetts] Project Pushes EMRs; Some Docs Fret About Future, http://www.healthdatamanagement.com/html/current/CurrentIssueStory.cfm?articleId=13616
Expected and Unanticipated Consequences of the Quality and Information Technology Revolutions, http://www.emrupdate.com/forums/thread/52384.aspx
Clinics Offer Fast Care and Copy of Records, http://www.emrupdate.com/forums/thread/52355.aspx
Interoperability Issues and Solutions: Work of the CCR Acceleration Task Force, http://www.emrupdate.com/forums/thread/52763.aspx
Microsoft to Offer Health Care Software, http://www.emrupdate.com/forums/thread/53030.aspx

The eCHIT Process

The emrupdate.com eCHIT section has been quiet for the past 2 months, but it’s far from dead. Right now everyone is frozen, trying to see how the CCHIT process will evolve and how they will adjust to the changes. The eCHIT will come in handy if and when it seems that CCHIT does somehow develop a real following outside of government and insurance company spending and incessant advertisement.

Medical Voice Recognition and General IT, Hardware & (non-EMR) Software Sections

The most important discussions have been concerning the new Dragon Naturally Speaking 9 and the new Paperport 11. There has been much debate on whether or not they are worth the upgrade. Paperport 11 in particular has been found to be buggy and at times much slower than the excellent predecessor, Paperport 9. Dragon Naturally Speaking 9 continues to become more of a memory hog than prior versions, and may require major upgrades to laptops and older desktop computers. Both of the newer versions of these products include the dreaded “product activation” schemes that limit the use of the software to one installation.

Other discussions have included Windows VISTA, Office 2007, setting up a RAID solution, FAX software solutions, and backing up your data. Numerous hardware devices have been discussed, including the Origami, the Motion LE1600, some weird USB devices, and wired and wireless network devices.

Editorial - The State of the IT Industry 1986 vs. 2006

For my recent trip to Vancouver/Alaska I quickly grabbed a book off my bookcase called Computers In Medicine, Applications and Possibilities by Jonathan Javitt, M.D., M.P.H.. This book was somewhat outdated, published in 1986- exactly 20 years ago. This mistake, though, was very interesting because the data reflected an era before Microsoft ruled the IT industry, before the microcomputers became the standard computer platform, and before Visual Basic and other RAD languages became the norm.

Chapter 1 begins discussing the then-current use of computers by physicians- for financial transactions, for scheduling and appointment keeping, for cognitive processes (“primitive software programs are now available…”), for medical education, and for accessing the literature. “The Future of Computers in Medicine” included uses for chief complaint and history taking, vital signs and laboratory workup, patient encounter documentation, diagnosis formulation, and plan of care. These things can be the “future” hallmarks of a general electronic record keeping process of what we now call the electronic medical record, or “EMR” (they didn’t call it that then). Futuristic statements made included:

“Truly portable computers will allow the writing of quick notes a the time of each office visit and while making rounds in the hospital.”
“Electronic interchanges can easily make those notes available to the hospital or to another medical office, as indicated.”
“Hopefully, the efficiency of record keeping will be a potent factor in leading doctors to get over their antipathy to computers as an integral part of the practice of medicine.”

Chapter 2 goes into some computer hardware and software basics. Interesting statements include:

“The best-known operating systems in the microcomputer world today are the CP/M for many eight-bit computers, Apple-DOS for Apple computers, PC-DOS and MS-DOS for IBM and IBM-compatible computers, and UNIX for newer 16- and 32-bit computers.” [Where’s MS Windows?]
“There are many available programming languages today, such as BASIC, FORTRAN, COBOL, and APL.” [No Visual Basic Net?]
“… the distinction between microcomputers and their larger cousins, known as mainframes, is becoming less and less distinct… The desktop IBM 370 may be able to run all the software of the room-sized [mainframe IBM 370] version.” [What- no Dell, Gateway, or HP?]
“Currently, microcomputers that the ability to handle the requirements of a medical practice cost between $2000 and $6000 initially. Most mainframe computers, on the other hand, start with initial costs in the range of $200,000.”
“With a microcomputer, software distribution is dominated by the commercial market. Most packages cost between $50 and $300…commercial software can be expected to be free of errors (although this is not always the case).” [Specialty “EMR” type programs had not become popular yet.]

Chapter 3 goes into the capabilities of the microcomputers versus the mainframe computers:

“Although microcomputers today tend to be single-user-oriented, pressure is being applied from medium-sized firms and small businesses to develop limited multi-user systems on microcomputers. A connected system of microcomputers allows hardware and software resources to be shared among many users.” [The LAN was still in it's infancy- available, but expensive. The operating systems did not offer an integrated peer-to-peer setup.]
“LANs usually employ a single coaxial cable that connects each User in the entire network.” [Think daisy-chain, 11 mbps LANs vs. the gigabyte LANs available today.]
“With the evolution of “windows,” software engineers have allowed more than one program to be run at the same time (a process called multi-tasking) and information from each program to be presented on the screen at the same time. [Nowadays we take this for granted!]

Chapter 4 goes into “basic tools”:

“In 1984, an integrated software package called Symphony (developed for the IBM PC) was released by the Lotus Development Corporation. Symphony is a fully integrated package that includes and improves upon the Lotus 1 2 3 spreadsheet, graphics, and data base capabilities while adding new word processing and data communications environments.”
“In late 1984, another competitive integrated package for the IBM PC and il5 compatibilities called Framework was released by Ashton Tate. Much like Symphony, Framework contains word processing, spreadsheet, data base, graphics and communications capabilities. Likewise, Framework also allows windowing and multi-tasking.”
“Also, in 1984, Apple released its version of the integrated persona1 computer with the introduction of the Macintosh computer. The Macintosh is a portable, user-friendly, personal computer based on a new generation of current microprocessors.”
[Note: MS Office would not be available for another 8 years.]
This chapter also went into word processing software. What was available was not much more powerful than a fancy WordPad type software. All were text based; WordPerfect and Word wouldn’t come up with graphic-centric software versions for another 7-8 years.

Chapter 5 goes into the “Use of the Electronic Network”:

The internet was not yet available; an electronic network meant dialing up a far away computer using primitive modems with speeds of up to 2400 baud.
Available communication software at the time included PC Talk III, KERMIT, Crosstalk, and Smartcom II.
There was available between major cities a set of data forwarding services, the prototype called ARPANET, a network developed to handle communications for the Department of Defense research projects in universities in many cities. Three major data forwarding networks in the United States provide service to the data base services of most interest to physicians. These networks are Tymnet, Telenet, and Uninet. In Canada, Datapac provides a similar service. The charges are quite reasonable, about $4 to $6 per hour, which at the time was much cheaper than the typical long distance lines.
There were several medical data base services, all of which were quite expensive, although could be used freely through libraries. Of the 14 services listed, I only recognized MEDLINE.

Skipping to Chapter 9 (“Computerized History Taking”) and Chapter 10 (“Software for Patient Management”) one can see the discussion of what is needed for a good EMR. All of it was text based to be run on DOS operating systems.
Chapter 11 discussed “Computer-Aided Diagnosis and Decision Making”. Systems available at the time included Consult-I, Mycin, Expert, and Caduceus. It’s actually well written going into the intricacies of these systems and how they can potentially help the physician in his decision making. This chapter is very thorough and well written, even though none of these software titles have survived the years.
Chapter 12 discussed “Computerized Medical Records”, how these systems can improve on medical care. Questions at the time included:

Should you supplement or replar.e the manual chart?
Should word processing data storage be used, or should the data be encoded?

The chapter went into the components of a good EMR, what should go into the EMR, and how data is entered into the EMR (at that time usually it involved typing in the data- hand scanners weren’t available, and touchscreens were to come out 6-7 years later.

Chapter 13 discussed “Data Management Systems in Research”. I won’t get into this section at all. Generally the book was a great read and I felt lucky to have both the modern day hardware and software that I currently work with. The EMR still has to progress a lot, but it’s well on its way to becoming mainstream worldwide. I would love to see where we’ll be in 20 years (year 2026). I’ll make another report then. Stay tuned!

Changes/Additions To emrupdate.com and Statistics

Nick has been hard at work changing the look and feel of the website. Noticable changes include:

The new blog sections on the right side column of the website window. Notice blogs that include-

EMR Interviews with Robert Gleeman talking to Doctors who have implemented their own EMR. So far he has performed 7 interviews, all of which make excellent reads.
The Doctors Lounge is where Naveen Venkatachalam and volunteers blog useful EMR information. There are now 5 major topics, including handling faxes, starting a new office with an EMR, making backups of your important data, and web surfing and reading your emails safely.
Medical Picks with Dr. Al Borges provides a useful place to catch up on Medical issues, diseases, latest treatments and hand-picked medical photos. There are 19 separate topics/case presentations so far.
Free Software with Nick Harrington, Ducknet and Techguy provides a showcase for useful Free Software to help run your practice office. There are simply too many neat software to list here.

• Nick has added a Google Search option onto the Advanced Search page.

Other neat information and statistics include:

Two welcome new sponsors have been added:

Terry Ellis at DescriptMED has finally caved into pressure from Nick and parted with some hard-earned sponsorship money.

MedInformatix have also generously offered to sponsor emrupate and are using a sponsor page, dynamically updated from their own web-site. I don't know how Nick does it.

Without our sponsors we couldn't afford to keep this site running. We encourage you to check out our sponsors links in our footer. As another reminder and a thank you, this is the complete list of our sponsors:-

A4 Health Systems
AutoMED Software
Bond Technologies
Cerner PowerWorks
Companion Technologies

e-MDs
DescriptMED
MedInformatix
NextGen

SynaMed™
SynapseDirect
TSI Healthcare
X-Paper

There are now 14 “President” class posters-

Jason Murdoch MD (DrMurdoch), Canada (4,989)
Lowell Kleinman MD (DrQuit), USA (3,144)
Chris Wilkerson DCM (digital-doc), USA (2,134)
Kirk Voelker, MD (DrVoelker) USA (1,845)
Al Borges MD (alborg), USA (1,758)
Layne Hermansen, MD (FPdoctor), USA (1,337)
Graham Chiu (gchiu), New Zealand (1,335)

MrLynn, USA (1,304)
Robert Gleeman, USA (1,238)
Nick Harrington, United Kingdom (1,190)
Brendon, USA (1,099)
cyath, USA (1,097)
DrWinn, USA (1,083)
Matt Chase MD (mchasemd), USA (1,013)

These are the general emrupdate.com statistics-

There are now 4,727 members.
There have been started (approx) 11,966 threads and there have been 52,919 total posts.
There have been over 2 million visits.

In July 2006 we received:

A total of 62,257 distinct visits were made to the site.
The average visit lasted 13 Minutes and 3 Seconds (Statistically longer than, you-know-what)
47,657 distinct web pages were viewed a total of 757,421 times.
The average visit contained 12.17 page views.
People spent an average of 1 Minute and 4 Seconds viewing a page.
Downloadable files were requested 137 times.
18.46 GigaBytes of Bandwidth
24.97% of all visits were by people using a version of Microsoft Internet Explorer (how quaint) to view the site, 6.44% used Netscape (anti-establishment), 9.65% used FireFox (way to go), and 7.98% used the AOL browser (oh, pity them).
44.85% of all visits were by people using a version of Microsoft Windows, 1.57% used MacOS (probably Cyath), and 0.43% used a version of Unix/Linux (Nick)

Really odd stuff:

The 12th most popular Search Phrase (that visitors came here from) was secret italian training video, the 13th was ass, 19th was uglywoman, 21st was misys buyout. What an odd bunch!
Microsoft , WA, USA visited us 1,033 times
We have only one visit from the following countries
- Kenya
- Nigeria
- Ghana
- Ivory Coast (or Cote d'Ivoire to be accurate)
- Sri Lanka
- Myanmar (formerly Burma)
- Nepal
- Cambodia
- Palau
- Slovakia
- Latvia
- Luxembourg (not that many folks in Luxembourg anyway)
- Argentina
- Chile

Well, that’s it! Many thanks to Nick for his efforts on making this site run smoothly. If any readers have any interesting comments, suggestions, or news stories, send a private email anyone or to Nick Harrington or Al Borges. I plan to make these newsletters updated either periodically throughout the year, or at least on a monthly basis.

If you read a thread which you think needs the spotlight of our front-page, please let us know.

Lastly, don’t forget that it not only takes volunteer time and effort to run emrupdate.com, but it also takes money to achieve the web presence. If you can, consider donating what you can afford. The donation link can be found here.

Cheers,
Al Borges MD

emrupdate Newsletter May 5, 2006 by Al Borges, MD

2006-05-03T12:13:00Z

This is the first newsletter of the emrupdate.com website. I hope I’ve skimmed through the most importants news events both worldwide and at emrupdate.com. Enjoy.

National Health IT Coordinator Resigns

According to the Department of Health and Human Services (HHS), Dr. David Brailer, the country’s National Coordinator for Health IT, announced his resignation last week. Dr. Brailer has held the newly created position for the past two years and plans on stepping down on 5/19/2006. In the interim the Office of the National Coordinator will be led by its four permanent directors. Dr. Brailer will continue as a consultant to HHS until his replacement is found. He will continue to serve as Vice Chair of the American Health Information Community.

Dr. Brailer help bring about significant progress on developing standards and promoting interoperability among various healthcare IT initiatives. According to HHS Secretary Mike Leavitt: "Over the past two years, David has made significant progress in advancing the President's health IT agenda and laying the building blocks for future progress,"

House Committee Holds Hearing on Smaller Practices

Adopting EHRs

This article discusses the plight of Dr. Normille in establishing an electronic health record system in his office. Problems encountered included:

He is not communicating with patients electronically, but in the future when he does, this will be another expense to absorb as this form of communication will not be reimbursed by insurance even if this electronic consultation with the patient is done in lieu of an office visit.
The cost of implementing an EHR system in the practice cost $50,000 and additional annual maintenance costs including software upgrades can cost up to $10,000.
He spends more time at the office because data still needs to be entered into the charts.
When the system was being installed, the number of patients had to be reduced during the time the office was learning to use the system.

It also discusses the presentation on how BJC Healthcare, one of the largest nonprofit healthcare organizations in the U.S located in St. Louis Missouri, is installing electronic health records in the BJC Medical Group network of employed physicians at a cost of $8 million dollars to achieve this goal in a timespan of 2 years. They plan to accelerate the adoption of EHRs by underwriting the one time implementation costs if physicians buy the needed equipment. This equipment, including scanners and printers, averages $10,000 per provider; however, the return on investment can be achieved over 2 to 3 years.

URL: http://www.federaltelemedicine.com/042406-05.html

Spanning the Globe

This is an excellent article that discusses how EHR projects in other countries may provide a roadmap for initiatives here at home. It’s a must-read, especially the part about the 10 lessons learned:

Lesson #1. Promote fundamental change industry wide. \
Lesson #2. Engage physicians and clinicians to participate and contribute their expertise.
Lesson #3. Include the vendor community.
Lesson #4. Adopt standards for interoperability- make this a “top priority”.
Lesson #5. Build a critical mass of users® whatever the solution, its success depends on having a critical mass of users.
Lesson #6. Address privacy and security.
Lesson #7. Communicate, keep EHR stakeholders informed to address the inherent intense scrutiny and politicization.
Lesson #8. Customize strategies. There is tremendous variability in the use of health information technology within countries, across regions and political jurisdictions, and among sectors (e.g., acute versus ambulatory). Because no one size fits all, national EHR programs must customize strategies for investment and deployment. [How CCHIT goes against this lesson is a matter of discussion.]
Lesson #9. Money matters. How can we ensure that every clinician's office has a computer and an Internet connection?
Lesson #10. People count. We need to understand how people behave and what they believe as individuals and as members of groups.

ULR: http://www.healthcare-informatics.com/issues/2006/04/48/

NYC Docs Will Get EHRs

New York City’s Mayor Michael R. Bloomberg and Department of Health and Mental Hygiene Commissioner Thomas R. Frieden recently announced that NYC has earmarked $27 million to provide electronic health records (EHR) systems to 1,000 of the city’s physicians by 2008. An additional $13 million will be contributed by community health centers participating in the program. The city expects that the EHRs will provide the DOH with more accurate and faster information on emerging pubic health problems and also improve care at community health clinics.

URL: http://www.medicalinformaticsinsider.com/2006/05/02/nyc-docs-will-get-ehrs/

Quicken And United Healthcare To Produce Health Care Software

UnitedHealth Group, a group of national health care companies, and Quicken plan to produce a series of healthcare software to help consumers manage their health care use. the software would allow customers to view and organize payments and medical records from physicians and hospitals in one system. The products are scheduled for a 2007 release, although the plans are in preliminary phases.

URL: http://www.bizjournals.com/losangeles/stories/2006/04/10/daily33.html?from_rss=1

TERP 2006

Remember that TERP 2006 will be held in Baltimore, MD on Saturday, 05/20/06 8:00 AM thru Wednesday, 05/24/06 6:00 PM. For fee schedule, event schedule, and for other miscellaneous information go to the Medical Records Institute website at: http://www.medrecinst.com/iebms/reg/reg_p1_form.aspx?oc=10&ct=TEPR06&eventid=5137.

The Evolution of EMR Standards

As providers increasingly adopt electronic medical records systems, the ability of those systems to interoperate will decide the fate of a national health information network. But there is a dizzying array of data standards designed to ensure EMR interoperability, with new standards being developed…

URL: http://www.healthdatamanagement.com/html/current/CurrentIssueStory.cfm?articleId=13354

Discussed at: http://www.emrupdate.com/forums/thread/49515.aspx

IT Implementation: How to do it right

When looking for an EMR you should try to circumvent common EHR pitfalls and plan the deal carefully and don't rush things. Here are some suggestions (copied from the article):

Don't ignore your practice management system
Don't do too much too fast
Watch for advisers with conflicts of interest
Tie payments to performance targets
Negotiate an exit strategy
Getting your money back won't be easy

URL: http://www.memag.com/memag/article/articleDetail.jsp?id=319416&pageID=1&sk=&date=

Discussed at: http://www.emrupdate.com/forums/thread/48920.aspx

Star Discussions, Events and News at emrupdate.com

Today there are now 4,468 users who have contributed to 8,807 threads and 49,136 posts. In the past month 140 new users have joined us. Nick's promising more statistics next month.
On April 25, 2006 Dr. David Winn, one of our most favorite and boisterous posters at emrupdate.com posted a farewell to all of us after some health concerns. We all wish him the best and hope that he achieves a quick recovery and comes back to share with us his achievements and life both as a physician and as CEO of e-MDs.
On April 29, 2006 Robert Gleeman, Marketing Consultant for DoctorsPartner EMR/PMS Integrated Software System and Moderator/President at emrupdate.com debuted as the consummate reporter, beginning the new “EMR Interview Forum”, a process whereby he will interview physician EMR users to see how they have implemented IT into their offices. His first interview was titled “An interview with Dr Thomas Rohrick ('Dragon' Meets S.O.A.P.)” is certainly a great read. Well done Robert.
Many new changes have been made by Nick on emrupdate.com during this past month, including:

Addition of several new forum folders, including “New Software (Forum)”, “New Software (Catalog)”, and “EMR interviews”.
The “Front Page News” has been changed to “News…”
Other minor changes.

CCHIT continues to take the limelight with numerous recent threads, including-

On 4/26/2006 we reported the addition of 2 new sponsors making the list sponsors of emrupdate.com a total of 11. Some of our sponsors are up for renewal last month; they haven't responded yet, so we may be losing a few of these. The current sponsor list now includes:

There have been also many private sponsors, the list which can be found here /about/supportus.aspx. If you would like to become a sponsor, visit this URL. Thanks! Also you may wish to visit the various sections of the new website, including the:

Files- for download of presentations, softwares, and other freebies.
Photos- for interesting personal photographs of various posters.
Blogs- for interesting themed discussions of EMR topics.
Jobs- for great job opportunities.
Community Forum Jokes- please add your pictures and stories to cheer us all up a bit.

Well, that’s it! Many thanks to Nick for his efforts on making this site run smoothly. If any readers have any interesting comments, suggestions, or news stories, send a private email to Nick Harrington or alborg (or regular email alborgmd@yahoo.com). I plan to make these newsletters updated either periodically throughout the year, or at least on a monthly basis. If you read a thread which you think needs the spotlight of our front-page, please let us know.

Cheers,

Al Borges MD

Launch of EMR Interviews

2006-05-02T14:21:00Z

With much fanfare, applause and general hullabaloo, Robert Gleeman has kicked off our inaugural EMR Interviews with this article about Dr Thomas Rohrick. Our roving reporter has generously followed this up in our main EMR Forum with an update on his interview with "The Dragon Lady" Ms. Judy Richard. "Dragon" or "DSN" is an often used short-hand name for Dragon NaturallySpeaking®. You can also see a photograph of Judith in the post, posing with a 1980s pulse telephone. Nice to hear good news about (small, dynamic) companies that do provide consistently excellent standards of customer care.

While things may have been a bit quieter Monday in the US of A - less shops open, no gardeners mowing lawns, restaurants closed - Nick, that dressed English Bloke, was busy posting a collection of Friday Funnies in payment for the last poster donation we had some months back. These hilarious posts were Laws of the Natural Universe, Things that you can't say when inebriated, Dictionary for Adverts..., Are you good at Parking?, Are Computers Male or Female?, and last but not least, not forgetting Graham Chiu's funny quip about Keith Richard titled Out of his tree.

This is a test blog by one of Al Borg's temporary stand-ins.