Stories about: electronic medical records

Patient-generated health data: Is health care ready to absorb it?

Health care data tsunamiIsrael Green-Hopkins, MD, is a second-year fellow in Pediatric Emergency Medicine at Boston Children’s Hospital and a fierce advocate for innovation in health information technology, with a passion for design, mobile health, remote monitoring and more. Follow him on Twitter @israel_md.

A few months ago, I spent 15 minutes filling out a detailed health data form at the doctor’s office. The paper form contained multiple questions about my health, family history, medications and basic demographic information. I assumed that an administrative specialist would code it into the practice’s electronic medical record (EMR) to be put to use. So it came as a surprise when I spent another 5 minutes reviewing the form with my physician, who then proceeded to type this information into the EMR herself. I’m confident neither my physician nor I felt enabled by the experience.

Countless people have had a similar experience—or worse, filled out a form with no sign that any clinician ever saw the information. Though the industry has made outstanding progress in adopting EMRs, the practice of data acquisition from patients remains cloudy. Patient-generated health data (PGHD), a term encompassing all forms of data that patients provide on their own, is a relatively new concept in health care. It falls into two broad groups: historical data and biometric data.

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cTAKES: Turning clinical notes into knowledge

medical_records_shutterstock_116827537

My mother often says that my handwriting is so bad I should have been a doctor. Luckily, digital systems like electronic medical records (EMRs) and computerized pharmacy ordering systems have largely taken the legibility factor out of medicine, especially when it comes to doctors’ and nurses’ notes.

Those notes—attached to millions of patient records—have the potential to do so much more than simply capture clinical observations. Within them lies a treasure trove of data about disease burden, risk factors, drug interactions and more, waiting to be mined for new insights that could dramatically impact research and care.

If the data can be extracted, that is.

The difficulty is that, to a computer, clinical notes are “unstructured” data. There are no standard entries, no numbers to be plugged into a field—just text in a box. And not every doctor or nurse uses the same words to describe the same thing.

So, how can we make the unstructured structured?

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DisCo: Keeping in touch with families after discharge

Mom & child receiving a text-ShutterstockKelly Dunn, a pediatric nurse practitioner in Medicine Patient Services at Boston Children’s Hospital, is primarily focused on helping families with hospital discharge and improving patient throughput.

A child hospitalized on 9 East, a general medical floor at Boston Children’s Hospital, was nearly ready to go home. The discharge order was written, and prescriptions were sent to the pharmacy. The staff nurse and I completed discharge teaching, competing with a very wiggly toddler for her tired mother’s attention.

Before this family went home, I had one more question: Would you like to receive a text message or email to check up on you once you are home?

Within a minute or two, I had entered the mom’s contact information and her preferred mode of communication (a text message to her cell phone) on an iPad. The family left, reassured to have a way of reaching a nurse familiar with their hospitalization should a problem or question arise at home—and pleased to have the option.

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Solving patient engagement: It’s about the data

Doctor and patient reviewing health data collected in an EMR.At the start of today’s National Pediatric Innovation Summit + Awards 2013 panel on patient engagement, healthcare journalist Carey Goldberg offered up a personal anecdote about engagement— or the lack of it—in medical care:

“I was having a minor dermatological procedure, and right before it started, I said to the doctor, ‘This really is a good idea to get this done, right?’ And she said, ‘No, actually, you don’t really need to get it done.’ And I didn’t stop the procedure. And I realized that I embodied the problem of patient engagement. It is a piece of [the health care] puzzle.”

Goldberg’s story framed a discussion that ranged from outcomes measurement to data access, from healthcare incentives to care coordination—all centered on one overriding question: How do we encourage patients to become more engaged in their own medical care?

And given the number of topics that were covered, it’s clear how complex a question that is. It’s one that engages multiple stakeholders—patients and their doctors for starters, but also insurers, policymakers and regulators, health care systems and more.

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Hacking pediatrics: Improving the patient experience

kids hacking-shutterstock_58262788Michael Docktor, MD, is director of Clinical Mobile Solutions at Boston Children’s Hospital and a pediatric gastroenterologist with a research and clinical interest in inflammatory bowel disease. (See a recent interview with him on MedTech Boston.)

How do the most disruptive companies of our day like Facebook and Pinterest get started? In the warm glow of Silicon Valley, in the shadows of technology titans such as Apple and Google, bright, enthusiastic young entrepreneurs, programmers and designers get together to “hack” ideas for the next big thing. The concept is simple and has worked in tackling challenges from creating the next great social network to developing an innovative green-energy technology.

However, applying this model of collaborative, rapid problem-solving to pain points in health care is still a relatively novel concept. Hacking Medicine, a community of passionate “hackers” at the Massachusetts Institute of Technology (MIT), has brought this practice to medicine and successfully organized events from Uganda to Boston. Graduates of one recent event with AthenaHealth—which develops and sells cloud-based services for electronic health records, practice management and care coordination—are on their way to developing successful businesses, including PillPack (helping patients manage their medications), the BeTH Project (inexpensive adjustable prostheses) and Podimetrics (a data-transmitting shoe insole for diabetics).

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Enhancing patient / care team interaction with an iPad “passport”

In just a 24-hour period, patients in the hospital typically see a variety of doctors, nurses, x-ray technicians and other medical professionals, and undergo a plethora of diagnostic tests—without an understanding of how all of it comes together to make them well.

The Diversity and Cultural Competency Council (DCCC) at Boston Children’s Hospital recently conducted a three-year study on patient satisfaction. It found that the main reason patients were sometimes dissatisfied was because they felt unfamiliar with the medical information they were receiving, and had difficulty understanding who was part of their care team and how best to communicate with them. And so the idea of MyPassport was born.

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Disrupting health care: The unique challenges facing health tech entrepreneurs

Inventions need a little extra incubating to make them attractive to health care.

Jenna Rose is director of Healthbox, a platform that brings together entrepreneurs, strategic partners, industry experts and investors to accelerate innovative healthcare solutions. She spoke recently at Boston Children’s Hospital at a forum sponsored by the Innovation Acceleration Program. She welcomes inquiries from entrepreneurs and others at info@healthbox.com

When we think about the future of health, it’s generally medical science that captures our imagination—the source of groundbreaking pharmaceuticals, medical devices and diagnostics. But what about the business of health care? With the passage of the Affordable Care Act and the widespread adoption of mobile technologies, there has never been a better time to be a health tech entrepreneur. One recent report suggests that the healthcare IT sector could receive more than $1B in venture capital in 2012.

But change won’t be easy. As they seek to disrupt this $2.7 trillion industry, health tech entrepreneurs face a unique set of challenges.

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Learned helplessness: Millennials and electronic medical records

Is healthcare IT ready to grow up? (N Kasp/Wikimedia commons)

As I read more about the Millennials, the generation to which I myself belong, I’m starting to see a connection between their attitude toward the world and the problems plaguing healthcare IT, an industry I research for a living.

Millennials (by one definition, people born between 1981 and 2000) tend to perceive greatness as something that is inherent, not acquired. This fallacy comes in part from the coddling we were given as young people. Millennials received trophies just for participating. Thanks to grade inflation in college, we could sleep through classes and still earn a B. We were told we were special: Success came to us simply by showing up.

This type of attitude leads to inevitable discouragement post-college, when Millennials are faced with challenges they haven’t been prepared to handle. Jobs aren’t handed out just because the applicant has a degree, but instead require connections or specialized skills or experience, and once in those jobs, success doesn’t come automatically. When he doesn’t face immediate success, the Millennial assumes that he’s “different” than the successful people, and attributes the failure to an intrinsic, unchangeable quality rather than faulty methods.

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Could texting patients reduce hospital readmissions? Thinking through an innovation

(Lars Plougmann/Flickr)

Your child has been in the hospital and it’s discharge day. It’s a chaotic scene: You’re trying to take care of him and maybe his little sister who keeps running down the hall, while completing hospital paperwork and packing your bags.

You’re finally out the door, in your car, kids strapped in and … what?  You’ve just lost contact with the medical professionals who took care of your son. What was it they said to do at home again?

Perhaps you try phoning but can’t get through to your doctor. Or you try to email through the hospital’s secure system, but can’t put your hands on the password. The doctors hope you remember to pick up your son’s meds.

Vinny Chiang, a physician at Children’s Hospital Boston, came up with a simple idea. Could day-after communication with patients be “pushed” — proactive and automated? Could it be texted?

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The Wild, Wild West of health apps: Can the FDA restore order without stifling innovation?

"Buffalo Bill's Wild West" show poster (cliff1066-TM/Flickr)

The business of smartphone health apps is growing exponentially. Here at Children’s, I coordinate and supervise a team of software developers who are helping our clinicians build apps. While I love the innovation and excitement health apps bring, the regulation is just starting to catch up with the industry. That makes the future uncertain.

The Food and Drug Administration’s proposed mobile health app guidelines, published in July, are a step in the right direction. But many concerns remain. In taming the Wild West, will the FDA go too far into overregulation? Will the new rules stifle the growing industry of app development by small startups or internal hospital developers? Can we continue innovating in the current state?

Consumers feel the uncertainty too. When considering the use of an app, how do you know whether it’s providing correct information?

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