RE: EHRs in Surgical Practices

Recently, on his blog “Life as a Healthcare CIO,” Dr. John Halamka gave advice on how to implement EHRs for surgical practices. Dr. Halamka points out many of the issues we’ve found when meeting with surgical practices and ambulatory surgery centers (ASCs). Surgical practices offer a unique set of problems as they have a very specific purpose, are less likely to have many returning patients, and capture a limited amount of information (the rest being captured by referring general practitioners/primary care physicians and their respective facilities). So where is the incentive for these practices to adopt an electronic solution? How can EHRs address these particular needs without being too disruptive to the surgeons’ workflows? Dr. Halamka has some ideas – based on his own experiences – but I think there’s more to add to this discussion.

From the Ashes: Ensuring that Your Health IT Data is Secured & Easy to Recover

The Most Popular Recovery Plan Today (Via Leonid Manchenkov's blog)

“Expect the unexpected.”

It’s one of those oxymoronic idioms that have become so ingrained in our culture, it’s hard to determine its origins but it’s taken as a universal truth. Obviously, if you expect the unexpected, then it’s no longer unexpected; but it’s not meant to be a literal set of instructions. As we all know, expect the unexpected means to assume that things will go wrong, or to at least have some contingencies in case your plan doesn’t work out as you intended them. I was reminded of this phrase while reading this list of Top 5 EHR Adoption Barriers and came upon the last one:

Can the Networks Support the Data?
Today’s data explosion is driven by many industries, but healthcare records and imaging are fueling a big part of the growth. Healthcare providers are worried about the complex networking capabilities and their ability to handle the 24×7 influx of massive amounts of data and the disaster recovery plans needed to support that data. VARs play a pivotal role in the networking and disaster recovery markets, so smart VARs will use their knowledge to close the deal.

It was an interesting issue that I hadn’t spent much time thinking about. That’s not to say that we hadn’t taken all of this into account when designing our products, but I personally had never conceived that this would be an obstacle or imposing barrier to health facilities that want to adopt electronic health solutions. And that’s when I decided to look at our products to see how they fare if the unexpected happened and we needed to recover data.

Common Language: The Rise of Standard Formatting for Surgical Reports

Gottfried Wilhelm von Leibniz

Gottfried Leibniz. That name doesn’t mean much to most people, outside of math nerds with a penchant for historical trivia. Leibniz is credited with simultaneously creating calculus at the same time of Sir Isaac Newton. Years of debate ensnared the scientific community as patriotic mathematicians of Germany and Britain argued for their respective countrymen. Each camp tried to prove the independent, solitary insight needed to develop calculus solely rested with one man or the other – but were unable to find definitive proof that Newton or Leibniz had been the one to originally conceive of this new field of mathematics. There are suggestions that Leibniz was inspired by some of Newton’s works but, as there’s still too many gaps in the works of Newton that would have been available for Leibniz to consult in order to develop calculus, there’s no substantial proof that Leibniz plagiarized Newton’s work.

Rob's attempt to innovate calculus was met with much less enthusiasm

So what happened then? Perhaps this is an example of Rupert Sheldrake’s pseudo-scientific theory of “morphic resonance” in which behavior is somehow transported across great geographical distances between similar types of animals or people. And while it is always interesting and neat to consider such a possibility – an example of some innate telepathic or cultural osmosis that seems to exist on a cellular level between people – it’s rather unlikely. How, then, did this rise of a new way of thinking occur at the same time in two different places? How were two men able to discover the same mathematical principles without being in collaboration? And what does any of this have to do with surgical reporting?

To put it simply – great minds think alike. The fact of the matter is that both Newton and Leibniz recognized a need for something in the world – in this case, the lack of a particular mathematics field that could be applied to many facets of our lives and used to explain so much of what we don’t understand. It is this same ability for multiple people, unrelated and independent of one another, to see the writing on the wall in the medical community and recognize the absolute need and demand for standardized and structured surgical reporting.

Security in the Time of EHRs

You are online right now.  I don’t just mean that you are sitting in front of your computer or using your smartphone to read this post on the internet.  I mean the majority of your “vital” information about your identity – bank account, social security, address, etc. – can be found somewhere in cyberspace right now.  You exist in the internet; and not just you, but also various versions of you complete with your interests, past transactions and other personal information that you’ve added to your social networking sites or the online store where you buy things.  All of these pieces of you are captured online and are out there in the ether of the web if someone wanted to find them.

It’s a bit creepy, isn’t it?  The fact that so much of our lives these days exist online – and therefore so much of who we are is being captured or constructed on the net – leaves many feeling unsettled.  This is especially true if you’re a person who doesn’t know much about software security, who doesn’t follow how data is captured and stored, who isn’t sure how much of the web works but you are fairly certain it will be working against you.

Now add in the idea that soon some (if not most, if not ALL) of your personal medical information will be stored on a similar system – and you understand why people are apprehensive about the idea of an Electronic Health Record (EHR).  There are those who believe that web-based data storage will only lead to security breaches or identity theft issues.  And there’s definitely the potential for such shenanigans to abound with an EHR.  While these concerns are valid and need to addressed as new systems are created, they shouldn’t stop us from proceeding with developing portable EHR systems.