Leave No One Behind: Necessary Incrementalism
Mr. John Moore, January 14, made his Top Ten Predictions for Healthcare in 2010, a blog item picked up by Healthcare IT News. As usual, it was a good read. Among the predictions: HITECH Birthing Pains, Small Practices Look on With Jaundiced Eye, Large Firms Acquiring Smaller Firms, Baby Boomers Struggle Caring for Parents, HealthVault as prime PHR Platform, and the Struggle of Telecom. All of these predictions relate to yet another published item.
Writing about the new NoMoreClipboard portal as a link between paper and digital communications for physicians and patients---a solution for ARRA---a press release was picked up by The Medical Quack and Inside Indiana Business. Ms. Barbara Duck, writing in the Medical Quack notes, as does Mr. Moore, that the role of the PHR in healthcare continues to evolve. She goes on to summarize that NMC (NoMoreClipboard) offers physician groups a portal to allow additional interaction between doctors and patients: appointments, refills and more---with information that can be integrated with an EMR/EHR and also HealthVault and Google Health.
How does this tie together several of Mr. John Moore's predictions? Some thoughts:
1. HITECH Birthing Pains? What percentage of physicians will be digital in a decade? Maybe half in four years---more or less, varying among regions urban and rural. The NMC technology using a portal, bar-coding, and patent-pending "fill out the physicians' own forms" technology can bridge an analogue-digital gap for a decade.
2. Small practices can use the MIE, minimally invasive EMR, or a competitor's web-based EMR to link with patients' PHRs. It seems certain that rural and small practices benefit from such SaaS-based EMRs in that the old server-based solutions were front-loaded with costs and followed by high maintenance. The nice opportunity for small practices is the minimal down payment and the affordable run-rate that consumes about one-third of the $44,000 stimulus payment over 5 years. This cost ratio is in line with years of IT-installation experience for software in manufacturing installations. In the interim, the NMC portal links physician and patient offering an easy transition to being fully digital.
3. Large firms acquiring smaller firms. Certain to happen. Not every good EMR has a PHR. Logical solutions are purchase, merger, or leasing. Many ways exist to solve a problem as long as interoperability and connectivity are present.
4. Mr. Moore references Baby Boomers Caring for Parents. The web-based PHR, of which one is NoMoreClipboard, is a key to distant care. Yes, there are problems with proxy sign-offs and Social Security, but many of the problems are solved in the interim. No More Clipboard offers bar-coding allowing physicians to FAX entire medical records directly and securely into patients' PHR mailbox. NMC has graphing capability for test results and storage for wills, directives and visitation documents. The portal extends functionality for secure messaging and more. The family care giver is too often a distant eldest daughter who can, by sharing a website and, with permission of the parent, a PIN, help manage records, appointments and other communication.
5. As to HealthVault and Google, NMC has been integrated with both since their inauguration. In the future, interoperability will need be a feature of every marketing plan---a break with the pre-regulatory past where the "Walled Garden" of software apps made hospitals, physicians and patients pay while they waited for software that suited workflow needs.
6. Struggling Telecom? NoMoreClipboard is accessible and may be FAXed from a smartphone today, and more functionality will be incorporated when value can be added. A large part of the problem is the interface---tiny buttons, tiny screens and dropped calls---all problems waiting to be solved.
Thus, as health IT policy works toward a new definition through policy changes and standards enunciations, it is likely that interim measures must serve for much of this decade of transition. This makes it all the more important to choose products designed to solve today's problems with planned transitions into tomorrow's solutions. Incrementalism is not bad as long as the future is planned for and workflow is understood. Neither physicians nor patients will accept solutions that are slower and seem less secure than paper, and no one wants a product designed for obsolescense.
Of course, EMR are made not to slow down the medical process. EMR have different design because hospitals have different problems on their practice.
-nj
Posted by: neurology emr | 02/23/2010 at 10:41 PM