MUMPS anyone?

As a kid I got mumps and stayed home from school with swollen glands;  today there is the MMR vaccination for children fortunate to live in developed countries.

I am not writing about the disease though, rather the programming language used to create electronic medical record software, for example: VISTA and EPIC. This is another assignment from my class, Healthcare Informatics – the University of California, Davis.

If you were writing a new Electronic Medical Record (EMR) software solution today, would you use MUMPS, which is admittedly widely deployed?

Those in favor might argue:

  1. MUMPS is the language used by existing EMR deployments from large established EMR vendors,
  2. The MUMPS database does not waste disk space as it uses sparse arrays and B-trees queries are  faster than indexed relational databases.
  3. MUMPS based EMR systems installed today are stable and reliable.

I posit no, because:

  1. Where would you find MUMPS programmers today? Are new college graduates proficient in MUMPS or JAVA/C++ ?
  2. How would you interface with other EMRs today? Interoperability is the one of the biggest challenges between healthcare systems today and creating a new EMR system based on older non-standards approaches will not result in an interoperable system.
  3. Rather than run a MUMPS based system on large monolithic hardware, a new EMR system could be written on distributed highly available hardware.

Of course there is also the option of not writing your own EMR software,  but rather using a Cloud computing EMR solution from vendors such as  AdvancedMD or (my local favourite) Practice Fusion.

How to select and deploy an Electronic Medical Record system

This blog entry is a brief summary of readings I have covered as part of my training in healthcare Informatics from the University of California, Davis and is sourced from this paper and this book

The medical practice has to be ready to adopt an EMR and most importantly to recognize that the medical practice is adopting a vision, not just a technology. A vision means the practice will offer better patient care, a more efficient office and improved financials.  The most important role in the implementation of an EMR is a ‘champion’. The role of this champion is to gain buy-in and trust from perhaps reluctant staff in the medical institution, since workflows and business processes will likely change. Users of the new system must have high psychological ownership of the new technology.

Steps in the implementation of an EMR

Information gathering

  • Collect information: Patient data, radiology and lab reports
  • Assess workflows: Appointment scheduling, events during and after a patient visit, unscheduled visits and questions etc
  • Financial impact: Beyond the initial cost of the software are costs for training, maintenance and upgrades.

Selection Phase

Subsequent to information gathering, the medical practice selects an EMR. A few choices: proprietary vendors such as EPIC, Cerner and Eclipsys or  OpenSource alternatives . Both require creating evaluation criteria and extensive RFI/RFP processes by a project steering committee. Furthermore members of the medical practice should visit other practices and view their EMR implementations.

Keys to success

  • People are key to the successful implementation of an EMR. Everyone, clinicians and yes patients, must be aware of the new system to gain buy-in.
  • Workflow will be redesigned
  • A good project plan: just like the rollout of any enterprise software system, a good project plan is required that that clarifies responsibilities, sets objectives, generates tasks, and provides tight control and feedback with ongoing problem solving.

Alternative solution to installing an EMR

Of course a simpler alternative would be to select a hosted SoftwareAsAService (SaaS) offering that requires no in-house software, servers, or expensitve technical support staff.  A SaaS solution that I like and have interacted with over the blogosphere is Practice Fusion. Contrarians might argue that a hosted service is a one-size-fits all solution that does not fit the current practices of a medical practice. I would counter that an in-house system will be expensive to modify to suit a medical practice’s needs.

Hosted or in-house, the medical institution must recognize that their workflows and practices will have to change if they wish to gain the undeniable benefits on an Electronic Medical Record.

Image below courtesy of HIMS Analytics

Hospitals and Facebook?

At first thought one would really wonder what connection there is between hospitals and Facebook….

Hospital – a medical institution where sick people are treated from simple outpatient treatment to lengthy stays for chronic illness or recuperation from surgery.

Facebook – probably the second or third most popular Internet destination, boasting 400 million users on the 6th anniversary of its founding.

Per the image below, email is a one-to-many form of communication – think of a tree: one trunk supports many branches and leaves. Facebook, is a many-to-many form of communication, users join groups; users create fan pages even pages belonging to corporations for example, Microsoft. Updates and posts sent by any user to the pages or groups in turn reach all the users in the group.

A hospital can use a social-media site like Facebook, to communicate with its patient community.  An excellent resource for social-media and healthcare is Edward Bennet’s blog, FoundInCache. For example, he lists one thousand hospitals that use social media.

How?

  1. To market the hospital: Yes a hospital is a consumer entity that needs to be sold to patients. Patients do, and should have, a choice of where to get their healthcare. Thus the overall marketing campaign of a hospital should include social-media sites like Facebook.
  2. To solicit feedback: Patients and their family/friends, can openly comment on the quality of care and treatment that a hospital provides.
  3. Online support network for patients: Patients can share treatment options on their maladies and exchange useful tips on what worked and did not. For example, MDAnderson Cancer hospital has several online support options for patients.

Consumer! – shop for medical services….

America consumers are adept at shopping for details when purchasing consumer items for example: a TV set, new vehicle or a piece of furniture. While price is important, consumers also take into account overall quality of service: the vendor’s reputation, after-sales service etc

Medical services are no different. While we may be accustomed to simply visiting the doctor and taking his/her advice and paying the co-payment stipulated by the insurance company, this process is rapidly changing. I provide two personal experiences to illustrate, focusing mostly on price:

1. I recently underwent a root canal treatment. My dentist referred me to an endodontist. Upon arrival at the office I presented them with my insurance card and was told “we are out of your network”, bottom line my co-payment would be 50% or $575 plus $238 for a procedure not covered by insurance at all. Total out of pocket expense: $813.  In pain and sensing the urgency of the matter,  I still managed to phone the dental insurance company,  requested an in-network provider and simply walked three blocks to my new appointment. At this office, my co-payment was 10% and $110 for the uncovered procedure, total out of pocket expense: $188. The endodontist provided a most pleasant and pain-free experience with excellent after-care instructions on how to remain pain-free.

2. Following my MRI experience, which I detailed here, I received a bill for a whopping $500 co-payment. I phoned several MRI clinics in the neighbourhood and was surprised to learn that the identical procedure (I quoted the standard ICD-9 code), was 10%-40% cheaper. My co-payment would have been far less than $500 (I am currently fighting the exhorbitant cost at my clinic quoting neighbouring facilities which charge less).   Lesson learned: shop around, call for price quotes on medical procedures before undergoing any.

Bottom line, It is your body, your health-care, your money:

  • Call around for price quotes and after sales service before undergoing a medical procedure.
  • Get to know your insurance company and in particular the diagnosis code (ICD-9).
  • Provide this number to the medical services provider and you will rapidly get a price quote and know what your total out-of-pocket expense will be.