Tuesday, June 29, 2010

Linking your ECM solution with your EMR

Recently I worked with Steve Sawyer from the Mayo Health System to produce a webinar in which Steve discusses why Mayo decided to acquire an ECM system and then to link it to their enterprise EMR.  Steve's done some remarkable work and Mayo, though only about a quarter of the way through their enterprise deployment, has begun to achieve good returns.  Most importantly, the docs like the solution!

Register to watch the webinar.

Monday, June 28, 2010

Leadership is hard work

General McChrystal has been fired. I have to admit that I was stunned to read his remarks in Rolling Stone - they reflect very poorly on his leadership; which is a shame, given his remarkable performance in the past.

As a staff officer, I often commiserated with my peers and with my subordinates about our higher-ups - we often used the phrase Echelons Above Reality to refer to our higher-ups, which was a play on the phrase EAC  (Echelons above Corps) .  And we often had much harsher phrases for individuals that were in staff and sometimes command positions above us. I've seen that kind of behavior in commerce, government and the military so I think it's fairly common.

As a commander, however, the situation was much different . Everything you do, everything you say, everything you write, and all the body language you send out is scrutinized, evaluated, assessed, and probed. It's the nature of the job. As a consequence, I was extremely careful about what I said, when I said it, how I said it, to whom I said it, and the body language I presented. And I'm not a 4-star general.

So, was General McChrystal being immature? Was he somehow caught off-guard?

Or, did he do as I did: prepare ahead of time for every encounter and go into every encounter with a plan to achieve a specific outcome?

My thinking is the later - he knew what he was doing and very specifically chose to do what he did.

What I can't figure out is why? What was he planning on achieving?

Friday, June 18, 2010

How to use eSignature with your EMR and your DM system

eSignature is a term that refers to applying some sort of signature to an electronic document.

One illustration of eSignature is when a physcian reviews and approves an electronic document - perhaps a progress note that has been scanned and linked to a patient encounter. 

There are several common requirements:

1. an audit trail must be retained that provides access details regarding changes to the document, including the signature.  Usually this audit trail will provide user and date / time stamps for each action taken with the document.  For example, when a physician affixes his / her signature to the document, the physician's details and date / time are recorded.

2. the original document needs to be altered in both a visual and a physical manner.  Often the signature is a text string, "Approved and digitally signed by John Smith, MD on June 18, 2010 at 1:07 PM ET." and the text is over-layed at a selected location on the document image; thus, visually the document has been altered.  Next, a new document is created that "burns' the signature into the image, permanently changing the image with the signature.

3.  the workflow associated with applying the signature varies but in general follows:  HIM analyst identifies who needs to approve / sign the document and where on the document the signature needs to be placed.  Next, the document is routed to those that need to review & sign.  The people that need to do the reviewing / signing are presented with options (approve / sign, reject) and make their selection.  Those that have been approved for signature are then signed and a new document created with the signature.  Finally, references to the unsigned-document are translated so that only the new, signed document is returned to users.

In terms of integrating the eSignature capability among multiple systems, usually an EMR for the user interface and a DM system for managing the documents, I recommend that you rely on the EMR's workflow to manage user interaction.  The key reason for this approach is that the EMR provides a consistent UI for the most critical user - the doctor.  There are other reasons too (such as the EMR typically implements a role-based security model and it usually has a chart deficiency module to control the workflow), but not having to train the doctors is essential.