State provides surgery cost comparisons

http://www.oshpd.ca.gov/commonsurgery/Default.aspx

More on usability of clinical systems

From Lyle Berkowitz, M.D.

While having physicians employed by vendors is a nice start, experience shows us that is certainly not enough. Rather, vendors need to start spending a lot more time with their actual users—physicians and other clinicians in the trenches. They should make their programmers go out and observe physicians using the systems they are creating, as well as use formal usability techniques to better understand how to improve their systems—the synergies and learning will be critical all the way around.

Convert PDF documents to Word

I occasionally get inquiries about how to convert a PDF document to the Microsoft Word format. This can be a tricky problem.

Going in the other direction (Word to PDF) is easy: upload the document to iSITE and then right-click on the document and select the Convert > PDF option on the Site Builder screen.

But if you're starting with a PDF file, then it's not so simple:

• First, was the original document (before it was first converted to PDF format) a word-processed document (i.e., an electronic file) or was it a paper document that was scanned and saved in the PDF format? If the latter (a paper original), you are out of luck. This type of PDF file is only an image, and the only way to get word-processable text out of it is by using optical character recognition (OCR) software. (Word 2007 does have built-in OCR capabilities, but that is a topic for another article.)


• If the PDF was created from a word-processing file (like a Microsoft Word doc), you can use the Adobe Acrobat application (either Standard or Professional versions) to convert the PDF file back to the .doc format. (Please note: the full Adobe Acrobat application is not the same as the free Acrobat Reader utility that is installed on most computers. Reader will only enable you to open and read PDF files, but it will not allow you to convert to a different format.)

If you don't have the full Adobe Acrobat application on your computer (and it's expensive, so don't bother requesting it unless you have an ongoing need for its added features), there is another option available: Go to www.pdftoword.com/ and use their free online service. Just upload your PDF document and give them your email address and they will email the converted Word version back to you.

I tried this with a 103-page PDF file, and the results, although not perfect, were better than a similar conversion performed by Adobe Acrobat. Here are some of the issues I encountered:

• First, it took some time: I uploaded my file in the middle of the day and did not receive my converted file until the following morning.


• Then, there were some font substitutions. There were checkboxes in the original (typically rendered using the Wingdings font), but the conversion utility apparently did not recognize the font or character and substituted something else.


• Finally, the page breaks didn't match, resulting in more pages in the converted document than in the PDF. This happened because the original author had used line spaces to move text to the next page (instead of using Word's page break feature); since the number of lines per page is a printer-specific setting, the extra lines did not fit the page (on my computer) resulting in the addition of extra blank pages.

E-nagging

Following up (loosely) on Anna Roth's post on the use of social media by CCHS, there is an article in the San Francisco Chronicle about a Kaiser study recently published in the American Journal of Preventive Medicine.

Kaiser Permanente researchers conducting a clinical trial on the impact of e-mailed reminders on diet and physical activity found gentle electronic nagging actually worked: People who received regular messages suggesting modest lifestyle improvements increased their activity level and made healthier food choices.

Such messages would probably not be regarded as "spam" if they come in direct emails from the primary care physician (PCP) to the patient. But another, less intrusive delivery method for such messages might be through occasional updates to CCHS's Facebook friends and Twitter followers.

On the Presentation of Test Results

In the ongoing dialog at Heathcare Business News, Bob Coli, M.D. and founder/CEO of Diagnostic Information System suggests that "the design of the key interface between the sources of diagnostic test results and the clinicians and patients who use those results is seriously flawed."

Since the beginning of the information silo era, clinical lab systems, ambulatory and inpatient electronic health records, and more recently, personal health records and health information exchange platforms have displayed cumulative test results for viewing and sharing as fragmented, incomplete data using variable formats.

The poor quality of the existing test results interface is responsible for the mismanagement of billions of diagnostic tests and contributes to estimated duplicate annual testing rates in the 15% to 20% range.

Do CCRMC providers share this perception? Where are the pain points and opportunities for improvement? Are there examples of good data presentation among our current portfolio of clinical applications?

Dr. Coli goes on to say:

[F]ull interoperability will require a standardized reporting format and comprehensive, clinically integrated data that presents a unified and common view to EHR, PHR and HIE users. Converting fragmented data into meaningful information will provide a workflow tool that has been shown to facilitate results viewing and sharing by producing a media reduction of up to 80% and greatly improved readability.

Significantly improving the viewing and sharing of test results information among collaborating physicians as well as between physicians and patients is just one example of how computer-savvy clinicians, imaginative software developers and experts in human-machine interface design can collaboratively create the next generations of EHR, PHR and HIE systems that will be easy and intuitive for both physicians and patients to use.

[emphasis added]

These are issues that deserve serious consideration as enhance and expand the application portfolio at CCRMC. We in Information Systems look forward to a substantive dialog with our medical colleagues on the topic of user interface affordance.

The Future of Healthcare IT?

Following up on my previous post, a recent report from the Committee on Engaging the Computer Science Research Community in Health Care Informatics suggests:

Today's clinical IT systems “provide little support for the cognitive tasks of clinicians or the workflow of the people who must actually use the system(s).” ... The “overarching, grand research challenge” of the computer science research community is developing “patient-centered cognitive support.” Computer systems need to build virtual models of a patient’s status, models that “depict and simulate a theory about interactions going on in the patient” similar to those models going on in the head of a physician working unaided by a computer.

Read the whole report online or purchase a copy of the 120 page book.

IT should adapt to clinician

From Dr. David M. Polaner of Children's Hospital in Denver:

The primary focus of virtually every computerized medical record system is documentation, meeting Joint Commission on the Accreditation of Healthcare Organizations, Health Insurance Portability and Accountability Act, third-party payer, medico-legal and regulatory stipulations. Only the most cursory and sophomoric thought is given to information and how to organize and present it to the clinician in a manner so that they can leverage that information to improve patient care. The inability to look simultaneously at multivariate, multimodal data in multiple windows to correlate and integrate information reveals an utter lack of understanding as to what physicians actually do when confronted with a clinical problem.... Until imaginative software developers work in tandem with computer-savvy clinicians and experts in human-machine interface design I fear the situation will get rapidly worse.

Here in Information Systems, we are dedicated to solving problems, and we are committed to working closely with all clinicians to fully understand the problems they face. We encourage clinicians in turn to proactively engage with us to fully define the problem space so that effective solutions are possible.

Once is not enough...

An information technology consultant reminds us that iteration is the key to successful IT initiatives, including electronic health records (EHRs):

Like any information systems, the ambulatory electronic health-record systems being sold to small practices are a point in an evolution. Prior systems designed to enhance revenue through improved accuracy of insurance claims are giving way to systems designed to eliminate medical errors and improve continuity of care. No one should think this is the final, ultimate objective -- evolution will continue. Also, new standards will emerge, network and interoperability issues will change, vendors will merge and fail and new ones will emerge. Practitioners should understand that a few years after investing in an EHR system they will be facing a conversion or at least an upgrade.

[emphasis added]

Dwight Arthur on ModernHealthcare.com (registration required)