Health Informatics

Evaluating WebMD’s Personal Health Record

March 25, 2016 by kidseyes Leave a Comment

#MI227 #4

Evaluation of an Electronic Health Record: the Personal Health Record or PHR

As part of course work for #MI227 Clinical and Laboratory Information Systems, we were tasked to evaluate an electronic health record system using published tools. I have chosen to evaluate webMD’s personal health record (www. webMD.com/phr) using as basis for evaluation the paper published by Pushpangadan S and Seckman C, on Consumer perspective on personal health records: a review of the literature.

Personal Health Record (or PHR) by definition is “an electronic, lifelong resource of health information needed by individuals to make health decisions.”( The American Health Information Management Association (AHIMA) in Burrington-Brown et al., 2005, p.4). With the PHR, an individual can manage, maintain and interact with his personal health information, personalizing and tracking health information. PHRs collect, track and store medical data in one accessible source. WebMD makes this accessible via the web, so that only an address, an internet access, and the individual’s password will allow sharing of this data. PHRs supply a means to monitor, maintain and support healthcare activities throughout an individual’s life span.

The following evaluates the PHR using the WebMD platform.

Usability

Is it user friendly? 4/5

Prescriptions and Refills 0/5

Viewing of

Medical History 4/5

Test Results 4/5

Medication History and Current Medications 4/5

Drug Interactions and Warning 4/5

I created a PHR for my mother because of the numerous ailments and medications she is taking. I found it user friendly, with her medical records viewable with date of diagnosis. Test results are entered manually (this can be tedious) and can be plotted over time if tracked. The results can also be scanned or uploaded. Current medications and history are listed clearly, with clear drug interactions and warnings. However, I wasn’t able to access the direct usability for prescriptions and refills, but this may be because I am a user from the Philippines and not the US.

Communication

PHRs improve communication with providers 5/5

Provider communication

Via email 3/5

Scheduling of appointments and reminders 3/5

Sharing of results 5/5

Resources and recommendations regarding health issues 4/5

Capable of being incorporated into an EMR 3/5

Using my mother’s example, the PHR listing provides good communication with providers as the PHR can be printed as a pdf file. Repeated history taking and date recall become a breeze with the PHR. Full communication with the provider, however, via email, and scheduling of appointments as well as reminders are not fully utilized (perchance because of my location). Sharing of results is easy either via full access of the PHR with a link or password, or via soft or hard copy sharing of pdf files, but full interoperability with an EMR remains to be proven. References and recommendations are provided if one is interested.

Medical terminology

Was medical terminology explained and understandable? 4/5

Was medical terminology in simpler words or layman’s terms? 3/5

Was an online dictionary embedded for easy reference? 3/5

Resources and recommendations 4/5

Health information and health promotion 4/5

While medical terminologies are not explained on the outset, links and reading materials are provided for better understanding. An embedded dictionary, however, is lacking, as the resources provided are also difficult reads for the layman. The information is readily available, however, to the interested PHR user. Health information and health promotion is aided by health tracking and education.

Privacy and Security

Is it HIPAA compliant? 4/5

Can patient control with whom they want to share data with? 4/5

To a certain extent, HIPAA compliance is probably a given, as the platform is used widely in the US with strict privacy and confidentiality rules. To a certain extent, the patient controls with who data is shared with. Latest terms and conditions, however, have clauses that permit data sharing of some personal information and is a concern.

References:

Pushpangadan S, Seckman C. Consumer perspective on Personal Health Records: A Review of the Literature. http://www.himss.org/ResourceLibrary/GenResourceDetail.aspx?ItemNumber=39756. Accessed March 25, 2016.

Burrington-Brown, J., Fishel, J., Fox, L., Friedman, B., Ginnangelo, K., Jacobs, E.,… & AHIMA e-HIM Personal Health Record Work Group. (2005). Defining the personal health record. AHIMA releases definition, attributes of consumer health record. Journal of AHIMA/American Health Information Management Association, 76(6), 24.

Abramson, E.L, Patel , V., Edwards, A. & Kaushal, R. (2013). Consumer perspectives on Personal Health Records: A 4- community study. American Journal of Managed Care. 20(4):287-96.

Somner, J., Sii, F., Bourne, R., Cross, V., & Shah, P. (2013). What do patients with glaucoma think about personal health records? Journal of Ophthalmic Physiological Optics,33, 627-633. doi: 10.1111/opo.12084

Fricton, J. R., & Davies, D. (2008). Personal Health Records to improve health information exchange and patient safety.Agency for Healthcare Research and Quality. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK43760/

Patel, V., Abramson, E., Edwards, A., Cheung, M., Dhopeshwarkar, V., & Kaushal, R. (2011). Consumer attitudes toward personal health records in a beacon community. American Journal on Managed Care, 17, 104-120.

Health Information Security

March 25, 2016 by kidseyes Leave a Comment

#MI227 Coursework #5: Health Information Security

This week we were asked to “be part of a group practice that has decided to implement an electronic solution for clinical documentation. However, you have come across many horror stories regarding health information security that have led to failed clinical information system implementations. How would you prevent this from happening to your group practice? Create an article listing down questions that your group practice should be able to answer to identify risks to securing electronic health information.”

On Confidentiality

Is it HIPAA compliant?
Is it compliant with the Philippines Data Privacy Act of 2012?
How do we deal with security breaches?
How can we ensure confidentiality of entries?

On Availability

Where is storage?
How is the system backed-up?
How will data to be retrieved from storage?
How fast can data be retrieved?

On Integrity

How do we ensure that data is not manipulated, corrupted or lost?
How do we maintain data integrity?
Who has access to data?
Who can modify data entries?
Is there a code of ethics for data handlers?

These are some of the questions that needs answers before one could feel secure about considering an electronic solution for clinical documentation.

Barriers to National EHR Implementation

March 2, 2016 by kidseyes Leave a Comment

Would I be project manager for the Department of Health (DOH) to implement a national electronic health record (EHR) for all government hospitals? Not by a long shot. Nonetheless, the task was assigned as coursework for #MI227, Clinical and Laboratory Information Systems.

Top three barriers I discuss here are what I think would affect me as a physician. (1) Time: Time to convert existing patient records and making it interconnect with the new EHR system, (2) Technical: Lack of customisability of EHR to conform to specific needs of a subspecialty, and (3) Social: Interference with doctor-patient relationship.

While learning a new EHR system represent a barrier in itself, I have yet to see how the “old charts” that comprise one’s clinical history can be integrated with full interconnectivity and readability with a new EHR system. Often, what is resorted to is just scanning of these documents and storing them as pdf files. I find this unacceptable even for my small clinic practice.

The lack of customisability is recognised as a barrier not just by physicians, but nurses as well. (ref) There are different specialty units in the hospitals. An EHR for one unit may not be as efficient for another unit. There needs to be some level of customisability of the EHR. This however, will make the process more tedious, and more expensive.

“Electronic health records affect the patient–physician eye contact dynamic differently than paper charts.”(ref) The advent of the EHR in the middle of the physician-patient encounter has brought to fore gaze patterns between physician, patient and the EHR.(ref) Witnessing how a physician dealt with my father as he filled up an EHR in his clinic, I thought there was lack of eye contact, with the physician looking at the computer tabs more than the patient. The “story-telling” of a patient’s story was reduced to tick boxes or drop-down menus. The art of medicine is lost. The encounter seemed cold.

References:

El Mahalli A. Adoption and barriers to adoption of electronic health records by nurses in three government hospitals in Eastern Provice, Saudi Arabia. Perspect Health Inf Manag.2015 Nov 1;12:1f. eCollection 2015. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4632875/
Montague E, Asan O. Dynamic modeling of patient and physician eye gaze to understand the effect of electronic health records on doctor-patient communication and attention. 2014 Mar;83(3):225-34. doi: 10.1016/j.ijmedinf.2013.11.003. Epub 2013 Nov 28. Accessed February 27, 2016. http://www.ncbi.nlm.nih.gov/pubmed/24380671

#HI201 #MSHI The Final Frontier

December 13, 2014 by kidseyes Leave a Comment

#HI201 #MSHI: The Final Frontier (Documenting the semester that was)

Online Interaction and (New) Learning Competencies

I felt accomplishing quite a feat, really. Never mind that I am late again in posting this homework. (It seems I have often been so!). For a mid-centenarian(?) I was able to blog, tweet, use Facebook to connect and comment, even got introduced to Basecamp, which incidentally, I could no longer open. [As a paranoid, mistrusting internet and computer user, luckily, I have printed the comments of Dr. MM on my EHR assignment). As my professor in HI201 said, I too, am not sure what I am doing here. There is probably some divine hand in this undertaking…for while I was a student, a foreign-based consultant wanted the local eyeMDs to post patient data via Facebook!, or even suggested using Dropbox, duh. Certainly, I have enjoyed the ride, and the “cool” learning experience, I could even discuss with my 16-year old son.

ENQUIRY.

I knew nothing about health informatics when I started. The course design, the reading materials, the assignments (although soooo many) helped me see the field, ask the right questions, and find the right sources. I know I am at the tip of the iceberg. I know there is a whole field waiting to be discovered. I only saw glimpses. I liked what I saw. There is more to look into. There is a wealth of information still waiting to be discovered.

PRODUCTION.

What I found the hardest, up to this date, is the making of the INFOGRAPHIC. I made a cryptic info graphic, didn’t realise I needed numbers, numbers, numbers, and not just information. Took me a while… went through piktochart, easel.ly, visual.ly among the many sites that gave “free” templates. It was supposed to be easy (ask Burr!, who did his info graphic homework 10 minutes before classes started), but it took me forever to modify my info graphic, to make it look a little bit closer to what an info graphic should look like.

There were a lot of presentations. Each week, there was a written blog, and an oral presentation we prepared for. The power point presentation was a breeze, as I had been a user of powerpoint for my lectures. I did know how to cram a presentation while my classmates were presenting, haha! Just before I started the course, I also had been sharing my slides on SLIDESHARE, so the transition (was there one?) was easy.

I still don’t get the difference between a MINDMAP and a CONCEPT MAP. Not sure if I did right or wrong there, but managed to answer the driving questions, and the assignment (I hope).

PARTICIPATION.

Rank has its privileges, or maybe age? I had a mentor, a colleague in Alexander Reyes, MD, a self-made Health Informatics Specialist. Like myself, he was an ophthalmologist. He pushed me to participate, beyond the usual comments. He provoked my thoughts with questions, or even twists on a current assignment. He had his own take on health informatics, topics, and controversies. He even invited me to take courses with coursera. I probably will, once I finish my homework. Even “strangers” commented on my work!

I also had a chance to look into my classmates thought processes. The novice that I am at health informatics, I could freely comment and give input, hoping I didn’t sound incomprehensible. It helped that we were coerced to comment on at least 3 of our classmate’s post on mobile health application.

I didn’t get as much activity on the assignments on twitter, but did learn a lot from attending a few of the #healthXPH Saturday night activities.

DIGITAL LITERACY. I am not sure how to classify myself with what I was when I was just starting #HI201. I knew email, how to send, attach files. The first assignment, was to blog, get on Facebook, and twitter. I had a Facebook account my son had set up, now I check it everyday– for homework, social networking, school announcements, among many things that get posted. I didn’t understand why the # sign is called a hashtag, when I new it as “number” or even a “pound sign.” I needed my son to help me follow my teacher on twitter, or tag you on Facebook. He taught me twitter syntax, and told me there was a limit to the number of characters…anything that exceeded, could not be tweeted.

And, finally, the last requirement was documentation of the semester that was. Here is that link.

https://www.dropbox.com/s/ypcn0a6bqo4m9tx/HI201%20Final%20documentation.docx?dl=0

Had a good time! and I #learnedsomethingnew. 🙂

Week 17: Game Based Learning

December 3, 2014 by kidseyes 2 Comments

Can games improve health? #HI201 Last week! #MSMHI task: Evaluate a health-related mobile game app.

My knee jerk response is yes, there could be applications where games can improve health. But I am an ophthalmologist, can a mobile game app improve eye health? Hmmm… could be a problem. It is unconscionable not to mention the ills of computer games in this blog (lest my patients and parents read this).

Before I proceed then, let me disclose that I am not an avid fan of computer games. I did not take my son to the video arcades, believing it was a money trap that only served to strain the eyes and even induce seizures!

Furthermore, I am a paediatric ophthalmologist. I get questions (which I sometimes think are rhetorical) such as, “do computers and gadgets affect children’s vision?,” and “how much time should a child spend in front of their gadgets?” Moreover, I can actually gain financially from patients using games in a mobile app who develop symptoms of headache, blurring of vision, diplopia, sometimes even nausea and vomiting, when they consult the clinic.

The following eye problems from computers and gadgets have been observed and reported:

1. Reduced blink rate, which in turn leads to

2. Dry Eye Syndrome, (child can complain of blinking, drying, foreign body sensation, burning sensation)

3. Asthenopia or eye strain

4. Ciliary muscle fatigue or accommodative spasm

5. Induced refractive error, typically myopia and astigmatism, and

6. Induced strabismus in predisposed individuals.

7. Computer eye syndrome or video terminal display syndrome

8. Computer addiction affecting social skills and interaction

These being said, I have also found gadgets and computers useful in the clinic to get and sustain a child’s attention; for orthoptics especially for patients with intermittent exotropia; give the child something interesting to look at; provide a good diversion; aside of course from the obvious tools in the clinic such as the eye chart and auto refraction machine many are familiar with.

Proceeding with the game application that needs to be evaluated for this task, I migrated to food-based games just like Mr. Cardenas’ “Gobbles Eat and Run.” [3]

The first one I looked at was “Awesome eats.” Although it had music and started with teaching the player how to swipe, then sort, I didn’t last long and found the game boring. The skills required were too elementary, but the trivia provided was for a much older age group. For example, the snippet for trivia text read “if you can’t tell a hard boiled egg from fresh eggs, give them a spin. The egg resistant to spinning is uncooked, but if it spins, it is hard boiled.” I needed less than 5 minutes to judge this app, and forget about it.

I checked out “Eat this not that! Game by Men’s Health,” Classic Edition and was finally happy with what I saw. It didn’t require finger dexterity, or eye-hand coordination required in “temple run” type games.

The game simply presented two types of meals one is commonly confronted with, the player having only to choose which food to eat. The pictures looked like what one would see in a food magazine, or in an actual life setting. It teaches facts, with details about calories, and explains why one food choice is better than the other. It quells common misconceptions, and simulates one’s dilemma when choosing from a menu. There is a classical version, a kids version, and even a drinks version.

I actually plan to keep playing this game, learn from the choices and repeat the game to reiterate the right choices in my mind and my easily tempted appetite. Perhaps though, this game appealed more to the “older” age group, not the kids who grew up with moving frenzied targets, with speed of graphics that keep changing as the clock ticked. The game I would think is more cerebral, and appealed more to the problems that beset an older age group needing to make the right dietary choices. It is not the type of game that will induce a seizure.

In conclusion, yes, games can improve health, and is an excellent tool for fun learning and edutainment. Games can motivate, enhance, prevent, support, train and rehabilitate. [1, 2] That knowledge, however, is tempered by the fact that as an ophthalmologist, I know games can affect eye health. If not moderated and abused, can open a Pandora’s box of eye symptoms and findings, not to mention seizures (!) in predisposed population.

References:

1. McCallum S. Gamification and serious games for personalized health. Studies in health technology and informatics 2012;177:85-96. http://www.miro.ing.unitn.it/download/Didactics/Misure2/2012%20pHealth%20-%20Gamification.pdf

2. Gamberini, Luciano, et al. “A game a day keeps the doctor away: A short review of computer games in mental healthcare.” Journal of CyberTherapy and Rehabilitation 1.2 (2008): 127-145. http://htlab.psy.unipd.it/uploads/Pdf/Publications/Papers/Cyber_rehab08.pdf

3. Cardenas, Isidor. Game based learning: theory and applications. Webinar given 30 November 2014, 1-2 pm.