News 3/15/10

From GoGirl: “Re: Transcription Services. What is going to happen to all these dictation companies as the pie gets ever so smaller with EMR deployment?! Epic deployments are reducing dictation by 90%.”

I think this is a great question – one which strikes at the core of transcription, and EMR documentation itself. I personally have come-around on the question of typing versus dictation – maybe not 180 degrees, but at least 120. Having implemented an EMR in the past, and being a big supporter of technology, I have been adamant that physicians should type, should use templates, should use the EMR as intended. I’m sure that I’ve said on at least one occasion that dictation flies in the face of the EMR.

My opinion has changed – not because of anything related to workflow or behavior modifications – but because I think documentation suffers. While typed and point-and-click notes are not inherently inferior to transcribed notes, I definitely think they encourage short-cuts and depersonalize the encounter. That’s just my opinion. Ultimately any note is only as good as the person taking it. Either way, I think we will see an increasing number of solutions that take a hybrid approach – templates, drop-down menus, free form text, and the option to append a dictation for note “enrichment.”

I thought it would be great to hear from the transcription companies on this question so I sent it over to a couple. They haven’t had much time to consider the question, but John Shagoury, President, Nuance Healthcare was kind enough to send me the following reply:

John Shagoury

I expect others to weigh-in over the coming days. Where do you think the industry is heading?

In the news…

MyHumana Mobile

Humana launches MyHumana Mobile. The mobile Web-based offering includes three tools: Mobile Urgent Care Finder – to locate an urgent care facility using either a zipcode or built-in GPS feature for smartphone users; Mobile Spending Account Balance Viewer – to view recent spending account activity and current balance details; and Mobile Member Information Tool – to view health-plan member details on demand, including the Member ID number and the member’s group name and group number.


RememberItNow! launches mobile medication reminder and eHealth service. The company claims to offer the first eHealth service which helps people take medications correctly by sending reminders to their cell phone. Presumably the distinction is that RememberItNow! runs as a web-based application that sends alerts to a companion mobile application. The HealthAssist iPhone app announced last month, for instance, is a standalone smartphone application that assists patients with medication management. RememberItNow! also includes a host of personal health record (PHR) capabilities… (BTW, I’ve gotta add that the company’s landing page has the same design as and Practice Fusion. Is this some kind of bizzaro conspiracy?)

Ok, I tried really hard to overlook this press release. I opened and closed the page three times. I just couldn’t let it go without comment. It’d be no easier to turn away from the gore of a jack-knifed semi and pan-caked Prius on the turnpike… “Hospital executives at largest healthcare IT event in nation witness launch of InfoLogix healthcare mobility solutions suite.” Really? And here I thought everyone was at HIMSS to see me. The company announced a $3m infusion from Hercules Technology Growth Capital on Tuesday.

Forrester: healthcare IT leaders need to address mobile security and management. In a report titled, “Managing and Securing Mobile Healthcare Data and Devices,” Forrester Consulting found that regulatory compliance tops the list of concerns among its network of healthcare and life sciences IT decision makers with 86 percent of the respondents ranking it as a high or critical priority. The study was commissioned by Fiberlink Communications Corporation and is available at


In tandem with the report, Fiberlink debuts business intelligence platform for healthcare mobile device compliance. The company, creator and developer of cloud-based mobility as a service (MaaS) solutions, offers the Healthcare IT Compliance Service. The MaaS360® Healthcare IT Compliance Service gives IT professionals a single, unified view of policy and status reporting for all their mobile devices, helping organizations to identify and manage compliance vulnerabilities and data security risks.


In separate, yet related news… I had a great conversation with Fraser Edward, Manager of Market Development – Healthcare, Research in Motion (RIM), better known by their Blackberry brand name. Fraser and I were scheduled to talk at HIMSS, but we had a slight mix-up… and too much GWCC ground to cover. I’m actually glad that I had a chance to talk to him without all the distractions and the rigid schedule. As you might imagine, we spent a bit of time talking about security and enterprise management. Makes perfect sense. RIM is still way out in front of their competitors in this area. As I told Fraser, I think just about everyone recognizes that RIM offers better security (at least for the time being). I think the challenge is that security is a relative term and, despite HIPAA and perhaps because of it, there are not clear, well-defined requirements. So, while Blackberry may be good enough for the FBI, is it good enough for healthcare? On one hand this is good for RIM because they surely score well on perception studies, on the other, how many enterprises are holding back on mobility because of fear of non-compliance? I don’t know. My guess is that the uncertainty favors RIM.

RIM is wisely making haste to leverage their strong enterprise position. While I really like to talk about niche or vertical solutions within the healthcare enterprise – such as PatientKeeper, Voalte, IQMax, AirStrip, etc… None of these solutions is driving large-scale adoption across the enterprise. True enough. RIM is particularly interested in nurse alert notification solutions, and unified communications (UC) more broadly. From their perspective, it’s great to have a handful of enterprise apps on a device that a clinician can use, but let’s make sure that we first get a device in everyone’s hand. As anyone attending HIMSS this year can attest, this a very popular goal. Solve the communication challenge and everything else follows.

I think this is a fantastic strategy for RIM for a couple of reasons. First, they already have substantial market penetration. The additional communication capabilities that they can bring to bear generally require only incremental investment. For example, if an enterprise is already using Blackberry Enterprise Server to manage corporate email, a number of add-ons can be implemented to tie into other key enterprise assets, including PBXs and even hospital information systems. Second, application developers tend to be device and OS agnostic. Sure there might be a sizzle factor to putting an app on an iPhone.  An iPhone may even be the preferred route for gaining end-user mindshare. But when it comes to selling applications to the enterprise, developers understand Blackberry’s position – just look how quickly they release a Blackberry version. This makes it very difficult for one smartphone to gain a competitive advantage over another in the realm of enterprise apps. Finally, the devices are just plain powerful. In other words, they can readily handle the multiple challenges of UC, including voice, text, email, and data. My bet is on a smartphone winning out the end-device race, and Blackberry’s multi-tasking capabilities give it yet another feather (though rumors are brewing that multitasking will be supported in iPhone’s 4.0 release expected in the summer).

As long as RIM can help advance the cause of UC, I think they are in the best position (of end-user device manufacturers) to capitalize in the short-term. The things I think they should be most concerned about: one, you’re never as far ahead as you think (and if you are, tell yourself otherwise), and two, don’t underestimate the power of sizzle. Sizzle can make people do irrational things – like, “maybe fleet management isn’t that important”, or “HIPAA schmippa” or “maybe we should hold-off on making a decision for a little while to see if the uber-device catches up”. 

While Fraser’s clearly not in a position to discuss products and features on the horizon, I think RIM gets the sizzle factor – after all, once upon a time, they were pretty cool, too. I fully expect them to respond to the iPhone in some form or fashion. In the meantime, they’ve got a great story to tell and the enterprise credentials to back it up…


Finally, congrats to Voalte for capturing almost 73% of the vote for the hottest new mobile app.  AirStrip finished second at 15% – though it was beginning to gain ground. Now that you can pre-order the iPad, take a second to answer my latest poll – Do you plan on purchasing one this year?

  • I think the dictation process is still the most efficient for the healthcare provider. I DO think the documentation process can be made more efficient with the use of technology using editors with speech recognition. The healthcare documentation is the patient’s story, and standard templates where you just point and click don’t really tell the whole story. It sure isn’t how I would want my own healthcare records done nor those of my family. I think the industry needs to work together to find solutions where there is an option for using technology to maximize what is now the medical transcription process.

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