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I understand the motivation for these applications, but anything that, in a room with a patient, takes one away from interacting with the patient has drawbacks.
by logjam 16y ago
I understand the motivation for these applications, but anything that, in a room with a patient, takes one away from interacting with the patient has drawbacks. A lot of docs are taught NOT to use this kind of device in the room. Even burying your nose in the patient's chart, of course, is problematic. Using it outside may have its advantages, but in the room it's ideally two humans and not much between them.
And if you'll forgive me, I have a hard time believing an app like this will drive pad adoption by physicians. Most docs have pads because, well, they just like toys.
Some docs have used laptops, which are a lot easier for data entry than these pads, and these don't require turning away from the patient either. In my experience, it's not common for physicians to write their progress notes in the room with the patient. Certainly writing a prescription and sending that to a pharmacy directly makes sense in the room, but there are classes of prescriptions where that cannot be done. Looking up drug interactions may be useful, but dedicated applications like eProcrates and other dedicated apps probably have become standard for that and I'm not sure I'd trust an "everything and the kitchen sink" app like this more than dedicated solutions (eg, these drug interaction databases require constant updating and care).
Billing info and medical data combined on a view is a no-go, if that's there. They don't belong together. Period.
Probably most importantly, most of us would need details about security of the transmission and storage of medical records before considering this at all. Someone said below this app is "HIPAA compliant", but I'm leery of that overused phrase because the HIPAA requirements are quite vague, and as far as I know there is no actual certification for something like HIPAA compliance. Vague claims of "HIPAA compliance" are likely NOT going to impress or satisfy juries and medical licensing boards. In addition, some information (depending on the state) requires more stringent care; for example, mental health records, record of drug abuse/dependence, etc. Hospitals and clinics typically have dedicated IT departments who put into place much more security than HIPAA requires. If someone hacks a system like this, the fact that you require passwords and do some encryption is not going to cut it if you can't demonstrate you are using standard of practice medical record security measures.
Specifically, many physicians would want to know, at a minimum, complete details for:
- backup, recovery, and retention policies for all data.
- logging mechanisms in place to track access and change of data. By "access" tracking, I mean a record of every last living creature who views the data, at any time, for any reason, and that includes everyone at "DrChrono", the employees of any firms that manage their servers, etc.
- audit mechanisms and schedules.
- policies Yet Another Third Party ("DrChrono") would have in response to subpoenas, direct request from patients for their medical records, requests from insurance companies, etc.
- mikeleeorg 16y agoYou just reminded me of something. Many doctors I've spoken to don't want to use a mobile device to look up information while in the presence of a patient. It's not good bedside manner and can hurt the doctor's credibility as a medical expert (a patient may think, "Gosh, I could have downloaded that app and looked up that info myself!"). There may be a few exceptions, of course, but that seems to be the more common use case.
- logjam 16y agoWhat you say may be true for some, but I don't mind looking stuff up in the room with a patient. Most of us try to do what's in the patient's best interests, which definitely includes in my case trying to refresh my highly fallible memory. However (and I'm waxing philosophical here) people don't come in to hear information from their docs as much as they come in to be heard by another human. Good docs ain't in that room with you to check off whether you had your oil changed and tires rotated, which tasks do seem like something a pad or laptop can be helpful in noting (paper does it just as well, however, and doesn't end up on the web). Data capture just isn't the big problem in all this. A major problem is developing novel, innovative and SECURE ways to track and make USE of that data for the benefit of patients.
- niels_olson 16y ago> innovative and secure ways to track and make use of This brings up the very real issue that this is not just a fancy secure email app like hushmail where the data is stored and transported encrypted: here the data will live on the server decrypted at least transiently to build those novel ways to "track and make use of".
- mkramlich 16y agoHaving a doctor that reads and post here on HN is like gold for anybody developing medical software. You and the folks behind DrChrono really should touch base.
- niels_olson 16y agoThis comment deserves a lot of up votes.