Strategic Informatics

A blog about the strategic application of technology


What about Patient Portals?

What makes a patient portal successful? Is it really worth the time and effort involved in integrating multiple systems into one cohesive view? Should you allow patients to view their medical records online? Will patients sign-up and use such features? Is the workflow change for my staff worth the effort?

These are common questions I commonly hear from our clients…My response is “What would your patients say?” I like being in a strategic position with our clients where we don’t have a product to sell or a framework for developing a cookie cutter solutions. Most vendor portal’s that I have seen are very much tied to a specific product and can’t take full advantage of all the features most requested by patients and their family members. As most who read this blog know both Google and Microsoft have made strides in providing a repository for your health data. This is not a new concept as we were designing this functionality back at in the late 90’s (yes before the bubble burst).  Patients have come to expect online services from the vendors it visits most.  I hear age and patient demographics as common reasons as to why such initiatives would not be of much value.  Nonsense.  This may have been true 8-10 years ago but regardless of your social or economic stature most patients have or know of someone who has Internet access and uses it frequently to access information online.   I’ve worked on projects for several Academic Medical Centers in Houston, Indianapolis, and Richmond and have seen and interviewed the full spectrum of patients that have great payer mixes to the indigent population that depend entirely on care from residents at a nearby teaching hospital.  Navigating health care services is far more difficult when you are poor and unemployed than it is when you are a middle-class taxpayer with a good insurance policy.  The value from patient portals comes in the diverse range of patients you can serve effectively with the integration of a patient portal.

I spoke at length with the Microsoft team at HIMSS (Health Information Managment Systems Society) about their efforts in the PHR space. Not surprisingly they opted out of providing a front end solution to capture this information but chose instead to let third-party vendors create front-end solutions and letting Microsoft provide the infrastructure for storing and transmitting this data securely from system-to-system. My experience with this is that a lot of vendors provide export capabilities in their product for patient information however there are not a lot that import this data making it a one way street. Microsoft and Google are hoping to change this and create a more extensible way to exchange this data. One of our clients purchased a portal product for GE’s Ambulatory EMR application which provided export capabilities compatible with the Continuity of Care Record (CCR) Standard (E2369-05). The problem with this is that the patient doesn’t know what to do with a text file full of XML tags. I designed a web enabled reader for our client that would parse this data and format it in such a way that would at the very least allow the patient to view their personal health record instead of opening IE or notepad to stare at seemingly endless strings of data. Vendors need to enable the inclusion of style sheets (XLST) into the CCR document so that patients can have this data formatted for them properly and it wouldn’t be a stretch to embed formatting and logo references to tailor it to a specific customer.  Again, this is a little effort would make a big difference in the overall patient experience.


Redmond…I’m still waiting!

Like most people who have used computers in the past 15 years I am very familiar with Microsoft’s products. Office 2007, which was made available to the general public on January 30, 2007 had some profound user interface enhancements; many of which I like. The ribbon interface is one of the more innovative features to come out of Redmond in quite a while. Why then, after the launch of such a money driving product such as Office, would Microsoft still not deliver any preview plug-ins for Outlook? I like the ability to preview files in Outlook 2007 within the preview pane. Instead of installing a non-registered third-party plug-ins I stumble across on the Internet I would like to go to Microsoft’s own website and install a compatible viewer. PDF is a standard, ZIP files are standard, why then hasn’t Microsoft or the vendors it claims to have been working with the past 13 months released any plug-ins you can download. Even Apple with their paltry market share of the software and hardware market ensures there are methods to allow developers to create software for their products.Microsoft states on their File Previewers for Outlook page, “Check back soon for updates. We are currently working with previewer developers to list previewers on this page.” This may be a trivial little quibble but if they think soon is over 12 months then perhaps they are not in total alignment with expectations of users on the Internet. This lack of attention to detail are the things that make me want to consider the use of other software and platforms and I get the feeling I might not be alone. I still like and use Office frequently but I think Microsoft can be a little more on top of their game. In my years of designing software interfaces and applications it’s the attention to detail that customers appreciate.


Patient Keeper on iPhone

It’s not often I see something that causes me to stop in my tracks while at a trade show. This year at HIMSS 08 in Orlando, FL I dropped by the PatientKeeper booth ( and noticed a wall of approximately 40 devices all running native software applications that allows providers to keep track of patient information on mobile devices while away from the clinic or hospital. Now a wall of mobile devices wouldn’t normally cause me to stop and take notice but one of the devices was an iPhone. Knowing that the tech community has been anxiously awaiting the release of Apples software development kit for the iPhone it was strange for me to see a mobile application from a vendor being run natively on a device that didn’t yet support native application. Upon further investigation it was clear the iPhone’s (yes there were several) displayed were jailbroken. Jailbroken iPhones are basically hacked to allow for third party application development and certainly not supported by Apple. It became very obvious to me that hackers weren’t the only users anxiously awaiting the release of Apples SDK. When you build your company around the support of mobile devices having support of a device that has commanded a huge 28% market share as of 4Q of 2007 is a top priority.  Not being content to wait for Apple to step up with an SDK they decided to build a virtual machine to allow their application to run natively on the iPhone. Although the iPhone and iPod Touch are not officially supported by the company it was great to see them keep its hand on the pulse of the market and shift their development accordingly.

Now all PatientKeeper has to do to complete the complete latest trends is adopt a new name ala Flickr fame. Do I see PatientKeepr in their future? The domain name is available. 🙂