Embracing Electronic Health Records

Lisa Moss Calderwood, MA

Senior Medical Writer

My primary doctor of the past 20 years has the tiniest handwriting. He’s fastidious about documenting what we discuss during exams and a visit with him is usually a solid half hour or more. I’ve learned to be patient and not speak while he’s writing. We have our routine: we chat, he examines me, we chat some more, and he takes his notes. His office hasn’t changed over the years either—the reception room’s wood paneling and travel photography have been the décor for as long as I’ve been a patient there, not to mention some of the posters on the wall in the exam rooms. I guess there’s some comfort in that constancy. But there are some not-so-small changes going on.

A couple of years ago my doctor and his wife, a family nurse practitioner who is part of the practice, began transferring thousands of patient files into electronic health records (EHR). At first it made me uncomfortable as everything I said seemed to be going into a huge database. I wondered how secure it was. Then I learned that he was following federally mandated guidelines for healthcare practitioners (HCPs) to have a certified EHR. Now when I see him, he turns to his laptop and enters everything electronically. It still seems to take the same amount of time, and I’m not sure if it’s because he types as carefully as he writes (and we still chit chat), but I imagine that my data is now in the EHR cloud. I still have to take out my reading glasses to read his writing on my prescriptions, so he’s still using that MD handwriting. 

I wondered what it was like for traditional docs like mine to make the leap to EHR and how others are following suit—or not. Some practices are more resistant, perhaps Luddites not interested in taking on the technology, whether it’s for patient records or even setting up more efficient office systems. But the cost to adopt EHR is also a significant factor, especially for a single primary doctor—about $30,000 to install a system, and $2,000 in monthly fees, according to Olga Khazan’s illuminating piece in The Atlantic about why more docs aren’t tech-savvy.¹ She notes that, to her frustration, some of those same EHR-avoiding doctors also avoid e-mail access and online scheduling.

Khazan acknowledges that some doctors are resistant because they fear abuse of patient data, the amount of work it takes to transfer thousands of files, or additional staff needed to properly use EHR. But, she reports, some larger practices are thriving and taking full advantage of the potential features the EHR system provides: “You can e-mail with your doctor or nurse, get medical records released by filling out a short online form, and schedule appointments or renew prescriptions with an iPhone app.”

As a medical writer of patient and HCP educational materials for Artcraft Health, I think of the broad teaching possibilities to help empower physicians and their colleagues to efficiently embrace EHR. How about education about EHR to acquaint patients with the process and explain to them why their doctors are collecting and sharing data about their health and medical history? If the ultimate goal of EHR is to foster a more patient-centric healthcare system, then responsive training is vital to its success.

In fact, physicians are not receiving adequate training either, according to Jeff Rowe in HealthcareIT News. “At least three to five days of EHR training was necessary to achieve the highest level of overall satisfaction” with a new EHR system, but “nearly half (49.3 percent) of respondents [in a survey] indicated that they received three or fewer days of training.”² That may explain why more physicians are not yet onboard with EHR.

About 54% of physicians nationwide have embraced EHR, according to a recent survey.³ The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act states that HCPs and hospitals must adopt EHR to “advance the use of health information technology by providing Medicare and Medicaid incentives to physicians and hospitals that adopt and demonstrate ‘meaningful use’ (MU) of [EHR] systems.” HITECH also states that EHR must be adopted by practices and hospitals by 2015 to be compliant and receive “meaningful use” compensation (reimbursement incentives to practices and hospitals by the Centers for Medicare & Medicaid Services).

According to HealthIT.gov, meaningful use of certified EHR technology enables practitioners to improve quality, safety, and efficiency, and reduce health disparities, while maintaining patient privacy. Essentially, the government website says, “with EHRs, information is available whenever and wherever it is needed.”⁴

The “real-time” advantages of EHR ideally offer integrated access to a patient’s medical history, diagnoses, medications, test results, and more. Physicians can also obtain evidence-based tools to help make care decisions, streamline workflow, increase accuracy, and stay on top of payer requirements. EHR consolidates information across healthcare facilities, including laboratories, medical imaging centers, or schools.

So I’m proud of my primary doctor for getting on the EHR bandwagon despite his office’s old-world feel and his meticulous handwriting. He has embraced the technology and has joined half of the country’s practices in doing so. Maybe he’ll upgrade to the multifunctional EHR service that allows for e-mail access, electronic prescriptions, and other whistles and bells. But for now, I’m happy to enjoy the mix in his office of technological progress and a very caring patient experience.

   References

1. Khazan O. The Atlantic Monthly. Why aren't doctors more tech-savvy? January 21, 2014. http://www.theatlantic.com/health/archive/2014/01/why-arent-doctors-more-tech-savvy/28. Accessed January 27, 2014.
2.  Rowe J. HealthcareIT News. Providers need proper EHR training. October 25, 2011. http://www.healthcareitnews.com/blog/providers-need-proper-ehr-training. Accessed February 6, 2014 
3. CDC. National Center for Health Statistics (NCHS) Data Brief Number 98, July 2012. Physician Adoption of Electronic Health Record Systems: United States, 201.1 [Updated 2013]. http://www.cdc.gov/nchs/data/databriefs/db98.htm. Accessed January 27, 2014. 
4. Benefits of electronic health records (EHRs). HealthIT.gov. http://www.healthit.gov/providers-professionals/benefits-electronic-health-records-ehrs. Accessed January 30, 2014.

Artcraft Health is a marketing communications agency specializing in educational solutions for healthcare professionals, patients, and caregivers. Our extensive background with pharmaceuticals, biotechnology, medical devices, and clinical trials enables us to meet most any challenge in health education. For more information about Artcraft Health, please visit our Web site at http://www.artcrafthealthed.com/.

FDA Draft Guidelines for Pharmaceutical Social Media

Samantha Reba

Junior Writer

Last week, the US Food and Drug Administration (FDA) released draft guidelines addressing responsibilities of pharmaceutical manufacturers and distributors related to real-time online communications and interactions. The proposal outlines various levels of responsibility related to content posted by or about a company. The guidelines cover but are not limited to corporate blogs, microblogs, online communities, podcasts, Facebook, and Twitter.

The guidelines limit pharmaceutical companies’ responsibility for content posted via social media where they have no control over or ownership of the platform or content. Firms would be held increasingly responsible in situations where they have powers of editorial review or otherwise influence posted content. The FDA draft calls for companies to send monthly reports of all covered online activity to the agency. If companies have any input into posted material, it would need to be reported to the FDA. 

The pharmaceutical industry has until April to submit comments and suggestions to the FDA concerning the guidelines. Until then, firms are being asked to file monthly reports while the debate over user-generated content continues. The new rules should allow more flexibility regarding interactions with patients via social media channels without requiring an audit of every comment submitted. Many questions remain to be answered but for now the discussion appears to be moving in the right direction.

Animating the Stent

Tom Savonick

Senior Medical Writer

Our client faced a challenge. They were a medical device manufacturer with a sensational new product, a coronary stent similar to this:

Coronary stents are small wire-mesh tubes that open up narrow or weak arteries. From the picture above, you can imagine our client’s challenge. Stents are small, they aren’t much to look at, and all stents look pretty much the same. To paraphrase Gertrude Stein, a stent is a stent is a stent.

But our client’s stent offered distinct competitive advantages over conventional stents. Using their stent, a cardiac surgeon could greatly reduce the number of steps required to install the stent, use fewer highly specialized tools, and reduce the duration of the surgical procedure by about 10 minutes. Shorter surgeries usually translate into shorter recovery times for most patients.

The significance of these benefits isn’t apparent from reading a bullet list in a PowerPoint presentation or even by looking at drawings that show how the stent works. To fully appreciate the stent’s advantages, you would have to look inside a coronary artery during a surgical procedure. Because the intended audience was cardiac surgeons, any presentation would require absolute anatomical accuracy. A scientifically correct animation seemed the best solution.

“Animation is the most effective solution for explaining how things work,” says Marc Sirockman, Executive Vice President and General Manager at Artcraft Health Education. “Animation can quickly orient viewers, transport them down to the cellular level inside the body, and demonstrate competitive advantages in a way that they can easily understand. Our illustrators, animators, and designers have incredible talent for producing anatomically accurate images that enable viewers to quickly grasp complex ideas.”

Our involvement in the stent project began with a face-to-face meeting between the client and Brian Schaechter, our director of business development. Brian listened intently as the client described their stent, its competitive advantages, the competitive landscape, and their marketing objectives.

After the meeting, Brian downloaded everything he had learned from the client to the Artcraft team that would remain with the project until its completion. In our lingo, this type of meeting is called the “internal kickoff.” Participants in an internal kickoff usually include our creative director and a sales rep, medical illustrator, animator, designer, and medical writer.

“The internal kickoff is a critical step because it’s where we come together as an official team for the project” says Mike Boasso, Director of Medical Illustration. “We assign roles and get a full explanation of the project from the sales rep. Then we devise a list of key questions to ask the client. At this point in a project, there are factors that are crucial to our understanding. We need to know who the intended audience is, what format the animation should be delivered in, and what will be the maximum resolution that the animation will be viewed in.” 

Answers to those crucial questions are delivered by the client in what we call an “external kickoff.” Here, the client team meets the Artcraft team in a face-to-face meeting, if possible, or if not, in a conference call. In the external kickoff, the Artcraft team describes the animation process to the client and discusses the project timeline and deliverables.

“The external kick-off is where I like to infuse a lot of enthusiasm into the project right off the bat, says Doug Walp, Medical Animator. “It's our first chance to discuss the project critically with the client. I want to be clear on every detail of the project and get answers about the animation’s aspect ratio, audience, and what the client is expecting as a final deliverable. I also want to educate the client about our process and why it has to be done a certain way. I want the client to leave the external kickoff as enthusiastic about the animation project as I am.”

After the external kickoff and with enthusiasm riding high, the team’s medical writer creates a story outline: all prose, no pictures, describing the animation’s progress from title screen to closing logo. A snippet of story outline for the stent animation might look something like this:

TITLE SCREEN (FADE OUT)
Stent enters introducer shaft (SHOWN FROM DISTAL TIP TO PROXIMAL HUB)
Introducer shaft enters catheter
Heart is beating as guiding catheter is engaged in left main coronary artery

The outline may not sound as compelling as The Godfather, but after the Artcraft Health Education animators work their magic, the finished animation could end up as the Citizen Kane of cardiac stent animations.

After receiving client approval on the story outline, the animation team begins to draw, adding a rough sketch to each scene in the story outline. One or 2 full-color images will be included to enable clients to sense the look and feel of the finished product. This step is the point at which you begin to appreciate the extreme talent of medical illustrators. They are professional artists, able to render any part of the human body in eye-pleasing detail. They are also healthcare professionals with advanced degrees in the life sciences. Every Artcraft Health Education medical illustrator and animator took courses such as anatomy, pathology, microanatomy, physiology, embryology, and neuroanatomy.

The completed sketch storyboard goes back to the client for review. After any changes are made and the client okays the sketch storyboard, our medical illustrators crank up their artistry to the next level and produce full-color, anatomically accurate renderings of each sketch. These drawings will be used in the finished animation, so they are created with utmost precision. Action notes, similar to the prose of the story outline, are included on every board. These notes provide details about movements, changes in lighting, special effects, and other directions. 

“The full storyboard is a turning point in the animation process,” says Brandon Keehner, Medical Illustrator/Animator. “Any changes that clients request are best made early in the process. Changes to the story outline are a matter of simply editing a Word file. Changes to a sketch take more time, and changes to the color images in the full storyboard are even more time consuming. But once the client approves the full storyboard and we begin animating, changes can have a serious impact on timelines and budgets.”

Before the Artcraft team can begin the animation, the audio track must be selected and recorded so that it can be synchronized with the animation during production. The voice talent who will record the voiceover is chosen by the client after we offer some suggestions and send sample voice recordings. The ideal voice talent will impress the intended audience with sincerity while accurately conveying the animation’s message.

Next, appropriate music samples are suggested by our team, approved by the client, and matched to the timing of the animation’s movements. If you’re unsure about the importance of music to a video, try to imagine 2001: A Space Odyssey without the playful Johan Strauss waltzes or the dynamic opening notes of Richard Strauss’ Thus Spake Zarathustra. Music matters.

With all the preliminary steps completed, the final animation begins. It’s an involved process that can take 20 business days or more, depending on the complexity of the finished product. Animations are constructed from a series of flat images that are displayed in rapid sequence to simulate motion. An average animation will contain about 25,000 images, each of which requires about 10 minutes of computer time to produce and will be synchronized to a snippet of music, voiceover, and special effects. A change to any one of those images usually requires a costly, time-consuming rerendering of the entire sequence. If there are no further changes, the project is now complete.

The animation process described here may sound lengthy. Actually, we left out a few steps along the way. There are some additional meetings and several medical/legal reviews involved in the process. Before each medical/legal review, Artcraft Health Education applies a thorough process of fact checking and quality assurance to ensure that every claim made in the animation is supported by scientific facts in the medical literature. Despite its time and expense, animation has an effect that no other medium can approach.

“Watching the finished product for the first time is magical,” says Jamie Rippke, Medical Illustrator/Animator. “With little more than a minute of animation, we help our client market their stent, cardiac surgeons improve their technique, and patients recover more quickly. No other medium enables us to accomplish so much in so short a time.”

But, don’t take our word for it, watch for yourself.