How Doctors Can Use Evernote As A Professional Memory Accessible Anywhere, Part 3: How to Use Evernote as an Electronic Health Record (EHR)

Please see part 1 for an introduction to Evernote and part 2 for an introduction to using Evernote as an EHR.

Let me be clear: I'm not suggesting that Evernote is a substitute for any of the excellent commercial EHRs currently available. The following is presented as a proof of concept only for how a simple, inexpensive, customizable EHR built on Evernote might work. Please see the disclaimer.

As always, HIPAA is a major issue: Evernote provides encrypted communication and many security safeguards, but it's uncertain whether Evernote fulfills all HIPAA requirements. (Update: Evernote has confirmed by email that, "At this time we do not plan to pursue HIPAA certification for our (consumer) Evernote service.") Thanks to those who directed me to the "Federal Security Standards for the Protection of Electronic Protected Health Information." Of course, if you're concerned about transmitting information to the Evernote servers, you can always instruct Evernote to keep all data on your local computer. This bypasses the HIPAA issue and you'd still be able to use Evernote, but this means that you won't be able to access patient data from the web unless you use a program like GoToMyPc.com.

A "hybrid EHR" has a combination of paper and digital elements. The following is a step-by-step guide to creating a hybrid EHR using Evernote that will allow you to type your notes directly into Evernote, use note templates, use shortcuts for commonly used sentences and paragraphs, print your notes for the paper medical record, and theoretically securely access your notes from the computer, the web, or the iPhone.

1. First, set up an Evernote account. (Sign up for the $5 a month premium account if you'd like your communication encrypted to the Evernote servers.)

2. Create a notebook on Evernote titled "Patient Notes" to separate these notes from other information you store on Evernote. (If you're concerned about HIPAA, be sure to set the notebook so that it doesn't sync with the Evernote servers.)

3. At this point, while you can immediately begin typing patient notes directly into Evernote, the system is most powerful if you create your own customized note templates for new patient visits and follow up visits. (See this post on creating customized note templates.) Ideally, you'd like to create "macros" or "snippets" which allow you to type a word which is "expanded" into a body of text. For example, you might type "NEWPATIENT" which would fill in a new patient template. Or typing "STATIN" might fill in — for example — "Benefits, alternatives, and risks of statin therapy discussed and patient consents. Advised not to drink grapefruit juice." Textexpander for the Mac and Activewords for the PC are both excellent programs that allow you to create these text shortcuts.

4. In Evernote, searching for and displaying previous patient visits is simple. You can easily copy and paste information from your previous note into the new patient note, then update all changes in medications, physical exam, etc., for the new visit.

5. Evernote also allows you to keep tracking of pending "To Do's" for patients, which turns out to be extraordinarily useful. (In Getting Things Done parlance, this would be called a "waiting for.") For example, let's say you've sent a patient for a chest X-ray or other test, and you'd like to ensure that the test stays on your radar screen and that you follow up on it. When you type the patient's note, simply click the blank checkbox in Evernote and it will automatically place the note in the "To Do" category. To review all your previous "To Do's" to see what tests are still pending, click on the "To Do's (Not Completed)" section in the sidebar. When you've received the chest X-ray or other test results, click the checkbox in the previous note, and you're done. (This is one of the simplest methods for keeping track of pending tests that I've ever seen.)

6. After the visit is complete, the patient's note can be printed, signed, and placed in the permanent medical record. Here's a sample workflow: a portable computer running Evernote is placed on a rolling laptop table, and the computer has a secure wireless connection a printer. After each patient is seen, the table is rolled between exam rooms. Meanwhile, the notes are wirelessly printed at the nurse's station then placed in the paper chart.

7. After the visit, let's say you hypothetically receive some new laboratory tests and need to retrieve the patient's previous note to help interpret them. Instead of hunting for the paper chart, you can simply open Evernote, search for the patient's name, and pull up the record. (Theoretically, if HIPAA wasn't a concern, you could also access your patient's note through the Evernote web application or through the Evernote iPhone app.)

Though Evernote is not specifically designed for doctors, it’s a useful tool for allowing physicians to capture and retrieve essential information in order to improve patient care. These three posts have provided just a small sample of how this program can be used. I'm interested to hear how other health care providers are using Evernote. Please feel free to comment.

(Also posted on The Efficient MD.)

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• How Doctors Can Use Evernote As A Professional Memory Accessible Anywhere, Part 2: Using Evernote as an Electronic Health Record (EHR)

Labels: EHR, Electronic health record, EMR, Evernote, iphone, Medical record

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Roundup of New Health and Medical Apps for the iPhone

Image via WikipediaThe number of applications in the iTunes App Store for the iPhone and iPod Touch is growing rapidly, and a surprising number of them are related to health and medicine. Here's a sampling. (The links will take you directly to the applications in iTunes.)

iChart a digital medical record system designed for iPhone, has been released by CareTools.

iChart has been designed to act as an electronic “personal medical assistant” and focuses on streamlining the daily “chart, bill and fill” routine of every healthcare provider. iChart leverages the advanced capabilities of iPhone and iPod touch to warehouse patient data, and images, in addition to providing an updated list of medications, drug interactions, pharmacies, billing codes and complaint specific clinical templates. Synchronization of new information is accomplished wirelessly using secure web technology and iChart allows a single provider or entire healthcare network to automate medical data capture and effortlessly look-up patient related information using an efficiently designed “touch and tap” interface.

PointsCalc, an application for dieters, allows you to quickly estimate the number of "points" in a given food.

Quitter tracks how long you've been cigarette-free and how much you've saved by not smoking.

Glucose-charter, an application for diabetics, is a blood glucose reporting tool (as well as a "food information display").

My Life Record is a personal health record (PHR).

One of the most powerful features of the My Life Record software are the ability to keep an official, verifiable copy of your exact medical chart within reach of your iPhone. While other personal medical applications rely on you or your doctor to enter the information into a program, My Life Record uses patent pending technology to take your exact medical record and retain it for your own use, for sharing with your doctors, for sharing with your family, or for any other purpose that a legally verifiable copy of your medical record is needed

If you have experience with any of these applications, please feel free to post a comment.

Labels: app store, iphone, iTunes App Store, Medical record

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