Hosting EHR Instances for the Education program

@sunbiz @yehster

I have completed the survey and plan to submit to AMIA once Kevin Yeh has looked at the presentation. Most of the marks were high but the System Usability Survey scores for students were below the norm of 66. Clearly, some didn’t like to read the PDF instructions (that is why we are creating YouTube tutorials) and some of the instructors learned the EHR for the first time at the last minute. Please see the actual results in the prior posting

1 Like

@tony @r0bby @teryhill

The person who took my place at the University of West Florida emailed me today stating she planned to use LibreHealth EHR this semester. It didn’t occur to her that this would not be automatic. I referred her to the YouTube videos but told her I would need to get back with her. I doubt she knows about the NHANES addition. Any advice?

I am not sure of the Issue. She would have to understand / Learn the system to use it. If there are fees for using it then they would apply in this case.

Does that mean we should make a contract with them to host/support an instance? Easy enough.

@tony

I told the young instructor to go back to her department and see if they could arrange for roughly $150 per month x 4 months.

1 Like

@tony @r0bby @teryhill @sunbiz @yehster

I would once again ask the steering committee to have a concrete plan on who, how and how much in terms of hosting the educational EHR. Once Kevin has made some new enhancements, is there any reason it can’t be advertised? Can’t do that without all the details worked out.

2 Likes

This is quite late in coming, but my graduate students did a reflection at the end of last semester on their EHR experience after class. I am sharing comments (with student permission):

  • Using EHR in class was completely new to me. Most of what we used in class was pretty intuitive, though there were some questions that we had to dig around for, and couldn’t find the answers to. I think that the benefits of having an EHR are clear after the class exercise. It is for the most part organized, and easier to do things than doing them by hand. More importantly is easy to keep up to date and share information between providers, which is important for the safety of the patient! I think we need to work with physicians to develop one that is intuitive to them, as they are the ones who use them. If we did this, they would not be annoyed to use it, and it would make a big difference in the lives of patients.

  • I had a much more pleasant interaction with LibreHealth than I have with other EHRs that I have had to use in the past. I have used a medical EMR/EHR and an EHR built in Microsoft access for a mental health agency, and both were a very difficult user experience. I thought things were easier to find and that the layout was more intuitive on LibreHealth. Unfortunately, the most frustrating part of my experience with EHR in the past has been entering information, which we didn’t do much in the exercise. I would have liked to go through the process of entering information and see what the alerts were like.

  • After the scavenger hunt in class assignment with the EHR system in class, my feelings regarding how EHRs benefit patients remain the same; I believe that EHRs greatly benefit patients, by allowing for providers to store pertinent health information in one place and streamline the important information that each provider needs to collect in order to provide the best patient care. However, I believe that many providers who are not as tech savvy as myself or my class members may struggle to use an EHR system like the one we used in class since it is not the most user friendly system, and this may negatively affect patients. Additionally, I do believe that EHRs are very useful tools that can be used by public health practitioners to contribute to systems level public health data and also to improve public health.

  • I thought that the EHR scavenger was a fun activity, but I did feel it was a bit basic in terms of layout and system. I may be a bit biased, because when I was working at the [Name of Hospital] before UMD, the EHR system was much more advanced (and upgraded quite a bit from its predecessor) and visually appealing. There was even a mechanism in place to assign your role when viewing the EHR (e.g., researcher, quality improvement, provider). With LibreHealth, it was a bit of a step down for me and could have been improved, such as having the patient names minimized as a search bar at the top, and having each category (documentation, visits, lab reports) as a tab in their “chart” that you could then open and view all encounters, tests, trends, etc. Despite this, I still agree that EHRs are definitely the way forward, and can lead to streamlined processes to share information among providers and public health professionals.

  • Having never used anything like an EHR, I found the experience really interesting. The other week I had tried to watch from a distance as the health center created an EHR for me, so I appreciated the up-close and hands-on opportunity. I would really love to see more integration of EHRs with patient intake forms. As a patient, I find the current system incredibly redundant and frustrating. I have filled so many new/returning patient work out by hand (or even electronically) and then have had to verbally tell the nurse (AND sometimes the doctor) the same information again as they type it in to a computer. Like why did they have me bother pre-filling stuff out? So if it doesn’t already exist, I’d like for patients to type in the information either at home or on a device in the waiting room that gets sent to a loading section from which the providers read through it with the patient to ask clarifying questions and making revisions before ultimately importing and approve the changes to the EHR. The patient-provider interaction also becomes more of a collaborative dialogue than the third round of answering the same question.

  • Until last week EHR was more theoretical to me than something I understood through use. I appreciate what EHR can be but navigating the version we used was not intuitive for me. Throughout the scavenger hunt, I wondered if it was difficult because I was not the target audience or if it was actually a usability flaw/concern. There were acronyms used in the scavenger hunt that were worded differently on the site. This slowed me down but I assume someone in the clinical field would have been able to answer the questions much quicker. I also found the windows opening or overlapping distracting. Whereas functioning like a link where you go into another page and can go back would be more like other web-based apps. Making the site work like conventional websites could go a long way toward usability. The lock for instance as the minimize is a new icon in a new use. It would seem like taking advantage of convention would reduce the learning curve significantly. The opportunity to explore an EHR went a long way for me to understand what clinicians may use and how they navigate my record in support of my health.

  • While I’ve never experienced an EHR system first hand, I’ve come to appreciate their significance in the health care sector. They may have their flaws and may seem as if they are more cumbersome than one would like, they have made significant changes in how out health care system works today, especially in improving errors; one of the many contributing factors to our health care debt. This particular EHR system was helpful in understanding all the things that go into creating an EHR system. While the use for a non-health professional was a bit confusing with the acronyms and “flow”, an experienced health care professional should have minimal problems maneuvering through it. I especially appreciated that reality of the patients listed in the system. The experience was great to be able to see what our doctors see first-hand our personal EHR systems. I am especially excited to see what our future holds in relation to EHR’s and their use. How will technology enhance the capabilities of an EHR? How can they further improve the future of our health care system?

3 Likes

Thanks for your thoughtful comments :grinning:

@tony if you will be working on this can you provide the documentation ?

@r0bby too

At this time only Medical Information Integration, LLC has proposed a plan to host. That would be a contract between MI2 and the university, no need for LibreHealth.io or SFC to be involved. User support will come from the community forums, etc (if any is needed). I can send you a contract and term sheet template to review if you like.

We have committed to sharing whatever we develop (including documentation), and using whatever you deem is needed / contributed to the project by Kevin or others that helps this out.

If, at some point, the project itself wants to provide the infrastructure and can work the money flow out with SFC, then we can migrate.

The community can also host it as well. Whatever works really, I’m fine with either.

@tony @yehster @r0bby @judywawira

I’m happy with this plan for now. My plan is to advertise it to the roughly 450 faculty members who requested a download of my book and who I have contact information on. I did not plan to do this until Kevin has finished his enhancements and the YouTube videos are ready to go.

Still no word back from Alfred P. Sloan Foundation (grant) or Pearson Publishing (partner). There is always a slim chance when I send out the notice about hosting LibreHealth EHR, someone will contribute a bright idea regarding how to help support hosting or obtain longer term funding.

@tony @r0bby @sunbiz @teryhill @judywawira

I probably should start a new thread but this relates to the Education LibreHealth EHR with the NHANES patients. A computer science professor from the University of Houston wanted to use the demo to teach a small class. Unfortunately, she like many others think that they can add facilities and new patients for exercises. She already started the exercise and then asked for permission.

On the landing page we need default language that alerts faculty not to do this. Any other thoughts?

1 Like

Well, whatever they do – we overwrite it nightly to reset things to sane state…or rather a state where the admin password is correct.

I agree, it should be fairly straightforward to add a notice on that page about the nightly resets. That would make instructors to think otherwise.

But really, I think we should also add to the notice that they can run a docker instance that will contain the NHANES data. Such a docker image with the NHANES data does not exist at the moment, but should be doable, if we create a ticket and someone puts some time to do it.

Very easy considering I merged in the docker work to do it. Not hard to do in the least. We do have an EHR image. The only db I don’t touch is the documentation site’s db – their passwords aren’t public and for good reason.

@sunbiz @r0bby @tony @judywawira

Thanks for the feedback. I would like to see the software Dockerized as I believe that would make implementation easier. Seeing talk about Kubernetes replacing Docker but I’m not knowledgeable enough to comment. What would be the cost to place software and NHANES patients in a container?

Kubernetes needs Docker or at least a container runtime. It’s a container orchastration system.

It would not cost anything – we already had work funded under the DIAL grant, some of which is completed. I have the Dockerfile in the repo right now.

Some work would need to be done to automate things, as of right now – it would be very manual. I’m waiting on the SFC to action on a ticket to add a CC to our AWS account, once that’s done – we could probably spin up a Kubernetes cluster and then it’s just about writing some code to automate things on our end.

Hi…

  1. why wouldn’t they be able yo add whatever they want when using the instances.

  2. lehr is deployable via containers, apifocal and mi2 did that work with Robbie’s help.

  3. kubernetes is a tool/process for deployment of containers. Requires containerized apps.

Finishing the container work to make it enterprise capable is still particially funded by UN, we only spent 1/2 the money granted, it should still be available.

Tony

1 Like

right now it’s kinda good enough…but not quite 100%