Adobe Healthcare Blog

Your Healthcare on Craigslist

Rick Borstein — Fri, 11 Mar 2011 14:28:05 +0000

Fast Company is a business and technology online and traditional magazine which always seems to have interesting articles.

Recently, Fast Company posted this article:

Can Health Care 2.0 Be as Easy as Craigslist? Craig Thinks So

The subject of the article was Craigslist Founder Craig Newmark who was interviewed about the work he is doing with the Department of Veteran Affairs to better utilize technology for healthcare.

The article notes that Adobe won the VA’s first Blue Button Developer Challenge for the creation of an interactive platform for medical records. An image of the Adobe application is included in the article.

One thing I found interesting was to learn about how the VA is going about bringing their technology up to date:

. . . the VA will open source its new health care ecosystem, permitting a community of developers to
co-construct the new database and allow outside institutions to modify
the codebase for their own systems. The vision is a system that permits
real-time communication between patients and doctors and isn’t held
hostage by either a painfully slow government entity or a single,
inflexible corporate partner. For developers, this means a whole new
sub-industry of opportunity.

Now, that’s forward thinking for a government agency!

An Interview with Adobe’s Michael Jackson on the Blue Button Initiative

Rick Borstein — Wed, 01 Dec 2010 06:56:00 +0000

At the 4^th Annual Health 2.0 conference in San Francisco, Adobe’s Michael Jackson accepted the Blue Button Developers’ Challenge Award from a distinguished panel featuring Aneesh Chopra, U.S. Chief Technology Officer in the White House Office of Science and Technology Policy, Todd Park, Chief Technology Officer at the Department of Health and Human Services, and Peter Levin, Chief Technology Officer at the Department of Veterans Affairs.

Learn more about the Blue Button Initiative
Check out the following video on the Health 2.0 website. It begins with Peter Levin of the VA, and it provides great background on the Blue Button initiative. It also includes footage of Michael Jackson accepting the award on behalf of Adobe at the Health 2.0 conference. http://health2challenge.org/blog/team-adobe-systems/

Congratulations on Adobe’s win. Tell us about your background?

I have what I like to call a “hybrid” background. I’ve always had passions for technology, healthcare, and business. Very early in my career, I served in the US Coast Guard as a Petty Officer Electronics Technician (ET). Later, I went on to earn a degree in Computer Information Systems and then an MBA, while working as a government sales manager at an IT company. For the past ten years, though, I’ve held progressive sales and marketing roles in the Life Sciences industry which supplies pharmaceuticals, implantable medical devices, and neural analysis software into the healthcare ecosystem. That’s where I developed an understanding of the complex relationships that exist between healthcare providers, payers, and patients; and the ultimate goal of improving clinical outcomes while optimizing efficiencies. Now, in my role as Healthcare Solutions Manager at Adobe, I leverage every aspect of my experience to develop strategies for real-world solutions in this rapidly evolving market.

What was the idea behind the Blue Button Challenge?

The idea behind the Blue Button is simple. By clicking a little blue button on a website, veterans are now able to download their personal health record from a portal offered by the Department of Veterans Affairs. The downloaded file, which often contains years’ worth of medical data, is presented in the form of a plain ASCII text file. So, a challenge was issued to developers to find ways to enable Blue Button users to meaningfully interact with their health data in a more useful way. Sharing that common goal, respondents to the challenge were diverse; ranging from start-up IT companies and individual developers to Google and Microsoft.

Tell me about Adobe’s entry in the challenge. What problems did it attempt to solve and what Adobe technologies were part of the solution?

Team Adobe approached the Blue Button Challenge development process from the very beginning with the desired end results in mind. For example, we knew that each veteran would have unique needs for the information contained within these comprehensive records. So the first order of business as we developed the vision was to simplify the user’s experience as he extracts the desired data from the health record. Whether categorized by entry type, such as lab results or prescriptions, or streamlined to within a specific time range, the health data needed to be easily manipulated in order quickly produce accurate query results.

The data output format of the Personal Health Record was critical to the solution as well, since users would need to effectively interact with their downloaded records from multiple platforms and device types. Additionally, as downloaded data leaves the confines of a controlled enterprise network, it is important to maintain the integrity and security of the files. Therefore, striking a balance between security and interoperability was a recurring theme throughout the process as well.

Adobe’s winning Blue Button Challenge submission provides two powerful options for securely downloading and interacting with personal health data. First is the Blue Button Health Assistant, designed with Adobe Air technology. Adobe AIR offers an exciting new way to engage users with innovative, branded applications, without requiring changes to existing back-end technology or processes. The intuitive Health Assistant proof-of-concept app includes a wealth of features that transform raw data into useful information. For example, the “Tracker” dynamically charts chronic data inputs, such as blood sugar levels, so the user can visually identify trends or spikes.

The other option for interacting with the Blue Button health record is a dynamic pdf document which is automatically generated and populated with extracted health data, incorporating PDF-Healthcare Best Practices. This feature-rich pdf document is viewable online or offline, from any browser on any platform, utilizing the ubiquitous Adobe Reader. Advanced features within Reader, including digital signatures, rights management, and others are activated by the document itself as it is accessed.

What did Adobe learn as part of this process?

It was especially rewarding to participate in this challenge where Adobe technologies demonstrated an immediate impact on a real-world scenario. The process overall helped to validate significant trends that we had previously identified, including the emerging prevalence of Personal Health Records and our ability to satisfy the need for secure and interoperable solutions throughout the healthcare enterprise.

Anything else you want to share?

Adobe continues to identify and develop ways to leverage Open Government as more than just a concept, but rather a tool to advance agency missions.

Wired Magazine redesigns Patient Lab Results Forms

Rick Borstein — Thu, 25 Nov 2010 02:39:54 +0000

At Adobe, we often talk about Engagement— the technology put in place to make customer interactions better and more meaningful.

One critical aspect of Engagement is good design. Good design is the “face” of the technology to the customer. Get it right, and you have the opportunity to delight the customer. Neglect design at your peril.

Unfortunately, as Wired Magazine pointed out in the December 2010 issue, good design in healthcare is an exception.

Here’s the lead-in paragraph from the Wired Magazine article ”Blood Simple”:

Lab reports are often beyond our comprehension. But they don’t have to be. Better design and more context can clarify the results— and help us understand our options.

Amen to that!

The article is not posted on the Wired website yet. I’d suggest getting to a newstand to check out the December issue yourself.

Here’s a spread from the article to get you thinking.

EMR Survival Tips Audiocasts

Rick Borstein — Sat, 13 Nov 2010 05:26:13 +0000

I just listened to Dr. Stasia Kahn’s latest EMR Survival Tips Audiocast—you can play it in your browser— and I was impressed!

I first met Dr. Kahn at a HIMMS Conference two years ago in Chicago. She’s very active in the EMR and PDF Healthcare community and a real champion for using electronic medical records.

Dr. Kahn’s website has a number of useful resources to help physicians make better use of EMRs, something the doctor has done in her practice since 2005.

I think what I like best about the audiocasts is how approachable Dr. Kahn makes a subject that might be a bit scary to the less technical among us.

I also appreciate the very frank information that she shares. There is a cost to implementing EMR systems, and you can hear the challenges that a small practice might have. I think— and Dr. Kahn concurs— that eventually government incentives will offset this cost.

I’ve written here about the frustration I have with paper-based processes in the health industry, so I look forward to hearing more about the use of EMR in Dr. Kahn’s practice . . .

. . . and hopefully yours in the future, too.

Acrobat X Announced. See my free eSeminars.

Rick Borstein — Wed, 27 Oct 2010 14:42:00 +0000

Acrobat X (Acrobat X) was announced last week and my colleague Mark Middleton and I will be putting on eSeminars to tell you all about this exciting new release.


	Welcome to the next generation of Acrobat Dynamic PDF. Adobe Acrobat X can help give your team the power to turn unrealistic deadlines into realistic deadlines.

	Acrobat X Top New Features eSeminar Three dates available: October 28, 10 a.m. PT November 09, 10 a.m. PT November 09, 1 p.m. PT (Opens in new window)	Join the Adobe Acrobat X software webinar and go from under pressure to overachieving. Enable your organization to get more done With the new Action wizard, you can automate repetitive tasks with a single guided action. Accelerate review and approval processes Use commenting tools to consolidate group feedback and easily manage shared reviews—all within PDF files. Help your team engage and communicate more effectively PDF Portfolio Wizard lets you quickly customize any project with new layouts, visual themes, and color palettes.

Meaningful Use Criteria for Electronic Health Records

Rick Borstein — Tue, 24 Aug 2010 06:40:13 +0000

The American Recovery and Reinvestment Act of 2009 offers payments to hospitals and doctors participating in
Medicare and Medicaid programs that adopt and successfully demonstrate meaningful use of certified electronic health record (EHR) technology.

On July 28, 2010, the Federal Register published the final ruling from the Centers for Medicare & Medicaid Services (CMMS) regarding the Electronic Health Record Incentive Program which begins in 2011.

The final ruling may be found in the document titled “Medicare and Medicaid Programs; Electronic Health Record Incentive Program”.

I reviewed the 275 page document (you can download it here) and it isn’t easy to follow. My goal was to find out where Adobe Acrobat and other Adobe offerings could be used, at least at a high level.

My first impressions is that from a technical level it is not a well-authored document and difficult to use. Notable problems with the document:

No navigational bookmarks or links
No Table of Contents
Tables are actually graphic elements and not searchable
Not accessible to the visually impaired
Protected from changes since it is a certified document

There are, however, a number of tables which make it easier to understand the main requirements. In particular, “Table 2: Stage 1 Meaningful Use Objectives and Associated Measures Sorted by Core and
Menu Set” offers a basic overview which is a good starting point.

I used a bit of Acrobat magic to extract Table 2 from the document and added a few checks to areas where I thought Adobe technology could fit in.

You can download the 944K document from the Acrobat.com widget below or directly from this link.

You can click the Continue Reading link below to read more about my thoughts.

What does this mean for Hospital and Healthcare Practitioners?

If you want to get the maximum Medicaid reimbursement, you must show “meaningful use” of electronic healthcare records.

Due to the complexity of implementing the technology, the CMMS has offered a phased approach to adoption. There are a ‘‘core set’’ of objectives and ‘‘menu set’’ of objectives. The “core” set must be implemented in order to be compliant. The “menu” set can have percentage achievement.

One vaguely worded Core requirement is to “Engage patients and families in their health care”.

In this section (page three of the document I provided), I see an immediate application for PDF:

Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies), upon request

Instead of walking out of your doctor’s office with a bunch of paper, you could instead receive your medical records on a thumbdrive, emailed to you, or made available via the web.

PDF is a perfect format to share medical records for individual practitioners:

Anyone with the nearly ubiquitous and free Adobe Reader can open a PDF document
Paper documents can be scanned and saved as PDFs
Electronic documents of any kind can be “printed” or saved to PDF
PDFs may be encrypted with a password so that they can be safely distributed electronically
PDFs can serve as a secure container for other types of documents such as audio or video

Large hospitals will likely try to fulfill these requirements in a more automated process, on the server or in the cloud.

Adobe offers a number of server-based tools in our LiveCycle family of products which can:

Create and PDFs from a number of sources, including XML health records
Combine documents, add page numbering and watermarks, and other document operations
Add security or digital rights management
Provide workflow and auditing

So, if you are wondering how all of this might work, you’ll be happy to know that a very hardworking group of professionals have already done much of the work for you.

AIIM is a non-profit industry group focused
on helping users to understand the challenges associated with managing
documents, content, records, and business processes. One AIIM working group has developed PDF Healthcare, a Best Practices guide for using PDF in the Healthcare industry.

AIIM offers a number of very useful PDF Healthcare Resources on their site including:

FAQs
PDF Healthcare Implementation Guide
Sample Files, including XML-based PDF health data interchange forms
Presentations and Testimonials

. . . and many others.

I’ve written about the PDF Healthcare options available on AIIM site previously in my article on PDF Healthcare Sample Materials.

I encourage you to check it out today!

New Personal Health Records Guide from Northern Illinois University

Rick Borstein — Wed, 26 May 2010 20:12:43 +0000

I recently received an email from Dr. Stasia Kahn announcing that a new white paper titled A Community View: How Personal Health Records Can Improve Patient Care and Outomes in Many Healthcare Settings, has been published and is available in an electronic and paper format.

Published by
the Northern Illinois University Regional Development Institute, this 163-page document includes a number of articles by doctors, nurses and healthcare technologists about Personal Health Records.

It’s a great read and discusses how practioners can work with electronic health records.

A PDF version is available for free download at the NIU Regional Development Institute website.

The white paper includes a broad range of topics, but there are quite a few mentions of PDF Healthcare.

Oh, let me mention this again . . . it’s free!

PDF Healthcare Sample Materials

Rick Borstein — Fri, 26 Feb 2010 17:26:39 +0000

PDF is certainly a broad universe, but the Healthcare industry has some specific needs, especially in regards to data exchange.

PDF Healthcare, is a relatively new, Best Practices guide for using PDF in the Healthcare industry.

The PDF Healthcare guidance was authored by AIIM, the Association for Information and Image Management.

AIIM is a non-profit industry group focused on helping users to understand the challenges associated with managing documents, content, records, and business processes.

AIIM offers a number of very useful PDF Healthcare Resources on their site including:

FAQs
PDF Healthcare Implementation Guide
Sample Files, including XML-based PDF health data interchange forms
Presentations and Testimonials

. . . and many others.

Read on to learn about the many different resources available on the AIIM PDF Healthcare site.

Getting Started FAQ

One of the first places to get started with PDF Healthcare is with AIIM’s Frequently Asked Questions page.

Here you’ll find all the basic information to get you started.

PDF Healthcare Implementation Guide

This 63-page guide is a great resource!

Here, you’ll learn gain a useful background on PDF and how the format handles images, vector drawings, fonts, attachments, comments and annotations and multimedia. You’ll also learn about the two types of from technology supported in Acrobat (Acroforms and XML-based forms) and when to use each.

There are examples of clinical use cases and other practical information, too.

There is quite a bit of space devoted to scripting XML-based forms for working with XML datastreams.

The PDF Healthcare Implementation Guide references sample files which are available. See below.

Sample Files

Downloadable sample files are available in AIIM’s PDF Healthcare Implementation Guide Examples section.

Over sixty sample files are available! There are samples of scanned data, dictation, DICOM imagery, multimedia elements as well as XML-based forms which can dynamically adjust to CCR data.

To save some time, scroll all the way down to the bottom of the page to download a single ZIP ARCHIVE of all of the sample files.

Presentations and Testimonials

AIIM offers a number of presentation (PDF and PPT formats) on PDF Healthcare. I’ve found these presentations to be very helpful when I am presenting PDF Healthcare to the industry.

You can find the on the main PDF Healthcare Page.

Community Forum

There is a very nice PDF Healthcare Community Forum available on Information Zen. Here, you can pose questions to other forum members and participate in an active discussion.

Materials for Acrobat for Healthcare eSeminar

Rick Borstein — Tue, 09 Feb 2010 14:03:59 +0000

Here are the slides which correspond to my “Acrobat for Healthcare Professionals eSeminar”.

All the links in the slide set are active in the downloadable PDF.

You can download the slides directly from the link below, or preview the slides in the Acrobat.com window.

Acrobat_9_Healthcare.pdf (620K PDF)

Creating a Patient Information Form with Acrobat 9

Rick Borstein — Mon, 08 Feb 2010 11:00:45 +0000

In my last article, Patient Information Forms: Making Patients Happy, I discussed my frustration with the entire paper-based Patient Information Form Process.

The frustration is fresh on my mind since I ran into the same problem today trying to schedule an appointment for my son today. My son is in school at California State University and I have to fill in forms for him here in Illinois. The receptionist couldn’t even fax me the forms since " . . . the pages are dark and they don’t fax well."

Aargh!

In this introductory article you’ll learn how to:

Create a form
Add or edit fields
Add buttons so that patients can email the form to you
Save the form and enable it for your patients who use the free Adobe Reader software

Acrobat Forms Basics

Using Acrobat 9, you can create a form that is fillable for your patients who are using an earlier version of the free Adobe Reader. Adobe has distributed almost a billion copies of the free Adobe Reader, so it is very unlikely that your patient won’t be able to fill out the document.

Architecturally, the form fields "live" in a layer on top of the base document.

The basic steps to create a form are:

Find your form
- If the form is on paper, scan it in. You can do that directly in Acrobat
- Locate your existing Word, Excel, etc. form file
Use Acrobat to auto-recognize form fields on the document
Add, delete fields as necessary
Test the form

To make it easy to try this yourself, I’ve you can download the "flat" and completed forms below.

Before Form – No fields (14K PDF)
Form with Fillable Fields, Reader Enabled (193K PDF)

Note: This article is first step for offices who wish to migrate from paper/faxed forms to electronic form. In future articles, I’ll try to cover deeper form topics.

Read on to learn how to do it yourself!

Acrobat Auto-Form Field Recognition

Acrobat includes a Wizard that makes the forms authoring process easy. Acrobat can automatically find boxes or underlines which have associated labels.

Here are a couple of examples:

Create your First PDF Form

On the Acrobat toolbar, click the Forms button and choose Start Forms Wizard . . .
You’ll be presented with some choices:

A) Use this choice if you already have a PDF or a Word doc to convert
B) Use this choice if you have a scanner attached to your computer
C) I only recommend this choice for
expert users who want to create a form from scratch

For this article, I will presume you will use option A above.
Click the Next button.
Locate the file you wish to convert by using the Browse button to find your file, then click the Next button.
(You can use the sample patient_information_form.pdf you downloaded above.
Acrobat will find the fields on your form and open the window below. Click the OK button.
Your form will appear in the Acrobat window in Editing View.
— A Fields panel on the left lists all of the form fields which were found.
— On the right, you can see your form with all the fields on top

Switching Modes
After field recognition is complete, Acrobat goes into Form Edit Mode. To exit, click the Close Form Editing button in the upper right.

To resume editing a form, click the Forms button and choose Add or Edit Fields

What next? Time to add or fix fields

Acrobat doesn’t always do a perfect job finding form fields.

Acrobat may find too many fields
Acrobat may not find all your fields
Acrobat might add the wrong type of field
Acrobat might make a field too big or too small

Deleting and Sizing Fields

To delete a field, simply select it and hit the DELETE key.
To make a field larger, simply drag one of the "handles" to the desired size.

Adding new Fields to the Form

Acrobat allows you stamp several kinds of fields on top of the form as needed.

Here are the types you will use most often are:

Text Fields
Allow your patient to type whatever they want into the field
Check Boxes
Allow the patient to tick off an item
Radio Buttons
Allow the patient to select only one out of a series of options
Regular Buttons
Allow the patient to clear fields or submit a form via email.

You can add additional fields by clicking the Add New Field button at the top of the window

Acrobat offers several types of form fields. Select the type you want from the list and stamp it on to the document.

Changing the Text Fields

Text fields in Acrobat can hold thousands of characters of text. By default, if the text doesn’t fit the field, Acrobat makes it smaller until it is eight points high. After that, Acrobat can (optionally) scroll the text in the field.

If you double-click on a Text field, you can change various options for it:

Font, size, color of the text
Allow or disallow multiple lines of text
Limit the amount of text in a cell
Formatting (e.g. make all phone number conform to a style like (888) 999-0000 even if the patient didn’t type it in that way

Adding or Changing Radio Buttons

Radio buttons offer a mutually exclusive set of choices to your form. By using a radio button, you can ensure that the patient only chooses one out of an allowable set of options. For example, you can be either married or single, but not both.

O the sample form, Acrobat did not create fields for minor, single, married, at the top of the form. I’ve marked them with the red lines below.

Adding radio buttons is a bit trickier because Acrobat maintains them as a group.

Here’s how to add a set of radio buttons:

Click the Add New Field button and chose Radio Button from the list
Stamp a Radio Button on top of the document
A yellow options window appears:

A) Fill in the name of the group of buttons
B) Fill in the name of the button that is being clicked
C) Click the Add another button to group and then add the next radio button

Adding an Email Button

HIPAA rules state that doctors and healthcare organizations need to be extremely careful when transmitting patient data.

Fortunately, patients are not covered entities and can choose to convey information to you the way in which they are comfortable, including email.

Here’s how to add an email button:

Click the Add New Field button and chose Button from the list
Stamp the button onto the form (usually in the upper right)
Give the button in name in the yellow options window, then click the Show All Properties link
Click the Appearance tab in the Button Properties Window
Change the fill and border colors to your taste
Click the Options tab of the Button Properties window
Fill in the Label field with the text you want to appear on the button face
Click the Actions tab of the Button Properties window
A) Choose Submit a form from the Trigger pop-up menu
B) Click the Add button
Make the following changes . . .
A) Enter mailto: followed by the email address you wish to receive the form
B) Click PDF The complete document
C) Click the OK button
Click the Close button

Reader-enabling the Form

Normally, a patient using the free Adobe Reader software can view, print and navigate a document, but cannot save any changes. This limitation includes saving data patients have typed into the form.

However, if you have Acrobat 9 (Standard or Pro), you have PDF superpowers. You can "bless" a PDF for your patients so that they can save their information in the form.

This process is called Reader-enabling the document.

Here’s how:

Open the form you wish to Reader-enable
Next choose the appropriate option based on which version of Acrobat you have:

Acrobat 9 Pro: Advanced> Extend Features in Adobe Reader . . .
Acrobat 9 Standard: Advanced> Extend Forms Fill-in & Save in Adobe Reader . . .
Acrobat will prompt you to save the form.

Tip: I recommend adding an underscore and RE to filename. That way, you can look at the filename and know if it has been Reader-enabled.

e.g. patient_form_RE.pdf

The Reader-enabled form may be emailed to patients or posted on your website. The email button is "wired" to always send the form back to you.

Licensing Limitations

The licensing agreement for Acrobat limits the number of times each individual form may be returned to you to 500 responses.

Note that this is a licensing limitation. Acrobat doesn’t actually count responses.

Five-hundred responses should be plenty to cover the needs of smaller practices. Since this is a per form limit, you could change the form which would allow for a reset of the limitation.