Saturday, February 27, 2010

Traveling with your medical records

When you're packing up for a fun RV adventure, likely the last thing you're thinking about is getting sick and needing medical attention while on the road. But it can certainly happen, especially if you're traveling for a number of months, or are a full-time RVer. Worse yet, it could happen to a friend or family member who's traveling with you (and whom you might not know all the specific details of their medical history).

Up until recently, medical records were purely paper-based. So if you wanted to travel with them, you had to ask each of your doctors to print you out copies of the various chart documents they each had, and then you had to carry this pile around with you-- not very fun, and certainly not very secure. Got a leak in your tent? Or a gust of wind through your RV? There go your documents! Going on a cruise or airline trip? Good luck fitting that into your carry-on bag!

Well fortunately, medical records in the U.S. are finally on a fast-track to electronic conversion. I've earned my living for the past 10 years implementing electronic medical records (EMR) systems to physician offices. The early years were slow and painful to get doctors on-board. That all began changing 2 years ago when Medicare began "carrot and stick" reimbursements to providers-- those who sent prescriptions electronically would get paid a little more than those who did not. Momentum really exploded last year, though, when Congress provided billions of new incentive dollars in the Stimulus Bill for physicians to implement and fully use EMR systems within the next few years. Physicians will also be incentivized to provide patients electronic-access to their medical records. So, within the next decade or so, we should finally see all participants in healthcare (patients, doctors, hospitals, pharmacies, labs) be able to share health data electronically.

As an internet-aged information-savvy patient, you don't have to wait until your doctor goes electronic-- you can take control over your own records now! There are a couple of good, safe, and free options for maintaining your own electronic personal health record (PHR). Not only do these systems allow you to track your own health, but they also allow you to track other family members on the same account (i.e. your kids immunizations, your parent/grandparent's complicated list of medications and med histories, etc). PHRs are particularly valuable if you need to track a chronic condition such as diabetes or high blood pressure, or have a complex medical or family history.

The key to any good PHR is to ensure that it can import and export health information via the standardized data formats (such as CCR, CCD, or CED xml-based formats). This allows you to receive med list information from a pharmacy, results from a lab, or send your PHR information to a new doctor. It also allows a hospital emergency room to quickly view or download your chart info as well.

There are a number of PHR solutions on the market right now (a great independent website, gives a great list of all of these vendors as well as general tips for creating your own PHR). The 2 "big fish" in PHR-land are Google and Microsoft. Millions of us have online accounts with these 2 vendors already for our email and other online storage needs, so it's super easy to just add your health record to that mix.

Both vendors see their systems as "hubs" where the patient can control what health data can come into and go out of their PHR. Unfortunately, neither of these vendors have designed their front-end application to be a "one-stop-shop" for a typical patient to enter their information (although Google comes much closer to this than Microsoft). So, I've found the best approach is to use one of the smaller vendor PHRs to do most of your data entry/editing (since these vendors are much more healthcare-focused), and then link that record to your Google or Microsoft "hub" record for greater accessibility, integration, and backup.

The only PHR solution that supports both Google and Microsoft hubs is It offers a very robust, free, online PHR application that you can access via a laptop/PC or via your mobile phone's web browser. If also you're interested in storing scanned documents or photos to your PHR, you can purchase a premium subscription for just $10/year for an individual chart, or $30/year for a family of up to 10 people.

NoMoreClipboard allows you to enter just about every bit of information that you typically need to fill out via paper on a clipboard whenever you go to a doctor's office-- your med list, allergies, current and past medical history, past surgeries, family history, pregnancies, immunizations, and so on. You also can enter your basic demographics (address, phone, date of birth, etc), insurance policy info, other physicians you see (along with their address/phone), your preferred pharmacy and hospital, and your emergency contacts/persons you allow providers to discuss your health information with.

Another area NMC excels at is tracking common health metrics such as blood pressure, glucose, cholesterol, height/weight/BMI. You can easily enter this data via the web or your mobile phone and print a chart of all entries to bring along to your next doctor's office visit.

NMC provides a nice overall Patient Summary document to bring with you to the doctor's office (so you don't need to fill out their paper forms!), or you can even transmit it to them electronically or grant them access to view your online record. You can also print an even smaller summary card for your wallet.

While NoMoreClipboard can exchange PHR info with both Microsoft and Google, I find the Google Health integration better to use because you can inividually select/delete what data elements you wish to send/receive. With Microsoft, it's an all or nothing affair.

Once your NMC information is imported, Google Health can do some pretty nifty things with it. For instance, it will analyze your medication list and alert you to any drug interactions or duplicate therapies. Next, it provides great internet reference links for each of your active or past health conditions to allow you to further research and manage that disease. Google also integrates with a number of pharmacy and lab systems so that you can download information from those systems into your Google record, and then sync your Google record back to NoMoreClipboard to keep your medication lists and test results updated.

Google also offers (for free) some of the features that NoMoreClipboard makes you pay extra for --such as storing documents/photos, or graphing your common result data such as daily blood pressure readings.

While NMC and Google offer good data entry, printing, sharing, and online research of your PHR information, and also use the industry-standard CCD/CCR xml format to exchange information between each system, neither let you save or import that CCD/CCR file yourself (for instance, if you want to carry one of these files on a USB stick so that your electronic doctor's office can easily import it into their EHR, or the office wants to give you a download of their EHR's electronic file). For this situation, Microsoft HealthVault shines.

Microsoft HealthVault is clearly a "back-end" hub. It's design premise assumes patients are not at all interested in manually entering all their health information, and that they'd rather just have a centralized storage location for all their health information to be "exchanged" by the patient's desired electronic providers. HealthVault provides no way to share this information with non-electronic providers (such as a printed patient summary document or wallet card). However, if all of your doctors are using EMRs and would prefer to give or receive your data as a standardized electronic CCD/CCR file, then HealthVault is the ideal solution.

HealthVault is also the only PHR solution that integrates directly with a number of new-aged medical devices-- there's a growing list of web-enabled devices that capture blood pressure readings, glucose levels, peak flows, etc and transmit these readings directly into your HealthVault record. No manual data entry required! Telemedicine is an exciting future that hopefully will allow us to live independently of nursing homes much longer, and have better chronic care management from our healthcare providers.

So, there you have it! Another way to keep your important data with you wherever you might be-- whether it's sitting at home or camping in the middle of Yellowstone!

Saturday, February 20, 2010

My favorite travelin' apps

The past few posts have highlighted some of my home-office solutions that keep me productive while on the road. Equally important, though, are the solutions that help me "in transit" to find where to go when and how.

My two "don't leave home without them" devices for RV travel are my Garmin 265 GPS and my iPhone 3Gs.

My Garmin unit features Bluetooth connectivity and customizable points of interest. So, not only can I do the typical GPS stuff like navigate from point A to point B or find the nearest gas station, if my RV ever breaks down, I can easily find the nearest Winnebago or Sprinter dealer and have the GPS dial the phone number for me.

Garmin provides a free POI Loader tool that you can download from their website onto your PC. Once you have that, you can find a lot of free POI (points of interest) files on the web. One very nice source for RVers is the Discovery Owners page of downloadable GPS files that identify everything from low clearance bridges, to the nearest campground or free overnight parking spot at a Wal-Mart, etc.

While some of the free POI files are great, some others can be out of date and in need of further editing. I use a shareware product called GeePeeEx to edit these files. It's not the prettiest product out there, but it does the job well. Once I've edited a POI file the way I want it, I use the Garmin POI Loader tool to upload the file onto my Garmin GPS.

Like millions of others, I've found my iPhone 3Gs simply indispensable. Not so much for it's hardware or phone features, but for it's applications. There's not only "an app for that", there are usually a half-dozen very good apps for that!

Here are a few of my favorite iPhone apps right now:

While Bing is a worthy competitor for voice-controlled web searches, I still like Google Mobile App and the iPhone's default Google Map app a bit better on the 3Gs. If I need to find the nearest laundrymat or post office, I just speak what I'm searching for and Google quickly provides a list of the nearest search results around me (based on the iPhone's built-in GPS and Compass) which I can then click to see them located on a map, click to call them, or click for driving directions. No typing required!

Keeping track of the weather is always important for an RVer. I've not found 1 perfect weather app, so I use a combination of 4 of them to gather all my weather info:

  • TheWeatherChannel app has the best animated maps that you can zoom and scroll easily on the iPhone to see where storms are and how they're tracking. It also gives good forecast info, but I find the small numbers on blue background makes their 10-day forecast a bit hard to read, so for that, I like WeatherBug with it's bigger fonts and white background a bit better. AccuWeather also gives a nice "at a glance" forecast view when I just want large numbers and graphics rather than detailed text.

  • Finally, if severe weather looms, and I'm aware from my dedicated weather radio in the RV, I use a neat app called WunderRadio that streams the nearest NOAA Weather radio station broadcasts (that app streams many other radio stations as well and is great for listening to your hometown radio stations while traveling!
There are a couple of very useful multi-purpose proximity-based apps that I use:

  • Where has a GasBuddy widget that allows you to find the cheapest nearby fuel by grade (great for RV'ing when I must locate diesel!). Where also can search the entire site, but you must type in search terms as it doesn't support voice search.

  • AroundMe is similar to Garmin's default POI where the categories are pre-defined so you don't need to type anything to find the nearest grocery store, gas station, restaurant, hospital, etc.
Now for some miscellaneous cool apps that are useful while traveling:

  • Clinometer is the best 99 cents I've ever spent! It provides a great 4-way bubble level that allows me to use my iPhone to level the RV when I arrive at a campground. It also measures slope/tilt/elevation, which can be helpful when pointing a satellite dish or for determining where the sun/moon will be at a certain time of day (see below for the companion app I use for that).

  • MyAltitude is a free app that simply displays what altitude you're at. Nice for climbing up mountain passes.

  • Flashlight is a silly, but useful app that fills the screen with a single color (which you can choose). Gives you enough light to find your glasses, unlock a door, or walk up a staircase in the dark.

  • Dragon Dictation is amazingly accurate way to generate text without typing. You can then copy/paste this text into any other iPhone app or can email or text message it.

  • EveryTrail is a neat little app for tracking a hike, bike ride, or paddling route you take and incorporating some iPhone photos of any cool things you see along the way. Another cool feature is that you can share your trip with other users and also search/view their trips (a great way to find interesting "trails" at a destination you'll be visiting soon).

  • Wikihood is a fun little app that provides you with Wikipedia entries for locations that are currently around you. An interesting way to learn more random and unusual facts about a place you're visiting (things that might not be in the typical travel guide books).

  • TapForms is a customizable database app that can take full advantage of iPhone features to capture/store information. Databases can contain the usual kinds of fields (text, dates, numbers, look-ups), but also can contain a photo, audio clip, or GPS location captured from your iPhone, a 5-star rating, a file attachment option for attaching any file the iPhone can view, a website URL, or even a phone number you can click to make a phone call. It's a great app to create inventories of all items in your RV or Household (for insurance purposes), and is also a great log book for remembering past campgrounds or great photo locations you've visited.

Speaking of photo locations, since that's one of my main reasons for traveling, there are a couple great photo apps on my iPhone as well:

  • Focalware is a "must-have" for any outdoor photographer. It uses the iPhone's GPS and compass to show you where and when the sun or moon will rise and set, and the position of where the sun/moon will be at any particular time of day. It provides this info for your current location, or a location you're wishing to travel to for today or in the future.

  • PhotoBuddy is a useful collection of photo tools for calculating depth of field, exposure, flash coverage, bracketing, and also provides a handy little bulb timer when taking long exposures.

Well, there you have it! My list of favorite traveling apps. If you've got some favorites not listed here, please post a comment and let me know about them!

Tuesday, February 2, 2010

Talk is cheap....and portable!

When I first began traveling alot for business, I had a cell phone for my business calls and a "Ma Bell" landline phone for home/personal calls. The home phone had an answering machine that I had to call periodically to see if I had any messages. It was a hassle, and I often wasn't aware of important messages until hours/days later.

So my next solution was to change my home phone to Vonage VOIP. It had a great feature that would email me any voice mails and allow me to listen to the message right from the email message. When I first got Vonage, it was about the same price as my basic AT&T home phone service (less than $20/mo). But over the years, it's fees continued to grow. Finally, a few months ago when the cost was now $27/mo, I decided to find a less expensive replacement.

I have a mobile phone with unlimited minutes, so that certainly could have been an easy solution-- but I didn't want to give my cell number out to all the places I do business with (as I'm sure telemarketing calls would inevitably result). I also didn't want to give up my multi-handset wireless phone system at home-- much nicer than carrying your cell phone up and down stairs.

Well, I've now found my solution(s)-- great features, super cheap, but rather techie to initially set up. Now, instead of paying nearly $30 a month, I'm paying around $3/mo and getting even more features!

Here's what I use:

Google Voice - This is an AMAZING free service that can be used with your existing number or they'll give you a new free phone number for your local area code. It shares the same contact list as Google Gmail and can import/export with various other address books. Google Voice is a call-routing service with a few cool twists. I gave my Google phone number out to all my friends and places I do business with. When they call the number, Google routes the call to whatever phones I wish to ring (such as my mobile and my home phones). Voice mail comes to me as email and includes not only the audio file but a text transcription of the call too.

But here's 3 really cool features--
- Advanced Call Routing: I can set it up so that some or all of my contacts ring my phones, but other contacts go right to voicemail (great way to avoid those telemarketing calls!), and if I ever get some weird stalker or rouge fax machine calling my number repeatedly, I can set Google Voice to give them a "We're sorry, the number you have reached is not in service" message. Wow!

- Free U.S. calls: Now this is really cool! My new home phone plan allows for unlimited free incoming calls, and low-cost outgoing calls. I thought that was a pretty good deal, but Google Voice makes it even better-- when I want to make a free call, I just select my desired contact (or type the number manually) in Google Voice and tell it to use my Home phone. Google Voice then calls my Home phone (a free incoming call) and connects me to the number I wish to talk to. Pretty mind-bending!

- Free SMS Text messages: I can send/receive free SMS text messages on my Google Voice phone number. I've got these set up to go to my email account (as that email gives me an auto-notification on my iPhone whenever new messages arrive). I can send SMS replies to these via email too, so it's essentially getting free unlimited text messages on my iPhone without having to pay AT&T for them.

Now if I didn't want to continue using my multi-handset cordless home phone system, I could have stopped right there and just have used Google Voice with my cell phone. But since I still wanted these phones, here's what I did to make them work:

D-Link DPH-50U USB Phone Adapter: I got this on close-out for about $20. It only works with Windows XP, so I use it with an old laptop that I leave running all the time at home. I then can plug any regular phone into this adapter (in my case, the cordless phone).

Skype provides a phone number for Google Voice with unlimited free incoming calls (SkypeIn). When I first signed-up for Skype, I bought a 1 month subscription which then allowed me to buy the SkypeIn phone number at 50% off ($30/yr rather than $60). Now that the subscription has ended, I'm now just buying SkypeOut credit as needed to make any outbound calls I wish to landlines and cell phones. Since I use the Google Voice trick above, I rarely need to use my SkypeOut credits, but they're nice to have around if I ever need them.

Skype is nice to use as a backup to my AT&T iPhone (which is notorious for dropped calls depending on where I happen to be). There's also a nice Skype iPhone app that lets me make calls from my iPhone via Wifi, so when paired up with my Verizon MiFi cellular modem, I can make an iPhone call via Verizon's network using Skype! Pretty cool and a very essential feature when RV traveling to not have to rely on a single cell carrier for all your phone calls.

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