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In Montana, One Physician Brings the EHR to the “Big(ger) Screen”

July 24, 2014
by Gabriel Perna
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James Legan, M.D., a primary care physician in an eight-physician practice, is one of the last people you’d expect to be a pioneer in electronic health record (EHR) visualization.

While the number of doctors in his practice has fluctuated over the years, Dr. Legan has been a steady presence in many ways. He has been in the same office for 21 years in the same town, Great Falls, Mo.—an aging area that has been relatively stagnant in its growth.

A few years ago, Legan says, he fought the idea of developing an electronic health record (EHR). Even when he used Microsoft Word to document something, he’d print it out and put it on the paper chart. It was only at the end of 2011 that his practice took the plunge.

“The emphasis to get me going was more out of fear than thinking this is going to do me any good,” Legan says. He picked a system from the North Kingstown, R.I.-based AmazingCharts. The man who is self-described as “non-computer savvy” said he immediately found his EHR easy to use. “I thought it would be a lot more difficult. Within a day or two of using it, I knew I wanted it,” he says.

James Legan, M.D.

A Chromebook, an HDMI, a TV, and Remote Access

Thanks to a confluence of circumstances, Legan transferred the EHR to a flat screen TV in the examination room. First, he had gone to conference in Laramie, Wyo. and got the idea of using the Google Chromebook in practice. Then he was given an 11-inch Acer computer as a Christmas present. He was using it at home because it was too small for the office. Around that time, he was reading electrocardiogram (EKG) tests on it and his 13-year-old son asked him a simple question.

“He said, ‘Dad why are you reading that on the small screen? Why don’t you put it on the big screen TV?’ He showed me the mirroring function with the HDMI cord and plugged the computer into the big-screen TV. I had these huge EKG tests on the screen. At that point I realized I could not only mirror what I’m doing, but I could do it through a remote database,” Legan recalls.

Legan runs a security-enabled remote-access application through the Google Chromebook and treats it as a conduit to get access the main database in his office. It can mirror what he has on his main computer. That Chromebook then connects through an HDMI cord to the big-screen TV, allowing patients to see their data on a 24-inch screen.

Breaking Barriers

With a lot of his patients being on Medicare, Legan wasn’t certain how this new set-up would play out. He didn’t get a positive response when initially floated the idea to some patients. However, within 24-48 hours of putting the new set up in his office, he noticed an immediate difference. It broke down the barrier between doctor and patient.

“When patients can see their own vitals over time, it is really powerful. When they can see their past medical history, it gives them a sense of power that they are a part of process. Going through and updating their family history, their allergy list, the medication reconciliation—it’s not just them looking at the data, it becomes a useful tool. I can e-Prescribe and print up a medication reconciliation form that’s accurate because the patient is right there telling me what’s accurate in real-time,” Legan says.

It’s also allowed Legan to stick his nose in the Chromebook without feeling bad that he is ignoring the patients. As he notes, they are sticking their nose in the data too. Furthermore, because it’s such a simple and cost-effective solution (approx. $500), Legan says there haven’t been many challenges.

“This has the potential to replace a desktop in every examination room,” Legan says. The HDMI cord could conceivably connect the device to every TV in any kind of care setting. The Chromebook also has the advantage of having a Linux operating system on top of the remote application, which runs Microsoft. The two operating systems can be easily switched. This allows him to use the internet when need be. The only upgrade he would consider with it is getting a chip that would allow him to not be Wi-Fi dependent.

Spreading the Wealth

While Legan notes that coming up with this idea was him being in the right place at right time, easy, affordable ideas—like using flat screen TVs to engage patients with their data—will sell themselves. He has taken to Twitter and other mediums in an attempt to spread the wealth.

“Maybe there is a 5-10 percent rate of physicians that can benefit from this simple technology and practical approach. I’d feel terrible if I kept it to myself. If I can help that 5-10 percent do things better day to day. There is clamor out there, a lot of frustration. I keep horror story after another. Maybe this solution can patch up some of this anger and detachment we’ve seen with EHR dealing with patients,” Legan says.