Thursday, August 7, 2008

How Doctors Can Use Evernote As A Professional Memory Accessible Anywhere (Part 1 of 3)

Evernote — a new searchable, available-anywhere, online personal database — recently became indispensable to my medical practice.

Technologies like Evernote make it obvious that we deal with information that lives in two worlds. The first, the physical world of paper, is populated by written medical records, scribbled notes, and stacks of printed journals that arrive in the mail. Information in this world is maddeningly localized — ask any physician who's struggled to find a missing lab report among piles of paper on their desk.

In contrast, the digital world — and we can substitute "cyberspace" or "the cloud" or your favorite phrase here — is inhabited by electronic medical records, web-based email, and online databases. The characteristic of this world is that information is searchable, available-anywhere, and (hopefully) securely backed-up online in multiple locations.

The beauty of Evernote is that it acts as a portal between the paper and digital worlds. Here's an example: let's say you've just read a review article on hypertension in the New England Journal of Medicine. This paper article contains an important table on drugs to treat hypertension that you'd like to refer to at a later time. Traditionally, articles like this would be torn out, stapled, and placed in a bulging filing cabinet for later retrieval. But too often, finding the article is too difficult, and it just takes up space for years until the information is outdated. Sound familiar?

By using Evernote, physicians can easily convert that critical table into digital form. (The journal itself can be recycled — it's no longer needed.) You can enter the table into Evernote in at least three ways:
  • By taking a photo using the camera on your phone and emailing it to your personal Evernote email address
  • By scanning the article directly into the Evernote program on your computer — I'm personally a fan of the Fujitsu Scansnap for quickly transferring any paper items I'd like to later retrieve to Evernote
  • By accessing the article on the NEJM website and using Evernote's "webclipping" program to highlight the table
Once in Evernote, the table can be named ("Table of Drugs to Treat Hypertension") and tagged ("Hypertension," "NEJM"). Evernote even recognizes the text in the table — for example, the drug "metoprolol" — and makes it all searchable. The online Evernote database synchronizes automatically with the Evernote database on your computer. And here's the beautiful thing — anytime you want to refer to that table, you can either
  1. Search for "hypertension," "metoprolol," or "NEJM" on the Evernote program on your computer
  2. Search Evernote online using any web browser
  3. Search Evernote with the web browser on your mobile phone or with the Evernote program for the iPhone
The information in that article is now available almost anywhere. Just think of all the space you'll save in your filing cabinets by never filing away a journal article again.

But this is only a small taste of the capability of Evernote. Without much fanfare, the Evernote Corporation has created the perfect tool for designing a customizable, hybrid electronic health record (EHR). I'll explain how to create an EHR in Evernote in Part 2.

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patandpan said...

I too discovered Evernote and use it as a way to store all my essential reference material. I am a cardiologist who specializes in echocardiography. There are many reference tables, figures and guidelines that I'd like carry around with me at work. Evernote is my perfect companion. The Evernote website is particularly useful when I am not at my own computer. I can quickly update my collection at a different location. My only complaint is that Evernote does not download the physical files into my iPhone and retrieving files using my iPhone tends to be slow. I hope the next version of the software will improve further but it is a great start.

Anonymous said...

I love Evernote, but have often been concerned with the security since I don't believe Evernote encrypts the data that is stored on their servers.

Are you storing any patient specific data, and if so will this impact your HIPPA compliance?

Joshua Schwimmer, MD, FACP, FASN said...

Re: The Security of Evernote. I was going to address that in the second post of the series, but it's an important point. The premium Evernote service, which is only $5 a month, provides for encrypted transactions with HTTPS. Here's a post from the Evernote Blog regarding security. There are enough safeguards in place to comply with HIPAA:

Security and privacy are extremely important topics for Evernote users, and for good reason. Evernote would like to provide a single service to manage your memories for many years. To achieve this, we must provide a very high level of system and data security while offering users a variety of choices to manage their own privacy requirements. Here is a high-level overview of some of the ways in which your data is protected by Evernote.

When you add a note to the service, it is secured like your email would be at a high-end email provider. This means that your notes are stored in a private, locked cage at a guarded data center that can only be accessed by a small number of Evernote operations personnel. Administrative maintenance on these servers can only be performed through secure, encrypted communications by the same set of people. All network access to these servers is similarly protected by a set of firewalls and hardened servers. Your login information is only transmitted to the servers in encrypted form over SSL, and your passwords are not directly stored on any of our systems.

Anonymous said...

I am waiting with bated breath for part 2. I can see the potential.

Anonymous said...

I love the use of Evernote for medical research data. Perfect. But not so fast on EHR's. There is a lot more to HIPAA than encrypted secure transmission of data. HIPAA wouldn't normally allow you to email yourself an EHR to a private email account no matter how secure. Be sure you know 45 CFR 164 and the penalties before trying this.

Joshua Schwimmer, MD, FACP, FASN said...

Thanks the last comment on security. I stress that this is a proof of concept only, and I'd value your analysis. Please let us know if information transmitted over Evernote is not in compliance with HIPAA. Thanks.

Scott said...

I don't believe it is a HIPAA issue unless you transfer/sync the information over the computer, i.e. to Evernote's database/cloud. If you keep the note/medical information/record local, i.e. on your local hard drive, I don't believe this is considered 'transmission'. HIPAA has to do with transmission of PHI electronically. If you are not transmitting, it is not HIPAA.

Scott Bushey

Joshua Schwimmer, MD, FACP, FASN said...


Thanks for the comment. Even so, if the information is transmitted to Evernote and stored securely, is it in violation of HIPAA?