Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and EHR for FREE!

The Return of the House Call? – UberHealth

Posted on October 24, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’d been hearing rumors about Uber (the black car service) creating an Uber Health service. I don’t think anyone is clear on the details and I’m not sure how they can do Uber Health when it seems like they have enough growth opportunities and challenges with their car service. Undeterred, yesterday Uber Health dipped its toe in the water with a Flu Prevention program for 1 day in 3 cities.

Uber partnered with Vaccine Finder to bring flu prevention packs and flu shots directly to you at the push of a button (an Uber button of course).

The offering was obviously really compelling. This version of Uber Health was free and Uber made it possible for the service to come to you and your 10 closest friends. I haven’t seen any reports on how it went, but I’ll be surprised if I hear that the service wasn’t swamped all day. They made it really convenient to get a flu shot. Hard to argue with something that comes to you for free.

What’s interesting to me is whether Uber can scale this kind of house call service in healthcare. No doubt they already have the transportation infrastructure in place to move the doctors and other medical personnel around as needed. However, that comes with a pretty steep cost which will have to be passed on to the patient. Plus, I don’t know how an Uber ride is any cheaper than the doctor driving her own car. I guess the doctor could chart the previous visit while the Uber drives her to the next one. Either way, it’s still an added cost that will have to be incorporated into the house call doctor visit.

You have to remember that Uber comes from the startup centric culture of Silicon Valley. In that culture, these companies will happily pay for a house call service like what Uber Health could be. First, these startup companies are competing for the best talent and being able to tell their employees that the Uber Health house call service is one of the benefits of working there could be a way to attract and retain the best talent. Second, these startup companies want their employees working as much as possible. A visit to the doctor takes a big chunk out of the day when they could be working and building their company. The lost productivity alone is reason enough for these companies to pay for a house call service like what Uber Health could become.

The real question is how will this scale across the nation. Are other companies as willing as silicon valley startup companies to pay for a service like this for their employees? My guess is that they won’t be, because the competition for talent isn’t nearly as fierce.

The reality is that I think most of us love the idea of a house call medical visit. I can’t think of anyone that wouldn’t love to avoid time spent waiting in the waiting room. However, we have to understand what that costs. There’s a reason why the house call doctor died in favor of office visits. They seem to be making a comeback, but I wonder if they’ll only work for the wealthy who don’t care about price.

Side Note: I just saw that Uber finally came to Las Vegas. That means you can try them out if you ever come and visit my beautiful town.

Healthcare’s Shift to Patient Self Pay

Posted on October 23, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This stat was absolutely remarkable. It came from Intermountain healthcare. Healthcare Scene writers and I have written about this shift multiple times, but it was pretty stark to see the stats on how big the shift really is for an organization.

This same speaker at the Craneware Summit also said that only 40% of self pay is collectible. That’s a huge chunk of money your organization use to collect that is now being sent to collections. Now do you see why this shift in payments really matters?

Barry Haitoff, CEO of Medical Management Corporation of America, offered these words of advice on how to deal with the increase in patient self pay:

There are two main things you need to do to prepare for these high deductible plans. First, make sure you have a solid method in place to know how much the patient owes before or immediately after the visit. There is no better way to reduce patient collections than to collect the payment while the patient is in the office. Many are ready and willing to pay, but some practices don’t have the systems that allow them to know how much to charge the patient before they leave.

Second, look at your processes for collecting patient payments once they’ve left the building. Do you have a good strategy in place to make sure the patient knows how much they owe? Do you have a variety of simple ways for the patient to make the payment? The use of an online payment portal for patients is the most obvious way to make submitting payment to physicians simple for patients. If you solve these two problems you’ll go a long way to improving your patient collections.

These really are two great steps to deal with patient collections and the increase in patient self pay. I’m also watching new payment technologies. I’ll be interested to see what new payment methodologies are rolled out now that the patient pay portion of the bill is so much higher. Now that it matters a lot more to a clinic, I think we’ll see some new tech solutions that work to solve it. Credit card on file is one example.

What are you doing to handle this increase in patient self pay?

Full Disclosure: Medical Management Corporation of America is a sponsor of Healthcare Scene’s EMR and HIPAA blog.

Patient Billing Experience is Tied to HCAHP Scores

Posted on October 22, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I first heard about this earlier this year when I met with ZirMed at ANI. Since then, I keep hearing this concept over and over and so it’s finally time for me to create a blog post on the topic. How you bill a patient has a tremendous impact on patient satisfaction and therefor your HCAHP scores.

When you read that, I’m sure you’re thinking “Well duh! Of course it does.” While it’s obvious once it’s stated, I don’t know many organizations that are working to improve their HCAHP scores by improving their patient billing processes. I have seen a lot of programs that look at the patient experience getting checked in, while their in the hospital, and how their discharge goes. Unfortunately, many organizations seem to stop one step short of the finish line. It’s like running 25 miles of a 26 mile marathon. The patient bill is the last mile of that journey.

The final experience a patient has with a hospital is usually when they get the bill from the hospital. There are so many ways this can be a terrible experience for the patient. If the charges are a lot more than what the patient expects, they’ll have a bad experience. If it’s not clear what charges they owe and whether insurance has paid their portion or not, they’ll have a bad experience. If they see the $5 aspirin (yes, that’s representative of charges that don’t make logical sense to the average patient), then it can damage their experience. If there’s no way to pay the bill online, it can leave a bad taste in the mouth for many. If it’s not clear what the bill is charging for, it can cause a bad experience. I could go on, but you get the idea.

All of these issues (and no doubt there are plenty more) have no impact on the care the patient received. In fact, your doctors and nurses could have provided an amazing customer service and literally worked miracles to save the patients life. However, if the billing experience is bad, it can leave a bad taste in their mouth and that will show up when they’re rating your hospital.

No doubt there are plenty of edge cases that we’ll never be able to satisfy. However, there’s a lot more we can do with our medical billing processes to ensure that the experience is a lot better than what it is today. Your HCAHP scores shouldn’t suffer because you didn’t take the time to make your billing process as beautiful as your clinical care.

ICD-10 Ebola Infographic

Posted on October 21, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In my post on funny ICD-10 codes ruining the ICD-10 brand, I briefly commented how there’s no ICD-9 code for Ebola, but that there is one for ICD-10.

Beth Friedman from Agency Ten22 shared a link to this ICD-10 Ebola Infographic that I thought readers would find really interesting.

Ebola ICD-10 Infographic

One more reason to finally implement ICD-10 in the US.

Are Researchers Ready to Use Patient Health Records?

Posted on October 20, 2014 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

There’s a groundswell of opinion throughout health care that to improve outcomes, we need to share clinical data from patients’ health records with researchers who are working on cures or just better population health measures. One recommendation in the much-studied JASON report–an object of scrutiny at the Office of the National Coordinator and throughout the field of health IT–called on the ONC to convene a conference of biomedical researchers.

At this conference, presumably, the health care industry will find out what researchers could accomplish once they had access to patient data and how EHRs would have to change to meet researchers’ needs. I decided to contact some researchers in medicine and ask them these very questions–along with the equally critical question of how research itself would have to evolve to make use of the new flood of data.
Read more..

Meaningful Use #HITsm Twitter Chat

Posted on October 17, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I had the honor today to host the #HITsm Twitter chat. For those not familiar with the #HITsm chat, you just join every Friday at Noon ET and watch the tweets that are sent using the #HITsm hashtag. There are usually 4-5 questions that are discussed over the hour chat. Since I was the host, I created the questions this week. I chose to focus the chat on the latest happenings with meaningful use. The transcript of the chat is found here.

I just took a look at the stats for the chat on Symplur and saw that the chat had 68 participants that sent out 474 tweets which had 3,196,079 impressions. You have to be a little careful looking at impressions since that’s potential impressions, but it’s still interesting to consider the possible reach of a chat.

There were some really interesting tweets during the chat, so here are the questions and a few (ok, more than a few since I got carried away) of my favorite tweets: Read more..

Insights from Dr. Eric Topol at #SHSMD14

Posted on October 16, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.


Patient care will eventually win, but sacred cows still have a lot of fight in them.


I’m still chewing on this one. I definitely love the idea of remote visits. Not sure it’s the smartest patient room.


This trend is definitely happening. Although, if you sound out Iwwiwwiwi, it sounds a lot like whining. I’m not sure that’s a good thing. Either way, I think the market is going to push towards on demand medicine.


I’d love to hear more about this topic. I think the first step is identifying the real cost problem. Seems like these top drugs could provide a really good start.

Are We Moving from Passive Patients to Active Consumers?

Posted on October 15, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.


This were the questions I was asking myself when I sat in on a presentation by Intermountain’s revenue cycle manager at the Craneware Summit in Las Vegas. I think the clear answer to the first question is that patients are becoming more active. Patients are shouldering a larger portion of the cost of their healthcare and so now they’re move involved in the care they receive. Plus, the internet and mobile applications have made it much easier for a patient to be informed on their health.

The later question is much harder. What impact will this change have on healthcare?

I certainly don’t have all the answers, but it’s going to take a dramatic shift by the current healthcare system to adapt to this changing consumer. The days of the omniscient doctor (at least perceived) are gone and there’s now a shift to a more collaborative care model.

Of course, many doctors fear that this shift is going too far. They usually point to the overbearing patient who thinks they know better than the doctor. Certainly these patients exist, but they are the minority and aren’t a huge shift from the patients who didn’t listen to their doctor before the shift happened. The problem is that 1 rotten apple spoils the bunch.

Overall, I think this change will be a good thing for the healthcare system. There are a lot of things you can’t change in healthcare if you don’t have an active patient that’s engaged and cares about their health. Hopefully this will be the start of that movement to helping patients care more about their health.

If you want proof that things are changing, Intermountain has changed their mission statement. First, it’s not very often that an organization as large as Intermountain makes a major change to their mission statement. Second, think about whether this mission statement would work for your hospital or healthcare organization:

Change is in the air. What are you doing to prepare for the change?

Will EHR Vendors Become Service and Consulting Companies?

Posted on October 14, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This is the topic of a really interesting LinkedIn discussion: Will EHR Vendors Become Service and Consulting Companies?

I think this is a really great question and one that’s worthy of serious consideration. I think we’ve seen this happen time and time again in the IT industry. Some of the best examples are IBM, HP, and Dell. As their IT hardware and software becomes a “commodity” then they leverage their relationships and domain expertise to change into a service and consulting company. Usually this also involves them spending their extra cash to acquire the leading consulting company (or companies) in the industry as well.

In some ways we’re already seeing this happen. Epic announced a consulting division of their company in order to retain their senior staff. Cerner’s always made a good chunk of their money from consulting services.

Of course, thanks to meaningful use incentive money and some still massive upgrade costs, EHR vendors haven’t needed to shift their business model to a service and consulting model yet. There’s still plenty of money to be made just selling the software, training, etc.

What will also be interesting to watch is whether the large service and consulting companies like Accenture, IBM, HP, Dell, etc. will eat up the market share so that the EHR companies don’t have as much of an opportunity to grow a service and consulting business. No doubt it will be a big dog fight. Not to mention many of the current EHR consulting companies (although, you could see many of these getting acquired by the EHR vendors).

I guess my short answer to this question is: In the short term, we’re not likely to see a massive shift towards services and consulting, but long term it’s very likely to happen. What are your thoughts?

Open Standards Advance in Health Care Through the Appeal of FHIR and SMART

Posted on October 13, 2014 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The poor state of interoperability between EHRs–target of fulminations and curses from health care activists over the years–is starting to grind its way forward. Dr. Kenneth Mandl, a leader of the SMART Platform and professor at the Boston Children’s Hospital Informatics Program, found that out when his team, including lead architect Josh Mandel, went to HIMSS this year to support Cerner’s implementation of his standard, and discovered three other vendors running it.

That’s the beauty of open source and standards. Put them out there and anyone can use them without a by-your-leave. Standards can diffuse in ways the original developers never anticipated.

A bit of background. The SMART platform, which I covered a few years ago, was developed by Mandl’s team at Harvard Medical School and Children’s Hospital to solve the festering problem of inaccessibility in EHRs and other health care software. SMART fulfilled the long-time vision of open source advocates to provide a common platform for every vendor that chose to support it, and that would allow third-party developers to create useful applications.

Without a standard, third-party developers were in limbo. They had to write special code to support each EHR they want to run on. Worse still, they may have to ask the EHR vendor for permission to connect. This has been stunting the market for apps expanding the use of patient data by clinicians as well as the patients themselves.

SMART’s prospects have been energized by the creation of a modern interoperability resource called FHIR. It breaks with the traditional health care standards by being lean, extendible in controllable ways, and in tune with modern development standards such as REST and JSON.

It helps that SMART was supported by funds from the ONC, and that FHIR was adopted by the leading health care standards group, HL7. HL7’s backing of FHIR in particular lent these standards authority among the vendor and health care provider community. Now the chocolate and peanut butter favored by health IT advocates have come together in the SMART on FHIR project, which I wrote about earlier this year.

Mandl explains that SMART allows innovators to get access to the point of care. As more organizations and products adopt the SMART on FHIR, API, a SMART app written once will run anywhere.

Vendors have been coming to FHIR meetings and expressing approval in the abstract for these standards. But it was still a pleasant surprise for Mandl to hear of SMART implementations demo’d at HIMSS by Intermountain, Hewlett-Packard, and Harris as well as Cerner.

The SMART project has just released guidlines for health care providers who want to issue RFPs soliciting vendors for SMART implementations. This will help ensure that providers get what they ask and pay for: an API that reliably runs any app written for SMART.

It’s wise to be cautious and very specific when soliciting products based on standards. The notion of “openness” is often misunderstood and taken to places it wasn’t meant to go. In health care, one major vendor can trumpet its “openness” while picking and choosing which vendors to allow use of its API, and charging money for every document transferred.

The slipperiness of the “open” concept is not limited to health IT. For years, Microsoft promulgated an “open source” initiative while keeping to the old proprietary practices of exerting patent rights and restricting who had access to code. Currently they have made great progress and are a major contributor to Linux and other projects, including tools used with their HealthVault PHR.

Google, too, although a major supporter of open source projects, plays games with its Android platform. The code is nominally under an open license–and is being exploited by numerous embedded systems developers that way–but is developed in anything but an open manner at Google, and is hedged by so many requirements that it’s hard to release a product with the Android moniker unless one partners closely with Google.

After talking to Mandl, I had a phone interview with Stan Huff, Chief Informatics Officer for Intermountain. Huff is an expert in interoperability and active in HL7. About a year ago he led an effort at Intermountain to improve interoperability. The motivation was not some ethereal vision of openness but the realization that Intermountain couldn’t do everything it needed to be competitive on its own–it would have to seek out the contributions of outsiders.

When Intermountain partnered with Cerner, senior management had by that time received a good education in the value of a standard API. Cerner was also committed to it, luckily, and the two companies collaborated on FHIR and SMART. Cerner’s task was to wrap their services in a FHIR-compliant API and to make sure to use standard technology, such as in codes for lab data.

Intermountain also participated in launching a not-for-profit corporation, the Healthcare Services Platform Consortium, that promotes SMART-on-FHIR and other standards. A lot of vendors have joined up, and Huff encourages other vendors to give up their fears that standardization is a catheter siphoning away business and to try the consortium out.

Intermountain currently is offering several applications that run in web browsers (and therefore should be widely usable on different platforms). Although currently in the prototype stage, the applications should be available later this year. Besides an application developed by Intermountain to monitor hemolytic disease among neonates and suggest paths for doctors to take, they support several demonstration apps produced by the SMART project, including a growth chart app, a blood pressure management app, and a cardiovascular app.

Huff reports that apps are easy to build on SMART. In at least one case, it took just two weeks for the coding.

Attendees at HIMSS were very excited about Intermountain’s support for SMART. The health care providers want more flexible and innovative software with good user interfaces, and see SMART providing that. Many vendors look to replicate what Intermountain has done (although some hold back). Understanding that progress is possible can empower doctors and advocates to call for more.