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Happy Thanksgiving – Family Health History Day Infographic

Posted on November 27, 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.

Did you know that today is Family Health History Day? I didn’t either, but this infographic spells it out. I hope everyone’s having a lovely Thanksgiving! I have to get back to football my family.

Family Health History Day Infographic

Epic Tries To Open New Market By Offering Cloud Hosting

Posted on November 26, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

When you think of Epic, you hardly imagine a company which is running out of customers to exploit. But according to Frost & Sullivan’s connected health analyst, Shruthi Parakkal, Epic has reached the point where its target market is almost completely saturated.

Sure, Epic may have only (!) 15% to 20% market share in both hospital and ambulatory enterprise EMR sector, it can’t go much further operating as-is.  After all, there’s only so many large hospital systems and academic medical centers out there that can afford its extremely pricey product.

That’s almost certainly why Epic has just announced  that it was launching a cloud-based offering, after refusing to go there for quite some time.  If it makes a cloud offering available, note analysts like Parakkal, Epic suddenly becomes an option for smaller hospitals with less than 200 beds. Also, offering cloud services may also net Epic a few large hospitals that want to create a hybrid cloud model with some of its application infrastructure on site and some in the cloud.

But unlike in its core market, where Epic has enjoyed incredible success, it’s not a lock that the EMR giant will lead the pack just for showing up. For one thing, it’s late to the party, with cloud competitors including Cerner, Allscripts, MEDITECH, CPSI, and many more already well established in the smaller hospital space. Moreover, these are well-funded competitors, not tiny startups it can brush away with a flyswatter.

Another issue is price. While Epic’s cloud offering may be far less expensive than its on-site option, my guess is that it will be more expensive than other comparable offerings. (Of course, one could get into an argument over what “comparable” really means, but that’s another story.)

And then there’s the problem of trust. I’d hate to have to depend completely on a powerful company that generally gets what it wants to have access to such a mission-critical application. Trust is always an issue when relying on a SaaS-based vendor, of course, but it’s a particularly significant issue here.

Why? Realistically, the smaller hospitals that are likely to consider an Epic cloud product are just dots on the map to a company Epic’s size. Such hospitals don’t have much practical leverage if things don’t go their way.

And while I’m not suggesting that Epic would deliberately target smaller hospitals for indifferent service, giant institutions are likely to be its bread and butter for quite some time. It’s inevitable that when push comes to shove, Epic will have to prioritize companies that have spent hundreds of millions of dollars on its on-site product. Any vendor would.

All that being said, smaller hospitals are likely to overlook some of these problems if they can get their hands on such a popular EMR.  Also, as rockstar CIO John Halamka, MD of Beth Israel Deaconess Medical Center notes, Epic seems to be able to provide a product that gets clinicians to buy in. That alone will be worth the price of admission for many.

Certainly, vendors like MEDITECH and Cerner aren’t going to cede this market gracefully. But even as a Johnny-come-lately, I expect Epic’s cloud product do well in 2015.

Consumers Are Still Held Back From Making Rational Health Decisions

Posted on November 25, 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.

Price and quality of care–those are what we’d like to know when we need a medical procedure. But a perusal of a recent report from the Government Accountability Office reminded me that both price and quality information are hard to get nowadays.

This has to make us all a little leery about trends in health reform. Governments, insurers, and employers want us to get choosy about where we have our procedures. They justify rises in copays and deductibles by saying, “You patients should start to take responsibility for the costs of your own health care.”

Yeah, as responsible as a person looking for his car keys in the dark. Let’s start with prices, which in many countries are uniform and are posted on the clinic wall.

Sites such as Clear Health Costs and Castlight Health prove what we long knew anecdotally: charges in the US vary vertiginously among different institutions. Anyone who had missed that fact would have been enlightened by Steven Brill’s 2013 Time Magazine article.

But aspirations become difficult when we get down to the issue at hand–choosing a provider. That’s because US insurance and reimbursement systems are also convoluted. We don’t know whether a hospital will charge our insurer their official price, or how much the insurer will cover. It might feel righteous to punish a provider with high posted prices (or prices reported by other consumers), but most patients have a different goal: to keep as much of their own money as they can.

We can gauge the depth of the cost problem from one narrow suggestion made in the GAO report that yet could help a lot of health consumers: the suggestion that Centers for Medicare & Medicaid Services (CMS) publish out-of-pocket expenditures for Medicare recipients as well as raw costs of procedures (page 31). Even this is far from simple. HHS pointed out that 90% of Medicare patients have supplemental overage that reduces their out-of-pocket expenditures (page 43). Tracking all the ancillary fees is also a formidable job.

Castlight Health is out in front when it comes to measuring the real impact of charges on consumer. They achieve great precision by hooking up with employers. Thus, they know the insurer and the precise employer plan that covers each individual visiting their site, and can take deductibles, exclusions, and caps into account when calculating the cost of a procedure. A recent study found that Castlight users enjoyed lower costs, especially for labs and imaging. Some nationwide system built around standards for reporting these things could unpack the cost conumdrum for all patients.

Let’s turn to quality. As one might expect, it’s always a slippery concept. The GAO report pointed out that quality may be measured in different ways by different providers (page 26). A recently begun program releases Medicare data on mortality and readmissions, but it hasn’t been turned into usable consumer information yet (pages 27-28). Two more observations from the report:

  • “…with the exception of Hospital Compare, none of CMS’s transparency tools currently provide information on patient-reported outcomes, which have been shown to be particularly relevant to consumers considering common elective medical procedures, including hip and knee replacements.” (Page 21)

  • “CMS’s consumer testing has focused on assessing the ability of consumers to interpret measures developed for use by clinicians, rather than to develop or select measures that specifically address consumer needs.” (Page 25)

Some price-check sites simply don’t try to measure quality. A highly publicized crowdsourcing effort by California radio station KQED, based on the Clear Health Costs service, admitted that quality measures were not available but excused themselves by citing the well-known lack of correlation between price and quality.

Price and quality may not be related, but that doesn’t relieve consumers of concerns over quality. Can you really exchange Mount Sinai Hospital in New York for Daddy-o’s Fix-You-Up Clinic based on price alone? Without robust and reliable quality data, people will continue choosing the historically respected hospitals with the best marketing and PR departments–and the highest prices.

A recent series on health care costs concludes by admonishing consumers to “get in the game and start to push back.” The article laments the passivity of consumers in seeking low-cost treatment, but fails to cite the towering barriers that stand in the way.

The impasse we’ve reached on consumer choice, driven by lack of data, reflects similar problems with analytics throughout the health care field. For instance, I recently reported on how hard a time researchers have obtaining and making use of patient data. Luckily, the GAO report cites several HHS efforts to enhance their current data on price and quality. Ultimately, of course, what we need is a more rational reimbursement system, not a gleaming set of computerized tools to make the current system more transparent. Let’s start by being honest about what we’re asking health consumers to achieve.

Review of “Patient Engagement is a Strategy, Not a Tool” by Colin Hung

Posted on November 24, 2014 I Written By

The following is a guest blog post by Colin Hung (@Colin_Hung), Co-Host of #hcldr and SVP of Marketing at Patient Prompt.
Colin Hung
If Leonard Kish’s new eBook – http://www.hl7standards.com/kish-ebook/”>Patient Engagement is a Strategy, Not a Tool was a song, it would be categorized as a “mashup” – and that’s a good thing.

Never heard a mashup song before? Just go to youtube.com and type it into the search bar and you’ll find thousands (or try this one https://www.youtube.com/watch?v=zbrWu8XyAcM). Mashups are a unique form of music. To make one, DJs will take snippets (called samples) from other songs usually from different artists and combine them into a single piece and in so doing create a whole new song in the process.

When done properly a mashup is both familiar and fresh. It has elements which you know and love yet the composition as a whole feels new. That is exactly what Kish has done in his eBook. He expertly weaves together numerous ideas, themes and approaches from different people and different industries into a single cohesive arrangement.

Kish starts by laying down a central idea that is carried like a melody from page 1 through to the end:

“The key to [patient] engagement in early stages is to get people’s attention and to let them see what’s possible by using the tools available to improve their health. It’s a process and a strategy, not a data set or any one tool”

With that idea track locked in, Kish proceeds to mix in concepts from:

  • Marketing – target audiences, key messages and clear calls-to-action
  • Product Management – inclusive design and agile development
  • Behavioral Science – Maslow’s hierarchy, social interaction and motivation

The eBook starts off strong with a nice definition of patient engagement – a rather amorphous term in healthcare right now –  and gets stronger with examples of successful “attention grabbing” marketing campaigns that could be adopted by healthcare organizations.

One particular statement that stands out:

“Engagement requires what marketers know very well: motivation, context and messaging.”

As a person who works in HealthIT Marketing, I’m tickled by this statement…but I think Kish is giving those of us in Marketing a bit too much credit. Although it is true that marketers should have a good grasp of our target audiences (their needs, wants, motivations and fears) – we are not seers. In fact, it is common for marketers to be a little “off key” when approaching new markets or when working with new products.

Truly successful marketers are the ones who are open to being wrong…and who can quickly adapt their messages/approach based on real data and feedback from the target audience. Like a good DJ, you must read the reaction of the audience and change the tune in order to keep things hopping.

The idea of iterating, fitting engagement into the world of the patient (context) and using feedback are the themes that fill the middle portion of Kish’s eBook. Using anecdotes, quotes and statistics from a wide array of leaders he encourages readers to draw parallels with healthcare and to think critically on how that wisdom from outsiders can be applied successfully in their own organizations.

Fittingly there is a section that draws a parallel between healthcare and music. Kish quotes former Talking Heads singer David Byrne in a particularly memorable and interesting chapter.

The finale is where “Patient Engagement is a Strategy, Not a Tool” shines. Having laid the ground work in the prior chapters on why getting patients’ attention is so critical and how difficult it can be to turn that attention into meaningful behavior change, Kish closes by giving readers 10 concrete steps to follow to “win the attention war” in healthcare:

  1. Know what health problem you are trying to solve
  2. Know whose attention you’re trying to get
  3. Use social tools
  4. Know behavior models and behavioral economics
  5. Focus on goals and narratives
  6. Start Simple
  7. Try something and measure results
  8. Understand context
  9. Take an open approach
  10. Follow an analysis-driven implementation plan

I was hoping for a little more depth from Kish on the Agile approach, especially as it relates to A/B testing, iterative design and high reliance on real-user feedback – something that I believe could DEFINITELY be used in healthcare – but perhaps he is keeping these concepts for his next composition.

Overall, Kish’s eBook is a solid mix of familiar theories/approaches from other industries and new ideas/success stories from within healthcare. It offers insight and practical advice on how to change from a tools-based approach to patient engagement to a process and strategy based one. If you work in healthcare and are involved in your organization’s patient experience, access or engagement initiatives this eBook should be on your reading list.

I am looking forward to Kish’s next release – which I hope drops soon.

“Patient Engagement is a Strategy, Not a Tool” can be downloaded for free courtesy of the good folks at HL7 Standards (http://www.hl7standards.com/kish-ebook/)

Treating a Healthy Patient

Posted on November 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.

I first coined the concept of what I call treating a healthy patient back in 2011. I’ve always loved the concept of a doctor actually treating someone who thinks and feels completely healthy. The challenge is that this type of relationship is very different than what we have in our current health system today.

While our current model is very different, I’m hearing more and more things that get me back to healthcare treating an otherwise healthy patient. Although, someone recently pointed out to me that we’re not really treating a healthy patient, because we’re all sick. We just each have different degrees of sickness. It’s a fine point, but I still argue we’re “healthy” because we feel “healthy.”

This analysis points out one layer of change that I see happening in healthcare. This change is being able to detect and predict sickness. Yes, that still means a doctor is treating a sickness. However, I see a wave of new sensors, genetics, and other technology that’s going to absolutely change what we define as “sick.”

This is a massive change and one that I think is very good. I recently read an article by Joseph Kvedar which commented that we’re very likely to seek medical help when we break our arm, because the pain is a powerful motivating factor to get some help. Can this new wave of sensors and technology help us know the “pain” our bodies are suffering through and thus inspire us to seek medical attention? I think they will do just that.

The problem is that our current health system isn’t ready to receive a patient like this. Doctors are going to have to continue to evolve in what they consider a “disease” and the treatment they provide. Plus, we’ll likely have to include many other professionals in the treatment of patients. Do we really want our highly paid doctors training on exercise and nutrition when they’ve had almost no training in medical school on the subjects? Of course, not. We want the dietitian doing this. We’ll need to go towards a more team based approach to care.

I’ve regularly said, “Treating a healthy patient is more akin to social work than it is medicine.” Our health system is going to have to take this into consideration and change accordingly.

Treating a healthy patient won’t solve all our healthcare problems. In fact, I’ve wondered if in some ways treating a healthy patient isn’t just shifting the costs as opposed to lowering the costs. Regardless of the cost impact, this is where I see healthcare heading. Yes, we’ll still need many doctors to do important procedures. Just because you detect possible heart issues doesn’t mean that patient won’t eventually need a heart bypass surgery some day. In fact, a whole new set of medical procedures will likely be created that treat possible heart issues before they become straight up heart issues.

What other ways do you see the system moving towards or away from “treating healthy patients”?

Ebola and EHR Workflow

Posted on November 20, 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.

Earlier this month, the EHR Workflow fanatic addict expert, Charles Webster, MD, put together a webinar on EHR workflow (imagine that). However, he decided to piggyback the Ebola headline and talk about EHR workflow and a bit about how it applied to the Ebola incident. I love the marketing behind it.

EHR workflow is a topic of interest to me and so this summer I had Charles Webster, MD do an EHR workflow series over on EMR and HIPAA. Turns out, he covers a number of the same EHR workflow topics in the webinar embedded below:
-What it workflow?
-What is workflow technology?
-What is a workflow engine?
-What is a workflow editor?
-What is workflow visibility?

If you have an interest in EHR workflow, here’s Chuck’s webinar:

EHR Requires You to Reconsider Your Workflow

Posted on November 19, 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.

Despite many EHR vendors best efforts to tell you otherwise, an EHR requires every organization to reconsider their workflow. Sure, many of them can be customized to match your unique clinical needs, but the reality is that implementing an EHR requires change. All of us resist change to different degrees, but I have yet to see an EHR implementation that didn’t require change.

What many people don’t like to admit is that sometimes change can be great. As humans, we seem to focus too much on the down side to change and have a hard time recognizing when things are better too. A change in workflow in your office thanks to an EHR might be the best thing that can happen to you and your organization.

One problem I’ve seen with many EHRs is that they do a one off EHR implementation and then stop there. While the EHR implementation is an important one time event, a quality EHR implementation requires you to reconsider your workflow and how you use your EHR on an ongoing basis. Sometimes this means implementing new features that came through an upgrade to an EHR. Other times, your organization is just in a new place where it’s ready to accept a change that it wasn’t ready to accept before. This ongoing evaluation of your current EHR processes and workflow will provide an opportunity for your organization to see what they can do better. We’re all so busy, it’s amazing how valuable sitting down and talking about improvement can be.

I recently was talking with someone who’d been the EHR expert for her organization. However, her organization had just decided to switch EHR software vendors. Before the switch, she was regularly visited by her colleagues to ask her questions about the EHR software. With the new EHR, she wasn’t getting those calls anymore (might say something good about the new EHR or bad about the old EHR). She then confided in me that she was a little concerned about what this would mean for her career. She’d kind of moved up in the organization on the back of her EHR expertise and now she was afraid she wouldn’t be needed in that capacity.

While this was a somewhat unique position, I assured her that there would still be plenty of need for her, but that she’d have to approach it in a little different manner. Instead of being the EHR configuration guru, she should becoming the EHR optimization guru. This would mean that instead of fighting fires, her new task would be to understand the various EHR updates that came out and then communicate how those updates were going to impact the organization.

Last night I had dinner with an EHR vendor who told me that they thought that users generally only used about 50% of the features of their EHR. That other 50% of EHR features presents an opportunity for every organization to get more value out of their EHR software. Whether you tap into these and newly added EHR features through regular EHR workflow assessments, an in house EHR expert who’s constantly evaluating things, or hiring an outside EHR consultant, every organization needs to find a way to regularly evaluate and optimize their EHR workflow.

Open Source Electronic Health Records: Will They Support Clinical Data Needs of the Future? (Part 2 of 2)

Posted on November 18, 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 first part of this article provided a view of the current data needs in health care and asked whether open source electronic health records could solve those needs. I’ll pick up here with a look at how some open source products deal with the two main requirements I identified: interoperability and analytics.

Interoperability, in health care as in other areas of software, is supported better by open source products than by proprietary ones. The problem with interoperability is that it takes two to tango, and as long as standards remain in a fuzzy state, no one can promise in isolation to be interoperable.

The established standard for exchanging data is the C-CDA, but a careful examination of real-life C-CDA documents showed numerous incompatibilities, some left open by the ambiguous definition of the standard and others introduced by flawed implementations. Blue Button, invented by the Department of Veterans Affairs, is a simpler standard with much promise, but is also imperfectly specified.

Deanne Clark, vxVistA Program Manager at DSS, Inc., told me that VistA supports the C-CDA. The open source Mirth HIE software, which I have covered before, is used by vxVistA, OpenVista (the MedSphere VistA offering), and Tolven. Proprietary health exchange products are also used by many VistA customers.

Things may get better if vendors adopt an emerging HL7 standard called FHIR, as I suggested in an earlier article, which may also enable the incorporation of patient-generated data into EHRs. OpenMRS is one open source EHR that has started work on FHIR support.

Tolven illustrates how open source enables interoperability. According to lead developer Tom Jones, Tolven was always designed around care coordination, which is not the focus of proprietary EHRs. He sees no distinction between electronic health records and health information exchange (HIE), which most of the health IT field views as separate functions and products.

From its very start in 2006, Tolven was designed around helping to form a caring community. This proved useful four years later with the release of Meaningful Use requirements, which featured interoperability. APIs allow the easy development of third-party applications. Tovlen was also designed with the rights of the patient to control information flow in mind, although not all implementations respect this decision by putting data directly in the hands of the patient.

In addition to formats that other EHRs can recognize, data exchange is necessary for interoperability. One solution is an API such as FHIR. Another is a protocol for sending and receiving documents. Direct is the leading standard, and has been embraced by open source projects such as OpenEMR.

The second requirement I looked at, support for analytics, is best met by opening a platform to third parties. This assumes interoperability. To combine analytics from different organizations, a program must be able to access data through application programming interfaces (APIs). The open API is the natural complement of open source, handing power over data to outsiders who write programs accessing that data. (Normal access precautions can still be preserved through security keys.)

VistA appears to be the EHR with the most support for analytics, at least in the open source space. Edmund Billings, MD, CMO of MedSphere, pointed out that VistA’s internal interfaces (known as remote procedure calls, a slightly old-fashioned but common computer term for distributed programming) are totally exposed to other developers because the code is open source. VistA’s remote procedure calls are the basis for numerous current projects to create APIs for various languages. Some are RESTful, which supports the most popular current form of distributed programming, while others support older standards widely known as service-oriented architectures (SOA).

An example of the innovation provided by this software evolution is the mobile apps being built by Agilex on VistA. Seong K. Mun, President and CEO of OSEHRA, says that it now supports hundreds of mobile apps.

MedSphere builds commercial applications that plug into its version of Vista. These include multidisciplinary treatment planning tools, flow sheets, and mobile rounding tools so doctor can access information on the floor. MedSphere is also working with analytic groups to access both structured and unstructured information from the EHR.

DSS also adds value to VistA. Clark said that VistA’s native tools are useful for basic statistics, such as how many progress notes have not been signed in a timely fashion. An SQL interface has been in VistA for a long time, DSS’s enhancements include a graphical interface, a hook for Jaspersoft, which is an open source business intelligence tool, and a real-time search tool that spiders through text data throughout all elements of a patient’s chart and brings to the surface conditions that might otherwise be overlooked.

MedSphere and DSS also joined the historical OSEHRA effort to unify the code base across all VistA offerings, from both Veterans Affairs and commercial vendors. MedSphere has added major contributions to Fileman, a central part of VistA. DSS has contributed all its VistA changes to OSEHRA, including the search tool mentioned earlier.

OpenMRS contributor Suranga Kasthurirathne told me that an OpenMRS module exposes its data to DHIS 2, an open source analytics tool supporting visualizations and other powerful features.

I would suggest to the developers of open source health tools that they increase their emphasis on the information tools that industry observers predict are going to be central to healthcare. An open architecture can make it easy to solicit community contributions, and the advances made in these areas can be selling points along with the low cost and easy customizability of the software.

A Little Digital Health Conference (#DHC14) Twitter Roundup

Posted on November 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’m at the Digital Health Conference in NYC and the Twitter stream has been going strong (search #dhc14 on Twitter to see what I mean). Sometimes I forget how much more satisfying a conference is when there’s an active Twitter stream. It enhances a conference for me in so many ways. I thought it would be fun to point out a few of the tweets that struck me today (and there were a lot to choose from).


I do think New York has made a lot of progress with their HIE. Pretty amazing that they got $30 million of state funding for it. Do you know of other states that are making good progress on their state HIE?


Topol’s comment about cigarettes is interesting. I had to throw in the CVS reference. Right now it doesn’t seem that crazy, but I wonder if 10 years from now it will be just as crazy as Cleveland Clinic giving out cigarette pack holders.


I love imagery and this is great imagery that could inspire a lot of people. What I don’t think many tech people realize is that they’re going to need to work collaboratively with scientists, chemists and doctors to do surveillance on the blood stream. Talk about an area that needs multidisciplinary efforts.


The common error that we compare the new way against perfection as opposed to comparing the new way against the alternative (or the previous model). I’ve been seeing this problem come up over and over in healthcare IT.

Mobile EHR Use

Posted on November 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.

One of the most fascinating sessions I attended recently was by Mihai Fonoage talking about the “Future of Mobile” at EMA Nation (Modernizing Medicine’s EHR user conference where I was keynote). At the start of the presentation, Mihai provided a bunch of really interesting data points about the EMA EHR use on mobiles:

  • 3,500,000 Screens Viewed Daily
  • 50,000 New Visits Each Day
  • 35,000 Photos Taken Daily
  • 12,000 New Consents Each Day
  • 8,000 Rx Prescribed Daily

The most shocking number there is the 35,000 photos taken daily. That’s a lot of photos being stored in the EHR. It is worth noting that Modernizing Medicine has a huge footprint in dermatology where photos are very common and useful. Even so, that’s a lot of photos being taken and inputted into an EHR.

The other stats are nearly as astounding when you think that Modernizing Medicine is only in a small set of specialities. 3.5 million screens (similar to pageviews on a website) viewed daily is a lot of mobile EHR use. In fact, I asked Modernizing Medicine what percentage of their users used their desktop client and what percentage used their iPad interface. Modernizing Medicine estimated that 80% of their EHR use is on iPads. This is a hard number to verify, but I can’t tell you the number of people at EMA Nation I saw pull out their iPads and log into their EMA EHR during the user conference. You could tell that the EMA iPad app was their native screen.

I still remember when I first saw the ClearPractice iPad EHR called Nimble in 2010. It was the first time I’d seen someone really make a deep effort to do an EHR on the iPad. DrChrono has always made a big iPad EHR effort as well. I’d love to see how their iPad EHR use compares to the Modernizing Medicine EMA EHR numbers above. Can any other EHR vendor get even close to 80% EHR use on an iPad application or any of the numbers above?

I’d love to hear what you’re seeing and experiencing with EHR iPad and other mobile EHR use. Is Modernizing Medicine leading the pack here or are their other EHR competitors that are seeing similar adoption patterns with their mobile EHR product lines?

Full Disclosure: Modernizing Medicine is an advertiser on this site.