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Health IT Gets Into the ALS Ice Bucket Challenge

The ALS ice bucket challenge has finally made its way to heatlhcare IT companies. I’m sure at some point I’ll get tired of seeing these videos, but it hasn’t happened yet. There’s something really enjoyable about watching someone get a bucket of ice water dumped on them. Especially people you wouldn’t expect to do it.

Here are two of the latest Health IT people to take part in the challenge.

Neal Patterson, CEO of Cerner accepts the ALS Ice Bucket Challenge

Neal challenges John Glaser, CEO of Siemens Health Services, and he accepted

John Glaser has nominated the whole Simens Health Services employees to take the challenge. So, there are more videos to come. What could bring a company together more than all dumping a bucket of ice on each other?

What an amazing effort for ALS too. The ALS site just noted that donations have reached $53 million. I want to see Judy Faulkner take part.

August 22, 2014 I Written By

John Lynn is the Founder of the 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 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: and, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Digital Health: How to Make Every Clinician the Smartest in the Room

The following is a guest blog post by Dr. Mike Zalis, practicing MGH Radiologist and co-founder of QPID Health.
Zalis Headshot
Remember the “World Wide Web” before search engines? Less than two decades ago, you had to know exactly what you were looking for and where it was located in order to access information. There was no Google—no search engine that would find the needle in the haystack for you. Curated directories of URLs were a start, but very quickly failed to keep up with the explosion in growth of the Web. Now our expectation is that we will be led down the path of discovery by simply entering what’s on our mind into a search box. Ill-formed, half-baked questions quickly crystalize into a line of intelligent inquiry. Technology assists us by bringing the experience of others right to our screens.

Like the Internet, EHRs are a much-needed Web of information whose time has come. For a long time, experts preached the need to migrate from a paper-based documentation systems – aka old school charts—to electronic records. Hats off to the innovators and the federal government who’ve made this migration a reality. We’ve officially arrived: the age of electronic records is here. A recent report in Health Affairs showed that 58.9% of hospital have now adopted either a basic or comprehensive EHR—this is a four-fold increase since 2010 and the number of adoptions is still growing. So, EHRs are here to stay. Now, we’re now left to answer the question of what’s next? How can we make this data usable in a timely, efficient way?

My career as a radiologist spanned a similar, prior infrastructure change and has provided perspective on what many practitioners need—what I need—to make the move to an all-electronic patient record most useful: the ability to quickly get my hands on the patient’s current status and relevant past history at the point-of-care and apply this intelligence to make the best decision possible. In addition to their transactional functions (e.g., order creation), EHRs are terrific repositories of information and they’ve created the means but not the end. But today’s EHRs are just that—repositories. They’re designed for storage, not discovery.

20 years ago, we radiologists went through a similar transition of infrastructure in the move to the PACS systems that now form the core of all modern medical imaging. Initially, these highly engineered systems attempted to replicate the storage, display, and annotation functions that radiologists had until then performed on film. Initially, they were clunky and in many ways, inefficient to use. And it wasn’t until several years after that initial digital transition that technological improvements yielded the value-adding capabilities that have since dramatically improved capability, efficiency, and value of imaging services.

Something similar is happening to clinicians practicing in the age of EHRs. Publications from NEJM through InformationWeek have covered the issues of lack of usability, and increased administrative burden. The next frontier in Digital Health is for systems to find and deliver what you didn’t even know you were looking for. Systems that allow doctors to merge clinical experience with the technology, which is tireless and leaves no stone unturned. Further, technology that lets the less-experienced clinician benefit from the know-how of the more experienced.

To me, Digital Health means making every clinician the smartest in the room. It’s filtering the right information—organized fluidly according to the clinical concepts and complex guidelines that organize best practice—to empower clinicians to best serve our patients. Further, when Digital Health matures, the technology won’t make us think less—it allows us to think more, by thinking alongside us. For the foreseeable future, human experience, intuition and judgment will remain pillars of excellent clinical practice. Digital tools that permit us to exercise those uniquely human capabilities more effectively and efficiently are key to delivering a financially sustainable, high quality care at scale.

At MGH, our team of clinical and software experts took it upon ourselves some 7 years ago to make our EHR more useful in the clinical trench. The first application we launched reduced utilization of radiology studies by making clinicians aware of prior exams. Saving time and money for the system and avoiding unnecessary exposure for patients. Our solution also permitted a novel, powerful search across the entirety of a patient’s electronic health record and this capability “went viral”—starting in MGH, the application moved across departments and divisions of the hospital. Basic EHR search is a commodity, and our system has evolved well beyond its early capabilities to become an intelligent concept service platform, empowering workflow improvements all across a health care enterprise.

Now, when my colleagues move to other hospitals, they speak to how impossible it is to practice medicine without EHR intelligence—like suddenly being forced to navigate the Internet without Google again. Today at QPID Health, we are pushing the envelope to make it easy to find the Little Data about the patient that is essential to good care. Helping clinicians work smarter, not harder.

The reason I chose to become a physician was to help solve problems and deliver quality care—it’s immensely gratifying to contribute to a solution that allows physicians to do just that.

Dr. Mike Zalis is Co-founder and Chief Medical Officer of QPID Health, an associate professor at Harvard Medical School, and a board certified Radiologist serving part-time at Massachusetts General Hospital in Interventional Radiology. Mike’s deep knowledge of what clinicians need to practice most effectively and his ability to translate those needs into software solutions inform QPID’s development efforts. QPID software uses a scalable cloud-based architecture and leverages advanced concept-based natural language processing to extract patient insights from data stored in EHRs. QPID’s applciations support decision making at the point of care as well as population health and revenue cycle needs.

August 21, 2014 I Written By

An Image Worth 1000 Words Offers a Great Healthcare Perspective

I have no idea where this picture comes from, but it’s a pretty interesting look into some of the history of medicine. As @notasmedicina points out, it’s pretty disturbing to see them working on someone without gloves. Take a look below to see what I mean.

As I saw this, I thought about how far we’ve come with EHR software. I wonder if 20-30 years from now we’ll look at a picture of a paper chart and feel disturbed. I imagine my children will look at it and wonder how a doctor could practice medicine with a paper chart.

August 20, 2014 I Written By

John Lynn is the Founder of the 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 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: and, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Could Population Health Be Considered Discrimination?

Long time reader of my site, Lou Galterio with the SunCoast RHIO, sent me a really great email with a fascinating question:

Are only the big hospitals who can afford the very expensive analytics pop health programs going to be allowed to play because only they can afford to and what does that do to the small hospital and clinic market?

I think this is a really challenging question. Let’s assume for a moment that population health programs are indeed a great way to improve the healthcare we provide a patient and also are an effective way to lower the cost of healthcare. Unfortunately, Lou is right that many of these population health programs require a big investment in technology and processes to make them a reality. Does that mean that as these population health programs progress, that by their nature these programs discriminate against the smaller hospitals who don’t have the money to invest in such programs?

I think the simple answer is that it depends. We’re quickly moving to a reimbursement model (ACOs) which I consider to be a form of population health management. Depending on how those programs evolve it could make it almost impossible for the small hospital or small practice to survive. Although, the laws could take this into account and make room for the smaller hospitals. Plus, most smaller hospitals and healthcare organizations can see this coming and realize that they need to align themselves to survive.

The other side of the discrimination coin comes when you start talking about the patient populations that organizations want to include as one of their “covered lives.” When the government talks about population health, they mean the entire population. When you start paying organizations based on the health of their patient population, it changes the dynamic of who you want to include in your patient population. Another possible opportunity for discrimination.

Certainly there are ways to avoid this discrimination. However, if we’re not thoughtful in our approach to how we design these population health and ACO programs, we could run into these problems. The first step is to realize the potential issues. Now, hopefully we can think about them going forward.

August 19, 2014 I Written By

John Lynn is the Founder of the 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 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: and, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Hospital M&A Cost Boosted Significantly By Health IT Integration

Most of the time, hospital M&A is sold as an exercise in saving money by reducing overhead and leveraging shared strengths. But new data from PricewaterhouseCoopers suggests that IT integration costs can undercut that goal substantially. (It also makes one wonder how ACOs can afford to merge their health IT infrastructure well enough to share risk, but that’s a story for another day.)

In any event, the cost of integrating the IT systems of hospitals that merge can add up to 2% to the annual operating costs of the facilities during the integration period, according to PricewaterhouseCoopers. That figure, which comes to $70,000 to $100,000 per bed over three to five years, is enough to reduce or even completely negate benefits of doing some deals. And it clearly forces merging hospitals to think through their respective IT strategies far more thoroughly than they might anticipated.

As if that stat isn’t bad enough, other experts feel that PwC is understating the case. According to Dwayne Gunter, president of Parallon Technology Solutions — who spoke to Hospitals & Health Networks magazine — IT integration costs can be much higher than those predicted by PwC’s estimate. “I think 2% being very generous,” Gunter told the magazine, “For example, if the purchased hospital’s IT infrastructure is in bad shape, the expense of replacing it will raise costs significantly.”

Of course, hospitals have always struggled to integrate systems when they merge, but as PwC research notes, there’s a lot more integrate these days, including not only core clinical and business operating systems but also EMRs, population health management tools and data analytics. (Given be extremely shaky state of cybersecurity in hospitals these days, merging partners had best feel out each others’ security systems very thoroughly as well, which obviously adds additional expenses.) And what if the merging hospitals use different enterprise EMR systems? Do you rip and replace, integrate and pray, or do some mix of the above?

On top of all that, working hospital systems have to make sure they have enough IT staffers available, or can contract with enough, to do a good job of the integration process. Given that in many hospitals, IT leaders barely have enough staff members to get the minimum done, the merger partners are likely costly consultants if they want to finish the process for the next millennium.

My best guess is that many mergers have failed to take this massive expense into account. The aftermath has got to be pretty ugly.

August 18, 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 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 @annezieger on Twitter.

HealthTap Offerings Track the Evolution of Health Care

Health care evolves more quickly in the minds of the most visionary reformers than in real health care practices. But we are definitely entering on a new age:

  • Patients (or consumers, or whatever you want to call them–no good term has yet been developed for all of us regular people who want better lives) will make more of their own decisions and participate in health care.
  • Behavior change will be driven by immediate interventions into everyday life, and health care advice will be available instantly on demand instead of waiting for an annual visit to the doctor. Health care will be an integrated into life activities, not a distinct activity performed by a professional on a passive recipient.
  • Patient information will no longer be fragmented among the various health care providers with whom the patient comes in contact, but will be centralized with the patients themselves, integrated and able to support intelligent decision-making.
  • Mobile devices will be intimately entwined with daily behavior, able to provide instant feedback and nudges toward healthy alternatives.

I have seen this evolution in action over several years at HealthTap, a fascinating company that ties together more than 10 million patients a month and more than 62,000 doctors. I interviewed the charismatic founder, Ron Gutman, back in 2011 before they had even opened their virtual doors. At that time, I felt intrigued but considered them just a kind of social network tying together doctors and patients.

Gutman’s goals for health care were far greater than this, however, and he has resolutely added ratings, analytics, and other features to his service over the years. Most recently, HealthTap has moved from what I consider a social network to a health maintenance tool with continuous intervention into daily life–a tool that puts public health and patient empowerment at the top of its priorities. And it may go even farther–moving from seeking help on illness to promoting health, which Gutman describes simply and winningly as “feeling good.”

The center of the offering is a personal health record. Plenty of other organizations offer this, most famously Apple’s HealthKit. HealthTap’s personal health record is unique in supporting the service’s search feature, where patients can search for advice and get results tailored specifically to their age, medical conditions, etc.–not just the generic results one gets from a search engine. It also ties into HealthTap’s new services, including real time virtual consults with doctors.

Sample update from HealthTap

Gutman is by no means interested in maintaining a walled garden for his users; he is looking for ways to integrate with other offerings such as HealthKit and with the electronic health records used by health providers. He says, “The only entity that will win the game is the one that adds the most value to the user.”

Other new features tied in to the HealthTap services include:

  • A recommendation system for apps that can improve health and well-being. The apps are rated by the doctors within the HealthTap system, must be in Apple App Store or Google Play, and must be approved by the FDA (unless they are part of the large, new category of apps that the FDA has chosen not to regulate).
  • Off-the-shelf checklists to help patients manage medication, keep track of healthy behaviors, etc. As part of HealthTap Prime, a concierge service ($99 per year for the first person and $10 for each additional family member), the user can get personalized checklists from doctors, as well.
  • With the concierge service, subscribers also have the opportunity to directly contact a doctor any time, 24/7, on all popular mobile platforms, using live video, voice, and text.
  • The “Get Help” module in the HealthTap app provides useful checklists through all mobile devices, and even Android wearables. Patients can get reminders, useful links to relevant content, and other content pushed to their devices, at a pace they choose.

Some of these features–such as the recommended apps and personalized checklists–go beyond advice and constitute a type of treatment that is subject to legal liability. HealthTap has covered all its bases insuring doctors have insurance against mistakes.

The numbers show that HealthTap is a big community; comments received from Gutman about patients who say they’ve saved their lives show that it is an effective one. I think the choices they’ve made are insightful and illustrate the changes all health care institutions will have to make in order to stay relevant in the twenty-first century.

August 15, 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 ( 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.

Interview with Gil Vidals, CEO of VM Racks

The following is an interview with Gil Vidals, CEO of VM Racks.
Gil Vidals
Tell us about VM Racks. How did you get started in the hosting business?
We started consumer hosting in 1997. This was simply vanilla hosting with nothing special. As the competition heated up, it became apparent that competing based on price alone was a formula for razor-thin margins, if any profit at all. Instead, finding a bonafide niche with a growing demand seemed like a better path. VM Racks was born to serve such a niche. Taking the hosting experience of over a decade and retooling that towards secure cloud hosting for companies that require HIPAA Compliant hosting was a better business model.

Why did you choose to focus so much effort on HIPAA Compliant hosting?
Cloud hosting is a very competitive market space. Competing on price alone won’t get you anywhere. Instead, VM Racks focuses on providing secure HIPAA Compliant hosting at an affordable price and we win customers with our amazing technical support. We answer the phone when clients call, we include support at no additional cost in all of our plans and we do this at an affordable price. HIPAA clients tell us how important it is to have a higher level of service and we deliver on that with our products and service.

What are some unique things you do to ensure HIPAA Compliant hosting that many other hosting providers don’t?
Typically, HIPAA hosting providers do not offer or sign a Business Associate Agreement (BAA) with their customers because they don’t want to be held liable in case there is a security breach; VM Racks offers and signs BAAs with all of our HIPAA clients. Amongst the competition, VM Racks also has a competitive edge as we offer HIPAA Compliant Hosting services to government agencies from the City, all the way up to the Federal level.

Beyond price, what other things should people consider when looking for a HIPAA Compliant Hosting Provider?
Unfortunately, the marketplace is looking for HIPAA Compliant hosting providers that are accredited as such. Since there is no governing body that issues accreditation, it isn’t possible to provide a certificate that officially signifies that we are a bonafide HIPAA host. This can be confusing to those looking for a legitimate solution. Instead of trying to find a “certified” HIPAA Compliant Hosting Provider (as there is no governing body that issues such an accreditation), those in need of HIPAA Compliant Hosting should look for a company that is responsive and will fulfill their obligations for the sake of security and well-being of the information to be protected. Such methodologies used for this process include (but not limited to): offsite backups, two-factor authentication, log management, vulnerability assessment scanning, web application firewalls (WAF), anti-DDoS protection, network perimeter firewalls, and multi-tenant isolation. In addition, HIPAA organizations should also ensure that their hosting provider maintains the following audits and certifications: SSAE 16 SOC 1 Type 2, SOC 2 Type 2, and SOC 3 Type 2.

Is VM Racks a better solution for smaller healthcare IT startup companies, mid-sized companies or large enterprise hosting solutions?
VM Racks is the hosting company-of-choice for both commercial startup customers as well as multi-level, high-dollar government agencies. For a healthcare startup, our $199/month HIPAA plan is the best in the industry. This pricing model allows new healthcare businesses, who don’t have a huge initial infrastructure investment and are still concerned about being HIPAA compliant, to quickly get off the ground at a reasonable price.

As a leading provider of HIPAA hosting for the Affordable Care Act, we are experienced in Federal, State, and Local hosting solutions. Our government and large enterprise hosting customers are typically looking for well-designed and constructed virtualization solutions.

Why should an organization consider going with a HIPAA Compliant Hosting solution as opposed to “in-house” hosting?
Hosting in-house is generally suited for enterprise-level organizations that already own/lease space from an existing data center. Building cutting edge servers is expensive. From a strategic perspective, it’s usually better for a business to invest in their core competencies and lease the IT infrastructure. We provide the infrastructure they need in the cloud and allow organizations the flexibility to add or remove resources on demand.

What new things are happening with hosting, servers, and data centers that we should keep an eye on?
Virtualization is no longer a “new” technology or unknown territory. It has been vetted and widely accepted for quite some time now. This process has become more readily available with ease-of-use by way of managed services allowing these virtual resources to be quickly adapted and molded to conform to each and every customer. We continue to focus on providing our customers with the latest in cloud infrastructure technology to transform the capabilities of doing business in a virtualized environment.

August 14, 2014 I Written By

John Lynn is the Founder of the 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 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: and, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Could Clinicians Create Better HIE Tools?

The following is a guest blog post by Andy Oram.His post reminds me of when I asked “Is Full Healthcare Interoperability a Pipe Dream?

A tense and flustered discussion took place on Monday, August 11 during a routine meeting of the HIT Standards Committee Implementation Workgroup, a subcommittee set up by the Office of the National Coordinator (ONC), which takes responsibility for U.S. government efforts to support new IT initiatives in the health care field. The subject of their uncomfortable phone call was the interoperability of electronic health records (EHRs), the leading issue of health IT. A number of “user experience” reports from the field revealed that the situation is not good.

We have to look at the depth of the problem before hoping to shed light on a solution.

An interoperability showcase literally takes the center of the major health IT conference each year, HIMSS. When I have attended, they physically arranged their sessions around a large pavilion filled with booths and computer screens. But the material on display at the showcase is not the whiz-bang features and glossy displays found at most IT coventions (those appear on the exhibition floor at HIMSS), but just demonstrations of document exchange among EHR vendors.

The hoopla over interoperability at HIMSS suggests its importance to the health care industry. The ability to share coordination of care documents is the focus of current government incentives (Meaningful Use), anchoring Stage 2 and destined to be even more important (if Meaningful Use lasts) in Stage 3.

And for good reason: every time we see a specialist, or our parent moves from a hospital to a rehab facility, or our doctor even moves to another practice (an event that recently threw my wife’s medical records into exasperating limbo), we need record exchange. If we ever expect to track epidemics better or run analytics that can lower health case costs, interoperability will matter even more.

But take a look at extensive testing done by a team for the Journal of the American Medical Informatics Association, recently summarized in a posting by health IT expert Brian Ahier. When they dug into the documents being exchanged, researchers found that many vendors inserted the wrong codes for diagnoses or drugs, placed results in the wrong fields (leaving them inaccessible to recipients), and failed to include relevant data. You don’t have to be an XML programmer or standards expert to get the gist from a list of sample errors included with the study.

And that list covers only the problems found in the 19 organizations who showed enough politeness and concern for the public interest to submit samples–what about the many who ignored the researchers’ request?

A slightly different list of complaints came up at the HIT Standards Committee Implementation Workgroup meeting, although along similar lines. The participants in the call were concerned with errors, but also pointed out the woeful inadequacy of the EHR implementations in representing the complexities and variety of patient care. Some called for changes I find of questionable ethics (such as the ability to exclude certain information from the data exchange while leaving it in the doctor’s records) and complained that the documents exchanged were not easy for patients to read, a goal that was not part of the original requirements.

However, it’s worth pointing out that documents exchange would fall far short of true coordinated care, even if everything worked as the standards called for. Continuity of care documents, the most common format in current health information exchange, have only a superficial sliver of diagnoses, treatments, and other immediate concerns, but do not have space for patient histories. Data that patients can now collect, either through fitness devices or self-reporting, has no place to be recorded. This is why many health reformers call for adopting an entire new standard, FHIR, a suggestion recognized by the ONC as valid but postponed indefinitely because it’s such a big change. The failure to adopt current formats seems to become the justification for keeping on the same path.

Let’s take a step back. After all those standards, all those certifications, all those interoperability showcases, why does document exchange still fail?

The JAMIA article indicated that failure can be widely spread around. There are rarely villains in health care, only people pursuing business as usual when that is insufficient. Thus:

  • The Consolidated CDA standard itself could have been more precisely defined, indicating what to do for instance when values are missing from the record.

  • Certification tests can look deeper into documents, testing for instance that codes are recorded correctly. Although I don’t know why the interoperability showcase results don’t translate into real-world success, I would find it quite believable that vendors might focus on superficial goals (such as using the Direct protocols to exchange data) without determining whether that data is actually usable.

  • Meaningful Use requirements (already hundreds of pages long) could specify more details. One caller in the HIT Standards Committee session mentioned medication reconciliation as one such area.

The HIT Standards Committee agonized over whether to pursue broad goals, necessarily at a slow pace, or to seek a few achievable improvements in the process right away. In either case, what we have to look forward to is more meetings of committees, longer and more mind-numbing documents, heavier and heavier tests–infrastructure galore.

Meanwhile, the structure facilitating all this bureaucracy is crumbling. Many criticisms of Meaningful Use Stage 2 have been publicly aired–some during the HIT Standards Committee call–and Stage 3 now looks like a faint hope. Some journalists predict a doctor’s revolt. Instead of continuing on a path hated by everybody, including the people laying it out, maybe we need a new approach.

Software developers over the past couple decades have adopted a range of ways to involve the users of software in its design. Sometimes called agile or lean methodologies, these strategies roll out prototypes and even production systems for realistic testing. The strategies call for a whole retooling of the software development process, a change that would not come easily to slow-moving proprietary companies such as those dominating the EHR industry. But how would agile programming look in health care?

Instead of bringing a doctor in from time to time to explain what a clinical workflow looks like or to approve the screens put up by a product, clinicians would be actively designing the screens and the transitions between them as they work. They would discover what needs to be in front of a resident’s eyes as she enters the intensive care ward and what needs to be conveyed to the nurses’ station when an alarm goes off sixty feet away.

Clinicians can ensure that the information transferred is complete and holds value. They would not tolerate, as the products tested by the JAMIA team do, a document that reports a medication without including its dose, timing, and route of administration.

Not being software experts (for the most part), doctors can’t be expected to anticipate all problems, such as changes of data versions. They still need to work closely with standards experts and programmers.

It also should be mentioned that agile methods include rigorous testing, sometimes to the extent that programmers write tests before writing the code they are testing. So the process is by no means lax about programming errors and patient safety.

Finally, modern software teams maintain databases–often open to the users and even the general public–of reported errors. The health care field needs this kind of transparency. Clinicians need to be warned of possible problems with a software module.

What we’re talking about here is a design that creates a product intimately congruent with each site’s needs and workflow. The software is not imported into a clinical environment–much less imposed on one–but grows organically from it, as early developers of the VistA software at the Veterans Administration claimed to have done. Problems with document exchange would be caught immediately during such a process, and the programmers would work out a common format cooperatively–because that’s what the clinicians want them to do.

August 13, 2014 I Written By

4 Health IT and EHR Blogs

As I’ve been putting together these blog posts about other Health IT and EHR bloggers, I’ve been astounded how many former bloggers have stopped blogging. I guess I was write to post one of my first blogger features as “EHR Blogger Attrition.” I imagine many previous bloggers are still sharing content, but have likely moved to other social media which is much easier to sustain. A tweet can be generated much more quickly than a blog post.

With that in mind, I feel grateful that I’m still able to blog and that enough people come and read my blog posts that I can provide for my family with my blogging. While some might define my blogging as micro blogging, I think there’s more value in a blog post than a tweet. You don’t have to dig into subjects in a tweet. People don’t go looking through your old tweets like they do blog posts.

Those musings aside, here are some other Health IT and EHR bloggers you might find interesting:
Health Blawg – David Harlow has a fascinating blog covering many of the various healthcare regulations that encumber our lives. Many lawyers are afraid to blog, but David has overcome that fear and created regular healthcare content that’s well worth following.

The Health Care Blog – While this blog isn’t exclusively health IT, a large portion o the topics are Health IT related. This blog never ceases to amaze me at the number of people they have contributing quality content to their site. It doesn’t have one voice, and that’s what makes the site so great. You might read a post about healthcare analytics and then one on value based contracts. Plus, it has one of the most active communities for comments. In fact, I often find myself more interested in the comments than the post itself.

Phil Baumann – While Phil is an RN by training, he’s more of a healthcare communicator and marketer than anything. Phil’s been doing this long enough that he doesn’t pull any punches. He just says it the way it is and isn’t afraid of saying things others aren’t comfortable saying. That makes for a good blog.

Galen Healthcare Solutions – I always like to feature at least one health IT company that’s creating great blog content. Galen Healthcare Solutions is definitely one of the best out there and they’ve been doing it consistently for a long time. Looks like their first blog post was in July 2008. I’m not sure who’s behind their consistency, but they deserve a lot of credit for the work they’ve done. It’s a great blog.

August 12, 2014 I Written By

John Lynn is the Founder of the 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 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: and, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Population Health Polls

I was thinking about population health today. It’s become a hot topic of discussion now that a lot more healthcare data is available for population health management thanks to EHR adoption. Although, in many ways, the various value based reimbursement and ACO programs are a form of population health. I guess, for me I classify all of these efforts to improve the health of a population as population health.

I just wonder how many organizations are really working on these types of solutions and how much of the population health is just talk. Let’s find out in the poll below.

I’ll be interested to hear how organizations are approaching population health. Also, let’s do another poll to see how much people will be working on population health in the future.

I’d love to hear more details to your responses in the comments. If you are working on population health, what programs are you doing and what IT solutions are you using to support it?

August 11, 2014 I Written By

John Lynn is the Founder of the 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 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: and, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.