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EHR: What’s Next?

Posted on September 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.

I realize this is a simple concept with a million answers. In fact, that’s why I’m posting about it and hopefully starting a rich discussion. A huge portion of the healthcare system has adopted EHR software. I now ask the question:

What’s Next?

I know that some of you reading this will reply meaningful use. Ok. We get that. We know what meaningful use requires. Let’s get beyond meaningful use and talk about what you’re doing with your EHR.

I’m really starting this as a conversation starter. Hopefully you can break it down into two areas:

1. What are you doing with your EHR to optimize your use of your EHR?

2. Now that you have an EHR, what are you going to do next? What are you working on next?

I look forward to hearing your thoughts and answers. Hopefully we’ll get a broad cross section of responses from small practices, hospitals, vendors, etc. I’ll join in the comments as well.

10 Health IT Rockstars and Their #NHITWeek Happenings

Posted on September 18, 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.

It’s National Health IT Week and so I thought it would be fun to take a quick look at what some health IT social media rockstars are doing to celebrate #NHITWeek.

Mandi Bishop (@mandibpro) is sorting through her petabytes of #HITHeroes selfies and creating a t-shirt that says “I Heart Big Data.”

Farzad Mostashari, MD (@Farzad_MD) is sending out bow ties to prospects for his new company Aledade.

Charles Wesbter, MD (@wareflo) is programming his Google Glass controlled robot to improve EHR workflow.

Wen Dombrowski, MD (@healthcarewen) is practicing to break the World Record for most tweets sent during a conference session.

Gregg Masters (@2healthguru) is reading the latest Flex-IT act and Final Rule on meaningful use flexibility from his surfboard in the ocean.

Cari McLean (@carimclean) and Michael Gaspar (@MichaelGaspar) are fighting over which Health IT meme is more likely to go viral.

Geeta Nayyar, MD (@gnayyar) is making medicine fun and meaningful.

Regina Holliday (@ReginaHolliday) is painting a Walking Gallery jacket for a statue dedicated to the patient that will be put in the CMS lobby in Washington.

Matthew Holt (@boltyboy) is creating a new conference dedicated to Health IT buzzwords. Sessions include #HealthAnalytics, #HealthcareSocialMedia, #ACOs, #PatientEngagement, #HIE, and many more.

Keith Boone (@motorcycle_guy) is doing an HL7 crossword puzzle.

What are you doing for National Health IT week? Feel free to add what other people are doing for #NHITWeek as well. Bonus points if you write what I’m doing for #NHITWeek.

Rise of the Digital Patient Infographic

Posted on September 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.

The social people behind CDW Healthcare are doing a good job putting out some great content on social media. A great example of this is this Digital Patient Infographic that they recently posted:
mHealth_DigitalPatient_Infographic_0914_1000

I recently took part in a webinar with Dodge Communications (I’ll add a link to the webinar once it’s available) yesterday and I made the comment that telemedicine is more efficient for the patient, but I wasn’t sure telemedicine was more efficient for the doctor. There might be a disconnect of benefits there that needs to be reconciled.

As I look at the infographic above, I’m reminded of something similar. The stats in the infographic and just some basic common sense says how much patients would love to do an eVisit. If this is the case, why is it that healthcare hasn’t filled this customer demand? I think the answer is the disconnect of benefits.

What are your thoughts?

Also, since CDW created the infographic above, It’s worth mentioning that CDW also listed this blog on their list of Top 50 Health IT blogs for 2014. I’m not sure I agree that it’s the top 50 health IT blogs since EMR and HIPAA and a number of other Healthcare Scene blogs aren’t on the list, but there are a lot of great bloggers on the list just the same.

#20HIT Comments on Health IT by HL7 Standards

Posted on September 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.

Many of you know that I’m extremely active on social media (see @techguy and @ehrandhit to start). I love the way it can connect people. It’s so powerful. One of the companies that’s done an amazing job with social media for their company is Corepoint Health and their HL7 Standards blog. The blog is most notable for being the home and birthplace of the #HITsm chat. If you haven’t participated in an #HITsm chat, then you’re missing out. Lots of great health IT discussions every Friday.

Along with being the home of the #HITsm chat, the HL7 Standards blog is a great place to find blog posts from voices throughout the #HITsm community. Plus, they recently started doing a series of “20 Questions for Health IT” with responses from a variety of health IT professional. Check out an example tweet and question that was answered by Mandi Bishop (better known as @MandiBPro):

I love the work their doing and I love hearing perspectives from across the industry. I’m going to think about ways I can do something like they’re doing to bring and amplify more of the interesting voices in healthcare IT. Nice work HL7 Standards.

What Are You Doing for #NHIT Week? Does It Matter?

Posted on September 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.

Today is the official start of National Healthcare IT Week (#NHITWeek). Do you have any plans for #NHITWeek? Are you doing anything special? I personally don’t have any huge plans, but I do have one post for #NHITWeek that I hope people will enjoy. Watch for that coming later this week on one of the Healthcare Scene blogs.

If you want a full run down of official #NHITWeek activities, EHR Intelligence has put that together. HIMSS seems to be the real driver behind the week from what I can tell. I’ve never been to Washington during #NHIT Week, so maybe that’s why I haven’t ever seen the impact of the week. I guess I’m skeptical about what it really accomplishes.

What I have enjoyed is following the #NHITWeek hashtag on Twitter. There’s a lot of activity on the hashtag. You just have to filter through the #NHITWeek fluff and marketing. From the looks of Regina Holliday’s tweet, there are quite a few people attending the event she’s attending:

Plus, you get to see other craziness like this QR code connected to Casey Quinlan’s health record that she had tattooed on her chest:

Not to mention, you get links to great resources like this one from Steve Sisko:

I think that Steve has the right spirit for what #NHITWeek is for me. It’s about connecting people in the space. It’s always great when we can share the work that’s being done across the spectrum of health IT. I’m always amazed at how many people are working so hard day in and day out to make healthcare IT work.

If I Were AHIMA and Wanted to Ensure ICD-10 Wasn’t Delayed Again

Posted on September 12, 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’ve been working on my schedule for the AHIMA conference happening at the end of the month (officially I think they call it the AHIMA Convention). As I’ve looked over the various meetings and topics that will be discussed, I’m once again faced with the ICD-10 discussion.

I’ll admit that the ICD-10 discussion feels a little bit like the movie Groundhog Day. A little reminder of the movie (man I need to rewatch it):

Much like Bill Murray, I think we’re entering the same ICD-10 cycle that we were in last year. People warning about the impending implementation of ICD-10. People talking about the need to train on ICD-10. The impact of ICD-10 on revenue, productivity, software, etc etc etc. If it feels like we’ve been through these topics before, it’s because we have.

I previously posted an important question, “What Would Make Us Not Delay ICD-10 in 2015?” Unfortunately, I think the answer to that question is that right now nothing has changed. All of the reasons that someone would want ICD-10 to go forward and all of the reasons that ICD-10 should be delayed are exactly the same. I’d love to hear from people that disagree with me. Although, so far people have only come up with the same reasons that were the same last year.

That doesn’t mean it’s a lost cause for organizations like AHIMA that really want ICD-10 to go forward. They could do something that would change the environment and help ensure that ICD-10 actually happens in 2015. (Note: When we’re talking about DC and congress, nothing is certain, but I think this strategy would change the discussion.)

If I were AHIMA and wanted to push forward the ICD-10 agenda, I’d leverage your passionate community and be sure that the story of ICD-10 was told far and wide. The goal would have to be to create the narrative that delaying ICD-10 would cause irreparable harm to healthcare and to millions of people.

I imagine a series of videos with HIM people telling their stories on the impact of ICD-10 delays. These stories aren’t hard to find. Just start by looking at the AHIMA LinkedIn thread about the 2014 ICD-10 delay. Then engage the AHIMA community in social media and provide them the tools to spread these videos, their own stories, and other pro ICD-10 messages far and wide. Don’t underestimate the power of storytelling.

Also, you have to change the conversation about the impact of ICD-10. Far too many proponents of ICD-10 just talk about how it’s going to impact them individually. These individual stories are powerful when creating a movement, but the people in Washington hear those stories all day every day. They don’t usually change decisions based on a few heartbreaking stories. So, you have to illustrate to those in Washington that the impact of another ICD-10 delay is going to cause some harm to the healthcare system. This is not an easy task.

A well organized effort by AHIMA and other organizations could really gather steam. Enough calls, messages, and letters into Congress and they have to take note. It’s a feature of the way their systems are done. Although, a few responses won’t work. It has to be a real grassroots wave of people talking about how delaying ICD-10 is going to cause major issues. The biggest challenge to this is that it was delayed this year and what was the impact?

Of course, the other option is to hire a lobbyist. They’re going to tell the same story, but in a much more direct way. If AHIMA and other ICD-10 proponents don’t work hard to change the narrative of ICD-10 through a lobbyist or a grass roots campaign, then I don’t see any reason why ICD-10 won’t be delayed again. The good part is that any effort to do this will likely be supported and amplified by organizations like CMS. The bad part is that other organizations like the AMA are fighting the opposite battle. However, being quiet means that the other side wins by default.

The Other Talk: EHRs and Advance Medical Directives

Posted on September 11, 2014 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

The Other Talk: EHRs and Advance Medical Directives

Most of us who have adult children can remember that awkward talk we had about life’s origins. We thought, whew, that’s done. Alas, there’s yet another talk. This time it’s with those adult children and it’s about you.

This one’s covered in Tim Prosch’s and AARP’s book, The Other Talk. The talk, or more accurately the process is how you want to spend the rest of your life.

The Other Talk

It’s about your money, where and how you’ll live and your medical preferences. It’s just as hard, if not harder, than the old talk because:

  • It’s hard to admit that you won’t be around forever and your independence may start to ebb away.
  • You don’t want to put your kids on the spot with difficult decisions.
  • Your children may be parents coping with their own problems. You don’t want to add to their burdens.
  • You’ve been a source of strength, often financial as well as emotional. That’s hard to give up.

Prosch and AARP want to make it easier on everyone to deal with these issues.

He covers many topics, but for those of us who live in the EHR world one is of significant importance: Medical directives.

Prosch explains directives and simply says you should give them to your doctor. Easier said, etc. Today, that means not only your PCP, but also making sure that hospitalists etc., know what you want. While the Meaningful Use program helps a bit. It’s still going to take some doing.

Medical Directives and EHRs

EHR MU1 recognizes directives’ importance requiring that they be accounted for:

More than 50% of all unique patients 65 years old or older admitted to the eligible hospital’s or CAH’s inpatient department have an indication of an advance directive status recorded.

This means that the EHR has to have the directives. However, MU 1 only goes halfway to what’s needed. It’s what the EHR does with directives that’s unsaid.

If the EHR treats a directive as a miscellaneous document, odds are it won’t be known, let alone followed when needed. To be used effectively, an EHR needs a specific place for directives and they should be readily available. For example, PracticeFusion recently added an advance directives function. That’s not always the case.

Practice Fusion: Advanced Medical Directives

Googling for Directives

To see how about twenty popular EHRs treat directives, I did a Google site search, on the term directive. I got hits for a directives function only from four EHRs:

  • Athenahealthcare
  • Cerner
  • Meditech
  • PracticeFusion

All the others, Allscripts, Amazing Charts, eClinicalWorks, eMDs, McKesson, etc., were no shows. Some listed the MU1 requirement, but didn’t show any particular implementation.

Directives: More Honored in the Breech

This quick Google search shows that the EHR industry, with a few exceptions, doesn’t treat directives with the care they deserve. It should also serve as a personal warning.

If you already have directives or do have that talk with your family, you’ll need to give the directives to your PCP. However, you should also give your family copies and ask them to go over them with your caregivers.

Some day, EHRs may handle medical directives with care, but that day is still far off. Until then, a bit of old school is advisable.

Are Limited Networks Necessary to Reduce Health Care Costs?

Posted on September 10, 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.

Among the dirty words most hated by health care consumers–such as “capitation” and “insufficient medical necessity”–a special anxiety infuses the term “out-of-network.” Everybody harbors the fear that the world-famous specialist who can provide a miracle cure for a rare disease he or she may unexpectedly suffer from will be unavailable due to insurance limitations. So it’s worth asking whether limited networks save money, and whether they improve or degrade health care.
Read more..

Purpose of EHR Incentive Program According to CMS

Posted on September 9, 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.

When I was reading through the EHR Certification flexibility final rule, I found a really interesting part of the rule (pg.49-50) that describes what CMS sees as the purpose of the HITECH act and all the money their spending on EHR software:

The entire overarching purpose of the EHR Incentive Program is to move providers towards advanced use of health IT to support reductions in cost, increased access, and improved outcomes for patients.

It’s been one of my pet peeves lately. People always come on this site or on social media and say “that goes against the purpose of the HITECH act.” I often would reply, “what is the purpose of the HITECH act?”

My problem with people’s comments about the purpose of all this spending on EHR software is that purpose changes depending on perspective. I’ve written before about the misalignment between “incentives” and “purpose.”

While I think the purpose for something changes based on whose perspective you’re talking about, I think it’s really important to know where CMS is coming from when it comes to the EHR incentive money and meaningful use. Now we know. They made it quite clear in the final rule.

How do you think the EHR incentive money is doing at achieving CMS’ purpose?

Top 5 Most Influential People in Healthcare

Posted on September 8, 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.

There are a whole bunch of top 10, top 50, and top 100 lists going around right now. It’s always interesting to browse through these lists. If you’re on the list, you love seeing your name or organization’s name in lights. When someone makes a list, you can almost always disagree with something on their list, which drives a good conversation.

As I was thinking about all these lists, I saw one that listed the 100 most influential people in healthcare. As I looked through the list, I didn’t really agree with the list. I knew where they were coming from, but everyone on their list was on a macro level. While those people have influence over the healthcare system as a whole, I think there are much bigger influences over the healthcare we receive.

Here’s my list of the top 5 most influential people in healthcare:

  1. The Patient
  2. The Parent of a Child
  3. The Caregiver for a Senior
  4. The Spouse of the Patient
  5. The Patient Advocate

That’s right. The patient and the people who care about and advocate for that patient are the most influential and powerful people when it comes to the healthcare you receive. There is literally nothing more powerful in healthcare than this.

This applies to patients getting care from the existing healthcare system, but also applies to the broader terms of health and wellness. Nothing is more powerful than a patient that cares about their health and wellness. The only thing that comes close is a loved one who cares about that patient. It’s a powerful force and one that we haven’t leveraged enough in healthcare.

Sure. The big names in healthcare that make huge sums of money in high profile roles have an impact on the overall state of healthcare. However, even they aren’t stronger than an empowered patient.