Welcome to EMR and EHR

I’m preparing for my time at the HIMSS conference. I can tell that the conference is going to be incredibly busy. Plus, I don’t want to over schedule my time since I want to make sure I spend plenty of time discovering new things and smaller companies that are doing really interesting things. Specially related to EMR is best, but even the technologies that make EMR better are great too.

Well, I got an email from HIMSS about one of the keynote speakers. When I looked at the subject line I read “Blumenthal HIMSS Address Should Prove Meaningless.” At first I didn’t realize the email was from HIMSS. I then came to the email again and realized that I’d misread it. The email actually said, “Blumenthal HIMSS Address Should Prove Meanignful.”

Well, I couldn’t help the irony of the misread. Blumenthal has a chance on a pretty large stage to make some important statements. I am interested to hear what he says. I have a philosophy to listen to smart people when they talk. That’s why I loved the chance to hear Marc Probst (HIT Policy Committee and CIO of IHC) and that’s why I plan to listen to Blumenthal. In many respects, Blumenthal holds the keys to billions of dollars in EMR stimulus money. Let’s hope he will provide something meaningful, but I’m not holding my breathe.

As a side note, I’ll be covering my time at HIMSS on this site and on EMR and HIPAA. I’m also hosting a couple meetups at HIMSS which I’ll be announcing tomorrow or the next day.

One of my readers sent me an interesting comment about Physician interest in the EMR stimulus:

Personally, I was under the impression that most physicians really didn’t take the time to read such things [like this post about harmful consequences of the Government's EHR stimulus]…that they’d rather be thumbing through Golfer’s Digest or Conde Nast’s Traveler. It’s become quite clear that, when something comes along such as a government program like this that can affect their bottom-line, ears perk up and attention is paid. Now, if only more would speak up and voice their opinions to HHS…

I’ve started to see a bit of a turn myself on this site and EMR and HIPAA by physicians who aren’t too happy with the EMR stimulus. They’re starting to voice their concerns more and more. Some of them are a bit uninformed. For example, they want a “cost effective product that works” and then they ask why the VA system can’t be expanded for civilian use. I’ve talked a lot before about why the VA system has challenges, especially in ambulatory EMR. However, by starting the conversation about EMR, they’ll learn things like this.

I have a feeling that the lasting legacy of the EMR stimulus will be the increased awareness and interest in EMR. Maybe the government should never spend the $18 billion of EMR stimulus money since they’ve already gotten the desired effect of increasing interest in EMR. If after this much increased interest doctors still don’t want to implement an EMR, then maybe we shouldn’t pay them [force them] to do it.

One of my regular readers and commenters, DKBerry, sent me some extracts on an article by Modern Healthcare about HITSP. DKBerry also commented, “HITSP is still operational through 30 April. Despite the extension question to its future is going to hurt its mission IMO.” I think HITSP does face a very uncertain future. Here are the excerpts from the article:

“It appears the Healthcare Information Technology Standards Panel, or HITSP, has become yet another organization formed at the behest of the Bush administration that is being forced to reapply for its job under the federal government’s new heath IT authority.”

…
“That contract was set to expire Jan. 31, but HHS issued a “no-cost extension” to the contract through April 30, according to HITSP Chairman John Halamka, a physician who is chief information officer at 621-bed Beth Israel Deaconess Medical Center and at Harvard Medical School, Boston.”

…

“Halamka said the HHS contract extension through April will enable HITSP “to have a presence at the upcoming HIMSS conference (scheduled to run March 1-4 in Atlanta) and support the quality reporting activities being demonstrated in the Interoperability Showcase there.”

In addition, HITSP will host “informational conference calls” over the next few months and its Foundations Harmonization Subcommittee set a schedule of three meetings, the first being today at 10:30 a.m. ET, with two more Feb. 8 and Feb. 17 to wrap up its work.

“HITSP is not done; the lights are on,” said Liz Neiman, an ANSI spokeswoman. HITSP and healthcare IT interoperability are “a tremendous priority for ANSI,” Neiman said. “Absolutely, we’ll be going for any RFP that’s coming out. What’s really important for us is to keep the momentum going.”

I was reading an online forum today and was blown away by something someone said about meaningful use:

The “Meaningful Use” stages can only be met if the systems are easy to use and the data is accessible in a timely matter. This will mean that EHR/EMR systems will need in-depth analytical capabilities or the information accessible by Business Intelligence systems that understand healthcare.

Healthcare organizations that understand this will be able to tap into the upwards of millions of dollars set aside by the government in the stimulus package.

Ok, I can’t really knock the fact that EMR software needs to be easy to use. I think they probably meant to say that the EMR vendor needs to make it easy to enter the data required to show “meaningful use.” This seems like a given that every EMR vendor that wants their users to get EMR stimulus money should consider. Sadly, I think they’re likely to find this a VERY difficult task.

Although, what bothers me about this quote is the idea that you need some sort of in-depth analytical capabilities or some sort of BI (Business Intelligence) system to show meaningful use. Take a quick look at this simple meaningful use matrix or the list of 25 meaningful use objectives. Which of the criteria requires this in depth analysis and BI? None of them. At most they’re a pretty simple report.

Now I’m not saying that meeting the requirements of meaningful use is easy. However, the work around meaningful use is around the entry of the data and ensuring that you’re entering the data for all 25 meaningful use objectives. The hard part isn’t accessing the data once it’s in the EMR.

The hype over the new Apple iPad has been really interesting to watch. You can’t even buy one and everyone under the sun is speculating on how well the Apple iPad will do. Everything from it changing the netbook space to Grandma’s first computer being an iPad to the iPad as a gaming machine.

I’m certain that the iPad is going to be a huge gaming machine. The question I have is will the iPad be a game changer in the EMR world.

For those of you not living in the tech bubble that I live in, the iPad is most simply described as an iPhone with a much larger screen. Now I’m sure the purist out there might point out some other differences, but that’s kind of beside the point. The touch input method is the same as the iPhone and it also uses the cell towers to connect to the internet. It also runs the iPhone OS including all of the apps that have been created for the iPhone.

Back to the original question, will the iPad be a game changer for EMR. My prediction is that we really won’t see many iPad’s in healthcare much at all. Sure, there will be one here or there, but it won’t be widespread and we won’t see an “iPad EMR” that was designed to leverage the interface and technology of the iPad.

So, why would I even bring it up? Well, I don’t see the iPad EMR coming to fruition I do see the input technology that’s in the iPad and that will come out of the iPad having an effect on future input interfaces. Apple’s making a huge bet on touch interfaces with the iPad. the adpoption of touch interfaces and the technology that comes out of it is likely to have a huge influence on future EMR interfaces.

One of the biggest complaints doctors have about the various EMR systems is the challenge of inputting the data. Don’t be surprised if the future EMR input methods are heavily influenced by the introduction of the iPad and the technologies that develop around it.

SRSsoft, an EMR vendor, put out an interesting press release putting the lost democratic senate seat in Massachusetts with healthcare reform and EHR adoption. Here’s a quote from the press release:

“The question is not whether we need healthcare reform,” says Evan Steele, CEO, SRSsoft. “Rather, the voters voiced their concern that reform must benefit consumers and physicians, not just government, insurance companies, and vendors. This election must open the government to input from all stakeholders, and that is a good sign for the constituents of SRS—the physicians—who feel that their voice is not being heard on healthcare reform and on EHR adoption.”

Honestly, I don’t see the change in the Senate seat affecting EMR adoption at all. However, I think it will have a big impact on healthcare reform. I’ve said before that the healthcare reform has opened our eyes to the government processes in ways we’d never seen before. I think that the HITECH act has done much of the same for those of us interested in EMR legislation and rule making.

I just found this really nice interview by InformationWeek with David Blumenthal, Health IT Czar. Here are a few snippets of what David Blumenthal said with my own commentary in italics.

Congress set very ambitious goals for the HITECH legislation. The concept of meaningful use is novel, and a very powerful and important concept. The process of defining meaningful use has gone through many months, through many public hearings.

I think David Blumenthal realizes that meaningful use is going to be a major problem for many doctors offices. I think we’re going to hear him blaming Congress for the “ambitious” HITECH legislation which has his hands tied. It probably does, but it’s too bad he can’t just say it that way if it is the case.

The Office of National Coordinator is still committed to developing the Nationwide Health Information Network. Many of our federal colleagues and quite a number of larger healthcare organizations are on the verge of using NHIN as it was originally conceived and configured for their own purposes, and we’re continuing to invest in it.

At its last meeting the HIT Policy Committee adopted recommendations that they have not yet formally transmitted to me to encourage the development of a more flexible, adaptable, less complicated method of health information exchange than the Nationwide Health Information Network. And that’s something that we’ll be studying.

I think this is a good move. This national network in its current state just doesn’t seem like it’s going to have much affect on small doctors offices, which last I checked make up a large part of our healthcare system. I think in politics they call this move taking it to the people.

InformationWeek: Once you get clinicians using e-medical records, who pays to maintain the exchange infrastructure?

Blumenthal: It’s a short-term issue. Long term it’s going to become an expectation on the part of the clinician and patient that information is going to be exchanged. And I think it will become a cost of doing business in the healthcare sector just as physicians and nurses consider it a cost of doing business to buy stethoscopes and run an office.

Doctors will hate to hear this quote. Although, they shouldn’t be too upset. In reality, they’ll be passing this cost on to the consumers. Now how we get to the point Blumenthal talks about is beyond me. That’s a huge gap to cross.

InformationWeek: Will the Certification Commission for Heath IT–CCHIT– remain the organization doing these certifications, or will there be others?

Blumenthal: We’ll have to see what the regulation actually is and see where CCHIT fits in. CCHIT is clearly going to have the option to participate in certification going forward, but I can’t tell you what role exactly it will play.

Translation: I don’t care about CCHIT. If they want to participate great, but I’m playing no favorites here.

These webcasts have been popping up all over the place. It’s really quite amazing. You could make it a full time career just attending various webcasts on the EMR stimulus and meaningful use. Well, I’ve seen a ton of them, but this one by Modern Healthcare looked pretty interesting with a variety of people including the Director of CMS Office of E-Health Standards and Services. You can read more about it here and I’ll put some of the details of the meaningful use regulations webcast below:

Wednesday, Jan. 27, 2010
10 a.m. Central Time
FREE REGISTRATION*

About this Webcast

The federal government is offering as much as $34 billion in financial assistance to healthcare providers that buy, implement and use information technology in a manner consistent with the way the government wants it to be used. The government explained what it wants in nearly 700 pages of proposed regulations issued earlier this month.

In this webcast moderated by Modern Healthcare Information Technology Reporter Joseph Conn, four healthcare IT experts will break down those regulations and help attendees:
Identify the key sections of the regulations
Understand the impact of the regulations on hospitals, health systems and physician practices
Teach providers strategies to qualify for federal funding
Featured Speakers

J. Michael Kramer, M.D.
Chief Medical Information Officer
Trinity Health
Novi, Mich.

David Seaman
CEO
Pronger Smith Medical Care
Blue Island, Ill.

Tony Trenkle
Director
CMS Office of E-Health Standards and Services
Washington

Paul Tang, M.D.
Chief Medical Information Officer
Palo Alto Medical Foundation
Palo Alto, CA

P.S. If you’re able to attend this or any other webcast and want to do a guest post on what was said at the webcast, feel free to contact me on the EMR and EHR contact us page.

CCHIT’s Mark Leavitt has published his analysis of the $400,000 contract that NIST awared to Booz Allen Hamilton to develop a framework for electronic health record certification (see certified EHR).

Honestly, it seems that Mark’s as confused as everyone about this whole process. This is an interesting development since I would have thought that CCHIT would have had a close relationship with HHS, ONC, NIST, CMS, etc. The fact that CCHIT and Mark Leavitt are kind of left in the dark and full of lots of questions is not a good sign for CCHIT and fans of CCHIT. It is a good sign for those who don’t care for CCHIT.

I found this about a week ago and found it really really interesting. Here’s the numbers for the EMR behemoth Allscripts per HIT News:

The company [Allscripts] made $15.8 million in net income for the quarter, turning around a $6 million loss for the same period last year. Non-GAAP net income increased 45 percent, from $16.6 million a year ago to $24 million this year.

The sad part is that Allscripts went through a nice round of layoffs last year. I can’t find the number right now, but I remember it was pretty significant. Too bad they had to fire so many people while turning such a large profit. Seems like an opportunistic cut to me. I wonder how well Allscripts support was with all the cuts.

Another quote from the same article:

“We believe that 2010 will be the ‘Year of the EHR’ in which we expect to see significant acceleration in the adoption and utilization of healthcare information technology to improve quality and reduce cost,” said Glen Tullman, Allscripts CEO. “This is a once-in-a-lifetime market opportunity, driven by the American Recovery and Reinvestment Act.”

There’s no doubt that Glen Tullman is salivating over the $18 billion of EMR stimulus money that’s on the table. He probably should be since Allscripts is likely to make a killing off of the stimulus money.

I think all of this is also a very good sign for smaller EMR vendors as well. I expect a number of EMR vendors to scale to 500 or so installs and sell off for a very nice return in the next few years. I guess we’ll see if Glen’s right about this being the “Year of the EHR.”