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Mr Spock’s ICD-10 Codes

Posted on February 27, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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.

How about a little Fun Friday post on a crazy busy Friday for me? Although, it’s not fun that Mr. Spock passed away. As one tweet I read said, “He lived long and prospered.” Have a great weekend.

Millennials Reshaping Digital Health

Posted on February 26, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 thought that the infographic below was really interesting and a nice balance to Paul’s previous post Mobile Health and Me…I Think Not! The infographic is based on the report, “Healthcare Without Borders: How Millennials are Reshaping Health and Wellness”, which looked to study Millenial healthcare values. There’s clearly a large divide between generations when it comes to how they approach healthcare. It will be interesting how this divide impacts healthcare going forward.

how-millennials-are-reshaping-digital-health

Is the Concierge Model A Real Option for Providers?

Posted on February 25, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This article last month in Crain’s New York Business talks about the pressures that primary care doctors are facing and how those financial pressures are getting many of them to try cash-only or concierge practices. Here’s an excerpt from the article:

To stave off the pressures prompting many physicians to sell their practices to hospital systems, Manhattan internist Peter Bruno has tried a number of creative solutions. They have ranged from forming a now-disbanded group practice with 60 colleagues to his ongoing strategy of working at a nursing home one day a week to supplement his income in his current solo practice.

With reimbursements dropping, Dr. Bruno made the bold move in July of converting his six-employee private practice on East 59th Street in Manhattan to a hybrid concierge model. In concierge care, patients pay an annual fee or retainer to get more immediate, customized care. Hybrid practices treat both concierge and traditional patients. He worked with SignatureMD, a Santa Monica, Calif.-based network that assists physicians in doing so.

I don’t think we need to cover the financial realities of being a solo physician here. You’re all to aware of the challenges. However, I’m interested to hear what you think about the potential for the concierge model of medicine for primary care doctors? Is that an option for most primary care doctors?

I ask this because I’ve seen concierge medicine work in the rich areas (the above case is Manhattan for example), but I have yet to see it really work in poorer areas. If we’re shifting to concierge medicine, what does that mean for the poorer areas of the country?

Here in Las Vegas, they have an interesting hybrid model that they’re trying where concierge medicine is part of the insurance plan. In fact, it could be part of the insurance plan your employer provides. I just signed up for the plan, so we’ll see how it goes.

I’m also watching how the EHR market is adapting to this trend as well. Over on EMR and HIPAA I wrote an article titled “An EHR Focused On Customer Requests, Not MU” which talks about what an EHR would look like that was just focused on patient care and how Amazing Charts was offering that product.

Just today SRSsoft announced their new SRS Essentials product that’s a non-MU EHR as well. Although, they offer an interesting wrinkle that allows their SRS Essentials customers to move up to an meaningful use certified EHR should they decide they later want to take part in meaningful use (or whatever that program eventually becomes).

Of course, SRSsoft focuses mostly on the specialty market and not general medicine. Although, maybe this physician focused EHR product will be of interest to the emerging concierge and direct primary care doctors as well.

What do you think of these new models of medicine? What’s their place in the healthcare world? Where are they going in the future? Will their technology needs be different than other doctors?

Health IT Security: What Can the Association for Computing Machinery (ACM) Contribute?

Posted on February 24, 2015 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.

A dazed awareness of security risks in health IT has bubbled up from the shop floor administrators and conformance directors (who have always worried about them) to C-suite offices and the general public, thanks to a series of oversized data breaches that recentlh peaked in the Anthem Health Insurance break-in. Now the US Senate Health Committee is taking up security, explicitly referring to Anthem. The inquiry is extremely broad, though, promising to address “electronic health records, hospital networks, insurance records, and network-connected medical devices.”
Read more..

Why Are So Many Big Health IT Companies from Small Cities?

Posted on February 23, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 was reading over something on HIStalk the other day that talked about how many major healthcare IT and EHR companies have come out of small cities. In fact, when you think about the EHR world, there are only a handful of EHR companies that have come out of the tech hub of the world, Silicon Valley, and they’ve all been started within the past 10 years.

In the article HIStalk mentioned the town Malvern, Pennsylvania. I hadn’t even heard of the town, but a look at Wikipedia has Siemens Healthcare, Ricoh Americas, and Cerner as among the companies based in Malvern. I think the Cerner mention in the list must be because Cerner just purchases Siemens Healthcare, so they are now claiming them. However, Cerner is definitely a Kansas City based company. Either way though, Kansas City is not a HUGE city either and certainly hasn’t been the hub of technology (although, I know they have some cool tech things happening now, like most cities).

The healthcare IT behemoth, Epic was founded in Madison, Wisconsin and now has headquarters in Verona, Wisconsin. If you aren’t in healthcare IT, my guess is that you’ve probably never even heard of Verona.

Those are just a few examples and I’m sure there are many more. Why is it that so many of the large healthcare IT companies have come from small cities? Will that trend continue or will large cities like San Francisco, Boston, New York, and LA start to dominate?

I’m a bit of a young buck in this regard. So, I don’t have the answer. Hopefully some of my readers do. I look forward to hearing your thoughts. Is there an advantage to being from a small town when going into healthcare? It’s exciting to me that healthcare innovation can come from anywhere. I hope that trend continues.

Mobile Health and Me…I think not!!

Posted on February 20, 2015 I Written By

All that I read tells me, or at least tries to, that the future of healthcare is embedded in mobile healthcare. Through the magnificence of technology, I can see how my health is, test results were and when done, shop for a doctor to fix me if I’m broken. I have the opportunity to find the least expensive option for a cure or, when and if I have the time and after a self-diagnosis I can research my options on the care I need to fix whatever is broken. AND, I can do it all from my iPhone. Are you kidding??? You guys believe that there really are Super Heroes flying around out there, right??

I know that I am not a kid anymore. I know that even though my local hospital is rated as one of the best in the country, it and the doctors in it are a long, long way from the health technology I read so much about. Do we really want them to “compete” for our business?

Forsaking the fact that I live out in the pucker brush, if I get sick, I don’t want to find out about it because I researched the results of some tests, did a self diagnosis and went shopping for a cure. I want MY doctor to tell me what the problem is, if there is one and what can be done to fix it. If I agree with MY doctor, I want him to come up with a cure and whom I might need to be referred to to make it happen. I know that that is not technologically advanced, but it works.

That is one of my problems with all this and I guess I qualify for the title of Dinosaur. I can accept that, but I am also a parent. I take that responsibility very seriously.

One of my son’s is at the tail end of baby boomers and the other at the leading edge of Millennials. Both are very technology savvy. I think that the healthcare expectations I read about are nuts and even if it means being labeled a Dinosaur, I have to caution them about mHealth.

I watched my youngest son ignore the fact that the cold he was suffering from was very severe and getting worse. He finally went to one of those minute clinics and found out that he really had the flu and a touch of pneumonia to go with it. They suggested that he go to where I was trying to get him to go to. A real doctor. Had he done it originally he wouldn’t have lost three weeks because he was too sick to do much.

Then there is my very tech savvy baby boomer son. He understands HIT and mobile health better than most. Two times in the last three years he needed medical care. The first time he went to the minute clinic and they gave him Ibuprofen. It cured the hurt. The second time, he was doing an EHR implementation at a major university hospital. He spoke to one of the doctors he was working with, explained his issues, and was referred to the emergency room. They diagnosed him, treated him and sent him home because he was still contagious. He had also done a self diagnosis, on his smart phone. while sitting in an airport. His diagnosis was faulty.

Having gone through 3-4 life threatening illnesses in my life, the future methods of healthcare scares the heck out of me. It’s the future of medicine, I’m told. Iron Man, Bat Man, where are you when we need you?

Patient Wait Time Tracking – Can We Learn Something from Fast Food?

Posted on February 19, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 was recently asked by @HIMTrainer (Jennifer Della’Zanna if you prefer) if I knew where my article was that I wrote about having a “patient wait” timer in an office. I vaguely remember talking about the idea, but couldn’t find and don’t remember specifically posting about the topic. However, the idea of a timer that tracks a patient’s wait time was interesting.

I’m sure that most of you are familiar with these timers at fast food restaurants. They track how long you’re waiting for your food and they often have some promise of free food if it takes over a certain amount of time. I’ve always found these timers interesting. In fact, I can’t remember a time when I’ve been to a restaurant with one of these timers that I ever had to wait very long for my food. Is that because of the timer or is that the nature of the restaurant and this was just a marketing mechanism? The answer is that it’s likely both.

The timer is a visual display of how long you’re really waiting. Time is a funny thing. A wait time that is relatively short can feel really long. We often lie to ourselves about how long something is, but that’s our perception. A timer helps to readjust that perception to the proper perspective. Of course, on a bad day it can also illustrate how much the restaurant needs to improve.

The other value of the timer is that it encourages the staff to work faster. At first this probably means the staff will feel some anxiety over the timer. However, over time it will just be a visual indication of how quickly or slowly their working and will help to ensure a consistent speed of service from most employees.

Now I’m sure that many of you are thinking that Fast Food is an awful comparison to healthcare. Fast Food is a pretty consistent product with a consistent request. Healthcare is a pretty inconsistent product with a wild variety of requests (almost limitless). Plus, I’m sure that many people’s gut reaction will be that this is an awful idea and corrupts the practice of medicine. I can already hear the cries for “Where’s the humanity in medicine?”

Certainly an organization could take this too far. However, maybe there’s something we can learn from the wait time clock that could help healthcare improve. Plus, when people cry fowl over something, that really makes me want to dig into that idea and see how it can help.

What’s Realistic in Healthcare?
There’s no way you’re going to see an actual clock at the check in or check out window in healthcare. I can’t even imagine how that workflow and tracking would work. So, it won’t be the same as fast food, but there are certainly a number of options available to track how long a patient is waiting. In fact, in many cases you can get quite granular.

Built in EHR Status Tracking
10 years ago when I first implemented an EMR system (yes, it was EMR, not EHR at the time), we could track the patient wait times in our EMR system. It wasn’t a perfect process, but you could get a good idea of how long a patient was in the office, how long they waited to be put in a room, how long they waited from the nurse to the doctor, and then when they checked out. Of course, you can add it all together and get an idea of how long the patient was in the office.

We simply used the statuses in the EHR to track this time data. It worked out pretty well with a few exceptions. If we didn’t have something that was specifically queued off of that status, then the data would be incorrect. For example, the nurses knew to bring a patient into an exam room based on the front desk changing them to a checked in status. So, the front desk always did this. The doctor would know to go into the room based on the nurse changing the status of the patient, so the nursing staff always did this. The patient was marked as discharged when the patient was making their payment (or checking to see if they had payments) and so this final status change was always done. Nothing was queued off of the doctor changing the status, so this often failed and so that data wasn’t very accurate.

Running these reports was fascinating and we could slice and dice the data in a variety of different ways. We could see it by provider, by appointment type, etc. Seeing the data helped us analyze what was taking the most time and improve it. We were also able to exclude any outliers that would skew the data unfairly to a provider who had a crazy complex case or in case a status change was missed.

Proximity Tracking
While EHR status tracking is good, there’s an even more powerful and effective way to track patient wait times in an office. I saw this first hand at the Sanford Health clinic in Fargo, ND at the Intelligent Insite conference. The entire clinic was wired with proximity tracking and other wireless monitoring technology that could track everyone in the clinic. Every nurse, doctor, MA, etc all had this technology embedded in their badge. Patients were issued a tracking device when they checked in for their appointment.

With this technology in place, you can imagine how the workflow for my above tracking is totally automated. They would actually immediately room the patient upon the patient’s arrival. In this case, the room would automatically know that the patient was in the room and provide an indication to the nursing staff that the patient was ready and waiting. I can’t remember the exact times, but they worked to have a nurse go into the room with the patient almost immediately after the patient got in the room. No doubt that’s a unique setup, but with these tracking devices they could know how well they were doing with the goal.

I won’t dive into all the other details of this workflow, but you can imagine how all of these tracking devices can inform the flow of patients, nurses and doctors through your office. Plus, all of this data is now trackable and reportable. The nurse, doctor, or patient don’t have to remember to do anything. The proximity devices do all the tracking, status change, etc for you.

I asked them if many patients walk out of the office with their tracking device. They told me that they’ve never had that happen, but they have returning the device as part of their checkout procedures so that could be why.

Informing the Patient
I think we’re just getting started on all of this. The price of this technology will continue to come down and we’ll do a much better job of tracking what happens in a practice. Plus, it offers so many interesting workflow benefits. I wonder if one of the next steps is to inform the patient of their wait time.

If we’re tracking the wait time, it’s not that far of a stretch to share that wait time with the patient. Kick off a clock that starts counting once they check in for their appointment. Maybe that wait time is displayed in an app on the patient’s smartphone. Maybe the wait time could be integrated into the Epion Health tablets a practice gives the patient during their office visit. If it’s a fast visit, do you prompt them to do a review of the doctor on a social site like Yelp or HealthGrades? Would doctors be ready for a patient to see front and center how long they’ve been waiting?

Final Thoughts
I’m sure that many doctors and practices will be afraid of this type of transparency. Plus, I’ve seen some general medicine doctors in particular make some serious arguments for why they run behind. Maybe the app could take this into consideration and inform the patient accordingly. While there are many unreasonable patients that are going to be unreasonable regardless of the situation, many other patients will have a much better experience if they just know more details on what’s going on.

While the comparison to a fast food timer clock is a stretch, the concept of tracking a patient’s time in an office is a discussion that is just starting. As providers work to differentiate themselves from their competitors, I’ll be interested to see how all these new technologies combine to make the patient experience better.

Remote Patient Monitoring and Small Practices

Posted on February 18, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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.

We’ve started to see the proliferation of wireless health devices that can track a wide variety of health data and more of these devices are becoming common place in the home. Here’s a great tweet that contains an image of some of the popular devices:

While many of these devices are being purchased by the patients and used in the home, there are a number of other programs where healthcare organizations (usually hospitals) are purchasing the devices for the patients who then use the device at home. These programs are designed for hospitals to remotely monitor a patient and identify potential health issues early in order to avoid a hospital readmission.

For those who work in hospitals, you know how important (financially and otherwise) it is for hospitals to reduce their readmissions. While this is great for hospitals, how does this apply to small practices and general and family practice doctors in particular. There’s no extra payment for a small practice doctor to help reduce the readmission of their patient to the hospital. At least I haven’t seen a hospital pay a doctor for their help in this service yet.

What then would motivate a small practice doctor to leverage these types of remote patient monitoring tools?

Sadly, I don’t think there is much motivation for the standard small practice office to use them. It’s easy to see where a concierge doctor might be interested in these technologies. As a concierge doctor or direct primary care doctor, it’s in their best interest to keep their patient population as healthy as possible. As this form of care becomes more popular, I think these types of technology will become incredibly important to their business model.

The other trend in play is the shift to value based reimbursement and ACOs. Will these types of remote patient monitoring technologies become important in this new reimbursement world? I think the jury is still out on this one, but you could see how they could work together.

I’ve recently had a number of doctors hammering me on Twitter and in the comments of blog posts about how technology is not the solution to the problems and that technology is just getting in the way of the personal face to face connection that doctors have been able to make in the office visit of the past. Their concern is real and those implementing the technology need to take this into account. The technology can get in the way if it’s implemented poorly.

However, these people who smack the technology down are usually speaking from a very narrow perspective. EHR and other technology can and does disrupt many office visits. We all know the common refrain that the doctor was looking at the computer not at me. This is a challenge that can be addressed.

While the above is true, how impersonal is a rushed 10-15 minute office visit with a doctor? How impersonal is it for the doctor to prescribe a medication to you and never know if you actually filed it? How impersonal is it for a doctor to prescribed a treatment and never follow up with you to know if the treatment worked? How impersonal is it for the doctor to never talk or interact with you and your health unless you proactively go to that doctor because you’re sick?

Technology is going to be the way that we bridge that gap and these remote patient monitoring technologies are one piece of that puzzle. I believe these technologies and others make healthcare so much more personal than it is today. It changes a short office visit to treat a chief complaint into actually caring for the patient.

This is what most doctors I know would rather be doing anyway. They don’t want to churn patients anymore than the patient wants to be churned, but that’s how they get paid. Hopefully the tide is changing and we’ll see more and more focus on paying providers for using technology that provides this type of personal care.

Small Meaningful Use Penalties for Small Practices

Posted on February 17, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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.

Michelle has posted an interesting CMS analysis of the price of EHR penalties for physicians:

CMS reports that the majority of physicians who will be penalized this year for not having met MU requirements will lose less than $1,000 of their Medicare reimbursement; 34% of the penalties will be $250 or less, while 31% will exceed $2,000.

The adjustments will impact approximately 257,000 eligible providers. While no one likes losing money, the CMS penalty “stick” is pretty small compared to the overall cost of implementing an EHR.

Unfortunately her link to the CMS report seemed to be the wrong link. I’d love to dig into the 31% of doctors who will exceed $2000 in penalties. $2000 still isn’t very compelling to most doctors I know, but if it scales from there we could see how many doctors are really going to suffer from the EHR penalties.

What’s also not clear to me is if this includes the PQRS penalties as well. All of the penalties start to add up. I also heard one doctor talk about the feared 22% Medicare cut that’s been delayed for a decade or so (I lose track of the number of years). I’ll be surprised if those cuts aren’t delayed again, but it’s interesting that many doctors fear these cuts even if they’re likely to be delayed. Perception is still very important.

Back to the meaningful use penalties, $1000 penalty is not something most doctors will bat an eye at. Even those who have an EHR are opting out of meaningful use stage 2. The math doesn’t work out for small practices. $1000 of penalties certainly won’t balance the equation either. I expect a very small number of small practices to do meaningful use stage 2. Hospitals on the other hand are a different story.

Teddy Roosevelt and Gerald Ford Quotes

Posted on February 16, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 thought it would be fun to look at some quotes from Presidents on President’s day that might inspire you. I hope you enjoy the following quotes.
Teddy Roosevelt - EMR and EHR

Gerald Ford - EMR and EHR