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Still No Sustainable Funding Model for HIE

Posted on February 28, 2010 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.

Today, I attended a forum at HIMSS 10 where I heard a representative from a small state talk about their plans for an HIE. They’ve already introduced some legislation that will allow people in their state to opt out of having their information stored in an HIE. She referred to it as a framework for HIE. Unfortunately, a framework doesn’t deal with issues like how you’d actually allow people to opt out of an HIE. Would you just discard the person’s data that’s sent from their doctor’s EMR? Not to mention, would the patient have the option to opt out at the doctors office or would they have to know they need to go to the government page to opt out?

These items aside, I was even more interested in trying to dive into the funding for an HIE in that state. I asked the representative whether the state would be able to fund a state HIE or if they would need federal money or some sort of private partnership.

Her answer was simple. Basically, her state (which might be different in other states) didn’t have the money to be able to fund an HIE. She thought that the most likely option would be some sort of private partnership which would make an HIE in her state a reality.

The HIMSS representative then talked about how the HITECH act has provided what amounts to seed money for states to be able to establish HIE. Unfortunately, this is just seed money and not a sustainable way to run an HIE. It’s like they’re just throwing some seed money out there and hoping that someone will figure out some creative way to have a sustainable revenue model for an HIE. Without this type of sustainable revenue model, then the HIE will start to disappear the way RHIO have basically disappeared.

Doctors’ Documentation Methods Not Ready for EMR

Posted on February 27, 2010 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.

An interesting link came across my twitter stream tonight that suggested that doctors aren’t ready for electronic medical records. Here’s a short section that basically captures the bloggers point:

Last week, a blog in the Houston Chronicle cited some staggering figures about the Texas Medical Board’s announced disciplinary actions against 70 doctors, 12 of whom were in the Houston area alone.

Of those 12, nine lost their licenses, were financially penalized, or are required to attend training because of their lack of proper medical record keeping. Four actions were specifically related to failed record-keeping practices.

And this isn’t the first time this has happened in Texas by a long shot — in November 2009, 75 actions were taken against physicians, and 28 of those were related to improper record keeping.

Hopefully, Texas will set a precedent and other states will start taking a harder look at this issue, especially with the pending incentives to increase the use of EMR/EHR.

I think this points out what I (and many others) have said previously, however: Simply moving from physical-format records to electronic records is not going to improve the quality of diagnostics and healthcare.

I personally am not convinced that this really matters. In fact, if anything an EMR will expose those doctors who have poor documentation methods. I think that’s a very good thing to have happen. I want them to be exposed and held accountable for their poor documentation. That’s better for the healthcare system as a whole.

One other interesting part of the article was that it said that the “punishment” for some of the above violations was being required to attend a CME training for medical writing. Next up is a CME training for medical writing in an EMR?

More Advertisers on EMR and EHR Just in Time for HIMSS 10

Posted on February 26, 2010 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’m seriously ramping up for HIMSS right now. Today I sifted through 200+ emails from PR people about HIMSS. I filtered that down to about the 15 best companies that would be of interest to readers of this site. Add that to my existing connections and get ready for the fire hose of HIMSS coverage on this blog. Between this site and my other site, EMR and HIPAA, you’ll hopefully feel almost like you’re there with me. I will try to save some for the few weeks after HIMSS as well.

HIMSS aside, I’m also happy to welcome 2 new advertisers to EMR and EHR. Check them out and see what they have to offer:

Ambir – A company providing high quality scanners to healthcare. They’ll be at HIMSS in booth #9023. I’m planning to stop by and shoot some video of their products. If you have an EMR, you know how important your scanner is to your office. if you don’t yet have an EMR, you’ll quickly learn the benefits of a great scanner when you implement.

1st Providers Choice – They’re offering a free trial of their EMR software. Plus, free on-line training is also available. In other words, you can install their EMR and try it, get professional training and decide whether you like it FREE of charge! I love EMR vendors that let you test drive their software like this.

I always appreciate these advertisers support. You can find more information on advertising on EMR and EHR here.

Also, tonight I’m hoping to start selling me EMR selection e-Book. I’m really interested to hear people’s feedback on it.

Healthcare IT Spending and the Banking Industry

Posted on February 24, 2010 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 did a pretty controversial post over on EMR and HIPAA which compared the adoption of IT in banking with adoption in healthcare IT. I guess a lot of people have opinions on why healthcare IT hasn’t adopted technology as quickly as other industries. From that post, I got an email from Rod Bennett, MBA, MMIS, that included some interesting questions and answers about the healthcare IT industry with some other comparisons to banking. I found them insightful and so I thought I’d share them with you:

1. What factors are driving the emergence of the healthcare information technology market?

In the last few years the integration of technology is being driven by the increase in technology such as MRI’s, CT’s, PET scans, and digital radiology. Also, the health care industry is adapting like all other industries using email, websites, and building some form of semblance of a fundamental knowledge management system for information distribution within their organization. What we are seeing in the healthcare industry is what we were seeing during the tech-boom. Healthcare is slow to change for the simple fact they don’t have to, until now. They have always utilized a paper based system simply because it was working for them and saw no real reason to do anything different, it would cut into their profits.

Today however, their suppliers, pharmaceutical companies, etc., are moving into the electronic age and now healthcare is finally beginning to catch up simply because they are being forced to. Their philosophy is if it isn’t broke don’t fix it. One additional factor is the next generations of physicians are more computer literate and understand the value of computers in accessing information. Many of our physicians use the Internet on a regular basis to search for information on specific disease management research for better and more accurate diagnosis.

2. Why did banking industry spend a higher % of budget on IT than the healthcare industry?

One of the key factors is “money is a finite object” it has a definitive predictable value. It can be easily interpreted in the digital world in the terms of ones and zeros. It is a mathematical based system with a predictable outcome. People can be replaced by a computer to make a simple comparison. It is predictable and identifiable.

Healthcare on the other hand is a subjective environment. It requires the integration of humans to make a determination based on subjective information to make an outcome based decision. At this point in time the development of a new system would have to have the analytical ability of a physician, a nurse, the diagnosis process, etc. That is going to require a more advanced computer system based on artificial intelligence rather than on ones and zeros. So, there is a void in the market space simply because of the technological infancy of the knowledge required to develop it.

3. Historically, why did the healthcare industry not spend money on IT?

In their world they did. They spent money on data collection systems, not on intelligent systems simply because they don’t exist yet. The status quo still has value. However, when someone is able to capture what a physician can do based on an artificial intelligence system, we could see the shift in healthcare as we know it. The computing capacity would take a super computer to drive the system. For right now it is dependent on the medical professional’s expertise. It’s more cost effective to have a medical professional than it is a computer. How do you define a numerical value to a cough?

4. Who spent more money on IT – Insurers, hospitals, nursing homes, physicians, or employers?

I would have to agree with Ray, insurance companies by far; again it is because it is easier to measure dollars and cents. The data collection is a much simpler system because everyone is identified by a number, it’s definable. They have also spent more on providing an insurance card to the member and providing them with a numerical number for identification, again definable as a numerical value identified in an operating system.

Hospitals are spending money on data collection systems because they can identify a person in their system as a number. That’s basically what an EMR system is. It is used to track a person in the hospital system by a medical record number, assign a numerical value to a lab test, and assign a numerical value to an x-ray result. You can manually add data input by typing descriptive information. This is the current state of the EMR system and can be collected for value in the form of a numerical charge or fee.

5. What barriers existed that prevented health information from being shared among the healthcare stakeholders?

The main barrier at this point is the proprietary systems being built by providers to ensure profitability. The main barrier is the data base it is built on might be different from other data bases. It boils down to a proprietary systems equal money and profitability. Who cares about the healthcare stakeholder, they get what they get and like it, or else!

EMR Conversions

Posted on February 22, 2010 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 got an email asking me about converting an EMR from one EMR vendor to another. No doubt as time progresses, we’re going to see more and more clinics having to make the switch as clinics continue to consolidate. Here’s my response to this person. Hopefully other people will find it informative.

Converting an EMR is an incredibly challenging affair. Especially when you’re trying to convert from an ambulatory EMR to a hospital EMR.

There’s so many factors I’m not really sure where to start. I guess the first question is did you negotiate in your contract with Practice Partner that 1. you own the data in your EMR and 2. they would provide the “database schema” of the EMR so you would know where and how the data is stored in the database?

If you don’t have these 2 things, then converting the data is going to be an extremely big challenge. Even with these things, you can expect some major challenges. One EMR vendor described the conversion process the best. He described it as an imperfect science where you’ll never know 100% for sure that you got ALL of the data out and done correctly. You can know you’re close, but it’s almost impossible to know you got everything out of the previous EMR. It’s basically a best guess and often requires an iterative process where you think you got most of it and then you realize that something else is missing and so you have to go back and see what you did wrong.

The future of EMR is for the EMR interoperability standards to improve to a point where you can essentially “export” all the data from your EMR in some sort of standard format which you can then import into a new EMR. Those standards will be used by patients when they switch doctors. They’ll also be used by patients that want to have their own “PHR.” They’ll also be used by specialists to interact with primary care doctors. However, these standards have a long way to go. So, until then, it’s going to be an imperfect science.

Anyone else have thoughts and suggestions for those looking to convert from one EMR to a new EMR?

Sad State of Healthcare

Posted on February 21, 2010 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.

It’s the weekend and so I have less readers. That means I like to post a wide variety of things on the weekend. The following came to my email and I laughed so hard I couldn’t help but post it. Enjoy!

So you’re a senior citizen and the government says no health care for
you, what do you do?

Our plan gives anyone 65 years or older a gun and 4 bullets. You are
allowed to shoot 2 senators and 2 representatives. Of Course, this
means you will be sent to prison where you will get 3 meals a day, a
roof over your head, and all the health care you need! New teeth, no
problem. Need glasses, no problem. New hips, knees, kidney, lungs,
heart? All covered.

And who will be paying for all of this? The same government that just
told you that you are too old for health care. Plus, because you are
a prisoner, you don’t have to pay income tax anymore.
IS THIS A GREAT COUNTRY OR WHAT?!

EMR Contract Negotiation

Posted on February 19, 2010 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’ve been working really hard on an EMR book that focuses on EMR selection. My goal is to have it out in the next week or so before I head off to HIMSS. It’s really coming along quite well and I think it will be a valuable e-book for physicians selecting an EMR vendor.

As I was writing, one section that I don’t have as much experience with is the EMR contract negotiation. I’ve found a couple nice resources online, but I thought I’d reach out to all you smart readers to get some more feedback on EMR contract negotiation.

Here’s some questions about it to get you thinking:
What’s the best advice for negotiating an EMR contract?
Which items should you make sure are in an EMR contract?
How much negotiating room do you have in an EMR contract?
Is it worth finding an EMR consultant to help with the negotiations?

Ok, that should get you started. Let me hear your experiences and knowledge with the EMR contract.

Chilmark Declares CCD Winner in Standards Battle

Posted on February 17, 2010 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’ve been really interested in the various standards of interoperability in healthcare. I previously posted a bunch of random items related to CCR and CCD in healthcare. I remember when CCR first came out. It was a very exciting movement to try and make EMR software interoperable.

So, today I was really interested to read Chilmark essentially declaring CCD the winner in the EMR interoperability battle. Officially he says that CCD is gaining traction and CCR is fading, but if you read his post you’ll see that in his opinion (which I trust a lot) CCD will be the winner in the battle between CCR and CCD.

The cool part is that I don’t think those that helped develop CCR will mind at all. Partially because CCD is a derivative of CCR and CDA. Plus, from what I understand, the people behind CCR were mostly interested in facilitating the flow of healthcare information between EMR software. If that is achieved by CCD, then the goal was achieved.

I’ll be interested to hear what the chatter will be around CCD and CCR at HIMSS to see if Chilmark’s feelings are shared by others.

Health IT Advisory Group Says Meaningful Use Bar Too High

Posted on February 16, 2010 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.

George Hripcsak, MD, the co-chair of the workgroup and a biomedical informatics professor at Columbia University, said the following during a Health IT advisory group meeting as reported by Healthcare IT News:

None would be dropped in the area of privacy and security. “You can do things that are easy to measure, and you want to make sure it’s done for some but not measures that force more manual labor,” Hripcsak said.

I think this is a very very good point. The idea that “meaningful use” will end up being satisfied thanks to more manual labor is sad to consider, but a very possible outcome. I’ve already heard people talking about how they’re going to satisfy the meaningful use requirements and many of the reporting components require a lot of manual footwork.

One thing is certain from my point of view. The meaningful use bar as it is now will be a major hindrance to doctors interested in finally implementing an EMR for stimulus money. I’m not sure if they’ll find this out before implementing or after they’ve implemented. Either way, it will not achieve the desired outcomes.

If you are interested, you can listen to the HIT Policy Committee meeting tomorrow, at 10 AM Eastern. Find all the details of the webcast here.

Drummond Group Launches EHR Certification Blog

Posted on February 15, 2010 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’ve written a number of times about Drummond Group becoming an EHR certification organization in order to obtain the EMR stimulus money. Well, the Drummond Group has created a blog to keep you informed about theri partcipation in EHR testing/certification.

Here’s the most important part of their first post on their blog:

It appears Booz Allen Hamilton (BAH) will be developing both the testing certification documents as well as the framework for authorizing certifying body for EHR certification.

Once that final piece of the puzzle is revealed, we can begin making more detailed plans for EHR certification. Until then, we believe attempting EHR certification is, at best, premature and, at worst, potentially a significant waste of time and money for ourselves, the certifying vendors and the adopting physicians and hospitals.

However, this waiting period does not mean we are idle. We will be making regular posts here on various EHR certification topics. Since many of you are not familiar with us, we will share a bit more about DGI and our qualifications to be an authorized HHS certifying body for EHR. We have a great deal of experience in system-to-system interoperability and are excited to bring that knowledge to the EHR community. Since we are getting so many emails from vendors interested in EHR certification, we will talk about some of the concerns we are hearing and thoughts on how to best address them.

This is exactly why you should want to be certified by Drummond Group and not CCHIT. I agree with them saying, “attempting EHR certification is, at best, premature and, at worst, potentially a significant waste of time and money for ourselves, the certifying vendors and the adopting physicians and hospitals.