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Federal Health Architecture (FHA) Program Director Leaves ONC

Posted on April 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.

I’ve mentioned a few times about the very interesting CONNECT open source project that was coming out of ONC. In fact, I did a video about CONNECT and NHIN at HIMSS. Turns out the mastermind behind CONNECT is a guy named Vish Sankaran.

Well, I just got news that Vish will be leaving ONC and FHA to pursue other opportunities. This is a real loss for ONC. It will be interesting to watch the progress of CONNECT and the NHIN without Vish at ONC.

The following is the letter that Vish sent out about his departure.

Dear Friends,

Within the next several weeks I will be departing from the Federal Health Architecture program to seek other opportunities.

This was not an easy decision, but it comes at an ideal time for FHA and for me, when FHA is reshaping to fit in with the overarching federal health IT body being formed.

This is also a great time to bring in new leadership to further the great work you’ve already accomplished. And on the personal front, I am exploring exciting new opportunities that will allow me to continue my passion.

My departure has allowed me to look back and review FHA’s legacy – a legacy built through all of our hard work. I joined the Office of the National Coordinator for Health IT shortly after our nation’s leadership issued Presidential Executive Order 13335, which set up the ONC and called for a commitment to build a nationwide electronic health information system.

When agencies were called upon to work together to enable interoperability and improve services to their beneficiaries, the agencies responded! Twenty federal agencies came together to discuss more than challenges – they joined workgroups dedicated to determining common needs, worked together to develop tools and solutions, and most importantly, they shared their experiences in advancing health IT within their own agencies and with their counterparts. We all learned and benefited from this collaboration.

Our achievements have been significant, creating a template for how the public and private sectors could work together to set a new bar for health information exchange and to create an “ecosystem” of buyers and sellers in the marketplace. A great illustration of our collaboration is the CONNECT solution, which has been adopted by both government agencies and the private sector. This open-source platform has evolved into a venue for innovation which continues to this day.

Our efforts have not gone unnoticed. FHA has been on the agenda of more than 150 conferences and meetings dedicated to health IT. Media coverage of the program can be found in a wide range of publications and online media sites. Most gratifying is that our program has received seven awards from organizations recognizing innovation in health IT.

Without your strong and steadfast support, we would not have made the mark that we did. My time here was my first exposure to the inner-workings of the federal government – and more than anything else, I learned that our government is staffed with dedicated and hard working individuals. I wish all Americans would have had the opportunity to share my experience. I now understand that public service is more than a career – it is a calling.

I look forward to continuing to be involved in the national effort to make health and human services a transformative force for our society. I know that I will have the opportunity to see many of you again. Until I do, I trust you know that you have my thanks and appreciation for all you have done during my tenure as FHA Program Director. Let us keep advancing the “openness” in our government activities and work across the public and private sector to reduce cost and improve health and human services to our citizens.

Friends, the “Patient is Waiting”!

Take care,

Vish Sankaran
Program Director
Federal Health Architecture
Office of the National Coordinator for HIT

Top 10 Meaningful Use Challenges

Posted on April 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.

CSC report lists top 10 challenges that doctors face when it comes to meeting the stage 1 meaningful use requirements. Here’s the list:

1. Capture the data–that includes collecting and entering data in a structured formats so that data can be sorted and selected for reporting purposes, said Zywiak.

2. Establish effective workflows to reinforce data entry, including medication reconciliation. For instance, “often, an organization’s workflow needs to be modified to make sure data is entered,” while patients are being cared for, whether it’s vital signs like blood pressure or allergy updates, said Zywiak.

3. Drive provider involvement in adoption of the EHR. “The primary users of these systems need a say” in what’s selected, said Zywiak.

4. Computer-based provider order entry (CPOE). “In ambulatory settings, 80% of orders, including tests, referrals and medication prescriptions, will need to be entered electronically,” he said.

5. Start e-prescribing. “Do this as soon as possible,” he said.

6. Develop a process for managing clinical decision support. This could include different clinical reminders for individual doctors in the same multi-specialty practice. For instance, a primary care doctor might need different alerts than a dermatologist caring for the same diabetic patient.

7. Implement patient health information exchange workflows. As a healthcare provider, “you’ve got to provide patients access with information–but will you do this via a patient portal or through a [third party] personal-health record” site, such as Google Health, said Zywiak.

8. Formulate a provider health information exchange strategy. “How will you exchange patient summary data with hospitals, specialists?,” he said.

9. Ensure privacy and security compliance. “Most primary care organizations haven’t been on an EHR, so they think of HIPAA in terms of protecting paper-based information,” he said.

10. Initiate EHR-based quality performance measurement support.“You’ll need to report quality measures to Medicare and Medicaid,” he said.

How does this list make you feel about the meaningful use guidelines?

e-Prescribing Medicare Penalties in 2012

Posted on April 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.

One of my readers pointed me to an article talking about the potential Medicare penalties that will be enforced starting in 2012 to physicians who don’t use e-Prescribing. Here’s the relevant info:

As previously reported, the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorizes incentive payments for eligible professionals who are successful e-prescribers. Under the MIPPA, the incentive payments are set at 2 percent for 2009 and 2010, 1 percent for 2011 and 2012, and 0.5 percent for 2013.

However, the MIPPA provides for a penalty to arise in 2012 for not successfully satisfying e-prescribing requirements. The penalty will be a percentage reduction in Medicare physician fee schedule payments equal to 1 percent for 2012, 1.5 percent for 2013, and 2 percent for 2014 and subsequent years.

It’s interesting to see these penalties. They’re almost as large as the penalties for not showing meaningful use of a certified EHR. Yet, I see so little discussion about these penalties. Is there a reason doctors aren’t worried as much about this as the EMR Stimulus Medicare penalties?

Also, it’s no wonder that many doctors are wondering whether they should continue to accept Medicare or not. First, the 21% Medicare cuts that have been floating out there. Second, the EMR stimulus medicare cuts. Now, the cuts for those that aren’t ePrescribing. Of course, all of these cuts are to the “insurance” that has in general the smallest reimbursement already. Are the insurance companies next to implement these cuts?

What’s Behind EMR Software

Posted on April 25, 2010 I Written By

Guest Blogger: Richard has over 15 years of experience as product manager and public policy analyst. He is currently researching the use of technology to improve health care access. You find more of Richard’s writing on his blog.

No doubt, electronic medical record (EMR) buyers would love to wave their hands and clear the fog that envelops the EMR software purchase process.  Buyers’ uncertainty and distrust combine to create angst and skepticism that their purchase will be the correct one.

One tool to navigate this process: Like a doctor taking a medical and family history, the history and heritage of an EMR vendor can tell you much about the direction and competency of offerings.

Vendors for large customers (hospitals over 250 beds and physician groups over 100) have a historical software competency much like a DNA thread of a virus, with many of the distinct markers carried down to descendents. In the case of software, it is the concept of how the software is built that is carried through each revision and new product.

Prior to EMRs, software was created to register and bill patients and to reconcile financial transactions and records. That is their core competency and strength. To leap to EMR is a complete anathema to the financial paradigm. While orderly in the financial side, the EMR side is counterintuitive to them and their software shows that monolithic belief that once a design has been settled, little else can be done to customize it for future use.

Like their larger brethren, smaller EMR vendors who specialize in the primary care medical market have difficulty in accommodating subspecialties.  That’s because primary care tends to be more uniform in their approach than subspecialists who are much more fragmented than primary care. That fragmentation creates numerous requests for special features that may not be economically feasible for a small EMR vendor.

In summary, the heritage of an EMR vendor won’t ensure that you will be satisfied with your purchase. It will, however, make you aware of the bias and alert to how that may translate to functionality and support.  Vendors can change, but it’s difficult to break that “DNA lineage” unless there is an abrupt break from the past. The next time a sales representative hails you for a sales presentation, look a bit closer at the history and values of the vendor. It might just save you money.

Practical Meaningful Use Details

Posted on April 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’ve spent a lot of time reading about and thinking about meaningful use requirements for the EMR stimulus money. I’ve posted about an easy 12 page matrix for meaningful use, a list of 25 meaningful use objectives, and some thoughts on meaningful use.

What bothers me as I’ve thought about all I’ve read about the all important meaningful use is the lack of real practical guidelines and information about how doctors are going to be able to show that they are meaningful users of an EMR to CMS. What types of measures is CMS going to use to know if a doctor is a meaningful use? In what form will doctors need to report and prove this to CMS?

I guess at its core I’m missing the real practical details of meaningful use. It’s one thing to have nice lists of meaningful use objectives. Then, people can look them over and try and guess what CMS might do with those objectives, but it’s a very different thing to have details about what will really need to be done to meet those objectives.

Am I just missing these details somewhere? I try and stay reasonably connected to what’s happening and I haven’t seen any practical details. Maybe it’s still waiting for a government committee to figure out the matrix.

Insane EMR Ideas

Posted on April 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.

In the vast amount of information that comes through my email, Twitter account, RSS feeds, etc one of them recently caught my eye. It was a webinar called, “Insane Ideas in Healthcare IT” by Christine D. Chang; Ovum, Analyst of Healthcare Technology (you can find the archived webinar here if you click around a bit). Here’s the description for the presentation:

All great ideas sound “insane” at first. This presentation will describe three insane ideas that Ovum believes will transform healthcare in the future including:
• Telehealth is for everyone, not just the elderly.
• Patient self-diagnosis is good and should be promoted.
• Personal health records are not just a passing trend, they are the solution.

I really love the concept of considering “insane ideas.” So, my question is what EMR ideas do you have that most people would consider insane?

On EMR and HIPAA, I wrote about an EMR platform which I think some might classify as an insane idea. Sometimes I wonder if becoming a full time entrepeneur doing mostly EMR blogging is an insane idea;-) I think that many might consider the Free EMR software an insane idea.

I had one EMR vendor recently ask me to write about them. He hoped that people’s response to my post would be that they all think it’s crazy to try and build an EMR company that way. I guess he prescribes to the best ideas sounding “insane” at first.

Let’s hear what ideas you think might be insane.

REC Grants

Posted on April 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.

I’ve been really interested in the Regional Extension Centers (RECs) and been interested to find out how they’re going to work. So, I’ve started a resource on the EMR and EHR wiki to list the various RECs and over time to populate the list with links to the REC websites. Since it’s a wiki please feel free to login and add whatever information you know or leave a comment with the information.

I also found these links to information about the RECs in Kentucky, Ohio and Indiana and Oklahoma and New Jersey.

Please let us all know any other information you have or find about RECs and their help in EMR implementation.

Would You Let Your CMO Do This?

Posted on April 13, 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 know I shouldn’t post 2 humorous posts in a row (Yes, my Extormity EHR post was a joke), but you’ll have to forgive me. I just couldn’t resist. Go and read this post that has the CMO of Practice Fusion calling out Greek Philosopher, Archimedes (Thanks Michelle W for sharing it).

Now, ask yourself the question, would your CMO write a post like that? More importantly (and interestingly) would your EMR vendor post something as tongue and cheek as that?

Honestly, that’s one of the things I love most about Practice Fusion. They’ve imbued an incredible sense of culture in that company and there’s an energy about it that I just love. As an internet startup junkie, maybe that’s why it feels so familiar. I don’t really know, but it’s definitely a different type of EMR vendor.

I’m still on the fence on the product that Practice Fusion has delivered so far, but I can tell you that this is one EMR vendor that I’d love to work at.

Extormity EHR Does It Again

Posted on April 12, 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.

One of the most entertaining things I’ve seen in the EMR industry in a while (the Meaningful Use rap gives it a run for the money) is the Extormity EHR website. Here’s a couple excerpts from their latest email alert:

“With all the hubbub about SaaS model EMRs, we elected to continue our track record of unexpected innovation and launch a SaSS, or Software as Scented Server, architecture,” stated Extormity CEO Brantley Whittington. “This is more than just a bolted on aromatherapy device, as our SaSS offering is fully integrated with the EHR utilizing a modified HL7 interface.”

According to Whittington, the Extormity SaSS platform will cost $43,900. “As luck would have it, the cost for this is just under the $44,000 available in stimulus funding for physicians who demonstrate meaningful use. Of course, aroma cartridges will be sold separately, and practices will be charged a ‘per whiff’ fee each time a smell is emitted.”

Got to love Extormity. The good news is that they’re “SEEDIE Certified” for all those looking for a certified EHR. They might want to work on their company tagline, “Extormity. Expensive, Exasperating, Exhausting.” lol

If that wasn’t entertaining enough, go and check out some other Extormity EHR news. Although, I will say that Extormity really could use a blog on their site. Would really help them better communicate their message.

Vista EMR Payback or Cost

Posted on April 8, 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 found this article on the WSJ Health blog titled, “Study: VA’s Computer Systems Cost Billions, but Have Big Payback” Of course, I was intrigued since I knew how much the VA had spent on their EMR and so I wanted to learn about this Big Payback that the study found.

Maybe I’m reading this wrong (in which case I’m sure you’ll correct me), but the article states that the four VA health IT systems they studied had a $3.09 billion cumulative benefit. Then, they say that just the Vista system alone cost $3.6 billion.That doesn’t seem like a good return to me. Unless, I’m misunderstanding the first number and they’re actually saying that the benefit received was a total of $3.09 billion over the $3.6 billion spent. Yes, $6.69 billion in benefit. Does either conclusion make sense to you?

Of course, the most insightful part of the article/study was the limits on the data: “the VA has a unique, integrated structure that is more likely to produce results from IT projects and is hard to match in the private sector. In short, they say your results may vary.”