Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and EHR for FREE!

The Demise of Google Health and Consumer PHR

Posted on May 31, 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 was really interested to read John Moore’s post about the irrelevancy of Google Health leading to its demise. It’s a great post that’s worth a read for anyone interested in the PHR space and in particular Google’s participation in healthcare. I’m a little reticent to bet against Google, but the lack of commitment on Google’s part to healthcare says something. I mean, Google has quite a bit going on with cell phones (Android), web browsers (Chrome), and operating systems (Chrome) just to name a few. You can see why Google Health isn’t high on their priority list. Oh yes, and of course they still have to maintain their dominance in search and all the other products they have (gmail, google docs, calendar, etc etc etc).

With that said, some of the most interesting things were found in the comments of Chilmark’s post. Here’s a couple excerpts:

My college health class used car upkeep as a metaphor for how we take care of our health. With my car, I know I should pay more attention to everything: it’d probably run better if I looked at it more, kept up with the latest from my manufacturer (hey, actually read my owner’s manual).
But honestly? I’m just as happy to pay a mechanic to keep track of what I need, when I need it. The money I pay is as much to escape the tedium of keeping up with all that knowledge as it is for the service itself. I’m willing to bet a lot of people feel that way about health: they probably believe they should be involved, but when push comes to shove they’d rather just pay someone else to worry about it.

This rings far too true. We care, but not enough to really care (at least until we really need to care).

I belive what we are seing here is the end of the B2C direction for PHR. John Moore was the 1st to say that PHR is for B2B model. Google designed it’s solution for B2C (login to data through Google). this was wrong. if you see real addade value apps in the market they are offred as B2B under Microsoft HealthVault.

PHR = B2B Very important lesson learned.

Features of an EMR for Practical Use

Posted on May 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.

For those of you who don’t read many of the comments on here and EMR and HIPAA, you’re really missing out. Some of the very best discussion and information comes out in the comments. At times I like to highlight some of the more interesting and thoughtful comments so that more people get to read them. This post is one of those comments where a doctor discusses the features that he believes should be included in an EMR that’s built for “Practical Use” as opposed to the meaningless “Meaningful Use.” I don’t agree with a number of his thoughts, but it does give you plenty to think about. I’m sure you’ll enjoy it!

Most of the charts look like:

Patient c/o cough.
HTN -controlled
DM – controlled
CHF – stable
No change in meds.

Those 5 short lines of text are the culmination of a clinical encounter and represent the result of a highly trained professional’s observations, conclusions and treatment plan. With the inclusion of patient name and date of service those 5 lines are the “Complete Medical Record” of that encounter. When Medicare or any other payer shows up to run a chart audit that’s all they want to see. There are certainly other documents like lab results that clinicians use in diagnosis and formulating a treatment plan, but those are simply part of the data “considered” by a clinician and are typically used once. That along with the more signifigant cognative data are processed through the clinician’s brain with the end result being output represented by those 5 lines of text.

When EMR products are designed around that work process EMR ubiquity is possible.

“Meaningful Use” is “meaningless” to clinicians.

“Practical Use” is easy to define, just ask a bunch of doctors who are resistant to the current generation of EMRs. What capabilities should an EMR contain at a minimum that would make it a “I’ve got to have that” clinical tool.

Here’s my list:

1. Must contain a textual clinical note.
2. Must contain a contextual/collaborative problem list.
3. Must contain a contextual/collaborative medication list.
4. Must allow access across enterprise boundaries.
5. Must not interfere with my existing documentation methodology.
6. Training should take no more than a coffee break.
7. Cost must be trivial like my cell phone service
8. Must not interfere with billing and administrative staff’s activities.

I already know how to write a clinical note.
I have finely honed cognative skills, don’t distract me from using them.
I already have a practice management and billing system.
I already get lab results electronically.
I already have e-prescribing.
I am not interested in drawing stupid little pictures on a screen with a mouse.

Finally an EMR must create a secure open channel of communication between clinicians.

I not going to spend $2,000 much less $100,000 to organize and share that information.

Doctors are not Technology Averse, they are Stupidity Averse.

Looking at Slow EMR Adoption

Posted on May 25, 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.

There’s been a whole lot of discussion going on in this post on EMR and HIPAA called Why EMR Efforts Are Proceeding Slowly. The comments are an interesting read for those interested in EMR adoption. However, Jack Callahan, Executive Vice President at SRSsoft, emailed me a very passionate response to that post. I couldn’t let a passionate response like that go relatively unseen in my email inbox, so here’s his response (published with permission):

A major reason why the rate of EMR adoption is so slow is that, despite vendor claims, the actual needs and priorities of the busy, practicing provider are not built in. I’ve worked closely with three EMR companies, and am aware of more than three hundred EMR products, almost all of which, like lemmings, have decided to follow the old CCHIT design-and-development pathway over the cliff. For them, the basic design criterion involves answering the question: “How can our EMR product more effectively generate an automatic Progress Note so the doctor doesn’t have to dictate it, thereby generating cost savings to pay for the EMR?”The answer to that question always seems to be: “Enter a boatload of data from each exam.” Since most of this is entered by the provider him or herself, this is very impractical, especially for busy providers with limited panels to see patients due to surgical or other procedures that generate their primary revenue. The current products pursuing certification have enormous amounts of irrelevant functionality, require way too much data entry, and are largely unusable, especially by specialists and surgeons.

To make an analogy, the current requirements and “certification” process basically dictate that an EMR should be like this:

It should have wings so it can fly, but be shaped like a dump truck because it has to carry a lot of data. It needs to have a half-track undercarriage to provide good traction, no matter the terrain, but it must also function like a submarine in case it ends up in water; further, it must be made totally of recycled, renewable-resource materials for environmental concerns. It must be able to dig deep holes, but also be able to hover; it must be capable of high speeds, but also of changing direction easily. Of course, it should seamlessly switch from any of these modes of operation to any other mode on the fly and without unreasonable delay. Further, it must be adaptable enough to be modified to whatever purpose each user wants, but without giving up a single one of the attributes above, just in case.

Providers must purchase the product with their own funds . . . but may qualify for ARRA reimbursements if they meet certain requirements. These requirements will not be clearly spelled out in advance, however, but will become increasing complex over the five-year reimbursement period, which will end up covering only a small portion of the cost of the product. To qualify for reimbursement, providers must show “Meaningful Use” of the product in their practice—i.e., they must show they can hover, dig holes, navigate underwater, cross a swamp, carry twelve tons of cargo, fly from point A to point B, and spit wooden nickels if requested . . . all without making any mistakes. These requirements will remain in effect even if the practice only needs a simple product that goes in circles around a track.

Any vendor will be allowed to produce these products, but all products will be subject to “certification” that proves they can do all of the above, and more. Every vendor’s product must to be able to exchange parts with every other vendor’s product . . . and with any government-designated agency as well; however, the parts to be exchanged are not specified at the time the product is made. There is no standard for how complex these devices will be to operate . . . vendors will differentiate their offerings by hiring trained users to demo for providers how easy to use their product is by performing “canned,” simple maneuvers that they have spent months, or years, demoing in the past. Vendors can also “guarantee” they have passed “certification” to providers, who may assume that this means that Meaningful Use is also guaranteed; however, vendors have no accountability for Meaningful Use, only for certification. That chicken will come home to roost in 2011.

Some providers see this conundrum more clearly than others. Those are the ones resisting the enthusiastic adoption of EMRs for reasons of incentives alone. But with the marketing and PR weight of more than three hundred vendors seeking certification, with $36 billion in incentives dangling from the government Giving Tree, with the threat of potential penalties for not buying one of the monstrosities above by 2015, and with the offices of ONC and HHS pushing for adoption under administration pressure, how many bad decisions are going to be made in the coming year?

Providers will do best to not use the ARRA incentives as a criterion for adopting an EMR. They should buy an EMR because it makes sense to improve their practice . . . and they should find one that truly fits the way they practice medicine. Meaningful Use should not mean hours of entering data into a menu-driven system. Converting from paper to electronic records provides probably 70% of the benefit of adopting the right EMR, and every single practice will benefit greatly from that alone. Anything else is gravy. And there is lots of gravy to be had, with the right choice. Unfortunately, a bad choice can leave you with a very expensive, unusable, “certified” monstrosity. There are lots of them already lining the roads along the EMR highway, especially where specialists are. And there will be many more starting in 2011 if practices don’t do their homework.

HHS Health IT Stories from the Road

Posted on May 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.

HHS has put up an interesting new part of their website called “Health IT Journey: Stories from the road.” Here’s their description:

Have you, your practice, or your organization been through a health IT implementation? We’d like you to share your story with us. After internal review, your story may be published to inspire other providers and organizations to become meaningful users of Electronic Health Records (EHRs). Let’s learn together.

Of course, it also comes with the following disclaimer:

Disclaimer
Posting of the articles on this Web site does not necessarily constitute HHS or ONC endorsement of the procedures followed; vendors, products and services named; or overall performance of the facility’s delivery of care. We do hope you find these narratives insightful and useful in your efforts to adopt health information technology and improve patient care.

It seems like ONC is mostly looking for stories that have been published somewhere. They link to 3 articles already, but only one of those is actually available without paying for the service or signing up. This was an article about using an EHR to quantify the number of patients you’re seeing in the New England Journal of Medicine (NEJM).

Of course, you can probably imagine how high the bar is to get your story shared in the NEJM. With that said, I’m always interested in posting interesting stories on this site about people’s use of an EMR or experiences with the EMR selection and implementation processes. So, if you have a story you want to share, just send it to me on the EMR and EHR Contact form. It will be interesting to see how HHS/ONC will look at publications on blogs like this one, but they’ve been pretty open to bloggers in the past.

It will be really interesting to see what other stories are submitted, approved and published by ONC. I do applaud their efforts to try and spread the stories of EMR success. That’s a very good thing. It’s just too bad they’re promoting these stories that are stuck behind a pay wall. That’s not the way to spread good stories of HIT success.

Signs EMR Job Market is Improving

Posted on May 18, 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.

Joe from Healthcare IT today wrote an interesting post highlighting 5 signs why the healthcare IT (which I translate as EMR) job market is heating up. Here’s a summary of his 5 reasons:
-His Healthcare IT friends that were unemployed are starting to find jobs
-The Healthcare IT and EMR job boards are overflowing with good jobs (I’ve seen lots of jobs on these boards myself)
-The number of projects at clients and potential clients has risen dramatically. Meaningful Use and ICD-10 initiatives are finally starting to happen
-Headhunters are starting to call
-Bloggers, columnists and reporters are writing about “the recovery” and how to get ready for it

Not a bad list. I’m seeing a large number of jobs listed on my EMR and HIPAA job board and even more click throughs to those jobs. I think that’s another really good sign. Although, I think we still have a ways to go, the healthcare job market and healthcare IT in particular has got to be one of the best ones out there right now.

Benefits of ICD 9 Codes and How EMR Can Improve Them

Posted on May 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 got the following email from an EMR vendor talking about a simple feature in their EMR that really adds value to their end users. The feature revolves around making the ICD-9 billing codes into something useful beyond billing. Here’s his message:

I was talking with one of my pediatrician docs the other day and she was saying how un-useful ICD-9 is for her. As part of her note in the EMR she has to code things saying otitis media. But, the important thing to her is saying “3rd ear inf. in 2mo”. It is this brief summary note that she includes in what we call an “interim” field in our EMR. That is what she looks for to get her “ah-ha” in working with kids. Looking down a list of previous visits which show date of service and primary dx takes mental work and analysis. But, being able to see this brief note on the next visit is what makes her do her job better – more meaningful shall we say?

These are the things that make EMRs great.

If you have other useful features that make your EMR great, feel free to submit them on my Contact Us page and I’ll post them in the future.

A New Day … A New EMR Vendor

Posted on May 11, 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 just absolutely amazes me how many companies are coming out with brand new EMR software and trying to compete with all the various EMR vendors out there. Obviously, that’s a very good thing for me, but it seems like every day a new EMR vendor whom I’ve never heard of is launching a new EMR software.

What’s amazing is that each company is taking their own little angle on the market. It kind of goes back to my assertion that there isn’t 1 EMR market, but 50 EMR markets. Plus, with only 15% adoption (or choose your favorite adoption number) we’re just at the beginning of the competition.

Just to illustrate my point, here’s a press release I just got in my email talking about a worksite health center EMR (see below). It’s really interesting the creative ways that EHR vendors are trying to market their software. Plus, there’s a whole group of EMR vendors who have create a software and don’t have any clue how to market their product.

Fort Wayne, Ind. – May 11, 2010 – Concentra, a leading provider of employer health care services, announced today that it will utilize Medical Informatics Engineering (MIE) to bring electronic health records (EHR) and employee health portal services to Concentra clients through its worksite health centers. As more companies seek ways to control rising health care costs and improve the health and wellness of their employees, workplace health care centers with advanced health information systems are becoming an increasingly popular choice.

Concentra has expanded its workplace service offerings to include primary care services, wellness programs and personal coaching, and MIE’s WebChart Enterprise Health EHR system, providing a comprehensive health care solution directly to employees. To date, the advanced information technology system has been implemented at five Concentra worksite locations, with more slated for implementation throughout 2010. WebChart offers a flexible suite of health information products that Concentra uses to support its innovative service delivery model, allowing for each implementation to accommodate the specific needs of each client.

“MIE stood out from other EHR vendors due to their extensive experience in and first-hand knowledge of the occupational and primary health care IT space,” said Concentra Senior Vice President of Medical Operations Bill Lewis, M.D. “MIE’s Web-based, Software as a Service (SaaS) EHR model allows for integration with other employer and employee health systems, and is easily customized to meet the needs of our clients, in a wide range of industries and backgrounds.”

Through MIE’s WebChart Enterprise EHR, Concentra clients can give their employees access to send health information to the worksite health center prior to a visit. Employees can also schedule visits online, review lab results online, answer health-related questionnaires, and report work-related injuries and illnesses. Medical information documented in the EHR during a clinical encounter can then be synced to the employee’s portal page, or shared with a personal health record (PHR) solution like Google Health, Microsoft HealthVault, or NoMoreClipboard.com.

“MIE’s versatile EHR module provides a user-friendly interface for a diverse group of employer stakeholders, including employees, supervisors, and health care providers, leading to improved productivity and communication between all parties,” added Lewis.

“Medical Informatics Engineering is honored to work with an organization like Concentra that is dedicated to improving the health of America’s employees and reducing the cost of health care for employers,” said Peter Norder, Executive Vice President of MIE. “Concentra’s impressive focus on streamlining the delivery of health care and measuring the benefits of improved patient care, through more than 250 workplace health clinics in the U.S., lines up exceptionally well with MIE’s mission to put employers and employees at the center of their own health care.”

By implementing advanced information systems, caring for employees, and delivering outcomes-based clinical practices, Concentra has become the leading provider of worksite employee health services for employers in dozens of different industries. With more than 250 worksite medical clinics and 300 national medical centers, Concentra serves more than 100,000 employers across the nation and treats more than 25,000 patients each day.

For more information, please visit www.concentra.com and/or www.mieweb.com.

Transcriptionists Partner with EMR Vendor

Posted on May 6, 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.

About 6 months to a year ago, a few transcription companies joined EMR and HIPAA as advertisers. Since that time I’ve had a chance to meet with these transcription companies and I must admit that the experience has been really quite intriguing.

So many people see the transcriptionists dieing out and being replaced by EMR and other related technology. Instead, I’ve seen a real strong set of transcription companies that are working to be a compliment to an EMR installation. That’s not to say that they’re not fighting for their lives. They are, but at least they’re not dead on the vine like many might have thought.

One example of this is in MxSecure’s offering an EMR for Medical Transcription companies.

We are really excited about this for other transcription companies. They are currently 2,000 small mom and pop transcription services across the country. They all are doing a great job documenting patient encounters for their customers. As technology is changing we want to help them add more value and keep their business. As compared to larger EMR companies that promote getting rid of your transcription we are the opposite. We are for whatever the physician thinks is most productive for them.

Add in a software like MModal to the dictated notes and I’m really interested to see how an EMR for medical transcription companies is going to work out.

Full Disclosure: As I stated above, MxSecure is an advertiser on my other EMR website, EMR and HIPAA. However, I was not paid or influenced to write this post. I just found it interesting and thought others would too.

REC Transparency in EHR Selection Process

Posted on May 4, 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.

A really interesting comment about the REC EHR selection process was made over on EMR and HIPAA:

It is beyond me how any REC could have already selected EHR vendors since no EHRs have yet gone through the HHS certification process. CCHIT certification in prior years simply isn’t relevant now. I bet ONC would be horrified to hear what people in this comment string are saying…or at least, I hope they would be horrified!

What ONC needs to do is establish a standardized and TRANSPARENT process by which the RECs select vendors. The RECs are supported by taxpayer dollars, so we all have a right to know how this vendor selection is going down.

I really love the idea of ONC requiring an open and transparent EHR selection process by the RECs that are getting millions of dollars from them. Remember, each of these RECs are non profit organizations that are suppose to be helping doctors show meaningful use of an EHR. Why wouldn’t they want to have a transparent EHR selection process? What are they trying to hide?

My fear is that many of the RECs are so worried about the short timelines they’ve been given that they’re just throwing darts at the wall instead of really involving people in the process. I’m a HUGE proponent of what’s been called crowd sourcing. It’s really amazing the type of information you can get to make a better decision when you involve a large group of people in the process. I hope the RECs will do just that and be transparent in their EHR selection process.

Side Note: We’re getting a lot of the RECs and their websites listed on this list of EHR Regional Extension Centers wiki page. Please add any others that you might know about.

Large EMR Responsiveness (or lack thereof)

Posted on May 2, 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 the following email from an EMR vendor that highlights a number of interesting things about what it’s like for customers interacting with their EMR vendor. It’s very much in line with the experiences I’ve seen and heard. I’ve removed the specific EMR vendor names since the names don’t matter as much as the general experience. Instead I’ve used “small EMR vendor” and “large EMR vendor” and “ePrescribing solution.”

I was looking for an ePrescribe solution to interface to our small EMR vendor about a year ago and settled on using ePrescribing solution. As you probably know, they bailed out of the business and sold their service to large EMR vendor. Now we’ve interfaced our product with theirs.

The thing that makes me chuckle is my clients beat me up all the time on saving “clicks” and yet they don’t say a negative thing about the steps associated with large EMR vendor. I guess its because they know I have control over my product and they realize there is zero from the large EMR vendor.

As an observation, questions and low-level technical support was very, very good from the old ePrescribing solution. It appears to be non-existent with large EMR vendor – maybe because they’re busy dealing with so many conversions from the purchased ePrescribing solution? Don’t know. I also know from first-hand experience that support is rather poor with large EMR vendor.