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Potential Medicare Exodus and EMR Stimulus Penalties

Posted on June 30, 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.

The idea that there will be penalties is a joke. The ongoing (10 years and counting) SGR debacle has thoroughly disgusted physicians who have already begun to reduce or completely eliminate Medicare patients from their practice. If Medicare starts to nickel and dime those still willing to take Medicare patients – for not using e-prescribing, not participating in PQRI (which is cash-negative for those who participate) or not implementing EMR, they’re even dumber than they’ve already demonstrated.

Pile on 5010 implementation, ICD-10 CM implementation, another ongoing PECOS fiasco, the interminable MAC transitions, RACs, PERMs, Z-PICs, HEAT, etc. and Medicare (or Congress) thinks a penalty will motivate physicians to buy new software – or that the doctors will tolerate a payment reduction when their 2010 payments are LESS than their 2000 payments?

I can’t remember where I found this quote. Probably on a LinkedIn forum or something. This voice is actually getting louder. Notice that it doesn’t really talk about whether they want to use EMR software or not. It’s really the start of what could be a huge exodus from Medicare as opposed to a revolution against EMR software. Plus, it highlights the fact that doctors (and people in general) don’t want to be forced to do something. Yes, even something that could be a benefit to them. Of course, that’s why I’ll keep telling doctors to not worry about the stimulus and the penalties and focus instead on the list of EMR benefits.

6 EHR Myths

Posted on June 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 got the following 6 EHR myths from this presentation:
Myth #1: EHR Projects are IT Projects
Myth #2: EHR Software is useful out of the box
Myth #3: EHR Vendors will provide all the project management and assistance I need
Myth #4: I can manage my own EHR project
Myth #5: All EHRs are the same
Myth #6: EHRs can communicate with one another

I thought this was an interesting list to consider. The only one that kind of bothers me is Myth #4. I think this one really depends on the size of the practice and the skill of the physician/office manager. Many a clinic had done a great job implementing an EMR on their own. Granted, there are probably more failed ones who’ve gone it on their own. I guess I’ll stand that you can do it on your own, but be sure to know what you don’t know. Don’t be afraid to ask for help with those things you don’t know.

What do you think of this list?

Relaxing of Meaningful Use Final Rule

Posted on June 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 a lot of interesting speculation going on right now around what HHS is going to do in regards to meaningful use. There’s no doubt that a lot of the feedback given to HHS on meaningful use surrounded the idea that it was too much and had too many objectives. The question remains, what will HHS do with this feedback?

A number of people have suggested that the meaningful use objectives will be relaxed. In this company is past healthcare IT czar, David Brailer. The interesting part of this chorus is that it includes a large number of providers that say it’s going to be relaxed. Then, they follow up that statement with something like, “If it’s not relaxed, then doctors won’t show meaningful use and will not worry about the EMR stimulus money.” Basically, it will become a failed government initiative if the meaningful use bar is too high.

Other people are suggesting that meaningful use is going to stay the same. Carol Flagg of HITECH Answers quotes the following from David Blumenthal as indication that meaningful use will not substantially change:

“Introducing change in health care is never easy. Historically, adopting our most fundamental medical technologies, from the stethoscope to the x-ray, were met with significant doubt and opposition. So it comes as no surprise that in the face of change as transformational as the adoption of health IT – even though it carries the promise of vastly improving the nation’s health care – some hospitals and providers push back….The question health care providers are facing today is whether we are pushing too hard, too fast to make this important change. I respectfully submit, no. In turn, I ask, ‘Can we make these changes expeditiously enough?… Every provider, every patient throughout our nation will benefit from the goals envisioned by the HITECH Act. Yes, this will be a challenge. While large hospital networks and smaller providers may be stretched to meet national health IT goals, it is not beyond their capacity for growth.”

Little by little I’m leaning this direction. I’m not sure exactly why, but I’m getting the feeling that HHS either can’t or won’t change the meaningful use criteria. It’s basically going to be similar to what we have now with maybe one or two items of note.

What do you think? What will happen with the MU final rule?

CCHIT Comments on Final Rule for Temporary EHR Certification

Posted on June 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.

After noting that CCHIT had gone quiet and posting about Drummond Group’s view of the EHR certification final rule, it seems appropriate that CCHIT has finally come out with their own comments.

The CCHIT blog post was done by Alisa Ray but says it’s a statement from Karen M. Bell, MD, Chair, CCHIT. I think that’s a bad sign for those of us who like executives that blog that Karen Bell sent the blog post through Alisa Ray, but maybe Karen’s still just getting setup on the new job.

There’s nothing really all that shocking or newsworthy in the CCHIT blog post. Here’s the cliff notes version (with some of my own commentary):
CCHIT will apply to be a “ONC Authorized Testing and Certification Body (ONC-ATCB).” – Not a surprise since EHR Certification is CCHIT’s only business model.
CCHIT will continue their “independently developed programs.” – They used their favorite word “assurance” in correlation with their programs again. Sadly, they just assure doctors that some programmer knows how to run their test scripts before paying CCHIT $30k+ to get their EHR certification. They don’t assure that an EMR is more usable, or has a higher implementation success rate, or that it saves more lives or increases reimbursement. Nope. Those assurances would run at least $100k to certify;-)

At least in the blogosphere, there’s been a number of healthcare IT bloggers proclaiming the end of CCHIT. Sadly, I’m not one of those. I think they’ll be around for a while and there’s still A LOT more educating that needs to spread about what an EHR certification is and what it is not.

Also, Michelle at Occam PM wrote a blog post that includes some interesting word clouds of the CCHIT and Drummond Group bog posts. An interesting view of what was said.

Drummond Group’s View of EHR Temporary Certification Program Final Rule

Posted on June 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.

If anybody was doubting that Drummond Group was ready to be a player in the EHR certification rule, I think this blog post should make them think twice. You can tell from the tone of the post that Drummond Group had been waiting for HHS to issue the final rule so they could get moving.

In the same blog post, Drummond Group provides a short summary of some of the major changes to the rule after the comments:

* Waiving of the 30-day delay in the effective rule. This is by far the most significant “change” in terms of how it impacts vendors, providers and hospitals. Typical procedure for Final Rules is to have 30-day delay after it is on the Federal Register before it becomes “effective”, but this can be waived in certain situations. What this means practically is that once the Final Rule goes into the Federal Register, say around July 1, the Temporary Certification Program will be active and ONC can begin processing applications from organizations like ourselves intending to be ATCBs. ONC does give themselves 30 days to process and approve the application so you still may not see an ATCB officially testing until possibly August.

* Temporary Certification Sunsets No Earlier than 12/31/11. The NPRM had stated that the Temporary Program ends (and the Permanent Program begins) when there is an accredited ONC-ACB. Now, the Temporary Program is given a clear window of operation through the end of 2011, and it may be extended if an ONC-ACB is not found by then. This gives more stability to the Temporary Program.

* All ATCBs Must Support Remote Testing. The NPRM had previously only required support of testing at the local ATCB facility. Now, remote testing is required for all ATCBs. Remote testing can be done either at the development site (vendor) or deployment site (provider or hospital implementation). Based on our DGI surveys, remote testing was by far the preferred method, and ONC also received the same feedback.

Drummond Group also suggests that ONC really did listen to the comments that were given. I don’t doubt this actually. The people I’ve met from ONC really do seem like good people that are trying to do their best within the government limitations. It’s just unfortunate that the government limitations are so onerous.

Now the real fun begins as the various EHR certifying bodies start to appear and EMR vendors get to decide which body they should use.

WSJ Says EMR Efforts Get Pushback

Posted on June 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.

The WSJ health blog wrote an interesting article a week or so ago that describe the EMR stimulus as “Too Much, Too Soon” Here’s an excerpt of the article:

At issue are the grants available under the stimulus bill to doctors and hospitals showing “meaningful use” of electronic health records. Early signs are that meeting that “meaningful use” standard will be tough, with about 24 requirements by 2011, Politico says. (A final rule is expected this month.)

It’s tough for doctors’ offices and hospitals to fully digitize their operations in that short period, and not clear that early returns on systems allowing such things as digitally transmitted prescriptions or patient access to electronic records will show gains in either costs or quality of care, Politico says. Suggestions include pushing back the deadline or, as one HHS official says, a partial credit system.

Here’s the link to the Politico article they mention.

Of course, my question is, are these comments “Too Little, Too Late” for HHS and the government to be able to do anything about changing the EMR stimulus plans around meaningful use and certified EHR?

iPad EMR Demo in Apple Store

Posted on June 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 find this completely fascinating. Yes, the Apple Store is demoing various medical applications like EMR on the iPad. Here’s an excerpt from blogger Iltifat Husain walking into an Apple Store:

When I recently walked into my local Apple store to buy an iPad accessory, I saw a group of about 20 people huddled around a large LCD screen while an Apple employee was giving a workshop.

When I saw the LCD screen full of medical applications, I was shocked. This wasn’t your run of the mill “how to use your iPhone” workshop.

The people gathered for the workshop consisted of healthcare professionals in medicine, dentistry, and other fields. About a third of the group consisted of physicians.

The workshop was focused on how the iPhone and iPad can be useful for their practices and as reference tools for day to day work.

The workshop was led by an Apple employee who went through a slideshow presentation of useful medical applications, such as Epocrates, iMurmur, Airstrips OB, and many of the other useful applications we’ve featured on iMedicalApps before.

Along with the presentation given by the Apple employee, a MacPractice representative was on hand to demonstrate their electronic health record and how it worked from the desktop to the iPhone and to the iPad.

Pretty interesting to see Apple committing that type of resource to marketing the clinical applications.

Analysis of REC Funding

Posted on June 14, 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 addition to what I wrote about in my previous post, Marc Holland also does a pretty detailed analysis of the resources that RECs will have available to help resolve these physician concerns. He estimates in New York (where there are 2 RECs), they will have $4850 per physician available. The Ohio REC has $4750 per physician and the Michigan REC has $3300 per physician.

Of course, this per physician rate is a little misleading since these RECs won’t get their entire grant if they don’t perform. So, depending on how they do, it could be even less.

He also estimated based on the above numbers and the average cost for an EMR consultant that the RECs to break even would be able to provide “roughly two person-weeks in total – for contracting, for site planning, for training, for installation and first line post-implementation support.” Then, he suggested that wasn’t likely enough.

I generally agree that 2 weeks is not enough. However, it depends on the EMR consultants and more importantly, how creative the RECs become in using their EMR consultants and other resources. I’ve implemented in a clinic in two person weeks total spread out over a bit of time. So, it’s definitely possible. However, is that the best use of the resources the RECs have been given?

I personally don’t see the RECs providing this type of “free EMR consulting” services. I think the RECs are going to focus on more broad based strategies. The problem is that if you’re too broad based, then you aren’t that helpful. However, if you’re too focused then you can’t help enough people. Walking this line is going to be an interesting challenge.

Marc Holland, also suggests from the above numbers that the New York RECs alone will have to ramp up staffing to at least 100-120 analysts in the next 60-90 days. For me, that’s just funny to even think about. How many qualified EMR analysts (consultants if you will) are there in the US? And how many of those that are really qualified will want to go and work for a REC?

This is going to be really interesting to watch.

CCHIT’s Gone Quiet

Posted on June 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.

If you’ve read this blog and/or EMR and HIPAA, you’re quite familiar with my feelings about CCHIT. I just don’t see the value that they add for doctors. If they could show me how they help doctors and not just EMR vendors who want a third party validation to sell more product, then I’d be willing to change my mind. But I digress…

Looks like with the new head of CCHIT Karen Bell taking the reigns, the CCHIT blog has mostly gone quiet. Mark Leavitt did post a good bye on his last day. Sadly, not a single person commented on that blog post saying thank you, best of luck, or anything. So much for 1723 readers subscribed to their blog. I honestly feel a little bad that no one commented. While I disagreed with many opinions that Mark and CCHIT represented, Mark always seemed like a very sincere guy that did care.

Besides that, there’s a post about preparing for the EMR stimulus, but it just links to an outside article. Maybe they should link to some of my articles or even my EMR selection e-Book. I bet they’d like that.

I can imagine how frustrating the EMR stimulus must be to them. Not to mention HHS’s inability to finalize the details of EHR certification bodies and meaningful use. They are kind of in a wait and see pattern until HHS finishes their work.

CCHIT did put out a new search tool. I’m just glad they’re not developing EMR software. Their search tool is one of the most confusing things I’ve seen. At least the lists were easy to understand (once I found them).

We’ll see if CCHIT starts blogging again once HHS gives us some meaningful details.

Allscripts Acquires Eclipsys

Posted on June 9, 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, it was announced that Allscripts will acquire Eclipsys for $1.3 billion. This is a really big move and not all that unexpected. We knew that consolidation was coming and for that matter it’s going to keep happening. However, this is a very large merger that has a lot of questions. Allscripts and Eclipsys have created a new site for the acquisition.

Here’s a video of Glen Tullman talking about the acquisition of Eclipsys:

The comments made on the HISTalk post about the merger were really interesting. Here’s just a few:
From NYC EMR:
Allscripts hosted a meeting Monday showing integration options with Eclipsys with some of their mutual clients (NYP, Lahey, etc). This didn’t go well for Allscripts, clients dont like the product and hate the integration obtions. One client calling it an abortion, one other saying it is a good attempt but falls short. They also commented negatively on AllScripts management saying they sell well, but can’t execute. Privately the clients me and to a tee they said Eclipsys new release is what they want with more content, but that AllScripts is well off the mark for a go-forward Ambulatory solutoin. Hopefully Eclipsys will continue to build out thier solution instead of some hokey integration story that Allscripts is touting to make up for their lack of an acute care offering. Does anyone else know anything about this?

From Not Happy:
“Eclipsys, you have over 20 million a year from a client and what did that go to? No enterprise revenue cycle product, 50 million for Bond and Medinotes? Now the investment goes towards 5 plus ambulatory and HIE products? Merger has WAY too many products for the same markets- Ambulatory alone has Mysis, allscripts touchworks, allscripts professional, Eclipsys sunrise amb, Eclipsys peak (bond clinician), and Medinotes.”. Forest Gump take away- RUN, RUN, RUN

From Lazlo Holyfeld:
Smorgasbord. My bet is that Sunset Ambulatory and MyWay get sunsetted in the end. Allscripts has Peak Practice for the small practices while keeping Professional & Enterprise for the big clients. Allscripts did waste some R&D funds on trying to update the source from Aprima to bring MyWay up-to-speed this year especially on the coding/billing side. In the end, it is still a pig with lipstick on it. If you really want MyWay, you are better off with Aprima (iMedica).

As for the HIE aspect, that is the harder part of this to guess what plays ot. Allscripts has several parternships with various HIE vendors but dbMotion is their contracted partner. If a client doesn’t want dbMotion, they have to have a seperate agreement.

More interesting to see what happens with the Eclipsys relationships with Medicity & Microsoft. Less clear on what happens there.