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EMR Doctor’s Blog: When does efficiency in documentation become misguided and counterproductive?

Posted on November 29, 2010 I Written By

We have all seen medical records from an emergency department (my apologies to the blissful ignorant out there — you don’t want to know if you don’t already). Much like sausage, they come out pretty much all ground up, full of information that at first glance can be difficult to figure out. If you find yourself asking questions such as, “Where is the part about why the patient came in and what the doctor thought about their case?” then you just might have one of these notes. They’re actually one of my favorite types of “old medical records” to sift through for the purposes of “reviewing and summarizing”. This is because when you’re dealing with gobbledygook, well, there’s not much to summarize. It’s easy to flip through forty or fifty pages in no time and say that you have honestly reviewed and summarized the old records, which are full of near meaninglessness that doesn’t impact my decisions in the patient’s care much, if at all.

The ER notes (and many primary doctor visit notes nowadays) result from having programmers who don’t appear to understand the appeal of a well-written note in facilitating basic communication. Computer programmers who get their hands on the list of required information that must be put into a note to pass by insurance standards don’t always design good products. Unfortunately, this really only highlights the insanity of criteria for medical documentation to gain the golden eggs of insurance company reimbursements for providing medical services. I’ll save those crazy criteria for some other day. Nonetheless, the tax man and the gobbledygook cometh. If only they had the guidance of a practicing physician in the design process!

Unfortunately, as the gold rush for economic stimulus dollars ramps up, poorly designed systems will most assuredly continue to be thrown onto the market. I recommend to anyone considering incorporating an EHR system into your practice that you actually consider and request to review a sample of the output format. If it looks like something that would embarrass you to show your former mentors from the residency or fellowship program in which you trained, then I would posit that this is probably not fit for medical documentation. If no one wants to read what you wrote, then is it really worth doing? And please don’t be fooled into thinking that spending more money is the key to getting a better product. Ask the EHR vendors to put their money where their mouth is.

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.

Giving Thanks

Posted on November 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.

I won’t repost here, but in case you don’t follow my EMR and HIPAA blog as well as EMR and EHR, go and check out my Thanksgiving post on EMR and HIPAA.

Happy Thanksgiving!

EMR Stimulus Money Secure from Political Changes

Posted on November 23, 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 discussed on multiple occasions the possible impacts of the congressional changes on the EMR stimulus money. Justin Barnes on The Health Care Blog recently posted the best reason I’ve seen yet for the EMR stimulus money and meaningful use being safe from being cut, stopped, or otherwise maimed due to some political change. Here’s his description:

Fundamentally it’s important to note that the Health Information Technology for Economic and Clinical Health (HITECH) Act, from which the Meaningful Use program and its funding originates within the American Recovery and Reinvestment Act (ARRA) of 2009, is an entirely different statute than PPACA.

Bipartisan support for the tenets and the spirit of HITECH dates back at least seven years, and it is also noteworthy that the Office of the National Coordinator for Health Information Technology (ONC), which administers Meaningful Use, was created by the Bush administration and a Republican Congress.

Politics aside though, the reason that Meaningful Use funds are secure is because they are drawn from the Medicare Trust Funds held by the U.S. Treasury, and are therefore not subject to annual Congressional budget appropriations or oversight.

From what I’ve read, the funding is really the only tool that the republicans have to damage the various democratic legislation that they don’t like. Since the meaningful use funds are part of the Medicare Trust Funds and not subject to the congressional budget, I think that clearly defines why the EMR stimulus money is safe.

So, you can all go out and safely buy your certified EHR and start showing meaningful use of your favorite EHR software.

Meaningful Use Resources Poll

Posted on November 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.

Inga at HIStalk Practice recently posted a poll about the types of resources that a practice plans to use in order to achieve meaningful use. Officially the poll asks, “For those employed by physician practices: which of the following do you expect to engage to help you reach Meaningful Use?” I thought it was an interesting question and since they use poll daddy, I could post the exact same poll below. So, let’s hear what resources people plan to use to achieve meaningful use.

Hospital Preparation for Meaningful Use

Posted on November 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.

HIMSS Analytics recently sent out some interesting results from a survey the did of hospital’s preparation for meaningful use. Here’s the results:

*Nearly one quarter (22 percent) of participating hospitals have the capability to achieve 10 or more of the required core measures in the meaningful use Stage 1 requirements.

*Some 34 percent of respondents have the capability to achieve between five and nine of the core measures for meaningful use.

*Just over 40 percent (40.47 percent) of the market indicated they have the capability to meet five or more of the menu items for meaningful use.


Click on the images to see the larger images.

As lone data points it’s hard to judge if hospitals are making progress or not. I’ve heard many people say that hospitals are going full bore towards meaningful use and that ambulatory practices are slower to adopt EMR and meaningful use. I’m not sure this is totally true. Plus, the lead time needed to implement in an ambulatory setting is so much shorter than in a hospital. Even a hospital that owns ambulatory practices.

I’m told that HIMSS Analytics will be doing this same survey every couple months. I’ll see about publishing the results as I get them so we can compare the change.

HL7 Interface Lady Gaga Pokerface Parody by EMR Vendor Nuesoft

Posted on November 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.

Looks like this is the week of the healthcare IT related videos. Yesterday I posted the EMR Stimulus overview video. Today, a much more exciting and fun video called “Interface.” This video is a parody of Lady Gaga’s Pokerface, featuring the IT department at EMR vendor NueMD.

Here are the revised lyrics:
You want your EHR to talk to NueMD?
No problem! – we’ll connect ‘em,
Data flows so easily.
Appointments and encounters are an easy place to start.
And after we’ve been hooked up
You’ll have data in your charts.
Oh o-oh oh oh, o-o-o-o-o-oh
We’ll hook ‘em up, show you what we’ve got (2x)
If you need a, you need an interface
We know the HL-7 (2x)
Int-int-int-interface, your interface
(mum-mum-mum-mah) (2x)
Tired of typing data into your machine?
Communication is a breeze with NueMD
Double data entry is making me work a ton
And when the patient leaves without the bill my money’s gone (gone)
Oh o-oh oh oh, o-o-o-o-o-oh
We’ll hook ‘em up, show you what we’ve got
(2x)
If you need a, you need an interface
We know the HL-7
(2x)
If you need a, you need an interface
We know the HL-7
(2x
If you need a, you need an interface
We know the HL-7
(2x)
If you need a, you need an interface
We know the HL-7
(2x)
Int-int-int-interface, your interface
(mum-mum-mum-mah)
(2x)
I will tell you that we link you, fix or plug you,
I’m Connectin’ it’s perfection,
I’m not lying, I’m just stunnin’ with my interface runnin’
Like a doctor on the go-go; take your info when you go out
And I promise this, promise this
That this interface – it’s marvelous!
If you need a, you need an interface
We know the HL-7
(2x)
In-in-in-interface

Short Video Overview on EMR Stimulus (HITECH)

Posted on November 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.

Check out this 4 and a half minute video that talks about the details of the EMR Stimulus (HITECH Act) EMR stimulus money. This is by far the best EMR stimulus video I’ve seen that gives a nice high level overview of the HITECH act. I hope that they do some other similar videos with more details on meaningful use and certified EHR since this is the only meaningful use video I’ve found.

If you know a lot about the HITECH act, you won’t enjoy this video. However, doctors who don’t know too much about the EMR stimulus money and how the HITECH act works will enjoy it.

Is this EMR Uncoventional?

Posted on November 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.

In a new series of posts (or maybe this will be the only one…we’ll see), I ask the question, Is this a conventional EMR or not?

This question comes from my post about Unconventional EMR software and the responses I receive. Now it’s up to you to look over the description I got of an EMR software and decide if it’s unconventional or not. I have a feeling the comments on this post are going to be very interesting.

First up is the BennPen EMR software by Bennethum Computer Systems.

BennPen sent me the following major advantages to their EMR software:

There are many Electronic Medical Records programs on the market. Ours is different because:
– BennPen is much simpler and easier to use than other EMR programs. Our goal in developing
BennPen was usability. A major reason why many Doctors are not using EMR is that most EMR
Programs are difficult and time consuming to use.
– BennPen is customized for each Doctor whereas other programs are not. This means BennPen
can be used for any specialty. BennPen is less expensive than other EMR programs initially and
ongoing because we do not charge an annual maintenance fee.
– BennPen has a 60 day free trial. To fill out your templates and letters you can use voice, drop
down lists, or a combination of both. A choice of an item on a drop-down list can automatically
bring up another list of items pertaining to that choice. A Medicare approved RX module is
available.
– E-mailing of patient chart information to other Doctors and/or to patients. Insurance
verification can be done thru BennPen. BennPen has a recall system.
– The BennPen data-base is stored on the server in your office. You have more control over your
data compared to a web-based program. There is no worry about the internet communication
going down. You do not need to purchase a separate server for EMR.

I then sent them this response to really have them try and make a case for their EMR being unconventional and to be able to get information on whether it’s unconventional or not:

I think that a few of your major advantages could be differentiators, but it seems like some of the things need more proof. Otherwise, it just sounds like marketing hype.

For example, it’s one thing to say that your EMR is “much simpler and easier to use than other EMR programs.” The question is, how can I know that this is the case? Do you have some examples that illustrate how it’s much easier and simpler? Do you have some doctors who have been on other EMR software that can support the claim?

Creating a customized EMR for a doctor is another example. If all you do is add in 5 or so customized template, that’s not really a differentiator. Now, if your EMR is modeled so that every step in the process is customized for the doctor to meet their practice needs and you have a couple examples of 2 doctors with drastically different work flows. Then, we’re talking.

Do you see what I’m trying to say? Maybe you really do have an unconventional EMR, but you really need to make the case for me (and my readers) to believe. I’d love to see the case made.

I then got the following response to my comments.

Thank you for reviewing our information. I’ll try to respond to your questions.

EASE OF USE: The fewer the screens the easier a program is to use. There are 8 descreet screens in BennPen but a Doctor would only need 5 screens to do his/her charting. I would think that a Doctor would have his staff do things like set up recalls, check eligability, etc. I have seen Doctors use other EMR’s and there appears to be a lot more screens used. Our screen have been designed to be uncrowded and easy to use. The EMRs I’ve seen have crowed screens.It takes me only 15 or 20 minutes to completly demonstrate BennPen. My guess is that other EMR demos would run alot longer than that.

CUSTOMIZATION: We put into our program the templates, forms, letters that the Doctor currently uses now. He or she then does electronic charting with the same forms they are used to using with voice and drop-downs. Among other things this means we can offer our program for any specialty.

Our program is much less costly than many others – $3,000 and no annual fees. If you would be interested I’d be happy to send you a demo of BennPen. If you’d like to speak with me our number is 800-982-2623.

So, I ask you…

Is This EMR Unconventional?

UPDATE: In the comments and online I was asked to get some screenshots of this EMR for people to evaluate. I got the following message and screenshots for people to see. Just click on the image to see a larger version.
There are 6 of these, one more than I previously said. I decided to include the screen for sending patient chart notes to another provider because the Doctor can send only selected notes that he/she desires rather than all medical history and that would be the Doctor’s decision rather than a staff member. There are other screens for printing reports, checking eligibility, setting recall appointments, etc. which functions I believe the staff would do.

Creative EMR Price Reduction

Posted on November 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.

I always love creativity and so I have to give credit to the marketing people at meridianEMR. They’re providing an interesting price reduction in their EMR that keys off of many physicians anger over the potential 21.9% Medicare reimbursement cuts. Here’s a few portions from the meridianEMR offer:

In order to provide physicians with relief from Medicare fix uncertainty, meridianEMR is offering a special “meridianEMR Doc Fix.” This includes a 21.9% reduction on all new meridianEMR system orders for new Urology customers starting November 10, 2010 and ending December 31, 2010. This unprecedented offer during these uncertain times directly reflects one of the core values of meridianEMR, which is partnership with clients.

“If the government does not rescind the “Doc Fix” of 21.9%, our offer still stands. We encourage our potential new clients to move forward with confidence that they will be receiving the market leading Urology EHR at the most affordable price ever offered by meridianEMR. This is our way of standing by their side in a challenging economic environment,” commented Lawrence Drappi, Executive Vice President, meridianEMR.

I’m sure that many doctors will appreciate the gesture. Pretty creative to key off of cuts that have been seen as such a negative thing. I wonder if other EMR vendors will follow their lead. Many of the EHR software out there could use at least a 21.9% cost reduction.

New HIMSS CPOE Wiki Illustrates Complexity

Posted on November 10, 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 got an email about the new HIMSS CPOE wiki that was just launched. I barely want to link to it since it makes me laugh. Plus, it’s not a true wiki since only members that have been approved can edit the wiki. It’s not open like the EMR and HIPAA wiki and other real wiki pages. That said, if you still want to take a look, here’s the link.

To be honest, I haven’t looked through much of the information on the wiki. First, because I was turned off by my inability to be able to edit the wiki if I saw fit. Second, because I saw this diagram on the main page which completely turned me off to it.

Here’s the diagram (click on it to see the full size image):

My blood pressure starts to rise just looking at the diagram. The number of lines that cross over with arrows going every which way is hard to follow. There are two starting points and no clear end point. It’s amazing the complexity they’ve put into what should be a clear diagram that tells a simple story. I should mention that the diagram is suppose to be the navigation diagram for the wiki, but it seems like their plan was for the navigation to be a model for someone going through the steps of a CPOE implementation.

Is there any wonder why CPOE hasn’t been implemented? Although, I can’t help but wonder if CPOE is this complex to implement or whether the people creating the diagram are what made the CPOE implementation so complex.

Maybe I should ask some of the CPOE workgroup members. After all, there names and emails are available to anyone on this page of the wiki.

I would have commented on the wiki itself since it says it has the capability for commenting. Only problem is that it says, “You don’t have permission to comment on this page.” Oh well, at least I have a blog where I can comment.