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Medical Care and Primary Care without Insurance Allows Technology to Flourish

Posted on June 30, 2011 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 previously posted that I believe the real EMR innovation will likely have to come together with healthcare innovation. The basic premise being that our current insurance reimbursement system is a weight on the backs of EMR software. The insurance requirements cause much of the unwieldy interfaces that are put out by EMR software and insurance requirements and limitations are a huge limiter on the technology innovation that could occur in healthcare.

Imagine how much more streamlined the EMR interface could be if EMR companies worried about patient care and not reimbursement. Imagine the new technologies that would be implemented if you weren’t so worried about the office visit reimbursement model we have today.

This premise is why I was so intrigued by this post on the popular Tech Startup blog, Techcrunch, called “The Most Important Organization in Silicon Valley That No One Has Heard About.” In the article, Dr. Samir Qamar has been putting together a different model for healthcare. “For only $49 per month and $10 per visit, MedLion is able to provide high quality medicine at a price point nearly any family can afford.”

How is he able to do this? Here’s a quote for part of how he’s able to accomplish it:

Part of MedLion’s value proposition has been availability to its patient base. Like many direct primary care practices, they find more than half of their patient interaction is via electronic means, as they aren’t forced by reimbursement rules to have a patient come to their office for something that could be done simply over phone or email. We want to be available for our patients whether they are in the Bay Area, Bali or Boise.”

I’m not sure if Dr. Qamar has found all the healthcare Innovation secret sauce, but I’m grateful for pioneering entrepreneurs like Dr. Qamar that are willing to try something different. Plus, there’s no better place for the application of technology than in these new models for healthcare. It’s exciting to consider what technology could really do when it’s not shackled by the 100 pound gorilla.

HIMSS EHR Association Offers HIE Strategy, World…Yawns?

Posted on June 29, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

In my naivete, I thought the following might be a serious milestone, or at least a thought-provoking read.  Consider the serious tone of this announcement:

The HIMSS Electronic Health Record Association (EHR Association), a collaboration of 46 EHR supplier companies, announced today the availability of a major new white paper “Supporting a Robust Health Information Exchange Strategy with a Pragmatic Transport Framework”.  The focused recommendations in the white paper, aimed at key health IT stakeholders, are based on proven standards and successful health information exchange (HIE) implementations around the world.

Then I took a few spoonfuls of my cereal, drank some coffee and my mind woke up. Oh yes, right, an announcement and a white paper will power the languishing HIE market into action. Right, and President Obama will show up next week and do my laundry.

Honestly, folks, I’m an analyst with health IT background, not a developer or CIO type — so I’m not qualified to say exactly what technologies will work. But I do know posturing when I see it, and that HIMSS press release is rife with quasi-visionary statements. More pointedly, the paper does little more than point to some successful projects and say “See, aren’t they great?”

In any event, I have little confidence in any announcement that proposes to offer the solution, or even the outline of the solution, to any of life’s big problems:  say, the national debt, the struggle for world peace or linking a bunch of fragmented, siloed regional clinical data-sharing projects into a workable whole.

Lest you think I’m a lone cynic, ponder this reaction from an EMR industry insider who preferred to remain anonymous:

“Just about all of this white paper beyond the Direct Project stage is pure B.S. Bits and pieces can be demonstrated at Connectathons, etc. but it will be impossible in the real world to have generalized usefulness with all this overly complicated garbage. It is almost as if the EHRA is conspiring to thwart real interoperability progress.

Look for the push methodologies/capabilities arising out of the initial Direct Project pilots to expand to provide the functionalities this report claims are not possible. This will happen and just supersede all this proposed nonsense because it will simply, incrementally work.”

Now *that* analysis makes tremendous sense to me. If The Direct Project — or other efforts to follow — can foster the growth of sensible data-sharing schemes, we might just get our national HIE. If not, well, don’t look to announcements like these for answers.

Haven’t Been Paid your EHR Incentive Money Yet? One Possible Reason Why

Posted on June 28, 2011 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 CMS FAQ site has a great question up that I have a feeling a number of doctors will be interested in knowing the answer to:
I am an eligible professional (EP) who has successfully attested for the Medicare Electronic Health Record (EHR) Incentive Program, so why haven’t I received my incentive payment yet?

Here’s their answer:

For EPs, incentive payments for the Medicare EHR Incentive Program will be made approximately four to eight weeks after an EP successfully attests that they have demonstrated meaningful use of certified EHR technology. However, EPs will not receive incentive payments within that timeframe if they have not yet met the threshold for allowed charges for covered professional services furnished by the EP during the year.

The Medicare EHR incentive payments to EPs are based on 75% of the estimated allowed charges for covered professional services furnished by the EP during the entire payment year. Therefore, to receive the maximum incentive payment of $18,000 for the first year of participation in 2011 or 2012, the EP must accumulate $24,000 in allowed charges. If the EP has not met the $24,000 threshold in allowed charges at the time of attestation, CMS will hold the incentive payment until l the EP meets the $24,000 threshold in order to maximize the amount of the EHR incentive payment the EP receives. If the EP still has not met the $24,000 threshold in allowed charges by the end of calendar year, CMS expects to issue an incentive payment for the EP in March 2012 (allowing 60 days after the end of the 2011 calendar year for all pending claims to be processed).

Payments to Medicare EPs will be made to the taxpayer identification number (TIN) selected at the time of registration, through the same channels their claims payments are made. The form of payment (electronic funds transfer or check) will be the same as claims payments.

Bonus payments for EPs who practice predominantly in a geographic Health Professional Shortage Area (HPSA) will be made as separate lump-sum payments no later than 120 days after the end of the calendar year for which the EP was eligible for the bonus payment.

For more information about the Medicare and Medicaid EHR Incentive Program, please visit http://www.cms.gov/EHRIncentivePrograms.

This is actually something that I’ve written about before (probably on EMR and HIPAA), but I have a feeling many people weren’t looking at the details to realize why they aren’t getting their incentive money. You have to wait until you have enough Medicare Allowable Charges before they’ll pay you. I think this is a smart plan I do find it interesting that there were some clinics that had enough allowable charges in 3 months to receive the full EHR incentive money right away. I’d love to see some stats on medicare allowable charges per provider. Would be interesting to see how this aspect of the EHR incentive program affects Medicare providers.

Either way, hopefully this information will help someone who is wondering where they EHR incentive money is. Thanks to @jimtate for tweeting the FAQ and reminding me of this part of the program.

Singapore Launches National EHR, London Hospitals Go To The Cloud

Posted on June 27, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Today I bring you a couple of interesting clinical data stories from outside the U.S. One involves a cloud pilot and the other a national EHR; while U.S. providers are toying with the former, I doubt the latter will ever happen. Anyway, without further ado:

* Singapore Launches National EHR

Working with Accenture, the country of Singapore recently launched one of the world’s first national EHR systems. The system itself seems straightforward — it will capture medical data and patient demographics across clinic, acute care and community hospital settings — but its scale makes the project unique.

Obviously, the U.S. is nowhere near to creating such a network, and given our industry’s chaotic structure, I don’t see it happening anytime soon. Even centralized, nationally-controlled health systems are struggling to pull something like this off.

It certainly helps that Singapore has a population of just five million; the country plans to spend $144 million just to reach this relatively small group. It’s hard to imagine what it would cost to roll out such a network across the U.K., much less a giant country like the U.S.

Not surprisingly, Accenture worked with many vendors to make the rollout work, including Oracle, Orion Health, IBM and HP.  The partners completed the first stage of the rollout in 10 months (pretty impressive, if you ask me!)

*  National Health Service Pilots Cloud-Based Health Data Services

Next month, London’s Chelsea and Westminster Hospitals plan to begin storing all patient data in in the cloud. The effort, known as E-Health Cloud, is a National Health Service pilot test. The system will offer fine-grained access controls, allowing patients to decide exactly which clinicians, friends and family members can access their records.  According to a report in Engadget, security is tight; users will have to verify their ID multiple times to access their medical data.

As you may know, a small number of U.S. hospitals are experimenting with storing data in private and public clouds. But I’d wager that this effort, backed by a national entity that can roll things out when it pleases, is likely to move far more quickly than U.S. healthcare cloud deployments.

So, progress in Singapore and the U.K.  Somehow, knowing what can be done, the state of regional HIEs and cloud projects in the U.S. seems a little bit depressing, doesn’t it?

What Should We Make of Google Health’s Failure?

Posted on June 26, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

So, Google Health’s slow collapse — akin to a tire with a slow but obvious leak — has finally come to an end. This week, Google officially ended the project, one of the pioneering efforts in the Personal Health Records space. While GH will stumble along through January 1, 2012, the jig is finally up.

Why did a high-visibility project backed by one of the world’s premier Internet companies fail so miserably? Well, according to former Google employee Adam Bosworth, who first launched GH, the effort failed because “it’s not social,” TechCrunch reports.  Another pundit, more convincingly, argued that unless PHRs are tied to reimbursement somehow, they’ll be “irrelevant” for most providers.

So, why should we care about the failure of a project that, I’d argue, was pretty much pie in the sky from day one? And more importantly, is the failure of GH relevant to people who care about the future of EMRs?

Well, for one thing, Google Health does offer some pretty interesting insights into what doesn’t work in the world of patient-centered clinical data. As I see it, they include the following:

*  Clinical data projects that aren’t interoperable are eventually going to wither away.

I think it’s telling that Google is, at the last possible moment, rolling out the ability for patients to transfer health data to other services supporting the Direct Project protocol.  Also notable is that Google is offering patients the option of downloading data that meets the Continuity of Care Record format. (That’s ASTM E2369 – 05e1 to any standards geeks out there.)

Does that imply that EMRs that don’t share data are going to be outmoded or a waste of time?  Certainly not, as EMRs can potentially solve many in-house problems that providers face, and serve a far more expansive purpose. That being said, the failure of siloed PHRs should be a warning.

* Without a live, fluid source of data, PHRs don’t matter.

In this cynic’s mind, the idea that patients would suddenly begin to post data to PHRs on their own was, to put it simply, pretty dumb.  Why would they?  Consumers seldom think about their health data unless they’re at a doctor’s office, if at all, and they don’t exactly know what do do with the data once they’ve compiled it.

Since day one of the PHR craze, I’ve been wondering who thought they’d change patient behavior en masse by dangling a technology carrot. What were they thinking? I’m not just slamming Google, I’m targeting pretty much any PHR that isn’t linked to an EMR or other clinical data source directly. (I’m talking about you, HealthVault, and probably Dossia too.)

* PHRs must be run by a trusted intermediary, and marketed vigorously to patients, before patients will take heed.

I think it’s no coincidence that while Google’s PHR, and possibly Microsoft’s, haven’t won over many consumers, patients are beginning to pay a bit more attention to PHRs provided by providers and health insurers.  (OK, I don’t have hard data on this, just a strong gut feeling — can any of you provide stats that support or contradict this assumption?)

A case in point: While they’ve arguably spent way, way too much to get there, Kaiser Permanente has built what may be the largest PHR user-base in the world — 3 million users as of spring 2010 — linked to KP’s big Epic installation.  True, Kaiser had to spend millions in advertising and other forms of outreach to get patients on board, but what’s telling is that patients seem to have stayed once they arrived.

So, I’m just wondering when the managers behind HealthVault will throw in the towel. Hey, MS, just turn out the light when you leave, OK?

Will Carts Delay Adoption of Hospital Mobile Devices? Could Be…

Posted on June 24, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

I just caught an interesting piece in on the use of plain old, unsexy carts in hospitals — one whose conclusions which may surprise you a bit.  The piece argues that since hospitals are comfortable using carts to haul around full-sized equipment, they may be slower than expected to adopt hot portable devices in care delivery.

The article notes that while mobile devices remain on hospital IT execs’ radar, carts laden with standard technologies like barcode scanners and laptops continue to be popular.

IT administrators interviewed by Health Data Management magazine said that hauling IT equipment with carts may be a better option than mobile deployment.  And research suggests that they’re not alone. According to a HIMSS study quoted in the article, carts are being used by 45 percent of hospitals in 2011, up from 26 percent in a related 2008 study. That’s a pretty dramatic leap.

It certainly makes sense. The fact is, carts make it possible to haul around a full-size keyboard (along with barcode scanners and medication), which allows nurses to work comfortably with EMRs at the bedside.

On the other hand, the small screens and awkward typing mechanisms used by mobile gear can actually slow down the care process.  Not only that, the small text used by mobile devices can be hard for an aging nursing workforce to read, according to Joan Harvey, RN, clinical nurse specialist at Ocean Medical Center, who was interviewed by HDM.

That being said, hospital IT leaders aren’t ignoring the mobile device explosion. At least one hospital interviewed by the reporter, Good Samaritan of Vincennes, Ind., is testing mobile devices for future use. But execs there are frustrated by problems with compatibility between the different operating systems used by the devices, and differences between devices using the same operating environment. When you consider how much easier it may be to just have nurses drag along a standard PC and keyboard, why would they consider buying an Android tablet or iPhone?

Unless this author’s got his facts completely wrong, he’s made a really important point — that mobile device makers had better get their act together if they want to really step into the healthcare market. No matter how fascinating their potential use cases may be, the reality is that mobile vendors won’t make major headway in hospitals unless they get smart about barriers like the ones mention here.  The cool factor just won’t cut it.

EHR and Healthcare IT Mosaic Image

Posted on June 23, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It’s definitely true that a picture is often worth 1000 words. That’s how I felt when I saw this image that Galen Healthcare Solutions posted on their blog.

What a great look at the challenge of our current healthcare IT environment. The blog post also discusses how the moasic helps us appreciate the complexity when talking about Interoperability, Patient Matching, Reporting and Analytics, and Trust.

Thanks for Having Me – New EMR and EHR Blogger, Jennifer Dennard

Posted on June 22, 2011 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

Editor’s Note: The following is an introduction to a new blogger in the EMR and EHR family, Jennifer Dennard. You’ll be able to read all of Jennifer Dennard’s posts here.

Little did I know 10 years ago as I sat through my graduation from journalism school at the University of Georgia that healthcare would be the industry in which I would find my writing niche. The minor in French hasn’t been put to good use, I’m afraid, and my corresponding aspiration to live abroad, writing for French Vogue, is still in the backseat of the Ford Escort I left in Athens, waiting to be fulfilled.

I’m sure I’m not the only college graduate who has left a few dreams behind. I was, however, one of the few in my class who put their degree to good use. The poor job market left many working in retail right out of school, but I somehow landed a job with Billian Publishing, working for Textile World Magazine. French Vogue it was not, but a greater professional stepping stone I could not have asked for.

Fast forward to 2011 and the publishing industry has changed dramatically, as has healthcare. Billian’s publications came and went, though Textile World and its sister publications are still kicking. Marriage and parenthood brought me closer to the world of healthcare and a role in social media marketing.

I like to joke that it was during my second maternity leave that I became addicted to Twitter. (I’ll blame it on my alter ego, @SmyrnaGirl.) A lot of time was spent in rocking chairs – much of which became devoted to playing around with the new social network. (I’m on Facebook, but not nearly as active.) Once back at work, I convinced the higher-ups (who, thankfully, have always been supportive of my new ideas) to allow me to use Twitter for marketing purposes, which, truth be told, only furthered my addiction.

The Dennard Family, Summer 2010

The @TextileWorldMag account was booming, but healthcare soon called my name from across the hall. Billian’s HealthDATA and Porter Research – also Billian Publishing companies – were in need of marketing assistance and I was ready for a new challenge. With the help of a few like-minded individuals, we worked to truly understand what healthcare was all about for our business and those of our customers – no small challenge as healthcare reform was ushered in – and to transition that knowledge into effective editorial marketing. (I like the term “branded” marketing, myself.)

To make a long story even longer, I am now Social Marketing Director at Billian’s HealthDATA and Porter Research, responsible for their overall social media strategies. This involves daily use of LinkedIn, Facebook, YouTube and Twitter, not-so-daily use of Foursquare, developing educational webinars around our products and services, managing editorial partnerships with industry-related websites, and staying abreast of the latest marketing developments these platforms enable. And I do a bit of writing for their websites and e-newsletter, the Healthcare Intelligence Hub.

Perhaps the part of my job that I love the most is the fact that I get paid to stay educated about a subject I have a true interest in – one that affects everyone I know. And then on top of that, I get to write about it! Which is why it pleases me so much to join the EMRandEHR.com team, whose writers I’ve been following for awhile now.

Do I need another excuse to peruse my favorite industry news sites and blogs? Not really. Will I take advantage of the excuse to stay up a little later, scribbling my thoughts down on how my daughter’s pediatrician’s new EMR will affect our next office visit? You betcha.

This is one dream that won’t get left behind.

Lettuce and EMR

Posted on June 21, 2011 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, Michael Archuleta from Red Planet EMR, sent me the following interesting narrative that talks about the Lettuce industry. It seems like there’s some interesting parallels to some of the government involvement we’re seeing in healthcare. Enjoy the story:

I recently attended the annual TigerLogic Conference to learn about new features and capabilities that are being incorporated into MvBase. While there, I had an interesting conversation with Eric, the data processing manager for a 30-user system. The company he works for is in the agribusiness field of growing lettuce.
“Why are you here?” I inquired.
“Well, the government wants to impose more regulations on us. Ever since the salmonella scare with spinach, the pressure has been on us growers to track things more effectively.”
“What,” I asked, “are you going to do? Spray- paint barcodes on heads of lettuce?”
“Not quite, but close. We are going to have to tag every crate of lettuce. The only problem is that once a problem is identified, that crate will have long since been destroyed.”
“So,” I pressed, “why are you here?”
“Well, we either have to spend 150,000 to upgrade our system, or we have to switch to a new government mandated system which will cost us 150K. It is huge either way.”
The government, I mused, invades yet another small American business.

I wonder if he got any of the stimulus money to upgrade their system.

How Many Doctors Does It Take To Doom An EMR Installation?

Posted on June 20, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Q: How many doctors does it take to doom an EMR installation?  A: Only one, even if everyone else wants to change.

OK, maybe that’s too harsh, but it does bring home a key point. When you’re trying to build support for your EMR launch, you’re probably best advised to root out potential naysayers and empower them to the dickens rather than trotting out your cheerleader (whoops, EHR champion) and having them make inspiring speeches.

I was thinking about this the other day at a local professional gathering, when one of the speakers made a remark that stayed with me.  A vendor executive, whose candor impressed the heck out of me, said the following: “You may not find any champions to drive your EHR installation, but you’ll always get at least one cynic.”

Amen, sister. It’s just human nature. No matter how bright and sparkly your software installation is, you’ll always have someone who just doesn’t like it and roots for it to fail. Unfortunately, if your application is an EMR, that someone may be a physician, who could — depending on their professional and social clout — talk your project into the ground.

Sadly, it’s often the people who know the least about something new that give it the worst rap, and my sense is that EMR projects are no different.

Beware the physician that hangs on the sidelines, slips away early during training sessions and doesn’t ask many questions. You may be more worried about the doctors that complain loudly, and heaven knows you should address their concerns, but sometimes the clinicians who quietly opt out are just as damaging to EHR user morale.

So, at the risk of being a real pain, I invite you to consider this: does your organization face internal dissent from clinicians who haven’t been given the attention they deserve? Are you taking silence for support?  And most importantly, do you have a strategy for making your cynics happy?