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Guest Post: The Case for Modular EHR Over Complete EHR

Posted on November 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.

Dr. Sullivan is a practicing cardiologist who joined DrFirst in 2004, just after completing his term as President of the Massachusetts Medical Society. He is known throughout the healthcare industry as the father of the Continuity of Care Record (“CCR”) and a leader on the future of healthcare technology. He is assisting DrFirst in ensuring that Rcopia continues to add the functionality necessary to maintain its leadership position both in electronic prescribing and in the channel of communication between various sectors of the healthcare community and the physician. Dr. Sullivan is active in organized medical groups at the state and national level, and is both a delegate to the AMA and the Chairperson of their Council on Medical Service as well as past Co-Chair of the Physicians EHR Consortium.

The buzz surrounding Electronic Health Records (EHR) is nothing short of constant.  The daunting task of selection, purchase and implementation is quite confusing, technical, and expensive, with many physicians, clinics and health systems uncertain of their needs and questioning how the technology is going to impact the way they practice medicine and their bottom line. It’s all about workflow and productivity.

More recently, Providers are faced with the intimidating task of deciding which kind of system to install. There are all inclusive systems, often referred to as fully paperless or standard EHRs and there are so called a la carte systems known as modular EHRs.

The Case for Modular

Modular EHR systems allow providers to take a stepping stone approach to health IT clinical documentation and order writing, by choosing the tools and functions which make the most sense in their practices and clinics; improving specialized workflow and efficiency.  Going the modular route can gradually ease the provider and the office staff into a more paperless environment without having to make a full and often-times difficult transition to a fully paperless workspace.

There is need for caution however. The sheer volume of modules available can make selecting appropriate ones an overwhelming task.  Not only do clinicians need to be wary of which modules they are choosing, but also what functions have been certified by an authorized organization.

By combining specific modular systems, it can become “qualified,” making the user eligible for the monetary reimbursements set forth by Title IV of the American Recovery and Reinvestment Act of 2009 (ARRA).

At DrFirst, our Rcopia-MUTM has taken all of the guess work out of this process and is a completely certified Modular EHR that physicians can implement and start earning incentive money directly out-of-the-box.

The implementation of a complete EHR system can be confusing and time consuming.  Herein lays some distinct advantages of implementing a modular EHR.  Practices that have already implemented e-prescribing or registry modules may not need to relearn a different system, or move their data from one to another (as long as the current module is certified).

Providers who are considering going the modular route can check the certification status of their options at Certified Health IT Products List. The cost for a modular approach is often much less expensive and providers can select the modules from various vendors to meet their financial and practice-based needs.  Upon implementation, providers must show they’re using certified EHR technology in measureable ways to receive their incentive monies from the Federal Government.  With this very high ROI, many providers see the advantage of using the modular approach to postpone the decision process in selecting a complete EHR and yet at the same time earn Meaningful Use incentive money to put towards the cost of  the much more expensive system.

According to the Centers for Medicare and Medicaid Services, doctors who have not adopted an EHR (either modular or complete) by 2015 will be penalized by Medicare — a 1% penalty to begin, then up to 3% within three years. Many providers are banking on the reimbursement that has been made available by the ARRA to help offset the initial costs.

What is your practice considering, complete EHR or modular? Do you see benefits of one over the other?

“Prius Effect” of Non-Judgmental Reporting

Posted on November 29, 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.

@forbodyandmind – Scott Henady, MSTCM
“Prius effect” changing behavior via non-judgmental reporting – quoting Dr. Ravi Iyer #pfconnect

The above was a tweet from Scott Henady who attended the panel that had Dr. Ravi Iyer at the Practice Fusion Connect user meeting. Dr. Iyer made some really interesting comments about Non-Judgmental reporting of data that helps to improve behavior. He called it the “Prius Effect.”

A search on Google seems to indicated there are a number of Prius Effects out there. However, the one that Dr. Iyer mentions is the display in the Prius that tells you how much gas mileage you’re getting and when you’re using the battery versus the gas in the car. It becomes quite clear as you accelerate, your miles per gallon goes down and so most people’s automatic response is to not push the gas pedal as much. I know I’ve had this exact experience. Just by being informed of the consequence of what I was doing, it changes behavior.

I believe it was Dr. Iyer also that talked about the signs on the side of the road that display how fast you’re driving down a street. It’s amazing how this little piece of non-judgmental information gets people to do something they wouldn’t have done otherwise (in this case push on the brake and slow down).

I think we could see a lot of benefit from these non-judgmental reporting of data in healthcare and EHR software as well. In fact, this is true for both a doctor who can provide better patient care with the right information warnings at the right time and also to patients who aren’t taking good care of their bodies. Just by providing good information to people, we can see behaviors improve. That’s a powerful concept that I think we need to see more of in EMR and EHR software and in healthcare.

A Report on ePrescribing Challenges

Posted on November 28, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

From the Center for Studying Health System Change (hschange.com) comes a study on e-prescriptions, and how providers and pharmacies work together to electronically transmit and fulfill prescriptions. Now, I don’t know how reliable this organization or its research is (the .com in its name, for example, is something that bothers me. Also the report focuses almost exclusively on SureScripts). But the study is interesting to me for what it reveals statistically.

HSChange.com conducted 114 phone interviews with 24 physician practices, 48 community pharmacies, divided between local and national companies. The national respondents included 3 mail-order pharmacies, and 3 chain pharmacy headquarters. Those of you who are interested in the numbers, the methodology and other sundries, go ahead and read the report in its entirety. Here’s a quick summary from the report’s results the rest of us. My comments are bolded.

According to the report:
Two-thirds of the practices sent at least 70% of their prescriptions electronically. Which means about 46.2% of the prescriptions are e-prescribed. Plenty of room for growth, methinks.

Pharmacists at more than 50% of Community said their pharmacies received less than 15% of their prescriptions electronically. The reasons: providers didn’t transmit electronically, or sent out computer-generated prescriptions by fax or mail. Interesting – could be indicative of either lack of knowhow, or infrastructure that allows for e-transmission.
New prescriptions are more likely to be e-prescribed than prescription refills (renewals). The report states that many pharmacies don’t use this feature in order to avoid SureScripts fees for renewals.

There are plenty of inefficiencies. E.g. a) multiple requests for the same prescription were sent (say by phone, fax and through SureScripts) by pharmacies b) providers mistakenly deny prescriptions and then re-send the same prescription as a new one.

E-prescribing to mail order pharmacies is a different process – (apparently providers need to be Surescripts certified to e-prescribe with community pharmacies, and also need to be certified to e-prescribe to mail order pharmacies. So, even when a provider selects a mail order pharmacy to fulfill an e-prescription, the prescription is delivered by fax to the the mail order pharmacy by Surescripts.)
Prescription specificity falls on the provider – tablets, capsules, and liquid formulations might have different costs. Pharmacists can’t change the prescription from a capsule to a tablet on their own, without consulting with the prescribing provider. This might result in unexpected costs.
Providers’ patient instructions are still incomprehensible! Pharmacists often have to play translator (maybe because as the report alludes to, the instructions are intended for pharmacist eyes, not the patient.)

an independent pharmacist explained, ‘A lot of times we can’t copy the directions word for word because the patient doesn’t understand them, just like with paper prescriptions. We have to go in and erase ‘t.i.d.’ and put in, ‘One tablet three times a day’.’

 

A Little EHR Education Could Go a Long Way

Posted on November 23, 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.

I’ve always got my eyes open for news of healthcare facilities marketing their healthcare IT systems to patients. To me, explaining the new high-tech gadgetry at check-in and the new computers/laptops/tablets in each exam room goes a long way towards making patients feel more comfortable before, during and after a visit to the doctor or even hospital.

I came across two recent examples of patient outreach that I think are great ideas, and would certainly get my attention, and perhaps even get me to consider switching providers.

The first is an ad from Martin Memorial Health Systems in Florida, promoting their transition from paper-based records to an electronic medical records system (Epic, if you must know.) News of the implementation in a recent HISTalk post mentions that the ad is part of a campaign announcing the system’s transition starting in December. I couldn’t find any mention of the campaign, or the transition, on the hospital’s website, so I’m not sure where exactly this ad will appear – hospital hallways, local newspapers, etc.

The second comes from Kay Gooding, Project Director of the Region D Health Information Technology Consortium at Pitt Community College. She alerted me to HealthIT.gov’s Campaign Toolkit – a variety of online resources that organizations can use to educate the general public about healthcare IT. The toolkit includes a short video (see below) on Ensuring the Security of Electronic Health Records. I could see this being played in hospital lobbies, doctor’s waiting rooms, or even embedded in some sort of physician-sponsored new patient welcome site, which could also house medical history/personal health records, consent and privacy forms, and the like.

I’d be interested to know from a marketing perspective, whether patient-facing educational campaigns result in an increase in new patients who are attracted to more technically advanced facilities, and if these same patients experience better clinical outcomes and satisfaction as a direct result of new HIT systems. If you hear of anything, let me know.

OccupyYourEMR! – An Idea Whose Time Has Come

Posted on November 22, 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.

Note:  The following is not to be taken at face value, exactly — I’m not literally convinced that it’s time for a revolution — but you might see a point or two here that are worth considering further.

Doctors, are you sick of having an EMR pushed down your throat by administrators and IT leaders that don’t care how disruptive or painful the change may be?  Do you feel like your complaints and concerns aren’t being heard?  Are you actually afraid a patient will be hurt someday because of the EMR’s limitations?

Well, I say it’s high time you get radical and OccupyYourEMR!  Get in there and resist until your (absolutely critical) voice is being heard.

If you don’t, you know you’re going to be steamrolled into using a platform that’s awkward, ugly, inflexible and slow — in short, a system only the IT admin and hospital board who funded it could love.   Maybe you’re not ready to stop working, but what if you refused to log in?

As things stand, you have little to gain and a lot to lose by blindly kowtowing to EMR adoption demands.

Hey, if Hospital X installs an EHR and it seems to work, the CIO and the CEO and the board of directors look like geniuses. Some of them will probably get big bonuses if everything falls into place just right.

You, on the other hand, will be lucky if the new system doesn’t cut your work pace in half, confuse you and make charting a painful chore. Oh, and if things really go badly, you’ll harm or kill a patient because you didn’t read the EMR right.  Of course, the hospital will be right there beside you offering the best legal defense money can buy, right? (Uh, not really…)

Yes, there are some stories out there about EMRs that actually improve patient care and make doctors’ lives easier, but let’s face it, there’s a reason we don’t publish a ton of those here (or on sister blog Hospital EMR and EHR).  I’m not suggesting that all EMR rollouts are a mess, but few are a walk in the garden either. And it’s more common than you might think for a provider organization to go through a second or even a third installation before everything works.

Hey, don’t misunderstand me, I still believe EMRs are going to be a positive force over the long term.  In the mean time, though, some clinicians will be casualties — either becoming burned out by new work expectations, hating the new process or even making dangerous mistakes. Don’t be one of them.

Demand an EHR that helps your workflow, helps you provide better patient care, makes your life better, and lives up to the expectations the EMR salesperson made. An EHR that does those things will be welcomed by almost all doctors and other staff.

EMR Data and Privacy

Posted on November 21, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

From MinnPost.com, a post on Sen. Al Franken’s second hearing as chairman of the Senate Subcommittee on Privacy, Technology and the Law. Franken’s take was that federal agencies tasked with enforcing digital privacy are not doing so. While we might be aware on some subliminal level about the lack of enforcement, when presented in sheer numbers, the statistics are shocking.

According to the MinnPost article:

“Total, there have been 364 “major breaches” of 18 million patient’s private data since 2009, Franken said. Meanwhile, enforcement of data privacy laws have been lax — out of the 22,500 complaints the Health and Human Services Department has received since 2003, it’s levied only one fine and reached monetary settlements in six others. Of the 495 cases referred to the Department of Justice, only 16 have been prosecuted.”

Here on the HHS website, you can see all the breaches affecting 500 or more people (sort by Breach Date to see recent breaches). Even with all the rules around reporting, effectively, given the lack of enforcement, hospitals and care organizations stand to gain the most in this lax enforcement landscape. I’d be curious to know the process of fining and reaching settlements, whether it is proportional to the amount of data stolen/lost. More importantly, I’d like to know what organizations are doing differently if data thefts have been identified – the worst thing for an organization would be to pay the fine, and continue with the same faulty processes that led the breach in the first place.

Great 140 Character Sound Bites from Ron Sterling at EHR Summit by HBMA

Posted on November 18, 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 been having a really great time all day at the EHR Summit by HBMA. It’s been an event with some really interesting content and a lot of people who really understand the underpinnings of the EMR industry. Most of the people I’ve met are those running their companies and so they’re very interesting to talk with.

Instead of doing a summary, I was basically live tweeting the sessions I attended on @ehrandhit. Ron Sterling was the keynote yesterday and the guy was like sound bite after sound bite. It made it perfect for live tweeting. So, I’m dedicating this post to all my tweets during Ron Sterling’s keynote at the EHR Summit. I know you’ll glean a lot of interesting perspectives from it.

https://twitter.com/#!/ehrandhit/status/137184627797397504

https://twitter.com/#!/ehrandhit/status/137185878060703744

https://twitter.com/#!/ehrandhit/status/137186748798214146

https://twitter.com/#!/ehrandhit/status/137188691104890880

https://twitter.com/#!/ehrandhit/status/137189519979065344

https://twitter.com/#!/ehrandhit/status/137189839010410496

https://twitter.com/#!/ehrandhit/status/137190521700483072

https://twitter.com/#!/ehrandhit/status/137191707673497600

https://twitter.com/#!/ehrandhit/status/137192432063356928

https://twitter.com/#!/ehrandhit/status/137193082004316160

https://twitter.com/#!/ehrandhit/status/137194619682299904

https://twitter.com/#!/ehrandhit/status/137196714535821312

https://twitter.com/#!/ehrandhit/status/137197709097570304

https://twitter.com/#!/ehrandhit/status/137198800543555584

https://twitter.com/#!/ehrandhit/status/137198992772702208

https://twitter.com/#!/ehrandhit/status/137200318369898496

https://twitter.com/#!/ehrandhit/status/137201007007498240

https://twitter.com/#!/ehrandhit/status/137203401061699584

https://twitter.com/#!/ehrandhit/status/137204288928751616

https://twitter.com/#!/ehrandhit/status/137206387909468160

https://twitter.com/#!/ehrandhit/status/137206682110541824

https://twitter.com/#!/ehrandhit/status/137207286937554945

https://twitter.com/#!/ehrandhit/status/137208414068682752

https://twitter.com/#!/ehrandhit/status/137209976077824000

https://twitter.com/#!/ehrandhit/status/137210243959635968

https://twitter.com/#!/ehrandhit/status/137211060372508672

https://twitter.com/#!/ehrandhit/status/137213019309604864

Some Interesting Thoughts from the EHR Summit

Posted on November 17, 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 enjoyed all day at the EHR Summit that’s being held by HBMA in Phoenix. It’s been a really interesting event for me. I had some sound bites from the Ron Sterling keynote queued up, but it’s not connecting to Twitter. So, I’ll see if I can post those tomorrow. Today, I thought I’d post some of my other tweets from the other session. I think you’ll find them interesting, enlightening, thought provoking or some other adjective. I really look forward to the discussion on this post.

EMR software has many versions of the same data. #interesting #EHRSummit11 Think about an HIE as well. They have a version of the data too

HIE’s aren’t good at getting the receiving doctor the second version of a clinical document. #interesting #EHRSummit11

Think about the records retention issues when you switch EHR software companies. Good thought. #EHRSummit11

If you haven’t lost a client to a hospital this year….you will next year. #EHRSummit11 #HBMA

How many EHR companies are billing companies? They have 7 listed on screen. Do you know of others? #EHRSummit11
They have MED3000, Allscripts, Greenway, NextGen, Athena, GE Centricity, Ingenix. Any other EHR companies do billing as well? #EHRSummit11

Shame on you if you hire an EHR Company and don’t check the references. Ask for a list of 10 in that specialty and size. #EHRSummit11

Pre-existing conditions, No lifetime maximum and kids on parents plan for longer are going to increase our insurance costs. #EHRSummit11

Definitely interesting to consider how the healthcare billing industry will be affected by things like ACO’s and concierge. #EHRSummit11

Super bills are going to go away once we get ICD-10. #EHRSummit11 #HBMA

The healthcare billing sales cycle is 12-18 months. #EHRSummit11

Since I’m putting some of my tweets. I also enjoyed a number of the tweets coming out of the ONC Meeting today. Here’s one that really hit me:

RT @INHSbeacon If you’ve seen one CCD, you’ve seen one CCD. Everyone interprets different, we need to find a standard to succeed #ONCMeeting

Gambling Our Way to Electronic Medical Records

Posted on November 16, 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.

I’m writing to you from the balmy, breezy and absolutely beautiful Palm Springs, where the Porter Research team presented several sessions at this year’s Healthcare IT Summit. It’s my second year attending this conference, unique in that it brings together providers and payers for joint sessions and networking opportunities. I enjoy it because it’s an intimate setting in which to chat with providers about what their challenges are and how they plan to face them. Something you definitely don’t get at big shows like HIMSS. California is a nice change from last year’s chillier venue of Washington, D.C.

Little did I know that casinos are part of the after-hours culture in Palm Springs. Driving in from the airport – the smallest and prettiest I’ve ever been through – I noticed the bright lights of one of them, which reminded me of an article I came across last week regarding the state of Massachusetts’ plans to use anticipated revenue from casinos to accelerate the adoption of electronic medical records. Apparently, 23% of licensing fees from the state’s three casinos and one slot parlor may potentially go to a fund “designated in part to help the state switch to an electronic medical records-keeping system.”

Massachusetts, which already requires nearly everyone to have state health insurance, is doing what many other states have done in terms of leveraging gambling revenues for government projects. I myself have benefited from Georgia’s HOPE scholarship, which is funded from the state’s lottery.

Will other states follow suit? Is this an example of creative thinking on the part of the state government, or is there something amiss with private citizens spending their money in Native American casinos, which the government then takes a chunk out of for its mandated programs? I’ll admit, I’m a bit torn. Do we rah, rah, rah the out-of-the box thinking, or pooh pooh it because it’s too close to the vest?

Judy Hanover at IDC predicted in one of her sessions at the summit that the majority of US providers will be using electronic medical records by the end of 2012, with large physician practices leading the way. According to the US Bureau of Labor and Statistics, there were 661,400 physicians in 2008, with 805,500 projected to be employed by 2018. Even taking into consideration the predicted shortage of physicians, that’s a big number to totally move from paper to digital in just a few years.

I wonder if we’ll see other creative funding ideas pop up – whether they be from the government, private investors, or even payers. A speaker at the summit brought up the notion of taxing soda to encourage folks to be healthy as part of this nation’s move to more coordinated care and more formal accountable care organizations. Could money from programs like that be used for EMR funding? Let me know what you’ve heard and think in the comments below.

FDA, EHREvent, NIST: Who’s up for an EMR Supercop gig?

Posted on November 15, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

Last week I wrote wondering who will police EMRs and EHRs. With the release of IOM’s report recommending the creation of a different federal agency to serve as EMR watchdog, this topic has been generating buzz in healthcare circles. I’m by no means an expert in healthcare IT or policy matters but the discussion surrounding this topic has helped me think things through better than last week. Commenter Don Fluckinger answered the blog post with the first comment on the post – saying “these guys” and pointing to EHREvent.org. Commenter Carl Bergman said the FDA, which is already tasked with gathering adverse events for medical devices, might be the ideal go-to-agency for software adverse events as well. It is my understanding that medical software would receive Category 3 classification, if FDA were to provide the oversight.

IOM’s approach has been to suggest the creation of a non-regulatory, NTSB-like body. IOM’s rationale for undercutting FDA’s role has been that FDA classification system might stifle health IT innovation. (I’ve only had the time to read the very first few pages summarizing the rest of the IOM report, so I’m not sure if/how they address these concerns later.)

Here’s what I don’t get: What’s the point of creating yet another powerless body to issue guidelines? If there’s already a body with regulatory and oversight powers that covers your domain, has a large database of medical device related adverse events, why can its capabilities not be extended further to medical software as well? Further, why are health IT vendors exempt from any slaps on the wrist?

No offense to anyone, but from what I’m reading about EHRevent.org, I don’t see much to recommend them: John says they “are not going to have high enough profile to be able to really collect the reports… a reporting system is great, but if no one knows to report something there, then it’s not worth much. Plus, if someone reports something but the organization doesn’t do anything with that information, it’s not very meaningful”. Valid question but I think there could be some easy workarounds for the problem of not knowing how/where to report shouldn’t be a major issue. Healthcare IT just needs the software equivalents of those “How’s my driving?” flaps adorning the backs of 18-wheelers. The bigger question is what happens when the EMR system fails? Who pays? How much? How does the vendor ensure the failure doesn’t happen again? Do we learn from the cumulative mistakes of the industry? Time will tell.