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10 Tips for Selecting the Right EHR

I recently stumbled upon the Insight Data Group website. I don’t know much about the organization, but they had an interesting page on their site listing 10 tips for selecting the right EHR. Here are there 10 tips.

  • Make sure the EHR is easy to use and customize
  • Get training and more training
  • Buy the ‘right sized’ solution for your practice
  • Know who’s filing your insurance claims
  • Get and check references
  • Get mobility / portability access
  • Use the government’s money to pay for your EHR
  • Compare total cost of ownership not monthly payments
  • Know the financial stability and reputation of your EHR vendor
  • Make sure your vendor’s meaningful use guarantee is meaningful

They have a full explanation of each tip at the link above, but I thought it was an interesting list to share. I have a little bias for the e-Book I wrote on EHR selection, but this is a good quick list to consider if you’re in the EHR selection and EHR implementation process. I would be careful with the government money recommendation. I’d probably have said, “Consider using the government’s money to pay for your EHR.”

Of course, many of you are likely already past this process. However, I know that many of you will need this list in a year or two when your current EHR software doesn’t deliver what you expected it to deliver. We’re already seeing this now, but the replacement EHR market is going to be huge over the next few years.

November 30, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Homegrown Health IT Innovation Takes Center Stage

I’ve had the good fortune over the last few months to be involved in the marketing efforts surrounding the Health IT Leadership Summit happening next week at the Fox Theatre in my hometown of Atlanta. A joint effort of the Technology Association of Georgia’s (TAG’s) Health Society, the Metro Atlanta Chamber of Commerce and the Georgia Department of Economic Development, the annual event does a wonderful job of spotlighting the strides Georgia is making in healthcare IT, both on the provider and vendor sides.

I’m particularly excited to learn more about the four finalists of the Intel Innovation Award, which will be presented to the winner at the summit. I think it’s no coincidence that Solo Health, last year’s winner, has seen a number of newsworthy business developments happen since accepting the award in the Fox’s Egyptian Ballroom last November.

I thought I’d share a brief synopsis of the finalists (courtesy of their respective websites), and then take bets on who will take home bragging rights!

AirWatch (@airwatchMDM)
“AirWatch is the leader in enterprise-grade Mobile Device Management, Mobile Application Management and Mobile Content Management solutions designed to simplify mobility. More than 4,700 customers across the world trust AirWatch to manage their most valuable assets: their mobile devices, including the apps and content on those devices. Our solutions are comprehensive, built on a powerful yet easy to use platform by leaders in the mobile space.”

In a word, it’s all about security in healthcare right now, as iPad minis, iPhone 5s and yes, even a new Blackberry or two make physicians that much more likely to join the BYOD movement. AirWatch is certainly in the game at an opportune time.

CardioMEMS (@cardioMEMS)
“CardioMEMS is a medical device company that has developed and is commercializing a proprietary wireless sensing and communication technology for the human body. Our technology platform is designed to improve the management of severe chronic cardiovascular diseases such as heart failure and aneurysms. Our miniature wireless sensors can be implanted using minimally invasive techniques and transmit cardiac output, blood pressure and heart rate data that are critical to the management of patients. Due to their small size, durability, and lack of wires and batteries, our sensors are designed to be permanently implanted into the cardiovascular system. Using radiofrequency, or RF, energy, our sensors transmit real-time data to an external electronics module, which then communicates this information to the patient’s physician.”

I first came across this company nearly two years ago, when I heard founder Jay Yadav, M.D., speak at a TAG luncheon, and I’ll be eager to see how their technology has evolved since then. From an EMR perspective, I’m especially interested in where the real-time data goes when a physician receives it. Is it fed into an EMR, perhaps? I’m taking a field trip to the CardioMEMS office next week, so hopefully I’ll find out. I’d also like to get their thoughts on the FDA’s move to regulate mobile health apps, which I assume will impact them in some tangential way.

Cooleaf (@cooleafhealth)
“Cooleaf is the easiest way to enroll in classes and programs for your health while earning rewards. Our mission is to harness the power of classes and programs to enhance the well being of the planet. We founded Cooleaf on the following principles:

  • There is no “one size fits all” solution in health and wellness
  • Living a healthy life should be easy
  • If you live a healthy life, you should be rewarded
  • If you live a healthy life and get rewarded, you should own those rewards
  • If you’re guided by experts face-to-face, you’re more likely to achieve your health goals (and enjoy yourself)”

Certainly the most consumer-oriented of the bunch, the Cooleaf website seems like a great way to get employees engaged in wellness initiatives. I wouldn’t be surprised if a few payers start sniffing around as its user base grows, and resource database moves beyond Atlanta-based locales.

Monocle Health (@monoclehealth)
“Monocle Health Data is the only company solely dedicated to providing independent, unbiased healthcare provider ratings and rankings based on both price and quality, for both episodic care and chronic illnesses.

Monocle’s tools – price rankings, quality ratings and analytics-based reporting – are the foundation of true healthcare price and quality transparency.”

As a patient – especially one who is in need of new family physicians – I am especially interested in transparency. How do the doctors in my area stack up against each other when it comes to patient satisfaction, quality and what my hard-earned dollars will get me? As patient engagement efforts continue to take off, so too I think will provider comparison tools such as this.

Only time will tell which of these Atlanta-based companies will win. I’ll follow up in a subsequent post with the victor’s details, and future plans for continuing to change the landscape of healthcare IT.

November 29, 2012 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.

Are EMRs Going To Generate Billing Audits?

As readers are likely to know, EMRs have already begun to get a bad rap among some payers — most prominently Medicare — as leading to upcoding and padding of services performed on the E/M side of medicine. It may seem a bit unfair for CMS to push for EMR adoption then waggle the finger of disapproval when they lead to billing changes, but that’s how the cookie crumbles.

The thing is, we’re not just talking about disapproval and public chastisements over billing patterns.  HHS has gone a step further than public tut-tutting. In the 2013 work plan for the HHS Office of the Inspector General, the OIG has specifically targeted EMR documentation for E&M services  as an area for study and possible audits:

We will determine the extent to which CMS made potentially inappropriate payments for E/M services in
2010 and the consistency of E/M medical review determinations. We will also review multiple E/M
services for the same providers and beneficiaries to identify electronic health records (EHR)
documentation practices associated with potentially improper payments. (emphasis mine)

According to Betsy Nicoletti, a prominent coding consultant who chatted with me this week about this topic, the OIG is going all out this year, looking at Medicare A, B, C, D and just about every type of provider you can imagine (such as, for example, skilled nursing facilities). Private payers are also getting particularly aggressive in looking for suspect billing patterns, particularly profiles that don’t fit with other physicians in a given specialty.

From what she told me, it’s not that EMRs are automatically suspect, but rather, that EMRs can create inconsistencies and red-flag billing patterns through the use of templates and forms.  For example, CMS may very well notice and audit your practice, she says, if the use of templates leads to using the same code too often (something CMS frowns upon, as it assumes patients’ conditions will vary widely).

If you want to get ahead of possible OIG audit problems, she suggests physicians read the work plan and self-audit in areas that are relevant to their medical practice.  Better safe than sorry, no?

November 28, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

HIT Acronyms Leave Me Needing a Nice Glass of Wine

I had quite a learning curve to overcome when I first started working in and writing about healthcare nearly four years ago. I quickly realized that industry insiders peppered their conversations, blogs, tweets and presentations with acronyms that no mere mortal (or patient) could be expected to easily derive definition from. Only after months of immersion was I able to grasp the meaning of acronyms I heard on an everyday basis.

I was reminded of this when several popped up during a recent #HITsm tweetchat.

Gregg Masters, i.e. @2healthguru, made a good point in response:

Is healthcare as an industry alienating patients with this type of healthcare-ese? Do healthcare acronyms make patients feel less confident when speaking with care givers – perhaps more willing to gloss over certain issues because they are not confident in their understanding of certain terms and conditions? I can only imaging how amplified this problem is with the non-English speaking.

As we spend time talking about patient engagement and education, let’s not forget that concepts and terms that we take for granted may not be fully understood by the majority of healthcare consumers. Care givers should set aside time with patients to ensure everyone is on the same page when it comes to understanding healthcare terms.

That being said, the next time new healthcare acronyms crop up, I’ll kick back and have a glass of wine before diving into definitions.

November 27, 2012 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.

Motivating Factors for Doctors and Hospitals to Participate in HIE

While attending the Digital Health Conference in New York, I had the chance to sit down and talk with Paul Wilder, Director of Product Marketing and Adoption for the New York eHealth Collaborative (NYeC). I was really impressed by Paul’s understanding of the benefits and challenges of an HIE. He knows them first hand with NYeC’s SHIN-NY project which is connecting all of the various HIE’s and RHIO’s in New York.

I pulled out my camera and asked Paul to talk about the motivating factors for doctors and hospitals to participate in an HIE. I think you’ll enjoy Paul’s answer in the video below. He brings up some ideas related to HIE that I hadn’t heard articulated that way before.

November 26, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Disaster Planning, Horrors of Generic HIT Training, and Snap.MD: Around Healthcare Scene

EMR and HIPAA

Disaster Planning and HIPAA

Unfortunately, it appears that far too many healthcare providers don’t follow this rule. There aren’t very many that even have an emergency plan in place. However, this will soon need to be remedied. HIPAA security general rules state that not only must a patient’s privacy be protected, but the ePHI is available at all times — even in the case of an emergency. All healthcare providers, regardless of size, will need to implement some kind of disaster planning, regardless of their situation, in order to be in compliance with these regulations.

EMR Add-On’s that Provide Physician Benefit

MedCPU is a part of the inaugural NYC Digitial Health Accelerator class. They have developed a new concept that will likely to very helpful to many. It analyzes free text notes and structured data, and checks for compliance with rules and to identify any deviances. The company described one hospital using the services the company provides as a benefit given to doctors who use EHR. This is just one of many add-ons available, but some are seeing them to be a large reason why some doctors want to adopt EMRs.

Hospital EMR and EHR

Video: The Horrors of Generic HIT Training

Need a break from the day-to-day monotony? Be sure to check at this video on the horrors of generic HIT Training. It “offers a wry take on what happens when EMR training isn’t relevant for the doctor who’s getting the training. In this case, we witness the plight of a heart surgeon who’s forced through a discussion on primary care functions that she neither wants nor needs.”

Study: EMR ROI Stronger In Low-Income Setting

A recent study revealed something interesting. Hospitals in low-income areas actually may have a decent return on investment when an EMR is integrated. Three different areas were looked at and analyzed, and it was found that after five years of having an EMR, the hospital examined had a net benefit of over $600,000. Not all hospitals will benefit this much, but it’s encouraging to see more EMR success stories popping up.

Smart Phone Healthcare

Get Peace of Mind and Avoid the ER With Snap.MD

It’s the middle of the night, and your child breaks out in a rash all of his or her body. The doctor’s office doesn’t have middle of the night, on-call doctors, so the only option is the ER, right? Maybe not for long. Snap.MD, a new telemedicine system, may help parents decide if the Emergency Room is the best course of action. Parents of pediatric patients are connected to physician, who will help evaluate the situation via video conferencing.

November 25, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Early Signs Of EMR Consolidation Appearing

Some of you are going to tell me that I’ve jumped the gun, but I’ve got my feeling about this and I’m sticking to it. Though nothing massive has happened yet, I believe we’re officially beginning to see consolidation in the EMR world.

I was struck with this idea today when I came upon the news that physician EMR company Imagine MD was closing. According to MedCityNews.com, the cloud-based EMR company had pulled in $25 million in venture money, $10 million of that in the last 12 months. And until recently, it looked as though it had staying power; Imagine MD had been in business since 2006, well ahead of the pack of competitors pitching small medical practices.

Another sign that we’re seeing consolidation comes in the form of the acquisition of Amazing Charts by Pri-Med, a provider of professional medical education to more than 260,000 clinicians. (I wouldn’t have expected a medical education company to be the one to acquire Amazing, but that’s a story for another time.)

While I admit two examples isn’t exactly a statistical bump, it’s a clear enough sign for me that the market has begun to pull together. After all, with EMR adoption on the rise among medical practices, there’s only so many customers left to compete for, and that can only mean more closings and M&A.

The really important question, if you’re a doctor hoping to avoid a big practice disruption, is whether you can predict which direction your present or future EMR vendor is going.  That is, of course, a pretty tricky game.

But if you’d like some food for thought, you might consider checking out a previous post by John, comparing “fast EMR companies” fueled by venture capital to slower-moving types that grow organically and don’t tend to accept venture capital investments.

While there are exceptions — notably Practice Fusion, which seems to have an extremely solid business — the tech business is rife with examples of fast companies that soared high on venture capital drafts then plummeted to earth.  I’m not suggesting that you should avoid VC-backed EMR firms, physicians, but I am suggesting that you find out as much as you can about the size of their customer base, finances and strategy before you commit your business into their hands.

Otherwise, you could end up like ImagineMD’s EMR-less customers. And if that’s not a bummer I don’t know what is.

November 23, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

Our Health Privacy Paranoia

Katherine’s recent post on using EMR data to Market to patients got a lot of really interesting discussion about how this data should be used and if it’s ok to use the EMR data for marketing. The majority of comments were quite scared of the idea of EMR data being used for marketing. Most saw that their could be benefits, but saw it as a slippery slope and we should be careful going down that path. Most wanted an opportunity to opt out from such a policy.

Mark H. Davis offered a little different view in his comment about the need for privacy in this and other healthcare situations. Here’s what Mark said:

And now for a slightly different take…

I have no issues with my hospital using its knowledge of my health situation to provide me with targeted opportunities that might be beneficial. I see it as potentially a positive and proactive outreach. They will need to be sensitive in doing this, however, but in my region, the hospital system is pretty tightly woven into the community, anyhow, and would be rather affected by any backlash. And honestly, sometimes I feel like we make an overblown fuss about health data privacy just because everybody else is making a fuss about it, without stepping back and examining the actual impacts. For example, my mailman, with only slight observation, could easily deduce the health issues my wife, children and I have been treated for. The folks behind me in line at the drug store could do the same. Even most doctor’s offices I visit do a poor job of protecting privacy within the office itself. Just last week, I had to forcibly ignore the conversation taking place in an adjacent examination room. It was easily audible. Anyone who signs in at their PCP can see who has checked in earlier, for what doctor, for what time. Anyone who signs the pharmacist waiver form at the CVS can see who has signed in front of them. The prevalence of OTC meds makes it easier to tell what your fellow shoppers’ ailments are just by looking at their shopping cart. And somehow, we still co-exist. I’m not saying we shouldn’t protect ourselves against a massive data breach that could have dire consequences in the form of identity theft and other fallout. I’m just asking everyone to be honest about how serious they really are about privacy. It’s easy to pick on a hospital system without recognizing other areas where we turn a blind eye.

Mark does a great job articulating how many healthcare situations expose our healthcare data without any major issues. Yet, people tend to get far more worked up over the potential idea of an EMR data breach.

Certainly I’m not advocating for reckless behavior when it comes to healthcare data and securing it properly. We need to make a thoughtful effort to ensure that patient data is kept secure and private. However, let’s be reasonable in our expectations about what’s possible and reasonable.

November 21, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Could Meaningful Use Be Axed In Fiscal Cliff Battle?

In past items, my colleague John and I have weighed in on the issue of whether a change of administration could endanger the Meaningful Use program.  We concluded, in summary, that the program has too much momentum to fall to the budget axe that easily.

Now, in the light of an article by a colleague, I’m rethinking my view a bit. In an excellent column for Health Data Management, Joseph Goedert suggests that the so-called “fiscal cliff” has changed everything for the Meaningful Use program. Though the still-sitting president who backed HITECH’s $20 billion spend stayed in office, the House of Representatives remains controlled by the opposition party.

Goedert argues that during the debate over the fiscal cliff negotiations, someone’s going to look at the fat, juicy $20 billion allocated to health information technology — probably the Republicans who have already slammed the program publicly — and target it for budget cutting.  He argues that Democrats are unlikely to push back too hard, given that HITECH is hardly a “sacred cow” that legislators fear to touch.

And then, he says, comes a disaster for the health IT community:  “Whatever federal funds are left to support electronic health records, meaningful use, health I.T. workforce training, health information exchanges, best practices dissemination, regional extension centers and anything else in the HITECH Act will be gone.”

In Goedert’s view, the only way to save HITECH is for individual physicians hospitals to go on a lobbying tear, pounding their representatives and senators, if they don’t want to see Meaningful Use become a casualty of party politics.

I think Goedert has a point.  As he reminds us, eight Republican leaders in the House and Senate finance and health committees have already demanded proof that Meaningful Use is worth the money. And a recent House hearing held to investigate the subject suggests that some members still aren’t satisfied.  Things could get ugly.

November 20, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

Will Meaningful Use Affect M&A In The EMR Space?

As some of you may recall, Allscripts is said to be floating the possibility of selling out to a venture capital firm. This follows several months of tumult at the board level, including some who might have been helpful in keeping its merger with Eclypsis moving forward.

I’ve been thinking about this deal for a while, wondering whether it would come to fruition and if so, what would make it happen. And I’ve realized an Allscripts deal, or other EMR company sale, might give us a window into just how valuable Meaningful Use criteria have proven to be. Let me explain.

If I was a EMR vendor looking for an acquisition or merger, I’d certainly look at the usual metrics, including the customer list, code base my target had in house, maturity of the product line, the extent to which in-house programming talent could support the roadmap and so on. (Naturally, I’d go over its books in depth too.)

But that’s not all. These days we have some new perspectives from which to evaluate the success of EMR vendors, a set of standards which are fairly unique in the software business.  Two important examples: We can look at how successfully a vendor’s customers have been able to meet Meaningful Use goals to date, and how far along the HIMSS EMR Adoption Model customers are as well.

While both are interesting, Meaningful Use is more important, as it’s such a politically fraught, complicated and rapidly evolving set of standards. In short, I’d argue that if a vendor’s customers are doing well with MU, then it’s likely the vendor is doing something right.

Now, you can’t draw a straight line between the quality of a vendor’s product and how well its customers  have done in qualifying  for Meaningful Use. Implementation is ultimately the hospital or doctor’s responsibility, even if the provider pays for EMR vendor consulting to get things going. And there’s lots of ways things can go wrong that have little or nothing to do with the product.

Still, I predict that Meaningful Use success is going to become a more important metric in EMR vendor M&A as time goes by. After all, the more bragging rights a company has regarding Meaningful Use success, the more they can improve the acquiring vendor’s profile. That’s gotta matter.

November 19, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.