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EMR Rollouts: Are They Ethical?

Posted on February 28, 2013 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Here’s something you should really see for yourself. Over at Dr. Wes’s blog, the good doctor has written a long and thoughtful post on whether rolling out EMRs to patients actually constitutes medical experimentation without patient consent.

I thought readers who don’t have time to read all of Dr. Wes’s carefully-structured argument might be interested in hearing a bit of what he has to say, as I believe his conclusions are important. Here’s some of his assertions:

*  EMR costs are ultimately passed along to patients, whether they like it or not. And with insurance premiums climbing as much as 20 percent in 2013, patients are already having serious trouble paying for care.

* With EMRs still not interoperable in most cases, the efficiencies we’d hoped for largely aren’t showing up yet.  In fact, EMRs are adding to inefficiencies as doctors struggle to add needless data to electronic charts.

* With health data breeches continuing and errors growing, EMRs may be part of the problem and not the solution.

So, he suggests that we take a pause and ask ourselves some tough questions:

Does the ends of presumed cost savings to our national health care system justify the deployment of poorly integrated, difficult-to-use systems? Are patients being subjected to new risks heretofore never considered with the adoption of this technology? Could a tiny programming error occur that negatively impacts not just one patient, but millions? If so, what are the safeguards in place to prevent catastrophic error? Who will be responsible? Who is the oversight body that assures the guiding principles of the Belmont Report (respect for persons, beneficence and justice) with respect to EMR deployment are followed? The Secretary of the Department of Health and Human Services or a more nebulous body like Congress?

Dr. Wes, in summary, wonders whether it’s unethical to roll out EMRs en masse given the still-unanswered questions about their benefits, their safety and their efficiency. And I think he’s asked a question worth answering. How about you?

CMIOs Bridge the Clinical & IT Gap

Posted on February 27, 2013 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.

It’s been interesting to see the evolution of conversation around healthcare IT at the provider-focused events I’ve attended over the last two years. Panels of hospital executives at first spoke about the benefits they were likely to see as a result of the HITECH Act and their facilities’ subsequent plans for EMR implementation. One-year later, it was all about best practices for go lives. Today, conversation has reached the “now what?” phase.

This was definitely top of panelists’ minds at the recent Georgia HIMSS Lunch & Learn, which offered attendees a hearty Italian meal and the chance to hear area CMIOs converse around the topic of “CMIO 2.0 – Leading Healthcare Transformation.” While “transformation” tends to be a bit overused, I think it was an apt word based on the remarks from moderator Debbie Cancilla, Senior VP and CIO at Grady Health System; Julie Hollberg, MD, CMIO at Emory Healthcare; Daniel Wu, part-time CMIO at Grady; Roland Matthews, MD, physician champion at Grady; and Steve Luxenberg, MD, CMIO at Piedmont Healthcare.

I hate to play favorites, but Wu was my favorite panelist. Calling himself the “least tech savvy CMIO in the country,” he was engaging and a good sport when it came to verbal sparring with his Grady colleague, Cancilla. No one in the audience was fooled by his self-deprecation, of course. Wu, who is also Assistant Medical Director at Grady’s Emergency Care Center, and Assistant Professor of Emergency Medicine at Emory University’s School of Medicine, knows a thing or two about healthcare IT, having put in an EMR for Grady’s emergency department. He continues to serve as a physician champion for the hospital.

Several telling themes emerged from panelists’ comments and audience questions, which I’ll share in part 1 of this post. I’ll cover challenges specific to each panelist and their facility next week in part 2.

gahimssCMIOpanel

Left to right: Julie Hollberg, MD, CMIO, Emory Healthcare; Roland Matthews, MD, Physician Champion, Grady Health System; Steve Luxenberg, MD, CMIO, Piedmont Healthcare; Daniel Wu, part-time CMIO, Grady; and Debbie Cancilla, CIO, Grady. Photo courtesy of Georgia HIMSS

Shining a Light on CMIOs
This was the first all-CMIO panel I’d ever seen, which may be indicative of their general reluctance to be put in the spotlight, and perhaps the increasingly important role they play in HIT implementations of all kinds. (I also wonder if the title of CMIO is growing. If anyone has statistics on that, please share.) Cancilla noted it was time for CMIOs to get in the healthcare transformation conversation, and while these four seemed at no loss for stories to tell and pain points to share.

CMIOs Don’t Play Favorites
When it comes to the clinical side of the house versus the IT side of the house, the panelists agreed that sometimes the two just don’t understand each other. And that’s where the CMIO steps in, acting as interpreter, smoother of ruffled feathers, and occasionally spokesperson for both departments to the higher ups. In describing his role, Luxenberg described himself as an objective third party, coming in to finesse sticky situations between clinical and IT staff. I got the impression from him that CMIOs often have more success in resolving disputes because they don’t have allegiance to one particular department, but rather the hospital as a whole.

(Sidenote: Wu mentioned a hilarious cartoon by Atlanta-based anesthesiologist Michelle Au that highlights the delicate verbal dance CMIOs must do when talking with various medical specialties. Check out “The 12 Medical Specialty Stereotypes.” It’s worth noting Wu would be considered a “cowboy.”)

Getting it Done for the Patient’s Benefit
Because they represent the interests of the hospital, these CMIOs ultimately hold themselves accountable to the patient, and benefiting the patient is a big part of the message they have to convey to clinical and IT folks, especially during times of implementation. Luxenberg noted that he gets better EMR buy in from different departments when he highlights the benefits to patient care, rather than focusing on details specific to one department in particular.

Talking with different departments does mean, however, that CMIOs must step out of their comfort zones and really get familiar with the pressures of each area within their facility. Conveying this information is where a great relationship with the CIO comes in. For the CMIO’s objectivity to truly be valuable, that assessment must be meaningfully discussed with the CIO. As Cancilla mentioned, CIOs need to step up and strengthen relationships with their CMIOs. All the panelists and Cancilla agreed the communication from the top down and bottom up is key to successful adoption of healthcare IT.

Sending PHI Over SMS

Posted on February 26, 2013 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 13 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 recently was talking with a doctor who told me about a healthcare communications company called YouCall MD. The doctor liked many of the features that YouCall MD provided. He loved that they would answer your Live Calls, transcribe a message to you and send you that message by SMS. Well, he loved all of it except the part that YouCallMD was using insecure SMS messages to send protected health information (PHI).

I wrote about this before in my post called “Texting is Not HIPAA Secure.” I know that many doctors sit on all sides of this. I heard one doctor tell me, “They’re not going to throw us all in jail.” Other doctors won’t use SMS at all because of the HIPAA violations.

While a doctor probably won’t get thrown in jail for sending PHI over SMS, they could get large fines. I think this is an even greater risk when sending PHI over SMS becomes institutionalized through a service like YouCallMD. This isn’t a risk I’d want to take if I were a doctor.

Plus, the thing that baffles me is that there are a lot of secure text message services out there. Using these services would accomplish the same thing for the doctor and YouCall MD and they wouldn’t put a doctor or institution at risk for violating HIPAA. Soon the day will come when doctors can send SMS like messages on their phones in a secure way and they won’t have to worry about it. I just think it’s a big mistake for them to be using their phone’s default SMS.

Few Healthcare Pros Have Attested To Meaningful Use

Posted on February 25, 2013 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Despite all of the attention given to Meaningful Use, it seems that eligible healthcare professionals have been relatively slow to achieve compliance. A new report published in the New England Journal of Medicine concludes that just over 12 percent of EPs had attested to the Medicare portion of Meaningful Use as of May 2012, well into the life of the program.

The reasons for this relatively low uptake are complex, but clearly, the EMRs physicians are buying are part of the problem. As a piece in iHealthBeat notes, the National Center for Health Statistics recently found that only 27 percent of office-based physicians had EMRs capable of supporting 13 of the Stage 1 objectives for the MU program.  Since EPs have to meet 15 core objectives, plus five of 10 menu options, that leaves the remaining 73 percent of office-based physicians out in the cold.

To calculate uptake of Meaningful Use attestation for the NEJM, researchers with Brigham and Women’s Hospital looked at combined CMS data from April 2011 to May 2012, and GAO estimates of the number of eligible professionals in the U.S.

The researchers found that 12.2 percent of 509,328 eligible professionals had attested to the Medicare portion of the MU program as of May 2012, including 17.8 percent eligible PCPs and 9.8 percent of specialists. PCPs accounted for 44 percent of all Medicare Meaningful Use attestations, the researchers concluded.

Looked at state by state, the median Medicare attestation rate was 7.7 percent of eligible professionals, though rates varied from 1.9 percent in Alaska and 24.2 percent in North Dakota.

These statistics must not be very encouraging ones for CMS, particularly the leaders are ONC. And they certainly make one wonder whether the mass of doctors will end up facing penalties in 2015 rather than making sure they attest to Meaningful Use Stage 1. This should be a real eye-opener for policymakers.  As for doctors whose systems simply won’t make the grade, well, this has been called the year of the big EMR switch. I guess we may see even more switching than we expected.

EMR Farce, Connected Health, and Lusty Love Affair with Magic EMR

Posted on February 24, 2013 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 13 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.


This is a well reasoned take from John Mandrola, MD on the challenges that EMR has with many doctors. Another entry in the EHR Physician Revolt. The tone of the article is right. Dr. Mandrola isn’t against EHR and technology in general. He’s just against them in their current form. When I say current form, I suggest that is thanks to current billing requirements and other government regulations.


This is related to the first tweet. This shouldn’t be the case.


Wouldn’t we all love an EHR that was connected? Yes, I’m using connected in the broadest terms. I’m talking about connected to patients, connected to hospitals, connected to labs, radiology, insurance companies, nurses, doctors, etc etc etc. A few of those in the list are connected, but far too many of the others aren’t.


This comment by Linda was too good not to point out. She’s right. EMR is here to stay, but the honeymoon period for EMR’s is over. Doctors are starting to ask the right questions when evaluating EHRs. This will make some EHR vendors very happy and others not as much.

Patient Accountability and Responsibility

Posted on February 22, 2013 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 13 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 think you can add this post to my series of posts on the Physician Revolt that I talked about earlier. The following message is from a doctor who emailed me. Obviously, they didn’t realize it would be published, so ignore some of the grammar errors, but the message is a good one that we should be discussing.

The doctors are going to be graded on the health outcomes but yet patients are going to do whatever. Nowhere in the law it states that patient is responsible for anything.

So while the ACOs are going to offer coverage…… there is going to be no immediate access due to shortage of MDs and the current MDs whose slots are overfilled are going to be dinged with penalties for not taking care of their patients completely (ie. all time coverage for all patients all the time). which means the MD has to refund the already reduced reimbursements back to the government because patients will complain about this.

Of course, the patients themselves will not tighten their belt and become personally responsible for their health so that they take up less appointment slots……..

So the significant question is Where are the patients held accountable in all these free health care reforms?

This is an important question as we shift to an ACO model. I think the above narrative places a little too much blame on the patient for the higher healthcare costs. Certainly there are things that doctors and our health system can do to lower costs that are outside of the patient. A simple example is 2 doctors ordering duplicate tests. If they just transferred the data, they’d provide the same care for a much lower cost. Plus, I think there are ways that a doctor together with a clinical care team can improve the overall quality of care of a patient population regardless of the patient’s choices. Another example of this is the hospital to PCP hand off. Doing this right can lower healthcare costs by reducing hospital readmissions.

While much can be done by doctors and the healthcare system as a whole, the doctor does raise a good question about patient responsibility. In what ways could we incentivize patients to take some accountability and responsibility for their healthcare as well?

The first thing that popped in my head was the way car insurance companies are doing it. One of the insurance companies is tapping into your car’s computer to monitor safe driving and then they provide discounts to you for being a safe driver. Are we going to have the same models in healthcare? In some ways we do, since if you’re a non-smoker your health insurance costs a lot less. Will health insurance companies start lowering a patient’s health insurance costs based on data from a wearable device that monitors your activity?

I’m honestly not sure how it’s all going to play out, but I am sure that healthcare IT is going to play a role in the process. We’ll never totally solve the issue of patient responsibility and accountability. That’s a feature of life, but I think that technology can help to hold us all more accountable for our health choices. What technologies do you see helping this?

Fostering Healthcare IT Career Opportunity

Posted on February 21, 2013 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.

Around this time last year, I wrote a series of blog posts focusing on the challenges some job seekers were facing as they either transitioned from an educational program to full-time employment, or made the move into healthcare IT from another profession:

This year finds the job market a bit rosier, and expectations more clearly defined regarding what kind of experience employers are looking for, and where job seekers can find it. There seems to be more consensus than ever that healthcare IT career opportunities – whether on the provider or vendor side – can only be fostered if there is a supportive educational component behind it. School systems – from middle to university – must be on the same page as their respective region’s workforce needs.

As moderator of the recent #GAHealthIT tweetchat on this very topic, I’ve culled some of the most telling tweets that address the issues mentioned above:

tweetchat5tweetchat4tweetchat2tweetchat1

You can view the full transcript of the tweetchat at Storify.com. We covered a range of topics, but I think the first, discussed above, has relevance no matter what part of the country you live in. What skills are most valued in an employee in healthcare IT? Is clinical knowledge give more weight, or IT know how? Please share your thoughts in the comments below.

US Lags Behind On Physician EMR Use

Posted on February 20, 2013 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

US doctors are far behind most of their counterparts in Europe and Australia when it comes to EMR adoption, according to a new study by The Commonwealth Fund.

To get a sense of EMR adoption internationally, the Fund surveyed almost 9,800 primary care physicians representing 11 countries.  The results: the U.S. still  has a ways to go to catch up with peers in other developed nations.

True, U.S. doctors’ uptake of health IT has gone up dramatically, from 46 percent using an EMR in 2009 to 69 percent in 2012, the study found.

That being said, doctors in such countries as the Netherlands, Norway, New Zealand, the U.K., Australia and Sweden all reported EMR usage rates above 88 percent in 2012.  The country with the lowest adoption rate was Switzerland, which trailed all countries in the survey with a 41 percent EMR uptake rate by physicians in 2012.

As for sophisticated usage of EMRs, defined by the Fund as using at least two electronic functions such as order entry management, generating patient information, generating panel information or clinical decision support, the U.S. didn’t make it onto the list of power users. Only the U.K., Australia and the Netherlands had more than 50 percent of doctors who did so.

Despite the gap in usage between other nations and the U.S., I thought the nearly 70 percent rate of primary care usage was a very positive sign.  I don’t know if this jump is 100 percent attributable to Meaningful Use — I believe PCPs see the writing on the wall and will go with EMRs to manage medical home functions regardless — but either way, it’s a sign that changes major and permanent have happened among the primary care flock.

Still, what really matters isn’t just how many PCPs have bought an EMR. What I’d like to know is how many of those 70 percent are tackling Meaningful Use requirements effectively, and how many are still stymied. If I find that data you can be sure I’ll share it here!

Free Food, Free Drink, and Great Peeps – New Media Meetup at #HIMSS13

Posted on February 19, 2013 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 13 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.

For those of you who only read EMR and EHR and don’t read EMR and HIPAA (you should really read both and consider subscribing to the EMR and HIPAA email list), I wanted to make sure you knew about the New Media Meetup at HIMSS 2013 (plus we have the details on the food). This is the fourth year for the event and I believe this will be the biggest and best one yet.

A big thanks to docBeat Secure Messaging for sponsoring the event so we can provide free food and drinks to everyone who attends. If you participate in new media at HIMSS, then we’d love to have you Register Here and come meet many other great healthcare social media people.

Now for the details:
When: Tuesday 3/5 6:00-8:00 PM
Where: Mulate’s Party Hall – 743 Convention Center Boulevard, New Orleans, LA MAP
Who: Anyone who uses or is interested in New Media (Blogs, Twitter, Social Media, etc)
What: Food, Drinks, and Amazing People

Be sure to Register Here if you plan to attend.

Along with an open bar, we’ve also just finalized the menu for the event:
Veggie, Fruit and Cheese Tray
Mini French Muffalettas
Bit size Catfish and/or Tilapia
Fried or Grilled Chicken Tenders
Meatballs

About Our Sponsor
docBeat Secure Text Messaging Logo
docBeat® allows physicians and other healthcare professionals to seamlessly communicate with one another using their mobile phone or web browser while ensuring HIPAA compliance and avoiding liability issues. Plus, there’s no more dealing with the hassle of being on hold to find out who is on call or busy. docBeat® allows physicians to provide a docBeat phone number to be reached at while keeping their actual phone number private. For more information visit www.docbeat.co.

A big thanks also goes out to Erin and Beth from The Friedman Marketing Group for helping us locate a great venue in New Orleans and helping us plan the event. They are class acts and I always love working with them and their PR company.

Finally, thanks as always to all the members of Influential Networks and Healthcare Scene that help us promote the New Media Meetup. We’ve hada record number of signups already. We look forward to seeing everyone at the event.

Let me know if you have any other questions about the event.

One Database Has Distinct Advantages for Data

Posted on February 18, 2013 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 13 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 recently was talking with an EHR vendor and they made the comment that having their EHR all on one database was a distinct advantage over the EHR vendors who install a new database with every new EHR install. I was intrigued by the idea and could easily see some of the benefits of an EHR vendor having all of the EHR data in one database. When you think some of the future quality programs that could come out, I think there could be some advantages there as well.

Considering this advantage, I started to think about ways that multiple database EHR vendors could level the playing field with their single EHR database comrades. One idea I had was using interoperability to level the playing field. If all the EHR vendors have access to all of the data, then not only will single database EHR vendors not have an advantage, but they’ll be at a disadvantage if they don’t work to exchange the EHR data as well.

When I think about this, it makes me wonder why multiple database EHR vendors aren’t accelerating the exchange of health information. This seems like it would be to their strategic advantage to exchange information.