I’m sure that some of you might have seen me complaining on Twitter about the challenge of trying to sift through the 300+ educational sessions at HIMSS. I even tried to convince the HIMSS expert Neil Versel to offer up some suggestions on which HIMSS 2012 sessions to attend. He suggested just leaving all of the education times open and decide later. It’s a good idea, but I think I prefer meeting with people more than some of the available sessions. Neil enjoys the sessions a bit more than I do.

One of my favorite old Neil Versel posts was when he basically said, “HIMSS is more than just the exhibit hall.” With 300+ sessions at HIMSS 2012 there should be something you will find interesting, so HIMSS should be more than just the exhibit hall.

Today I started ripping through the HIMSS sessions to try and identify those I found interesting and worth putting on my schedule. While they might make it on the schedule, that doesn’t mean I’ll necessarily attend. I debate attending based on the flow of the conference, people I’m with at the time, and if I’d already heard enough on that subject for one HIMSS. Plus, I often put multiple sessions that are at the same time on my schedule. In those cases, I use the above criteria to decide which ones I should attend.

The other X Factor with this all is that I still have to schedule my meetings with vendors I find interesting during HIMSS as well. I’ll start doing that now that I know which HIMSS sessions are happening when. At least now I won’t schedule a meeting with a vendor during the Biz Stone keynote. That would be a travesty.

Below you’ll find my HIMSS 2012 schedule of sessions (which will likely continue to change), but for those interested here’s the process I did to find interesting sessions. First, I added the exhibit hall hours and keynotes. Next, I went through the HIMSS Specialty Programs and HIMSS Social Media Center schedule (My HIMSS Panel on Wed, 2/24 from 4-5 made it on my schedule from this list). Then, the HIMSS Education section has the sessions broken out into “Core Education” areas. I found the Federal Participation at HIMSS 12, Senior Executive sessions and EHR Best Practices sections quite interesting.

There you have it. I’m sure I missed some sessions I should attend, so if you know of some that you think are worthwhile do let me know and I’ll check them out. Now without further ado, my current schedule for HIMSS 2012:

As you can see it’s going to be a full and crazy week for me at HIMSS 2012, but as I said before HIMSS is great for me. Everyone goes there with a little different plan on what they want to accomplish and learn, but hopefully my list of sessions will be helpful to someone else navigating the HIMSS 2012 gauntlet.

Let me know if you have any questions about particular sessions and I’m happy to tell you why they made the list as well.

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I can’t believe that this is the last post in the series. I think it’s been a good series chalk full of good tips for those looking at implementing an EHR in their office. I’d love to hear what people thought and if they’d like me to do more series like this one. Now for the final 5 EMR tips.

5. Automatic trending helps all over the place – A picture is worth a thousand words and this is never more true than when we’re talking about trending. Make sure your EHR software can quickly take a set of results and/or data points and graph them over time.

4. Keep training over and over – Are you ever done learning software? The answer for those using an EMR is no. Part of this has to do with the vast volume of options that are available in EMR software. However, the training doesn’t necessarily have to come from formal training sessions. Much of the training can also come by facilitating interaction and discussion about how your users use the software. By talking to each other, they can often learn from their peers better ways to use the software.

3. Infrastructure is key to performance – I love when people say “My EMR is Slow” cause it’s such a general statement that could have so many possible meanings. Regardless of the cause of slowness, the EMR is going to get the blame. For those wanting to dig in to the EMR slowness issue, you can read my pretty comprehensive post about causes of EMR slowness. I think you’ll also enjoy some of the responses to that EMR slowness post.

Infrastructure really matters when someone is using an EMR all day every day. There’s no better way to kill someone’s desire to use an EMR than to have it be slow (regardless of who’s responsible).

2. Quit pulling charts as soon as possible – I think this tip should be done with some caution. In certain specialties the past chart history matters much more than in others. Although, it’s worth carefully considering how often you really look through the past paper chart in a visit. You might be surprised how rare it is that you really need the past paper chart. If that’s the case, consider only pulling the chart when it’s needed. If you only find yourself looking through the past paper chart for 2 or 3 key items, then just have someone get those 2 or 3 items put into the EMR ahead of time. Then, it will save you having to switch back and forth. Plus, then it’s there for the next time the patient visits.

1. Crap process + Technology = Fast Crap – Perfect way to end 101 EMR and EHR Tips! I like to describe technology as the great magnifier. The challenge is that it will magnify both the good and bad elements of your processes. Fix the process before you apply the technology.

If you want to see my analysis of the other 101 EMR and EHR tips, you can find them all at the following link: 101 EMR and EHR tips analysis.

I came upon this comment from Kay Kirchler, MD in regards to the ePrescribing penalties and other government incentive money for health IT. You’ll have to overlook the poor grammar and abbreviations, but I wonder how many other doctors feel the way Dr. Kirchler does.

who made all these rules and why are we just lying down and taking it? the arbitrary requirement for “10 escribes ” by june 30th or “penelty” when our emr ( we have had emr for >>10 yrs) will not escribe due to delay in “retro-fitting ” our emr instead of spending yet another fortune for a new “government approved ” version. the requirement to print out visit note to be available w/i 3 days rule .. rediculous. pts dont want it , not going to pick it up, costly and opens door for pts info to be floating out in parking lots, garbage cans etc .. i could go on for days. i spend more time loading info in emr ( much more w “meaningless use” than i do taking care of the patient .why are we not organizing to stand up and fight this power grab !!!!

The line that gets me is the one where he says that he spends more time loading data into the EMR than he spends with the patient. As a patient, the idea of this just makes me cringe. However, it’s a reality for many.

The other part that is quite interesting is that there really haven’t been many physician voices in all of this. There’s definitely not been any #OccupyMeaningfulUse protests happening by doctors. The closest thing I’ve seen to doctors rising up against Meaningful Use and other government programs for health IT has been at medical association conferences where doctors have gotten quite worked up. However, the message rarely leaves the medical conference. Plus, the majority of doctors in the room just shake their head, but don’t do anything after that.

I imagine many doctors look at it and see EHR software as the inevitable.

It seems like everyone I talk to or interact with in the Health IT world is in full on HIMSS 12 preparation mode. I only attended my first HIMSS 2 years ago in Atlanta. So, I’m mostly a newbie at HIMSS. I sometimes long for the days when I just went to HIMSS with little real planning. I just went and enjoyed myself.

As you can imagine, HIMSS is a perfect place for me and my business. I’ve often told people that the core of my business is great content and advertisers. Turns out that every booth and every person at HIMSS is possibly both. For me, it’s like being a kid in a candy store. So, many exciting things to try (and you might even say you get sick after “eating” too many as the flavors all run together). To be quite honest, I love the entire experience. I was meant for the system overload that happens at HIMSS. I love large crowds of people and being overstimulated. I guess that’s why I love living in Las Vegas (which is also convenient for this year’s HIMSS).

HIMSS Attendee and Exhibitor Count
Enough about me. What can we expect at this fantastic affair called HIMSS 2012? Last year there were 30,000 attendees and I wouldn’t be surprised if this year it’s somewhere in the neighborhood of 35,000 people attending HIMSS. During an #HITsm twitter chat about HIMSS, I said that there would be at least 1000 vendors exhibiting at HIMSS. If I remember right (I can’t find the tweet), one of the HIMSS staff corrected me and said there would be 1100 companies exhibiting at HIMSS this year.

What does all this mean? Well, as my mother always told me: You can’t do everything. I’d always look at her shaking my head saying, “You’re right….but I’m sure going to try.” I think this describes my approach to HIMSS as well. Although, each year I am getting more selective on what I spend my time doing.

Press at HIMSS
I’m sure that many reading this are wondering how they can get some coverage on the Healthcare Scene blog network at HIMSS. Considering the 40 or so emails from PR people that I have filed away already, I’m going to have to apply a pretty strict filter.

What then are my filters?

First, if you’re an EHR company, then I’m probably interested in connecting with you in some form. Although, if you’re an EHR company that’s just seen me and has nothing new to say, then I’ll probably pass at this HIMSS. To be honest, I could probably fill my entire schedule with just EHR companies considering how many EHR companies there are out there. Plus, I think I’m going to bring around my flip video and do an EHR series called “5 Questions with EHR Companies.” I’ll see how many EHR companies I can get to answer the same 5 questions.

However, an entire week of just EHR talk would be a little rough. Plus, I asked on Twitter if I should look at things outside of EHR and they all said I should. I’m a man for the people, so I must listen. How then could another healthcare IT company get me interested in meeting with them at HIMSS?

The best way to get me interested in talking with your company is to provide something that will be interesting, unique and insightful to my readers. Remember that my main goals are great content and advertising. If you provide me with great content that my readers will love, then I’ll love you and likely write about that content.

I didn’t realize this when I started blogging, but I’m not like a lot of journalists. I don’t go to any conference with stories in mind. I’m not digging around HIMSS to try and find an ACO story for example. Instead, every person that I talk to I’m trying to discover what stories are being told at HIMSS that are worth telling. I’m always happy when people help me find interesting stories.

Social Media at HIMSS 12
Speaking of finding stories. One of the most interesting ways I use to find stories and connect with people is through social media and in particular Twitter (see this post I did on EMR and HIPAA about Twitter). I guarantee you that Twitter usage at HIMSS 12 is going to be off the charts. There is going to literally be no way to keep up. I love the idea that Cari McLean had of the HIMSS Social Media Center summarizing the most important tweets during HIMSS. Granted, that’s an almost impossible task to ask anyone to do.

Of course, the HIMSS related hashtags will be another great way to filter through the various HIMSS related tweets that are happening. Here are some of the ones I’m sure I’ll be using:
#HIMSS12 — official hashtag for the event
#HSMC — HIMSS Social Media Center
#HITX0 — HIT X.0: Beyond the Edge specialty program
#LFTF12 — Leading from the Future specialty program
#eCollab12 — eCollaborative Forum
Here’s a bunch more HIMSS related social media hashtags you might want to consider:

HIMSS Social Media Center
If you love social media like I do, then you’re also going to love the HIMSS Social Media Center. They’re doing a number of Meet the Bloggers sessions again and I’ve been invited to participate in the Health IT Edition of Meet the Bloggers at HIMSS. I’m on the panel along with: Brian Ahier (Moderator) Health IT Evangelist, Mid-Columbia Medical Center, Jennifer Dennard, Social Marketing Director at Billian’s HealthDATA/Porter Research/HITR.com, Neil Versel, Freelance Journalist and Blogger, Carissa Caramanis O’Brien, Social Media Community and Content Director, Aetna. Should make for a pretty interesting conversation. Plus, you know I always like to mix it up a bit.

New Media Meetup at HIMSS
More details coming soon. We’ll have to work on Neil Versel’s idea of starting a Twitter storm to get Biz Stone to come to the HIMSS meetup.

Dates of HIMSS
Be sure to check the dates of HIMSS. As Neil Versel noted, it’s a little different days than it’s been in the past. I personally like these dates better than the other ones.

There you have it. I thought I’d do a short post on HIMSS and I guess I had a lot more to say. I’d love to hear if you’re going to HIMSS. If you know of any events, sessions, parties, announcements, technologies etc. that I should know about at HIMSS, let me know.

And the most exciting part of HIMSS…seeing old friends and making new friends. I can’t wait.

I recently saw a tweet to the National Conference of State Legislatures (NCLS) list of “Top 12 Legislative Issues of 2012.” It’s an interesting look into issues that state legislatures will be dealing with in 2012. Plus, it makes an interesting observation at the outset that state budgets have been cut so much in past years that lawmakers won’t have to focus all of their initial energy on budget shortfalls.

Most of the list is not surprising with managing the state budget and jobs are at the top of the list. However, there are a couple healthcare and health IT related sections in their list of top government issues as well.

One of the issues is Medicaid: Efficiencies and quality. It talks about how the tough economy is making the Medicaid budgets in states a real challenge and many are looking for cost containing actions. Plus, it points to ACO type reimbursement based on patients’ health outcomes, medical homes and streamlining services. The ACO part was quite interesting to me. I wonder how much of an effect lack of Medicaid budget will push forward a new model of healthcare.

The disturbing part of the report comes in the “Health: Reform in the states, health care exchanges, technology and benefits. Here’s the section on health IT, the EHR incentive money and HIEs.

HEALTH INFORMATION EXCHANGE: One focus for state legislatures in 2012 will be how to move health care providers, especially those participating in the Medicaid program, toward the adoption of certified electronic health records (EHRs). Essentially, instead of having a different health record at each doctor or provider you visit, an EHR will serve as one file that all of your doctors can see. EHRs, once fully implemented, are expected to provide doctors and health professionals with easier access to patient histories and data, resulting in cost-savings and better health outcomes by removing costly errors and duplications in services.

I love how this basically assumes that by having widespread adoption of EHR software, that we’ll then have one patient record that each doctor you visit can see instead of having a different health record at every doctor. Of course, those of us in the EHR world know that this is a far cry from the reality of EHR software today. In most cases you can’t even share a patient record with someone using the same EHR software as you let alone sharing a patient record with a doctor who is using a different EHR.

The sad part is that whoever wrote these legislative issues must have realized that there was some issue with EHR software exchanging information, because then they wrote the following about the state HIE initiatives.

In addition, states are responsible for building and implementing health information exchanges (HIEs) where those EHRs can be accessed by health care providers. HIEs function like an online file cabinet where your medical record is securely stored, and can be accessed by any doctor or health care professional you visit. By mid-year 2012, every state should have Medicaid EHR Incentive programs in place and will be working toward building an HIE by late 2014 or early 2015 as required by deadlines attached to federal cooperative agreements.

So, wait. If EHR software has created one file where any doctor can access our patient record, then why do we need “an online file cabinet” for our medical records? We know the answer is that we need the online filing cabinet because EHR software isn’t connected and there isn’t one patient record. Each doctor maintains their own patient record and that’s not going to change any time soon.

The above quote also implies that every state is working towards an HIE program per the federal program. I must admit that I haven’t gone through every state, but is every state working on an HIE? I certainly know there are a lot of states working on some sort of HIE project, but I didn’t think that every state had funding for HIE. I guess maybe the question is whether there is any state that doesn’t have some sort of HIE program in the works.

Reading issues described like this, you can understand how government passes legislation with limited understanding. Based on this resource, EHR software creates one patient record. Wouldn’t that be nice if it were the case?

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I met someone at a conference who commented that they liked this series of posts. I hope you’re all enjoying the series as well. This is the second to last post in the series of EMR tips

10. Build performance dashboards, not just quality dashboards
Yes, Dashboards can work well for clinicians, but for support people as well. If you start measuring something and displaying the results of that measurement, then the measurement improves. Study after study has shown this.

9. Flexibility with physician devices is important, but you still need to standardize
I think this is a little bit of an evolving issue. However, it’s unreasonable to expect your IT staff to support every platform, every version, and every type of device out there. Tech innovation is moving way too fast and an attempt to go this route will lead to failure. Create some standards so you don’t have your IT staff spinning their wheels and cursing your name for a bad policy.

8. Do time studies
My gut reaction to this one is two fold. First, get the data. Don’t assume you know the data. Get as much data as possible and focusing on the time it takes to do things is one of the best places to get data since this is incredibly important for users. Second, don’t shy away from the truth. If your EHR software has doubled the time it takes to do something, don’t be afraid to find that out. It’s better to know that there’s a problem and try to fix it than to let the problem fester because you didn’t want to know the truth.

7. Make sure IT shadows the clinicians
I’d probably take this one step further. If your IT doesn’t want to shadow the clinician, then you might want to find other IT. There’s no way that IT can help to design the proper system for the clinicians if they don’t understand the daily processes that the clinician has to do. Clinicians need to be willing to let IT in on what they do as well. It takes two to Tango and this is certainly true when you’re talking about implementing an EHR. It’s not nearly as pretty if they aren’t dancing together.

6. Use predicative analytics
I’m definitely not an expert on predicative analytics and its application, so I’ll just give you Shawn’s summary:
Predictive analytics are old hat in most industries. However, health care hasn’t put PA in a real forefront of the clinical practice. If you want your physicians (especially in a ED / UC) to be able to prepare for trends due to environment or time, make sure to have PA built into your EMR and easily available for all providers.

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.

As most of you know, I’m attending the Digital Health Summit at CES this year. As happens at most conferences, it’s hard to blog about the happenings at the conference while attending the conference. Particularly with all the CES traffic issues (it’s a literal zoo) and the packed CES Press Room. Although, I must admit that I haven’t found too many things all that impressive. More on that later.

For today, I thought I’d give you a little picture view of what I call the Garden of Eden booth that United Health Group has at CES (click twice to see full size image):

They seriously have grass on the ground and a wood path through their booth. Plus, they have some of the only benches at CES (many really enjoyed those including myself). They’re also doing the pedometer promotion they did last year at CES and that they did at mHealth Summit, but this time you record your findings through the OptumizeMe app. I better win the iPad for all the walking I’m doing at CES. At least this time we’re not up against the exercise demo lady in the booth across from United Health Group. That was totally unfair (No, I’m not bitter).

Also, I’m surprised how few people know about SOPA. So I thought I’d do my small part to get the word out to more people. SOPA is an abomination that they’re trying to push through Congress. Here’s the tweet I sent out recently about it:

Join me & change your profile picture to protest SOPA: BlackoutSOPA.org #BlackoutSOPA #vegastech #HITsm

— John Lynn (@techguy) January 12, 2012

As you can see I’ve put the STOP SOPA badge on my Twitter icon and will be doing it on some other places, likely including the blog logo above. I’m good with legislation that actually works to stop copyright infringement, but SOPA does nothing to stop it and does a lot to really screw up the internet as we know it today. I hope others will join me in helping to stop SOPA. This weekend I’ll see if I can do a full post on why SOPA is bad if people are interested.

#AHIMA11 these people talking about a genomics-based #EHR are blowing my mind…storage vendors must love the concept…lawyers, too

— Don Fluckinger (@DonFluckinger) October 4, 2011

This is a pretty old tweet that I’d stored away, but I’m completely interested in the idea of a Genomics based EHR. I meant to reach out to Don Fluckinger to see what he was talking about. I don’t think that there is any EHR that is based on Genomics. Although, if there is I’d love to know about it. Instead, I’m pretty sure that Don is just talking about integrating Genomics into EHR software.

I’ve made this prediction for a number of years now: Genomics will be part of the EHR software of the future. Genomics is one of the core elements that I think a “Smart EMR” will be required to have in the future. I really feel that the future of patient care will require some sort of interaction with genomic data and that will only be able to be done with a computer and likely an EHR. I love some of the quotes by Shahid Shah in this eWeek article about Digital Biology and Digital Chemistry.

As I think about genomics interacting with EHR data and the benefits that could provide healthcare going forward, I realize that at some point doctors won’t have any choice but to adopt an EHR software. It will eventually be like a doctor saying they don’t want to use a blood pressure cuff since they don’t like technology.

I’d been meaning to do a post about Emdeon‘s EHR lite (that’s their term for their EHR) since I first heard about it at MGMA. While I think that EHR Lite might be some good branding, I’m not sure you can really classify Emdeon’s EHR as lite. I’m sure they’re just trying to differentiate themselves from the 300+ EHR companies out there. The idea of a lite EHR is great since it gives the impression that the EHR is easy to use and implement. Not a bad strategy at all.

As most of you know by now, instead of doing full reviews of EHR software I like to try and dig into the EHR software to try and find points of differentiation. When I talked to the people at Emdeon about their EHR lite, I wanted to do the same.

I think I found the thing that most differentiates Emdeon from many other EMR companies. it’s their network. Here’s a summary they sent me of their network:

Emdeon’s network encompasses:
340,000 providers
1,200 government and commercial payers
5,000 hospitals
81,000 dentists
60,000 pharmacies
600 vendor partners

I think if you asked most people what Emdeon the company did, you’d say claims processing. The title of their website for search engine rankings (at least that’s usually the intent) is Revenue Cycle Management. However, I won’t be surprise if they reinvent themselves a little bit and become a connection company.

I strongly believe that healthcare will be a very heterogeneous environment. Some might argue that 3-4 EHR vendors will dominate the market (which I don’t believe), but even if this is the case EHR software is still going to have to connect with hospitals, pharmacies, labs, payers, government entities etc. An EHR is going to be key to integrating with these other heterogeneous software as I do believe the EHR will be the “Operating System of Healthcare.”

Today a silo’d version of an EHR is not an issue at all. However, the writing on the tea leaves that I read is that healthcare providers that have a well connected EHR are going to be at an advantage. We’ll see if Emdeon can use their current connections as an advantage in this way.

In every situation online it seems like at some point someone takes the business model as deep as it goes and then someone just finally says, “Let’s make it free.” Readers of this site will be familiar with the leading Free EHR companies Mitochon and Practice Fusion (both advertisers on this site). They both seem to be doing really well and are working on some really interesting business models.

With my familiarity with the Free EHR business model, I was intrigued when I read about HealthTap’s model for basically providing an online medical visit for free. This was particularly interesting since I knew that HealthTap had received $11.5 million in funding recently.

Andy Oram summarizes what HealthTap is trying to solve really well:

In this digital age, HealthTap asks, why should a patient have to make an appointment and drive to the clinic just to find out whether her symptoms are probably caused by a recent medication? And why should a doctor repeat the same advice for each patient when the patient can go online for it?

Plus, he makes two important observations of what HealthTap has found:
1. Doctors will take the time to post information online for free.
2. Doctors are willing to rate each other.

It’s pretty interesting when you think about how many doctors visits could be saved using something like HealthTap. On face, I’d think that a site like this wouldn’t make much sense. Although, as I think back on my medical experiences I can think of about a dozen or so times where I tapped into my physician friends before going to the doctor. Basically, I wanted to know if going to the doctor would be worth my time or not. In about 90% of those cases I ended up not going to the doctor since the doctor wouldn’t have really been able to do much for me anyway.

As I think through these experiences, I realize that many people aren’t lucky enough to be like me and have lots of physician friends around to ask the casual medical question. I could see how HealthTap could fill that role.

One key to this model is that it doesn’t always replace the visit to the physician. In fact, in a few cases I was told that I’d need an X-ray and that I better go see the doctor. In that case I was more likely to go to the physician since I knew I needed to get something done. I already knew the physician would do something for me when I went so I didn’t have the fear that they just tell me to take some Tylenol and be careful with it.

I’m not quite sure if doctors would be glad to actually have only people that are sick visiting their office or not. Maybe they enjoy the break of the easy patient that doesn’t require any effort on their part.

I think there are still questions about the quality of information that patients will get on HealthTap. This is going to be the most interesting issue to follow. No doubt they’re going to be toeing a fine line called medical advice. However, whether it’s HealthTap or some other online source that someone likely finds through Google, people are going to be looking for this kind of health information online. The idea of a free online medical visit sounds good to me.

Let’s also not be surprised if the Free EHR vendors eventually get into online visits as well. Seems like a natural progression for them to offer this service if they wanted to go that direction. From what I understand they have plenty on their plates right now, but a few years from now it could get pretty interesting.