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Rep. Phil Gingrey Comes After Healthcare Interoperability and Epic in House Subcommittee

On July 17th, the House Energy and Commerce Committee’s subcommittee on Communications and Technology and Health (that’s a mouthful) held a hearing which you can see summarized here. Brought into question were the billions of dollars that have been spent on EHR without requiring that the EHR systems be interoperable.

In the meeting Rep. Phil Gingrey offered this comment, “It may be time for this committee to take a closer look at the practices of vendor companies in this space given the possibility that fraud may be perpetrated against the American taxpayer.”

At least Rep. Gingrey is a former physician, but I think he went way too far when he used the word fraud. I don’t think the fact that many EHR vendors don’t want to share their healthcare data is fraud. I imagine Rep. Gingrey would agree if he dug into the situation as well. However, it is worth discussing if the government should be spending billions of dollars on EHR software that can’t or in more cases won’t share data. Epic was called out specifically since their users have been paid such a huge portion of the EHR incentive money and Epic is notorious for not wanting to share data with other EHR even if Judy likes to claim otherwise.

The other discussion I’ve seen coming out related to this is the idea of de-certifying EHR vendors who don’t share data. I’m not sure the legality of this since the EHR certification went through the rule making process. Although, I imagine Congress could pass something to change what’s required with EHR certification. I’ve suggested that making interoperability the focus of EHR certification and the EHR incentive money is exactly what should be done. Although, I don’t have faith that the government could make the EHR Certification meaningful and so I’d rather see it gone. Just attach the money to what you want done.

I have wondered if a third party might be the right way to get vendors on board with EHR data sharing. I’d avoid the term certification, but some sort of tool that reports and promotes those EHR vendors who share data would be really valuable. It’s a tricky tight rope to walk though with a challenging business model until you build your credibility.

Tom Giannulli, CMIO at Kareo, offers an additional insight, “The problem of data isolationism is that it’s practiced by both the vendor and the enterprise. Both need to have clear incentives and disincentives to promote sharing.” It’s a great point. The EHR vendors aren’t the only problem when it comes to not sharing health data. The healthcare organizations themselves have been part of the problem as well. Although, I see that starting to change. If they don’t change, it seems the government’s ready to step in and make them change.

July 30, 2014 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.

What Will the Shifting Reimbursement Model Require?

I was really intrigued by this post on the First Databank blog titled “Making the Most of the Meaningful Use Extension.” Here’s an excerpt of the post that really struck me.

We are looking at an industry undergoing a change in the reimbursement model, from fee for service to a risk-based model. Therefore, our systems must support quality measure reporting, tracking of specific treatment responsibilities for improving outcomes, and they must provide health information to the patient that allows them to be an active participant in their care.

We have to incorporate access to the care guidelines and research that has been proven to provide the best outcomes. There are a number of areas where there is overwhelming evidence as to what is the best course of care for the patient. For reasons that sometimes escape me, providers often do not follow these best practices.

We’re absolutely going through a shifting reimbursement model. In this post, Tom Bizzaro outlines what he thinks is needed to be able to handle this changing reimbursement model. Do you agree with Tom’s ideas? Is there anything he missed?

The last part of the above quote really hit me since I’ve seen the same thing. I don’t think we’re going to do much to change people who choose to go against evidence based medicine. However, I do think there’s a great opportunity for technology to more quickly diffuse the evidence based practices throughout the medical profession. While some people ignore best practices, I think the bigger problem is that there is just so much information out there that it’s hard for healthcare professionals to keep up to date.

This is just one example of how technology is going to improve patient care. Plus, I believe access to the best information at the point of care is going to be an essential part of the changing reimbursement model. This is just one reason why I don’t think you’ll be able to practice medicine without technology in the future.

July 29, 2014 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.

Social Determinants of Health (#SDOH)

In a recent chat that I think was hosted by HIMSS, they used the hashtag #SDOH. I’ll admit that the hashtag wasn’t familiar to me, so I was glad that they included a link to resources on the HIMSS Future Care website that defined #SDOH as Social Determinants of Health. Had you heard of this hashtag or term before?

I’d never heard of Social Determinants of Health before, but I’d certainly heard of some of the concepts. I think there is a lot to be said about how our social interactions can be used to determine our health. I think the real challenge with it is taking it from a conceptual idea and turn it into a science. Not to mention turning it into a science where technology could be applied.

What I just described is the perfect opportunity for an entrepreneur. Some of the best new companies take something really challenging and make it simple for the end user. I think that’s exactly what will happen with social determinants of health. With the plethora of social signals that are easily available and accessible now, a large mix of entrepreneurs will be able to work on this challenge. That’s really exciting for me.

The real question I have with social determinants of health is whether they’ll just be a consumer based application or whether the healthcare system will embrace these notions as well. My guess is that it will start as a consumer focused application and then as the science of SDOH matures, the rest of the healthcare system will start to accept and use it as well.

Have you seen applications of SDOH? Do you think social signals aren’t very valuable in determining someone’s health? Can they be leveraged reliably? Will we eventually see SDOH in EMR and EHR software?

July 28, 2014 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.

Is the End of the Standalone EHR and PM Near?

News this week came out that simplifMD and Azalea Health were merging companies. It’s an interesting merger since Azalea Health has been strong on the PM side of things and an EHR that’s not yet MU 2 certified, while simplifyMD has been more focused on the EHR side of things. As one company they can put together their PM and EHR into one standalone system.

As Shahid Shah recently pointed out on his Healthcare IT Guy interview with Melissa McCormack from Software Advice, buyers are decidely more interested in an integrated PM and EHR. Here’s one of the questions and answers:

1. As EHR meaningful use requirements grow more involved, standalone billing or scheduling systems are becoming less viable. In fact, nearly 70 percent of the buyers we spoke with wanted integration between practice management and EHR. The trend of PM buyers looking for robust EHR integration grows more pronounced each year, and shows no signs of tapering off since EHR meaningful use requirements increasingly require physicians to utilize charting, billing and scheduling in tandem. Vendors who can offer seamless integration between these applications will have a clear advantage over those who cannot.

I find this question interesting, because the trend towards an integrated EHR and PM started when I first started blogging about EHR software about 9 years ago. Now there are only a few standalone EHR companies left. There are more standalone PM vendors left, but most of them see the writing on the wall and know that they won’t survive as just a PM. In fact, some of those PM companies have stopped developing their PM and are just at a stand still waiting for their last customers to leave. It’s been amazing to see how long some of these extremely small PM vendors have survived.

With that said, is the end of the separate EHR and PM near? I’d love to hear your thoughts.

July 25, 2014 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.

EMR vs EHR

This tweet tried to define the difference between EMR and EHR:

Let me make it even simpler:

EMR and EHR are the same and used interchangeably!

That’s all.

July 24, 2014 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.

The Impact of Meaningful Use on EHR Development

I’ve been getting a really strong response to my post calling for EHR vendors to expand their definition of customer service. Although, the title doesn’t do the post justice since I also talk about the impact of meaningful use on EHR development. Many of the readers of EMR and HIPAA (and if you don’t read EMR and HIPAA you should go subscribe to the emails now) have highlighted some important points I wanted to share with a broader audience.

First, Peggy Salvatore provides this insight about the impact of billions of dollars of EHR incentive money:

Almost 15 years ago, I wrote material for Intel (the computer chip company) based on research they were doing on physician workflow to make EHRs more usable. It was one of the early efforts to tackle this issue. I mention this to say that a lot of spade work has been done in this field but (in my humble opinion) government regulation has gotten in the way of software businesses trying to build electronic patient record products that work for the end users. Experience has shown time and again that customers will drive product improvements, and the same is true in the healthcare industry as in all others. The government has wasted tens of billions of dollars requiring systems be installed to meet timelines that were not realistic given the budgets and time available, or, to this point, to install products that were not really ready for prime time. Let the customers – in this case – the providers and the patients – drive development and you will end up with products that solve problems, not create them.

Brenden Holt, CEO of Holt Systems, offers this startling commentary on the EHR industry:

To me it is more clear. EHR Vendors, large and small and all points in between are currently working on the support nightmare (R&D and Direct Support) of Meaningful Use. It is the same when CCHIT was coming out, and not much different then the 100′s, if not 1000′s, of current copy cat products, all in one way or another a copy of the master Logician (GE).

Innovation does not bring in customers in the current environment. Government Adherence and more importantly relationships (Marketing and Sales) accomplish this. That is to say products need to be improved upon, but only to the extent of meeting the Government Regulatory Demands and the demands of the Large Organizations that are buying these things in bulk.

Innovation is available, but more then likely will take some time, as will thinking of how we document patient care as a whole, which is antequated methodology.

So as a CEO of a software company, one in the sea of many, I will say, innovation will happen when the phones get off the hook form highly demanding end users who want to make sure the MU is met and a Government Final Ruling that will get Government out of Development. Government is a terrible manufacture of innovation. One other major issue is that the end users don’t really want to pay for the innovation, if the EHR is working they are happy with the LOB application. That in and off itself is a issue, new features don’t translate to higher fees, the opposite is the case, less features in a Free Package can be much more attractive as both meet the basic LOB requirements.

We are the US, as much as the rest of the world tries, inguinity is what makes us great, our leading export, but in this vertical it is all but dead.

Catherine Huddle offered this insight about MU not just derailing EHR development innovation, but also possibly making things worse:

As for MU, as an EHR vendor I would agree that it and related government programs such as PQRS and PCMH have significantly derailed most other product development. Not only was Stage 2 a development “hog” but it brought in required changes that are often unnatural in a practice’s workflow and overly complicated.

MU has changed the goal from delivering what providers need to finding the best way to deliver MU to make it easiest for the providers and other staff – while still trying to make other improvements to the EHR. Unless the government repeals MU and the Medicare penalties the winning EHRs will be the ones that make MU as easy as possible.

While there’s plenty to be pessimistic about what’s happened with EHR, I’m still optimistic that we’ve passed through the meaningful use waters and that the future will bring forth opportunity for EHR development innovation. I’m hopeful (although not 100% certain) that the people in Washington have seen the toll that meaningful use has paid on the industry and they’ll lighten the load so that EHR vendors can start listening to end users instead of regulators.

July 22, 2014 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.

Meaningful Use Stage 2 Save Doctors’ Time

I recently saw an older document from an EHR vendor that outlined some reasons why a doctor should take part in meaningful use stage 2. They suggested that meaningful use stage 2 would save our healthcare system money, save doctors’ and hospitals’ time and save lives.

All of these are noble goals worthy of consideration. If meaningful use could achieve this triple aim, then I think every doctor and healthcare organization would happily hop on this new triple aim. Let’s look at each and see how meaningful use stage 2 is doing with this meaningful use stage 2 triple aim:

Save Our Healthcare System Money – This one is interesting because many of the doctors I talk to are afraid that this is exactly what’s going to happen with meaningful use stage 2. They’re deeply afraid that meaningful use is really a way for the government to get access to a physician’s data so that they can pay the physician less. You have to remember that if we save the healthcare system money that means that some organization is going to get paid less.

While I think that the fear these doctors portray is a little overstated, it is true that the government wants the data to be able to pay people using that data. One could argue that a doctor doing good work has nothing to fear and it’s only the crooks that are over billing for their services are the ones that have to worry. Although, we know that data isn’t perfect and there will be collateral damage. I would just argue that the government doesn’t know what to even do with the data right now. So, we won’t see this change happen in the near future. We’ll see if they can achieve this goal long term.

Save Doctors’ and Hospitals’ Time – This suggestion is so ridiculous that I had to make it the title of the post. What I think is possible is that EHR adoption can save an organization time, but I think we need to be careful substituting EHR adoption with meaningful use. Sure, the EHR incentive money has pushed EHR adoption forward, but any time savings that has come from EHR adoption has been lost to the meaningful use check boxes that are required.

Save Lives – Once again, with this one you have to balance the idea of EHR adoption against meaningful use adoption. However, I am hopeful that things like clinical decision support, ePrescribing (ie. legible prescriptions) and a myriad of other things can save some people’s lives. This is hard to quantify, track and measure and so I don’t think we really know. I think there are anecdotal stories of times where care was improved and even lives saved because of something in an EHR. Certainly there’s also some evidence that EHRs can make care worse. Although, I think that is usually just as anecdotal as the lives saved. For now, I’d say this is a bit of a wash, but long term I like the potential of what EHRs can do to save lives. Although, I’m not sure that MU will be the basis for the lives saved.

July 21, 2014 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.

Another EHR Glass Implementation

HealthTech has a really terrible write up of the latest EHR vendor to put out a Google Glass EHR implementation. The iPatientCare EHR application is called miGlass. However, the article states that it’s the first wearable EHR App for glass, but we’ve already written about one from DrChrono and Kareo’s Google Glass implementation was probably the first one that I saw. Plus, there are a number of hospital based EHR implementations that have happened as well. Maybe iPatientCare was the first and they just didn’t get any coverage until now.

Timing aside, the article lists the technology available on this new Google Glass EHR application, miGlass:

  • Web browser based EHR and PM System
  • Microsoft .net Technology
  • Services Oriented Architecture
  • HL7 CCD and ASTM CCR for Interoperability
  • HL7 Integration with leading Lab
  • Information Systems
  • SureScripts/RxHUB Certified ePrescribing
  • Reporting & Analytics using Cognos and Business Objects
  • Available on iPhone and iPad

Maybe the article just made a mistake (I make them all the time as you know), but that list seems like a list of EHR technology and not Google Glass application functionality. iPatientCare also has a video that’s not even worth linking to since it doesn’t say anything about what the Google Glass application really does.

While I love to see EHR vendors experimenting and testing the integration of Google Glass into their EHR, I still haven’t seen the killer use case in action. Although, there are a few hospital EHR Google Glass implementations that I’d like to see in action. I do love the potential of Google Glass. There’s something beautiful about an always on, always connected application that’s sitting there waiting for you when it’s needed. Plus, as the camera recognition technology gets better, the workflow will get better as well.

Imagine walking into an exam room and as you do it, your Google Glass scans a QR code on the door and pulls up the patient waiting for you in the room. Hopefully that’s the naive and simplistic view of where the technology is going to be taken. As more EHR vendors tinker with the technology it will be really interesting to see what becomes a reality.

July 18, 2014 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.

Risk of Interoperability is Worse Data

I’m a huge fan of healthcare interoperability. I think it needed to happen yesterday and that we could solve a number of our cost issues with healthcare data interoperability and we could save lives. Both of these are very worthy goals.

While I’m a huge fan of healthcare data interoperability, we also have to be careful that we do it right. While there are huge potential benefits of exchanging healthcare data, there are also huge risks involved in it as well. We have to address those risks so that interoperability doesn’t get a black eye because it was poorly implemented.

A great example of the potential risk of interoperability is making sure that we process and connect the data properly. Some might argue that this isn’t that big of an issue. Healthcare organizations have been doing this forever. They get a medical record faxed to their office and the HIM team lines up that medical record with the proper patient. I’m sure the medical records folks could tell us all sorts of stories about why matching a faxed medical record to a patient is a challenge and fraught with its own errors. However, for this discussion, let’s assume that the medical records folks are able to match the record to the patient. In reality, they’re certainly not perfect, but they do a really amazing job given the challenge.

Now let’s think about the process of matching records in an electronic world. Sure, we still have to align the incoming record with the right patient. That process is very similar to the faxed paper record world. For the most part, someone can take the record and attach it to the right patient like they did before. However, some EHR software are working to at least partially automate the process of attaching the records. In most cases this still involves some review and approval by a human and so it’s still very similar. At least it is similar until the human starts relying on the automated matching so much that they get lazy and don’t verify that it’s connecting the record to the correct patient. That’s the first challenge.

The other challenge in the electronic world is that EHR software is starting to import more than just a file attached to a patient record. With standards like CCDA, the EHR is going to import specific data elements into the patient record. There are plenty of ways these imported data elements could be screwed up. For example, what if it was a rule out diagnosis and it got imported as the actual diagnosis? What if the nurse providing care gets imported as a doctor? Considering the way these “standards” have been implemented, it’s not hard to see how an electronic exchange of health information runs the risk of bad health data in your system.

Some of you may remember my previous post highlighting how EMR perpetuates misinformation. If we import bad data into the EMR, the EMR will continue to perpetuate that misinformation for a long time. Now think about that in the context of a interoperable world. Not only will the bad data be perpetuated in one EMR system, but could be perpetuated across the healthcare system.

Posts like this remind me why we need to have the patient involved in their record. The best way to correct misinformation in your record is for the patient to be involved in their record. Although, they also need a way to update any misinformation as well.

I look forward to the day of healthcare data interoperability, but it definitely doesn’t come without its own risks.

July 17, 2014 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.

Healthcare IT and EHR Conferences – Fall 2014

I’m regularly asked which Health IT and EHR conferences I’ll be attending and also asked for suggestions on which conferences people should attend and sponsor. After thinking about the best way to let everyone know the answers to these questions, I decided to create a page of Health IT and EHR Conferences and events that I’ll update regularly.

As you’ll see, I’ve broken the page into three sections: conferences I’m attending, important annual conferences, and user conferences. This is not meant to be an all inclusive list. There are some other people who do that pretty well. Instead, I wanted to focus on those events that are annual events that I attend or would like to attend regularly (I’m trying to limit my travel, but that’s not working so well. Although, you’ll see the bias towards Vegas events since I live in Vegas.). Plus, we’ll include discount codes to the events when we can.

I’d love to hear if there are other events that you think we should add to the list. I especially would like to know about the various Health IT and EHR user conferences that are happening. I’ve really fallen in love with those events because you get so many of the in the trenches users at the events.

I love to connect with readers, so if you’re at one of these events let me know so we can meet and say hi. I’ll also likely be speaking at some of the events as well, but I’m finalizing the details of that now.

Hopefully you’ll find this list useful. Also, you’ll notice that Healthcare Scene readers can get a discount to the Digital Health Conference in New York City. Just use the discount code “HCS” when you register and you’ll get a 20% discount on your registration. It’s a great event and one I look forward to every year.

Looks like it’s going to be a fun fall full of too much travel, but worth it to meet with hundreds of amazing people. I hope to see you at one of the events. Let me know what events you have on your list for Fall 2014.

July 16, 2014 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.