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Could Clinicians Create Better HIE Tools?

The following is a guest blog post by Andy Oram.His post reminds me of when I asked “Is Full Healthcare Interoperability a Pipe Dream?

A tense and flustered discussion took place on Monday, August 11 during a routine meeting of the HIT Standards Committee Implementation Workgroup, a subcommittee set up by the Office of the National Coordinator (ONC), which takes responsibility for U.S. government efforts to support new IT initiatives in the health care field. The subject of their uncomfortable phone call was the interoperability of electronic health records (EHRs), the leading issue of health IT. A number of “user experience” reports from the field revealed that the situation is not good.

We have to look at the depth of the problem before hoping to shed light on a solution.

An interoperability showcase literally takes the center of the major health IT conference each year, HIMSS. When I have attended, they physically arranged their sessions around a large pavilion filled with booths and computer screens. But the material on display at the showcase is not the whiz-bang features and glossy displays found at most IT coventions (those appear on the exhibition floor at HIMSS), but just demonstrations of document exchange among EHR vendors.

The hoopla over interoperability at HIMSS suggests its importance to the health care industry. The ability to share coordination of care documents is the focus of current government incentives (Meaningful Use), anchoring Stage 2 and destined to be even more important (if Meaningful Use lasts) in Stage 3.

And for good reason: every time we see a specialist, or our parent moves from a hospital to a rehab facility, or our doctor even moves to another practice (an event that recently threw my wife’s medical records into exasperating limbo), we need record exchange. If we ever expect to track epidemics better or run analytics that can lower health case costs, interoperability will matter even more.

But take a look at extensive testing done by a team for the Journal of the American Medical Informatics Association, recently summarized in a posting by health IT expert Brian Ahier. When they dug into the documents being exchanged, researchers found that many vendors inserted the wrong codes for diagnoses or drugs, placed results in the wrong fields (leaving them inaccessible to recipients), and failed to include relevant data. You don’t have to be an XML programmer or standards expert to get the gist from a list of sample errors included with the study.

And that list covers only the problems found in the 19 organizations who showed enough politeness and concern for the public interest to submit samples–what about the many who ignored the researchers’ request?

A slightly different list of complaints came up at the HIT Standards Committee Implementation Workgroup meeting, although along similar lines. The participants in the call were concerned with errors, but also pointed out the woeful inadequacy of the EHR implementations in representing the complexities and variety of patient care. Some called for changes I find of questionable ethics (such as the ability to exclude certain information from the data exchange while leaving it in the doctor’s records) and complained that the documents exchanged were not easy for patients to read, a goal that was not part of the original requirements.

However, it’s worth pointing out that documents exchange would fall far short of true coordinated care, even if everything worked as the standards called for. Continuity of care documents, the most common format in current health information exchange, have only a superficial sliver of diagnoses, treatments, and other immediate concerns, but do not have space for patient histories. Data that patients can now collect, either through fitness devices or self-reporting, has no place to be recorded. This is why many health reformers call for adopting an entire new standard, FHIR, a suggestion recognized by the ONC as valid but postponed indefinitely because it’s such a big change. The failure to adopt current formats seems to become the justification for keeping on the same path.

Let’s take a step back. After all those standards, all those certifications, all those interoperability showcases, why does document exchange still fail?

The JAMIA article indicated that failure can be widely spread around. There are rarely villains in health care, only people pursuing business as usual when that is insufficient. Thus:

  • The Consolidated CDA standard itself could have been more precisely defined, indicating what to do for instance when values are missing from the record.

  • Certification tests can look deeper into documents, testing for instance that codes are recorded correctly. Although I don’t know why the interoperability showcase results don’t translate into real-world success, I would find it quite believable that vendors might focus on superficial goals (such as using the Direct protocols to exchange data) without determining whether that data is actually usable.

  • Meaningful Use requirements (already hundreds of pages long) could specify more details. One caller in the HIT Standards Committee session mentioned medication reconciliation as one such area.

The HIT Standards Committee agonized over whether to pursue broad goals, necessarily at a slow pace, or to seek a few achievable improvements in the process right away. In either case, what we have to look forward to is more meetings of committees, longer and more mind-numbing documents, heavier and heavier tests–infrastructure galore.

Meanwhile, the structure facilitating all this bureaucracy is crumbling. Many criticisms of Meaningful Use Stage 2 have been publicly aired–some during the HIT Standards Committee call–and Stage 3 now looks like a faint hope. Some journalists predict a doctor’s revolt. Instead of continuing on a path hated by everybody, including the people laying it out, maybe we need a new approach.

Software developers over the past couple decades have adopted a range of ways to involve the users of software in its design. Sometimes called agile or lean methodologies, these strategies roll out prototypes and even production systems for realistic testing. The strategies call for a whole retooling of the software development process, a change that would not come easily to slow-moving proprietary companies such as those dominating the EHR industry. But how would agile programming look in health care?

Instead of bringing a doctor in from time to time to explain what a clinical workflow looks like or to approve the screens put up by a product, clinicians would be actively designing the screens and the transitions between them as they work. They would discover what needs to be in front of a resident’s eyes as she enters the intensive care ward and what needs to be conveyed to the nurses’ station when an alarm goes off sixty feet away.

Clinicians can ensure that the information transferred is complete and holds value. They would not tolerate, as the products tested by the JAMIA team do, a document that reports a medication without including its dose, timing, and route of administration.

Not being software experts (for the most part), doctors can’t be expected to anticipate all problems, such as changes of data versions. They still need to work closely with standards experts and programmers.

It also should be mentioned that agile methods include rigorous testing, sometimes to the extent that programmers write tests before writing the code they are testing. So the process is by no means lax about programming errors and patient safety.

Finally, modern software teams maintain databases–often open to the users and even the general public–of reported errors. The health care field needs this kind of transparency. Clinicians need to be warned of possible problems with a software module.

What we’re talking about here is a design that creates a product intimately congruent with each site’s needs and workflow. The software is not imported into a clinical environment–much less imposed on one–but grows organically from it, as early developers of the VistA software at the Veterans Administration claimed to have done. Problems with document exchange would be caught immediately during such a process, and the programmers would work out a common format cooperatively–because that’s what the clinicians want them to do.

August 13, 2014 I Written By

4 Health IT and EHR Blogs

As I’ve been putting together these blog posts about other Health IT and EHR bloggers, I’ve been astounded how many former bloggers have stopped blogging. I guess I was write to post one of my first blogger features as “EHR Blogger Attrition.” I imagine many previous bloggers are still sharing content, but have likely moved to other social media which is much easier to sustain. A tweet can be generated much more quickly than a blog post.

With that in mind, I feel grateful that I’m still able to blog and that enough people come and read my blog posts that I can provide for my family with my blogging. While some might define my blogging as micro blogging, I think there’s more value in a blog post than a tweet. You don’t have to dig into subjects in a tweet. People don’t go looking through your old tweets like they do blog posts.

Those musings aside, here are some other Health IT and EHR bloggers you might find interesting:
Health Blawg – David Harlow has a fascinating blog covering many of the various healthcare regulations that encumber our lives. Many lawyers are afraid to blog, but David has overcome that fear and created regular healthcare content that’s well worth following.

The Health Care Blog – While this blog isn’t exclusively health IT, a large portion o the topics are Health IT related. This blog never ceases to amaze me at the number of people they have contributing quality content to their site. It doesn’t have one voice, and that’s what makes the site so great. You might read a post about healthcare analytics and then one on value based contracts. Plus, it has one of the most active communities for comments. In fact, I often find myself more interested in the comments than the post itself.

Phil Baumann – While Phil is an RN by training, he’s more of a healthcare communicator and marketer than anything. Phil’s been doing this long enough that he doesn’t pull any punches. He just says it the way it is and isn’t afraid of saying things others aren’t comfortable saying. That makes for a good blog.

Galen Healthcare Solutions – I always like to feature at least one health IT company that’s creating great blog content. Galen Healthcare Solutions is definitely one of the best out there and they’ve been doing it consistently for a long time. Looks like their first blog post was in July 2008. I’m not sure who’s behind their consistency, but they deserve a lot of credit for the work they’ve done. It’s a great blog.

August 12, 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.

Publicly Traded Health IT Companies

I keep forgetting how good of a resource Quora is. For those not familiar with Quora, it’s a Q&A platform. If you have a question, you can get answers from the community of users. While asking questions is interesting, it’s also fun to just browse other people’s questions and answers. In some ways it’s an active and opinionated Wikipedia.

Here’s a good example. Someone asked about Healthcare IT companies or digital health companies that are publicly traded and here’s the list they generated:

  • Allscripts (NASDAQ: MDRX) builds electronic health records and practice management solftware
  • athenahealth (NASDAQ: ATHN) provides cloud-based billing and clinical software to medical group practices
  • Benefitfocus (NASDAQ: BNFT)
  • Careview Communications (OTCBB: CRVW) high speed data network system deployed in a healthcare facilities using existing cable television infrastructure.
  • Cerner (NASDAQ: CERN) develops EMR software to support clinical practice in hospitals, worksite clinics, physician practices and pharmacies
  • Computer Programs and Systems (NASDAQ: CPSI) Develops an EMR system specifically for rural, community and critical access hospitals
  • Epocrates (NASDAQ:EPOC) is a mobile health app publisher for medical professionals
  • Greenway Medical (NYSE: GWAY) builds electronic health records and practice management solftware
  • HealthStream (NASDAQ: HSTM) develops a learning management system for healthcare providers
  • iCAD (NASDAQ: ICAD) CAD solutions for digital and film-based mammography systems
  • MedAssets (NASDAQ: MDAS) provides cloud-based software for clinical spend management and revenue cycle management
  • Medidata Solutions (NASDAQ: MDSO) provides a cloud-based clinical trial data management solution
  • Merge Healthcare (NASDAQ: MRGE) builds “enterprise imaging” software company
  • Omnicell (NASDAQ: OMCL) automated solutions for hospital medication and supply management
  • Quality Systems (NASDAQ: QSII) develops practice management and EHR solutions as well as HIEs for medical and dental group practices and hospitals
  • Simulations Plus (NASDAQ: SLP) simulation software for use in the pharmaceutical research and in the education of pharmacy and medical students
  • Streamline Health Solutions (NASDAQ: STRM) workflow and document management technology solutions for hospitals and physician groups
  • Vocera (NASDAQ: VCRA)  wearable voice-controlled communication badge and software platform for hospitals
  • WebMD (NASDAQ: WBMD) provides health information services for consumers and healthcare professionals through its public/private portals

Pretty interesting to look through the list. Of course, it doesn’t include publicly traded companies that have a big footprint in healthcare, but do a lot of other things as well (GE, Siemens, Dell, CDW, Canon, etc etc etc).

When I saw the list of publicly traded health IT companies I wondered if something cool could be done to track these companies. I’ve noticed that HIStalk has been following the publicly traded companies a lot closer lately. A lot can be learned about the healthcare IT market by following these companies.

How many of you use Quora on a regular basis? Do you just consume content or do you ask and answer questions too?

August 8, 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.

Karen DeSalvo’s Sit Down Interview with Shahid Shah at the Health Privacy Summit

At the 2014 Patient Privacy Summit, Shahid Shah had a “Fireside Chat” with Karen DeSalvo. The interview was really great because it was the first time that I’ve seen Karen DeSalvo talk in a more casual and less scripted setting. In the interview you learn a lot about the leader of ONC and what’s on her mind and how her and ONC plan to approach healthcare IT in the future. Of course, since it’s at the Patient Privacy Summit, there’s a specific emphasis on privacy, but they also cover a lot of other related topics. Enjoy!

August 7, 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.

If You Were an EHR, Which Would You Be?

I was recently watching a video of Derek Hough, Dancer on Dancing with the Stars (and much more). In the interview Derek was asked which dance best fit various periods of his life. As an #HITNerd, I thought we could do something similar with EHR vendors. So…

If You Were an EHR, Which Would You Be? Are you…

Epic – Single minded, focused and dominating in their sphere. Closed to outside discussions, but very thoughtful and caring of those in your inner circle. A bulldog if someone comes after something you consider important. Built on an aging system that’s done well, but many question how much longer they can be successful on top of such an old platform.

Cerner – The second child who’s done really well for themselves, but wonders why the older brother gets all the attention. They’re successful, well educated, built on a strong foundation, open to improvement. They’ve recently taken on a little bit of baggage. They decided to marry someone who’s been divorced and has four children. We’re not sure how this new marriage is going to work out and how it’s going to impact the family structure.

MEDITECH – This is the middle child. Ahead of their time, but no one notices them anymore. They’re quiet and mostly stay to themselves in their corner. Sure, they’d like to be noticed and get more attention, but they don’t mind too much since they’ve been so successful.

Allscripts – Flashy. Exciting and unpredictable. They’re the one that wears the flashy green jacket to the party. They’ve worked on so many things in their life that it’s hard to really place who they are and what they do. They’ve seen a lot of success, but don’t make us predict what they’ll do next. They seem to have a clear vision of where there going (albeit different than it was 2-3 years ago), but that could change so you have to stay on your toes.

athenahealth – Despite some ADD tendencies, they’ve largely stayed the course on what they want to do and what they want to become. They’re always interesting to be around, because they’re never shy to say what they think or feel about anything. While not as successful as some other people, they still have a lot of potential that could blow up for good or bad. If nothing else, they’re the life of the party and always keep things interesting.

I could keep going, but that’s a good start using a few of the larger or more well known EHR vendors. Which one is most like you? Also, I really hope that many of you will join me in the comments and revise/improve upon what I’ve written or do something similar for another EHR vendor. Let’s have some fun and learn about people’s perceptions of these companies in the process.

Note: Cerner is an advertiser on this site.

August 6, 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.

1300 Blog Posts and 3.5+ Million Pageviews

I need to try and remember to celebrate each blogs accomplishments more often. I just noticed that EMR and EHR just passed 1300 blog posts and 3.5 million pageviews since we started this blog on April 30, 2009 (Note: The full Healthcare Scene network is well over 6000 blog posts). I just came across this tweet and it seemed fitting to describe what I’ve done with EMR and EHR.

I guess one could argue that the Ark was built with help from THE EXPERT, but let’s not get dig into Bible doctrine here. No doubt this is the ark. People ask me all the time if I have a background in journalism. Short Answer: No. Long Answer: I was the guy that avoided any kind of English class in college and so I only took one business writing class my whole college career. After that they also ask me if I have a background in healthcare. Short Answer: No. Long Answer: I interviewed for my first job in healthcare about 9 years ago and when asked about my experience in healthcare I replied, “I’ve been to the doctor.” For those wondering, I do have an IT background. That’s why I’m appropriately @techguy on Twitter.

Why then has EMR and EHR been such a success? I’ll admit that my timing was good. The $36 billion in EHR stimulus money really helped this site grow. Although, this site wouldn’t have the thousands of email subscribers and regular readers that it has if there wasn’t something more.

At the end of the day, I think there are two major things that have made EMR and EHR a success: passion and community.

I love healthcare IT. More specifically, I love the impact of technology on systems. I love how you can use technology to improve something (yes, I know we could argue whether EHR improves something or not, but that’s another post). I have a deeply held belief that technology can improve processes. Luckily that belief is deeply rooted and proved out in millions of ways. Sadly, only a few of those are in healthcare, but to me that just means there’s so much opportunity. This passion is what makes 1300 blog posts possible. Any blogger can tell you that about 50 blog posts in, the low hanging fruit is gone. Passion is what gets you past 50 blog posts and why there’s a never ending well of content that can be written.

While passion is important (especially at the beginning when no one is reading), the real reason EMR and EHR is a success is because of the community behind it. The regular readers who comment publicly and privately make it something special. The readers who forward a post to their colleagues and friends are all apart of the makeup of the blog. The people who tweet and share these posts on social media are what make this blog tick. Thanks to all of you who contribute in some small or large way to the community.

Thanks for letting me muse for a minute about EMR and EHR. I’m looking forward to the next 1300 blog posts and 3.5 million pageviews. I think we’re entering one of the most exciting times for healthcare IT. I see a bunch of grunt work ahead, but the results of that grind are going to provide solutions we would never expect.

August 4, 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.

EHR Change Doesn’t Always Mean Better

In the comments of my post “EHR Replacement Roadmap to Success“, John Brewer provided a great reminder that changing EHR software doesn’t always mean that you’ll change to a better EHR. You might change to something worse. At least that’s my summary of his comments. You can read his full comment if you want.

I’ve learned this lesson over and over in my career. Sometimes you need to be content with what you have. One example of this was when I was working at a University in Hawaii. I was quite disappointed with the CIO and thought that he could do a lot of things different. Well, I got my wish and the CIO was replaced with someone else. Considering the topic of this blog post, you can imagine what happened next. The replacement CIO was so much worse than the previous CIO. Lesson learned.

Change doesn’t always mean a change for the better. It can certainly mean a change for the worse.

This applies fully to EHR replacement, which is quickly becoming a hot topic as many people regret their EHR purchase decision. You do need to be careful that you’re so afraid of change that you never change. In many situations change is the right decision. Plus, unlike my story where I had little control over who was hired as the new CIO, when you switch EHR software you can have some impact on the selection and end results. In many cases, you might even discover that you shouldn’t switch EHR before it’s too late.

I expect most people who think they need to switch EHR need to be careful to not set a predetermined course early in the process. Instead of saying, “Which EHR should I switch to?” I believe that many should dig deeper into the question, “If I switched EHR software, what would improve?”

As I replied to John Brewer in the post linked above, it is often (but not always) the case that the second EHR selected goes better than the first. I’ve found that the first “failed” EHR implementation usually teaches some great (albeit costly) lessons that they’re able to avoid the second time around. However, there is a tendency the second time around to focus too much on the first EHR issues that can cause different trouble the second time around. As in most things, there’s a balance to be had.

My best suggestion is to not do anything too impulsive. Let the idea sit and germinate a little before you do anything too drastic. Emotional decisions with EHR software selection (and quite frankly many other decisions) often leads to bad outcomes.

August 1, 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.

EHRs Don’t Make Errors, People Do

An intriguing blog title, I know. I saw it on Bill Crounse, MD’s blog post and couldn’t resist extending the discussion. This is a really challenging topic and so it’s definitely worth of discussion.

On the one hand it’s clear to me that EHR software isn’t perfect. However, paper charts weren’t perfect either. On the other hand, people aren’t perfect either. Unfortunately, we don’t want to admit our imperfection and our society has gotten to the point that imperfections are unacceptable.

In the blog post mentioned above, Dr. Crounse offers the following suggestions and I’ll add my own commentary for each:

Involve the Patient Right from the Start – I’m hopeful that some of the companies working on this problem will get widespread adoption. The patient could definitely be more involved in entering their patient data before the visit even happens and thus relieve the burden on the clinician. This is a challenging problem to solve though when you consider the vast array of physician preferences.

Ease the Documentation Burden on Clinicians – This is mostly a knock on our current billing system. If we make the switch to value based reimbursement can we ease the documentation burden on clinicians? That’s worthy of its own post and some deeper thought. Sadly, I think in the short term it likely means more documentation burden for clinicians. I don’t see this happening soon, but it’s a noble goal.

Prohibit Templates, Cut and Paste – I generally disagree with this one. Ironically, the title of the post illustrates my issue with it, “Electronic Health Record solutions don’t make errors, people do.” It’s not templates and cut and paste that’s the problem as much as it is rushed physicians who don’t use it appropriately. I think one word describes most of the issues: laziness. I know. When I use a template for my blog posts or email blasts, I get lazy on them sometimes too. Fortunately, my blog posts or emails don’t have people’s lives hanging on them. So, maybe Dr. Crounse has a point. It’s just too easy to screw up templates and copy/paste.

Share Information with Patients – I’ve long been a proponent of the patient being aware of the information in the paper chart. I know that many doctors fear this. Usually they reference the fear that patients won’t understand the information that’s in the chart. I’ve just not seen this to be the case in practice and the benefits of the patient being able to be involved in their chart is so much more valuable than any perceived risk. The harder part is that I haven’t seen any system which creates a simple way for the patient to update/correct/verify information in a chart. Access is a great step forward, but the next steps is to empower the patient to assist in the patient chart quality control process.

As long as we have imperfect humans using imperfect EHR software, errors are going to happen. However, we can do better than we’re doing today. I like the ideas that Dr. Crounse suggested. I’d love to hear any ideas you have as well.

July 31, 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.

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.