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Meaningful Use Is Dead?

Posted on January 29, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Over on EMR and HIPAA, I got the following passionate response on my post titled Meaningful Use Created A Big Need for Certified MAs that I thought many readers on this site would enjoy.

In the EP world, MU is dead. There are some larger groups, especially primary care still struggling to overcome the huge hurdles of MU2, but most I know have given up and running for the hills. There is a ginormous gap between what ONC is peddling in terms of numbers and real MU use.

This is good example of another hidden cost of trying to MU. We have some excellent MA’s, and I could not tell you which are and are not certified. Makes no difference. Sadly, CMS and ONC, do not realize that they are literally driving EPs from accepting Medicare patients, especially us specialists. And once we are gone, or severely limit new patients with Medicare, we are not coming back.

So the 17 times in 11 years fix for SGR, PQRS, VBM, MU, CPQ, ICD10, HIPAA, RAC audits, sequester cuts, etc. Its too much cost. clicking, paper work to take care of these patients. We actually had a serious discussion with our hospital about cutting back severely on doing Medicare total knees and hips next year due to all this. And the hospital initiated the conversation. So its not just us, even EHs are looking into this.

We all know that CMS and ONC want something, anything in terms of numbers to report anything to Congress, but this is the wrong way to do it. Again, everyone out there that is sitting in their cubicle Monday morning quarterbacking our care for these patients, will be very sad, very soon as we will just stop seeing them.

You can see by the numbers, if 250,000 EPs are taking the first MU hit this year, just wait until the rest give up. EPs can see that MU does not equate to better care, safer care, or more efficient care. We all may use an EHR, but could care less about attestations and audit risks and counting numerators/denominators forever. Again now that at least half the EPS are out, the rest will be right behind.

CMS and ONC need to realize that penalties NEVER work. Incentives like the heady days of MU1, got people to try EHR, but the costs are now piling up, big time. Everyone wants their piece of the pie. But as the incentives have gone away and the clerk like data entry has gone up, EPs have left the program. And are never, I mean never, coming back.

This provider makes an interesting assertion about meaningful use being dead. Do you think that MU is dead?

I thought this post’s timing was interesting given the announcement that CMS is changing the meaningful use stage 2 reporting period to 90 days. Correction…they intend to change it, but I think we all see that it’s going to happen. Just let the rule making process take it’s course.

Before this announcement, I would have largely agreed that meaningful use was pretty close to dead. I know some people have sifted through the meaningful use stage 2 attestations and have said it’s better than we thought, but I think those are the early birds and not the majority. With this announcement, I think the majority will take a much deeper look at taking on MU stage 2. If CMS can simplify some things, I could see many participating to get the incentive money, but to also avoid the penalties. Penalties aren’t the end all be all for doctors, but they represent a big chunk of money for many doctors.

I’d love to hear your thoughts. What are you seeing in the trenches?

ONC Annual Meeting – Who’s Going?

Posted on January 28, 2015 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

ONC’s Agenda – February 2-3, Washington, DC

Next Monday, ONC holds its annual meeting in downtown DC. I’m going, one small advantage of living here. Here’s the agenda. To see day two, click on the agenda header.

I’m particularly interested in these topics:

  • Adverse event reporting,
  • Interoperability standards,
  • Meaningful Use program’s future, and
  • Usability.

Looking at the agenda, I should stay busy with one exception. There isn’t much on usability. The word’s only on the agenda once. Not a surprise since ONC has pretty much relinquished any role to the vendors.

How important do you think the ONC meeting and also the ONC run Healthdatapalooza now that meaningful use has kind of run its course? Will these two meeting gain steam and influence or will organizations start to go other places? I’ll be interested to watch that trend as I attend the event.

If you can’t attend, you can follow on various webcasts and twitter. If you do plan to attend, I’d love to see you there. To email me, click on my name in my profile blurb, or at carl@ehrselector.com.

Clinical Decision Support Should Be Open Source

Posted on January 26, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Clinical decision support is a long-standing occupant of the medical setting. It got in the door with electronic medical records, and has recently received a facelift under the term “evidence based medicine.” We are told that CDS or EBM is becoming fine-tuned and energized through powerful analytics that pick up the increasing number of patient and public health data sets out in the field. But how does the clinician know that the advice given for a treatment or test is well-founded?

Most experts reaffirm that the final word lies with the physician–that each patient is unique, and thus no canned set of rules can substitute for the care that the physician must give to a patient’s particular conditions (such as a compromised heart or a history of suicidal ideation) and the sustained attention that the physician must give to the effects of treatment. Still, when the industry gives a platform to futurists such as Vinod Khosla who suggest that CDS can become more reliable than a physician’s judgment, we have to start demanding a lot more reliability from the computer.

It’s worth stopping a moment to consider the various inputs to CDS. Traditionally, it was based on the results of randomized, double-blind clinical trials. But these have come under scrutiny in recent years for numerous failings: the questionable validity of extending the results found on selected test subjects to a broader population, problems reproducing results for as many as three quarters of the studies, and of course the bias among pharma companies and journals alike for studies showing positive impacts.

More recently, treatment recommendations are being generated from “big data,” which trawl through real-life patient experiences instead of trying to isolate a phenomenon in the lab. These can turn up excellent nuggets of unexpected impacts–such as Vioxx’s famous fatalities–but suffer also from the biases of the researches designing the algorithms, difficulties collecting accurate data, the risk of making invalid correlations, and the risk of inappropriately attributing causation.

A third kind of computerized intervention has recently been heralded: IBM’s Watson. However, Watson does not constitute CDS (at least not in the demo I saw at HIMSS a couple years ago). Rather, Watson just does the work every clinician would ideally do but doesn’t have time for: it consults thousands of clinical studies to find potential diagnoses relevant to the symptoms and history being reported, and ranks these diagnoses by probability. Both of those activities hijack a bit of the clinician’s human judgment, but they do not actually offer recommendations.

So there are clear and present justifications for demanding that CDS vendors demonstrate its reliability. We don’t really know what goes into CDS and how it works. Meanwhile, doctors are getting sick and tired of bearing the liability for all the tools they use, and the burden of their malpractice insurance is becoming a factor in doctors leaving the field. The doctors deserve some transparency and auditing, and so do the patients who ultimately incorporate the benefits and risks of CDS into their bodies.

CDS, like other aspects of the electronic health records into which it is embedded, has never been regulated or subjected to public safety tests and audits. The argument trotted out by EHR vendors–like every industry–when opposing regulation is that it will slow down innovation. But economic arguments have fuzzy boundaries–one can always find another consideration that can reverse the argument. In an industry that people can’t trust, regulation can provide a firm floor on which a new market can be built, and the assurance that CDS is working properly can open up the space for companies to do more of it and charge for it.

Still, there seems to be a pendulum swing away from regulation at present. The FDA has never regulated electronic health records as it has other medical software, and has been carving out classes of medical devices that require little oversight. When it took up EHR safety last year, the FDA asked merely for vendors to participate voluntarily in a “safety center.”

The prerequisite for gauging CDS’s reliability is transparency. Specifically, two aspects should be open:

  • The vendor must specify which studies, or analytics and data sets, went into the recommendation process.

  • The code carrying out the recommendation process must be openly published.

These fundamentals are just the start of of the medical industry’s responsibilities. Independent researchers must evaluate the sources revealed in the first step and determine whether they are the best available choices. Programmers must check the code in the second step for accuracy. These grueling activities should be funded by the clinical institutions that ultimately use the CDS, so that they are on a firm financial basis and free from bias.

The requirement for transparent studies raises the question of open access to medical journals, which is still rare. But that is a complex issue in the fields of research and publishing that I can’t cover here.

Finally, an independent service has to collect reports of CDS failures and make them public, like the FDA Adverse Event Reporting System (FAERS) for drugs, and the FDA’s Manufacturer and User Facility Device Experience (MAUDE) for medical devices.

These requirements are reasonably light-weight, although instituting them will seem like a major upheaval to industries accustomed to working in the dark. What the requirements can do, though, is put CDS on the scientific basis it never has had, and push forward the industry more than any “big data” can do.

HIM and Where It’s Heading with Charlie Saponaro

Posted on January 23, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Lately I’ve started to really see the importance of HIM In the future of healthcare. I like to break HIM work into: managing the record (ie. Avoid Lawsuits), improving the coding/documentation (ie. More $$), and HIPAA compliance (ie. Avoid penalties). While their future has been questioned during the shift to EHR, I think they have a very important future in these areas.

With this as background, I did an interview with Charlie Saponaro, President and CEO of Medical Record Associates, to talk about the State of HIM. We talk about some major HIM trends like remote HIM and outsourced HIM for example. If you’re over HIM, in HIM or interested in the future of HIM, you’ll enjoy this chat with Charlie.

Athenahealth Goes After Hospitals and Tavenner Steps Down

Posted on January 22, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

There were two big pieces of news this week that I thought I’d discuss. Hopefully you’ll also add your thoughts and insights in the comments.

1. Athenahealth Moves Into Hospital Market With Acquisition Of Atlanta Startup RazorInsights
I thought the announcement of this acquisition was really interesting. Literally the day before this came out, someone asked me what I thought of Athenahealth. After some discussion, they said do you think they’ll take on Epic and Cerner. I quickly responded, “Well, they don’t have an inpatient EHR, so they don’t have a dog in the fight.” Well, now they do have a dog in the fight. Of course, RazorInsights still isn’t a big competitor of Epic and Cerner. However, if I know Jonathan Bush, that’s the ambition. At least that’s what his numerous cloud rants lead you to believe that he thinks he can take down Epic and Cerner with one single word: Cloud. We’ll see what RazorInsights can do under the Athenahealth umbrella.

2. CMS Leader Marilyn Tavenner Steps Down
Neil Versel has a great article covering Tavenner’s departure. His comments are pretty interesting when it comes to her staying low-profile and away from the media during her tenure at CMS. She’s certainly taken a lot of heat from the botched rollout of Healthcare.gov and other programs.

Personally, I’ll most remember her for her promise at HIMSS 2014 that ICD-10 was going to happen and that healthcare organizations better be ready. Of course, we know how that story played out with Congress passing a few lines in the SGR bill to delay ICD-10 another year. Given Tavenner’s promise, I’m quite sure she was blind sided by Congress’ move as well.

I’m not sure her departure is a good or a bad thing for healthcare. I’m sure that the healthcare behemoth will move along like it always has. Best of luck to her wherever she lands. No doubt working in the government in a high profile position is a rather thankless job that usually pays below market wages.

Who do you think will take Tavenner’s position at CMS? Does it matter?

Exploring the Role of Clinical Documentation: a Step Toward EHRs for Learning

Posted on January 19, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

We need more clinicians weighing in on the design of the tools they use, so I was gratified to see a policy paper from the American College of Physicians about EHRs this week. In a sporadic and tentative manner, the paper recognizes that our digital tools for clinical documentation are part of a universal health care system that requires attention to workflow, care coordination, outcomes, and research needs.

The strong points of this paper include:

  • A critique of interfaces that hobble the natural thought processes of the clinician trying to record an encounter

  • A powerful call to direct record-keeping away from billing and regulatory requirements, toward better patient care

  • An endorsement of patient access to records (recommendation 6 under Clinical Documentation) and even more impressively, the incorporation of patient-generated data into clinical practice (recommendation 5 under EHR System Design)

  • A nod toward provenance (recommendation 3 under EHR System Design), which tells viewers who entered data and when, thus allowing them to judge its accuracy

Although the authors share my interests in data sharing and making data available for research, their overarching vision is of an electronic record that supports critical thinking. An EHR should permit the doctor to record ideas about a patient’s condition as naturally as they emerge from his or her head. And it should support other care-takers in making treatment decisions.

That’s a fine goal in itself, but I wish the authors also laid out a clearer vision of records within a learning health care system. Currently a popular buzzword, a learning health care system collects data from clinicians, patients, and the general population to look for evidence and correlations that can improve the delivery of health care. The learning system can determine the prevalence of health disorders in an area, pick out which people are most at risk, find out how well treatments work, etc. It is often called a “closed loop system” because it can draw on information generated from within the system to change course quickly.

So at the start of the policy paper I was disappointed to read, “The primary goal of EHR-generated documentation should be concise, history-rich notes that reflect the information gathered and are used to develop an impression, a diagnostic and/or treatment plan, and recommended follow-up.” What about supporting workflows? Facilitating continuous, integrated care such as in a patient-centered medical home? Mining data for new treatments and interventions? Interfacing with personal health and fitness devices?

Fortunately, the authors massage their initial claim by the time they reach their first policy recommendation under Clinical Documentation: “The primary purpose of clinical documentation should be to support patient care and improve clinical outcomes through enhanced communication.” The primary purpose gets even better later on: “As value-based care and accountable care models grow, the primary purpose of the EHR should remain the facilitation of seamless patient care to improve outcomes while contributing to data collection that supports necessary analyses.”

One benefit of reading this paper is its perspective on how medical records evolved to their current state. It notes a swelling over the decades in the length of notes and the time spent on them, “the increased documentation arguably not improving patient care.” Furthermore, it details how the demands of billing drove modern documentation, blaming this foremost on CMS’s “issuance of the evaluation and management (E&M) guidelines in 1995 and 1997.” I suspect that private insurers are just as culpable. In any case, the distortion of diagnosis in the pursuit of payments hasn’t worked well for either goal: 40% of diagnoses are wrongly coded.

The pressures of defensive medicine also reveal the excessively narrow view of the EHR currently as an archive rather than a resource.

The article calls for each discipline to set standards for its own documentation. I think this could help doctors use fields consistently in structured documentation. But although the authors endorse the use of macros, templates, and (with care) copy/forward, they are distinctly unfriendly toward structured data. Their distemper stems from the tendency of structured interfaces to disrupt the doctor’s thinking–the presevervation of which, remember, is their main concern–and to make him jump around from field to field in an unnatural way.

Yet the authors recognize that structured data is needed “for measurement of quality, public health reporting, research, and regulatory compliance” and state in their conclusion: “Vendors need to improve the ability of systems to capture and manage structured data.” We need structured data for our learning health care system, and we can’t wait for natural language processing to evolve to the point where it can reliably extract the necessary elements of a document. But a more generous vision could resolve the dilemma.

Certainly, current systems don’t handle structured data well. For instance, the article restates the well-known problem of redundant data entry, particularly to meet regulatory requirements, a problem that could be solved with minimally intelligent EHR processing engines. The interactive features available on modern mobile devices and web interfaces could also let the clinician enter data in any manner suited to her thinking, imposing structure as she goes, instead of forcing her into a rigid order of data entry chosen by the programmer.

Already, Modernizing Medicine claims to make structured data as easy to enter as writing in a paper chart. As I cover in another article, they are not yet a general solution, but work only with a few fields that deal with a distinct set of health conditions. The tool is a model for what we can do in the future, though.

The common problem of physicians copying observations from a previous encounter and pasting them into the current encounter is a trivial technical failure. On the web, when I want to cite material from a previous article, I don’t copy it and paste it in. I insert a hyperlink, I did in the previous paragraph. EHRs could similarly make reporting simple and accurate by linking to previous encounters where relevant.

The ACP recommendations are sensible and well-informed. If implemented by practitioners and EHR developers who keep the larger goals of health care in mind, they can help jump over the chasm between where EHRs and documentation are today, and where we need them to be.

Full Disclosure: Modernizing Medicine is an advertiser on this site.

Possible Future EHR UIs at CES

Posted on January 16, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

If you haven’t been following all of my CES Digital Health coverage, you might want to check out some of the following articles:
Initial CES 2015 Observations
Wearables Explosion at CES 2015
A Video Look at the Digital Health, Fitness and Wellness Section of CES 2015
A Look at Digital Health at CES 2015

While I was mostly focused on the Digital Health section of CES, I also took note of a number of new user interface approaches that various companies were demoing at CES. Since it’s CES, some of these are still conceptual, but they got my EHR UI thoughts going.

Finger Mouse
The Motix Touch Mouse was one of the most intriguing new user interfaces I’ve ever seen in the 10 years I’ve been attending CES. Your hands basically stay on the keyboard and a motion capture device follows your finger which works like a mouse on screen. It was a really interesting evolution of the mouse. Unfortunately, they didn’t have a great form example which would replicate the EHR world in which I live. So, I’m not sure how well this finger mouse would work filling out the long forms that many have in their EHR. However, the concept was really intriguing to consider.

Here’s a video demo of the Motix Touch Mouse:

3D Rudder
The 3D Rudder really blew my mind when I tried it out. I’m not exactly sure of its application in the EHR and healthcare IT world, but the experience of controlling your computer with your feet was really amazing. Plus, the foot control was able to work in 3 dimensions which made it really unique. It took me a second to learn, but I’d love the new way to look at how an input control could work.

You can see the 3D Rudder’s Indiegogo campaign, and here’s a video demo of the 3D Rudder:

While the mouse and keyboard have been tremendously powerful input devices for computers, I’m fascinated to consider how the evolution of computer input will go. We’ve seen the amazing growth of voice and touch over the past couple years. However, I think and hope we’re just getting started with how simple it will be to control the computers of the future. I believe the small innovations like the two mentioned above are part of the process of improving computer UIs as we know them.

What Happens When An EHR Vendor is Acquired?

Posted on January 12, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

With meaningful use money running out, and as the EHR industry matures, we’re going to see more and more consolidation in the EHR market. Many EHR vendors are going to start running out of money. Other larger EHR vendors are going to want to try and buy up market share. In some ways this has already begun. See Greenway being purchased by Vitera Healthcare Solutions and Cerner acquiring Siemens to name some of the larger ones that have happened recently. Although, anyone that’s been a user of Bond EHR (people still miss that EHR software), Allscripts MyWay, Misys, etc etc etc knows the challenges of when your EHR vendor gets acquired.

While your EHR being acquired by another EHR vendor is almost never a good thing for your EHR software’s future, L Nelms visited this post on EMR and EHR News and offered an even worse story of an EHR being acquired and the fallout the doctors felt. I’ve removed the name of the vendors since the principle could apply to many vendors that get acquired.

After completing Stage one of Meaningful Use, I am now dropping out of the whole damn thing. This decision is based entirely on my continued dissatisfaction with the EMR program I chose. I started using EHR Vendor A in 2012. As many know, EHR Vendor A was subsequently bought by ABC corporation who refused to honor the original contract which promised no additional fees. ABC corporation, knowing that they had customers “right where they wanted them” — knowing that switching programs would incur tremendous costs and disruption to the practices’ work flow, immediately imposed a $250.00 monthly “support fee”, requiring automatic payments from the customers credit card. I do not know what constitutes “support” from this company, as I had problems with the program and attempted to contact them numerous times from Nov 19, 2014 to Dec 9, without a SINGLE reply in any form from them. On Jan 1, 2015, they increased this fee to $300.00.

They continue to inundate us with newsletters telling us how wonderful they are, including an alert urging us to “respond today” to arrange to get the new certified software installed. This was sent on Christmas Eve! They warned us repeatedly that we must be using the new software ON Jan 1,2015, in order to meet MU. What they didn’t mention until the day before the install, was that there is a “one-time installation fee of $99.00″ (charged immediately, of course, to you credit card).

I asked if I could do the install myself and was told “yes, but we’re not really charging for the install, we’re charging for the SQL server update (which actually can be done oneself ). But I was told I had to pay. And now, the new certified software, which is COMPLETELY different from the previous version, is a nightmare. It is agonizingly slow, painstakingly labor intensive, and heaven forbid I should require tech support who, on top of being nowhere to be found, are so disrespectful (the last one one I spoke to actually said — when I expressed my dissatisfaction with not being able to get my data when I terminate my contract — “well we didn’t force you to buy our program”

Which doesn’t explain why I feel so violated…..

I should clarify that my data from EHR Vendor A is “available”: after many cryptic replies from them over several days, I was finally told that I can access the data from the server, but then — and you all know the story– I must take out a second mortgage on my home to have the data converted to some semblance of a usable format. This may not be illegal (only because the the recklessness of the companies has not yet been regulated), but it is certainly of questionable ethicacy

I think this is a fear that many doctors have when selecting and purchasing their EHR software. It’s why many of them still choose to go with the big name EHR vendors. Stories like this one scare doctors away from a small EHR vendor with an uncertain future. Although, I’ve written previously about the uncertain future of large EHR vendors as well.

The EHR industry should do better than this. I hope this story is an aberration, but I’m afraid we’re going to see more and more stories like it as the EHR industry consolidates. There will still be many good EHR actors out there that are appalled by these stories like I am. Hopefully, more and more doctors will find those good actors who are sincere in their efforts to provide a quality product with a quality user experience for the doctor. They’re out there, but bad actors like what’s described above give the good apples a bad name.

The New Congressional Rider: Unique Patient ID Lemonade?

Posted on January 8, 2015 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

Note: Previous versions referred to Rand Paul as the author of the first congressional rider. That was in error. The first rider was authored by then Representative Ron Paul. I regret the error. CB

Last month, I posted that Ron Paul’s gag rule on a national patient identifier was gone. Shortly, thereafter, Brian Ahier noted that the gag rule wasn’t dead. It just used different words. Now, it looks as if we were both right and both wrong. Here’s why. Paul’s rider’s gone, but its replacement, though daunting, isn’t as restrictive.

The gag rules are appropriation bill riders. Paul’s, which began in 1998, was aimed at a HIPAA provision, which called for identifiers for:

…. [E]ach individual, employer, health plan, and health care provider for use in the health care system. 42 US Code Sec. 1320d-2(b)

It prohibited “[P]lanning, testing, piloting, or developing a national identification card.” This was interpreted to prohibit a national patient id.

As I noted in my post, Paul’s language was dropped from the CRomnibus appropriation act. Brian, however, found new, restrictive language in CRomnibus, which says:

Sec. 510. None of the funds made available in this Act may be used to promulgate or adopt any final standard under section 1173(b) of the Social Security Act providing for, or providing for the assignment of, a unique health identifier for an individual (except in an individual’s capacity as an employer or a health care provider), until legislation is enacted specifically approving the standard.

Gag Rule’s Replacement Language

Unlike Paul’s absolutist text, the new rider makes Congress the last, biggest step in a formal ID process. The new language lets ID development go ahead, but if HHS wants to adopt a standard, Congress must approve it.

This change creates two potential adoption paths. Along the first, and most obvious, HHS develops a mandatory, national patient ID through Medicare, or the Meaningful Use program, etc., and asks congress’ approval. This would be a long, hard, uphill fight.

The second is voluntary adoption. For example, NIST could develop a voluntary, industry standard. Until now, Paul’s rider stopped this approach.

NIST’s a Consensus Building Not a Rulemaking Agency

NIST’s potential ID role is well within its non regulatory, consensus standards development mandate. It could lead a patient ID building effort with EHR stakeholders. Given the high cost of current patient matching techniques, stakeholders may well welcome a uniform, voluntary standard. That would not solve all interoperability problems, but it would go a long way toward that end.

Congress has loosened its grip on a patient ID, now its up to ONC, NIST, etc., to use this new freedom.

2014 Was the Year of the Healthcare IT Videos

Posted on January 2, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In 2014, I made a good effort to create a lot more video content. You can check out our Healthcare IT Videos on YouTube (Subscribe to the Channel if you like them). The majority of our videos were done as Google Plus hangouts and we posted them on our EHR Video blog as well. Although, I did also do a number of videos at conferences.

Here’s a playlist of all my Healthcare Scene Google Plus hangouts:

I just checked the YouTube stats for the videos and they tell an interesting story:
11,921 views
47,900 minutes watched
39 Likes
50 Comments
38 Shares
56 Subscribers Gained

Just for reference, here are the stats for the life of the channel:
30,596 views
90,032 views
100 Likes
76 Comments
66 Shares
119 Subsribers Gained

Another interesting stat is that 36% of views of these videos came from a YouTube Search or YouTube suggested video. One of the big reasons I started doing more videos is YouTube is the second largest search engine in the world (Google is the first). Although, as you can tell from the numbers above, the percent of healthcare IT and EHR searches on YouTube is an infinitesimally small number of total searches.

I still think video presents a great opportunity. Although, as I enter into 2015, I’m looking at making some changes in my approach. First, I’m not sure that the video really matters that much. I always told people I talked to that people watching the videos were doing it for what was said as opposed to the production value. With that in mind, in my latest video I did more of a radio style interview with just our headshots: http://www.ehrvideos.com/2015/01/02/the-future-of-him-with-charlie-saponaro/ There’s something infinitely simpler about audio than video which will make doing these much easier for everyone involved. I’ll be exploring people’s reaction to an audio stream like the one linked and see what people think of them. I’ll still throw in the occasional video one where it makes sense.

Second, I want to find a way to do more short videos that focus on some key insights. I’ve got a few ideas on how to execute this, but it’s basically an extension of what we’ve done here on the blogs. We give you short and sweet value. I want to do more of that with videos. Some of those will be chopping up my larger videos into shorter segments. Although, we’ll also be exploring new short format options that I think you’ll enjoy.

All in all, I’m excited by what we’ve started with video. I think the 2014 work we did with video has laid the groundwork for the future and 2015 should be our best year ever with video. It will be fun to look back on this post and see how we do in 2015.

Oh yes, I’m also determined in 2015 to do a few Healthcare IT music videos with some help from Health IT Rock Star, Mandi Bishop.

What do you think of the videos we’ve created? Are there other things you’d like to see us do with video?