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Participants Wanted for Remote EHR Usability Study

My friend Bennett Lauber of  The Usability People is looking for medical professionals, MD’s, RN’s or CMA’s to participate in a remote EHR usability study. Here’s the information on the project:

This study will be conducted during the first and second week of May, 2014. Qualified participants that complete the study will receive compensation up to a $100 Amazon gift card.

Please complete the following form to see if you qualify:

http://www.theusabilitypeople.com/participate

Thanks in advance

 Bennett Lauber
Chief Experience Officer
The Usability People, LLC

Check it out if you think you can help. We all know that EHR Usability can use all of our help.

April 17, 2014 I Written By

When Carl Bergman’s not 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.

What Software Will Replace EHR?

I’m usually a very grounded and practical person. I’m all about dealing with the practical realities that we all face. However, every once in a while I like to sit back and think about where we’re headed.

I’ve often said that I think we’re locked into the EHR systems we have now at least until after the current meaningful use cycle. I can’t imagine a new software system being introduced in the next couple years when every hospital and healthcare organization has to still comply with meaningful use. Many might argue that meaningful use beyond the current EHR incentive money might lock us in to our existing EHR software for many years after as well.

Personally, I think that a new software will replace the current crop of EHR at some point. This replacement will likely coincide with the time an organization is up for renewal of their current EHR. The renewal costs are usually so high that a young startup company could make a splash during renewal time. Add in a change of CIO and I think the opportunity is clear.

My guess is that the next generation of healthcare documentation software will be one that incorporates data from throughout the entire ecosystem of healthcare. I’m not bullish on many of the current crop of EHR software being able to make the shift from being document repositories and billing engines into something which does much more sophisticated data analysis. A few of them will be able to make the investment, but the legacy nature of software development will hold many of them back.

It’s worth noting that I’m not talking about the current crop of data that you can find outside of the healthcare system. I’m talking about software which taps into the next generation of data tracking which goes as far as “an IP address on every organ.” This type of granular healthcare data is going to change how we treat patients. The next generation healthcare information system will need to take all of this data and make it smart and actionable.

To facilitate this change, we could really use a change in our reimbursement system as well. ACOs are the start of what could be possible. What I think is most likely is that the current system will remain in place, but providers and organizations will be able to accept a different model of payment for the healthcare services they provide. While I fear that HHS might not be progressive enough to do such a change, I’m hopeful that by making it a separate initiative they might be able to make this a reality.

What do you think? What type of software, regulations and technology will replace our current crop of EHR? I don’t think the current crop of EHR has much to worry about for now. However, it’s an inevitable part of a market that it evolves.

April 15, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently 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.

EMR Customer Service, EMR Not Meeting ACOs Needs, and Patient Centered EMR Rollout


Zappos is in Las Vegas, and I can assure you that this story is true. I’ve always wondered how they’d scale that policy if thousands of people called for pizza. The key I think is that they do focused customer service. Chandresh asks an important question. Which EHR vendors have delightful customer service?


If EHR vendors don’t make the ACO possible, who will?


I’d be more interested in seeing an EHR roll out that considered the patient.

April 13, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently 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.

Not All EHR Clicks Are Evil

There’s a great blog post on HIStalk that is a beautiful CMIO Rant. He provides some really needed perspective on the issues with EHR software. In many ways, the post reminded me of my post titled “Don’t Act Like Charting on Paper Was Fast.” In that post, I highlight the fact that far too many people are comparing EHR against doing nothing versus comparing EHR against the alternative. Those are two very different comparisons.

The money line from the CMIO rant was this one:

If we insist that all clicks are wasted time, then we can’t have a conversation about usability, because under the prescription pad scenario, the only usable computer is one you don’t have to use at all.

I love when you take something to the extreme. It’s true that we all want stuff to just happen with no work. That’s perfect usability. However, that’s just not the reality (at least not yet). If we want the data to be accurate and to be recorded, then it takes human intervention (ie. clicks). Some clicking is necessary.

The CMIO goes on to say that the key to EHR usability is expectations. I thought that was an interesting word to describe EHR usability. I’ve written about this topic before when I compared the number of EHR clicks to the keys on a piano. In that article I suggested that the number of clicks wasn’t the core issue. If we could create EHR software that was hyper responsive (like a piano key), was consistent in its response speed, and we provided proper training, then having a lot of EHR clicks wasn’t nearly as big an issue.

Not that this should be an excuse for EHR vendors to make crappy software. They should still do what they can to minimize clicks where possible. However, the bigger problem is that we haven’t achieved all three of these goals. So, we’ll continue to hear many people complaining about all the EMR clicks.

April 11, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently 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.

Scribes and Problems with the Healthcare System

In a recent #HITsm chat we had a pretty good discussion about scribes and their place in healthcare. I know a lot of people that are really big proponents of scribes, but I also know many people who are against them.

During the discussion, the question was asked if scribes mask the problems of the EHR software. This was my reponse:

If I were to do that tweet again, I might replace healthcare system with reimbursement system. Scribes are a mask to the fundamental problems with how we pay for healthcare. I’ve always loved to think about what an EHR would look like if it didn’t have to worry about billing. It would be a completely different system than what we have with EHRs today.

The reality is that doctors want to get paid and so EHRs have to deal with billing. Plus, now they have to deal with meaningful use regulation as well. Add those two together and you can understand why scribes are so popular with doctors.

Every single EHR would be better and easier to use if they were just worrying about providing a tool to doctors that lets them document the visit and ensure quality patient care. However, until that happens (which is never) scribes and other alternative methods to document are going to be very popular with many physicians.

April 8, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently 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.

Where is Clinical Decision Support Heading?

A few months ago I had a chance to sit down an interview Jonathan Teich, MD, PhD, Elsevier’s Chief Medical Informatics Officer and a physician at Brigham and Women’s Hospital in Boston. In our discussion we dig into the current and future state of clinical decision support. For example, I ask Dr. Teich if you’ll be able to be a doctor in the future without it. If you want to learn more about clinical decision support and where it’s going, you’ll enjoy this video interview:

April 7, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently 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.

Barriers and Pathways to Healthcare IT

The following is a guest blog post by Andy Oram, writer and editor at O’Reilly Media.

Those who follow health IT for a long time can easily oscillate between overenthusiasm and despair. Electronic records will bring us into the 21st century! No, electronic records just introduce complexity and frustration! Big data will find new cures! No, our data’s no good!

Indeed, a vast gulf looms between the demands that health reformers make on information technology and the actual status of that technology. But if we direct a steady vision at what’s available to us and what it provides, we can plan a path to the future.

This is the goal of a report I recently wrote for O’Reilly Media: The Information Technology Fix for Health: Barriers and Pathways to the Use of Information Technology for Better Health Care. As part of a comprehensive overview, it dissects the issues on some topics that often appear on this blog:

  • Patient empowerment. After looking at the various contortions hospitals go through to provide portals and pump up patients’ interest in following treatment regimes, I conclude that the best way to get patients involved in their care is to leave their data in their own hands.

    But wresting data out of doctors’ grip will be heavy exercise. Well aware that previous attempts at giving patients control over data (Google Health and Microsoft HealthVault) have shriveled up, and that new efforts by Box and Apple seem to be taking the same path, I suggest a way forward by encouraging people to collect health data that will hopefully become indispensable to doctors.

  • What’s wrong with current EHRs? We know that doctors grab any opportunity handed them to complain about their EHRs. Even more distressing, the research bears out their pique; my report cites examples from the medical literature finding only scattered benefits from EHRs. Sometimes their opacity and awkward interfaces contribute to horrific medical errors.

    One might think that nobody is actually getting what they want from their EHR, but in fact plenty of providers are quietly enjoying their records–success has a lot to do with their preparation and whether they take the extra effort to make effective use of data gathered by the EHRs.

    New interfaces such as tablets, convenient storage in the cloud, and agile programming may be producing a new crop of EHRs that will meet the needs of more clinicians. But open source software would lead to the most widespread advances, enabling more customization and a better response to bug reports.

  • The viability of ACOs. Accountable care, pretty much a synonym for the notion of pay-for-value, is on the agendas of nearly all payers, from CMS on down. It certainly makes sense to combine data and keep close tabs on people as they move from one institution to another. But it’s really a job to be done on a national level, or at least a regional one. Can a loose collection of hospitals and related institutions muster the data and the resources to analyze patient data, created viable health information exchanges, and perform data analysis? I don’t think the current crop of ACOs will meet their goals, but they’ll provide valuable insights while they try.

  • Can standards such as ICD-10 improve the data we collect? What about the promise of new standards, such as FHIR? I’m a big believer in standards, but I’ve seen enough of them fail to know they must be simple, lithe, and unambiguous.

    That doesn’t characterize ICD-10 to be sure. Perhaps it does pretty well in the unambiguous department. But like most classifications, it’s a weak representation of the real world: a crude hierarchy trying to reflect many vectors of interlocking effects–for instance, the various complications associated with diabetes. And although ICD-10 may lead to more precise records, the cost of conversion is so burdensome that the American Medical Association has asked the government to just let doctors spend their money on more pressing needs. The conversion has also been ruthlessly criticized on the EMR & EHR site.

    FHIR is a radical change of direction for the HL7 standards body. For the first time, a standard is being built from the ground up to be web-friendly as well as sleek. It currently looks like a replacement for C-CDA, so I hope it is extended to hold patient-generated data. What we don’t need is another hundred vendors going off to create divergent formats.

    For real innovation, we should look to the open SMART Platform. Its cleverness is that it functions as a one-way valve channeling data from silo’d EHRs at health providers to patient-controlled sites.

We need to know what current systems are capable of contributing to innovative health solutions, and when to enhance what we have versus seeking a totally disruptive solution. I look forward to more discussion of these trends. Comment on this article, write your own articles on the topics in the report, and if you like, comment to me privately by writing to the infofix alias @ the oreilly.com domain.

April 3, 2014 I Written By

Reply to Dr. Jacob Reider on NIST Dissects Workflow: Is Anyone Biting?

One comment on my latest post, NIST Dissects Workflow: Is Anyone Biting?, deserves a more than casual reply.

Here’s the comment from Jacob Reider (Note: Dr. Reider is ONC’s Acting Principle Deputy National Coordinator and Chief Medical Officer. He has made major contributions to the HIT field and is one of its significant advocates.)

Carl, ONC’s UCD requirement references ISO 9241–11, ISO 13407, ISO 16982, NISTIR 7741, ISO/IEC 62366 and ISO 9241–210 as appropriate UCD processes.

We also require summative testing as defined in NISTIR 7742.

Might “Refuses to incorporate NIST recommendations” be a bit of an overstatement?

We solicited public comment in our proposed rule for 2015 certification and would welcome specific suggestions for how we can/should improve user experience of health IT products for efficiency and safety.

Dr. Reider, thank you for your comment – it certainly falls into the category of you never know who’s reading.

Let’stake a look at your last comment first, “Might ‘Refuses to incorporate NIST recommendations’ be a bit of an overstatement?”

Obviously, I don’t think so, but I am not alone.

I based my comment on ONC’s statement in its rule making that refers to NIST’s usability protocols. It says:

While valid and reliable usability measurements exist, including those specified in NISTIR 7804 “Technical Evaluation, Testing and Validation of the Usability of Electronic Health Records,” (21) we are concerned that it would be inappropriate at this juncture for ONC to seek to measure EHR technology in this way.

Sounds like a rejection to me, however, don’t take my word. Here’s the AMA’s response to this decision. First, they demur and quote ONC:

We disagree with ONC’s assertion in the Version 2014 final rule that, “[w]hile valid and reliable usability measurements exist, including those specified in NISTIR 7804 ‘‘Technical Evaluation, Testing and Validation of the Usability of Electronic Health Records,’’ we expressed that it would be inappropriate for ONC to seek to measure EHR technology in this way.”

It then says:

To the contrary, we believe that it is incumbent upon ONC to include more robust usability criteria in the certification process.  The incentive program has certainly spurred aggressive EHR uptake but has done so through an artificial and non-traditional marketplace.  As a consumer, the physician’s choice of products is limited not only by those EHRs that are certified but also by the constraint that all of these products are driven by federal criteria.  The AMA made several detailed recommendations for improving Version 2014 certification in our Stage 2 comment letter, which were not adopted, but still hold true, and we recommend ONC consider them for the next version.  Testimony of AMA’s Health IT Policy Committee’s Workgroups on Certification/Adoption and Implementation, July 23, 2013, pp. 5-6

I recognize that ONC says that it may consider the protocols in the future. Nevertheless, I think the plain English term rejected fits.

In the first part of his statement, Dr. Reider cites several ISO standards. With the exception of the Summative Testing, all of these have been referred to, but none have been adopted. Reference to a standard is not sufficient for its inclusion under the operation of the federal Administrative Procedure Act, which governs all federal agency rulemaking. In other words, these standards are important, but ONC simply calls them out for attention, nothing more.

I think two factors are at work in ONC’s reluctance to include the NIST usability protocols. The first is that the vendors are adamantly opposed to having them mandated. However, I believe there is a way around that objection.

As I have argued before, ONC could tell vendors that their products will be subject to a TURF based review of their product for compliance and that the results would be made public. That would give users a way to judge a product for suitability to their purpose on a uniform basis. Thus, users looking at the results could determine for themselves whether or not one or more non compliance was important to them, but at least they would have a common way to look at candidate EHRs, something they cannot do now , nor under ONC’s proposed approach.

The other factor is more complex and goes to the nature of ONC’s mission. ONC is both the advocate and the standards maker for HIT. In that, it is similar to the FAA, which is vested with both promoting and regulating US aviation.

It’s well established that the FAA’s dual role is a major problem. It’s hard to be a cheerleader for an industry and make it toe the line.

With the FAA, its dual mandate is exacerbated when the highly respected NTSB investigates an incident and makes recommendations. The FAA, acting as industry friend, often defers NTSB’s authoritative and reasonable recommendations to the public’s determent.

I believe that something similar is going on with ONC. NIST’s relationship to ONC is roughly analogous to that of the NTSB’s to the FAA.

NIST is not an investigative agency, but it is the federal government’s standards and operations authority. It isn’t infallible. However, ONC dismissing NIST’s usability protocols, in one word, inappropriate. It did this without explanation or analysis (at least none that they’ve shared). In my view, that’s really inappropriate.

ONC has a problem. It’s operating the way it was intended, but that’s not what patients and practioners need. To continue the aviation analogy, ONC needs to straighten up and fly right.

March 31, 2014 I Written By

When Carl Bergman’s not 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.

Time Using EMR, EMR Copy and Paste, and Larry Page on EMR


The good news is that EMRs will get better.


I’ve often said that it’s not copy and paste that’s bad. It’s how you use it. Many use it poorly which leads to bad data.


This whole interview with Larry (Founder of Google) is great. Plus, I adore Charlie Rose interviews.

March 30, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently 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.

No Shortage of Excitement (This Week) in Healthcare IT

When I began contemplating the subject of this blog earlier in the week, I thought I’d make room for thoughts on recent improvements in EMR adoption in the small practice and physician community, and the general state of optimism and enthusiasm some op-ed pieces would have us believe is finally taking hold of the industry. But then came along the potential delay of ICD-10, which also begs a quick comment or two.

A bill that included an effort to delay the ICD-10 compliance date a full year was passed, but only after partisan drama over the fact that legislators received the proposed bill just a day before the vote on it was to take place. I tend to turn to AHIMA on ICD-10 matters, and its official stance is fairly obvious:

ahimaicd10tweet

Its reasoning is similar to that of the Coalition for ICD-10, which in a letter to the CMS, stated: “ … any further delay or deviation from the October 1, 2014, compliance date would be disruptive and costly for health care delivery innovation, payment reform, public health, and health care spending. By allowing for greater coding accuracy and specificity, ICD-10 is key to collecting the information needed to implement health care delivery innovations such as patient-centered medical homes and value-based purchasing.

“Moreover, any further delays in adoption of ICD-10 in the U.S. will make it difficult to track new and emerging public health threats. The transition to ICD-10 is time sensitive because of the urgent need to keep up with tracking, identifying, and analyzing new medical services and treatments available to patients. Continued reliance on the increasingly outdated and insufficient ICD-9 coding system is not an option when considering the risk to public health.”

AHIMA has even started a campaign to encourage its constituents to email their senators to urge them to also vote no when it comes to delaying ICD-10. At the time of this writing, the Senate vote is not yet scheduled. I don’t feel the need to restate my support of no further delay. You can read it here.

With regard to the other hot news items of the week, I was intrigued by the findings of the SK&A survey, which found that the EMR adoption rate for single physician practices grew 11.4%. One reason SK&A gave in the survey analysis was due to the “availability of more than 450 different solutions to fit their practice needs, size and budget.” Call me crazy, but I’m willing to bet that many solutions will not exist in the next three to five years thanks to market consolidation. What will these physicians do when their EMR vendor closes up shop? Time will tell, I suppose.

March 28, 2014 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.