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A Private HIE is a Vendor Neutral Archive Applied to EHR

I’ve been really fascinated by the work many hospital systems are doing to create a private HIE in their organization. As I wrote, I think that private HIE could lead to a nationwide HIE. It’s still a bit of a long shot, but I think it has more promise than the other HIE initiatives I’ve seen in action.

Along with my interest in private HIEs, I’ve also been fascinated by the switch to Vendor Neutral Archives (VNA) in the radiology space. In a VNA, you can store any medical image in the archive and it doesn’t matter what device you use to capture or view the image. Think about the flexibility that this provides. You’re no longer locked into a certain piece of imaging equipment or to a certain viewing application. Instead, you can switch as needed.

As I consider these two areas, it seems that a private HIE is the first step to having a vendor neutral archive. In fact, I’m not sure why more people haven’t applied the principles of vendor neutral archives to the EHR world. I imagine the challenge is in the complexity of the data. Sure, DICOM isn’t a simple piece of data either, but at least there are some DICOM standards that most medical imaging companies follow. The same can’t be said in the EHR world.

The problem now is that the term HIE has so much failure associated with it. I imagine that’s why we moved from RHIO to HIE as well. However, I think that the change from creating an HIE to a vendor neutral archive for EHR data would be a dramatic shift in thinking. This could be an important decision for a large hospital system. Instead of just trying to share data from EHR to EHR, what if they created a vendor neutral archive of all their EHR data such that your future EHR was built around that VNA instead of around a specific piece of software. I’m not sure there are many hospital CIOs brave enough to look this far out.

What do you think of the VNA concept applied to EHR? Is a private HIE the start of a VNA for EHR?

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June 17, 2013 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.

Filed Under: EHR  Electronic Health Record  Electronic Medical Record  EMR  Healthcare IT
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Epic’s Reputation, Datapalooza, and Interoperability — #HITsm Chat Highlights

Topic One: Do you honestly believe, when the clock runs out, CMS will dock non-#MeaningfulUse docs’ reimbursement? Why/Why not?

 

Topic Two: Explain in technical terms why Epic has such a bad reputation for interoperability.

What’s the data roadblock? How to fix? #HITsm — CapSite (@CapSite) June 14, 2013

 

 

 

Topic Three: In your opinion: Coolest thing coming out of D.C. last week with Datapalooza and the other health IT conferences/meetings?

Topic Four: Congress blaming EHRs & #MeaningfulUse for “upcoding” is like blaming screwdrivers for burglaries. Agree/Disagree/Your take?


Topic Five: Will ICD-10 be a non-problem we blew out of proportion like Y2K, or will it be a pretty rough transition? Explain.

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June 15, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Filed Under: EHR  Electronic Health Record  Electronic Medical Record  EMR  Healthcare  Healthcare IT  Meaningful Use  mHealth
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Hospital Mergers Complicate EMR Transition

Getting an EMR up and running in a hospital or health system is complicated enough. But managing EMR implementations in the midst of hospital mergers is even more difficult.

Like it or not, though, hospital CIOs are increasingly facing the likelihood that they’ll be facing a merger in the midst of their EMR rollout, notes a new piece in the Wall Street Journal. With reimbursements from both Medicare and private insurers falling, hospitals’ margins are growing perilously thin, and the pace of hospital mergers is likely to increase, according to a March report by Moody’s.

Right now, for example, two of New York’s biggest hospital chains — NYU Langone Medical Center and Continuum Health Partners — have agreed to discuss a possible merger. Continuum CIO Mark Moroses is in the process of moving his chain of hospitals to its GE Centricity EMR, in a move which will allow the chain to collect $20 million to $30 million in Meaningful Use incentives.

If the merger between Langone and Continuum goes through, Moroses will have to stitch together dozens of billing,  procurement and patient care systems over the next few years, the WSJ notes. But more than that, the hospital chains will have to synchronize their clinical information management, a formidable job which, as Moroses says, leaves no room for error.

It’s not just systems integration that merging systems will face, however. As the WSJ piece notes, when North Shore-Long Island Jewish Health System took over Lenox Hill Hospital in 2010, the systems’s CMIO Michael Oppenheim had to bring Lenox Hill’s data to a new version of its Allscripts EMR.  The system used currently by Lenox Hill is an old one which isn’t certified for Meaningful Use.

Ultimately, hospitals’ urge to merge makes sense on a lot of levels. Given their tremendous capital costs (including EMR spending) it only makes sense to achieve economies of scale.  Unfortunately, the commonsense desire to save money and be more efficient is going to subject HIT leaders to an even rougher ride then they might have expected.

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June 14, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Filed Under: Certified EHR  EHR  Electronic Health Record  Electronic Medical Record  EMR  Healthcare  Healthcare IT  Hospitals  Meaningful Use
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Must-See Sessions, Exhibitors at HFMA #ANI2013

It’s that time of year again. The Healthcare Finance Management Association’s annual ANI conference is just days away. I’ve come to associate the month of June with all things revenue cycle and the anticipation of learning more than I ever wanted to know about financial risk, reimbursement strategies, RACs, coding … the list could go on and on. I do enjoy the show, almost more than HIMSS, because it is smaller, shorter and so much more manageable from a logistics standpoint. HFMA puts out a great mobile app each year, and this year marks the first time I’ll be able to take advantage of it thanks to a (finally) upgraded phone.

Last year in Las Vegas, the show floor and educational sessions were largely focused on ICD-10 and ACOs. Flipping through this year’s brochure, I see that health insurance exchanges, Stage 2 of Meaningful Use and payer relationship strategies will also see a bit of the limelight. Personally, I’m looking forward to learning what healthcare finance folks think of this surge in healthcare consumer cries for price transparency. Are they paying attention? Will charge masters ever change (for the better)?

I thought I’d share some of the sessions I’m most looking forward to attending. I admit that I’m a big fan of panel discussions. Solo presenters can turn into sleep-inducing monologues far too quickly.

To Merge or Not to Merge: Hospital Executive Panel Discussion (Monday, 6/17)
What are the advantages and challenges of maintaining stand-alone status? What factors could influence a decision to see affiliation partners? What various affiliation strategies have worked for others?

Living in Atlanta, which has seen its fair share of hospital mergers and partnerships, I’ve often wondered why some facilities choose to go it alone and some choose to affiliate. I’m looking forward to hearing some inside scoop from the four scheduled hospital executives.

Transitioning to Value: Barriers, Solutions and Opportunities (Tuesday, 6/18)
Former CMS administrator Don Berwick will give this keynote address, which promises to “identify the barriers that must be overcome to reform the delivery system, the outcomes of successful delivery models, and the signals of progress within provider organizations.”

I can’t help but wonder how his stage presence will compare to Farzad Mostashari’s, and what sort of neck attire he’ll don.

Physician/Hospital Revenue Cycle Integration: a Panel Discussion (Tuesday, 6/18)
This session will cover the “opportunities and challenges of unifying the revenue cycle to reduce overall costs while increasing collections and patient satisfaction.”

I think it will be interesting to hear from providers just how important patient satisfaction (and presumably referrals) are to a provider’s bottom line. I expect at least one of the panelists will bring up Stage 2, as I’m learning that patient engagement and satisfaction are closely intertwined.

Women as Leaders: Charting the Course (Tuesday, 6/18)
As I mentioned in a recent post, I’m looking forward to learning how the HFMA board members (dare I call them #RevCycleChicks?) on this panel manage careers, families and communities.

Quiet: Harnessing the Strengths of Introverts to Change How We Work, Lead and Innovate (Wednesday, 6/19)
This keynote from author Susan Cain seems tailor-made just for me. Until social media came into my life, I’d always considered myself an introvert. But social networks have turned that idea on its head in unexpected ways, and so I wonder if Cain will touch on digital media in her presentation.

Best Practices for Managing Consumer Payments in the Current Environment (Wednesday, 6/19)
This “late-breaking session” promises to share best practices on improving collections and patient satisfaction.

I hope they’ll touch on the “future” environment, as it seems reasonable to assume that 2014 will likely make a number of current best practices out of date.

Then, of course, there is the exhibit hall, which I always enjoy roaming around without plan or purpose. A few recent postcards have piqued my interest in several companies:

sock

I’m not even sure what the name of this company is, but the idea of a singing sock intrigues me.

emdeon

I fared poorly at Emdeon’s Cash Stacker games last year, and am determined to do better this time around. Plus, the company always seems to be doing interesting things in the revenue cycle space, so I look forward to catching up with several of their team members to get the inside scoop.

relayhealth

I’m very intrigued by the idea of provider benchmarking at the moment, so I’m planning to learn more about what RelayHealth is doing in this area.

athenahealth

While this postcard doesn’t allude to athenahealth’s recent claims of guaranteed ICD-10 compliance, it will definitely be my main talking point when I stop by their booth.

Good works are always a good idea, and several companies are making charitable contributions in lieu of giveaways:

optum

jpmorganbnymellon

What sessions and exhibitors are you looking forward to? Let me know what I shouldn’t miss via the comments below.

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June 13, 2013 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 its three key properties – Billian’s HealthDATA, Porter Research and HITR.com. She is a regular contributor to a number of healthcare blogs, and currently manages the Technology Association of Georgia Health Society’s social media channels. You can find her on Twitter @SmyrnaGirl.

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KLAS: Strong Support Distinguishes Top EMR Vendors

Wth EMR usability still shaky at best, it’s the developers that offer hands-on support that score highest when EMR usability gets rated, according to HIT researcher KLAS Enteprises, reports Modern Healthcare.

KLAS, which just completed its report “Ambulatory EMR Usability 2013, More Nurture than Nature,” spoke with 163 providers, specifically leaders of practices with more than 25 physicians.  In nearly every case, the magazine said, providers’ greatest frustration was related to vendor relationships, not the software itself, KLAS told MH.

As part of its research, KLAS ranked nine vendors on how well “the typical physician” could efficiently and effectively perform six common EMR tasks/functions, including e-prescribing, medication reconciliation, physician documentation, problem lists, viewing patient information  and supporting mobile devices.

Coming out on top was athenahealth, a Web-based vendor, which topped the list for getting providers to usability at first use, and second for having strong handholding relationships with customers.

Epic, which came up second in the overall composite ranking, was number one when respondents asked whether their vendor gave them good support in guiding them to usability.  This was true despite the fact that Epic is also well known for usability complaints by physicians, and that Epic is built on configurable modules that lead to a steep learning curve.

GE Healthcare and Greenway Medical Technologies tied for third in the composite scoring.

Meanwhile, Allscripts’ Enterprise EHR and McKesson Corp.’s Practice Partner got low scores for initial usability, the magazine said. Allscripts got higher grades for getting customers situated over time; 74 percent ranked the vendor good or okay as compared with 54 percent of McKesson customers.

McKesson had the most customers of any vendor in the survey reporting that the company was “not good” at helping users with its technology.

So, we have an interesting conclusion here: even if vendors turn out a difficult-to-use product, strong customer support can largely erase that disadvantage. Now, let’s see what happens when a big vendor turns out a product which is easy to use without a lot of handholding…

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June 12, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

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Meaningfully Use EHR or Lose Your Medical License

The premise of this article just disgusts me. I must admit that I remembered the discussion of tying medical licenses to EHR adoption, but I’d forgotten that Massachusetts actually passed the EHR requirement law. The topic was again ignited by Hayward K Zwerling, MD in this Health Care Blog post. Here’s the Massachusetts law that he sites:

The relevant law is Section 108 of Chapter 224 of the Acts of 2012, which reads as follows:
The first paragraph of section 2 of chapter 112 of the General Laws … is hereby amended by inserting (the following)… The board (of Registration in Medicine) shall require, as a standard of eligibility for (medical) licensure, that applicants demonstrate proficiency in the use of computerized physician order entry, e- prescribing, electronic health records and other forms of health information technology, as determined by the board. As used in this section, proficiency, at a minimum shall mean that applicants demonstrate the skills to comply with the “meaningful use” requirements (1).

This law, if it remains, would mean that effective 2015 any physician who isn’t a meaningful user of a certified EHR will be denied a license to practice medicine. That means 50-75% of Massachusetts doctors would lose their license to practice medicine. That’s a huge number of doctors. Can you imagine the impact?

Plus, it’s not like Massachusetts is lagging behind the rest of the country in EHR adoption. In fact, Massachusetts is one of the states with the best EHR adoption. I’m really just dumb founded that someone would be willing to propose, let along pass a law like this.

Don’t get me wrong on this. You won’t find someone that’s more interested in seeing widespread EHR adoption. I think there are tremendous benefits waiting for us once we achieve widespread EHR adoption. I just think you’re insane to think that holding physician’s licenses over their heads is the right way to do it. The very worst way to get doctors to adopt EHR is through coercion.

My gut tells me that there’s no way this law will actually go into effect. Something will have to change between now and 2015. Maybe that was the goal of the legislation. Scare people enough so that they adopt EHR and then repeal the law. That’s a terrible tactic if it’s the case. That’s a strategy that leads to even more EHR switching.

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June 11, 2013 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.

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Replacement EHR Trend


I’m a huge numbers guy even if numbers can lie if you’re not careful. However, what I love most is the change in numbers which often can tell an important story of trends. One trend we knew was coming is the replacement EHR trend, so I was quite interested when I saw the tweet above that said that 31% of EHR buyers are purchasing a replacement EHR. That’s a huge number and up from the previous 10% replacement EHRs in 2010.

The report linked above also has a number of other interesting EHR numbers. 30% of respondents reported that their practice would replace their current practice management or EHR solution if their current vendor was purchased by another vendor. Considering we’re about to enter an unprecedented stage of EHR consolidation, this should be quite unsettling to any company looking to acquire an EHR vendor.

I was also fascinated to see that 60 percent of hospital-owned groups reported purchasing their current practice management solution before 2006. Is the age of some of these systems going to lead to many of them being replaced? You’d think that 7 years isn’t that long for a system, but in the tech world it’s not young either. With that said, I wonder what EHR or PM systems have been created in the past 3-5 years. I can’t think of many. If we use meaningful use as a point of demarcation, I can’t think of any EHR or PMs that came after meaningful use. I wonder if we’ll see this change.

One thing I’m certain of is that we’re going to get really good at replacing EHR software. Hopefully EHR vendors will embrace the liquidity of data for those who choose to switch EHR, but I’m not too hopeful on this.

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June 10, 2013 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.

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Bold EMR Move, Universal Personal Medical Record, and Unified EMR


I’ll be really glad when the day arrives that this isn’t a bold move. Really, it’s a bold move to give patients access to the charts that they’ve always been able to request and get access to on paper?


I know dozens of companies working on this. Too bad I see so few patients adopting it. Although, if you go to the tweet itself (it may embed the whole conversation above as well), @nursefriendly and @JamieKaufmann have a nice conversation about security and privacy of this information. I’m definitely on @nursefriendly’s side of the conversation. I don’t agree with Jamie that a smart phone app with your health information is necessarily any less secure than an HIS system at a hospital. In fact, the value of hacking the HIS system is much more than hacking an individual record. So, I could easily argue that an HIS has a much higher risk.


I guess we can all dream.

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June 9, 2013 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.

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EMRs Help Identify High-Risk Pregnancies

A group of researchers have begun a project in which they use EMRs to identify pregnant mothers who may be at high risk for medical complications.

The researchers, who are being supported by Johns Hopkins University’s Center for Population Health IT (CPHIT), are conducting a pilot using predictive modeling and natural language processing to find indicators of possible risk in the text of records for pregnant Medicaid beneficiaries, according to an article in iHealthBeat.

Maryland, where the pilot is taking place, has had a statewide HIE in place since 2009. The HIE data is useful for spotting trends in the medical histories of individual patients, as it ensures that doctors have the whole story, but obviously, the data doesn’t analyze itself.

That’s where CPHIT comes in. Its job is to find ways to improve public health using existing sources of data.

To find high-risk moms, the researchers are working with CPHIT to find such hints such as whether the mother smokes or lives in an abusive environment. Historically, those beneficiaries don’t receive regular follow-up care, the story notes.

The team of researchers and CPHIT learned which beneficiaries should be considered a risk, in part, by taking a trip to a Johns Hopkins campus in East Baltimore, where a nurse shared warning signs for complicated pregnancies and along the way, shared different phrases which could confuse the search (such as ‘former tobacco user’ or ‘this patient is not a tobacco user’ or ‘this patient lives with a tobacco user.’)

Now armed with this information — and a difficult-to-obtain link between OB, primary care charts and insurance files — the pilot is slowly moving forward. When researchers find mothers who could be at risk for complicated pregnancy, they contact those mothers about receiving care needed to increase the odds of their having a safe, normal pregnancy and delivery.

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June 7, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

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Telemedicine Not Connecting With EMRs

As smartphones and tablets become a standard part of healthcare as we know it, telemedicine is gaining a new foothold in medicine too.  In some cases, we’re talking off the cuff transactions in which, say, a patient e-mails a photo to a doctor who can then diagnose and prescribe.  But telemedicine is also taking root on an institutional level, with health systems rolling out projects across the country.

The problem is, however, that these telemedicine projects simply don’t integrate with EMRs, according to an article in SearchHealthIT.  The piece’s writer, Don Fluckinger, recently attended American Telemedicine Association’s 2013 Annual International Meeting & Trade Show, where complaints were rife that EMRs and telemedicine don’t interoperate.

I really liked this summary of the situation one executive shared with Fluckinger:

For now, the executive (who asked not to be named) said, telemedicine providers need to keep away from the “blast radius” of EHR vendor conflicts, lest their budgets get consumed by building interfaces to the various non-interoperable EHR systems.

Not only are health systems struggling to integrate telemedicine data with EMRs, telemedicine providers are in a bit of a difficult spot too, Fluckinger notes. As an example, he tells the tale of Seattle-based Carena Inc., a provider of primary care services to patients via phone and video, which provides after-hours support to physicians at Franciscan Health System in Tacoma, Wash.

Carena itself has an EMR which has the ability to share searchable PDF documents for use in patient EMRs, but Franciscan’s seven hospitals are bringing up an Epic implementation which can’t support this trick.  Top execs at Franciscan want to connect Carena’s data to Epic, but that won’t happen right away.  So Franciscan may end up setting up Carena’s after-hours service within Franciscan’s Epic installation to work around the interoperability problem.

This is just one sample of the interoperability obstacles healthcare organizations are encountering when they set out to create a telemedicine service. As telemedicine explodes with the use of portable devices, I can only imagine that this will impose one more pressure on vendors to conquer compatibility problems. (But sadly, I doubt it will force any real changes in the near future.)

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June 5, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Filed Under: EHR  Electronic Health Record  Electronic Medical Record  EMR  EMR Technology  Healthcare  Healthcare IT  Hospitals  mHealth  Telemedicine
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