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Meaningful Use #HITsm Twitter Chat

Posted on October 17, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

I had the honor today to host the #HITsm Twitter chat. For those not familiar with the #HITsm chat, you just join every Friday at Noon ET and watch the tweets that are sent using the #HITsm hashtag. There are usually 4-5 questions that are discussed over the hour chat. Since I was the host, I created the questions this week. I chose to focus the chat on the latest happenings with meaningful use. The transcript of the chat is found here.

I just took a look at the stats for the chat on Symplur and saw that the chat had 68 participants that sent out 474 tweets which had 3,196,079 impressions. You have to be a little careful looking at impressions since that’s potential impressions, but it’s still interesting to consider the possible reach of a chat.

There were some really interesting tweets during the chat, so here are the questions and a few (ok, more than a few since I got carried away) of my favorite tweets: Read more..

Will EHR Vendors Become Service and Consulting Companies?

Posted on October 14, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

This is the topic of a really interesting LinkedIn discussion: Will EHR Vendors Become Service and Consulting Companies?

I think this is a really great question and one that’s worthy of serious consideration. I think we’ve seen this happen time and time again in the IT industry. Some of the best examples are IBM, HP, and Dell. As their IT hardware and software becomes a “commodity” then they leverage their relationships and domain expertise to change into a service and consulting company. Usually this also involves them spending their extra cash to acquire the leading consulting company (or companies) in the industry as well.

In some ways we’re already seeing this happen. Epic announced a consulting division of their company in order to retain their senior staff. Cerner’s always made a good chunk of their money from consulting services.

Of course, thanks to meaningful use incentive money and some still massive upgrade costs, EHR vendors haven’t needed to shift their business model to a service and consulting model yet. There’s still plenty of money to be made just selling the software, training, etc.

What will also be interesting to watch is whether the large service and consulting companies like Accenture, IBM, HP, Dell, etc. will eat up the market share so that the EHR companies don’t have as much of an opportunity to grow a service and consulting business. No doubt it will be a big dog fight. Not to mention many of the current EHR consulting companies (although, you could see many of these getting acquired by the EHR vendors).

I guess my short answer to this question is: In the short term, we’re not likely to see a massive shift towards services and consulting, but long term it’s very likely to happen. What are your thoughts?

Open Standards Advance in Health Care Through the Appeal of FHIR and SMART

Posted on October 13, 2014 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.

The poor state of interoperability between EHRs–target of fulminations and curses from health care activists over the years–is starting to grind its way forward. Dr. Kenneth Mandl, a leader of the SMART Platform and professor at the Boston Children’s Hospital Informatics Program, found that out when his team, including lead architect Josh Mandel, went to HIMSS this year to support Cerner’s implementation of his standard, and discovered three other vendors running it.

That’s the beauty of open source and standards. Put them out there and anyone can use them without a by-your-leave. Standards can diffuse in ways the original developers never anticipated.

A bit of background. The SMART platform, which I covered a few years ago, was developed by Mandl’s team at Harvard Medical School and Children’s Hospital to solve the festering problem of inaccessibility in EHRs and other health care software. SMART fulfilled the long-time vision of open source advocates to provide a common platform for every vendor that chose to support it, and that would allow third-party developers to create useful applications.

Without a standard, third-party developers were in limbo. They had to write special code to support each EHR they want to run on. Worse still, they may have to ask the EHR vendor for permission to connect. This has been stunting the market for apps expanding the use of patient data by clinicians as well as the patients themselves.

SMART’s prospects have been energized by the creation of a modern interoperability resource called FHIR. It breaks with the traditional health care standards by being lean, extendible in controllable ways, and in tune with modern development standards such as REST and JSON.

It helps that SMART was supported by funds from the ONC, and that FHIR was adopted by the leading health care standards group, HL7. HL7’s backing of FHIR in particular lent these standards authority among the vendor and health care provider community. Now the chocolate and peanut butter favored by health IT advocates have come together in the SMART on FHIR project, which I wrote about earlier this year.

Mandl explains that SMART allows innovators to get access to the point of care. As more organizations and products adopt the SMART on FHIR, API, a SMART app written once will run anywhere.

Vendors have been coming to FHIR meetings and expressing approval in the abstract for these standards. But it was still a pleasant surprise for Mandl to hear of SMART implementations demo’d at HIMSS by Intermountain, Hewlett-Packard, and Harris as well as Cerner.

The SMART project has just released guidlines for health care providers who want to issue RFPs soliciting vendors for SMART implementations. This will help ensure that providers get what they ask and pay for: an API that reliably runs any app written for SMART.

It’s wise to be cautious and very specific when soliciting products based on standards. The notion of “openness” is often misunderstood and taken to places it wasn’t meant to go. In health care, one major vendor can trumpet its “openness” while picking and choosing which vendors to allow use of its API, and charging money for every document transferred.

The slipperiness of the “open” concept is not limited to health IT. For years, Microsoft promulgated an “open source” initiative while keeping to the old proprietary practices of exerting patent rights and restricting who had access to code. Currently they have made great progress and are a major contributor to Linux and other projects, including tools used with their HealthVault PHR.

Google, too, although a major supporter of open source projects, plays games with its Android platform. The code is nominally under an open license–and is being exploited by numerous embedded systems developers that way–but is developed in anything but an open manner at Google, and is hedged by so many requirements that it’s hard to release a product with the Android moniker unless one partners closely with Google.

After talking to Mandl, I had a phone interview with Stan Huff, Chief Informatics Officer for Intermountain. Huff is an expert in interoperability and active in HL7. About a year ago he led an effort at Intermountain to improve interoperability. The motivation was not some ethereal vision of openness but the realization that Intermountain couldn’t do everything it needed to be competitive on its own–it would have to seek out the contributions of outsiders.

When Intermountain partnered with Cerner, senior management had by that time received a good education in the value of a standard API. Cerner was also committed to it, luckily, and the two companies collaborated on FHIR and SMART. Cerner’s task was to wrap their services in a FHIR-compliant API and to make sure to use standard technology, such as in codes for lab data.

Intermountain also participated in launching a not-for-profit corporation, the Healthcare Services Platform Consortium, that promotes SMART-on-FHIR and other standards. A lot of vendors have joined up, and Huff encourages other vendors to give up their fears that standardization is a catheter siphoning away business and to try the consortium out.

Intermountain currently is offering several applications that run in web browsers (and therefore should be widely usable on different platforms). Although currently in the prototype stage, the applications should be available later this year. Besides an application developed by Intermountain to monitor hemolytic disease among neonates and suggest paths for doctors to take, they support several demonstration apps produced by the SMART project, including a growth chart app, a blood pressure management app, and a cardiovascular app.

Huff reports that apps are easy to build on SMART. In at least one case, it took just two weeks for the coding.

Attendees at HIMSS were very excited about Intermountain’s support for SMART. The health care providers want more flexible and innovative software with good user interfaces, and see SMART providing that. Many vendors look to replicate what Intermountain has done (although some hold back). Understanding that progress is possible can empower doctors and advocates to call for more.

Is EHR on Life Support? Short Answer…No

Posted on October 10, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

Today, David Swink sent me a link to an article from the Washington Examiner and this quote from the article:

“A revolt is brewing among doctors and hospital administrators over electronic medical records systems mandated by one of President Obama’s early health care reforms.”

“The American Medical Association called for a “design overhaul” of the entire electronic health records system in September because, said AMA president-elect Steven Stack, electronic records “fail to support efficient and effective clinical work.”

It seems like there have been a wave of articles similar to this coming out in the national media. For some reason the national media only likes to report on things when “the sky is falling.” It’s kind of a ridiculous report though.

What’s not ridiculous is that many doctors are dissatisfied with their EHR software. That is something that is real and many are extremely frustrated with it and many of the EHR regulations that require a lot of extra work by them. Does that mean that we’re going to see an EHR “design overhaul” or that the doctors are going to revolt against EHRs and stop using them?

My answer (as the headline alludes) is that it’s not going to happen. Certainly we’re going to see some EHR switching over the next few years. In fact, we might see a lot of EHR switching. However, we’re not going to see a mass of people revolting against EHR and going back to paper. That would be a true revolt and it’s just not going to happen. Like it or not, EHR is the go forward technology that will be used by healthcare to document healthcare.

Meaningful use on the other hand is a different story. I do think that meaningful use is on life support. If the congress can somehow get the Flex-IT Act to pass, then we can take meaningful use off life support, but I’m still not planning to discharge MU from the hospital. The program has some serious health issues.

On a more optimistic note, I’m really excited to see what doctors and hospitals start doing with the data stored in EHR. Is it everything we want it to be? No, but I believe we’re still going to see a lot of good come from EHR software now that EHR’s are implemented and we’ve largely got MU behind us.

Ebola Lapse in Dallas Offers Few Lessons, Except About Our Over-reliance on Technology

Posted on October 8, 2014 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.

Of all the EHR problems encountered daily across the country, the only one to hit the major news outlets was a non-story about a missed Ebola diagnosis in Dallas, Texas. Before being retracted, the hospital’s claim of an Epic failure launched a slew of commentary in the health IT field. These swirled through my head last night as I tried to find a lesson in the incident.

The facts seem to be as follows. A 42-year-old man named Thomas Eric Duncan arrived from Liberia and checked in to the emergency room at Texas Health Presbyterian Hospital Dallas complaining of symptoms consistent with an Ebola diagnosis. He told the admitting nurse he had come from Liberia, and the nurse entered the data into the Epic EHR.

The purpose of recording the patient’s travel history, however, seemed to be simply to determine the need for immunizations, so the EHR kept it within a nurse’s section of the data (which the hospital called a “workflow”) and did not display it to the doctor. The doctor sent Duncan home, where he came into contact with about 100 people who were potentially infected. His symptoms worsened and he returned to the hospital two days later, where he was finally diagnosed correctly and admitted.

Late night musing #1: If Texas Health Presbyterian Hospital Dallas can’t diagnose a case of Ebola, why do they think they can treat one? The hospital has won numerous awards, including one for patient safety–I guess you’re safe once you’re admitted.

Meanwhile, the city of Dallas waited several extra days to clean up infected sheets and other belongings from the Duncan home. In Africa, such detritis are recognized as a major source of new Ebola infections.

Late night musing #2: Does this reflect the competence of public health officials in this country? Maybe we should turn the job over to the Secret Service.

It’s really a shame that the national press jumped on the hospital’s announcement that the EHR was the source of the problem. Commenters criticized the hospital right away, asking why the nurse didn’t simply tell the doctor, and why the doctor didn’t ask on his own.

Finally, the hospital backed off from blaming Epic, thus making the hospital look even stupider and more guilty than it already appeared. Nevertheless, EHRs at some hospitals may be designed to flag warning signals.

Clearly, there are many layers to this health care failure. I don’t blame the nurse, or even the doctor. ERs are always busy, and the nurse might never have known who would see the patient or even be in the ER when the doctor finally saw him.

But I do find a small lesson in the brief appearance of the EHR as a pivotal character in the story. The nurse thought he or she was doing their job just by entering the data into the EHR, and the doctor thought he was doing his job by reading it. The EHR had loomed as a magical solution to health care workflow–in the minds of hospital administrators, if not the ER staff.

Maybe if the nurse knew that the travel history was for the purpose of immunizations, he or she would not have relied on the EHR to use that information for diagnosis. Besides showing the need for training, some of my colleagues suggest that this problem calls for FDA regulation of EHR interfaces. They also suggest that systems use good user interface design to highlight important information (which would require a definition of what’s “important”) or at least allow searches for critical elements of the record.

Late night musing #3: Behind this also lies the mindlessness of much data collected by EHRs. I’m sure the nurse knew whether the unfortunate Mr. Duncan was a smoker and whether he suffered from depression, because regulations require these things to be recorded. Travel history became just another one of these automatic requirements to be tossed into the EHR and forgotten.

My story also concerns the musings of other health IT commentators, who suggested that EHRs be better integrated into “workflows”–as if every clinician follows a mechanical path of treatment and the EHR can figure out what it is.

Another thoughtful posting calls for integrating infectious diseaess into clinical decision support. But as my colleague Sandra Raup (R.D., J.D., M.P.H.) points out, CDS depends on a long history of clinical data collection. One can’t instantly add a new disease.

It might have been useful for some international health organization to realize, when the Ebola outbreak began to spread, that it would eventually break out of central Africa, and then to provide an app to hospitals around the world for checking symptoms and travel history. There is certainly a creative role for health IT to play.

I think the messiness of the Texas Health Presbyterian Hospital Dallas story shows why EHR failures, numerous as they are, don’t get reported in the press. There are just too many complicating factors. The EHR is partly configured by the clinic’s staff, who thereby become responsible for some of its decisions. The EHR failure usually comes when the staff is under stress, when they have communication problems, when the patient’s condition is rare. Ascribing blame becomes a tangled mess; one must start designing systems with multiple, redundant points to catch failures that can fall through the cracks.

So one level, this is just another sad story of humanity’s tendency to trust too much in its technology, a story that ranges from the flight of Icarus to the sail of the Titanic and the failure of the Fukushima Daiichi nuclear power plant. On other, it’s a familiar story of a systemic problem leading to what’s sometimes called a “normal failure.” Not much new to learn, but lots of work to do. Clinicians have to evaluate EHRs and know how the data is used, a more open system in all directions.

Should Healthcare Institutes Perform “Rip-and-Replace” to Achieve Interoperability? Less Disruption, Please!

Posted on October 7, 2014 I Written By

The following is a guest blog post by Dr. Donald Voltz, MD, Aultman Hospital, Department of Anesthesiology, Medical Director of the Main Operating Room, Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University.
Dr Voltz
A KLAS Research Report on the EMR buying trends of 277 hospitals with at least 200 beds has identified that almost half will be making a new EMR purchase by 2016.  Of the providers considering a change, 34 percent have already selected a vendor and another 44 percent are strongly leaning toward a specific vendor. Driving factors include concerns over outdated technology and health system consolidation.

But is the technology really outdated and health system consolidation necessary, or is the real issue lack of interoperability?  And if you are a hospital looking for a new EMR, let’s not forget the history of technology before we jump to conclusions that the greatest market share means the best of breed.

When we look at EMR adoption over the past number of years, we need to be careful with the data we use. Implementations, and now rip and replace switching to other venders, has been the only choice offices, clinics, hospitals and health systems had to address the issues with interoperability.

Most of current deployed EMRs are designed as a one-size-fits-all, leading to the situation where today out-of-the-box functionalities fit none of the care providers’ requirements. Besides that, EMR vendors have been designed with proprietary data where patient medical sharing (or exchange) becomes the biggest roadblock for patient care continuum. The reason for the rip-and-replace approach by some hospitals is to reach interoperability between inpatient and outpatient data with a single integrated and consolidated database approach.

A 50 percent turnover of EMRs is an incredibly high numbers of hospitals and clinics who have either replaced or are looking to replace their current EHR’s. Being that the majority of the initial implementations were supported by the HITECH act, one would think the government would raise issue with vendors to address this high turnover of EHR’s. There seems to be a general misperception that if our current systems do not meet the demands and needs of providers, administrators, and financial arms of a healthcare delivery system, ripping out the system and implementing a new one will solve the issues.

What is the True Total Cost of Ownership of an EMR?

Healthcare management must look beyond the actual cost paid to an EHR vendor as the only cost but they must look into the total cost, much beyond the normal Total Cost of Ownership (TCO). TCO only includes the initial license cost, maintenance cost, IT support cost, but in healthcare, there is another cost – it is the disruption of the care providers’ workflow. That disruption is directly correlated to healthcare system revenue and patient care outcomes.

Stop this disruption and let’s look for another solution where we integrate disparate systems since many of them are built upon databases that can address the needs of health. The cost to providers in time to learn a new system, the migration and loss of patient data that has been collected in the current systems, the capital expense of system software, the hardware, trainers, IT personnel, etc. all add to the burden, something that is currently being looked at as a necessary expense.

Interoperability Saves Resources

This need not be the case when platforms exist to connect systems and improve access for providers. Having a consistent display of data allows for more efficient and effective management of patients and when coupled with a robust collaborative platform, we close many of the open loopholes that exist in medicine today, even with EHR’s.

2.0 EMR connectors like Zoeticx and others have taken the medical information bus, middleware platform, to solve the challenges that current EHR’s have not.  This connection of systems and uniform display of information that physicians depend on for the management of patients is crucial if hospitals want their new EMRs to succeed. In addition, a middleware platform allows for patients to access their medical information between EMR’s in a single institution or across institutions, a major issue for Meaningful Use.

Fragmentation Prevents Some EMRs From Connecting With Their Own Software

Large EMR vendors’ lack of healthcare interoperability only reflects on how they compete against each other. Patient medical data and its proprietary structure is the tool for such competition where the outcome would not be necessarily beneficial for the hospital, medical professionals or patients. There are plenty of examples where healthcare facilities with EHRs even from the same vendor fail to interoperate with each other.

Such symptoms have little to do with the EMRs that have the same data structure, but about the fragmentation being put in place over the years of customization. We believe that the reason for this is to address fragmentation of the software product. Fragmentation is a case where deployments from the same software products have gone through significant amounts of customization, leading to its divergence from the product baseline.

To believe that ripping the whole infrastructure – inpatient and outpatient–as the method to reach interoperability would only cause a lot of disruption, yet the outcome would be very questionable down the road. Appreciating the backlash of calling the implementation of EMR’s a beta-release, we have much data to use in looking for the next solution to HIT.

As with much of medicine, we are constantly looking for the best way to take care of our patients. Like it or not, EMR’s have become a medical device and we need to start to evaluate them as we would any device used to manage health and disease. As we move forward, there will be an expansion in the openness of patient data, and in my prediction, a migration away from a single EHR solution to all of the requirements of healthcare, and into a system of interconnected applications and databases.

Once again, we have learned that massively engineered systems do not evolve into complex adaptive systems to respond to changing environmental pressures. Simple, interrelated and interdependent applications are more fluid and readily adaptable to the constantly changing healthcare environment. Currently, the only buffer for the stresses and changes to the healthcare system are the patients and the providers who depend on these systems to manage healthcare.

About Dr. Donald Voltz
By Dr. Donald Voltz, MD, Aultman Hospital, Department of Anesthesiology, Medical Director of the Main Operating Room, Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University.  A board-certified anesthesiologist, researcher, medical educator, and entrepreneur. With more than 15 years of experience in healthcare, Dr. Voltz has been involved with many facets of medicine. He has performed basic science and clinical research and has experience in the translation of ideas into viable medical systems and devices.

Facebook in Healthcare

Posted on October 6, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

A story on Reuters reported late last week that Facebook is making an entry into the healthcare space. Here’s an excerpt from the article about Facebook’s plans for healthcare:

The company is exploring creating online “support communities” that would connect Facebook users suffering from various ailments. A small team is also considering new “preventative care” applications that would help people improve their lifestyles.

In recent months, the sources said, the social networking giant has been holding meetings with medical industry experts and entrepreneurs, and is setting up a research and development unit to test new health apps. Facebook is still in the idea-gathering stage, the people said.

This move is especially interesting when paired with the announcements of Apple Health, Samsung Health, and Google Fit (and a few other Google health initiatives like Calico). It’s not the first time that big corporations have seen an opportunity in healthcare (See Microsoft HealthVault and Google Health). However, we have yet to see any of these big corporations really make a dent on healthcare.

The reality for many of these large corporations is that they don’t realize the crazy complexities that exist in healthcare. Many like to site the healthcare privacy argument as a reason for their failure. No doubt, HIPAA and privacy are a challenge for these organizations. In fact, I can already hear the outcry of people talking about Facebook and privacy of their health data. Many don’t trust Facebook with privacy and with good reason. However, privacy is the least of the reasons why these big corporations have a challenge entering the healthcare space.

Remember that healthcare is a complex beast with the largest customer being the government (ie. Medicare and Medicaid). Healthcare is not a rational market. The government, employer owned health insurance, health insurance plans, etc etc etc all make healthcare extremely complex to navigate full of perverse incentives. Plus, how do you do an ROI on the value of saving someone’s life?

While I’m skeptical of any large corporation entering healthcare, I’m actually quite interested in what Facebook could do to help healthcare. No doubt, a lot of healthcare already exists on Facebook.

Just a few weeks ago I was running up an escalator to catch a flight and sliced my big toe from top to bottom (you should see the pics). Luckily TSA was really helpful and I made my flight. Once I got home, I assessed the damage and wasn’t sure if I should go get sutures or not. I turned to Facebook where I posted a picture of my toe and tagged a few of my doctor friends. Long story short, my doctor friends told me I should go to the doctor and quickly, because if I waited until the next day they wouldn’t be able to suture it.

This is a small example, but Facebook was really effective for me. In fact, I posted a follow up picture a few days later (you know how men always like to show off their scars) and a doctor friend told me it was healing well. Of course, many might say that it was a small flesh wound and so that’s not as big a deal to post on Facebook. Would I post me health details if I had some chronic condition?

The interesting thing is that chronic patients are more than happy to give up all privacy in search of a cure. Unfortunately, they have nothing to lose and everything to gain. It’s part of the reason why Patients Like Me has been so successful. Plus, Patients Like Me has proved that we want to take part in online support communities for our conditions.

We’ll see if Facebook can really execute on online support communities like they have on Patients Like Me. It will be a real challenge for them because it’s not the focus of the company. However, they’re obviously well connected to a lot of people that could and would benefit from these types of healthcare communities. No doubt many people on Facebook don’t visit or even know about sites like Patients Like Me.

I’ll be interested to see what Facebook does in this space. I think they’d be smart to roll it off into a separate product that focuses on things like privacy and security. Being tied to the Facebook brand is a huge liability in this case. Plus, the value of Facebook to a Facebook created healthcare community is not in the Facebook brand, but in the Facebook audience and reach.

Besides creating various healthcare communities similar to Patients Like Me, I think Facebook has a huge opportunity to use social pressure to influence healthcare decisions. Changing behavior is an extremely hard thing to accomplish. However, never underestimate the power of positive peer pressure. Peer pressure can be one of the most powerful ways to change people’s behavior. Unfortunately, it works for good and bad. Facebook has all of your peers mapped to you. Can Facebook use that to help you become healthier? If they can, they’ll be on to something.

What do you think of Facebook possibly entering healthcare?

Health IT Thought Leadership

Posted on October 3, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

One of the big trends I see happening in the Health IT world is that every company wants to be a thought leader in the industry. It’s a powerful thing to provide thought leadership to your potential customers. It can also be an extremely challenging thing for an organization to sell that type of investment to their executive leadership team.

With that in mind, we’ve been working on some really compelling thought leadership marketing packages for health IT companies. It’s literally a fully integrated marketing package which integrates with our existing readership, email marketing, social media mentions (Twitter, LinkedIn, Facebook, Google Plus, etc), and ongoing traffic from search engines and related posts. Plus, you can use that thought leadership content in your own marketing efforts.

You can see some of the companies who’ve been sponsoring content on our network of Healthcare IT blogs. Barry Haitoff from Medical Management Corporation of America has been doing a series of posts focused on ways ambulatory practices can improve revenue. The Breakaway Group has sponsored a series of posts called Breakaway Thinking which focuses on ways to really improve what we’re doing in healthcare and break away from the competition. Vishal Gandhi from ClinicSpectrum has done an amazing job with the Cost Effective Healthcare Workflow Series. I love the way Vishal merges both technology and people into the optimal workflow.

I love the win win that these sponsored series provide. They allow us to keep the lights on here at Healthcare Scene, while still meeting our primary goal of providing value to the readers. We’d love for you to Contact Us if you’re interested in sponsoring your own series of blog posts.

Along with the sponsored series, we’re also extremely grateful for the various advertisers that have supported the site as well. Here are a few of the advertisers that have renewed their ad recently. Take a look at them and see if one of them could help you in your job.

Ambir (Advertiser since 1/2010) – I appreciate Ambir since they’ve been a sponsor for so long. I have one of their scanners on my desk and it’s worked great for me. Plus, they’re working on some really interesting workflow iPad applications that are really exciting too. Check them out to see what they’re working on.

Digital Health Conference (Advertiser since 7/2011) – This is the 4th year the Digital Health Conference, organized by NYeC, has advertised with us to promote there event in November. I’ll be at the event (see my full Fall HIT Conference schedule), so let me know if you plan to attend. Plus, you can get 20% off your registration if you use the discount code: HCS. Hopefully I’ll get to see many of you readers at the event.

Cerner (Advertiser since 9/2011) – Another great long term supporter of the site. Cerner Ambulatory EHR really needs no introduction. If you’re looking for an EHR, check them out. Their iPad application still had the coolest EHR iPad application feature I’ve seen: one swipe prescription refill.

gMed (Advertiser since 8/2013) – I had a really great chance this summer to get to know gMed on a much deeper level when they invited me to give the Keynote on the future of EHR at their EHR user conference. They certainly do make a compelling case for their Gastro specific EHR software. There are things they do because they’re specialty specific that you’ll really never see from a general EHR vendor.

Modernizing Medicine (Advertiser since 1/2014) – This is another specialty specific EHR vendor that takes a really unique approach to how you document a visit. If they are in your specialty (Dermatology, Ophthalmology, Orthopedics, Plastic Surgery, Otolaryngology, Gastroenterology, Urology, Rheumatology, Cosmetics), be sure to get a demo and see what makes them unique. I’ve also been invited to speak at their EHR user conference in November.

Finally thanks to the 3.6 million times this website’s been loaded by a reader and the 2166 people who subscribed to EMR and EHR and read the almost daily emails. To those who haven’t yet subscribed, here’s a link to subscribe to all the Healthcare Scene blogs you find interesting. It’s really hard to believe that we’re well over 5 years and 1,344 blog posts into this journey and in some ways it feels like we’re just getting started.

Physician Bandwidth is Tapped Out

Posted on October 2, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

As I look at the healthcare industry, I run into a lot of doctors that are totally fed up with the healthcare system and where it’s headed. They’ve basically reached a point where they’ve run out of bandwidth and many are ready to tap out.

I’d be less concerned with this trend if I didn’t see it across the whole spectrum of doctors. The older doctors are crying for the “good ole days” when it was fun for them to practice medicine. The middle aged doctors are trying to figure out if they have enough time to make a bunch of career changes or if they need to grind it out until retirement. The new doctors enter the workforce not realizing how screwed up the business of medicine has become. No doubt, every new doctor since the start of time has been blown away by the business of medicine, but never to the extent that we see today.

A lot of people like to point to EHR software as the real problem with physician dissatisfaction. I’ve seen some of the EHR implementations out there, and there is plenty for them to complain about when it comes to EHR. However, I think far too often the EHR takes the blame for all the other healthcare regulations that it’s required to implement. The EHR is just the messenger and it’s much easier to blame the messenger.

Think about some of the insane reimbursement requirements that exist in healthcare. Is the EHR the reason that these are so terrible. No. In fact, if the EHR didn’t have to worry about reimbursement, it would make for a much simpler workflow. HIPAA is another example. While I think HIPAA is often inappropriately used as an excuse for an organization not to do something, it does add some overhead to the work a doctor does.

Of course, we can’t talk about this without bringing up the overhead that meaningful use adds to an EHR system. Yesterday I commented that it was meaningful use that has required so much more physician time. That’s not the EHR’s fault.

Layer in things like medical malpractice risk, changing patient populations, etc etc etc to everything listed above and it’s a really trying time for a doctor practicing medicine. The single best thing we could do to change this situation would be to simplify healthcare. Unfortunately, I see almost nothing out there that’s heading this direction. In fact, I see the potential for it to get even more complex (see ACOs).

Has EHR software and the move away from paper to digital charts caused some physician stress? Absolutely! Is it the only reason physician bandwith’s tapped out? Definitely not. Props to all the physicians out there that are grinding through this mess and still provide amazing patient care. Knowing how many great physicians there are out there gives me some hope that we’ll find ways to improve the situation.

Poorly Done Report that Physicians Lose 48 minutes a Day to EHR

Posted on October 1, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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’s been a study that’s been pandered around making the assertion that Physicians lose 48 minutes a day to EHR. This story in Medical Economics is just one example of many. A comment on that story from Dr. Rah describes generally my feelings about the study:

I find it disappointing that such drivel is even reported. #1. A 2012 survey! Data is > 2 yrs old. #2. 411 respondents is a very small N; hardly significant in that there are at least a million users now of EMRs. #3. You can do better–why report such meaningless info??

Of course, this only begins to describe the flaws in this study. First, they were just asking physicians for their perceived views on how long something took with the EHR as opposed to actual time. As humans, we’re really bad at judging the amount of time that’s passed. Not to mention that many of the respondents were trainees who had no history with which to compare. I could go on and on, but I’ll stop there.

I’m not arguing whether EHR saves doctors time or whether it takes more time. I’ve seen places where both sides of the coin have occurred. So, I think that you could write an article that EHR saves doctors time and another article that talks about how EHR takes more time. You can find both experiences out there. There are hundreds of factors at play that influence the answer to this question.

One thing I don’t think anyone would disagree with is that meaningful use has required a lot more time from doctors. So, when you layer on a new EHR with the meaningful use requirements, then you’re probably going to be spending more time documenting in the EHR. Although, is that the EHR’s fault or meaningful use?

It would be nice for someone to do a high quality study on EHRs and the time a doctor spends. However, when you think about the factors that could influence the time spent: EHR software, specialty, location, tech skill of doctor, meaningful use, not meaningful use, etc etc etc, you can see why we haven’t seen a proper study on the impact of EHR on efficiency. There are too many variations for which you’d have to test.