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Karen DeSalvo Remains as National Coordinator of ONC Along with New Position

Posted on October 31, 2014 I Written By

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

In case you missed it, last week it was announced that Karen DeSalvo had been appointed Assistant Secretary of Health focused on Ebola by HHS Secretary Burwell. In that same announcement Jacob Reider also announced his departure from ONC.

While the news was true that DeSalvo was taking on a new role at HHS as Assistant Secretary of Health, ONC also published a blog post that DeSalvo would stay on as National Coordinator of Health IT as well:

Dr. DeSalvo will serve as Acting ASH while maintaining her leadership of ONC. Importantly, she will continue to work on high level policy issues at ONC, and ONC will follow the policy direction that she has set. She will remain the chair of the Health IT Policy Committee; she will continue to lead on the development and finalization of the Interoperability Roadmap; and she will remain involved in meaningful use policymaking. She will also continue to co-chair the HHS cross-departmental work on delivery system reform.

Lisa Lewis will provide day to day leadership at ONC. Lewis served as Acting Principal Deputy National Coordinator before Dr. DeSalvo joined ONC, so she has had experience with all parts of our work. She will lead our extremely talented and very strong team during Dr. DeSalvo’s deployment to the Office of the Assistant Secretary for Health.

But most importantly, the team that is ONC is far more than one or two leaders. The team of ONC is personified in each and every individual – all part of a steady ship and a strong and important part of HHS’ path toward delivery system reform and overall health improvement.

Seems like an awkward arrangement if you ask me. DeSalvo will be providing high level leadership on policy direction, but Lisa Lewis will handle the day to day leadership. That job description for DeSalvo sounds like something an Assistant Secretary of Health might do and Lisa Lewis’ job sounds like something the National Coordinator would do.

I’m sure there’s more to this story. Maybe moving DeSalvo to Assistant Secretary was a way for ONC to save money and keep DeSalvo on board working on healthcare IT. If ONC’s budget gets cut, then HHS still has a way to pay for DeSalvo. Maybe that’s why Lisa Lewis can’t be promoted to full National Coordinator. Then again, maybe it’s like I mentioned when we first heard the DeSalvo news, DeSalvo is more of a public health person than she is a healthcare IT person.

The fact that DeSalvo is remaining as National Coordinator is interesting. However, I just came back from CHIME (healthcare CIO conference) where DeSalvo was scheduled as one of the plenary session speakers. However, she didn’t show and so the whole session was cancelled. I guess you could make the case that she’s got Ebola to deal with right now, but it also illustrates how health IT will be playing second fiddle for her going forward. Likely says something about the future of ONC.

6 Physician Website Tips

Posted on October 30, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 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 was asked to write an article for gMed users about Building a Better Physician Website. It’s an important topic that often gets overlooked by clinics and doctors and something I’ve worked on building physician websites. Here’s the intro to the article:

In this ever changing world, a physician’s website is how a new patient is going to judge that physician’s skills and capabilities. Whether they find their doctor on their insurance list, Google, a physician rating site or from a friend, a large majority of patients are now reviewing websites before scheduling an appointment. What does your website tell your patients about you? Does it portray a doctor who’s still stuck in the 90’s and hasn’t stayed up-to-date with the latest changes in technology? Does it allow a visitor to your website to easily become a patient? Does it make the patient feel like you are the best doctor for them?

I also offer the following 6 tips for physician websites:

  • Make Your Website Beautiful
  • Mobile Optimized Website
  • Engage Potential Patients
  • Engage Existing Patients
  • Online Payment Options
  • Regularly Updated Content

Be sure to read the full article where I go into more detail on each tip. What have you seen with Physician websites?

Full Disclosure: gMed is an advertiser on this site.

Connected Health takes the stage at Partners symposium

Posted on October 28, 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 Connected Health Symposium is not one of the larger health conferences, but it is one of the most respected. I met a number of leaders in health IT there who praised it for the conference scope and seriousness, and told me they were glad to see me there covering it.

Many issues in health IT and patient empowerment, however, are best learned not from any conference, but from the tussles and tears of everyday life. Let us hope no reader has undergone the personal experience of having her reports dismissed and of being misdiagnosed, as did several speakers at the conference.

But many of us have spent three hours on the phone with an insurer to approve a single medication shipment, or fought in vain to get the medical records that US law requires providers to give us, or watched our doctor fumble with his new EHR for fifteen minutes while trying to stay engaged with us.

It’s encouraging to see the progress of patient engagement at Massachusetts General Hospital, as reported by Gregg Meyer of Partners Healthcare System (the funder behind the Center for Connected Health that put on the symposium). But can small and rural providers struggling with cash flow join the movement?

These institutions would be comfortable using swyMe, a HIPAA-compliant telemedicine system that allows doctors to interview patients over everyday mobile devices and perhaps avoid a trip to the hospital. swyMe can also transmit audio and video from devices that EMTs can connect up to the phone. (Not many devices with the necessary hardware connectors are on the market, though.)

swyMe was one of the “innovators” highlighted in a conference demo. Jeffrey Urdan, COO of the company that makes it, told me later that he felt “low tech” compared to some of the fancy, expensive devices at the demo. But most of the providers in the US, and elsewhere, are more on swyMe’s level than theirs.

Another hurdle to forming connected teams that serve the patient is interoperability. A sign of the distance we have yet to come can be found in iCancerHealth, a service for cancer patients offered by Medocity. A free app is available to individuals, but the main integrated service is offered through providers or pharma companies doing clinical trials. The service includes such conveniences as medication tracking, treatment plans, a diary, audio and video connections to their physician, and even a way to form communities with other patients.

This is great, but iCancerHealth works with data from only one provider. This can be a limitation even for the few months that cancer patients typically use the service, and could certainly be a problem if the service were expanded to a broader range of illnesses. Similarly, there’s no seamless way to share data with patient communities; it has to be re-entered manually. Enhancing the service to encompass multiple providers would probably require wider adoption of electronic health record standards.

As an example of finding a creative solution to devices that lack interoperability, Mobile Diagnostic Services demonstrated an app that could photograph the display panel of a device, interpret the bars on the display to create digital data, and transmit the values to a health record in the cloud. This is a process well-known to computer programmers from thirty years ago as “screen scraping,” now relevant to the health industry.

One of the strengths of the Connected Health Symposium was the platform it gave to patients and doctors to express their frustrations with the old way of delivering care and the slow pace of change. The testimony could come from entrepreneur Robin Farmanfarmaian, who lost three organs unnecessarily to misdiagnosis, or Sarah Krüg, president of the Society for Participatory Medicine, whose parents died from diseases that might have been caught if the doctors had paid attention to their reported symptoms.

Or the testimony could come from Greg LaGana and Barry Levy, MDs who write and perform in a musical review called Damaged Care that skewers everything about doctors behavior as well as the legal and financial environment in which they have to operate.

Anna MCollister-Slipp, co-founder of Galileo Analytics and a sufferer from type 1 diabetes, regaled us with the dozens of vital sign measurements, treatments, and other details she has to manage on her own manually. She still get lab reports only because her doctor sends them via email (using a private account, so that HIPAA zealots don’t discipline him–the rights and wishes of the patient are supposed to be paramount). Like other conference attendees, though, she reported progress in tools and patient-oriented culture.

Less was heard at the symposium from other sectors of the medical field, but we did hear from Michael of Aetna, Jonathan Bush of athenahealth, and Beverley Bryant of England’s National Health Service. The panel on which Bryant spoke proved to be discouraging. Many of us in the US like to think that other developed nations with their universal health care systems have solved the coordination and interoperability messes that the US is in. But the panelists expressed many familiar frustrations.

I plan to return to the Connected Health Symposium next year, and I’m sure each year will bring a bit of progress toward better communication among staff, better use of patient data, and better integration of tools. The mood at the show was largely positive. But a little probing turned up barriers in the way of the healthcare system we all want.

#MGMA14 Twitter Roundup

Posted on October 27, 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’ve been spending the past couple days at the MGMA Annual conference in Las Vegas. It’s been interesting to talk to many of the leaders in healthcare. There seems to be a lot of confusion and uncertainty in the air. In fact, that seems to be the case at all the healthcare conferences I’m attending lately. While the industry is going through a turbulent period, it’s still been interesting to see the ongoing evolution that’s happening.

The Twitter stream has been a little disappointing to me. I’d like to see more attendees tweeting content. The vendors are extremely active. However, I found a few tweets which highlight a few of the topics being discussed.


I’m always amazed with how many people want their EHR to be connected. If it being connected was so valued by end users, then why hasn’t it happened? There’s still a misalignment of incentives that needs to be solved.


Lots of these ideas floating around. Everyone agrees that the move to some sort of quality based reimbursement is coming. We’re going to see a lot more discussions like the one above. Unfortunately, right now it’s a lot of speculation.


I wasn’t able to make this session, but it certainly brings up some interesting questions. We’ve written a number of times before about the value of a practice with and without an EHR. This certainly seems to call into question whether a practice without EHR is worth saving. This is going to become a really interesting topic as more doctors who’ve never used EHR in their practice decide to retire.

The Return of the House Call? – UberHealth

Posted on October 24, 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’d been hearing rumors about Uber (the black car service) creating an Uber Health service. I don’t think anyone is clear on the details and I’m not sure how they can do Uber Health when it seems like they have enough growth opportunities and challenges with their car service. Undeterred, yesterday Uber Health dipped its toe in the water with a Flu Prevention program for 1 day in 3 cities.

Uber partnered with Vaccine Finder to bring flu prevention packs and flu shots directly to you at the push of a button (an Uber button of course).

The offering was obviously really compelling. This version of Uber Health was free and Uber made it possible for the service to come to you and your 10 closest friends. I haven’t seen any reports on how it went, but I’ll be surprised if I hear that the service wasn’t swamped all day. They made it really convenient to get a flu shot. Hard to argue with something that comes to you for free.

What’s interesting to me is whether Uber can scale this kind of house call service in healthcare. No doubt they already have the transportation infrastructure in place to move the doctors and other medical personnel around as needed. However, that comes with a pretty steep cost which will have to be passed on to the patient. Plus, I don’t know how an Uber ride is any cheaper than the doctor driving her own car. I guess the doctor could chart the previous visit while the Uber drives her to the next one. Either way, it’s still an added cost that will have to be incorporated into the house call doctor visit.

You have to remember that Uber comes from the startup centric culture of Silicon Valley. In that culture, these companies will happily pay for a house call service like what Uber Health could be. First, these startup companies are competing for the best talent and being able to tell their employees that the Uber Health house call service is one of the benefits of working there could be a way to attract and retain the best talent. Second, these startup companies want their employees working as much as possible. A visit to the doctor takes a big chunk out of the day when they could be working and building their company. The lost productivity alone is reason enough for these companies to pay for a house call service like what Uber Health could become.

The real question is how will this scale across the nation. Are other companies as willing as silicon valley startup companies to pay for a service like this for their employees? My guess is that they won’t be, because the competition for talent isn’t nearly as fierce.

The reality is that I think most of us love the idea of a house call medical visit. I can’t think of anyone that wouldn’t love to avoid time spent waiting in the waiting room. However, we have to understand what that costs. There’s a reason why the house call doctor died in favor of office visits. They seem to be making a comeback, but I wonder if they’ll only work for the wealthy who don’t care about price.

Side Note: I just saw that Uber finally came to Las Vegas. That means you can try them out if you ever come and visit my beautiful town.

Healthcare’s Shift to Patient Self Pay

Posted on October 23, 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 stat was absolutely remarkable. It came from Intermountain healthcare. Healthcare Scene writers and I have written about this shift multiple times, but it was pretty stark to see the stats on how big the shift really is for an organization.

This same speaker at the Craneware Summit also said that only 40% of self pay is collectible. That’s a huge chunk of money your organization use to collect that is now being sent to collections. Now do you see why this shift in payments really matters?

Barry Haitoff, CEO of Medical Management Corporation of America, offered these words of advice on how to deal with the increase in patient self pay:

There are two main things you need to do to prepare for these high deductible plans. First, make sure you have a solid method in place to know how much the patient owes before or immediately after the visit. There is no better way to reduce patient collections than to collect the payment while the patient is in the office. Many are ready and willing to pay, but some practices don’t have the systems that allow them to know how much to charge the patient before they leave.

Second, look at your processes for collecting patient payments once they’ve left the building. Do you have a good strategy in place to make sure the patient knows how much they owe? Do you have a variety of simple ways for the patient to make the payment? The use of an online payment portal for patients is the most obvious way to make submitting payment to physicians simple for patients. If you solve these two problems you’ll go a long way to improving your patient collections.

These really are two great steps to deal with patient collections and the increase in patient self pay. I’m also watching new payment technologies. I’ll be interested to see what new payment methodologies are rolled out now that the patient pay portion of the bill is so much higher. Now that it matters a lot more to a clinic, I think we’ll see some new tech solutions that work to solve it. Credit card on file is one example.

What are you doing to handle this increase in patient self pay?

Full Disclosure: Medical Management Corporation of America is a sponsor of Healthcare Scene’s EMR and HIPAA blog.

Patient Billing Experience is Tied to HCAHP Scores

Posted on October 22, 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 first heard about this earlier this year when I met with ZirMed at ANI. Since then, I keep hearing this concept over and over and so it’s finally time for me to create a blog post on the topic. How you bill a patient has a tremendous impact on patient satisfaction and therefore your HCAHP scores.

When you read that, I’m sure you’re thinking “Well duh! Of course it does.” While it’s obvious once it’s stated, I don’t know many organizations that are working to improve their HCAHP scores by improving their patient billing processes. I have seen a lot of programs that look at the patient experience getting checked in, while their in the hospital, and how their discharge goes. Unfortunately, many organizations seem to stop one step short of the finish line. It’s like running 25 miles of a 26 mile marathon. The patient bill is the last mile of that journey.

The final experience a patient has with a hospital is usually when they get the bill from the hospital. There are so many ways this can be a terrible experience for the patient. If the charges are a lot more than what the patient expects, they’ll have a bad experience. If it’s not clear what charges they owe and whether insurance has paid their portion or not, they’ll have a bad experience. If they see the $5 aspirin (yes, that’s representative of charges that don’t make logical sense to the average patient), then it can damage their experience. If there’s no way to pay the bill online, it can leave a bad taste in the mouth for many. If it’s not clear what the bill is charging for, it can cause a bad experience. I could go on, but you get the idea.

All of these issues (and no doubt there are plenty more) have no impact on the care the patient received. In fact, your doctors and nurses could have provided an amazing customer service and literally worked miracles to save the patients life. However, if the billing experience is bad, it can leave a bad taste in their mouth and that will show up when they’re rating your hospital.

No doubt there are plenty of edge cases that we’ll never be able to satisfy. However, there’s a lot more we can do with our medical billing processes to ensure that the experience is a lot better than what it is today. Your HCAHP scores shouldn’t suffer because you didn’t take the time to make your billing process as beautiful as your clinical care.

ICD-10 Ebola Infographic

Posted on October 21, 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.

In my post on funny ICD-10 codes ruining the ICD-10 brand, I briefly commented how there’s no ICD-9 code for Ebola, but that there is one for ICD-10.

Beth Friedman from Agency Ten22 shared a link to this ICD-10 Ebola Infographic that I thought readers would find really interesting.

Ebola ICD-10 Infographic

One more reason to finally implement ICD-10 in the US.

Are Researchers Ready to Use Patient Health Records?

Posted on October 20, 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.

There’s a groundswell of opinion throughout health care that to improve outcomes, we need to share clinical data from patients’ health records with researchers who are working on cures or just better population health measures. One recommendation in the much-studied JASON report–an object of scrutiny at the Office of the National Coordinator and throughout the field of health IT–called on the ONC to convene a conference of biomedical researchers.

At this conference, presumably, the health care industry will find out what researchers could accomplish once they had access to patient data and how EHRs would have to change to meet researchers’ needs. I decided to contact some researchers in medicine and ask them these very questions–along with the equally critical question of how research itself would have to evolve to make use of the new flood of data.
Read more..

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..