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Which Parts of an EHR Implementation Should Be Their Own Project?

Posted on September 29, 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 really great discussion has been started on this post about staged patient portal implementations. Here’s one comment that really struck a chord with me:

I think that on a lot of strategic roadmaps “patient portal” is listed as a goal…a one time deadline without understanding how the patient portal works; what information flows into a fully functioning portal and to the patient; and what the system, risk, and security requirements are to consider.

This will require C level suite and decision makers to ask questions that might be getting them “into the weeds” a bit or questions that they may not know to ask. This is why a several strong consultants that are specialists in individual subject matter might be needed – instead of one project manager expected to move the project plan forward on the road map and to know everything.

This comment is right that the patient portal is often seen as a line item on a project plan that just needs to be completed. That couldn’t be farther from the truth. As one person said, sometimes you can get a grand slam, but most of the time you have to do a bunch of little things along the way. A patient portal is a great example of this. You don’t just implement a patient portal one time and then it will run forever. There’s more you can do to leverage a patient portal for your institution.

Are there other parts of an EHR implementation that exhibit similar characteristics? Maybe you implement them, but there’s always more that could be done to improve its use in your organization? Templates and workflow are one that come to mind. There should be an ongoing evaluation of your templates and workflow in order to ensure that it’s as optimized as possible.

What other pieces of your EHR project could benefit from a separate staged project plan? Of course, this assumes you’re starting to think more strategically than just trying to check off the MU check boxes.

ACO by ACO Savings and Payments Report

Posted on September 26, 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 my favorite former CMS people, Travis Broome, recently shared a link to the ACO Savings and payment report. It provides an interesting view into the year 1 results of the Medicare Shared Savings Program (Medicare ACO program if you prefer).

It’s interesting to see which ACOs and other organizations got paid, but probably even more interesting to see ones that didn’t get paid at all. My guess is that many of them dropped out. If I’m reading the report properly, I could only find one organization that incurred a loss. It seems that Dean Clinic and St. Mary’s Hospital ACO in Wisconsin owes $3.96 million. Looks like they took the high risk-high reward option and lost. I’d love to talk to someone from that organization and hear what happened.

Travis Broome offered a number of other insights into the ACO report:

What do you think of the ACO program? I think it’s a bad sign that so many organizations fell out of the program. However, the trend and move towards this reimbursement is going to happen. I really don’t see how it could stop.

What Would You Do If your EHR Vendor Shut Off Access to Your EHR?

Posted on September 25, 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.

Anne Zieger at Healthcare Dive has an interesting summary of a practice who just had their EHR access shutdown by an EHR vendor. Here’s the summary of what happened:

*A small medical practice in northern Maine has been blocked from accessing patient medical records because its EMR vendor has shut them off.
*Vendor CompuGroup says the practice, Full Circle Health Care, won’t get access to its records back until it pays $20,000 in overdue charges to the vendor.
*The medical group acknowledges that it stopped paying CompuGroup $2,000 per month in monthly fees 10 months before the July shut off, but said that was after months of attempting to address what the practice considered to be exorbitant, unexpected maintenance fees and charges for hardware that didn’t arrive.

This is a really challenging situation. No doubt the vendor wants to make sure it gets paid and needs some sort of recourse. Although, if you’ve ever had an EHR on which you relied, you know how important it can be to the care you provide. Just ask anyone who has had their EHR go down. Unless you have great EHR downtime procedures it can get a little crazy. Now just imagine that your EHR was taken down with no sign of when it will be back up.

Of course, we’re a little short on the exact details of what happened with Full Circle Health Care and CompuGroup. I’d love to know how many warnings CompuGroup gave Full Circle Health Care before they turned it off. If they gave them the right number of warnings over a certain period, then I don’t begrudge them for making the decision they made. If they just pulled the plug without very specific warnings about what was going to happen, then CompuGroup should get some of the blame.

This would make for an interesting court case. I imagine there’s previous case law from other industries that would illustrate what would happen. Although, in healthcare we’re not just talking about lost business and financial impact. Turning off someone’s EHR could literally kill someone. That’s pretty scary to consider.

I’m surprised that CompuGroup hasn’t gotten ahead of the story. That’s what I’d want to do if I were in their shoes. Unless the facts don’t put CompuGroup in a very nice light. However, it’s hard to put them in a worse light than they already are in with the story above.

Do you think it’s ok for an EHR vendor to turn off someone’s EHR if they stop paying? Should there be laws that say that an EHR vendor can’t do that? What would you do if you were in this practice’s situation?

For me this is really hard to think about, because if I were at that practice I would never let it get to this point. I’ve heard of a few cases where EHR vendors have become a black hole of unresponsiveness. However, that’s really rare and usually only happens when other really major and scarier things are happening at the company.

Jonathan Bush Loves Health Data–But How Will We Get As Much As He Wants?

Posted on September 24, 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 fervent hope of health care reformers is that someday we will each know as much about our bodies–our vital signs, the health of our organs, the contents of our genomes-as corporations know about our marketing habits. One of the recent expressions of this dream comes in Jonathan Bush’s engaging and readable account of the healthcare system, Where Does It Hurt?.

Bush is a tireless advocate for bottom-up, disruptive forces in healthcare, somewhat in the same camp as Vinod Khosla (whose Health Datapalooza keynote I covered) and Clayton Christensen (who wrote the forward to Bush’s book). What Bush brings to the discussion is hands-on experience at confronting the healthcare behemoth in an explicitly disruptive way (which failed) as well as fitting into the system while providing a bit more light by building athenahealth (which succeeded).

Bush’s book tours the wreckage of the conventional health care system–the waste, errors, lack of communication, and neglect of chronic conditions that readers of this blog know about–as well as some of the promising companies or non-profits that offer a way forward. His own prescription for the health care system rests on two main themes: the removal of regulations that prevent the emergence of a true market, and the use of massive data collection (on physicians and patients alike) to drive a rational approach to health care.

Both government and insurers would have a much smaller role in Bush’s ideal health care system. He recognizes that catastrophic conditions should be covered for all members of society, and that the industry will need (as all industries do) a certain minimum of regulation. (Bush even admitted that he “whined” to the ONC about the refusal of a competitor to allow data exchange.) But he wants government and insurers to leave a wide open field for the wild, new ideas of clinicians, entrepreneurs, and software developers.

Besides good old-fashioned human ingenuity, the active ingredient in this mix is data–good data (not what we have now), and lots of it. Bush’s own first healthcare business failed, as he explains, through lack of data along with the inconsistency of insurance payments. A concern for data runs through this book, and motivates his own entrance into the electronic health records market.

What’s missing from the Where Does It Hurt?, I think, is the importance of getting things in the right order: we can’t have engaged patients making free choices until an enormous infrastructure of data falls into place. I have looked at the dependencies between different aspects of health IT in my report, The Information Technology Fix for Health: Barriers and Pathways to the Use of Information Technology for Better Health Care. Let’s look at some details.

Bush wants patients to have choice–but there’s already a lot of choice in where they get surgery or other procedures performed. As he points out, some of the recent regulations (such as accountable care organizations) and trends in consolidations go in the wrong direction, removing much of this choice. (I have also written recently about limited networks.) One of Bush’s interesting suggestions is that hospitals learn to specialize and pay to fly patients long distances for procedures, a massive extension of the “medical tourism” affluent people sometimes engage in.

But even if we have full choice, we won’t be able to decide where to go unless quality measures are rigorously collected, analyzed, and published. Funny thing–quality measures are some of the major requirements for Meaningful Use, and the very things that health IT people complain about. What I hear over and over is that the ONC should have focused laser-like on interoperability and forgone supposedly minor quests like collecting quality measurements.

Well, turns out we’ll need these quality measures if we want a free market in health care. Can the industry collect these measures without being strong-armed by government? I don’t see how.

If I want a space heater, I can look in the latest Consumer Reports and see two dozen options rated for room heating, spot heating, fire safety, and many other characteristics. But comparable statistics aren’t so easy to generate in health care. Seeing what a mess the industry has made of basic reporting and data sharing in the data that matters most–patient encounters–we can’t wait for providers to give us decent quality measures.

There’s a lot more data we need besides provider data. Bush goes into some detail about the Khosla-like vision of patients collecting and sharing huge amounts of information in the search for new cures. Sites such as PatientsLikeMe suggest a disruptive movement that bypasses the conventional health care system, but most people are not going to bother collecting the data until they can use it in clinical settings.

And here we have the typical vicious cycle of inertia in health care: patients don’t collect data because their doctors won’t use it, doctors say they can’t even accept the data because their EHRs don’t have a place for it, and EHR vendors don’t make a place for it because there’s no demand. Stage 3 of Meaningful Use tries to mandate the inclusion of patient data in records, but the tremendous backward tug of industry resistance saps hope from the implementation of this stage.

So I like Bush’s vision, but have to ask: how will we get there? athenahealth seems to be doing its part to help. New developments such as Apple’s HealthKit may help as well. Perhaps Where Does It Hurt? can help forward-thinking vendors, doctors, health information exchanges, entrepreneurs, and ordinary people pull together into a movement to make a functioning system out of the pieces lying around the landscape.

Celebrating Simple Solutions

Posted on September 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.

Yesterday I had a chance to tour the beautiful Samford Health facility in Fargo, ND. What a thoughtful patient design and use of tracking technology. Plus their Disney like approach to front of house and back of house was fascinating. I recommend the tour if you’re ever in the area.

However, there was a really simple extra chair solution that caught my eye:
image

You often need an extra chair in the room. What a great little implementation that saves the space when you don’t need the chair, but it’s there when you need it. I love simple little design solutions.

What Happens When You Forget Your Laptop?

Posted on September 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.

Many people have long talked about the day when desktops and laptops will no longer exist. When you think about it, there is really nothing that couldn’t be done on your cell phone that can be done on a desktop or laptop.

Sure there are some applications that haven’t yet been made available on a cell phone (I mean natively. Of course a remote desktop environment can run anything) yet. However, every application could be made available on a cell phone if desired. The cell phone is powerful enough. Especially when attached to a powerful server. Yes, I know that many of the mobile apps aren’t as great as their desktop counterparts, but they could and will be.

If we could just use our cell phone for these applications, why don’t we? It admins would happily get rid of desktops and laptops in order to have a much smaller device footprint that they have to manage. It would take some time to make the switch, but it would happen.

The biggest reason I think we have yet to go all in with cell phones as our primary device is the value of peripherals. I think we seriously underestimate the value of a decent keyboard and extra screen real estate.

I’m amazed at how well you can type on a cell phone keyboard, but it still pales in comparison to a quality keyboard. Voice recognition might help in some situations, but it can’t be used everywhere a keyboard can be used. I don’t see us ever beating a physical keyboard at least until it starts typing our thoughts.

Screen real estate is an even bigger issue. As much as you shrink the internals of a cell phone you’re still bound by the size of the screen. Just look at Apple’s choice to release an iPhone with a larger screen. We love as much screen space as we can get. If you’ve never had the delight of using dual monitors on your desktop, you have no idea the efficiencies you’re missing out on. I can do everything on my laptop that I can do on my desktop, but dual monitors makes doing so much more effecient. I even bought a second monitor I could plug into the USB on my laptop. It’s that valuable.

I think the clear solution to this problem is to be able to easily connect your cell phone to external “monitors” and other peripherals like keyboards. Soon these connections will all be available wirelessly. I put “monitors” in quotes since I think we’ll have electronic viewing areas on everything from windows to tables and everything in between. That’s an exciting future to consider (we’ll leave the security issues for another post).

Unfortunately, we’re not there yet, but I think it’s where we’re headed. Eventually we’ll sit down at our desk where our cell phone will wirelessly connect to the monitors and peripherals on your desk. Until then we do this awkward dance between cell phone, laptop and desktop.

In fact, I just boarded a flight with my laptop charging at home instead of being in my laptop bag. Now I get to see first hand the difference between my laptop and cell phone on a work trip. If only the seat back was a monitor and the tray table a keyboard I could connect to my cell phone. Then, I’d been in business and wouldn’t even need my laptop. One day!

Afterthought: This is definitely a first world problems” post. Also, excuse any typoes, because I wrote this post in air on my cell phone keyboard. Certainly the lack of keyboard and monitor didn’t stop me from doing this post, but I could have probably done it twice as fast. Although, it’s a bit ironic that this post wouldn’t exist if the tech was already available. If you’ll be at the Insite Build conference in Fargo, ND, we’ll see you there. Just don’t be surprised if I ask to borrow your laptop.

EHR: What’s Next?

Posted on September 19, 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 realize this is a simple concept with a million answers. In fact, that’s why I’m posting about it and hopefully starting a rich discussion. A huge portion of the healthcare system has adopted EHR software. I now ask the question:

What’s Next?

I know that some of you reading this will reply meaningful use. Ok. We get that. We know what meaningful use requires. Let’s get beyond meaningful use and talk about what you’re doing with your EHR.

I’m really starting this as a conversation starter. Hopefully you can break it down into two areas:

1. What are you doing with your EHR to optimize your use of your EHR?

2. Now that you have an EHR, what are you going to do next? What are you working on next?

I look forward to hearing your thoughts and answers. Hopefully we’ll get a broad cross section of responses from small practices, hospitals, vendors, etc. I’ll join in the comments as well.

10 Health IT Rockstars and Their #NHITWeek Happenings

Posted on September 18, 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.

It’s National Health IT Week and so I thought it would be fun to take a quick look at what some health IT social media rockstars are doing to celebrate #NHITWeek.

Mandi Bishop (@mandibpro) is sorting through her petabytes of #HITHeroes selfies and creating a t-shirt that says “I Heart Big Data.”

Farzad Mostashari, MD (@Farzad_MD) is sending out bow ties to prospects for his new company Aledade.

Charles Wesbter, MD (@wareflo) is programming his Google Glass controlled robot to improve EHR workflow.

Wen Dombrowski, MD (@healthcarewen) is practicing to break the World Record for most tweets sent during a conference session.

Gregg Masters (@2healthguru) is reading the latest Flex-IT act and Final Rule on meaningful use flexibility from his surfboard in the ocean.

Cari McLean (@carimclean) and Michael Gaspar (@MichaelGaspar) are fighting over which Health IT meme is more likely to go viral.

Geeta Nayyar, MD (@gnayyar) is making medicine fun and meaningful.

Regina Holliday (@ReginaHolliday) is painting a Walking Gallery jacket for a statue dedicated to the patient that will be put in the CMS lobby in Washington.

Matthew Holt (@boltyboy) is creating a new conference dedicated to Health IT buzzwords. Sessions include #HealthAnalytics, #HealthcareSocialMedia, #ACOs, #PatientEngagement, #HIE, and many more.

Keith Boone (@motorcycle_guy) is doing an HL7 crossword puzzle.

What are you doing for National Health IT week? Feel free to add what other people are doing for #NHITWeek as well. Bonus points if you write what I’m doing for #NHITWeek.

Rise of the Digital Patient Infographic

Posted on September 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.

The social people behind CDW Healthcare are doing a good job putting out some great content on social media. A great example of this is this Digital Patient Infographic that they recently posted:
mHealth_DigitalPatient_Infographic_0914_1000

I recently took part in a webinar with Dodge Communications (I’ll add a link to the webinar once it’s available) yesterday and I made the comment that telemedicine is more efficient for the patient, but I wasn’t sure telemedicine was more efficient for the doctor. There might be a disconnect of benefits there that needs to be reconciled.

As I look at the infographic above, I’m reminded of something similar. The stats in the infographic and just some basic common sense says how much patients would love to do an eVisit. If this is the case, why is it that healthcare hasn’t filled this customer demand? I think the answer is the disconnect of benefits.

What are your thoughts?

Also, since CDW created the infographic above, It’s worth mentioning that CDW also listed this blog on their list of Top 50 Health IT blogs for 2014. I’m not sure I agree that it’s the top 50 health IT blogs since EMR and HIPAA and a number of other Healthcare Scene blogs aren’t on the list, but there are a lot of great bloggers on the list just the same.

#20HIT Comments on Health IT by HL7 Standards

Posted on September 16, 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.

Many of you know that I’m extremely active on social media (see @techguy and @ehrandhit to start). I love the way it can connect people. It’s so powerful. One of the companies that’s done an amazing job with social media for their company is Corepoint Health and their HL7 Standards blog. The blog is most notable for being the home and birthplace of the #HITsm chat. If you haven’t participated in an #HITsm chat, then you’re missing out. Lots of great health IT discussions every Friday.

Along with being the home of the #HITsm chat, the HL7 Standards blog is a great place to find blog posts from voices throughout the #HITsm community. Plus, they recently started doing a series of “20 Questions for Health IT” with responses from a variety of health IT professional. Check out an example tweet and question that was answered by Mandi Bishop (better known as @MandiBPro):

I love the work their doing and I love hearing perspectives from across the industry. I’m going to think about ways I can do something like they’re doing to bring and amplify more of the interesting voices in healthcare IT. Nice work HL7 Standards.