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Hard Doc’s Life – Fun Friday Video

Posted on July 31, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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.

We’ve regularly written about physician burnout and physicians’ frustration with EHR software. It’s a real issue that needs to be dealt with on so many levels. So, it seems appropriate for this Fun Friday post to share a video ZDoggMD posted from the Wisconsin Med Society where ZDoggMD pulls out a live performance of a Hard Doc’s Life. Enjoy the video below:

Tell us about your Hard Doc’s Life in the comments.

Where’s the Health IT Innovation?

Posted on July 30, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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.

Becker’s Health IT’s Akanksha Jayanthi, has put together an article which outlines the 11 most interesting developments in health IT this year. Here’s the list:

1. Data breach overload.
2. Meaningful use forges on.
3. Epic gets vocal.
4. Telemedicine takes off.
5. The talent gap widens as a need for IT leaders emerges.
6. Mayo Clinic pick makes Epic more epic.
7. IBM ventures into health IT.
8. ICD-10 upheaval.
9. EHR-related lawsuits skyrocket.
10. Hospitals and health systems shift IT priorities.

I won’t argue about what’s missing on the list since when it’s “most interesting”, then that has a lot of personal bias. However, as I read through the list I was saddened by how few things were really interesting. In fact, most of them were big negatives (ie. breaches, meaningful use, lawsuits etc). Our industries most interesting items are government regulations and purchases?

Does it make anyone else sad to consider that this is the interesting part of our industry? Unfortunately, many of these are interesting, because they’re such a massive part of our industry. They’re so massive that we don’t get to hear the many interesting, exciting and positive things that are happening in healthcare IT.

I’d love to hear other people’s lists or things that they’d put on their most interesting health IT happenings. Where’s the healthcare IT innovation happening?

The Power of Saying “I Don’t Know”

Posted on July 29, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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.

Somewhere in our culture we decided that you were incompetent if you said “I Don’t Know.” It’s unfortunate, because it’s created a society that often fakes it when they shouldn’t. That can lead to dire consequences. There’s a real power in saying “I Don’t Know” and we should embrace it. This is true for everyone, but particularly doctors. Here’s an excerpt from an article that talked about this phrase:

As physicians, we aim for perfection. We want to have all the answers. All the time. Especially standing at the front of a room full of more junior learners. But that’s not real life. Every day, we see patients that give us cause to look up something or consult a colleague. This uncertainty and life-long learning needs to be built into, and even explicitly role-modelled in teaching. Not only is it not feasible nor realistic to be prepared for every clinical teaching session, it frankly looks pretty fake when it’s attempted. Sure, every medical resident should have the management of common life threatening problems like seizures and hyperkalemia at their fingertips (which no chief resident would need to prepare in advance), but the diagnostic criteria for rare diseases can (and should) be looked-up rather than portrayed as something that people should just know.

Often, one of the most powerful teaching points that can be made during clinical teaching is to say, “I don’t know.” Not only will it make people appreciate you for your honesty; but it also permits the more junior learner to feel less anxious and less alone.

I still remember my first real job out of college. I was hired to essentially be a backup to everything that my boss did. They wanted her to be able to take a vacation and so I needed to be able to do anything that she could do (sounds a bit like what doctors are required to do when they enter the field). On one of my first days someone came in with a major problem and I had no idea how to solve it. I turned to my boss and asked her how to solve it. I was a bit stressed and worried about getting it fixed. She calmly told me, “John, I don’t know how to fix it…but we’ll figure it out.”

That one moment taught me a great lesson in life. You don’t have to know everything. It’s ok to say I don’t know and you can work to find a solution to the problem.

We should have this expectation from our doctors. They may not know the answer right off the top of their head. We should be ok with that and ok with them making sure they give us the best answer possible. I remember a doctor once telling me that the body of medical knowledge is so big that it’s impossible for the human mind to know it all. What does that mean? It means that there are plenty of cases where the doctor should say that they don’t know and we should be ok with that. It also means that we should leverage technology to help doctors find the answers to those challenging questions.

As the article states, being able to say “I Don’t Know” shouldn’t let doctors (or us in our own lives) not know how to handle common problems. We need a baseline of understanding and not knowing some things is incompetence and you can’t shield yourself from incompetence with the phrase “I Don’t Know.” If you do, that will definitely catch up to you.

It’s a powerful thing to say “I don’t know, but I’ll figure it out.”

What Are You Doing To Protect Your Organization Against Your Biggest Security Threat? People

Posted on July 28, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 was a great tweet coming out of the HIM Summit that’s run by HealthPort. I agree with the comment 100%. Sure, we see lots of large HIPAA breaches that make all the news. However, I bet if we looked at the total number of breaches (as opposed to patient records breached), the top problem would likely be due to the people in an organization. Plus, they’re the breaches that are often hardest to track.

What’s the key to solving the people risk when it comes to privacy and security in your organization? I’d start with making security a priority in your organization. Many healthcare organizations I’ve seen only pay lip service to privacy and security. I call it the “just enough” approach to HIPAA compliance. The antithesis of that is a healthcare organization that’s create a culture of compliance and security.

Once you have this desire for security and privacy in your organization, you then need to promote that culture across every member of your organization. It’s not enough to put that on your chief security officer, chief privacy officer, or HIPAA compliance officer. Certainly those people should be advocating for strong security and privacy policies and procedures, but one voice can’t be a culture of compliance and security. Everyone needs to participate in making sure that healthcare data is protected. You’re only as strong as your weakest link.

One of the attendees at the session commented that she’d emailed her chief security officer about some possible security and compliance issues and the chief security officer replied with a polite request about why this HIM manager cared and that the HIM manager should just let her do her job. Obviously I’m summarizing, but this response is not a surprise. People are often protective of their job and afraid of comments that might be considered as a black mark on the work they’re doing. While understandable, this illustrates an organization that hasn’t created a culture of security and compliance across their organization.

The better response to these questions would be for the chief security officer to reply with what they’ve done and to outline ways that they could do better or the reasons that their organization doesn’t have the ability to do more. The HIM manager should be thanked for taking an interest in security and compliance as opposed to being shot down when the questions are raised. It takes everyone on board to ensure compliance and security in a healthcare organization. Burning bridges with people who take an interest in the topic is a great way to poison the culture.

Those are a few suggestions about where to start. It’s not easy work. Changing a culture never is, but it’s a worthwhile endeavor. Plus, this work is a lot better than dealing with the damaged reputation after a security breach.

Will We Need Billing Codes Once We Have Nice Structured EHR Clinical Data?

Posted on July 27, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 a really fascinating discussion recently with @AlexHBurgess where we discussed the role of billing codes in an EHR today and also the future of billing codes as EHR notes get much better and more granular. This is particularly interesting to me as I’m at the HealthPort HIM Summit the next couple days.

Here’s the question that started the conversation:

This was @AlexHBurgess’s response:

And then I replied:

The last question is something worth chewing on. I’ll have to ask it of a few HIM managers the next couple days. I think the simple answer is that we’ll still likely need billing codes. I don’t think that our payers are forward thinking enough or at least progressive enough to try and push forward a non-billing code reimbursement system. It’s pretty interesting to think about though.

The second reason I don’t think it’s likely to happen is that the data in the EHR will likely not be good enough. Although, if the data in the EHR (and not just the billing codes that were selected) were how you got paid, then you’d see a dramatic improvement in the quality of the EHR data. So, maybe it’s not a bad idea after all. I’m pretty sure my medical billing friends would scoff at this idea as they think about the number of times they’ve had to have doctors correct something in the paper chart to make sure the billing was ok.

Long story short, I think that you could theoretically get rid of medical billing codes and just use EHR data for reimbursement. However, in practice I don’t really see this ever becoming a reality. At least not in the short to medium term.

Medical Tourism Infographic

Posted on July 24, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 wonder how many healthcare organizations are thinking about medical tourism. I know there’s quite a bit of discussion about it in Las Vegas where I live. I know some practices that make a killing off of medical tourism. As you can imagine, the biggest medical tourism in Las Vegas is around your appearance (plastics, bariatrics, spas, etc). Vegas happens to be a great thing for all of those with some of the leading experts. It doesn’t hurt that it has cheap flights from everywhere and great hotels to stay in while you recover.

The medical tourism topic is unique to each locale. However, what does apply everywhere is that patients are seeking out the best and cheapest care they can find. That often includes travel out of state or out of country.

With this in mind, I was intrigued by this Medical Tourism Infographic put together by PreTaxHealth. It offers some interesting insights into the medical tourism industry.
Medical Tourism and the Cost of Healthcare Technology

If EHR Had a Tech Problem We’d Blame the Vendors

Posted on July 23, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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.

During last week’s #KareoChat, the chat host @GabrielSPerna offered the following tweets from the @PhysiciansPract account for which he is now managing editor (Gabriel Perna was formerly @HCInformatics):

When I saw this tweet, I knew I needed some time to chew on the concept. Do we really blame our vendor when it’s a tech problem? I’m reminded of a time my EHR software ran out of control and was literally chewing up RAM and never spitting it out. I’d restart the server and we’d be fine until the EHR software had chewed up all the RAM again and then the EHR was slow as molasses. You can bet I was blaming my EHR vendor for the tech problems we were having.

However, did I blame them for our cultural challenges as well? I guess the key term there for me is “blame.” I know many practices (and have heard of others) who have switched EHR vendors 3, 4, even 5 times. They loved to blame the previous EHR vendors for their problems. However, by the 2nd or third, you can be sure there are some cultural problems there that need to be resolved. As much as they want to blame the EHR vendor they’re likely not to blame.

Another tweet from today’s #KareoChat seems to also illustrate the challenge is cultural and not technical:

I can already hear Dr. Tom in his EHR product management meetings asking why they’re building a certain feature into the software when it supports a flawed process. The developers respond that it’s what the customer wants. This highlights a major cultural problem.

Back to the original discussion. The fact that many doctors haven’t seen an ROI from their EHR, but less than 20% are dissatisfied with their EHR vendor does seem to say that most EHR vendors have not had tech issues. Instead the EHR dissatisfaction likely stems from a lot of other cultural problems in healthcare.

All of this reminds me of some old posts where I asked “Can An EMR Focus on Patient Care in the Current Reimbursement Environment?” and what would an EHR look like if it was focused on customer requests and not MU? Is the healthcare culture what has created these less than happy EHR users or is that letting the EHR vendors off the hook?

How Does Your EHR Vendor Solve Challenging Situations?

Posted on July 22, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 I was asked if I thought a specific EHR feature (in this case it was cloud hosted) was one area practices should consider looking at to avoid having a short sighted view of their EHR vendor. The specific feature and question are interesting, but I think it’s a short sighted way to look at an EHR vendor.

My immediate response was that when I look at an EHR vendor, I look at how they solve challenging situations and if they’re still solving those problems. I’m more interested in the EHR vendors direction and approach than I am any specific feature or function they offer today.

Let’s take them in the inverse order. Is your EHR vendor still solving your problems? This is a hard one to evaluate since meaningful use and EHR certification has hijacked the EHR development process. However, when you dig into an EHR vendor you can tell which ones are really investing in improving their platform and which ones are just doing the minimum necessary to retain their customers. It’s a totally different mindset. A forward thinking EHR vendor is trying to push the envelope, is interested in user feedback and is working towards a brighter future. An EHR vendor that’s doing the minimum necessary is just barely meeting the EHR certification and meaningful use requirements and never really responds to customer requests. Sure, they’ll do a bug fix here or there or fix anything major, but there’s no real investment in the future.

One easy way for you to start evaluating which vendors are investing in their future and which aren’t is to talk to their sales people. Does the salesperson have something new to sell you (like RCM or some other service)? If they do, it’s quite possible your EHR vendor has started focusing (and investing) on some new product and not the EHR anymore. Just remember that it’s really hard for a company to focus and invest in more than one area.

Sadly, I think many EHR users know that their EHR vendor has stopped innovating their product. They know this based on the release cycles of the EHR vendor. When was the last time your EHR vendor put out something that made your life as a clinician or a practice easier and it didn’t have to do with MU?

Related to the above is something that’s even more telling when it comes to the future of your EHR. Ask yourself the question, how does my EHR vendor approach solving challenging situations? If you talk to a lot of EHR vendors like I do, you can pretty quickly tell how an EHR vendor approaches problems. Unfortunately, many of them do the minimum work possible to solve the problem. The best EHR vendors dive deeply into the problem and not only solve the problem, but try to think of a better way to optimize everything surrounding the problem.

I still remember sitting down with an EHR vendor for breakfast one day. As they described their ePrescribing solution, they described how they could have implemented ePrescribing really quickly. However, they didn’t just want to have ePrescribing. They wanted to take the time to really understand ePrescribing and ensure that the doctor could ePrescribe with as few clicks as possible. They wanted to make sure that the process was efficient and accurate. It wasn’t enough to just be able to ePrescribe, but they wanted their doctors to be efficient while doing it too.

Reminds me of many of the ICD-10 implementations I’ve seen. I’d describe EHR vendor implementations as ok, better, and best. The “ok” implementation is that they have a search box which can search by word or code. Theoretically, this works. It just means you’re going to have a big book next to you or an app on your phone which lets you really find the code and then all you’re doing is entering the code. Not good!

The “better” implementation is the vendors that group codes so that when you search you can choose the group of codes and then essentially drill down into the group and find the code you need. In most cases, I’ve seen this type of implementation done by integrating a third party vendor. The EHR vendor often passes that third party cost on to the end user (imagine that). I’ll admit that a third party vendor integration for this feels kine of lazy. I’m all for third party integrations, but your EHR vendor won’t ever be able to take coding to the next level if they’re working with a third party. This kind of “grouping” approach is better, but it’s not the best.

The best type of ICD-10 implementation I’ve seen is one that integrates deeply into the EHR documentation. The documentation essentially narrows down the ICD-10 code list for you as you document the visit. Then, when it’s time to do your assessment, the hard work of identifying the right codes is already done for you. Sure, you’ll need to verify that the machine approach to ICD-10 identification is right, but it’s the best approach I’ve seen to ICD-10.

Hopefully this ICD-10 example gives you a view into what I mean when I say that you have to evaluate how an EHR vendor works to solve a problem. Are they just trying to get by or do they take their solution to the next level of automation? I feel sorry for the doctors who are stuck on EHR software that’s no longer investing in their EHR and just take the minimal necessary approach to EHR development.

Going back to the person’s initial question about cloud hosted EHR, it’s easy today to say that every EHR vendor should be on the cloud. The cloud has won in every industry and it will eventually win in healthcare as well. However, cloud or not is not what concerns me. I’d be more interested in hearing an EHR vendors reason for going cloud or not. Not to mention their reasons for moving to cloud or not. That will tell you how an EHR solves a problem and how an EHR works with new technology. Their direction and approach to those challenges is much more important than the specific choice they make.

Are We Short Sighted in Ambulatory?

Posted on July 21, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 recently having a conversation with Susan Clark from eHealthcare Consulting and we were talking about the ambulatory world and what makes it unique. I commented to her that many in ambulatory are just trying to survive and so they want the simplest, cheapest solution possible. She then commented that many of them make very short sighted decisions.

I thought the comment was fascinating since I’ve seen this happen over and over again in the ambulatory world. There are some exceptions, but for the most part I’ve seen many in the ambulatory environment want the quick, dirty, easy solution as opposed to making a long term decision that will pay long term benefits.

Since I live in the EHR world, that’s where I’ve seen it most. In fact, I think it’s why we’re heading into the next generation of EHR switching. Many doctors chose the cheap and easy way out with their EHR (which wasn’t always that cheap) and now they’re paying the price as they have to switch EHR vendors.

The sad part is that many of them actually spent a lot more on their EHR thinking that it was a great long term investment when in fact the great long term investment would have been to spend more time evaluating, planning, and implementing the right EHR in the right way. Instead they just threw money at the most expensive EHR with the idea that if it costs more it must be better. Sadly, many of the high end EHR brands haven’t lived up to their high end price tag. In fact, many doctors would have been much happier to go with the less expensive mid-tier EHR vendor that worked better with their practice and their workflow.

This brings up a key point in an ambulatory practices decision making. Long term decision making doesn’t mean that you always have to pay more money for something up front. However, it almost always means you have to spend more time and energy up front evaluating the decision. That extra time and energy has a cost, but it pays big dividends long term. However, I think Susan Clark’s right that there’s far too many ambulatory practices who are short sighted and don’t want to make that kind of investment.

Ready For a Third-Party Market for Apps on Your EHR? athenahealth Explains How (Part 2 of 2)

Posted on July 20, 2015 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.

In part 1 of this article, I explained why EHR vendors need to attract outside developers to remain competitive, and how athenahealth’s More Disruption Please (MDP) program pursued this goal by developing open APIs. This part goes on to describe how they made their athenahealth Marketplace an actuality.

Through experimentation, API developers throughout companies and governments have found a toolbox of best practices to develop and promote their APIs. athenahealth pretty much did everything in this toolbox:

  • A prominent public announcement (in this case, coming from the CEO Jonathan Bush himself)

  • A regular set of hackathons to answer developer questions and familiarize them with the APIs,

  • An early pilot partnership that created a demonstration project and produced insights for further development, described in Part 1 of this article

  • An accelerator program that offers seed funding, free office space, mentorship, technical resources, support, and contacts with the client base

  • A commitment to support both physicians and partners, including a requirement that athenahealth developers work on API documentation

Access to the APIs is easy–for security purposes, a developer has to agree to the run-of-the-mill terms and conditions, but the process is fast and there is no charge. The athenahealth Marketplace is large and thriving, with more than 2,500 members.

Having spent a lot of money for an EHR, clinicians who are growing more tech-savvy and have come to love their mobile apps will demand more and more value for the money. Vendors are coming to realize that they can’t produce all the value-added solutions and functionality their customers want.

The SMART Platform has, for several years, championed the availability of EHR data to fuel app development by EHR users and third-party companies. The recent FHIR standard has drawn enthusiasm from vendors. A number of them, including athenahealth, have formed the Argonauts project to develop shared definitions and ensure that, in an interoperable way, they can provide the most common types of data used by US clinicians.

But as explained before, supporting an API does not automatically lead to more effective, beneficial apps or services. athenahealth has gone to the next level to attract real-time, dynamic applications to its Marketplace, and in turn is reaping the benefits.