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Adverse Event Reporting and EHRs: The MEDTECH Act’s Effects

Posted on December 18, 2014 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

Medical systems generate adverse event (AE) reports to improve service delivery and public safety.

As I described in my first blog post on Adverse Events, these reports are both a record of what went wrong and a rich source for improving workflow, process and policy. They can nail responsibility not only for bad acts, but also bad actors and can help distinguish between the two. The FDA gathers AE reports to look for important health related patterns, and if needed to trigger recalls, modifications and public alerts.

EHRs generate AEs, but the FDA doesn’t require reporting them. Reporting is only for medical devices defined by the FDA and EHRs aren’t. However, users sometimes report EHR related AEs. Now, there’s proposed legislation that would preclude EHRs as medical devices and stop any consideration of EHR reports.

MEDTECH Act’s Impact

EHRs are benign software systems that need minimal oversight. At least that’s what MEDTECH Act’s congressional sponsors, Senators Orrin Hatch (R- Utah) and Michael Bennett (D- Colorado) think. If they have their way – and much of the EHR industry hopes so – the FDA can forget regulating EHRs and tracking any EHR related AEs.

EHRs and Adverse Events

Currently, if you ask MAUD, the FDA’s device, adverse event tracking system about EHRs, you don’t get much, as you might expect. Up to October, MAUD has 320,000 AEs. Of these about 30 mention an EHR in passing. (There may be many more, but you can’t search for phrases such as “electronic health,” etc.) While the FDA hasn’t defined EHRs as a device, vendors are afraid it may. Their fear is based on this part of the FDA’s device definition standard:

[A]n instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related article, including a component part, or accessory which is:

…[I]ntended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease, in man or other animals…

I think this section clearly covers EHRs. They are intended for diagnostic, cure, mitigation, etc., of disease. Consistent public policy in general and a regard for protecting the public’s health, I think, augers for mandatory reporting of EHR caused AEs.

Why then aren’t EHRs devices that require AE reporting? In a word, politics. The FDA’s been under pressure from vendors who contend their products aren’t devices just software. They also don’t want their products subject to being criticized for failures, especially in instances where they have no control over the process. That may be understandable from a corporate point of view, but there are several reasons for rejecting that point of view. Consider what the FDA currently defines as a medical device.

Other Devices. The FDA captures AE reports on an incredible number of devices. A few examples:

  • Blood pressure computers
  • Crutches
  • Drug dose calculators
  • Ice bags
  • Lab gear – practically all
  • Robotic telemedicine devices, and many, many more.

ECRI on EHR Adverse Events

The respected patient safety NGO, the ECRI Institute, puts the issue squarely. Each year, it publishes its Top Ten Health Technology Hazards. Number one is inadequate alarm configuration policies and practices. Number two: “Incorrect or missing data in electronic health records and other health IT systems.” Its report says:

Many care decisions today are based on data in an electronic health record (EHR) or other IT-based system. When functioning well, these systems provide the information clinicians need for making appropriate treatment decisions. When faults or errors exist, however, incomplete, inaccurate, or out-of-date information can end up in a patient’s record, potentially leading to incorrect treatment decisions and patient harm. What makes this problem so troubling is that the integrity of the data in health IT (HIT) systems can be compromised in a number of ways, and once errors are introduced, they can be difficult to spot and correct. Examples of data integrity failures include the following:

  • Appearance of one patient’s data in another patient’s record (i.e., a patient/data mismatch)
  • Missing data or delayed data delivery (e.g., because of network limitations, configuration errors, or data entry delays)
  • Clock synchronization errors between different medical devices and systems
  • Default values being used by mistake, or fields being prepopulated with erroneous data
  • Inconsistencies in patient information when both paper and electronic records are used
  • Outdated information being copied and pasted into a new report Programs for reporting and reviewing HIT-related problems can help organizations identify and rectify breakdowns and failures.

ECRI spells out why AE reporting is so important for EHRs:

…[S]uch programs face some unique challenges. Chief among these is that the frontline caregivers and system users who report an event—as well as the staff who typically review the reports—may not understand the role that an HIT system played in an event…

The MEDTECH Act’s Effects

The move to curtail the FDA’s EHR jurisdiction is heating up. Senators Hatch and Bennett’s proposed act exempts EHRs from FDA jurisdiction by defining EHRs as passive data repositories.

Most industry chatter about the act has been its exempting EHRs and others from the ACA’s medical device tax. However, by removing FDA’s jurisdiction, it would also exempt EHRs from AE reports. Repealing a tax is always popular. Preventing AE reports may make vendors happy, but clinicians, patients and the public may not be as sanguine.

The act’s first two sections declare that any software whose main purpose is administrative or financial won’t come under device reporting.

Subsection (c) is the heart of the act, which exempts:

Electronic patient records created, stored, transferred, or reviewed by health care professionals or individuals working under supervision of such professionals that functionally represent a medical chart, including patient history records,

Subsection (d) says that software that conveys lab or other test results are exempt.

Subsection (e) exempts any software that makes recommendations for patient care.

There are several problems with this language. The first is that while it goes to lengths to say what is not a device, it is silent about what is. Where is the line drawn? If an EHR includes workflow, as all do, is it exempt because it also has a chart function? The bill doesn’t say

Subsection (d) on lab gear is also distressing. Currently, most lab gear are FDA devices. Now, if your blood chemistry report is fouled by the lab’s equipment ends up harming you, it’s reportable. Under MEDTECH, it may not be.

Then there’s the question of who’s going to decide what’s in and what’s out? Is it the FDA or ONC, or both? Who knows Most important, the bill’s negative approach fails to account for those AEs, as ECRI puts it when: “Default values being used by mistake, or fields being prepopulated with erroneous data.”

Contradictory Terms

The act has a fascinating proviso in subsection (c):

…[P]rovided that software designed for use in maintaining such patient records is validated prior to marketing, consistent with the standards for software validation relied upon by the Secretary in reviewing premarket submissions for devices.

This language refers to information that device manufacturers file with HHS prior to marketing. Oddly, it implies that EHRs are medical devices under the FDA’s strictest purview, though the rest of the act says they are not. Go figure.

What’s It Mean?

The loud applause for the MEDTECH act coming from the EHR industry, is due to its letting vendors off the medical device hook. I think the industry should be careful about what it’s wishing for. Without effective reporting, adverse events will still occur, but without corrective action. In that case, everything will seem to go swimmingly. Vendors will be happy. Congress can claim to being responsive. All will be well.

However, this legislative penny in the fuse box will prove that keeping the lights on, regardless of consequences, isn’t the best policy. When something goes terribly wrong, but isn’t reported then, patients will pay a heavy price. Don’t be surprised when some member of Congress demands to know why the FDA didn’t catch it.

Microsoft Joins Battle for Wearables Market

Posted on November 4, 2014 I Written By

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

Following the lead of several other companies big and small, Microsoft has jumped into the wearables healthcare market with a watch, a fitness tracker and a cloud-based platform that condenses and shares data.

It’s little wonder. After a few years of uncertainty, it seems pretty clear that the wearables market is taking off like a rocket. In fact, 21% of US consumers own such a device, according to research by PricewaterhouseCoopers. That’s slightly higher that the number of consumers who bought tablets during the first two years after they launched, PwC reports. Not only Microsoft, but Apple and Samsung, as well as smaller players with a high profile — such as Fitbit — are poised to take the sector by storm.

Microsoft’s new entry is called Microsoft Health, a platform letting users store health and fitness data. The date in question is collected by a Microsoft Health app, available on Android, iOS and Windows Phone. The platform also gathers data generated from the Microsoft Band, a smart and designed to work with Microsoft’s new platform.

The idea behind pulling all of this data into a single platform is to integrate data from different devices and services in a smart way that allows consumers to generate insights into their health. The next step for Microsoft Health, execs say, is to connect all of that data in the platform to the tech giant’s HealthVault, a Web-based PHR, making it easier for people to share data with their healthcare providers.

Other tech giants are making their own wearables plays, of course. Google, for example, has released Google Fit, a fitness-based app designed to help users track physical activity. Google’s approach is  Android smart phones, relying on sensors built into the smart phones to detect if the user is walking, running or biking. Users can also connect to devices and apps like Noom Coach and Withings.

Apple, for its part, has launched HealthKit, its competing platform for collecting data from various health and fitness apps.  The data can then be accessed easily by Apple users through the company’s Health app (which comes installed on the iPhone 6.) HealthKit is designed to send data directly to hospital and doctor charts as well. It also plans to launch a smart watch early next year.

While there’s little doubt consumers are interested in the wearables themselves, it’s still not clear how enthusiastic they are about pulling all of their activity onto a single platform. Providers might be more excited about taming this gusher of data, which has proved pretty intimidating to doctors already overwhelmed with standard EMR information, but it remains to be seen whether they’ll find fitness information to be helpful.

All told, it looks like there will be a rollicking battle for the hearts and minds of wearables consumers, as well as the loyalty of providers.  As for me, I think it will be a year or two, at minimum, before we get a real sense of what consumers and providers really want from these devices.

The Other Talk: EHRs and Advance Medical Directives

Posted on September 11, 2014 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

The Other Talk: EHRs and Advance Medical Directives

Most of us who have adult children can remember that awkward talk we had about life’s origins. We thought, whew, that’s done. Alas, there’s yet another talk. This time it’s with those adult children and it’s about you.

This one’s covered in Tim Prosch’s and AARP’s book, The Other Talk. The talk, or more accurately the process is how you want to spend the rest of your life.

The Other Talk

It’s about your money, where and how you’ll live and your medical preferences. It’s just as hard, if not harder, than the old talk because:

  • It’s hard to admit that you won’t be around forever and your independence may start to ebb away.
  • You don’t want to put your kids on the spot with difficult decisions.
  • Your children may be parents coping with their own problems. You don’t want to add to their burdens.
  • You’ve been a source of strength, often financial as well as emotional. That’s hard to give up.

Prosch and AARP want to make it easier on everyone to deal with these issues.

He covers many topics, but for those of us who live in the EHR world one is of significant importance: Medical directives.

Prosch explains directives and simply says you should give them to your doctor. Easier said, etc. Today, that means not only your PCP, but also making sure that hospitalists etc., know what you want. While the Meaningful Use program helps a bit. It’s still going to take some doing.

Medical Directives and EHRs

EHR MU1 recognizes directives’ importance requiring that they be accounted for:

More than 50% of all unique patients 65 years old or older admitted to the eligible hospital’s or CAH’s inpatient department have an indication of an advance directive status recorded.

This means that the EHR has to have the directives. However, MU 1 only goes halfway to what’s needed. It’s what the EHR does with directives that’s unsaid.

If the EHR treats a directive as a miscellaneous document, odds are it won’t be known, let alone followed when needed. To be used effectively, an EHR needs a specific place for directives and they should be readily available. For example, PracticeFusion recently added an advance directives function. That’s not always the case.

Practice Fusion: Advanced Medical Directives

Googling for Directives

To see how about twenty popular EHRs treat directives, I did a Google site search, on the term directive. I got hits for a directives function only from four EHRs:

  • Athenahealthcare
  • Cerner
  • Meditech
  • PracticeFusion

All the others, Allscripts, Amazing Charts, eClinicalWorks, eMDs, McKesson, etc., were no shows. Some listed the MU1 requirement, but didn’t show any particular implementation.

Directives: More Honored in the Breech

This quick Google search shows that the EHR industry, with a few exceptions, doesn’t treat directives with the care they deserve. It should also serve as a personal warning.

If you already have directives or do have that talk with your family, you’ll need to give the directives to your PCP. However, you should also give your family copies and ask them to go over them with your caregivers.

Some day, EHRs may handle medical directives with care, but that day is still far off. Until then, a bit of old school is advisable.

Hospital M&A Cost Boosted Significantly By Health IT Integration

Posted on August 18, 2014 I Written By

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

Most of the time, hospital M&A is sold as an exercise in saving money by reducing overhead and leveraging shared strengths. But new data from PricewaterhouseCoopers suggests that IT integration costs can undercut that goal substantially. (It also makes one wonder how ACOs can afford to merge their health IT infrastructure well enough to share risk, but that’s a story for another day.)

In any event, the cost of integrating the IT systems of hospitals that merge can add up to 2% to the annual operating costs of the facilities during the integration period, according to PricewaterhouseCoopers. That figure, which comes to $70,000 to $100,000 per bed over three to five years, is enough to reduce or even completely negate benefits of doing some deals. And it clearly forces merging hospitals to think through their respective IT strategies far more thoroughly than they might anticipated.

As if that stat isn’t bad enough, other experts feel that PwC is understating the case. According to Dwayne Gunter, president of Parallon Technology Solutions — who spoke to Hospitals & Health Networks magazine — IT integration costs can be much higher than those predicted by PwC’s estimate. “I think 2% being very generous,” Gunter told the magazine, “For example, if the purchased hospital’s IT infrastructure is in bad shape, the expense of replacing it will raise costs significantly.”

Of course, hospitals have always struggled to integrate systems when they merge, but as PwC research notes, there’s a lot more integrate these days, including not only core clinical and business operating systems but also EMRs, population health management tools and data analytics. (Given be extremely shaky state of cybersecurity in hospitals these days, merging partners had best feel out each others’ security systems very thoroughly as well, which obviously adds additional expenses.) And what if the merging hospitals use different enterprise EMR systems? Do you rip and replace, integrate and pray, or do some mix of the above?

On top of all that, working hospital systems have to make sure they have enough IT staffers available, or can contract with enough, to do a good job of the integration process. Given that in many hospitals, IT leaders barely have enough staff members to get the minimum done, the merger partners are likely costly consultants if they want to finish the process for the next millennium.

My best guess is that many mergers have failed to take this massive expense into account. The aftermath has got to be pretty ugly.

I Want to Thank the Academy, Err, the Hospital CIO: EHR Hospital Market Share

Posted on July 7, 2014 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

We’re always interested in who’s up and who’s down. Whether it’s TV shows, Senate races, book sales or baseball stats, we want to know who’s up, who’s down and who’s going nowhere.

We’re big on trends, shares and who’s going where. The closer the race, the more avid the interest – My Nats would be sitting pretty if only the Braves weren’t so pesky. The EHR market place is no exception for interest, even if the numbers are a lot harder to follow than the National League East.

In my last foray into EMR market share, I looked at SK&A’s stats from their rolling survey of US medical practices.

Another company, Definitive Healthcare similarly tracks the hospital EHR marketplace. They’ve generously shared their findings with Healthcare Scene and I’ve used them here. Please note: Any errors, mistakes or other screw-ups with their numbers are mine alone. With that said, here’s what I’ve found.

How Many Divisions Does the Hospital Market Have?

Definitive divides the hospital market into several categories that can be daunting to follow. That’s not their making. It’s the nature of the market.

The major division that Definitive reports on is inpatient versus ambulatory systems. You might think that ambulatory systems are only for non hospital setting, but hospitals, of course, have many outpatients and use ambulatory EHR systems to serve them.

The Inpatient Marketplace

Among inpatient systems, EPIC leads with a 20 percent share shown in Tables I and II. The market is highly concentrated with EPIC, Cerner and Meditech commanding 54 percent. The remaining 46 percent scatters with no one breaking double digits.

Table I All Inpatient Hospitals EHR Vendor Market Shares

Table II All Inpatient EHR Shares

 The Ambulatory Hospital Marketplace

The picture for hospital ambulatory systems used is notably different. See Tables III and IV. While EPIC and Cerner vary slightly from their inpatient share, the other vendors shift all over the place. Allscripts barely registers 4 percent in inpatient, jumps to third place with 14 percent.

Siemens and HMS drop off the top ten being replaced by eClinicalWorks and NextGen. At 22 percent is the catchall, Other EHRs. This is up 8 percent from its inpatient 14 percent.

Table III All Ambulatory Hospitals

Table IV All Amb Hospitals

Inpatient EHRs: Health Systems and Independent Hospitals

Definitive also breaks down inpatient hospitals by health system hospitals v independents. Almost a majority of health systems, 47 percent, choose EPIC and Cerner. See Tables V and VI. Indeed, the top four vendors, EPIC, Cerner, Meditech and McKesson astoundingly have a 74 percent share. The other vendors are at 7 percent or less.

Table V Inpatient Healthcare Systems Hospitals

Independent hospitals differ a bit from this pattern. Non major vendors have 12 percent and open source Vista has 5 percent, but otherwise the pattern is similar.

Table VI Inpatient Independent Hospitals

Inpatient Hospitals by Size: Under and Over 100 Beds

Hospitals with 100 plus beds, no surprise, favor EPIC, Cerner and Meditech. These three have a monopolistic 64 percent. See Table VII.

Table VII Inpatient Hospitals with =>100 Beds

Small, Inpatient Hospital Systems: A More Competitive Market

Small hospitals are a different story. The top five vendors are bunched around 14 percent each. See Table VIII. The mix of vendors is starkly different. Meditech and Cerner lead with EPIC third. However, Epic drops nine percent from the prior group to 14 percent in this.

In the prior tables, the top three vendors have a market majority. In this group, 65 percent of the market belongs to the third through tenth vendors. You can see the difference in competition in Tables VIII and IX.

Table VIII Inpatient Hospitals =>100 Beds

Table IX Inpatient Hospitals <100 Beds

Hospital Ambulatory EHR Systems by Bed Size

The ambulatory market for hospitals with 100 plus beds is similar to the inpatient market. EPIC, Cerner and Allscripts have a 53 percent share.

The remaining share is split among several vendors, with eClinicalWorks, and athenahealth making an appearance. Significantly, Other EHRs ranked second.

Smaller hospitals’ ambulatory systems, as with smaller inpatient hospitals, show a competitive market. The category Other EHRs actually leads with a 21 percent share. Tables X and XI show the difference between these two markets.

Table X Ambulatory Systems =>100 Beds Table XI Ambulatory Systems <100 Beds

Market Shares: What’s the Conclusion?

In this and previous posts, I’ve looked at EHR vendor market shares sliced up in several ways. I’ve used what I consider reliable, independent data sources from SK&A and Definitive Healthcare. I used their information because they are careful to include all practices in their surveys not just those that bother to reply.

I also used them for the simple reason that they were freely available to us. There are other sources, such as KLAS, that produce market surveys, but they charge about $2,500 for their analysis. Moreover, they keep all but the most general findings behind their paywall.

What then is the message from all these numbers? It’s this: there is a competitive market, but it’s only robust among small practices. Those with three or less practioners have the most competitive market with eClinicalWorks in the lead. Within major segments, EPIC, Cerner and Meditech dominate. The non hospital market is more mixed, but EPIC, Cerner, etc., share increases as practice size grows.

For these larger practices, it’s monopolistic competition. If you’re looking for an EHR and you have ten or more docs, you can find any number of vendors. It’s most likely you’ll end up choosing among just a few big guys.

This reminds me of when we shopped for kitchen cabinets and counter tops. We were impressed with some dramatic possibilities. The sales rep, who we got to know well, laughed:

“When folks start out they focus on the avant garde. Then they realize they’re choosing for several years. Suddenly they get more conventional.”

If you come by our place, you’ll see our oak cabinets and white tile counter top. I think it goes that way with hospital execs choosing EHRs. They may toy with something different, but in the end, they’ll go with what they know. After all, no one every got fired for buying EPIC. Well, almost no one.

Next: Attribution and Market Share

If you still haven’t got your fill of market numbers, I have one more topic to explore. I’m interested in knowing how market share relates to MU attestations. That is, does a high market share guarantee a high attestation rate? The next post in this series will look at that.

If you have questions on market share, please post a comment or write me at:

HIE Cuts Back On Excess Imaging, But Savings Aren’t Huge

Posted on January 21, 2014 I Written By

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

For years now, we’ve been told that HIEs would save money and reduce redundant testing by hospitals and doctors.  Until recently, such has mostly been the stuff of anecdote rather than hard results.  But a new study comparing hospitals on an HIE with those that were not seems to offer some of the hard evidence we’ve been waiting for (though the cost savings it finds aren’t spectacular overall).

According to a piece in Healthcare IT News, a new study has come out which demonstrates a link between HIE participation and the level of imaging performed in hospital emergency departments.

The study, which was done by Mathematica Policy and the University of Michigan, found that when hospitals were joined in an HIE, the number of redundant CT scans, x-rays and ultrasounds fell meaningfully, generating savings in the millions of dollars.

To conduct the study, Mathematica and the U of Michigan compared the level of repeat CT scans, chest x-rays and ultrasounds for two groups.  One group consisted of 37 EDs connected to an HIE; the other group was 410 EDs not connected to an HIE.  Researchers collected data on the two groups, which were based in California and Florida, between 2007 and 2010, using the state emergency database and HIMSS Analytics listing of hospital HIE participation.

The researchers found that hospital EDs participating in an HIE reduced imaging across all the modalities compared with hospitals not participating in an HIE.  For example, EDs using an HIE worth 13 percent less likely to repeat chest x-rays, and 9 percent less likely to repeat ultrasounds.

Ultimately, the study concluded that if all of the hospital EDs in California in Florida were participating in HIEs, the two states could save about $3 million annually by avoiding repeat imaging.  This is just fine, but this translates to $3 million in lost revenue for those hospitals. Once you split up $3 million across that many hospitals, you don’t end up with an impressive amount per hospital, but it’s still a cut to revenues. A cut in revenue isn’t a strong motivator to implement an HIE even if it does help to lower healthcare costs.

This is why it’s a real challenge to get many hospitals on an HIE. When you throw in the technical issues involved in HIE membership, it could be quite some time before the majority of hospitals jump on board without more external incentives.

Why Secure Text Messaging Is So Much Better Than SMS

Posted on January 14, 2014 I Written By

John Lynn is the Founder of the 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 and 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 most popular articles of 2013 was titled “Texting is Not HIPAA Secure.” Certainly HIPAA compliance is good enough reason for every healthcare organization to implement a secure text messaging solution in their office. Considering the number of organizations I hear are recklessly sending PHI over SMS, I expect this is going to come back and really hit some organization where it hurts. Plus, you won’t be able to hide since the carriers often save the SMS messages for easy discovery by a legal team (which is another reason why SMS isn’t HIPAA compliant). It might take a major HIPAA violation for the industry to wake up.

HIPAA violation issues aside, there are so many other reasons why a healthcare organization should consider using a secure text messaging solution as opposed to insecure SMS as many do today.

As most of you know, I’m adviser to secure messaging company, docBeat (Full Disclosure). As I’ve worked with docBeat, I’ve been amazed at how much more a secure messaging platform can do beyond the simple messaging that you get with SMS. All of these features make a secure messaging option not just a way to avoid a HIPAA violation, but also a better option than default SMS.

Here’s a look at some of the ways a secure messaging solution like docBeat is better than SMS:

Message Delivered/Read Status – I think this is one of the most underrated features of a secure message solution. With an SMS message you have no idea what’s happening with the message. You have no idea if the message has even been delivered to the recipient, let alone read. We’ve all had times where we receive a SMS message well after it was sent. In the case of docBeat, they have a status indication on each message so you know if the message has been delivered to the recipient and if it’s been read. A simple, but powerful feature.

Secure Text to Groups – While SMS is great for sending a message to one individual, it fails when you want to include an entire group in a conversation. The concept of group messaging is really powerful in so many areas of healthcare. Much like the reply to all in email, you have to be careful not to abuse a group text message, but it’s easier to manage since they’re usually short messages that are easily consumed. In docBeat, they offer this group text messaging to a predefined group of users or to an adhoc group that you create on the fly. I especially like this feature when you need help from any one of many doctors, but you’re not sure which is available to help.

Controlled Message Storage – While this has HIPAA implications, the ability to control and audit the messages that are sent is really valuable for an organization. In the wild world of SMS you have no idea what the carrier is doing with those messages. Once they’re on the phone, there’s not an easy way to wipe them off if something happens to the device. With a secure message solution you can control and audit the secure messages. This might include knowing how many messages are sent, how quickly the messages were read, where the messages are stored, etc.

Mobile and Web – In a healthcare organization there are often a lot of people you want to message who don’t have a mobile phone issued by the organization. This often means those people start using their personal device to SMS providers (not a good thing) or they just can’t participate in the messaging. docBeat runs on the iPhone, Android and the web. In most cases, the web option is a perfect way for the non mobile staff to participate in the messaging. Try making that a reality with SMS.

Quick Messages for Common Responses – While many people have gotten very fast at typing on their cell phone, it still takes some time. One way to streamline this is to use quick canned messages for responses you give all the time. It’s much easier to one click a message like “I’m on my way. Be there in a minute.” than to try and type that message into the phone.

Scheduled Messages – Considering the 24/7 nature of healthcare, there are often times when someone is working late at night, but the message doesn’t need to be read until the next morning. Scheduled messages are a perfect solution for this problem. You can create and schedule the message to get sent at a reasonable time rather than waking the doctor up needlessly.

Secure Attachments – While MMS mostly works, I’ve seen where some telcom providers don’t support attachments using MMS. Unfortunately, the telcom provider doesn’t tell you this and so you have no way of knowing that the attachment you sent never made it to the recipient. Plus, MMS works best for pictures. It doesn’t support the wide variety of document formats that a secure messaging provider can support.

Ability to Send Location with Text – While you have to be careful with this feature, it can be a really nice added value to your organization to know their location. Are they sending you a message at your hospital or at their kids soccer game? Knowing this little piece of information can change your workflow so the patient gets better care.

Message Expiration – We could call this feature the snapchat feature. As we saw with the popularity of snapchat, there are times when you may want a message to only live for a certain duration. As is the case with most data retention policies in healthcare, some organizations love this feature and some hate it. Of course, each institution can choose how they want to use this type of feature. In the SMS world, you don’t have a choice. You’re at the mercy of the telcom providers decisions.

Automatic Message Routing to On Call Individual – One of the great features of docBeat is the ability to identify the On Call individual in a group. This was originally applied to docBeat’s call forwarding functionality, but they recently applied it to their secure messaging as well. Now you can message a provider and if they’re not around it can be auto routed to the on call provider. A powerful concept that wasn’t possible before.

One Messaging Platform – This is going to take a while to see fully fleshed out, but those in healthcare are starting to get messages from a variety of sources: SMS, phone, EHR, HIE, Patient Portal, medical devices, etc. As it stands today, those messages have to be checked and responded to in a number of different ways and locations. Over time, I believe each of these messages will be integrated into one messaging platform. The beauty of a secure messaging platform like docBeat is that it can handle any type of message you throw at it. We’re not far off from the day where a doctor can check her docBeat message list and see messages from all of the sources above. The idea of a unified messaging platform is really beautiful and can’t come soon enough.

I’m sure I’m leaving off other examples that I hope you’ll share in the comments. As I look through this list of secure text messaging benefits over SMS, I think we’re at the point where many will choose a secure messaging solution in healthcare because of the added features and not just to try and avoid a HIPAA violation.

Scanners – The Forgotten Device Series

Posted on November 20, 2013 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Far too often in healthcare IT we get so caught up talking about the big projects, big software systems, and huge hardware buys that we forget about many of the little guys that make so much difference in our lives. This isn’t always a bad thing. When $36 billion in government money is available, we should talk about EHR. Although, there are a bunch of little things that can impact an organization as much as the large projects.

In this series of posts, I want to look at the Forgotten Devices that can make or break a user’s healthcare IT experience but we sometimes forget about them. In most cases, these devices are used multiple times a day and can have a significant impact on the happiness of your healthcare organization. In some cases, these devices are hidden from view, but facilitate all of the work done in healthcare.

To start this series off, we’re going to look at: SCANNERS.
Scanners unfortunately seem to be an afterthought in most healthcare organizations. For some reason we have the false perception that once we move to EHR, we’ll be paperless and so the idea of needing a scanner is somewhat foreign. I know in my first EHR implementation I went cheap on the scanners as I underestimated the volume of scanning that would be required post-EHR implementation. I quickly learned post EHR implementation that I better rethink my scanner strategy.

The reality is that paper still plays a key role in every healthcare organization. It’s really romantic to think of the paperless healthcare environment. However, in many respects EHR software are great at printing out reams of paper. Not to mention paper signatures are still required in many environments. Plus, there are waves of paper coming in from outside your healthcare organization which has to be incorporated into your IT systems. A well implemented scanner strategy is the cornerstone to converting this paper into your IT systems.

The great part is that scanner technology has come a long way as well and comes in a variety of options. You can buy a scanner like the Canon DR-M160 all the way up to the Canon ScanFront 300P network scanner. All of these can handle the heavy workload that’s required in healthcare at a much more reasonable cost than we have ever had before.

Outside of the daily scanning needs, many organizations also have to apply a scanner workflow to their old paper charts. I won’t dig into all of the various approaches organizations take to scanning old paper charts since we’ve done so many times previously. However, many organizations still opt to scan the old paper charts in house. In fact, many still take a scan as you go approach to incorporating old paper records into their EHR. The same scanner you use to capture the daily paper inflow can also be used for this scan as you go approach. Certainly there are even higher volume scanners that can be used for scanning a whole chart room, but those really aren’t necessary for most healthcare organizations.

The other issue many people forget with scanners is doing regular scanner maintenance. This is not a hard task to do, but it will really impact the scanners effectiveness if you don’t do it regularly. There’s nothing more frustrating for an end user than putting the paper in the scanner and having it jam. You can imagine the frustration a busy nurse experiences when she tries to scan something and runs into a jam in the scanner. With proper maintenance, this issue can be generally avoided.

Another major challenge with scanning is handling the document workflow. Most EHR systems support the standard TWAIN driver that comes with most scanners today. This makes it really simple to scan directly into the patient chart. Otherwise, you can build really advanced workflows that are deeply integrated into the scanner software itself. In healthcare, the former is much more common than the later. However, it will be interesting to see how smart scanners continue to improve the scanning workflow.

As with most technology, you don’t need to focus on scanning every day, but it’s important to regularly consider your approach to scanning and whether it enhances or detracts from your workflow. Scanning will be an important part of every healthcare organization for the foreseeable future. If you don’t keep up with the latest scanning technology and regular scanning maintenance, it can have a negative impact on your end users’ experience. Nothing’s worse than hearing about a bad user experience that could have been avoided.

Sponsored by Canon U.S.A., Inc.  Canon’s extensive scanner product line enables businesses worldwide to capture, store and distribute information.

21 Tips to Help Advance Female HIM Leadership

Posted on November 8, 2013 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

As I mentioned in last week’s post, I had the opportunity to attend several sessions at the AHIMA conference on leadership. These sessions focused on the role of female leaders in the HIM industry, and, more importantly, the need to bolster this demographic up from its currently low numbers.

In her session, “Breaking the Glass Ceiling: Are You Up for the Challenge?” Merida Johns, Principal/Owner at The Monarch Center for Women’s Leadership Development, threw out some interesting statistics:

  • 50% of today’s workforce is female
  • 73% of hospital managers are female
  • 18% of hospital CEOs are female
  • 4% of healthcare vendor CEOs are female
  • 25% of senior healthcare IT positions are held by women
  • 79% of female executives think more female executives are needed in the workforce; but only 42% of men feel the same way
  • 92% of AHIMA members are female; yet only 6% hold an executive position

Johns suggested that in order to raise the bar (or break the glass ceiling) to propel more women into HIM leadership positions, we need to:

Develop Career Clarity

  • identify strengths,
  • develop a personal vision,
  • know your purpose and
  • know what you want

Raise Career Ambitions

  • develop big goals,
  • categorize the goals,
  • break the goals into doable chunks,
  • be specific about when you’ll achieve goals, and
  • develop a vision board

Raise Confidence

  • start success and gratitude journals,
  • sideline the inner critic, and
  • be in the right place at the right time

Promote Yourself

  • accept compliments,
  • use social media effectively,
  • display awards,
  • hone your elevator speech and use it, and
  • develop your brand

Amass Social Capital

  • get a mentor and a sponsor;
  • volunteer, connect and promote;
  • use social media; and
  • provide benefits to others

Being that I’m an avid tweeter at events (and a fan of educating and empowering women in healthcare IT), I threw out several snippets of the sessions I was in, which resulted in an interesting dialogue between myself and several other folks:









How have you taken the lead and advanced to the next level? Whether you’re in HIT, HIM or HC, how did you position yourself to reach that next career phase? Please share your experiences and advice in the comments below.

Will Experience Prompt HHS to Delay ICD-10?

Posted on November 4, 2013 I Written By

John Lynn is the Founder of the 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 and 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 don’t think it will be news to anyone reading this that HHS is getting hammered for their implementation of Sebelius congressional testimony was brutal. Certainly the botched implementation of will have long lasting impacts on all future HHS IT projects.

While not purely an IT project, I wonder if the experience of will have an impact on the ICD-10 implementation. Will HHS be gun shy after the debacle that they’ll delay ICD-10 to avoid another one?

My gut reaction is that I don’t think this will happen, but it’s worthy of consideration.

On October 1, 2014, HHS’s IT isn’t ready to accept ICD-10, then you can read the headline already: “HHS Botches Another IT Project.” For those of us that work in healthcare IT, we know that ICD-10 has deep IT implications. Not the least of which will be CMS being ready to accept the ICD-10 codes. While you’d think this is a simple change, I assure you that it is not. Plus, if CMS isn’t ready for this, a lot of angry doctors and hospitals will emerge. It will be a major cash flow issue for them.

We still have almost a year for HHS to get this right. Plus, HHS has had years to plan for this change so they shouldn’t have any IT challenges. Although, if they do have IT challenges this extended time frame will damage them even more. The article will say they had plenty of time and they still couldn’t implement it properly.

With the comparison, there are also plenty of reasons why ICD-10 is very different than In many ways, ICD-10 is a project implemented by companies outside of HHS as opposed to a project run by HHS. First, I think it’s unlikely that HHS won’t have their side ready for ICD-10. Second, their part of ICD-10 is very little compared to what has to be done by outside payers, hospitals, and doctors offices.

If ICD-10 has issues it will likely be seen as the payers or healthcare organizations not being ready as opposed to HHS. That’s not to say that HHS won’t have some damage if they force an ICD-10 mandate and people aren’t ready. They could have some collateral damage from it, but not the same as where the product is really their own product.

Plus, if ICD-10 goes bad, consumers/patients won’t know much difference. No patient cares if you code their visit in ICD-9 or ICD-10. They’ll still get the exact same care when they’re visiting the doctor. If ICD-10 goes bad, it will be doctors and hospitals that suffer. That’s a very different situation than which was to be used by millions of Americans.

I hope that HHS doesn’t delay ICD-10 based on their experience with If HHS becomes gun shy about any project that IT touches, nothing will ever get done. That’s a terrible way for an organization to function.