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Epic’s Reputation, Datapalooza, and Interoperability — #HITsm Chat Highlights

Topic One: Do you honestly believe, when the clock runs out, CMS will dock non-#MeaningfulUse docs’ reimbursement? Why/Why not?

 

Topic Two: Explain in technical terms why Epic has such a bad reputation for interoperability.

What’s the data roadblock? How to fix? #HITsm — CapSite (@CapSite) June 14, 2013

 

 

 

Topic Three: In your opinion: Coolest thing coming out of D.C. last week with Datapalooza and the other health IT conferences/meetings?

Topic Four: Congress blaming EHRs & #MeaningfulUse for “upcoding” is like blaming screwdrivers for burglaries. Agree/Disagree/Your take?


Topic Five: Will ICD-10 be a non-problem we blew out of proportion like Y2K, or will it be a pretty rough transition? Explain.

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June 15, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Filed Under: EHR  Electronic Health Record  Electronic Medical Record  EMR  Healthcare  Healthcare IT  Meaningful Use  mHealth
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Hospital Mergers Complicate EMR Transition

Getting an EMR up and running in a hospital or health system is complicated enough. But managing EMR implementations in the midst of hospital mergers is even more difficult.

Like it or not, though, hospital CIOs are increasingly facing the likelihood that they’ll be facing a merger in the midst of their EMR rollout, notes a new piece in the Wall Street Journal. With reimbursements from both Medicare and private insurers falling, hospitals’ margins are growing perilously thin, and the pace of hospital mergers is likely to increase, according to a March report by Moody’s.

Right now, for example, two of New York’s biggest hospital chains — NYU Langone Medical Center and Continuum Health Partners — have agreed to discuss a possible merger. Continuum CIO Mark Moroses is in the process of moving his chain of hospitals to its GE Centricity EMR, in a move which will allow the chain to collect $20 million to $30 million in Meaningful Use incentives.

If the merger between Langone and Continuum goes through, Moroses will have to stitch together dozens of billing,  procurement and patient care systems over the next few years, the WSJ notes. But more than that, the hospital chains will have to synchronize their clinical information management, a formidable job which, as Moroses says, leaves no room for error.

It’s not just systems integration that merging systems will face, however. As the WSJ piece notes, when North Shore-Long Island Jewish Health System took over Lenox Hill Hospital in 2010, the systems’s CMIO Michael Oppenheim had to bring Lenox Hill’s data to a new version of its Allscripts EMR.  The system used currently by Lenox Hill is an old one which isn’t certified for Meaningful Use.

Ultimately, hospitals’ urge to merge makes sense on a lot of levels. Given their tremendous capital costs (including EMR spending) it only makes sense to achieve economies of scale.  Unfortunately, the commonsense desire to save money and be more efficient is going to subject HIT leaders to an even rougher ride then they might have expected.

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June 14, 2013 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 FierceHealthcare.com 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.

Filed Under: Certified EHR  EHR  Electronic Health Record  Electronic Medical Record  EMR  Healthcare  Healthcare IT  Hospitals  Meaningful Use
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Replacement EHR Trend


I’m a huge numbers guy even if numbers can lie if you’re not careful. However, what I love most is the change in numbers which often can tell an important story of trends. One trend we knew was coming is the replacement EHR trend, so I was quite interested when I saw the tweet above that said that 31% of EHR buyers are purchasing a replacement EHR. That’s a huge number and up from the previous 10% replacement EHRs in 2010.

The report linked above also has a number of other interesting EHR numbers. 30% of respondents reported that their practice would replace their current practice management or EHR solution if their current vendor was purchased by another vendor. Considering we’re about to enter an unprecedented stage of EHR consolidation, this should be quite unsettling to any company looking to acquire an EHR vendor.

I was also fascinated to see that 60 percent of hospital-owned groups reported purchasing their current practice management solution before 2006. Is the age of some of these systems going to lead to many of them being replaced? You’d think that 7 years isn’t that long for a system, but in the tech world it’s not young either. With that said, I wonder what EHR or PM systems have been created in the past 3-5 years. I can’t think of many. If we use meaningful use as a point of demarcation, I can’t think of any EHR or PMs that came after meaningful use. I wonder if we’ll see this change.

One thing I’m certain of is that we’re going to get really good at replacing EHR software. Hopefully EHR vendors will embrace the liquidity of data for those who choose to switch EHR, but I’m not too hopeful on this.

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June 10, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Filed Under: EHR  Electronic Health Record  Electronic Medical Record  EMR  Healthcare IT  Healthcare IT Market  Meaningful Use
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Three Tips For EHR Transitions

Moving a medical practice from paper to an EHR is no picnic.  Staff and physicians both may find the process difficult, and the changes they have to make to be threatening. But there are approaches you can take which can make the process easier.  Here’s a nice triad of suggestions from EHR implementation manager Amanda Guerrero:

* Make workflow changes gradual:

Too often, medical practices assume that they can implement an EHR without making major changes to their workflow.  The reality is, however, that many processes which worked fine on paper don’t work when you switch to using EHRs, Guerrero notes. So how do you go about making changes without upsetting and confusing staff and clinicians?  The idea, she says, is to make sure changes happen gradually. Giving people time to adapt to changes helps a lot with staff morale. (It doesn’t hurt to explain how the changes will benefit both staff and patients, either.)

* Ask for feedback:

Bearing in mind that changes to workflow will have to be made, how do you choose which changes come first? One way, Guerrero says, is to ask the people who are using the EHR which processes are slowing things down the most.  Be sure, she recommends, to include doctors, nurses, front desk and even billing staff in collecting feedback — after all, virtually any part of the practice can be affected by the EHR.  Once you’ve figured out which areas are the most troublesome, arrange them in order of importance so you can take them on in the most effective manner.

* Educate patients:

Now that Meaningful Use has pushed practices into making patient health data available to them, it’s time to encourage them to use it. That being said, patients may be overwhelmed by the amount of data being presented, especially when interpreting lab results, Guerrero suggests.  To reduce the impact of this change on patients, and avoid confusion, make sure you help them understand what they’re looking at and how it can help them improve their healthy, she says. And make sure let patients know you’re available to help answer questions.

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May 20, 2013 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 FierceHealthcare.com 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.

Filed Under: EHR  Electronic Health Record  Electronic Medical Record  EMR  Healthcare  Healthcare IT  Meaningful Use  PHR
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CHIME Seeks Year-Long Meaningful Use Stage 2 Extension

Recently, six senators wrote a letter to HHS Secretary Kathleen Sebelius criticizing the Meaningful  Use program.  The letter, which came with a white paper listing their concerns about federal health IT policy, questioned whether the $35 billion allocated to Meaningful Use was being spent effectively, especially given the fact that provider interoperability is still minimal.

This week, the College of Healthcare Information Management Executives (CHIME) sent a letter to the six senators responding to their concerns, one which largely defends Meaningful Use though advocating for a one year extension of Stage 2.

In the letter, CHIME leaders concede that that there is some reason to be concerned with the current state of interoperability. However, they note, “we strongly believe that EHR incentive payments under the policy of Meaningful Use have been essential in moving the nation’s healthcare system into the 21st Century.”  The incentive payments providers are receiving are critical to the business plans and interoperability solutions they’re developing, CHIME says.

And while we may not have interoperable EMRs in place just yet, the MU program has helped make progress in that direction, they say. “The work accomplished through Meaningful Use to reach consensus on transport, vocabulary and content standards is foundational to advancing interoperability and exchange,” the letter argues.

All that being said, it would be a good idea to extend Stage 2 of Meaningful Use for another year before moving ahead with Stage 3, CHIME contends:

A year extension of Stage 2 will give providers the opportunity to optimize their EHR technology and achieve the benefits of Stage 1 and Stage 2; it will give vendors the time needed to prepare, develop and deliver needed technology to correspond with Stage 3; and it will give policymakers time to assess and evaluate programmatic trends needed to craft thoughtful Stage 3 rules.

Personally, I hope that HHS agrees to CHIME’s request and moves Stage 2 up a year. After all, the existing timelines aren’t holy writ, and if changing the deadline allows providers and vendors to consolidate their gains significantly, it’s probably worth the wait.

John’s working on an interview with CHIME to discuss their letter. Watch for that over on Hospital EMR and EHR.

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May 8, 2013 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 FierceHealthcare.com 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.

Filed Under: Electronic Health Record  Electronic Medical Record  EMR  EMR Adoption  Healthcare  Healthcare IT  Meaningful Use
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CMS Plans To Audit 5 Percent of Meaningful Use Participants

Are you ready to be reviewed?  Well, get prepared. As part of its ongoing program of supervision, CMS plans to audit 5 percent of participants in the Meaningful Use program for compliance, according to Modern Healthcare.

Since January, CMS has been auditing program participants that have already received their money, as well as those who have applied to receive incentive payments.  Going forward, the two groups will receive about the same level of attention, with a total of 5 percent of program participants ending up getting closer scrutiny from the feds, MH reports.

To date, there haven’t been many adverse findings by CMS, though the agency has discovered a few questionable situations, Robert Anthony, deputy director of the HIT Initiatives Group at CMS, told the magazine. But a few providers are already beginning the appeal process, and several providers may face fraud enforcement investigations, he said.

The bulk of the Meaningful Use reviews will be what the agency dubs “desk audits,” done by the CMS audit contractor Figliozzi and Co., in which information is exchanged electronically. However, a few on-site audits may be conducted as well, Anthony told Modern Healthcare.

To date, among the most common problems CMS has learned about has been provider failures to meet the requirement that they complete a data security risk assessment, a step also required by HIPAA.  When the auditors find that a provider hasn’t done the required data security risk assessment, they could be referred to the HHS Office of Civil Rights for a HIPAA compliance investigation.

Another issue which has turned up frequently has been a lack of adequate documentation that providers have answered some of the “yes or no” questions which are part of Meaningful Use criteria, such as whether their EMR has been tested for clinical data exchange. In that case, providers must be able to document what happened whether or not the test was successful.

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April 29, 2013 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 FierceHealthcare.com 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.

Filed Under: ARRA  EHR  Electronic Health Record  Electronic Medical Record  EMR  Healthcare  Healthcare IT  HIPAA  Meaningful Use
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User Experience is Hot HIT Topic with Good Reason

User experience in the world of healthcare IT has never been a hotter topic. It seems not a day goes by that I don’t come across an article, blog, tweet, or outright rant regarding the state of user friendliness, especially with regard to EMRs. (Who can forget the American Medical Association’s note earlier this year to Farzad Mostashari, peppered with complaints about physician usability of EMRs?) I see plenty of negative coverage around the topic – plenty of folks like to have a soapbox to stand on, after all.

I don’t, however, see enough coverage devoted to businesses and providers working to make the backlash better. Surely there are unsung heroes out there in the world of HIT UX that are at their drawing boards right now, attempting to take the sting out of those extra clicks, and listening with bated breath to providers’ complaints and praises.

I came across one such story in New Orleans a few months ago, where, like many of you, I tried to successfully drink from the fire hose (bottled water, actually) that was HIMSS13. I was able to sate my thirst for good UX news at the PointClear Innovation Awards breakfast, which honored a select group of the company’s clients for their work in the realm of user experience.

McKesson took home top honors this year, and while I had some knowledge of their work in the area, I didn’t realize how great of an emphasis they have placed on making sure their healthcare IT solutions are used in the most optimal way for the best possible patient outcomes.

“The big dynamic we are trying to tackle is around critical decision makers,” explains Bobby Middleton, Executive Director, Enterprise Intelligence Product Management at McKesson. “Through experience with our customers and continued research, it is becoming very obvious that our healthcare leaders are often put in a position to make critical decisions without pertinent, relevant and timely information.

“Our Enterprise Intelligence solutions are all geared around providing the right information to the right person at the right time,” he adds. “Our User Experience research is being used to make sure the targeted offering we are delivering via these solutions help a specific set of critical decision makers make the right decision. It is going great so far, and really allowing our technology teams to connect with their end consumers.”

I wonder if we’ll start to see more positive publicity of efforts like McKesson’s, especially as Stage 2 draws closer, more and more providers consider switching to more mature EMRs, and next year’s predicted influx of the newly insured start to clamor for greater digital engagement options and price transparency. One less click or toggle may just make all the difference when it comes to quality patient care.

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April 18, 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 its three key properties – Billian’s HealthDATA, Porter Research and HITR.com. She is a regular contributor to a number of healthcare blogs, and currently manages the Technology Association of Georgia Health Society’s social media channels. You can find her on Twitter @SmyrnaGirl.

Filed Under: EMR  Healthcare  Healthcare IT  Meaningful Use
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Meaningful Use Attestations With Faked Vendor Info?

When providers attest to Meaningful Use Stage 1 compliance, they have to identify the vendor whose EMR they used. But what if a large number of providers were faking this step in an effort to get incentive money that they don’t deserve?  That would be a lot of fraud, no?

Well, according to one vendor CEO, this could be happening on a large scale. Mike Jenkins, CEO of cloud-based vendor BuildYourEMR.com, reports that after going over CMS data on Meaningful Use, he found that a whopping 74 percent of providers who attested to using his company’s technology were not his customers.

Jenkins points out that if fraud were actually this common, a full $5.4 billion of the $7.6 billion paid out to providers would have been paid out in error. He admits that there could be something wrong with the CMS data, or that providers selected his company’s product name by accident, but concedes that it’s possible attestation fraud is more common than we think.

I’m not telling you this to suggest that the Meaningful Use program is riddled with fraudulent activity.  I’m doubful, in fact, that even a fraction of providers would dare incur the wrath of Medicare by making such a traceable error, much less consciously try to rip the incentive program off.

This does suggest, however, that more healthcare IT people should take a look at the CMS data and go over it themselves, especially EMR vendors. While there may not be a hailstorm of fraud going on, something may be seriously amiss in how CMS collects data or how providers report on their attestation.  It’d definitely be good to get ahead of any pending troubles with CMS, for sure.

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April 17, 2013 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 FierceHealthcare.com 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.

Filed Under: Certified EHR  EHR  Electronic Health Record  Electronic Medical Record  EMR  Healthcare  Healthcare IT  Meaningful Use
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Ignore Patient Engagement (and Consumer Reviews) at Your Own Peril

I know several readers of this blog (if not dozens) don’t pay much attention to the world of consumer healthcare reviews. Some seem to think they are populated only by the disgruntled few, and don’t paint a fair picture of providers’ true abilities. Some are of the opinion that too few patients utilize physician review sites (positively or negatively), and don’t present a large enough sample size for reviews to be meaningful. But, like social networks, those that read them are often far greater than those that actively contribute to them, as a recent study by PricewaterhouseCoopers points out.

“Scoring Healthcare: Navigating customer experience ratings” points that though only 24 percent of those surveyed have left online reviews, 48 percent have read them. The report also points out that, “Among those who have read healthcare reviews, 68 percent said they have used the information to select a doctor, hospital and to a lesser extent, a health plan, pharmacy and drug or medical device.”

PwC’s U.S. Health Industries Leader Kelly Barnes sums up my biggest takeaway nicely: “As consumerism in healthcare gains steam, customer feedback has become a determining factor in the success of health organizations. Ratings connect consumers’ experience to quality, and quality connects to financial performance, market share and reputation.”

Say what you will about sites like Healthgrades, Yelp, Consumer Reports or Facebook, they are becoming powerful consumer engagement tools, and giving them short shrift will not win providers any points in the countdown to Stage 2 of Meaningful Use. (October 1 is just over 170 days away, in case you were wondering.)

It’s interesting to note in light of the PwC report that the new Patient Engagement Index from Axial Exchange bases 25 percent of a hospital’s score on its social engagement, which includes its ratings on consumer review sites.

What I’d like to know from providers is:

  •  Are you starting to pay more attention to consumer reviews?
  • If so, how are they affecting your overall patient engagement strategy?
  • If not, why? What other baskets are you placing your patient engagement eggs in?

Please share your thoughts in the comments section below.

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April 12, 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 its three key properties – Billian’s HealthDATA, Porter Research and HITR.com. She is a regular contributor to a number of healthcare blogs, and currently manages the Technology Association of Georgia Health Society’s social media channels. You can find her on Twitter @SmyrnaGirl.

Filed Under: EMR  Healthcare  Healthcare IT  Meaningful Use
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Meaningful Use Audit Costs, Email and HIPAA, and OpenEMR


Reports like this one and others are what scare many organizations when it comes to meaningful use. Reminds me of the post I did about EHR penalties after Meaningful Use failure. These crazy meaningful use audit experiences should scare many people. If you’ve attested to meaningful use you should read the article above to learn more about the MU audit process. I expect many aren’t ready. The article does make the auditors sound like they don’t know what they’re doing. That’s the worst thing in an audit.


I assume that 9/23 is a HIPAA Omnibus date. I bet there’s a lot of PHI going over email right now that shouldn’t be. It could be a big issue if the institution hasn’t gotten it under control.


I love open source, so I’m always glad to hear about good progress from the open source EMR community. OpenEMR has long been a leader in that area when it comes to ambulatory EMR.

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April 7, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Filed Under: ARRA  EHR  Electronic Health Record  Electronic Medical Record  EMR  Healthcare IT  Meaningful Use
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