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An Example Where an EHR Overcharges Healthcare

Posted on September 5, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In response to my post “Study Says Overcharging by the Hospital Might Be Overstated“, Patrick Duffy from PDA Consulting offered these added insights into the “overcharging” that exists in healthcare.

Some are overcharging thanks to EMR upgrade coding errors. How about $720 for ONE nitro tablet. Insurance company did not catch it either. About 9 months after an EPIC implementation so how many people/Insurance were overcharged and never knew?

In the meantime a gastric band operation in the UK is $7500 average. In the US it is between $15k and $30k depending on State. Is that not overcharging?

I’d never heard of an EHR software doing this, but it’s not surprising at all. In fact, it’s probably not even happening because an organization is trying to be dishonest. When you look at the complexity of an EHR implementation, it’s not surprising at all that things like this happen.

It’s also not surprising that the insurance company hasn’t caught it…yet. Notice how I added in the yet there. We’ll see if this comes back to bite healthcare organizations. Insurance companies do get behind on a lot of things, but they do go back and plug holes and then it hurts.

There are so many issues with the way we reimburse healthcare, that I’m honestly not sure where to start in order to fix it. It’s a complex web of overhead.

In the tech world, a software program has technical debt (also known as design debt or code debt). We see it happen across the EHR and health IT software world. Over time, you accrue a debt of issues in your software that make it easier to scrape the old software that’s encumbered by technical debt and rewrite it from scratch so that you can do it the right way.

When I look at the healthcare reimbursement system it’s got a very similar problem. There’s a healthcare reimbursement design debt that’s grown so large that there are no easy fixes to the system. I guess that’s why I asked the question, “Is Healthcare So Complex That It Can’t Be Fixed with the Existing Parts?

Why Electronic Attachments Matter in Healthcare

Posted on September 4, 2014 I Written By

The following is a guest blog post by Lindy Benton, CEO of MEA|NEA.
Lindy Benton
Receiving and responding to medical record requests continues to be one of the primary contributors to lengthy claims processing delays and denials for providers. Health plans request supporting documentation, which can delay processing the pre- and post-payment review up to 45 days, on average. Technology, however, is allowing hospitals and practices the ability to efficiently and securely capture, transmit and store electronic health record information and supporting clinical data to reduce denials and reviews by payers.

Are these solutions really important for payers and providers? At present, it does not seem top of mind for payers even with CMS’ push to (finally) move toward electronic exchange of data between providers being audited by Medicare claims auditors, for example, doesn’t mean the industry – from the payer’s perspective – is moving with gazelle intensity toward the capability of doing so. The reasons are many, and understandable, of course.

Payers have bigger priorities right now with ACA, ICD-10 and other highly complex processes that require their attention. The attachment system that’s currently being used by many payers (manual delivery) works, and the thinking that “if it ain’t broke, don’t fix it” moving attachments to an electronic environment at this point may just not be important enough to these organizations to supersede everything going on at present.

But when it comes time for providers to get paid, the use of simple electronic image files can securely change the way providers get paid and grow their businesses. There are more than a billion ambulatory care visits a year producing claims in which 13 percent of those requiring attachments to support them. Each attachment averages more than three pages that the payer must review before being able to adjudicate the claim and pay the provider, according to a 2010 National Ambulatory Medical Care Survey.

For example, the annual claim denial rate in 2013 was 2.17 percent, meaning more than 70 million attachment pages were required by payers annually. Hospitals, ambulatory care centers, surgery centers, home health agencies and long-term care facilities simply experience significant improvements in their revenue cycles by using electronic attachments for their medical documentation exchange and claim processing time can be greatly reduced – in some cases by as much 60 percent.

So, why do electronic attachments matter in healthcare? Electronic document management improves processes by enabling hospitals and practices to securely capture, transmit and store supporting documentation for medical review. They are secure and HIPAA-compliant for document transfer, require minimal time and training to implement and essentially offer integrated services with some hospital information systems.

The value proposition is simple for health systems, including increased productivity (less phone time spent tracking status of mailed or faxed claims); fewer denials; faster payment; detailed tracking reports; records of every employee who viewed the attachment; and real-time follow-up on claims with attachments.

The solutions allow providers the ability to transmit both solicited and unsolicited documents via an information exchange to all participating health plans. The claim attachments are then able to be viewed and acted upon in a timely manner. According to the American Medical Association, automating the claims process can cut costs, helping organizations save thousands a year while relieving staff members of some of their most tedious and time-consuming tasks. Additionally, automating the claims submission process can:

  • Minimize claim rejections and resubmissions
  • Deliver claims to health insurers in real time
  • Expedite payer responses and boost cash flow
  • Free up time for other revenue-enhancing tasks
  • Reduce claims submission costs

An evidence of savings realized can be seen as published by Milliman from 2006. For example, the cost to submit manual claims is $6.63 x 6,200 (6,200 is based on an average of claims submitted for a single physician) equals $41,106 per year. Compare that to the cost to submit electronic claims, which is $2.90 per claim x 6,200 = $17,980. Thus, the average annual savings per physician from automating claims submission: ≈$23,126.

However, even with a cost-savings of more than $23,000, practices saving money may not be the most important factor of the solutions. Security and safe transfer of the information to payers is the priority of all practices, and is possible. Also, the money saved may not mean as much as the efficiencies created or the comfort and reliability of being able to track, monitor and follow claims and attachments throughout the adjudication process.

Additionally, the solutions create a sense of interoperability, a concept much hyped but often difficult to achieve and often lagging in other areas of the hospital or practice. With electronic attachment solutions, information can easily be transferred across multiple systems securely and efficiently, with little effort and implementation time.

HIPAA-compliant data transfer

Even with these benefits, often overlooked is that the technology exists for HIPAA-compliant transfer of electronic data, allowing for information exchange between providers, payers and clearinghouses. Even with the oft discussed lack of exchange capabilities with current solutions, such as between competing electronic health record systems, hospitals and health systems can simply deposit required information into a secure electronic envelope to support the clinical coding on a claim, which can then be easily transmitted to a payer. Though not an exchange of data in the “traditional” sense – between electronic health record and electronic health record, for example – it is possible for hospitals to use their technology and systems to communicate with outside parties, such as payers (including CMS for Medicare/Medicaid,) clearinghouses, and other practices.

In relation to electronic attachments, with a few simple keystrokes, providers can simply upload or capture requested documents whereby a unique tracking number is then assigned to the claim, and it gets transmitted securely to the payer. Once the third party receives the claim, examiners then have the ability to view the supporting documentation. Not only is the data transferable, but the attachment is stored in a secure repository and is accessible to designated payers and providers. Attachments sent by providers can include a number of components, such as adverse drug reaction information, lab and operative reports, ER records, certificates of medical necessity and any other documentation required by a payer to adjudicate a claim. Attachments can be sent along with the initial claim submission (unsolicited) or in response to a request for additional information (solicited).

How the technology is changing healthcare

The technology is changing healthcare in a number of ways. In the near term, organizations will be able to continue achieving clinical and financial excellence as health information becomes more fluid and mobile.

Additionally, automating manual processes makes routine tasks more efficient. Clinical excellence furthered by the use of EHR and other technologies will continue to facilitate the ability for practitioners worldwide to share patient information to enable them to treat patients more efficiently. Additionally, automating billing, claims and attachment processes will reduce lengthy reimbursement periods from payers and reduce unnecessary costs associated with the redundancies in healthcare administrative processes (i.e. refilling claims/documents, manually tracking reimbursements, etc.)

Certain electronic solutions enable providers to electronically respond to RAC, MAC, CERT and ZPIC audits given certain guidelines, for example, by being able to connect through Medicare’s esMD program. The esMD program was launched by CMS to provide an electronic mechanism for providers to respond to audits. Because of these electronic solutions, responding to audits is much quicker, more secure and easier with this technology than when using traditional paper methods to manage the same process.

Additionally, with the technology, providers can import documents using a variety of acquisition methods including scanning, screen capture, file import and print capture. When used to defend against audits, these solutions typically help those in healthcare eliminate faxed or mailed audit responses, ensure timely and confirmed responses, reduce postage and fax charges, decrease administrative time spent copying, eliminate lost submissions and provide HIPAA-secure transmission and storage of files.

The benefit to providers and to health systems is clear, especially in the age of the “wireless” office. With the push toward EHRs, electronic transfer of health information and seamless interoperability, these technologies go hand-in-hand with those developments. Specifically, in regard to this case, the technology can improve acceptance rates for claims requiring supporting documentation, as well as decrease days claims spend in A/R; reduce occurrences of pended and denied claims; eliminate lost attachments; reduce postage and fax charges; eliminate paper-based claims, appeals and audit processes; improve office staff productivity and overall billing efficiency; and provide secure HIPAA-compliant transmission and storage.

All of this supports a more efficient and profitable health system driven by technology. Secure electronic claim attachments improve outdated processes with little intrusion and minimal investment – something many of healthcare’s other IT solutions can’t claim.

Lindy Benton is CEO of MEA|NEA, a provider of health information exchange and secure electronic attachments.

Apple’s Security Issues and Their Move into Healthcare

Posted on September 3, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’m on the record as being skeptical of Apple’s entrance into healthcare with Apple Health and HealthKit. I just don’t think they’ll dive deep enough into the intricacies of healthcare to really make a difference. They underestimate the complexity.

With that disclosure, I found a number of recent tweets about Apple and healthcare quite interesting. We’ll start first with this tweet that ties the recent nude celebrity photos that were made public after someone hacked the celebrities’ iCloud account together with Apple’s HealthKit release.

For those who don’t follow Apple, they have a big announcement planned for September 9, 2014. Rumors have the new sizes of the iPhone 6 could be announced and the new iWatch (or whatever they finally call it) will be announced alongside the iPhone 6. We’ll see if the announcement also brings more details on Apple Health and HealthKit which has been short on concrete details.

Even if Apple Health and HealthKit aren’t involved in the announcement, every smartwatch I’ve seen has had some health element to it. Plus, we shouldn’t be surprised if the iPhone 6 incorporates health and wellness elements as well. Samsung has already embedded health sensors in the S5. I imagine iPhone will follow suit.

With Apple doing more and more in healthcare, it does bring up some new security and privacy issues for them. In fact, this next tweet highlights one healthcare reaction by Apple that is likely connected with the iCloud security issues mentioned above.

This reminds me of a recent business associate policy I saw from a backup software vendor. They were willing to sign a business associate agreement with a healthcare organization, but only if it was their most expensive product and only if it was used to backup your data to your own cloud or devices. Basically, they just wanted to provide the software and not have to be responsible for the storage and security of the data. Apple is taking a similar approach by not allowing private health data to be stored in iCloud. Makes you wonder if Apple will sign a business associate agreement.

We’ll continue to keep an eye on Apple’s entrance into healthcare. They have a lot to learn about healthcare if they want their work in healthcare to be a success. Security and privacy is just one of those areas.

Fitting the Failure Glorified IT World Into the Failure Free Healthcare World

Posted on September 2, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As most readers know, I’m a tech person by background (and literally @techguy on Twitter). It’s fair to say that I come from a tech perspective when it comes to dealing with most things in life. However, I think I’m a very reasonable tech person that understands the best solution to a problem and applies it appropriately. I’ve always loved people as much as I’ve loved tech.

I feel lucky that I’m usually able to bridge the divide between the two different worlds quite well. In fact, my favorite compliment I get is when people who’ve read my blog forever meet me in person and learn that I’m not a doctor. I’m definitely not a doctor, but I’ve always tried to write from a physician perspective. However, what is very clear to me is that the IT perspective on the world and the Healthcare perspective on the world are very different. In fact, it’s very much a clash of cultures.

The best example I’ve seen of this is in how each of these worlds (IT and Healthcare) approach failure. In the technology world, there is a culture that glorifies failure. The idea that you tried something and failed means that you’re that much closer to a solution. The tech world doesn’t see it as failure at all. The so called “failure” is just a way to rule out one of the available options. This is even true for tech startup companies. Having a failed tech startup company is almost a badge of honor that will help you get more funding for your next company.

On the other side of the world is the healthcare world which has a culture defined by their efforts to make sure that they never fail. While that’s not achievable, that’s their goal in everything they do. Look at the medical device industry regulation as a simple example of this. Look at how doctors take care of patients. As a patient, I want my doctor to try every way possible to make sure they don’t fail. The cost of failure in healthcare can mean someone loses their life. This is not something to take lightly and I’m glad that most in healthcare don’t take it lightly.

Thus we have this amazing clash of cultures. One that glorifies failure as part of the learning process and another that has deeply embedded that failure is unacceptable. You see this in every large healthcare organization. You see it even more when a young tech startup company tries to enter healthcare. It’s why so many of these young startup health companies fail to gain any traction in hospitals and healthcare.

What’s the solution? There is no easy solution. Changing culture is never a simple or quick process. However, both sides can learn from each other. The key is that we need to move away from an all or nothing approach to failure and move to a much more nuanced view of failure. Healthcare leaders need to realize that not all failure is bad, even in healthcare. Yes, there are some times when failure can never, ever be acceptable. However, there are plenty of other times where failure will not only not do any major damage, but will be an important step towards learning and growing. On the other side of the coin, tech people need to realize when something they’re doing in healthcare can not fail and realize there are plenty of situations where this is a requirement in healthcare.

Much like privacy, it’s not that avoiding failure isn’t important in healthcare. It’s extremely important, but we need to have a more nuanced and sophisticated view of when it’s important. This is not an easy balance, but not doing so will cause us to miss out on so many needed opportunities. The good part is that a great leader will have the tech people pulling for more failure and the medical people pulling for more reliability and security. We just need to bring the two together.

Happy Labor Day!

Posted on September 1, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Here in the US, today is Labor Day. I’ve got plans to spend the day at a waterpark with the family. I can’t wait since I’ve grown addicted to the water park this summer. As I think about why, I realize that a waterpark is a great mix of thrills and relaxation. You can go catch a waterslide and have some fun and get your heart going or you can go hang out in the lazy river or wave pool shallow area. It describes me really well. I love thrill and excitement, but I also love to just chill and hang out in my own thoughts or with good friends.

That’s my fun plans for today. What’s yours?

Also, I can never celebrate a holiday these days without thinking about all the amazing people in medicine who are working today. My hospital friend recently texted me “The hospital is always open. It’s one of the great and terrible things about working in a hospital.” She’s right. My thanks goes out to all those people who make a sacrifice on these holidays. Your labors are certainly appreciated my millions.

Impact of EHR and Technology on Nurses’ Wellbeing Infographic

Posted on August 29, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Who doesn’t like an informative infographic? I don’t think we’ve talked enough about the ergonomics of EHR. This is going to become a really big issue for nurses, doctors, front desk staff, etc. It’s good news for the chiropractors though.

ergotron_hospital_infographic

Do We Really Like the JASON Recommendations for Interoperable Health Data?

Posted on August 28, 2014 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The health IT community has been abuzz over the past few months about a report released by the Agency for Healthcare Research and Quality. Although the report mostly confirmed thoughts that reformers in the health IT space have been discussing for some time, seeing it aired in an official government capacity was galvanizing. The Office of the National Coordinator has held several forums about the report, known by the acronym JASON, and seems favorably inclined toward its recommendations.

Even though only four months have passed since its publication, we can already get some inkling of how it will fare at the ONC, which is going through major realignment of its own. And to tell the truth, I don’t see much happening with the JASON recommendations. In this article I’ll look at what I see to be its specific goals, and what I’ve heard regarding their implementation:
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One Physician’s Experience Seeing an Ophthamalogist Pre and Post EHR

Posted on August 27, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I always love to hear doctor’s perspectives on EHR and how they’re impacting their day. You can be certain that they’ll lead with a long list of complaints. Many of the initial complaints are minor things that can be easily resolved with workflow or by a small enhancement by the EHR vendor. Once you get past the initial complaints, then you get to the heart of what they really think about the EHR software. I’ve had this experience hundreds of times and it’s always insightful.

However, this time a doctor shared something even more interesting. This was a doctor visiting another doctor as a patient. Rather than put words in his mouth, I’ll just share with you what he shared with me (EHR vendor name excluded since this could apply to many different EHR vendors):

I was in my ophthalmologist today. He is a really nice, busy doctor. He is in group practice and used to run his wing with one long time nurse with no hassles. He could previously see a patient in 10 min finish refraction, move from room to room and breeze through cases jotting what he needed to write down on one clean ophthalmology SOAP note. Since 2011 they have had EHR Vendor A. (because a consultant sold them on it and promised rewards from CMS)

Today, It took them a total of 1.5 hours to get my refraction, eye exam done. The workflow seemed to be in a complete disarray (remember this is an installed cloud based software since 2011, supposed to the be cream of the crap for Ophthalmology). What shocked me the most was that he now has 4 ladies doing inane things with EMR, trying to help him. I can also see why errors can creep in because he was reading out numbers for the assistant/ Nurse to enter into EHR Vendor A. Distraction fatigue, EMR ennui can cause errors of entry. So the cost of running crappy software far exceeds the physical costs / monthly service costs of the product. It amplifies personnel costs. It took the lady 20 minutes to take totally pointless history and do ROS!

I did not tell her I was a physician and she was clicking away to glory. I counted more than 50 clicks before anything of substance was even gathered. Based on the EMR prompts she made me do finger counting and asking me if I can see her face etc..>! I had clearly indicated to her that I just wanted a retinal exam and prescription for glasses because I wanted to buy new lenses and that I had not required change of prescription for glasses in 10 years!

Then I walk out with mydriatic in my eyes…and saw a hazy illusion of one of my ex-patients, a severe schizophrenic waiting for his turn to be checked in. He was talking about meeting Jesus and asked if I have had a “meeting Jesus moment” in my life.. I assured him I just did…

In those 1 hr and 45 min, the good doctor had seen just 4 patients and 6 more were still waiting impatiently on one arse looking irate, checking their iphones and smart watches …spreading anxiety.

I’m always torn on sharing these type of stories. I know that this doesn’t have to be the case since I know many EHR users who don’t have these issues. However, far too many of them do that it’s worth keeping this perspective in mind. Plus, regardless of how efficiently someone has incorporated the MU requirements, it’s had a huge impact on everyone that’s participating.

I guess it’s fair to say that the above ophthamologist doesn’t agree that meaningful use saves a doctor time.

Trying to Regulate Twitter

Posted on August 26, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I recently saw a bunch of people tweeting about a conference in Milan which was supposedly trying to regulate the use of Twitter at the medical meeting. It turns out that the post about what you should tweet about at the meeting was mostly a joke and the comments that were highlighted were largely taken out of context. Plus, it wasn’t the organizer of the event that did the post, but just a participant in the conference. Because of the stir up, the post was taken down, but Dr. Bryan Vartabedian captured a piece of the post in his commentary:

The social side of any conference is important, and Twitter, being part of the social media, will naturally show that side. There is, however, a danger that the orchestra’s symphony will be drowned out by foot-shuffling, program brandishing, and a general clucking and chattering.

Ironically, this story ends up being a case of where Twitter can go wrong. It’s easy to misconstrue what people mean in a blog post or on Twitter. I have it happen all the time with the blog posts I write. I’m often amazed at people’s responses to my blog post since they either miss the point of my post or they think I’m making a point which is definitely not the case. Over time I think I’ve gotten better at this, but with thousands of readers over thousands of blog posts there’s bound to be a miscommunication. The great thing is that once I engage them, there’s usually clarity. But I digress…

Regardless of the particular situation at the medical meetings in Milan, the discussion of regulating Twitter (feel free to insert other social media as well) is a really good one. Although, it doesn’t just apply to meetings. I’ve seen many people try and regulate what’s done on all sorts of hashtags or other social media. I find the efforts people make to control other people on social media entertaining.

I’m sure this says a lot about me, but when someone tries to regulate what’s said or done on a hashtag on Twitter (meeting or otherwise), it just makes me want to do the opposite. While I have that innate need to not be controlled (some might call it rebellion), the reality is that I take a much more pragmatic approach to people’s suggestions about what should be said or done with a hashtag. I use a simple measure: “Will their suggestion make me a better part of the community?” (Yes, communities come together around hashtags) If I think that someone’s suggestion is a good one that will make me a better part of that community, then I usually listen. If I don’t think their suggestion matters or actually detracts from the community, then I ignore. Do I make mistakes? Absolutely, but this is my approach to it.

My personal approach aside, the reality is that even if you want to control what happens on Twitter and with certain hashtags, you can’t! If someone wants to be a bad actor in a hashtag community, then they’re going to do it. Bad community actors aren’t usually listening to the other people in the community anyway. So, trying to police it usually just leaves you dirtying the conversation stream even more.

Personally, I love the diversity and freedom that’s seen by participants in a Twitter stream. It tells me a lot about the person or company. Plus, I like the human elements of Twitter as well. I love to see that someone’s excited about a conference, their puppy, a great meal, a certain vendor, etc. Those that only talk about these things I can easily block if needed, but the reality is that a tweet is so easily consumed I can skip over any that don’t interest me.

I know many people hate when a Twitter stream is overwhelmed with vendor tweets at a conference as well. This doesn’t bother me much. It tells me a lot about the vendor as well. If they don’t care enough to be thoughtful in their tweeting, do they also not care enough about their product? Plus, if they’re spamming the stream with sales tweets, is that how I’ll be treated as a customer? This is good for me to know and so I don’t mind seeing their true form on Twitter.

With that said, I have found that the quality of a hashtag Twitter stream is directly proportional to the number of humans that are tweeting on that hashtag. Social media is about connecting people and so it makes sense that when more people (as opposed to no personality companies) are participating, then it’s a better experience.

I’m sure many will still try and influence what’s done on a Twitter stream. More power to them, but it’s a losing battle. Instead of trying to regulate Twitter, I think we’re better served encouraging and promoting those people and tweets that are adding value to the hashtag community. Plus, we can contribute value to the stream ourselves. There are bad actors in every community in the world. However, if enough good people are on board adding value, then the bad actors fade into the background.

Ten-year Vision from ONC for Health IT Brings in Data Gradually

Posted on August 25, 2014 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

This is the summer of reformulation for national U.S. health efforts. In June, the Office of the National Coordinator (ONC) released its 10-year vision for achieving interoperability. The S&I Framework, a cooperative body set up by ONC, recently announced work on the vision’s goals and set up a comment forum. A phone call by the Health IT Standards Committeem (HITSC) on August 20, 2014 also took up the vision statement.

It’s no news to readers of this blog that interoperability is central to delivering better health care, both for individual patients who move from one facility to another and for institutions trying to accumulate the data that can reduce costs and improve treatment. But the state of data exchange among providers, as reported at these meetings, is pretty abysmal. Despite notable advances such as Blue Button and the Direct Project, only a minority of transitions are accompanied by electronic documents.

One can’t entirely blame the technology, because many providers report having data exchange available but using it on only a fraction of their patients. But an intensive study of representative documents generated by EHRs show that they make an uphill climb into a struggle for Everest. A Congressional request for ideas to improve health care has turned up similar complaints about inadequate databases and data exchange.

This is also a critical turning point for government efforts at health reform. The money appropriated by Congress for Meaningful Use is time-limited, and it’s hard to tell how the ONC and CMS can keep up their reform efforts without that considerable bribe to providers. (On the HITSC call, Beth Israel CIO John Halamka advised the callers to think about moving beyond Meaningful Use.) The ONC also has a new National Coordinator, who has announced a major reorganization and “streamlining” of its offices.

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