Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and EHR for FREE!

Not All EHR Clicks Are Evil

There’s a great blog post on HIStalk that is a beautiful CMIO Rant. He provides some really needed perspective on the issues with EHR software. In many ways, the post reminded me of my post titled “Don’t Act Like Charting on Paper Was Fast.” In that post, I highlight the fact that far too many people are comparing EHR against doing nothing versus comparing EHR against the alternative. Those are two very different comparisons.

The money line from the CMIO rant was this one:

If we insist that all clicks are wasted time, then we can’t have a conversation about usability, because under the prescription pad scenario, the only usable computer is one you don’t have to use at all.

I love when you take something to the extreme. It’s true that we all want stuff to just happen with no work. That’s perfect usability. However, that’s just not the reality (at least not yet). If we want the data to be accurate and to be recorded, then it takes human intervention (ie. clicks). Some clicking is necessary.

The CMIO goes on to say that the key to EHR usability is expectations. I thought that was an interesting word to describe EHR usability. I’ve written about this topic before when I compared the number of EHR clicks to the keys on a piano. In that article I suggested that the number of clicks wasn’t the core issue. If we could create EHR software that was hyper responsive (like a piano key), was consistent in its response speed, and we provided proper training, then having a lot of EHR clicks wasn’t nearly as big an issue.

Not that this should be an excuse for EHR vendors to make crappy software. They should still do what they can to minimize clicks where possible. However, the bigger problem is that we haven’t achieved all three of these goals. So, we’ll continue to hear many people complaining about all the EMR clicks.

April 11, 2014 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.

Healthcare IT Innovation – #HITsm Chat Topics

I’m excited to be hosting this week’s #HITsm chat. For those not familiar with it, every Friday at Noon EST we all follow the #HITsm tag on Twitter and participate in a Twitter chat covering 4-5 questions. If you want to participate you can just watch, or chime in with your own thoughts and questions. To do so, just add the #HITsm tag to your tweets. I’m the host this week and so I chose the topic and questions.

I’ve had healthcare IT innovation on my mind a lot lately, and so I thought it would make for an interesting topic. It might be worth reading my first LinkedIn post called “Why We Should be Optimistic in Healthcare.” In that post I outline why I think there’s a lot of innovation in healthcare that’s about to happen and that’s why I’m so optimistic.

I hope you’ll join me and a few hundred others on Twitter for the #HITsm chat. Here are the topics we’ll be discussing. Feel free to start the discussion early in the comments.

Topic 1: Can innovation happen within the current healthcare beauracracy or will innovation have to replace our current model?

Topic 2: What’s the most innovative thing you’ve seen in healthcare IT in the last 6 months?

Topic 3: What type of results will we see from the tricorder Xprize? Does innovation come from contests like this?

Topic 4: If you had a million dollars you had to invest in health IT, where or how would you invest it?

Topic 5: Think 5-10 years out, what will be the most exciting innovation in healthcare?

April 10, 2014 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.

5 Health IT Marketing Resources You Didn’t Know You Needed – #HITMC

The inaugural Healthcare IT Marketing and PR Conference concluded with tears of gratitude, many tweets of thanks and too many takeaways to list here. (I suggest you check out the #HITMC tweet stream before it disappears, or watch the recorded sessions, which will soon be available via the conference website.) I will take a moment to highlight several marketing resources and tools that I heard about from attendees and speakers – services and solutions actual HIT marketing professionals rely on to more easily create engaging campaigns that connect with prospects and customers on a Human2Human level.

TheShortCutts.com
Don’t know who Matt Cutts is? Neither did I until I attended Kristine Schachinger’s session on the realities and myths of SEO. Cutts is the man at Google who can make or break a website’s Google rankings. Officially, he is head of Google’s webspam team. No matter how you refer to him, he’s certainly worth paying attention to, especially if SEO is your thing. The folks behind ShortCutts.com provide easy to understand interpretations of Cutts’s videos, which he produces prolifically to help “struggling site owners understand their site in search.”

cutts

Smartsheets.com
Smartsheets seem to be about helping users better manage workflows via online tools that allow you to “assign tasks, attach files, share sheets, view timelines, set alerts, create rollups and go mobile.” It features specific marketing templates for event marketing, campaign tracking and product launches. I’m not quite sure how it works, only that it came highly recommended from the HITMC community. I also found this article from my local paper on the way Northeast Georgia Medical Center’s paramedics and cardiologists have used Smartsheets to improve cardiac care.

smartsheet

Whiteboard Animated Videos from JillAddison.com
One attendee recommended Jill Addison as her go to source for high quality yet cost-effective animated whiteboard videos.

whiteboard

Abukai.com
Abukai provides a free service that lets you snap photos of your receipts with your phone, and then automatically dump them into an expense report – perfect for healthcare IT marketers on the go.

abukai

Rev.com
Do you have any idea how laborious it is to transcribe a phone interview? It’s extremely time consuming, and can often cost big bucks to outsource. Imagine my pleasant surprise when someone mentioned Rev.com, which provides transcription services at $1 a minute. That is incredibly inexpensive, and worth its weight in gold if you’re in a time crunch.

rev

The Health IT Marketing and PR Community on LinkedIn
“A community of health IT marketing and healthcare IT PR professionals. First started after the inaugural Health IT Marketing and PR Conference as a place to collaborate with colleagues across the health IT marketing & PR community, but welcome to anyone interesting in healthcare IT marketing and PR.” This should serve as a great resource, and I’ve already submitted a discussion around a question I didn’t get a chance to ask panelists from Agency Ten22.

linkedin

April 9, 2014 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.

Scribes and Problems with the Healthcare System

In a recent #HITsm chat we had a pretty good discussion about scribes and their place in healthcare. I know a lot of people that are really big proponents of scribes, but I also know many people who are against them.

During the discussion, the question was asked if scribes mask the problems of the EHR software. This was my reponse:

If I were to do that tweet again, I might replace healthcare system with reimbursement system. Scribes are a mask to the fundamental problems with how we pay for healthcare. I’ve always loved to think about what an EHR would look like if it didn’t have to worry about billing. It would be a completely different system than what we have with EHRs today.

The reality is that doctors want to get paid and so EHRs have to deal with billing. Plus, now they have to deal with meaningful use regulation as well. Add those two together and you can understand why scribes are so popular with doctors.

Every single EHR would be better and easier to use if they were just worrying about providing a tool to doctors that lets them document the visit and ensure quality patient care. However, until that happens (which is never) scribes and other alternative methods to document are going to be very popular with many physicians.

April 8, 2014 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.

Where is Clinical Decision Support Heading?

A few months ago I had a chance to sit down an interview Jonathan Teich, MD, PhD, Elsevier’s Chief Medical Informatics Officer and a physician at Brigham and Women’s Hospital in Boston. In our discussion we dig into the current and future state of clinical decision support. For example, I ask Dr. Teich if you’ll be able to be a doctor in the future without it. If you want to learn more about clinical decision support and where it’s going, you’ll enjoy this video interview:

April 7, 2014 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.

You might be an #HITNerd If…

You might be an #HITNerd If…

you love this Lady Gaga parody video…or this Katy Perry parody video for that matter.

Find all our #HITNerd references on: EMR and EHR & EMR and HIPAA and check out the new #HITNerd t-shirts, hat, and phone cases.

NEW: Check out the #HITNerd store to purchase an #HITNerd t-shirt of cell phone case.

Note: Much like Jeff Foxworthy is a redneck. I’m well aware that I’m an #HITNerd.

April 6, 2014 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.

What Happens in Vegas … will be Tweeted During #HITMC

And the excitement in healthcare IT continues. Whether you’re worried about ICD-10, our government’s proclivity for voice votes, or the lack of response from one industry group or another, there has been no shortage of water cooler topics this week.

The impending Healthcare IT Marketing & PR Conference is at the top of my list when it comes to discussion topics. Regular readers of HealthcareScene.com may already know that it kicks off Monday, April 7, in Las Vegas. I’m looking forward to networking with many of my #HITsm friends, and speaking on a panel about social media ROI with several leading experts. I find tremendous value in social networking before, during and after events like this, so I thought I’d offer a list of speakers’ Twitter handles to help those of us getting ready for Vegas jump into conversations early. (You may also consider it my handy list of #FF mentions.) For those not attending, do yourself a favor and follow the #HITMC hashtag over the next several days and register for the live video stream (Note: It’s Free). I will definitely try to cover session takeaways via Twitter on @JennDennard.

Shahid Shah@ShahidNShah

John Lynn@techguy and @ehrandhit

Warren Whitlock@WarrenWhitlock

Julia Goebel - @goebeljulia

Marcy Fleisher@fleish

Jodi Amendolajamendola

Kate Ottavio@kottavio

Sam Stern@mHealthMarketer

Mandi Bishop@mandibpro

Joy DiNaro@TheSocialJoy

Cari McLean@carimclean

Dr. Patricia Salber@docweighsin

Scott Collins@sscottcollins

Tim Tyrell-Smith@TimsStrategy

Michelle Boucher@medmastermind

Sunny Tara - @SunnyTaraVegas

Christine Slocumb@CLSlocumb

Shane Pilcher - @spilcher

Thomas Knoll@thomasknoll

Chandresh Shah@chandresh27

Stacy Goebel@stacygoebel

Beth Friedman@HealthITPR

Erin Wabol - @HealthITMktg

Brad Dodge@braddodge

Don Seamons@donseamons

Kristine Schachinger - @schachin

Jeff Walker@ContentCarnivor

Check out the conference website for more details about what the experts above will be speaking about. See you in Vegas, or via the #HITMC hashtag!

April 4, 2014 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.

Barriers and Pathways to Healthcare IT

The following is a guest blog post by Andy Oram, writer and editor at O’Reilly Media.

Those who follow health IT for a long time can easily oscillate between overenthusiasm and despair. Electronic records will bring us into the 21st century! No, electronic records just introduce complexity and frustration! Big data will find new cures! No, our data’s no good!

Indeed, a vast gulf looms between the demands that health reformers make on information technology and the actual status of that technology. But if we direct a steady vision at what’s available to us and what it provides, we can plan a path to the future.

This is the goal of a report I recently wrote for O’Reilly Media: The Information Technology Fix for Health: Barriers and Pathways to the Use of Information Technology for Better Health Care. As part of a comprehensive overview, it dissects the issues on some topics that often appear on this blog:

  • Patient empowerment. After looking at the various contortions hospitals go through to provide portals and pump up patients’ interest in following treatment regimes, I conclude that the best way to get patients involved in their care is to leave their data in their own hands.

    But wresting data out of doctors’ grip will be heavy exercise. Well aware that previous attempts at giving patients control over data (Google Health and Microsoft HealthVault) have shriveled up, and that new efforts by Box and Apple seem to be taking the same path, I suggest a way forward by encouraging people to collect health data that will hopefully become indispensable to doctors.

  • What’s wrong with current EHRs? We know that doctors grab any opportunity handed them to complain about their EHRs. Even more distressing, the research bears out their pique; my report cites examples from the medical literature finding only scattered benefits from EHRs. Sometimes their opacity and awkward interfaces contribute to horrific medical errors.

    One might think that nobody is actually getting what they want from their EHR, but in fact plenty of providers are quietly enjoying their records–success has a lot to do with their preparation and whether they take the extra effort to make effective use of data gathered by the EHRs.

    New interfaces such as tablets, convenient storage in the cloud, and agile programming may be producing a new crop of EHRs that will meet the needs of more clinicians. But open source software would lead to the most widespread advances, enabling more customization and a better response to bug reports.

  • The viability of ACOs. Accountable care, pretty much a synonym for the notion of pay-for-value, is on the agendas of nearly all payers, from CMS on down. It certainly makes sense to combine data and keep close tabs on people as they move from one institution to another. But it’s really a job to be done on a national level, or at least a regional one. Can a loose collection of hospitals and related institutions muster the data and the resources to analyze patient data, created viable health information exchanges, and perform data analysis? I don’t think the current crop of ACOs will meet their goals, but they’ll provide valuable insights while they try.

  • Can standards such as ICD-10 improve the data we collect? What about the promise of new standards, such as FHIR? I’m a big believer in standards, but I’ve seen enough of them fail to know they must be simple, lithe, and unambiguous.

    That doesn’t characterize ICD-10 to be sure. Perhaps it does pretty well in the unambiguous department. But like most classifications, it’s a weak representation of the real world: a crude hierarchy trying to reflect many vectors of interlocking effects–for instance, the various complications associated with diabetes. And although ICD-10 may lead to more precise records, the cost of conversion is so burdensome that the American Medical Association has asked the government to just let doctors spend their money on more pressing needs. The conversion has also been ruthlessly criticized on the EMR & EHR site.

    FHIR is a radical change of direction for the HL7 standards body. For the first time, a standard is being built from the ground up to be web-friendly as well as sleek. It currently looks like a replacement for C-CDA, so I hope it is extended to hold patient-generated data. What we don’t need is another hundred vendors going off to create divergent formats.

    For real innovation, we should look to the open SMART Platform. Its cleverness is that it functions as a one-way valve channeling data from silo’d EHRs at health providers to patient-controlled sites.

We need to know what current systems are capable of contributing to innovative health solutions, and when to enhance what we have versus seeking a totally disruptive solution. I look forward to more discussion of these trends. Comment on this article, write your own articles on the topics in the report, and if you like, comment to me privately by writing to the infofix alias @ the oreilly.com domain.

April 3, 2014 I Written By

Planning a Successful Patient Engagement Strategy

On social media and at events like HIMSS, we hear a lot of discussion about this new trend called patient engagement. While there are certainly new tools to help an organization engage the patient, I don’t think it’s fair to say that patient engagement is a new strategy. Patient engagement has always been considered a good thing in practices and healthcare organizations.

The challenge is that we’ve never rewarded those who actually did engage the patient. Healthcare reimbursement has actually discouraged patient engagement despite providers natural desire to want to engage the patient. Every doctor I know would love to sit down with a patient for an hour and really engage them in their health. Unfortunately, we don’t pay them to do this.

While I don’t think we’ll see an over night transition to hour long visits with our doctors, the move to value based reimbursement will finally start rewarding providers who engage deeply with their patients.

The next question doctors should ask is where to start when it comes to patient engagement in this changing landscape. This whitepaper on 5 Elements of a Successful Patient Engagement Strategy would be a good place to start. It provides a realistic strategy for your organization to consider.

The whitepaper also has this great quote from Leonard Kish:

“If patient engagement were a drug, it would be the blockbuster drug of the century and malpractice not to use it.”

Those practices that choose to not have a patient engagement strategy are going to fall behind. This won’t be an issue right away, but it will catch up to many practices who don’t see the coming change.

April 2, 2014 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.

Reply to Dr. Jacob Reider on NIST Dissects Workflow: Is Anyone Biting?

One comment on my latest post, NIST Dissects Workflow: Is Anyone Biting?, deserves a more than casual reply.

Here’s the comment from Jacob Reider (Note: Dr. Reider is ONC’s Acting Principle Deputy National Coordinator and Chief Medical Officer. He has made major contributions to the HIT field and is one of its significant advocates.)

Carl, ONC’s UCD requirement references ISO 9241–11, ISO 13407, ISO 16982, NISTIR 7741, ISO/IEC 62366 and ISO 9241–210 as appropriate UCD processes.

We also require summative testing as defined in NISTIR 7742.

Might “Refuses to incorporate NIST recommendations” be a bit of an overstatement?

We solicited public comment in our proposed rule for 2015 certification and would welcome specific suggestions for how we can/should improve user experience of health IT products for efficiency and safety.

Dr. Reider, thank you for your comment – it certainly falls into the category of you never know who’s reading.

Let’stake a look at your last comment first, “Might ‘Refuses to incorporate NIST recommendations’ be a bit of an overstatement?”

Obviously, I don’t think so, but I am not alone.

I based my comment on ONC’s statement in its rule making that refers to NIST’s usability protocols. It says:

While valid and reliable usability measurements exist, including those specified in NISTIR 7804 “Technical Evaluation, Testing and Validation of the Usability of Electronic Health Records,” (21) we are concerned that it would be inappropriate at this juncture for ONC to seek to measure EHR technology in this way.

Sounds like a rejection to me, however, don’t take my word. Here’s the AMA’s response to this decision. First, they demur and quote ONC:

We disagree with ONC’s assertion in the Version 2014 final rule that, “[w]hile valid and reliable usability measurements exist, including those specified in NISTIR 7804 ‘‘Technical Evaluation, Testing and Validation of the Usability of Electronic Health Records,’’ we expressed that it would be inappropriate for ONC to seek to measure EHR technology in this way.”

It then says:

To the contrary, we believe that it is incumbent upon ONC to include more robust usability criteria in the certification process.  The incentive program has certainly spurred aggressive EHR uptake but has done so through an artificial and non-traditional marketplace.  As a consumer, the physician’s choice of products is limited not only by those EHRs that are certified but also by the constraint that all of these products are driven by federal criteria.  The AMA made several detailed recommendations for improving Version 2014 certification in our Stage 2 comment letter, which were not adopted, but still hold true, and we recommend ONC consider them for the next version.  Testimony of AMA’s Health IT Policy Committee’s Workgroups on Certification/Adoption and Implementation, July 23, 2013, pp. 5-6

I recognize that ONC says that it may consider the protocols in the future. Nevertheless, I think the plain English term rejected fits.

In the first part of his statement, Dr. Reider cites several ISO standards. With the exception of the Summative Testing, all of these have been referred to, but none have been adopted. Reference to a standard is not sufficient for its inclusion under the operation of the federal Administrative Procedure Act, which governs all federal agency rulemaking. In other words, these standards are important, but ONC simply calls them out for attention, nothing more.

I think two factors are at work in ONC’s reluctance to include the NIST usability protocols. The first is that the vendors are adamantly opposed to having them mandated. However, I believe there is a way around that objection.

As I have argued before, ONC could tell vendors that their products will be subject to a TURF based review of their product for compliance and that the results would be made public. That would give users a way to judge a product for suitability to their purpose on a uniform basis. Thus, users looking at the results could determine for themselves whether or not one or more non compliance was important to them, but at least they would have a common way to look at candidate EHRs, something they cannot do now , nor under ONC’s proposed approach.

The other factor is more complex and goes to the nature of ONC’s mission. ONC is both the advocate and the standards maker for HIT. In that, it is similar to the FAA, which is vested with both promoting and regulating US aviation.

It’s well established that the FAA’s dual role is a major problem. It’s hard to be a cheerleader for an industry and make it toe the line.

With the FAA, its dual mandate is exacerbated when the highly respected NTSB investigates an incident and makes recommendations. The FAA, acting as industry friend, often defers NTSB’s authoritative and reasonable recommendations to the public’s determent.

I believe that something similar is going on with ONC. NIST’s relationship to ONC is roughly analogous to that of the NTSB’s to the FAA.

NIST is not an investigative agency, but it is the federal government’s standards and operations authority. It isn’t infallible. However, ONC dismissing NIST’s usability protocols, in one word, inappropriate. It did this without explanation or analysis (at least none that they’ve shared). In my view, that’s really inappropriate.

ONC has a problem. It’s operating the way it was intended, but that’s not what patients and practioners need. To continue the aviation analogy, ONC needs to straighten up and fly right.

March 31, 2014 I Written By

When Carl Bergman’s not rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, 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.