I’m writing to you from the balmy, breezy and absolutely beautiful Palm Springs, where the Porter Research team presented several sessions at this year’s Healthcare IT Summit. It’s my second year attending this conference, unique in that it brings together providers and payers for joint sessions and networking opportunities. I enjoy it because it’s an intimate setting in which to chat with providers about what their challenges are and how they plan to face them. Something you definitely don’t get at big shows like HIMSS. California is a nice change from last year’s chillier venue of Washington, D.C.

Little did I know that casinos are part of the after-hours culture in Palm Springs. Driving in from the airport – the smallest and prettiest I’ve ever been through – I noticed the bright lights of one of them, which reminded me of an article I came across last week regarding the state of Massachusetts’ plans to use anticipated revenue from casinos to accelerate the adoption of electronic medical records. Apparently, 23% of licensing fees from the state’s three casinos and one slot parlor may potentially go to a fund “designated in part to help the state switch to an electronic medical records-keeping system.”

Massachusetts, which already requires nearly everyone to have state health insurance, is doing what many other states have done in terms of leveraging gambling revenues for government projects. I myself have benefited from Georgia’s HOPE scholarship, which is funded from the state’s lottery.

Will other states follow suit? Is this an example of creative thinking on the part of the state government, or is there something amiss with private citizens spending their money in Native American casinos, which the government then takes a chunk out of for its mandated programs? I’ll admit, I’m a bit torn. Do we rah, rah, rah the out-of-the box thinking, or pooh pooh it because it’s too close to the vest?

Judy Hanover at IDC predicted in one of her sessions at the summit that the majority of US providers will be using electronic medical records by the end of 2012, with large physician practices leading the way. According to the US Bureau of Labor and Statistics, there were 661,400 physicians in 2008, with 805,500 projected to be employed by 2018. Even taking into consideration the predicted shortage of physicians, that’s a big number to totally move from paper to digital in just a few years.

I wonder if we’ll see other creative funding ideas pop up – whether they be from the government, private investors, or even payers. A speaker at the summit brought up the notion of taxing soda to encourage folks to be healthy as part of this nation’s move to more coordinated care and more formal accountable care organizations. Could money from programs like that be used for EMR funding? Let me know what you’ve heard and think in the comments below.

If you have been using GE Healthcare’s Centricity Practice Solution or Centricity Electronic Medical Record solution to demonstrate Meaningful Use, you might be in for something of a rude shock. According to an InformationWeek Healthcare story by Neil Versel,

“Some customers of GE Healthcare may not be able to achieve Meaningful Use with their current electronic health records (EMR) systems, as the vendor has discovered “inaccuracies” in its software’s reporting functions.”

According to Versel, GE admitted the problem in a letter that went out to users of the two Centricity products on Thursday and promised a solution by end-November. At the time the InformationWeek story was written, this GE link was not working, but is now. In the document, GE details exactly where its reporting was going wrong. It appears as if the problems lay in the following areas:
- the default race and ethnicity provided by GE’s Centricity products didn’t always map exactly to OMB’s race and ethnicity categories (as an example, GE’s Centricity provided for a single Multi-Racial category, whereas OMB requires that a multiracial person be allowed to select as many races as s/he wants)
- inaccurate recording of smoking status
- inadequate training of doctors on educating their patients about medications
[Link]

Among the recommendations put forward by GE:

- If you’ve already attested for 2011, run reports again for attestation period once GE issues its software update. If the results don’t match up,
a) check if you clear all applicable Meaningful Use thresholds for the original period
b) check if you meet thresholds for all applicable measures

- If you haven’t attested for 2011, hold off on attesting till GE issues its updates.

- Prospectively follow GE’s recommendations for the rest of the year

While the GE letter points out there is still time till Feb 29, 2012 for 2011 attestations, these were my first reactions to reading this piece of news:
- Even a Stage 1 Meaningful Use certified software from a well-known company is not immune to inaccuracies in reporting

- It might seem like a trivial change to move from “Multi-racial” to allowing multiple check-boxes for races, but it could mean the difference between demonstrating MU and not being able to. From GE’s perspective, I would want to know why these small-seeming errors were not caught at the time these Centricity products were Stage 1 MU certified

- How many/what percentage of Centricity EMR and Practice Solution users were affected? It’s not very clear/GE doesn’t say.

- The letter and recommendations don’t show up on GE Healthcare website, and to me it’s also quite interesting that a story like this doesn’t have any hits beyond the InformationWeek article.

- Are there any recourses apart from following GE directives? Maybe if you have softwares other than GE’s Centricity, maybe you can cross-check your results. But I don’t know how many practices actually can afford two or more EMRs. So this really might be a worthless suggestion, unless you can press one of those free EMRs into service!

Full Disclosure: GE is an advertiser on this site, but I’m not sure Priya Ramachandran knew that when she wrote this article.

It’s not secret that social media continues to play an increasingly powerful role in connecting folks within the healthcare IT community. Sites such as LinkedIn, Facebook and Twitter offer easy-to-navigate platforms that enable communication with peers on any continent, in any time zone. Twitter has become a personal favorite – both for its brevity and its simplicity. (Yes, I’ve heard promising things about Google+, but haven’t yet checked it out.)

The healthcare IT community has also embraced Twitter. Follow a variety of hashtags, including personal favorite #HITsm, and you’ll encounter a variety of opinionated, educated, and often humorous industry folk who, through their activity in the social space, are either emerging as thought leaders or bolstering their credibility as one.

The hashtag #HIT100 has been popular of late thanks to the crowdsourcing efforts of Michael Planchart, aka @theEHRguy. According to his Twitter profile, he is a “Healthcare Interoperability Consultant, Enterprise Architect for Healthcare IT and Standards Specialist.” According to his LinkedIn profile, he is a chief software architect at ProKSys. One thing is for sure – he is passionate about the healthcare IT community on Twitter. So much so that just a few weeks ago he began compiling nominations from his peers on Twitter of the top 100 tweeters (personal or company accounts) in the healthcare IT space.

The resultant list, published earlier this week, can be downloaded here: Final HIT100 Nominees. It is a great resource of folks to keep up with. (Be sure to check out @billians at #78!) Anne Zieger at EHROutlook.com (@ehroutlook at #86) has helpfully distilled the list into the top EMR/EHR tweeters.

I’ve met many in person at industry events, and know even more through Twitter. Hopefully I’ll run into Michael Planchart himself at some point. In the meantime, I chatted with him via email about why he wanted to take on this project, and why the healthcare IT community has embraced social media, particularly Twitter.

Why did you decide to embark on this project?

I wanted the healthcare IT community to vote for their most valued peers. Many well-intended folks would come up with their personal list and publish it. I wanted everyone to participate to create a more objective and transparent selection. This one may not yet be perfect, but it is open and publicly created. Hopefully, for 2012 we will have greater participation from many more folks. But for now, we have this to evangelize from.

Do you think there are more influencers in the #HIT space this year than last?

I know many of the folks that I follow and those that follow me. I’ve personally met many at RSNA, HIMSS and other healthcare events. But I’ve noticed a lot of newcomers to the social media space. Many of them I know as excellent contributors to healthcare IT, since I belong to the same standards committees that they do, although many times we work on different projects. What’s new is not them being in healthcare IT, but being in social media representing healthcare IT.

But answering your question more directly, yes there are many more participants this year. To be an influencer like John Halamka, Brian Ahier, Keith Boone, Matthew Holt and Dave deBronkart, just to name a few, most have some miles to go.

And why do you think there has been such an increase?

Twitter has been an open platform to create networks from the beginning. Linkedin and Facebook are too closed to create peer-to-peer networks. So Twitter has been highly influential in creating these peer-to-peer specialized networks like our #hcsm or #HIT groups.

I encourage you to take a look at the list and start connecting, communicating and educating. Be sure to follow this blog – @ehrandhit, and myself – @SmyrnaGirl, while you’re at it!

Editor’s Note: The following article is written by a new blogger in the EMR and EHR family: Jennifer Dennard. A big welcome to Jennifer and we’ll have to have her do an intro post in the future so everyone can learn about the great work Jennifer is doing in the healthcare IT world.

The day the tornado struck in Joplin, Missouri, “luck” wasn’t a word that made it to very many people’s lips. Nearly a month has passed, however, giving the town time to reflect on just how “lucky” its citizens have been, particularly with regard to the quick thinking and incredible dedication of the staff at its area hospital, St. John’s Regional Medical Center, part of the Sisters of Mercy Health System.

Numerous reports have detailed the efforts of the hospital’s medical teams to move patients and staff to safety during and after the storm, as well as to establish the mobile version of the hospital after the original structure was hit. Stories are now coming to light of the well-timed – some would even say “lucky” – opening of a brand-new data center some 250 miles from Joplin and the corresponding implementation of an EPIC electronic medical records (EMR) system at the hospital close to a month before the storm hit. The Joplin facility was the last of the 28 acute-care hospitals in the Mercy system to go live on an EMR.

Tales have been told of X-ray images being found as far as 70 miles away from the hospital, but the EMR and off-site data center made flying files a moot point, as HealthDataManagement.com recounted in a recent article:

“”We’ve got the connectivity, so for us it doesn’t really matter where it’s at physically,” says Mike McCreary, chief of services for Mercy Technology Services, a unit of the health system.

“Joplin resident Paul Johnson, 78, was hospitalized with pneumonia at St. John’s when the tornado struck. Guided safely by his family from the facility to a triage center, Johnson was then taken to another Mercy hospital in Springfield, Mo., where all of his electronic records were available.

“”I knew that they would want to know my medications, dosages and what tests had been done, and I knew that I couldn’t remember all of it,” Johnson said, according to a press release from Mercy. “The doctors in Springfield were able to pull up my records and ask me questions. It worked out beautifully.”

Some would even say he was lucky.

Carl Bergman, from EHRSelector.com, sent me the following email which poses some interesting questions about various certified EHR vendors and the software that they depend on to be certified.

Many of the [certified EHR] products relied on several other software companies to function. Usually this was Dr. First’s Rocopia, Surescripts, etc. However, many others had required several subsidiary modules to work. For example, Pearl EMR lists: MS .NET Framework 3.5 Cryptographic Service Provider; SureScripts; BCA Lab Interface; Oracle TDE.

There is nothing inherently wrong with this, but it raises three questions. Does the vendor include the price, if any, for subsidiary software? More importantly, how well integrated are these programs integrated into the main program? Does the vendor take responsibility if the subsidiary software changes making them incompatible?

He definitely asks some interesting questions. I’d say that in most cases, there will be little issues with the dependent software. Any changes by the dependent software are going to have to be dealt with or in some cases replaced by the EMR vendor. That will just be part of the EMR upgrade process that the EMR vendor does for you.

The only exception might be things like the third party ePrescribing software. Depending on how this is integrated it could be an issue. In most cases, integration with the ePrescribing software can be very much like an interface with a PMS system or even a lab interface. If you’ve had the (begin sarcasm) fun (end sarcasm) of dealing with these types of interfaces you know how it can be problematic and often a pain to manage. I believe the interface with an ePrescribing module is less problematic, but it will exhibit similar issues depending on how the EMR software works with the ePrescribing.

Personally, I don’t have much problem with these types of integrations. As long as the EMR vendor is providing all of the software for you. The reason this is important is because if you get the EMR software from one vendor and the ePrescribing software from another vendor and then tell them to work together, you’re just asking for a lot of finger pointing. However, if your EMR software chooses to integrate a third party software to flesh out the certified EMR requirements and provides you all of the software, then you’re in a much better position. As they say, then you only have one neck to ring if something goes wrong. You don’t want to have to call both vendors and have each vendor point the finger at the other. That’s a position that no one enjoys.

Many of you will probably remember my post about Jim Tate and all his EHR certification experience. As I said in that post, Jim Tate knows his stuff when it comes to the EHR certification bodies (ONC-ATCB). So, I found his advice for EHR vendors on HITECH Answers pretty interesting when it comes to selecting which ONC-ATCB an EHR company should use.

You can go read the whole article, or here’s the Cliff notes version: Responsiveness and Support of the EHR certifying body is most important.

Today, the most interesting thing I heard in the hallway of HIMSS was about ONC and the government’s perspective on the current EHR certification and meaningful use stage 1.

Someone I spoke told me that ONC is vry focused on getting all EHR software certified. It won’t quite be a basic rubber stamp, but ONC-ATCB’s are to work with the EHR vendors to help as many EHR vendors be certified as possible.

Similar to that, ONC wants doctors to easily be able to show meaningful use stage 1. Then, they’ll tighten down on future stages.

On face, this might not seem like a big deal. No doubt, ONC wants as many certified EHR vendors and doctors that are meaningful users as possible.

However, I find it interesting to think that they’re deliberately trying to get as many people as possible meaningfully using a certified EHR even if those users and EHR vendors aren’t likely to be able to comply with future more stringent requirements.

Will this mean we’ll have a whole wave of EHR users having to switch EHR software once the more stringent standards are implemented? Or will doctors just take the meaningful use stage 1 EHR incentive money and then not worry about the rest of the government handout?

I’m not sure the outcome, but it’s definitely something worth thinking about.

I’m not sure how many of you find it interest, but I know I have at least a reasonable number of EHR vendors out there that read this site. Plus, the number of available certified EHR vendors should be interesting to anyone that participates in the industry.

The EMR Daily News recently did a post breaking down the official ONC CHPL list of certified EHR vendors. Here’s my general summary of the numbers:
Total EHR Certifications: 329
Certified Ambulatory EHR: 234
Certified In Patient EHR: 95

I just checked the list myself and found 350 total EHR vendors, 250 ambulatory certified EHR, and 100 Certified In Patient EHR. Although, since those numbers are so round, I’m going to assume that EMR Daily News did a better job looking at the list. I just went off the numbers that the website provided.

Either way, 329 EHR companies is a lot of companies. Granted, that’s not 329 full comprehensive EHR vendors, but the majority of them are or will be. Is there any wonder that there’s such a thirst for tools to help people narrow down the EHR vendor selection process?

EMR Daily news also broke down which ONC-ATCB companies are certifying the 329 EHR vendors:
CCHIT: 54%
Drummond Group: 35%
InfoGard: 11%

I know that SLI is talking to a lot of EHR vendors and I imagine the Verizon associated ATCB is too. Of course, this says to me that there’s still a lot of EHR vendors that are going to be added to this list.

I talked to one industry person about the number of EHR vendors and they said they had 600 on their EHR vendor list. From the looks of this, they might not be all that far off with that number.

Drummond Group has updated their FAQ with an interesting question about how to obtain a CMS EHR certification ID and the difference between the CMS EHR certification ID and the ONC EHR Certification ID that Drummond Group issues.

Q: How do I obtain a CMS EHR Certification ID? Is it the same as my ONC EHR Certification ID I received from Drummond Group?

A: The unique ONC EHR Certification ID issued by Drummond Group is associated with the CMS EHR Certification ID but distinct from it. The ONC EHR Certification ID is one of the “inputs” into the calculation and creation of the CMS EHR Certification ID. However, it is ultimately the CMS EHR Certification ID number which EPs and hospitals will use for the incentive payments.

The ONC Certified Health Product Listing functionality was updated December 24, 2010 and it now has the addition of a shopping cart to create CMS EHR Certification ID number. Users can obtain the CMS EHR Certification ID number by following these steps:

1. Go the ONC CHPL website: http://onc-chpl.force.com/ehrcert

2. Following the instructions on the site, search for the certified EHR products. There are many ways to search, but one option is to search by the ONC EHR Certification ID assigned to the vendor.

3. When the EHR product(s) is found, select the link on its row called “Add to Cart”. There is a shopping cart icon next to it.

4. When all EHR products used by the EP or hospital have been added to the cart, select the “View Cart” link at the top right which also has a shopping cart icon next to it.

5. Now in the Certification Cart section, verify the products in the cart are correct. Then, select the “Get CMS EHR Certification ID” button in the top right corner to request a CMS EHR Certification ID. However, the button will not be activated until the items in your cart meet 100% of the required criteria. If your EHR product(s) do not meet 100% of the Meaningful Use incentives, then a CMS EHR Certification ID number can not be issued.

6. Finally, you will see the CMS EHR Certification ID. It is typically a 15 digit string made up alphanumeric characters.

Interesting that the CHPL website has been redesigned to be able to know which EHR are certified to which module and knows if you’ve reached a 100% certified set of software.

Looks like it also pays off to have a number for your EHR product name so that you’re listed first on the CHPL site.

Ok, was that enough abbreviations in the title of a post? Well, if you care about this post, you’ll probably recognize all of the abbreviations.

In a post I did on EMR and HIPAA about SureScripts as an ePrescribing ATCB, there was a comment made that possibly some of the ATCB were “in bed” with ONC in order to get their EHR certification body status. In response to the comment, Mark Joyce from SLI Global Solutions (an ATCB) provided some good insight into the process and costs associated with becoming an ATCB that can certify EHR software.

As the team lead for SLI’s application to the ONC I can assure you that our company has no political connections, traded favors or made contributions that won us our certification by the ONC. It was 10 weeks of grueling research by two independent companies (one company focusing on testing and the other certification) that resulted in a 1200 page application.

The application was in two parts: part one required both companies to expand and/or create a Quality Management System for the new process. It’s no easy task to develop both a 17025 and a Guide 65 conformant QMS. Part two required the applicant to have a thorough understanding of EHR architectures as well the NIST testing procedures and tools.

It was evident by the followup questions from the ONC that the application had been very carefully reviewed.

Obtaining certification from the ONC was no easy task. I am proud to be a part of our companies significant investment in the ATCB testing and certification process.

Yes, becoming an ONC-ATCB is definitely not a walk in the park to achieve. Anyone that says otherwise, likely hasn’t ever been through the process.