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Is Interoperability Worth Paying For?

Posted on August 18, 2016 I Written By

When Carl Bergman isn't 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.

A member of our extended family is a nurse practitioner. Recently, we talked about her practice providing care for several homebound, older patients. She tracks their health with her employer’s proprietary EHR, which she quickly compared to a half-dozen others she’s used. If you want a good, quick EHR eval, ask a nurse.

What concerned her most, beyond usability, etc., was piecing together their medical records. She didn’t have an interoperability problem, she had several of them. Most of her patients had moved from their old home to Florida leaving a mixed trail of practioners, hospitals, and clinics, etc. She has to plow through paper and electronic files to put together a working record. She worries about being blindsided by important omissions or doctors who hold onto records for fear of losing patients.

Interop Problems: Not Just Your Doc and Hospital

She is not alone. Our remarkably decentralized healthcare system generates these glitches, omissions, ironies and hang ups with amazing speed. However, when we talk about interoperability, we focus on mainly on hospital to hospital or PCP to PCP relations. Doing so, doesn’t fully cover the subject. For example, others who provide care include:

  • College Health Systems
  • Pharmacy and Lab Systems
  • Public Health Clinics
  • Travel and other Specialty Clinics
  • Urgent Care Clinics
  • Visiting Nurses
  • Walk in Clinics, etc., etc.

They may or may not pass their records back to a main provider, if there is one. When they do it’s usually by FAX making the recipient key in the data. None of this is particularly a new story. Indeed, the AHA did a study of interoperability that nails interoperability’s barriers:

Hospitals have tried to overcome interoperability barriers through the use of interfaces and HIEs but they are, at best, costly workarounds and, at worst, mechanisms that will never get the country to true interoperability. While standards are part of the solution, they are still not specified enough to make them truly work. Clearly, much work remains, including steps by the federal government to support advances in interoperability. Until that happens, patients across the country will be shortchanged from the benefits of truly connected care.

We’ve Tried Standards, We’ve Tried Matching, Now, Let’s Try Money

So, what do we do? Do we hope for some technical panacea that makes these problems seem like dial-up modems? Perhaps. We could also put our hopes in the industry suddenly adopting an interop standard. Again, Perhaps.

I think the answer lies not in technology or standards, but by paying for interop successes. For a long time, I’ve mulled over a conversation I had with Chandresh Shah at John’s first conference. I’d lamented to him that buying a Coke at a Las Vegas CVS, brought up my DC buying record. Why couldn’t we have EHR systems like that? Chandresh instantly answered that CVS had an economic incentive to follow me, but my medical records didn’t. He was right. There’s no money to follow, as it were.

That leads to this question, why not redirect some MU funds and pay for interoperability? Would providers make interop, that is data exchange, CCDs, etc., work if they were paid? For example, what if we paid them $50 for their first 500 transfers and $25 for their first 500 receptions? This, of course, would need rules. I’m well aware of the human ability to game just about anything from soda machines to state lotteries.

If pay incentives were tried, they’d have to start slowly and in several different settings, but start they should. Progress, such as it is, is far too slow and isn’t getting us much of anywhere. My nurse practitioner’s patients can’t wait forever.

EMR Nurses’ Wishes, Doing Good, and Good-Better-Best EHR

Posted on May 11, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of 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.


Seems fitting to start off our Twitter roundup with a nurse related tweet for Nurse Week. Lisa makes an interesting comment in this tweet. Unfortunately, most of the EHR effort is focused on the doctors and not nearly enough time on the nurses. When you look at the nurse interface of many EHR, it feels like an afterthought. It’s too bad since they spend so much of their work life in the EHR.


I wrote this post over on EMR and HIPAA, but I wanted the readers of EMR and EHR to read it as well. I think this is an important question for all of us. What good can we do? Can we do more than we’re doing today?


The concept of Good, Better and Best EMR is a really interesting question. We all know that there are good, better and best EMR, but there’s no really good way to know which EMR falls into which category. Plus, it changes based on an individual clinic or hospital’s environment. I wish I knew an easier way to tell the difference.

EMR Customer Service, EMR Not Meeting ACOs Needs, and Patient Centered EMR Rollout

Posted on April 13, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of 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.


Zappos is in Las Vegas, and I can assure you that this story is true. I’ve always wondered how they’d scale that policy if thousands of people called for pizza. The key I think is that they do focused customer service. Chandresh asks an important question. Which EHR vendors have delightful customer service?


If EHR vendors don’t make the ACO possible, who will?


I’d be more interested in seeing an EHR roll out that considered the patient.

Physician Designed EHR, EHR MU Documentation, and Top EHR Ratings Lists

Posted on March 16, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of 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 really hate this discussion. It reminds me of the republican-democrat debates. They always go too far and both sides (in this case Physicians and EHR vendors) often only see their side and miss the opposite viewpoint. It’s very polarizing. The best situation is the mix of both sides of the equation. Plus, you usually need someone who can help translate and moderate between the two viewpoints. That’s much easier said than done. You can definitely learn a lot about an EHR vendor when you learn if they’re more physician designed or tech designed.


Many people unfamiliar with these standards probably don’t undstand this tweet from Mandi since they assume it’s a standard and so the ONC documentation should be good enough, no? The reality is that every implementation of the ONC standard is different and you have to have documentation of how that EHR vendor implemented the standard.


I appreciate Chandresh’s tweet more than most. I’ve often considered the idea of starting an EHR rating site. They are a dime a dozen and I don’t think any of them are very good. The best ones use some high level filters to help you narrow the search. This has some value, but isn’t really an EHR rating site. The problem with an EHR rating is the sheer scale of responses that you need to collect for it to be valuable. There are 300+ EHR vendors. There are 40+ specialties. There are practices from solo doctor up to hundreds in a multi specialty clinic. There are 50 states. There are hundreds of insurance plans. You get the picture. The number of randomly collected quality ratings you would need is impossible. I enjoy a good list as much as the next person, but just remember what I mention above when you see the next list of Top EHR vendors.

Then again. Maybe Chandresh and I should get together and do an EHR rating service based on if the EHR was a physician designed or tech designed EHR.