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ONC’s Budget Performance Measure Dashboards Makes Goal Tracking Easy

Posted on August 9, 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.

I recently wrote a post how it’s not easy to compare ONC’s spending plans with what it actually did. That’s not the case with ONC’s Budget Performance Measures. Its Performance Measure dashboard makes those comparisons easy and understandable. For example, you can look up EHR adoption among office based physicians.

Here’s how to use it. On the dashboard page, Figure I, select a general area using the radio buttons. Depending on your choice, the system will list specific issues. You select the one you want from the drop down menu on the right. You can also adjust the period covered. Right clicking a graph downloads it.

Figure I – ONC Dashboard Menu

ONC Dashboard Menu

It’s in the graph that the dashboard excels. It clearly shows targets and results. For example, Figure II shows that while office EHR adoption has grown over the years, it’s running below ONC’s goals. If you’d only saw the actual – which is the case with ONC’s budget — you’d only see adoption going up. You’d have no clue ONC’s goal wasn’t met.

Figure II – ONC Primary Care Adoption

Office Based Primary Care Doc Adoption

These dashboards give the public a way to understand what ONC wants to do and how well — or not so well — its done toward its goals. In doing so, ONC has given us a scoreboard that not only measures what it’s doing, but it also allows the public to focus on benchmarks. ONC’s fiscal reporting isn’t the clearest, but with these dashboards they’ve done themselves well.

EHR Usage – Best and Worst States

Posted on September 11, 2015 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.

A recent Becker’s article used some CDC data to rank the best and worst states when it comes to EHR usage. Here’s the top 8 states for EHR usage:

• North Dakota — 79.1 percent
• Minnesota
• Montana
• North Carolina
• South Dakota
• Utah
• Wisconsin
• Iowa — 64.7 percent

And here are the bottom 6 states:

• Tennessee — 38.5 percent
• Florida
• Louisana
• Nevada
• Rhode Island
• New Jersey —29.2 percent

What’s ironic is that just this week I was talking with someone about me writing this healthcare IT blog from the healthcare hub known as Las Vegas (that’s a joke for those following along at home). This person commented that Nevada was way behind on EHR adoption and then they added the small caveat, right? I acknowledged that we were behind, but I must admit that seeing Nevada on this list kind of makes me sad. No one wants their state to be on the bottom of anything.

I did end our discussion by saying that maybe being on the bottom could be a good thing. In other states, they may have rushed their EHR selection and implementation process. If you’re going to choose the wrong EHR or not spend the time to implement the EHR properly, then it might be better to not have an EHR. With that said, I’m still pro-EHR and I hope my state catches up and implements the right EHR in the right way.

Is your state on the list? It would be interesting to see if there’s a correlation between states that have adopted EHR and the quality of care those states provide. Of course, the real challenge is knowing how to measure quality of care.

No Shortage of Excitement (This Week) in Healthcare IT

Posted on March 28, 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.

When I began contemplating the subject of this blog earlier in the week, I thought I’d make room for thoughts on recent improvements in EMR adoption in the small practice and physician community, and the general state of optimism and enthusiasm some op-ed pieces would have us believe is finally taking hold of the industry. But then came along the potential delay of ICD-10, which also begs a quick comment or two.

A bill that included an effort to delay the ICD-10 compliance date a full year was passed, but only after partisan drama over the fact that legislators received the proposed bill just a day before the vote on it was to take place. I tend to turn to AHIMA on ICD-10 matters, and its official stance is fairly obvious:

ahimaicd10tweet

Its reasoning is similar to that of the Coalition for ICD-10, which in a letter to the CMS, stated: “ … any further delay or deviation from the October 1, 2014, compliance date would be disruptive and costly for health care delivery innovation, payment reform, public health, and health care spending. By allowing for greater coding accuracy and specificity, ICD-10 is key to collecting the information needed to implement health care delivery innovations such as patient-centered medical homes and value-based purchasing.

“Moreover, any further delays in adoption of ICD-10 in the U.S. will make it difficult to track new and emerging public health threats. The transition to ICD-10 is time sensitive because of the urgent need to keep up with tracking, identifying, and analyzing new medical services and treatments available to patients. Continued reliance on the increasingly outdated and insufficient ICD-9 coding system is not an option when considering the risk to public health.”

AHIMA has even started a campaign to encourage its constituents to email their senators to urge them to also vote no when it comes to delaying ICD-10. At the time of this writing, the Senate vote is not yet scheduled. I don’t feel the need to restate my support of no further delay. You can read it here.

With regard to the other hot news items of the week, I was intrigued by the findings of the SK&A survey, which found that the EMR adoption rate for single physician practices grew 11.4%. One reason SK&A gave in the survey analysis was due to the “availability of more than 450 different solutions to fit their practice needs, size and budget.” Call me crazy, but I’m willing to bet that many solutions will not exist in the next three to five years thanks to market consolidation. What will these physicians do when their EMR vendor closes up shop? Time will tell, I suppose.

Will Healthcare Ever Solve These Issues?

Posted on January 24, 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.

On James Ritchie’s post on EMR and HIPAA extolling the virtues of Patient Portals, Bill made the following comment:

I visited an ENT practice today for the first time. I was referred by my primary care physician. Guess what? NO PATIENT PORTAL! And this is a large multi-location group. Here’s the really strange part…they bought an EHR 10 years ago and are still using paper charts!!! Flabbergasted!

A couple of days ago, I went to their website, downloaded and filled out the forms. (Yes, I typed them). I then called the practice to ask if they wanted me to fax them so they could get my info entered into their system, the girl replied “no, that’s ok, we don’t create your chart until you get here”. That’s how I found out they are still using paper charts. Unreal!

When I arrived for my appointment today, (NOT 30 minutes early) I could tell the girl at the window was ready to jump on me for being “late”, until I handed her my completely filled out forms. She looked at me in utter amazement. She took my drivers license and insurance card (no, they did not have a scanner for either) so I didnt get them back until I was called back and the nurse gave them back to me. So I had to ask the doctor, “why are you not using your EHR”, he replied, “yeah, we need to start using it” He even commented that he couldnt remember any of his patients that actually typed and then printed the PDF forms. Am I the weirdo here?

Earlier, while in the waiting room, I sat and watched patient after patient go up to the window and get the “high tech” clipboard. They then sat down to fill out their forms…all the while stopping from time to time to text or perhaps reply to an email on their smartphones. The irony. I watched sadly as an older woman was trying to get the forms filled out with what appeared to be great difficulty because it was obvious she didn’t have all of the information with her that she needed. But she had a smartphone. More irony.

Just think if my primary care provider and this ENT group were both using EHR and PP. Perhaps I would of had to fill out NOTHING!! All of my info would of been readily available to the ENT doc. I could view the notes from both of the docs..see my reports and tests results and even forward it to another provider of care if necessary. The study is encouraging, but there are going to be so many benefits once PP’s become mainstream.

I responded to Bill with the following comments:

Such a sad story and far too repeated in healthcare today.

I’ve often said if someone could figure out a way for patients to not have to fill out those dang intake forms, they’d have a golden business. Turns out, it’s a really complex problem to solve because of how many parties are involved and the non-standard way they do it.

Yes, we still have a long way to go to solve even some of the most obvious healthcare issues.

Patient Loyalty, EHR Adoption, and EMR vs. EHR

Posted on December 22, 2013 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.


This is interesting to consider. I’m really not sure how you can measure this result. I think this will eventually be true, but I don’t think we’re there yet. In theory everyone wants their doctor to have an EMR. However, they really just want more services for themselves as patients. That’s very different from what an EMR provides today.


My we’ve come a long ways. Now we’ll see how many organizations end up switching EHR software because they rushed their EHR implementation.


I prefer EMR and I think most doctors do as well. Although, $36 billion has a way of changing things.

More Details From Study: Health IT Could Cut Demand For Physicians

Posted on December 11, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Earlier, we wrote up the following study, which strongly suggests that health IT can boost physician productivity. But we didn’t include some of the details you’ll see below — and we thought they were important enough for a follow-up.

Much of the talk about health IT in physicians’ offices addresses the struggles doctors face when adopting new technologies, and the effort it takes to get productivity back to normal levels. But this study takes things a step further, asserting that if health IT was fully and widely implemented, it could reduce demand for physicians substantially.

The study, which originally appeared in Health Affairs, concluded that if health IT were fully implemented in 30 percent of community-based physicians’ offices, efficiency improvements would cut demand for physicians by 4 percent to 9 percent. What’s more, using health IT to delegate work to midlevel practitioners and from specialists to primary care docs could reduce demand for physicians by 6 percent to 12 percent, according to a story in Information Week.

Meanwhile, growing the amount of IT-enabled remote and asynchronous care could cut the volume of overall care that physicians provide could  have a big impact as well. Remote care could cut the percentage of care that physicians provide by 2 percent to 5 percent, and asynchronous care by 4 percent to  7 percent, Information Week reports.

And that isn’t all. If 70 percent of office-based docs adopted comprehensive IT support, including interoperable EMRs, clinical decision support, provider order entry and patient Web portals with secure messaging, the drop in demand for physician services would be twice as large, the Health Affairs study concluded.

That being said, the comprehensive use of health IT by even 30 percent of office-based doctors is at least five years and maybe as much as 15 years away, according to one of the study’s authors, Jonathan Weiner, professor of health policy and management at Johns Hopkins’ Bloomberg School of Public Health.

Meaningfully Use EHR or Lose Your Medical License

Posted on June 11, 2013 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.

The premise of this article just disgusts me. I must admit that I remembered the discussion of tying medical licenses to EHR adoption, but I’d forgotten that Massachusetts actually passed the EHR requirement law. The topic was again ignited by Hayward K Zwerling, MD in this Health Care Blog post. Here’s the Massachusetts law that he sites:

The relevant law is Section 108 of Chapter 224 of the Acts of 2012, which reads as follows:
The first paragraph of section 2 of chapter 112 of the General Laws … is hereby amended by inserting (the following)… The board (of Registration in Medicine) shall require, as a standard of eligibility for (medical) licensure, that applicants demonstrate proficiency in the use of computerized physician order entry, e- prescribing, electronic health records and other forms of health information technology, as determined by the board. As used in this section, proficiency, at a minimum shall mean that applicants demonstrate the skills to comply with the “meaningful use” requirements (1).

This law, if it remains, would mean that effective 2015 any physician who isn’t a meaningful user of a certified EHR will be denied a license to practice medicine. That means 50-75% of Massachusetts doctors would lose their license to practice medicine. That’s a huge number of doctors. Can you imagine the impact?

Plus, it’s not like Massachusetts is lagging behind the rest of the country in EHR adoption. In fact, Massachusetts is one of the states with the best EHR adoption. I’m really just dumb founded that someone would be willing to propose, let along pass a law like this.

Don’t get me wrong on this. You won’t find someone that’s more interested in seeing widespread EHR adoption. I think there are tremendous benefits waiting for us once we achieve widespread EHR adoption. I just think you’re insane to think that holding physician’s licenses over their heads is the right way to do it. The very worst way to get doctors to adopt EHR is through coercion.

My gut tells me that there’s no way this law will actually go into effect. Something will have to change between now and 2015. Maybe that was the goal of the legislation. Scare people enough so that they adopt EHR and then repeal the law. That’s a terrible tactic if it’s the case. That’s a strategy that leads to even more EHR switching.

EHR Adoption Percentage, EHR Story, and Future of EHR

Posted on May 12, 2013 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 always love to grab the various EHR adoption numbers. Seems like most are hovering around the 60% number now. This one says 57% EHR adoption.


Of course, this is coming from ONC’s Twitter account, but I’m always happy to read someone’s story. If you’re willing to put your name to it, I’m willing to read it and see what you have to say. Plus, he takes a realistic look at some of the benefits of an EHR in a real matter of fact way.


This is probably the most focused and well written description of the real reasons why EHR software is a disappointment today. Unfortunately, the issues described are a fundamental problem with the healthcare system and something unlikely to change in the near future.

US Lags Behind On Physician EMR Use

Posted on February 20, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

US doctors are far behind most of their counterparts in Europe and Australia when it comes to EMR adoption, according to a new study by The Commonwealth Fund.

To get a sense of EMR adoption internationally, the Fund surveyed almost 9,800 primary care physicians representing 11 countries.  The results: the U.S. still  has a ways to go to catch up with peers in other developed nations.

True, U.S. doctors’ uptake of health IT has gone up dramatically, from 46 percent using an EMR in 2009 to 69 percent in 2012, the study found.

That being said, doctors in such countries as the Netherlands, Norway, New Zealand, the U.K., Australia and Sweden all reported EMR usage rates above 88 percent in 2012.  The country with the lowest adoption rate was Switzerland, which trailed all countries in the survey with a 41 percent EMR uptake rate by physicians in 2012.

As for sophisticated usage of EMRs, defined by the Fund as using at least two electronic functions such as order entry management, generating patient information, generating panel information or clinical decision support, the U.S. didn’t make it onto the list of power users. Only the U.K., Australia and the Netherlands had more than 50 percent of doctors who did so.

Despite the gap in usage between other nations and the U.S., I thought the nearly 70 percent rate of primary care usage was a very positive sign.  I don’t know if this jump is 100 percent attributable to Meaningful Use — I believe PCPs see the writing on the wall and will go with EMRs to manage medical home functions regardless — but either way, it’s a sign that changes major and permanent have happened among the primary care flock.

Still, what really matters isn’t just how many PCPs have bought an EMR. What I’d like to know is how many of those 70 percent are tackling Meaningful Use requirements effectively, and how many are still stymied. If I find that data you can be sure I’ll share it here!

ICD-10 Implementations and EHR Workflow Optimization

Posted on December 11, 2012 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.

These two topics don’t necessarily go together, but they were both short and sweet thoughts I’d written down at one of the many healthcare IT events that I’ve attended this Fall (Thankfully I don’t have any travel on my schedule until HIMSS).

Here’s the first one that was said by an EHR vendor:
“Not All ICD-10 Are Created Equal”

Obviously the idea here is that this EHR vendor believes that his EHR has produced a higher quality ICD-10 engine than many of the others he’s seen on the market. It’s interesting that an ICD-10 engine could be so different when the output is exactly the same (a number). Although, when you get into the complexities of how a doctor may go about finding the right ICD-10 code, it makes more sense. Maybe we need to have an ICD-10 lookup challenge with each EHR vendor at HIMSS 2013. Would be interesting to see the results.

This next one was an interesting insight info one of the side effects of meaningful use on EHR adoption. This came from a former hospital CIO and current hospital EHR consultant who said, “There’s no time to optimize as you go anymore, because you have to get to meaningful use to get the EHR incentive money.”

I wonder how many others have seen this change as well. I’ve no doubt seen the rush to implement EHR in order to show meaningful use and get access to the government money for EHR. It’s just unfortunate to think that the process is rushed by the dangling carrot. Rushing an EHR implementation can lead to very bad results in the long term. Many EHR users will be dissatisfied. EHR does not solve bad workflows. In fact, it often accentuates whatever bad workflows may exist.