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EMR/EHR: The Good, The Bad & The Uncertain

Posted on June 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.

The following is a guest blog post by Abby Norman from BHM Healthcare Solutions.
Abby Norman
One of the hottest topics in healthcare right now is the great debate about electronic health records. Ideally, the “one patient, one record” dream would create a healthier population, but with many false starts, unforeseen complications both technological and financial and an overarching resentment to change, it seems that the implementation is off to a rocky start. Here’s a breakdown of the pros and cons, as heard in the trenches of medical life.

The Pros

Availability

No matter where you are, or where your physician is, your health information could be accessible in the event of a health emergency. It takes the pressure off you to try to remember your doctor’s phone number, or insurance information, if you’re in a serious accident or land in the hospital while on vacation. On the flip side, when you get home and follow up with your own doctor, you don’t have to try to conjure up all the details of your treatment – they’ve already got it, in real time. Furthermore, your care is better coordinated, in theory. If your vacation doctor can see your record and run their treatments against your history, they’ll be able to make informed choices about how to treat you, while avoiding any adverse reactions or allergies, much faster than if they had to attempt to call your physician. Another benefit to escaping paper records is that, in the case of a natural disaster, the information is stored electronically, in cyberspace, and is immune to fire or flooding.

Reduced Errors

If a doctor can have real-time views of your health information, it’s less likely that they’ll overlook an allergy or contraindication, something that could be missed in the paper chart, especially if it’s misfiled. While there is still room for human error in preliminary EMRs, ideally, there would be less data input by human hands. It’s also much faster to get a longitudinal look at your health care on a computer than in a chart. Some patients who have complex medical needs have volumes upon volumes of paper charts. When I worked in medical records, it was not an uncommon sight for a single person to have as many as eighteen volumes of paper charts. Imagine being a physician, or a nurse, and trying to find something from several years ago.

Tracking and Auditing

Another benefit of the electronic record is that it’s much easier and more intuitive to audit access to the documentation. With a paper chart, it’s hard to keep track of how many hands it passes through- and what, exactly, those hands are flipping to in the chart. With the EMR, you know exactly who looked at what, and when, and for how long. This not only discourages “snooping” but can help direct investigators to the origin of identity theft.

Less Duplication

In the paper chart, if it is misfiled or missing from the file room, there’s always a chance you’ll end up with a duplicate chart. Furthermore, when it comes to creating a medical record number, by which the patient will be identified in the system, EMRs have stopgaps to prevent duplications. Having two medical record numbers can be problematic, not only for health information but billing as well. If there are programs in place in the EMR to “catch” an attempted duplicate, or combine previous duplicates, it will cut back on missing information in the record and inappropriately billed services.

 

The Cons

Advances 

In the last few decades, increasing availability of technology in healthcare has lead to some amazing advances, both for physicians and patients. Documentation for physicians is well on its way to becoming more streamlined, thanks to the interconnectivity of electronic health records, and the potential for “One patient, one record” only becomes more of a reality with each new innovation. Patients who use computers, tablets or smartphones have more access to their health information than ever before, with many patient portals available through participating healthcare systems. With these advances, however, comes risk. Technology is heavily safeguarded, particularly in healthcare, but it’s imperfect. As technology advances, so do the hackers who attempt to find loopholes into healthcare systems. After all, in terms of identity theft, what holds more useful information than a medical record? Perhaps that’s why, in the last year, of all identity theft claims, 43% were medical related. So, when thieves are perusing vulnerable spots, almost half the time they’re looking to healthcare organizations, hospitals and these online portals. So, what are some of these vulnerabilities that you should be safeguarding against?

Insecure Browsers 

Just this last week, Microsoft warned consumers of a vulnerability in Internet Explorer that made users particularly vulnerable to hackers looking to insert malware into their computer systems. While the bug was patched relatively quickly, it was the first time that the United States government actually told users to cease using a browser. A bug that big could easily have made patient portals vulnerable to malware, as based upon consumer statistics, IE has more than 1 billion users; more than any other browser currently on the market.

Unsupported Operating Systems

Microsoft has also recently announced they will no longer support older versions of their Windows operating system (OS). As they are progressing more toward the chic, Mac-like appearance and functionality, it didn’t come as much of a surprise that they are all but abandoning older OS’s. The problem is, smaller healthcare organizations, as well as patients and consumers, may take the “don’t fix it if it isn’t broken” mentality and continue to use an unsupported Windows OS to avoid the costly upgrade. This leaves them vulnerable to malware, loss of data, and many other inconveniences that could potentially cause enormous problems if they store or access personal data through their computers.

Electronic Records

Even though most EMRs on the market claim that they are “bulletproof”, they are clearly not immune from serious threats of patient information seeking hackers. This risk intensifies when physicians and patients use third-party applications to access electronic records, or email, on iPhones and tablets. Handheld devices may not be under the same amount of scrutiny as hospital or office computers. Particularly in the case of “remote” work, there might be technological vulnerabilities that go virtually unrecognized until a threat is made.

Inside Threats

Again, with EMRs, comes the potential for hacking — but from within an organization. Not that this is vastly different from the information that could be gleaned from a paper chart by a snoop, but with technology making it much easier to capture and send data, the breaches can now happen faster — and reach a greater distance. Where an “inside hack” of days past might have jotted down names, dates of birth, and social security numbers–not to mention billing and insurance information– from a few paper charts, now, someone who intended to breach an organization’s data could obtain hundreds of patient charts with much less effort. Audits at an organizational level need to be done routinely to safeguard against this, and users of the electronic records need to be made aware of access policies. Those policies may need to be revisited several times a year, and adjusted, to meet the demands of healthcare’s ongoing reliance on information technology.

Lack of Upper Level Understanding

Healthcare leaders are overburdened as it is by the growing demands and changes necessitated by healthcare reform. IT security needs to be higher on their list of priorities, but it’s easy for it to fall through the cracks. CEOs of 2014 were not educated during a time in history when technology pervaded every element of one’s personal, professional and social life. Quite frankly, the general lack of understanding in upper level management stems both from disinterest and lack of exposure. While the education is there, technology is vast and can’t be grasped overnight, or through one seminar. To understand and to use efficiently the technological advances available to medicine are two completely different arenas, and many healthcare CEOs who are at the end of their tenure may not see the point. But the reality is, technology is quickly becoming the foundation for many industries, not just healthcare, and to continue to place it lower on one’s priority list is a grave mistake that will have financial ramifications.

The future of EMRs is uncertain, but one thing remains clear: we ultimately still want to pursue the “one patient, one record” ideal and in order to achieve that we might need to head back to the drawing board.

Abby Norman is a writer and health guide living and working in Maine. She writes for BHM Healthcare Solutions and has had work featured in The National Medical Records Briefing, HuffPost UK, SALTArtists and The Almost Doctor’s Channel, as well as many international print and online publications.

3 Keys to Improving your EHR ROI

Posted on December 6, 2013 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 of you know, I’m a big fan of EHR. However, we still hear of many cases where the EHR isn’t living up to its potential. In most cases, they start talking about the ROI of their EHR software. While there are many reasons why a practice could not be seeing an ROI on their EHR software, the reality I’ve seen over all these years is that an EHR ROI is possible, but it takes the right focus, the right people and the right software to make it happen.

The benefits of EHR software are there and quite clear. What’s not clear is whether your EHR implementation is going to be done in a way that it achieves those goals.

While I still think that EHR selection is the most important factor in determining the ROI of your EHR software, this whitepaper called Improving the ROI of Your EHR: 3 Keys for Success provides a pretty good set of ideas as well. In fact, you should consider the 3 keys in this whitepaper as part of your EHR selection process.

Here are the 3 keys that they offer:

  1. Choose a Product that Enhances Profitability
  2. Optimize Implementation for Faster Time to Value
  3. Attack Meaningful Use in a Way that Maximized Value

The whitepaper digs into a lot more details on what each key really means.

As I look at those keys, I think:

  • Do you have the right software?
  • Are you implementing the software thoughtfully so you get to the value as quick as possible?
  • Can you benefit from the government EHR money?

Of course, there’s a lot of dirty worked involved in each point. EHR ROI doesn’t come without work, but ROI rarely involves sitting back with a cold drink in hand.

EMR Analysis Detects Childrens’ Growth Disorders

Posted on September 16, 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 @annezieger on Twitter.

EMRs can be used to detect growth disorders in children, according to new research published in the Journal of the American Medical Association . The study, which was written up in FierceEMR, used a special automated growth monitoring algorithm integrated into an EMR system to track childrens’ growth.

To conduct the study, researchers compared three “control” years to an “intervention” year. An annual average of 33,029 children were screened, according to FierceEMR.

Researchers found that in a control year an average of four children were diagnosed with a growth disorder. During the intervention year, however, 28 new diagnoses of growth disorders were made among 32,404 children, FierceEMR reports.

Looked at another way, the rate of growth disorder diagnoses was 0.1 per 1000 screened children in the control years versus 0.9 per 1000 screened children in the intervention year, FierceEMR noted.

These study results are part of an emerging body of literature suggesting that EMRs to help clinicians detect and manage disease states.

For example, another study appearing in the Journal of the American Medical Association found that EMRs can be associated with a drop in emergency department visits and hospitalizations among diabetics.  That study, which analyzed all of the 169,711 records for patients enrolled in the Kaiser Permanente Northern California diabetes registry during a four-year period, found a 10.5% decline in hospitalizations for preventable ambulatory care sensitive conditions where EMRs were in use.

Another study, which recently appeared in BMJ Quality & Safety, recently concluded that EMRs can help reduce hospital readmissions of high-risk heart failure patients by sorting out high from low risk patients in the ED.

5 EHR Myths

Posted on July 1, 2013 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’ve been debunking EHR myths for the 8+ years I’ve been blogging about EHR software. There are a lot of them. Some are perpetuated because people don’t want to change. Others were true, but aren’t true today. Others are just complete misunderstandings of the benefits and challenges of EHR Myths.

ADP AdvancedMD has put out a whitepaper called “EHR Myths Debunked: 5 Status Quo Myths that Hold You back and Reduce Your Bottom Line“. You know I couldn’t resist taking a look at such a whitepaper. I was quite pleased the it was full of a lot of numbers related to EHR.

For example, it says the cost of “creating a new chart” is $7. I imagine they’re taking into account the cost of the materials and the cost of the person creating the chart. They also look at the costs of replacing a chart, pulling or refiling a chart, faxing a chart, storing a chart, etc. I love how many doctors take these EHR benefits and sweep them under the rug. It’s really interesting to put a dollar value to them and consider how those costs add up.

In some ways, the EHR Myths whitepaper covers a lot of the areas I’ve talked about in my EMR and EHR Benefits series. It really is amazing how many EHR myths there are out there and the whitepaper looks at 5 of them that are worth analyzing. I wish the whitepaper would have also covered some of the possible negative impacts EHR can have on a practice like physician productivity. Although, most practices are really good at analyzing the negative side of EHR, so the numbers in this whitepaper will help to round out your analysis of EHR.

I’d love to hear your thoughts on the myths talked about in this whitepaper. Are there other EHR myths that those in healthcare should know about? Do you agree with the 5 myths mentioned in the whitepaper?

Is Your EHR Stupid?

Posted on March 20, 2013 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.

Yes, I know it’s a bit of a salacious title, but I think it’s an important question. Although, the answer to the question is completely obvious. Yes, your EHR is stupid.

At least the current state of EHR software is a bunch of dumb data repositories of healthcare information. That’s not to say that EHR software today doesn’t have value. The current EHR software can have tremendous value as I’ve been highlighting in my EHR benefit series. Although, just because something is useful and beneficial, doesn’t make it smart and also doesn’t mean we’re anywhere near the potential benefits that EHR will provide.

It’s worth considering a quick look back at how we got to where we are in the EHR world. First, EHR’s (really EMR if we’re splitting hairs) were created to be big billing engines. Since that was their goal, they got really good at it. In fact, the ugly spew of information that we know as templated notes came out of this desire to meet billing requirements easily.

In the next stage of EHR’s history, we layered on EHR certification and meaningful use. That’s right, EHR vendors went from coding software to increase a doctor’s ability to bill to now creating software that meets a set of government regulatory requirements.

Considering this history, is it really any wonder why we’re having a discussion of the EHR backlash that we see happening today?

While many might think this is a doom and gloom perspective. I’m actually incredibly optimistic about the future of EHR and the impact for good it can have on healthcare. Why am I optimistic?

My optimism stems from a number of different areas. First, I have tremendous respect for the creativity of people. I’m certain that we as a people will come up with EHR solutions that benefit healthcare greatly. Second, I think the “stupid EHR” that we have today lay the groundwork for all of the future benefits that will come.

This second point is a very important one. Most of the time people look at innovative ideas and think that they just came out of no where. Instead, when you start to study innovation you realize that most of the very best innovations have come from a mixture of small changes that are put together in a way that no one could have conceived before. I think we’ll see this applied to the EHR world.

The best example of this is what the IBM Watson technology is doing in healthcare. It’s great that a technology like Watson can take in so much information. However, Watson wouldn’t be able to learn anything about healthcare if the data wasn’t in digital form. That’s right, the simple process of having medical knowledge available in electronic form is an essential building block for something as powerful as Watson. The same is true for Watson’s analysis of a patient’s chart. How could Watson analyze a patient if all of their patient information was stuck in an offline world? Each move into the electronic world facilitates the next layer of innovation.

Yes, your EHR is stupid, but that’s ok. Just wait until you see the creative ways entrepreneurs and innovators will take your stupid EHR and make it smart.

If you have examples of this, I’d love to see them. If you have ideas of how to make a smart EHR, I’d love to hear them.

Results of EHR Motivation Poll

Posted on November 14, 2012 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.

A few months back I posted a poll asking “Which Factor most influences your EHR use?” I was really interested to see the results of this poll since I often think that most clinics are so blinded by the EHR stimulus money that they lose touch with the reality of running a clinic.

Here’s the results from the poll:

As you can see, the results are pretty dramatic. At least the majority of readers of EMR and EHR are implementing an EHR for something more than the EHR incentive money. This is a very heartening thing for me. Not that any clinic should ignore meaningful use and the EHR incentive, but I’m glad that most are focusing on the benefits of an EHR to their clinic more than meaningful use and government handouts.

This gives me added motivation to start a series of posts on EMR and HIPAA about the various EMR and EHR benefits not related to EHR incentive money. I hope that series will help those implementing an EHR find all the benefits possible from EHR use. Watch for that over the next couple days.

Study: EMRs Improve Ambulatory Care

Posted on October 30, 2012 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 @annezieger on Twitter.

A new study done by researchers from the Weill Cornell Medical College has concluded that community-based physicians who move to EMRs can improve care meaningfully.

The study, which was done in collaboration with New York’s Health Information Technology Collaborative, gathered baseline year data gathered from 500+ physicians in ambulatory practices and 75,000 patients with five different health plans in New York’s Hudson Valley.  They then compared quality scores for EMR-using physicians and those without EMRs.

Researchers concluded that 56 percent of physicians who were using EMRs scored significantly higher on quality of care provided, particularly in managing chlamydia, diabetes, colorectal cancer and breast cancer.  A combined score across nine quality measures also also suggested that EMRs helped generated better care than paper-based records overall.

What made the study results particularly interesting, researchers said, was that the physicians using EMRs used off-the-shelf systems which hadn’t been specialized to achieve these kind of results.

Researchers seem to think that the improved ambulatory results are just the tip of the iceberg:

EHRs may improve the quality of care by making information more accessible to physicians, providing medical decision-making support in real time and allowing patients and providers to communicate regularly and securely,” says Dr. Rainu Kaushal, director of the Center for Healthcare Informatics and Policy and the Frances and John L. Loeb Professor of Medical Informatics at Weill Cornell. “However, the real value of these systems is their ability to organize data and to allow transformative models of health care delivery, such as the patient-centered medical home, to be layered on top.” 

Interesting. I would have assumed that reminders and warnings had generated , as they certainly help doctors make sure overworked doctors are on target with tests, avoid drug interactions and the like. But researchers like Dr. Kaushal and her colleagues seem to think that the big EMR payoff will come as EMR systems change the core models doctors use to deliver care.

Given that new models are all but inevitable at this point, I guess we’ll get to find out!

What’s Your EHR Motivation?

Posted on September 6, 2012 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.

Ever since I first got a job implementing an EMR system, I’ve been fascinated with the idea of the benefits that could be had with using an EMR. In fact, back in 2006, I started a list of EMR and EHR benefits on my EMR and HIPAA blog. I haven’t touched the page in a while, so I think I’m going to do a series of posts on EMR and HIPAA about each possible benefit.

Before I dive into those details, I thought it would be interesting to post a poll about what is motivating a physician’s use of EHR. This is a simple poll, and it’s meant to be simple. Notice that it says most influences. We all know that both things influence decisions. I did add the “Other” option though for those that might want to share something else.

I think this poll will be quite revealing. I’ll be sure to share the results in a future post.

Costs of Healthcare, Benefits of Healthcare IT and Health Tracking at #chs11

Posted on October 21, 2011 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.

Seems like people really liked my tweets from yesterday at the Connected Health Symposium. So, I thought I’d do it again today. Here’s some of the interesting tweets I saw and wrote during the Connected Health Symposium.

The cost of healthcare was a major theme throughout the entire conference. I agree completely that as patients start to pay more of their healthcare, they need more information and make better decisions.

I found this really interesting. Twitter (and even this blog) doesn’t quite capture the irony of the statement. Basically, Dr. Tippets from Verizon really highlights how if we did IT right in healthcare we have the potential of saving lives and live longer. Both noble goals.

I think Blumenthal might have actually said Healthcare IT instead of EHR, but there’s a lot of overlap in this. I agree with Blumenthal that the media and even blogs like mine love to write about the negative more than the positive. It makes for a compelling headline. Maybe the people behind the good research studies need to promote themselves more too.

This kind of hit me on multiple levels. First, I found it interesting that 15% are tracking their weight and exercise. Is that too low? It’s probably the highest level of any other healthcare data tracking app. I wonder where the rest of the apps stand. The second thing that hit me was the fact that doctors aren’t using this data. Finding some way to make it easy and useful for doctors to use all this collected information is going to be a challenging, but important next step. I’ll be interested to see how EHR companies work through the process of taking that data and integrating it into their EHR software. It won’t be easy, but I believe patients will love this type of integration. Plus, it would encourage many others to start using these medical devices.

Does an EMR Improve Patient Care?

Posted on September 16, 2011 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.

Everyone probably realizes by now that I love to read first hand experiences with EMR and EHR. I guess I’ve always loved stories and I’ve always loved to tell stories, so maybe that’s where that comes from. I guess this is why I loved Katherine Rourke’s post called “Would An EMR Have Improved My Son’s ED Care?” on the Hospital EMR and EHR website. It’s a great read if you love first hand experiences with EMR as I do.

Katherine does raise a challenging question, “Does an EMR improve patient care?”

In past presentations, I’ve always put the idea of an EMR improving patient care under the “possible EHR benefits.” (See a full list of EMR and EHR Benefits) As many things in life there’s a big “Depends!” that is the b est answer to that question. The answer to this question depends on what kind of care you were offering previously, the type of care you offer, the EMR you chose, the features you chose to employ in that EMR, the match between your workflow and the EMR workflow, and I’m sure another dozen other depends as well.

What’s more important to point out is that an EMR can improve patient care. I certainly can’t guarantee that an EMR will improve patient care in your clinic, but I’ve seen many cases where it has improved patient care and so I know it’s possible. The biggest determining factor in whether an EMR will improve patient care in your clinic is your desire to have it do so.

Many times in life, you get what you want. Do you want an EMR to improve your patient care? Or were you too focused on wanting to get the EHR Incentive money? Not that these and other benefits are mutually exclusive, but the focus of your EHR implementation matters a lot. Make sure you’re focused on the right things and your EMR selection and implementation will go 100 times better. In fact, it will even improve patient care if you want it to.