One foggy morning last week, I made my way to the Georgia State Capitol for a Technology Association of Georgia (TAG) Health event relating to the intersection of healthcare IT and state legislation. Little did I know that the state’s government is somewhat unaware of the benefits HIT can bring, both to the patient in terms of more coordinated care and improved quality outcomes, and to the state in terms of job creation and revenue.

I also was not aware that, when it comes to moving from paper to electronic health records, some doctors take a bit more convincing than others. And when I say “a bit,” I really mean they may need to be gently dragged kicking and screaming into the digital age. At least that’s the impression I got at the TAG event after speaking with Sherri Mesquita, an EMR/EHR Consultant – Project Manager, at Community Health Systems Inc. She works with ambulatory clinics and hospitals to help them establish strategy around meeting Meaningful Use deadlines, and has developed a keen sense of when doctors may need an extra “bit” of convincing.

What do you think the biggest challenge is for doctors when it comes to accepting that it’s time to change – to make the move from paper to electronic health records?
I believe the biggest challenge is that in order for them to understand how the EHR experience will be beneficial, you have to get them to actually buy into the idea of an EHR. Doctors want to know that the ROI on their investment is going to bring increased revenue to the practice/hospital, provide more efficiency in the practice, and above all provide the best possible quality of care while keeping costs down.

Physicians talk to other physicians about these newer technologies. If they see their cohorts are doing well, and consistently discuss the positive attributes of the EHR software, other physicians are more likely to follow them in adoption – depending on how much money, time and staff resources are currently available.

In addition, some physicians have already implemented an EHR system in the past and, unfortunately, did not get the right information or customer support, or the vendors were not trained in how and which system works best for that specific clinic. Therefore, those doctors have not had a positive experience in the past, and even went back to using paper after spending thousands of dollars on a system that either was not customizable or did not integrate well with the other practice management or billing programs.

In your experience, when does the light bulb go off in a doctor’s mind – when do they realize that it will truly be to the benefit of their practice, their bottom-line and, ultimately, their patients?
There needs to be a lot of hand holding in the beginning stages, and education is key to them seeing what benefits to the practice an EHR can be. Other doctors again are a very important and vital aspect to implementing an EHR. They bring actual experience and important testimony for the process of going electronic.

Last year, I worked on a program with the Rockdale Chamber of Commerce in Georgia to provide a “transfer of knowledge to doctors” by educating them on the important benefits of implementing an EHR, as well as adopting “Lean” and “Continuous Improvement” in their practices. The purpose of the CI/Lean techniques is to achieve unity of purpose to identify and sustain improvements to patient critical needs.

How do you help them reach this point? What examples do you typically give to show them the value of an EHR?
Though the initial costs and implementation challenges are considerable, delaying implementation today may create additional resource drains tomorrow. The availability of an EHR may soon be a minimum standard for new physicians, public and private payers, and patients.

• EHRs are an essential component of reform-related efforts such as the Patient-Centered Medical Home (PCMH).
• Practices that do not meet Meaningful Use criteria will face Medicare penalties in 2015.
• A certified, operating EHR will be essential to participation in both public and private pay-for-performance programs expected in the future.
• According to the Deloitte Center for Health Solutions, 42 percent of consumers are interested in establishing an online connection to their physicians through a personal health record and 55 percent of consumers want the ability to communicate online with physicians.

Can you give any specific examples of EHR implementation success stories? Or perhaps from the other viewpoint – an example of a doctor or practice that absolutely refused to make the transition, and why?
Most recently, I have worked with ambulatory practices in Toledo, Ohio – Catholic Health Partners. The doctors and nurses fought it every step of the way, and even threatened to leave the practices. It was a very hard adjustment in the beginning, and for me as a consultant to come in and change the workflow processes and implement new software rollouts was such a challenge.

I was able to work one on one with the clinical staff and help them to understand they had someone there to guide them through the entire process. They definitely demonstrated gratitude when they could see the end result after two weeks of being live with the software. The practices needed to make sure they scheduled their patients at a 50-percent reduction rate to accommodate the change in software for the first two weeks.

The practices gradually implemented the EHR software of Epic, which resulted in maintaining positive patient-physician relationships and fostering the sharing of medical information. After demonstrating proficiencies, the physicians and other clinical staff were comfortable with the new EHR systems and even say they could then see the potential benefits of the new changes.

I came upon this comment from Kay Kirchler, MD in regards to the ePrescribing penalties and other government incentive money for health IT. You’ll have to overlook the poor grammar and abbreviations, but I wonder how many other doctors feel the way Dr. Kirchler does.

who made all these rules and why are we just lying down and taking it? the arbitrary requirement for “10 escribes ” by june 30th or “penelty” when our emr ( we have had emr for >>10 yrs) will not escribe due to delay in “retro-fitting ” our emr instead of spending yet another fortune for a new “government approved ” version. the requirement to print out visit note to be available w/i 3 days rule .. rediculous. pts dont want it , not going to pick it up, costly and opens door for pts info to be floating out in parking lots, garbage cans etc .. i could go on for days. i spend more time loading info in emr ( much more w “meaningless use” than i do taking care of the patient .why are we not organizing to stand up and fight this power grab !!!!

The line that gets me is the one where he says that he spends more time loading data into the EMR than he spends with the patient. As a patient, the idea of this just makes me cringe. However, it’s a reality for many.

The other part that is quite interesting is that there really haven’t been many physician voices in all of this. There’s definitely not been any #OccupyMeaningfulUse protests happening by doctors. The closest thing I’ve seen to doctors rising up against Meaningful Use and other government programs for health IT has been at medical association conferences where doctors have gotten quite worked up. However, the message rarely leaves the medical conference. Plus, the majority of doctors in the room just shake their head, but don’t do anything after that.

I imagine many doctors look at it and see EHR software as the inevitable.

I recently saw a tweet to the National Conference of State Legislatures (NCLS) list of “Top 12 Legislative Issues of 2012.” It’s an interesting look into issues that state legislatures will be dealing with in 2012. Plus, it makes an interesting observation at the outset that state budgets have been cut so much in past years that lawmakers won’t have to focus all of their initial energy on budget shortfalls.

Most of the list is not surprising with managing the state budget and jobs are at the top of the list. However, there are a couple healthcare and health IT related sections in their list of top government issues as well.

One of the issues is Medicaid: Efficiencies and quality. It talks about how the tough economy is making the Medicaid budgets in states a real challenge and many are looking for cost containing actions. Plus, it points to ACO type reimbursement based on patients’ health outcomes, medical homes and streamlining services. The ACO part was quite interesting to me. I wonder how much of an effect lack of Medicaid budget will push forward a new model of healthcare.

The disturbing part of the report comes in the “Health: Reform in the states, health care exchanges, technology and benefits. Here’s the section on health IT, the EHR incentive money and HIEs.

HEALTH INFORMATION EXCHANGE: One focus for state legislatures in 2012 will be how to move health care providers, especially those participating in the Medicaid program, toward the adoption of certified electronic health records (EHRs). Essentially, instead of having a different health record at each doctor or provider you visit, an EHR will serve as one file that all of your doctors can see. EHRs, once fully implemented, are expected to provide doctors and health professionals with easier access to patient histories and data, resulting in cost-savings and better health outcomes by removing costly errors and duplications in services.

I love how this basically assumes that by having widespread adoption of EHR software, that we’ll then have one patient record that each doctor you visit can see instead of having a different health record at every doctor. Of course, those of us in the EHR world know that this is a far cry from the reality of EHR software today. In most cases you can’t even share a patient record with someone using the same EHR software as you let alone sharing a patient record with a doctor who is using a different EHR.

The sad part is that whoever wrote these legislative issues must have realized that there was some issue with EHR software exchanging information, because then they wrote the following about the state HIE initiatives.

In addition, states are responsible for building and implementing health information exchanges (HIEs) where those EHRs can be accessed by health care providers. HIEs function like an online file cabinet where your medical record is securely stored, and can be accessed by any doctor or health care professional you visit. By mid-year 2012, every state should have Medicaid EHR Incentive programs in place and will be working toward building an HIE by late 2014 or early 2015 as required by deadlines attached to federal cooperative agreements.

So, wait. If EHR software has created one file where any doctor can access our patient record, then why do we need “an online file cabinet” for our medical records? We know the answer is that we need the online filing cabinet because EHR software isn’t connected and there isn’t one patient record. Each doctor maintains their own patient record and that’s not going to change any time soon.

The above quote also implies that every state is working towards an HIE program per the federal program. I must admit that I haven’t gone through every state, but is every state working on an HIE? I certainly know there are a lot of states working on some sort of HIE project, but I didn’t think that every state had funding for HIE. I guess maybe the question is whether there is any state that doesn’t have some sort of HIE program in the works.

Reading issues described like this, you can understand how government passes legislation with limited understanding. Based on this resource, EHR software creates one patient record. Wouldn’t that be nice if it were the case?

#AHIMA11 these people talking about a genomics-based #EHR are blowing my mind…storage vendors must love the concept…lawyers, too

— Don Fluckinger (@DonFluckinger) October 4, 2011

This is a pretty old tweet that I’d stored away, but I’m completely interested in the idea of a Genomics based EHR. I meant to reach out to Don Fluckinger to see what he was talking about. I don’t think that there is any EHR that is based on Genomics. Although, if there is I’d love to know about it. Instead, I’m pretty sure that Don is just talking about integrating Genomics into EHR software.

I’ve made this prediction for a number of years now: Genomics will be part of the EHR software of the future. Genomics is one of the core elements that I think a “Smart EMR” will be required to have in the future. I really feel that the future of patient care will require some sort of interaction with genomic data and that will only be able to be done with a computer and likely an EHR. I love some of the quotes by Shahid Shah in this eWeek article about Digital Biology and Digital Chemistry.

As I think about genomics interacting with EHR data and the benefits that could provide healthcare going forward, I realize that at some point doctors won’t have any choice but to adopt an EHR software. It will eventually be like a doctor saying they don’t want to use a blood pressure cuff since they don’t like technology.

I have been thinking more and more about ACOs coming together and the ACO movement in general lately. Everything seems to be heading straight towards the ACO reimbursement model and so I think we all better start to consider what that’s going to mean to a clinic. Plus, in my case I’m particularly interested in how EHR software will enable the ACO to work properly.

It is quite clear to me that EHR software and technology in general will be one of the core pillars to a successful ACO.

As I thought about ACOs, the question came into my head: How will an ACO deal with a non-compliant patient?

Since the ACO reimbursement is tied to the health of the patient, then patient non-compliance becomes a really important issue. Plus, patient non-compliance is an incredible challenge since the physician only has so much control over a patient once they leave their office. In fact, they only have so much control of their patient even within their office.

I certainly don’t have all the solutions to this problem, and I’m not sure how reimbursement will handle a doctor who did everything right to improve the healthcare of a patient and they chose not to comply. However, this makes me start to think of ways that technology could help a doctor to improve patient compliance.

I’ve written before about some really great mobile health applications for people with diabetes. It was amazing to see how simple text message reminders could improve compliance by patients with diabetes. There are probably dozens and maybe even hundreds of other models where mHealth could improve patient compliance.

One of the real challenges I see with this is that much of this compliance could best be served by an EHR software connected to the patients. Unfortunately, most EHR software is so busy helping the doctor do what he needs to do in the office and meeting government guidelines that EHR software doesn’t have the focus to create these types of connections with the patient which could improve patient compliance. I’m not sure they will ever have this focus.

This is why EHR vendors need to fully embrace the idea of creating an ecosystem where smart “app developers” can create these patient compliance apps that connect directly into the EHR software. This won’t be easy for EHR companies to embrace, but those that do and do it well will be wildly successful. Plus, they’ll improve healthcare in the process.

Are there other ways that ACOs will deal with non-compliance by patients? I’d love to hear what people think.

I’ve gotten word from a couple of different places now that a number of RECs have had to open up another RFP to increase their “preferred” (or whichever term they like to use) EMR vendor list in order to reach the number of meaningful EHR users they need to reach.

Most of you that have read my stuff for a while know how much I dislike how many of the RECs approached the EMR selection process. There are a few RECs that have done a great job of remaining neutral and supporting any and all certified EHR vendors. I applaud their efforts.

I’m just really glad that doctors weren’t fooled by RECs’ preferred vendor lists. The idea that a REC could identify the appropriate EHR vendor for such a wide variety of doctor specialties, sizes, etc is just wrong. I’m glad that the net has been widened by many RECs even if their hand seems to be kind of forced into it to meet their numbers.

I’m fine with RECs specializing in certain EHR software. There’s no way they can be experts in all 300+ EHR software. However, the EMR selection should be driven by the doctors and practice managers and then the RECs support the EMRs selected most often by the actual users.

I guess now we’ll see if RECs start searching for the low hanging fruit to meet their numbers.

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.

Information matters when patients are paying for their healthcare. #HighDeductiblePlanMember #chs11

October 21, 2011 10:18 am via webReplyRetweetFavorite

@techguy

John Lynn

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.

RT @perficient_hc: Dr Tippet: If #healthit was as strong as IT in Finance we’d save money and live longer #chs11

October 21, 2011 10:30 am via HootSuiteReplyRetweetFavorite

@Independa4U

Independa, Inc.

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.

“The literature is overwhelmingly positive on the benefits of EHR, but the negative gets more attention.” -Blumenthal at #chs11

October 21, 2011 9:22 am via webReplyRetweetFavorite

@techguy

John Lynn

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.

15% of Internet users track weight diet or exercise routinely online but h/c is not using this #CHS11

October 21, 2011 10:31 am via TweetDeckReplyRetweetFavorite

@drnic1

Nick van Terheyden

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.

I still remember the first time I heard about Practice Fusion offering a Free EHR. My first response was, “Really?” Of course, having Practice Fusion as an advertiser, being on stage at the Practice Fusion User Group meeting and a number of other interactions with other Free EHR vendors like Mitochon Systems (also an advertiser) has opened my eyes into the real business model behind the “Free EHR” software.

As I thought on the Free EHR business model, I wondered whether some EHR vendor will come out and actually pay doctors to use their EHR software. Yes, that’s right…

An EHR Vendor that Pays Doctors to use EHR.

I haven’t seen one yet, but I could see it happening. It’s not a business model that I would navigate, but I wonder how the Free EHR vendors would react if a well funded venture backed EHR company came out and offered to pay doctors to use their software. Basically, this new company would be doing to the Free EHR vendors what Free EHR vendors did to the rest of the EHR industry.

Would someone really have the moxie to do such a move?

Would the ads, research or other revenue models play out so well that someone could pay doctors to use an EHR?

I’m not talking about the government paying doctors to use an EHR. That’s a different thing all together. Maybe the EHR vendor that does it could be one that’s a sinking ship and making a last ditch effort to somehow monetize their EHR since their EHR software is great, but their EHR marketing is lacking. What better way to improve the marketing of your EHR than paying doctors to use it?

It’s a crazy world that we’re living in today. The market is on a roller coaster. The riots in London. A lot of other crazy things happening. Not the least of which is the high unemployment in the US. Despite the challenging times, I’m not seeing as many of the same challenges in healthcare IT.

This was higlighted in some recent tweets I saw that talked about the job growth that’s happened in healthcare. That’s right, healthcare has actually had job growth. It’s quite amazing to consider, no?

Healthcare IT is especially interesting thanks to the $36 billion in EHR stimulus money. It’s a frother EMR and EHR market out there and I expect the froth is going to continue for another couple years. Is it fair to say that we’re in an EMR and healthcare IT bubble? I think so.

The question I’m starting to consider is what’s going to happen when the bubble pops? I’m not sure that we’re going to see one big pop in the EMR market. Maybe I’m wrong, but I think that we’re going to see a long protracted fall out of EMR and EHR companies. I guess this type of slow failing EMR companies is better than a major pop, but it still doesn’t sound good.

Well, at least it doesn’t sound good for those clinics who are using the EMR software from the EMR companies that fail. However, it’s going to present some interesting opportunities for EMR companies that can clean up the mess that’s left. Of course, most of us won’t know the details of the mess. We’ll just see flowery announcements about EMR companies selling off to larger EHR companies. However, those acquisitions will be a great customer acquisition buy for the EHR companies who have the cash and can transition users effectively to their EHR software.

How far off is this? I’d say at least 2 years. So, the next 2 years are going to be an interesting time for EHR vendors that are trying to position themselves for these types of acquisitions.

A little while back I came across this EHR comparison chart on the Amazing Charts website. I was really intrigued. The first thing to note about the chart is that this is a page that’s designed to “sell” the Amazing Charts product. It’s actually a really smart move by Amazing Charts to use these comparisons as a way to increase their profile and compare them against many of the large EHR companies out there.

My biggest problem with an EHR comparison chart like this is that Amazing Charts conveniently decided to list themselves against a whole list of the HUGE and generally legacy EHR software companies. I don’t see the comparison chart including any of the Free EHR vendors. There are no EHR software companies that have come out in the past couple years on that list. There aren’t any of the more nimble EHR software companies that have done similar to Amazing Charts and focused on building an EHR company using revenue instead of outside funding.

Point being that an EHR comparison chart should include more of the 300+ EHR vendors that are out in the market today. If you only compare yourself to the largest and most expensive EHR software, then of course you look a lot cheaper. Plus, it seems they also focused on the most expensive EHR software from the companies that offer multiple EHR software as well.

The other challenge that they note in a footnote is that getting good pricing and EHR market share data is really hard. Most providers don’t publish it and as Dr. K mentions in this well written Future of Meaningful Use piece, “The sum of the number of installed users claimed by each of the top EMR vendors exceeds the number of practicing physicians in the U.S.”

Then, that EHR comparison chart also focuses a bit too much on the various EHR ratings services. I won’t dive into my feelings about the EHR ratings services that exist out there. Let’s just say that I wouldn’t base my EMR selection on any of those ratings services.