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Not All EHR Clicks Are Evil

Posted on April 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.

There’s a great blog post on HIStalk that is a beautiful CMIO Rant. He provides some really needed perspective on the issues with EHR software. In many ways, the post reminded me of my post titled “Don’t Act Like Charting on Paper Was Fast.” In that post, I highlight the fact that far too many people are comparing EHR against doing nothing versus comparing EHR against the alternative. Those are two very different comparisons.

The money line from the CMIO rant was this one:

If we insist that all clicks are wasted time, then we can’t have a conversation about usability, because under the prescription pad scenario, the only usable computer is one you don’t have to use at all.

I love when you take something to the extreme. It’s true that we all want stuff to just happen with no work. That’s perfect usability. However, that’s just not the reality (at least not yet). If we want the data to be accurate and to be recorded, then it takes human intervention (ie. clicks). Some clicking is necessary.

The CMIO goes on to say that the key to EHR usability is expectations. I thought that was an interesting word to describe EHR usability. I’ve written about this topic before when I compared the number of EHR clicks to the keys on a piano. In that article I suggested that the number of clicks wasn’t the core issue. If we could create EHR software that was hyper responsive (like a piano key), was consistent in its response speed, and we provided proper training, then having a lot of EHR clicks wasn’t nearly as big an issue.

Not that this should be an excuse for EHR vendors to make crappy software. They should still do what they can to minimize clicks where possible. However, the bigger problem is that we haven’t achieved all three of these goals. So, we’ll continue to hear many people complaining about all the EMR clicks.

What if the FDA Started Regulating EHR?

Posted on March 20, 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.

In the world of mobile health, we’ve often talked about what will happen if the FDA starts to regulate the various mobile health apps out there. In fact, the FDA has come out with some pretty detailed guidelines on what mobile health applications and devices need FDA clearance. To date, the FDA has stayed away from any regulation of EHR software.

On my ride to the airport after the Dell Healthcare Think Tank event, we had an interesting and engaging conversation about the FDA when it comes to EHR software. Some of the discussion was around whether the FDA would start regulating EHR software.

Shahid Shah suggested that it was extremely unlikely that the FDA would touch EHR software at least until meaningful use was complete and the current President was out of office. He rightfully argues that this administration has hung their hat on EHR and the FDA wasn’t going to step in and stop that program. Plus, Shahid suggested that ONC wouldn’t let the FDA do it either. Janet Marchibroda from the Bipartisan Policy Center was hopeful that Shahid was right, but wasn’t as confident of this analysis.

After hearing them discuss this, I asked them the question:

What would happen to the EHR Market if the FDA started regulating EHR?

Shahid quickly responded that the majority of EHR vendors would go out of business and only a small handful of companies would go through the FDA clearance process. Then, he suggested that this is exactly why the FDA won’t regulate EHR software. FDA regulation of EHR would wipe out the industry.

This is a really interesting question and discussion. The reality is that there are a lot of similarities between EHR software and medical devices. One could make a really good case for why the FDA should regulate it like medical devices. One could make a case for the benefit of some rigor in the development of EHR software. However, there’s no appetite for such a change. In fact, the only people I’ve seen calling for it are those who think that EHR is unusable and potentially harmful to patients. I’m not sure FDA regulation will make them more usable though.

Now, juxtaposition the above conversation with this post by William Hyman titled “A Medical Device Recall of an EHR-like Product” In this case, the FDA announced McKesson’s voluntary recall of it’s Anesthesia Care system. This software was tightly integrated with other FDA regulated medical devices. I wonder what this means for other EHR software that is starting to integrate with a plethora of FDA cleared medical devices and other non FDA cleared medical devices.

I’m personally with Shahid in that I don’t think the FDA is going to touch EHR software with a long pole. At least, not until after meaningful use. After meaningful use, I guess we’ll see what they decide to do.

Survey Takers Show No Love for EMRs

Posted on February 13, 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.

Just in time for Valentine’s Day … in case it hasn’t crossed your device or desk, Modern Economics – a self-described web community for health professionals – recently released the results of a survey that attempted to gauge physicians’ satisfaction with EHRs. Of the nearly 1,000 folks polled, nearly 70% concluded their investment in EHRs had not been worth it. Other stats included:

  • 67% are dissatisfied with system functionality
  • 65% indicated systems resulted in financial losses
  • 45% indicated patient care is worse
  • 69% indicated care coordination has not improved
  • 73% of largest practices would not purchase current system

These numbers certainly reflect what many in the industry have been saying for the last few years, but I find the statistics related to care incredibly high. My friends over at HISTalk.com reported that survey takers were “self-selected,” so I have to wonder if the entire field of respondents was skewed to the negative from the beginning.

I came across an interesting tweet exchange about the survey results:

tweet4

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I’m no expert, but I definitely think the horse has left the barn, and that if a more impartial survey were done, we’d find more providers satisfied with EHRs and their impact on patient care.

In Blue Button news, I came across several articles this week announcing that leading pharmacies and retailers have joined the Blue Button movement. According to HealthIT.gov, these organizations are “committing to work over the next year towards standardizing patient prescription information to fuel the growth of private-sector applications and services that can add value to this basic health information.”

It’s encouraging to see businesses like Walgreens and Kroger – two places I shop at –  pledge to bring more awareness of health data to their customers. Perhaps my next post will shed light on how these businesses will accomplish their Blue Button goals.

Replacement EHR Trend

Posted on June 10, 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’m a huge numbers guy even if numbers can lie if you’re not careful. However, what I love most is the change in numbers which often can tell an important story of trends. One trend we knew was coming is the replacement EHR trend, so I was quite interested when I saw the tweet above that said that 31% of EHR buyers are purchasing a replacement EHR. That’s a huge number and up from the previous 10% replacement EHRs in 2010.

The report linked above also has a number of other interesting EHR numbers. 30% of respondents reported that their practice would replace their current practice management or EHR solution if their current vendor was purchased by another vendor. Considering we’re about to enter an unprecedented stage of EHR consolidation, this should be quite unsettling to any company looking to acquire an EHR vendor.

I was also fascinated to see that 60 percent of hospital-owned groups reported purchasing their current practice management solution before 2006. Is the age of some of these systems going to lead to many of them being replaced? You’d think that 7 years isn’t that long for a system, but in the tech world it’s not young either. With that said, I wonder what EHR or PM systems have been created in the past 3-5 years. I can’t think of many. If we use meaningful use as a point of demarcation, I can’t think of any EHR or PMs that came after meaningful use. I wonder if we’ll see this change.

One thing I’m certain of is that we’re going to get really good at replacing EHR software. Hopefully EHR vendors will embrace the liquidity of data for those who choose to switch EHR, but I’m not too hopeful on this.

Balancing EHR Change vs Train

Posted on May 21, 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 was talking with Heather Haugen from The Breakaway Group (A Xerox company) today and in our discussion she used the word “train”, but I heard the word “change”. I always love a good play on words and so it was interesting for me to consider the difference between change and train in an EHR implementation.

Every EHR implementation I’ve been apart of walks a fine line between users wanting the EHR software to change versus the need for an EHR user to change. One of the most common phrases out of a doctor’s mouth during an EHR implementation is, “Why did the EHR vendor implement that feature like this? Did they not talk to a doctor? This makes no sense.” We’ve dug in previously to the concept of EHR vendors consulting doctors during their EHR development so we won’t go into that further now. Every EHR vendor consults doctors, but no two doctors practice alike. So, it’s normal that every doctor would wonder why certain features are implemented the way they are implemented.

When faced with this issue, the doctor is faced with an important decision with two options. The first option is to work with the EHR vendor and convince them to change how their EHR works. In a large hospital EHR vendor situation, this can be almost impossible. Plus, even if that EHR vendor does like your suggested change it’s going to take months and sometimes years before that change is implemented in the EHR software, tested, and released all the way to you the end user. Yes, these changes can go faster with a SaaS EHR, but it still will likely take months before the change reaches the end user.

In some cases, you can wait for the change to be made before using that EHR feature. However, more often than not a doctor is going to have to train on how the EHR vendor has implemented the feature. This highlights to me why having great EHR training is so important. Sure, many of the things in an EHR will be intuitive, but great EHR training is still always beneficial. EHR software is too complex to just pickup and use. Plus, even if you can use the basic EHR features, good training points out the ways to optimize the EHR workflow.

Most doctors don’t understand why various parts of an EHR workflow can’t be easily changed. They just think change should happen easily. Ironically, the doctor then proceeds to resist any change to how they want to work.

Challenges and Risks Associated with Disclosure of Health Information in an EHR World

Posted on October 22, 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.

While at AHIMA 2012, I had a chance to sit down and talk with Rita Bowen, MA, RHIA, CHPS, SSGB, Sr. VP of HIM and Privacy Officer at HealthPort to talk about some of the challenges and risks associated with the disclosure of health information in this new world of EHR software. In this video, Rita talks about some challenges with EHR software disclosures that I bet a lot of people haven’t thought about before.

Battle of the AHIMA Buzzwords: Upcoding vs. ICD-10

Posted on September 26, 2012 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.

I’m heading to Chicago this weekend for the annual AHIMA show. It will be my second time attending, and last year’s experience will be hard to beat. I stayed at the Grand America hotel, which has now spoiled me for days when it comes to tradeshow accommodations (or vacation accommodations, for that matter). The show was in beautiful Salt Lake City, which literally was a breath of fresh air every time I walked from the hotel to the convention center. The show floor was bustling, attendees were friendly and chatty, and exhibitors were eager to talk about their latest offerings in the world of coding, transcription and health information management, with a dash of healthcare IT thrown in for good measure. And how can I forget the great networking off the show floor? Those HealthPort folks sure know how to karaoke!

Needless to say, AHIMA set the bar high in Utah, and I’m eager to see if my experience in Chicago will live up to it. The time definitely seems right for talking to providers and vendors about ICD-10, of course; but I believe ICD-10 has met its match in the EMR-related buzzword “upcoding.” You may have seen it mentioned in the major news outlets in recent days, read John’s post about EHR Incentive Increasing Medicare Costs, or come across this statement from the government:

“There are … reports that some hospitals may be using electronic health records to facilitate “upcoding” of the intensity of care or severity of patients’ condition as a means to profit with no commensurate improvement in the quality of care.

“False documentation of care is not just bad patient care; it’s illegal.”

The government obviously means to let providers know that inappropriate documentation will result in legal action, but there is another side to this story in that some providers claim they aren’t “upcoding,” but rather more accurately documenting care now that they have the technology to do so. For hospitals that are struggling financially, implementing new EMR/billing technology may simply allow them to clean up their documentation and billing methods. Seems to me that it’s pretty easy to immediately go from red to black if you’re used to using paper, but now have all kinds of efficient technology at your fingertips.

At any rate, the upcoding conundrum has, for me, elucidated the link between coding and documentation, the EMR and a healthcare facility’s fiscal health. Harold Gibson makes a number of good points around this relationship is his recent blog, “Medical Documentation Specialists can do Better Medical Billing:”

“The medical record is the basis for every financial transaction that follows its creation. EHRs have the advantage of being instantly accessible to a credentialed medical coder or biller at any location. The value of EHRs cannot be underestimated, nor can computer assisted coding software, but they are not a panacea for the elimination of billing errors.”

I hope to find out as I walk the show floor next week how vendors and providers alike are trying to get past this problem. If you have any insight, please share them in the comments below, or, if you’ll be at the show, grab me on the show floor for a quick chat.

Also, if you’re in Chicago and/or at AHIMA 2012, then be sure to come by the AHIMA Tweetup on Monday, 10/1 5:30-6:30. Swissotel, Friedman Marketing suite.

Will Hospital Ownership of Small Practices Kill Ambulatory EHR Vendors?

Posted on August 30, 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.

There are a lot of interesting trends in the EHR and healthcare industry right now. One trend that everyone is seeing and talking about is the trend of hospitals buying up ambulatory practices. There are a number of reasons that we see this happening. Not the least of which is the move to Accountable Care Organizations. While I still think that this trend is cyclical, there’s some possibility that the small ambulatory practice might be in long term danger.

If the small ambulatory practice is in danger, what does that mean for EHR software vendors?

One of the first projects that hospital acquired practices experience is the move to the hospital owned EHR. In fact, I know of many cases where the move to the hospital EHR was part of the contract. I’m not sure all of the reasoning, but many hospital systems are moving their recently acquired practices onto EHR before they move their existing practices.

I have yet to see a hospital system use anything but a large EHR vendor. In many ways it makes sense. The hospital system is buying practices across dozens of specialties. Many of the smaller EHR vendors focus on a few different specialties and so they just aren’t an option for a big multi specialty environment.

Then, there’s the issues of scale and control. Can a smaller EHR vendor support such a large implementation? Can a smaller EHR vendor provide the hospital system the control they want of their EHR environment? The first one is an interesting challenge since I’ve seen some hospital owned ambulatory environments having scaling issues with some of the largest EHR vendors. The problem as I saw it from the outside was that the hospital system couldn’t get the attention of the right people at the large EHR vendor. This wouldn’t have been an issue at a small EHR vendor.

With that said, I do think that small EHR vendors will have a huge challenge getting into the large hospital owned clinical practices. Will enough small practices remain for ambulatory EHR vendors to survive? I enough will survive, but in the short term there could be some shrinking of that market.

Retail Clinics Buddy Up with HIT and MU Lessons from a 3 Year Old

Posted on August 23, 2012 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.

It seems I can’t read a blog, tweet or even old-fashioned newspaper these days without coming across some headline having to do with retail health clinics buddying up to healthcare IT. Announcements from two companies come to mind.

The first involves SoloHealth – developer of health and wellness kiosks. It received FDA approval for its product earlier this summer, and followed that development up with news of financial investment from benefits company WellPoint. It also has announced plans for a national rollout of its kiosks sometime this fall. Assuming its website is up to date, there are SoloHealth Stations across the country at retailers like Walmart, Safeway, Publix, Sam’s Club and Schnucks. CVS appears to be its only traditional retail clinic customer at the moment.

The second involves Greenway Medical – well-known developer of electronic health records for a variety of healthcare organizations, including Walgreen’s Take Care Clinics. It currently has placed its PrimeSuite EHR in more than 700 Take Care pharmacies, and just this week announced plans to implement a custom EHR – WellHealth – to coordinate other types of care in Walgreen’s locations. I’m assuming the two EHRs will play nice with other from an interoperability standpoint. Implementation of all WellHealth systems is expected to be finalized by the end of next summer.

I can’t help but point out that both of these companies are based in Atlanta, and I know for a fact that their team members congregate at similar networking events, so I wonder if we’ll see some synergy between them in the near future.

In any case, if predictions of retail clinic growth prove to be true – a recent Rand Report notes that use of retail health clinics quadrupled between 2007 and 2009, and will continue to grow – it seems likely that we’ll see HIT companies popping up in clinics across the country.

On a completely unrelated note, my daughters and I joined the rest of my company’s team members at the annual Lekotek Run 4 Kids last weekend. We had a great time and enjoyed helping out a great cause. I was a bit apprehensive that my youngest would enjoy it. Before the race began, she came up to me with number in hand and asked, “Is it okay if I lose?” Happily, she declared herself a winner after crossing the finish line and receiving a medal along with her sister and all the other kids.

I wonder if this is a sentiment physicians in smaller practices sometimes have as they consider implementing an EHR in the hopes of receiving Meaningful Use incentive money. Do some just want to throw in the towel and “lose?” Do some not want to even start the race? I’m always looking for additional Meaningful Use wisdom from the under-6 set, so please enlighten me in the comments below.

A HFMA ANI Postcard is Worth a Thousand Words

Posted on June 21, 2012 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.

I’m heading back to Vegas this weekend, as the world of healthcare finance, compliance and IT gets ready to converge at Mandalay Bay for the annual HFMA ANI show. It seems like I was just there for HIMSS, somewhat under the weather the entire time thanks to East Coast jet lag. Hopefully this time around the warmer weather and smaller event (and hopefully better wifi throughout) will help me to spend more time on the show floor, checking out EHR-related technologies and clever marketing gimmicks. (I still remember the Captain Jack look-alike from last year’s show, and the great caricature I got at Paragon Revenue’s booth.) I might also end up showing our fearless leader John Lynn around, as he attends for the first time.

I’ve been stockpiling postcards from vendors as they’ve arrived in my mailbox, sending out a tweet here and there if one strikes my fancy for no particular reason. (I didn’t receive a single one prior to HIMSS, oddly enough.) I’ve culled a few that caught my attention, either for their EHR tie-ins or marketing schtick. Here are a few of my favorites, with additional details in case you feel like stopping by their booths.

EHR-Related

Microsoft Dynamics for Healthcare
Booth #1163
Solution: MazikCare, an EMR/ERP Solution built on Microsoft Dynamics AX2012
My take: Since they picture the EMR on a mobile phone, I’ll likely stop by to have a larger conversation around mobile health. I might even see if they’ve got a new Surface tablet just lying around, waiting to be tested.
Giveaway: Windows phones, free training

M*Modal
Booth #750
Solution: an EHR that helps maximize value, according to the postcard
My take: I’d be interested to learn just HOW their EHR maximizes value.
Giveaway: $500 donation to the charity of your choice

Cutest

TransUnion
Booth # 528
Solution: Smart revenue cycle solutions
Giveaway: potentially an iPad 3, provided you play their trivia game first

Most Clever

Parallon Connect
Booth # 844
Giveaway: Invites to a special HFMA concert featuring Eddie Money, $1,000 Best Buy gift card

Best for Book Lovers

Medical Management Professionals
Booth #1043
My take: Being a book lover, I’m very interested to see what titles their Emergency Medicine Book Club will be reading in the coming months.
Giveaway: “If Disney Ran Your Hospital – 9 ½ Things You Would Do Differently” by Fred Lee

Most Intriguing (and Best for Those with Lots of Dexterity)

Emdeon
Booth # 608
My take: Their Cash Stacker challenges intrigue me. I’ve never heard of the “Tube Topper,” “Stack Nicklaus,” “Popstackle,” “Chopped Nuts,” or “Change it Up,” but perhaps I don’t go to Vegas enough.
Giveaway: iPads and cash

By Far the Biggest

Athenahealth
Booth #1629
My take: The size of the postcard certainly got my attention, as did the blurb about the “athenaCoordinator, athenahealth’s cloud-based care coordination service.”
Giveaway: Kindle 4

Most Charitable

US Bank
Booth #1461
My take: Their partnership with Children’s Miracle Network hospitals will prompt me to definitely stop by their booth, as they’ll make a donation to the network for every business card received.
Giveaway: Warm fuzzies

SPi Healthcare
Booth #1645
My take: While I didn’t receive a postcard from them, the email I did receive caught my attention for its call for attendees to stop by and enter its charity poker chip drawing. For every entry, SPi will donate $1 to Helping Kids Clinic
Giveaway: $100 poker chips

So there you have it, folks! These are just a sneak peek into the many companies that will be exhibiting at the show. I’m looking forward to learning about many more, and sharing my recap in next week’s post. If you’re going to be there, feel free to send me a “let’s connect” tweet via @SmyrnaGirl. I can’t guarantee I won’t be wearing my Elvis glasses.