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Healthcare Needs Clinician Data Experts

Posted on November 2, 2016 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.

This week I read an interesting article by a physician about the huge challenges clinicians face coping with unthinkably large clinical data sets — and what we should do about it. The doctor who wrote the article argues for the creation of a next-gen clinician/health IT hybrid expert that will bridge the gaps between technology and medicine.

In the article, the doctor noted that while he could conceivably answer any question he had about his patients using big data, he would have to tame literally billions of data rows to do so.

Right now, logs of all EHR activity are dumped into large databases every day, notes Alvin Rajkomar, MD. In theory, clinicians can access the data, but in reality most of the analysis and taming of data is done by report writers. The problem is, the HIT staff compiling reports don’t have the clinical context they need to sort such data adequately, he says:

“Clinical data is complex and contextual,” he writes. “[For example,] a heart rate may be listed under the formal vital sign table or under nursing documentation, where it is listed as a pulse. A report writer without clinical background may not appreciate that a request for heart rate should actually include data from both tables.“

Frustrated with the limitations of this process, Rajkomar decided to take the EHR database problem on. He went through an intense training process including 24 hours of in–person classes, a four-hour project and four hours of supervised training to obtain the skills needed to work with large clinical databases. In other words, he jumped right in the middle of the game.

Even having a trained physician in the mix isn’t enough, he argues. Ultimately, understanding such data calls for developing a multidisciplinary team. Clinicians need each others’ perspectives on the masses of data coming in, which include not only EHR data but also sensor, app and patient record outcomes. Moreover, a clinician data analyst is likely to be more comfortable than traditional IT staffers when working with nurses, pharmacists or laboratory technicians, he suggests.

Still, having even a single clinician in the mix can have a major impact, Rajkomar argues. He contends that the healthcare industry needs to create more people like him, a role he calls “clinician-data translator.” The skills needed by this translator would include expertise in clinical systems, the ability to extract data from large warehouses and deep understanding of how to rigorously analyze large data sets.

Not only would such a specialist help with data analysis, and help to determine where to apply novel  algorithms, they could also help other clinicians decide which questions are worth investigating further in the first place. What’s more, clinician data scientists would be well-equipped to integrate data-gathering activities into workflows, he points out.

The thing is, there aren’t any well-marked pathways to becoming a clinician data scientist, with most data science degrees offering training that doesn’t focus on a particular domain. But if you believe Rajkomar – and I do – finding clinicians who want to be data scientists makes a lot of sense for health systems and clinics. While their will always be a role for health IT experts with purely technical training, we need clinicians who will work alongside them and guide their decisions.

Why We Store Data in an EHR

Posted on April 27, 2016 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.

Shereese Maynard offered this interesting stat about the data inside an EHR and how that data is used.


I then made up this statistic which isn’t validated, but I believe is directionally accurate:


Colin Hung then validated my tweet with his comment:

It’s a tricky world we live in, but the above discussion is not surprising. EHRs were created to make an office more efficient (many have largely failed at that goal) and to help a practice bill at the highest level. In the US, you get paid based on how you document. It’s safe to say that EHR software has made it easier to document at a higher level and get paid more.

Notice that the goals of EHR software weren’t to improve health outcomes or patient care. Those goals might have been desired by many, but it wasn’t the bill of goods sold to the practice. Now we’re trying to back all this EHR data into health outcomes and improved patient care. Is it any wonder it’s a challenge for us to accomplish these goals?

When was the last time a doctor chose an EHR based on how it could improve patient care? I think most were fine purchasing an EHR that they believed wouldn’t hurt patient care. Sadly, I can’t remember ever seeing a section of a RFP that talks about an EHRs ability to improve patient care and clinical outcomes.

No, we store data in an EHR so we can improve our billing. We store data in the EHR to avoid liability. We store data in the EHR because we need appropriate documentation of the visit. Can and should that data be used to improve health outcomes and improve the quality of care provided? Yes, and most are heading that way. Although, it’s trailing since customers never demanded it. Plus, customers don’t really see an improvement in their business by focusing on it (we’ll see if that changes in a value based and high deductible plan world).

In my previous post about medical practice innovation, Dr. Nieder commented on the need for doctors to have “margin in their lives” which allows them to explore innovation. Medical billing documentation is one of the things that sucks the margins out of a doctor’s life. We need to simplify the billing requirements. That would provide doctors more margins to innovate and explore ways EHR and other technology can improve patient care and clinical outcomes.

In response to yesterday’s post about Virtual ACO’s, Randall Oates, MD and Founder of SOAPware (and a few other companies), commented “Additional complexity will not solve healthcare crises in spite of intents.” He, like I, fear that all of this value based reimbursement and ACO movement is just adding more billing complexity as opposed to simplifying things so that doctors have more margin in their lives to improve healthcare. More complexity is not the answer. More room to innovate is the answer.

Docs Using EMR Data Order Fewer Lab Tests

Posted on December 2, 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.

A new study has concluded that when doctors viewed lab test cost data in an EMR, they decreased their order rates for certain tests, cutting the overall cost of lab tests meaningfully, according a story in Healthcare IT News.

The Atrius health study, published in the Journal of General Internal Medicine, found that docs who reviewed lab test cost data decreased their ordering rates for certain tests and saved up to $107 per 1,000 per month. The study also found that lab test utilization decreased by up to 5.6 lab orders per 1,000 visits  per month, HIN reported.

The study, which was led by Daniel Horn of  Massachusetts General Hospital’s Division of General Medicine, surveyed 215 primary care docs at Atrius Health. Physicians in the intervention group got up-to-date information on lab costs for 27 individual tests when they placed e-orders. There was also a control group of physicians who didn’t get the information.

Researchers saw significant decreases in ordering rates for five out of 27 high and low cost lab tests, and a decrease in utilization for all 27 tests, though not all shifts were statistically significant. Meanwhile, 49 percent of doctors felt that they had enough information to make their ordering decisions.

Thomas Sequist, MD, Atrius Health director of research and co-author of the study, said these findings suggest that seeing lab data in EMRs could scale up in big ways. For example, he notes, in a large physician practice managing 20,000 visits per month, that’s $2,140 per month and more than $25,000 per year.

This isn’t the only evidence that access to lab test costs and info reduces ordering. A study published last year in the Archives of Internal Medicine concluded that during the period between January 1, 1999  and Dec. 31, 2004, during the test of a health information exchange, there was a 49 percent reduction in number of tests for patients with recent off-site tests.

That being said, other studies — such as this one appearing in Health Affairs — have found that doctors who see earlier tests and images actually tend to order more follow up tests.

It seems clear that this is an important area for further study, as needless tests are a big cost driver. In the mean time, we’ll have to make do with contradictory evidence.

Physicians Face Flood of Unsolicited Data

Posted on October 30, 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.

Over the last few years, the sources of information an EMR can contain have exploded. Where it once included only clinical information generated by the provider, these days EMRs may also embrace health information exchange data, input from personal health records, contributions from patient mobile device use and remote monitoring data.

As iHealthBeat writer Michelle Stuckey points out, this information may not have been requested by the provider, but they have to contend with it anyway.  Adapting to these new data sources is possible, but for the near term, it’s likely to disrupt provider workflows and affect the usability of their EMRs.

To combat this problem, AHIMA recently came out with a practice brief which outlines the challenges unsolicited health information can pose for providers. The brief makes several recommendations health organizations should consider in handling the problem, including the following:

  • Develop policies with providers that outline which unsolicited information will be retained
  • Create policies that establish the legal definition of the health record, and which unsolicited information fits the criteria
  • Review the incoming information to determine whether a patient-provider relationship exists, and verify that the information is needed for treatment
  • Develop protocols, by specialty, clinical area or document type which establish which types of information will be accepted into the EMR
  • Provide education to all providers and staff in the health organization on steps to be taken when they receive  unsolicited health records

While it’d be nice, in some ways, for EMRs to remain in silos — at least for those who use them — it simply isn’t going to last. Data is going to come at doctors from every angle, including some we probably haven’t even considered yet.  Forward-looking medical organizations should take a hard look at the AHIMA recommendations before they’re swamped in data they can’t handle.

Our Health Privacy Paranoia

Posted on November 21, 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.

Katherine’s recent post on using EMR data to Market to patients got a lot of really interesting discussion about how this data should be used and if it’s ok to use the EMR data for marketing. The majority of comments were quite scared of the idea of EMR data being used for marketing. Most saw that their could be benefits, but saw it as a slippery slope and we should be careful going down that path. Most wanted an opportunity to opt out from such a policy.

Mark H. Davis offered a little different view in his comment about the need for privacy in this and other healthcare situations. Here’s what Mark said:

And now for a slightly different take…

I have no issues with my hospital using its knowledge of my health situation to provide me with targeted opportunities that might be beneficial. I see it as potentially a positive and proactive outreach. They will need to be sensitive in doing this, however, but in my region, the hospital system is pretty tightly woven into the community, anyhow, and would be rather affected by any backlash. And honestly, sometimes I feel like we make an overblown fuss about health data privacy just because everybody else is making a fuss about it, without stepping back and examining the actual impacts. For example, my mailman, with only slight observation, could easily deduce the health issues my wife, children and I have been treated for. The folks behind me in line at the drug store could do the same. Even most doctor’s offices I visit do a poor job of protecting privacy within the office itself. Just last week, I had to forcibly ignore the conversation taking place in an adjacent examination room. It was easily audible. Anyone who signs in at their PCP can see who has checked in earlier, for what doctor, for what time. Anyone who signs the pharmacist waiver form at the CVS can see who has signed in front of them. The prevalence of OTC meds makes it easier to tell what your fellow shoppers’ ailments are just by looking at their shopping cart. And somehow, we still co-exist. I’m not saying we shouldn’t protect ourselves against a massive data breach that could have dire consequences in the form of identity theft and other fallout. I’m just asking everyone to be honest about how serious they really are about privacy. It’s easy to pick on a hospital system without recognizing other areas where we turn a blind eye.

Mark does a great job articulating how many healthcare situations expose our healthcare data without any major issues. Yet, people tend to get far more worked up over the potential idea of an EMR data breach.

Certainly I’m not advocating for reckless behavior when it comes to healthcare data and securing it properly. We need to make a thoughtful effort to ensure that patient data is kept secure and private. However, let’s be reasonable in our expectations about what’s possible and reasonable.

PricewaterhouseCoopers Finds EMR Data to be Health Industry’s Most Valuable Asset

Posted on October 2, 2009 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 following is an expert from the press release by PricewaterhouseCoopers (PWC) about EMR data:

Hundreds of billions of gigabytes of health information are now being collected in electronic medical records, and three-quarters (76%) of more than 700 healthcare executives recently surveyed by PricewaterhouseCoopers LLP agree that the secondary use of this information will be their organization’s greatest asset over the next five years. The data that could be mined from the health system can improve patient care, predict public health trends and reduce healthcare costs, but PricewaterhouseCoopers finds lack of standards, privacy concerns and technology limitations are holding back progress.

According to PricewaterhouseCoopers, the healthcare industry won’t see the full value of investments in electronic medical records and other health IT investments until it finds secondary uses for the information being gathered. Yet 90 percent of executives surveyed feel the industry needs better guidelines about how health information can be used and shared, and 76 percent feel that national stewardship over, or responsibility for, the use of the health data should be regulated.

In its newly published report “Transforming Healthcare through Secondary Use of Health Data,” PricewaterhouseCoopers calls for public-private collaboration and a role for government in creating incentives for the private sector to collect, share and use health data; to establish standards; and to redefine technical architecture to allow interoperability.