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.

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I can’t believe that this is the last post in the series. I think it’s been a good series chalk full of good tips for those looking at implementing an EHR in their office. I’d love to hear what people thought and if they’d like me to do more series like this one. Now for the final 5 EMR tips.

5. Automatic trending helps all over the place – A picture is worth a thousand words and this is never more true than when we’re talking about trending. Make sure your EHR software can quickly take a set of results and/or data points and graph them over time.

4. Keep training over and over – Are you ever done learning software? The answer for those using an EMR is no. Part of this has to do with the vast volume of options that are available in EMR software. However, the training doesn’t necessarily have to come from formal training sessions. Much of the training can also come by facilitating interaction and discussion about how your users use the software. By talking to each other, they can often learn from their peers better ways to use the software.

3. Infrastructure is key to performance – I love when people say “My EMR is Slow” cause it’s such a general statement that could have so many possible meanings. Regardless of the cause of slowness, the EMR is going to get the blame. For those wanting to dig in to the EMR slowness issue, you can read my pretty comprehensive post about causes of EMR slowness. I think you’ll also enjoy some of the responses to that EMR slowness post.

Infrastructure really matters when someone is using an EMR all day every day. There’s no better way to kill someone’s desire to use an EMR than to have it be slow (regardless of who’s responsible).

2. Quit pulling charts as soon as possible – I think this tip should be done with some caution. In certain specialties the past chart history matters much more than in others. Although, it’s worth carefully considering how often you really look through the past paper chart in a visit. You might be surprised how rare it is that you really need the past paper chart. If that’s the case, consider only pulling the chart when it’s needed. If you only find yourself looking through the past paper chart for 2 or 3 key items, then just have someone get those 2 or 3 items put into the EMR ahead of time. Then, it will save you having to switch back and forth. Plus, then it’s there for the next time the patient visits.

1. Crap process + Technology = Fast Crap – Perfect way to end 101 EMR and EHR Tips! I like to describe technology as the great magnifier. The challenge is that it will magnify both the good and bad elements of your processes. Fix the process before you apply the technology.

If you want to see my analysis of the other 101 EMR and EHR tips, you can find them all at the following link: 101 EMR and EHR tips analysis.

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I met someone at a conference who commented that they liked this series of posts. I hope you’re all enjoying the series as well. This is the second to last post in the series of EMR tips

10. Build performance dashboards, not just quality dashboards
Yes, Dashboards can work well for clinicians, but for support people as well. If you start measuring something and displaying the results of that measurement, then the measurement improves. Study after study has shown this.

9. Flexibility with physician devices is important, but you still need to standardize
I think this is a little bit of an evolving issue. However, it’s unreasonable to expect your IT staff to support every platform, every version, and every type of device out there. Tech innovation is moving way too fast and an attempt to go this route will lead to failure. Create some standards so you don’t have your IT staff spinning their wheels and cursing your name for a bad policy.

8. Do time studies
My gut reaction to this one is two fold. First, get the data. Don’t assume you know the data. Get as much data as possible and focusing on the time it takes to do things is one of the best places to get data since this is incredibly important for users. Second, don’t shy away from the truth. If your EHR software has doubled the time it takes to do something, don’t be afraid to find that out. It’s better to know that there’s a problem and try to fix it than to let the problem fester because you didn’t want to know the truth.

7. Make sure IT shadows the clinicians
I’d probably take this one step further. If your IT doesn’t want to shadow the clinician, then you might want to find other IT. There’s no way that IT can help to design the proper system for the clinicians if they don’t understand the daily processes that the clinician has to do. Clinicians need to be willing to let IT in on what they do as well. It takes two to Tango and this is certainly true when you’re talking about implementing an EHR. It’s not nearly as pretty if they aren’t dancing together.

6. Use predicative analytics
I’m definitely not an expert on predicative analytics and its application, so I’ll just give you Shawn’s summary:
Predictive analytics are old hat in most industries. However, health care hasn’t put PA in a real forefront of the clinical practice. If you want your physicians (especially in a ED / UC) to be able to prepare for trends due to environment or time, make sure to have PA built into your EMR and easily available for all providers.

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.

I’m not a big fan of reality shows, especially those that involve contestants singing, telling jokes, dancing, or anything else that could potentially result in public humiliation. I’m in the minority, of course, as this style of television programming shows no sign of abating anytime soon. It’s a worldwide epidemic, in my opinion.

I am a fan of creative marketing – applying concepts traditionally associated with one particular medium (like television) to something entirely different (like healthcare). Needless to say, the Big Break job recruitment program – you could also call them auditions – intrigued me.

In a nutshell, pre-screened candidates take part in a one-day audition process put on by recruitment firm Intellect Resources and participating hospitals. Candidates then compete to become trainers and instruct staff on the use of the sponsoring hospital’s electronic medical record system or related healthcare IT system.

Seems like a slam-dunk concept, in my opinion. Those who are unemployed get a job within their community, and also get a taste of what that popular 15 minutes of fame is like. Did I mention that candidates go through video interviews and public presentations during the daylong process?

I recently chatted with Tiffany Crenshaw, President and CEO of sponsoring organization Intellect Resources, about how the program came about and the impact it has had on its participants’ lives (and go-lives).

How did the Big Break come about?
Tiffany Crenshaw: The Big Break spawned out of a project we were working on at Mt. Sinai Hospital last year. Last fall, they were getting ready for their Epic training and called me in a panic. They were expecting to get 90 to 100 trainers, and were going to use nurses, but realized at the last minute that wasn’t a viable idea. So they called us and said, “We have to do something now – we have no budget and we have no time. And we want to do some sort of done-in-a-day type audition. What can you do?”

So we said this is right up our alley. We created a really cool event – it was at the big Marriott Marquis in Times Square. We had around 500 contestants, and they all went through a timed audition process – stressful for them, but it was still fun.

They had to go through seed interviews and get in front of cameras. They had to get in front of a boardroom of judges and do presentations. At the end of the day, we ended up with 100 trainers that worked at Mt. Sinai to help roll out the hospital’s Epic training and go-live.

So that’s really the model of Big Break. We created it as a solution for Mt. Sinai, and now other folks are getting the word about it. Ochsner Health System is our next one. We’ve got the Big Break event for them in just a couple of weeks (January 21).

Did they reach out to you?
A consultant and dear friend of mine that was actually helping them with their system selection and project planning for their Epic implementation recommended this business model, and brought us in as the vendor to run this product for them. So yes, they did reach out to us, but it was really a consultant that made it happen.

Are you an all-Epic recruiting firm?
At the moment, that’s just about all we’re doing. Through the years, we’ve worked with many other products – with McKesson, Cerner, Siemens. The demand right now is Epic, so by default we’re doing all Epic. That’s just where the demand is, and so that’s where we’re spending our time.

How have you seen this type of program impact sponsoring hospitals and surrounding communities?
We think it’s a business model that works very well for hospitals. It’s a very low-cost way to get good resources. It’s also a good marketing opportunity for them to promote the fact they’re installing an electronic health record to the benefit of their patients, and it’s a great way for them to reinvest in their own community.

At Ochsner, the idea is that this is really for the New Orleans community. They don’t like to hire outside consultants. They really want to empower and revitalize their own community.

Many of the folks that we worked with at Mt. Sinai have gone on to work at other places. Big Break was really their footprint in the door. The end result is that the consultants that come through with really good experiences.  Over 50 percent of them are now working in the industry. Mt. Sinai actually hired four full-time employees. There was a big project up in Rochester, N.Y., that a lot of the people went to after that first project. We redeployed probably 20 of them on several go-lives.

Is there an opportunity for this to work in other cities?
At our very first meeting with Ochsner’s project executive, we talked about the fact that there are several area hospitals in and around New Orleans gearing up for Epic implementations. Our original thought was, let’s do this together, but the go-live timeframes didn’t work.

It would make perfect sense if there were multiple hospitals that could do the event together, do the credentialing together, and then take people from a generic credentialing and deploy them to the individual hospitals to learn the individual builds. I think it’s a model that could be a really good collaboration.

I think one of the neatest things about Big Break is that this industry is so thin on the amount of really good resources that are out there. It’s a great way to breed new talent

I’ve blogged before about the importance of decreasing the digital divide in this country in order to truly move healthcare interoperability forward. As I mentioned last month, “Only those patients who have access to these digital healthcare technologies will begin to clamor for them at their next doctors’ visits. Only patients’ whose doctors in turn have reached out to them via email, text or social media regarding the switch to electronic medical records, development of health information exchange and the benefits to care these will hopefully bring will be ready and willing to go with the digital flow.”

When news came across my somewhat cluttered desk of Emdeon’s initiative to provide electronic health record (EHR) technology to physicians in New Jersey’s underserved communities, I first thought, “Yes! That’s what I’m talkin’ about!” Then I put on my journalist/blogger hat and thought, “Will this truly change anything in these particular communities, or is this just good PR?”

A quick bit of background: Emdeon is partnering with the U.S. Department of Health and Human Services’ (HHS) Office of Minority Health, New Jersey Health Information Technology Extension Center (NJ-HITEC), the state’s REC, and the HIMSS Latino Community. Through the initiative, Emdeon will donate Emdeon Clinician licenses to 100 healthcare providers who practice within medically underserved areas and/or healthcare provider shortage areas, as designated by the Health Resources and Services Administration (HRSA), according to a recent Emdeon press release. The company will waive the license fee for these physicians for one year.

The same press release also mentions “EHR adoption is lower among providers serving Hispanic patients who are uninsured or rely on Medicaid, and is lower among providers serving uninsured, non-Hispanic black patients than among providers serving privately insured, non-Hispanic white patients.”

The initiative sounds like a great idea, but the one-year stipulation got me thinking (a bad habit, I know). What will these physicians, who presumably can’t really afford this technology now, do after their year is up? I reached out to Miriam Paramore, Senior Vice President – clinical and government services at Emdeon, to learn more about the ins and outs of the program.

How did the initiative come about?
Miriam Paramore: During the fall of 2010, leaders from the Office of Minority Health (OMH) and Health Information Technology issued a public, written request to health IT vendors, asking them to pay special attention to healthcare providers within underserved communities. This initiative is known as The Alliance to Reduce Health IT Disparities. Emdeon is serving as a private partner with the OMH to offer access to health IT products and services to providers within undeserved communities in New Jersey. We were thrilled to volunteer and to work within these communities.

Has Emdeon ever done anything like this before?
We’re happy to do part of this effort with HHS and it is the first time we’ve partnered with them.  We have great empathy for the challenges of the physicians in underserved communities and we want to help.

What sort of challenges do small physician practices in underserved communities typically encounter?
In addition to challenges like poverty and health disparities amongst their patient population, providers in underserved communities and smaller practice offices face expensive costs associated with on-boarding EHRs. Emdeon created the Emdeon Clinician solution as an affordable EHR “lite” solution for these small practice physicians or those working in underserved communities. They now have an affordable, easy-to-use solution that will help them to qualify for federal HITECH stimulus dollars without unnecessary disruption and expense of a full-blown EHR system.

How will you work with these 100 physician practices to ensure they are able to continue using the donated EHR after the year-long license expires?
Once the 12-month period expires, providers will be able to continue using Emdeon Clinician for only $99 per provider, per month. Emdeon usually has a $500 implementation and training fee [that, for this program,] has been discounted to a one-time fee of $200 for the providers participating in this project. This is a considerable discount and the fee would only have to be paid once. We will begin outreach to these providers in advance of the expiration date so they are aware of the opportunity to remain with Emdeon Clinician for the low fee following the initial 12-month period.

How will Emdeon work with NJ-HITEC and the HIMSS Latino Community throughout this year to ensure that these practices receive continued training and support?
Emdeon has taken the lead with managing this initiative between all partners with monthly meetings to monitor progress. We have a dedicated project manager, who has mapped a process with the internal team to assist with implementing these physicians as soon as possible. Our custom phone number (1-855-840-7120) connects interested providers directly with a dedicated clinical sales executive who can assist them throughout the enrollment process.

The NJ-HITEC and HIMSS Latino partners are assisting in the recruitment of providers who practice within medically underserved areas for this program from their vast networks across New Jersey communities. These partners are working cooperatively with Emdeon to create a strategy that focuses upon identifying and recruiting providers within underserved communities who are willing to adopt EHRs, especially those interested in qualifying for federal incentive dollars.

How many practices do you anticipate being eligible, and how many do you expect will apply?
While we aren’t sure how many will apply, the HHS OMH recognized that the counties of Camden, Essex and Passaic have the largest percentage of underserved communities. Through our collaborative efforts with the OMH, HIMSS Latino and NJ HITEC, we hope to reach many of those physicians within those counties to take advantage of the 12-month program.

How will Emdeon and its partners determine if this program is a success?
Together with our partners, we believe success will be donating all 100 licenses to providers in underserved communities. The reporting element of this project will help OMH understand the progress of EHR adoption in the context of how long implementation takes in its entirety.

So it seems that Emdeon and its partners certainly have their ducks in a row when it comes to aiding and abetting these physicians before, during and even after the program is technically over. I’ll be interested to see if this model will, in fact, be successful, and if it can be supported in other underserved areas across the nation.

For more information on participating in the program, check out: http://www.emdeon.com/newjersey/

Earlier this year I had the good fortune (and the support of my employer) to join the Technology Association of Georgia (TAG), an organization that offers interest groups for every possible IT niche you can think of. I’ve attended a few of their health society events, and at every one I’m confronted with statistics and anecdotes surrounding the dearth of qualified healthcare IT professionals in the city and surrounding areas. Much attention at these events is also given to the fact that these professionals are needed now more than ever to help smaller physician practices and larger healthcare systems demonstrate Meaningful Use and achieve associated electronic medical record (EMR) adoption goals.

I’ve commented before on the disconnect between the increasing number of healthcare IT educational opportunities being created by the government and vendors’ willingness (or unwillingness, as the case may be) to hire fresh grads. EJ Fechenda of HIMSS JobMine posed a question related to this conundrum better than I ever could have: “With federal deadlines looming, healthcare organizations need to get moving and there are a lot of job seekers out there ready for the challenge. Are there organizations or companies willing to extend opportunities to these candidates? Is there a training or job-shadowing program that can be used as a best practice for other organizations to implement? Who are the champions already doing this or willing to lead the charge?”

I may have found a champion in Rich Wicker, HIMS Director at Shore Memorial Hospital in New Jersey. Wicker is also an adjunct professor at two HITECH-affiliated community colleges, teaching students who already have strong backgrounds in healthcare or IT the basics of process, analysis, redesign, installation and ongoing maintenance to prepare them for second careers in physician office EMR implementations.

He certainly seems to have a passion for the subject. “I’m devoted to the EMR,” he told me during a recent phone interview. “That’s why I started teaching, really, because I want to see that [adoption] happen so badly.”

He tells me his students are guardedly optimistic about their future job opportunities, which he believes will surge this summer alongside an expected increase in physician adoption of EMRs – six months before the deadline to qualify for Meaningful Use incentives.

As we discussed the state of the HIT job market, we both wondered if what type of organization might have a greater role to play in ensuring that graduate from programs like Wicker’s find jobs.

“We had to really battle our way to get one [software] copy from one EMR vendor,” he explains. “I wish they were more amenable to providing educational software/packages like Apple does throughout all their PCs. I know a few different schools have joined with a vendor. One place I know of is showing Vista, another is showing eClinicalWorks, and another partnered with a local hospital that happens to use Sage.

“I have a relatively limited view, but from what I can see, the vendors are not really engaged with the HITECH student development program. I think they’d probably rather do it themselves.”

“Here’s an idea that I came up with,” he adds. “I’ll throw out the RECs (Regional Extension Centers). That’s another entity that’s funded – it’s kind of their job to get the docs to convert. If they could partner with the colleges and the graduates to possibly divert some of their funding to supplementing the graduates’ income while they worked at a physician practice … So the physician, let’s say, for $5 an hour, they could hire a qualified, certified person. These people are pretty good, too. They know what it is to work. They’ve probably worked 10 or 20 years already, either in IT or in healthcare. So they’re mature employees and highly motivated. They would be great to go in and do a 6-month installation. I think it would be great for the physician if, for $5 an hour, you get somebody that would probably cost you $30 an hour somewhere else.

“Let’s say the student can get another $10 an hour supplemented from the REC or somehow through the government. So they get $15 an hour to go in there … they get four or five months of experience doing an installation and then the physician can make a decision … maybe they ultimately hire the person. That’s just a crazy idea that I had that seemed like the pieces are out there that kind of potentially could work. I sent it into the ONC a couple of days ago.”

Could the RECs have a bigger role to play in ensuring that HITECH graduates gain on-the-job experience and employment? I’d love to hear from any readers out there who may work for or with RECs . Is Wicker’s idea doable? Have we found our champion?

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I met someone at a conference who commented that they liked this series of posts. I hope you’re all enjoying the series as well.

15 Avoid multiple sign-ins if possible.
One thing seems abundantly clear to me: healthcare IT will be a heterogeneous environment. This is particularly true in the hospital world. Even the biggest behemoth of an HIS can’t satisfy all of the healthcare IT requirements of a hospital. So, getting a great SSO (single sign on) solution will be really important and turns out to be a great thing for your users and your help desk.

14 Make sure security is solid, but not prohibitive.
One thing about healthcare security and HIPAA that’s often misunderstood is that it should protect patient’s information, but it should also not get in the way of a clinician doing what they legitimately need to accomplish. Many security policies go too far and make legitimate healthcare work too hard. This is a huge mistake.

13 PDSA – Use it! Plan – Do – Study – Act
In this one, Shawn talks about the idea of continuous improvement which is a really good one. I also think far too many companies get stuck in the planning and do far too little doing and acting. All four steps of the process are important and useful, but don’t over think it either.

12 LEAN
Lean isn’t about being cheap. Lean isn’t about providing substandard care. Lean is about spending where it matters most. It’s about focusing on what’s most important and creating value from the things you spend money on. I’d love to see more LEAN concepts used in healthcare.

11 Buy MORE printers
Yep! Printing increases dramatically with an EHR. Almost all those forms that you use to print in bulk will now be coming out of your printer. Also, just because somewhere is fully electronic doesn’t mean that they are paperless. Paperless is a mythical creature that will likely never be achieved in our lifetime. Make the printers accessible for your providers.

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I met someone at a conference who commented that they liked this series of posts. I hope you’re all enjoying the series as well.

20 Data collaboration is key to patient safety
I think this tip might need to be worded, “Data collaboration should be key to patient safety.” Unfortunately, it’s a mostly unrealized dream at this point. You might even be able to say that data collaboration will be key to patient safety. There really are amazing use cases where data collaboration can improve the care patients receive. It’s a sad state of affairs that so many of the major EHR companies are dead set on protecting their walled gardens. One has even gone so far as to say that patient safety is in danger with multiple systems. Certainly there are some risks associated with multiple systems, but the benefits far outweigh the risks. In fact, patient safety is at stake thanks to those who won’t participate in healthcare data collaboration.

19 Know how customizable the clinical work flows are!
This is a good tip when doing your EMR selection. It’s incredibly valuable to understand how the EMR handles clinical workflows and how well those workflows fit into your established clinical workflows. I’m a proponent of doing the best you can to use established workflows when implementing an EHR. Then, over time adjusting those workflows as needed to gain more efficiency.

18 How easy is it to customize the system overall?
I’d take this EHR tip from a couple angles. First, is how easily can you customize the EMR system. Yes, some of it could be the EMR workflows that I talked about in EMR Tip #19 above, but it could be a whole set of other options (billing, scheduling, messaging, etc). The second part of this suggestion relates to how well this EHR will adapt to the constantly changing clinical environment. Will they be able to handle ICD-10 without too much pain for you? Will you be able to make it work in an ACO environment? Healthcare is constantly changing and so you want to make sure your EHR can be customized to fit your changing needs.

17 Know work flow can be hard coded to ensure compliance.
There are times when hard coding the workflow is incredibly valuable. Certainly this will frustrate some providers, but if done correctly most will understand the need to hard code the workflow to ensure compliance. It’s a fine line to walk, but there are plenty of instances where hard coded workflows can do wonders to improve the care you provide.

16 Ensure easy access to the system via multiple platforms.
As much as providers might not like checking in on the EMR remotely, it’s often absolutely necessary. So, it’s important to ensure that your EMR is available on every medium possible. Can it be connected to remotely? Does it work on the latest devices? Yes, the iPad has a huge portion of the physician market share right now, but we’ll see how long that lasts. Every year a new device comes out and you’ll want an EMR vendor that’s keeping an eye on this movement and making the EMR available on the best technology.

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.

I’ve been having a really great time all day at the EHR Summit by HBMA. It’s been an event with some really interesting content and a lot of people who really understand the underpinnings of the EMR industry. Most of the people I’ve met are those running their companies and so they’re very interesting to talk with.

Instead of doing a summary, I was basically live tweeting the sessions I attended on @ehrandhit. Ron Sterling was the keynote yesterday and the guy was like sound bite after sound bite. It made it perfect for live tweeting. So, I’m dedicating this post to all my tweets during Ron Sterling’s keynote at the EHR Summit. I know you’ll glean a lot of interesting perspectives from it.

Ron Sterling addressing the challenge of losing the patient chart indicators (ie piles of charts that indicate workflow) post EHR #EHRSummit

November 17, 2011 7:05 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

What’s doctors biggest complaint about flat screens? Less space to put post-it notes. -Ron Sterling #EHRSummit11 #HBMA

November 17, 2011 7:10 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

“Over 80% of EHR attempts fail.” -Ron Sterling I think that’s an old percentage. Success rate lately seems much higher. #EHRSummit11

November 17, 2011 7:14 am via HootSuiteReplyRetweetFavorite

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EMR, EHR and HIT

Will electronic scheduling of specialists change which specialists are referred to by the primary care doctors? #EHRSummit11

November 17, 2011 7:21 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

EMRs can make it so I “do it once and use it many times” An interesting message to think about. #EHRSummit #HBMA

November 17, 2011 7:25 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

The cost of moving EHR is so ugly that they’re willing to put up with a bad EHR. #sadbuttrue Message: Spend time selecting the right EMR.

November 17, 2011 7:26 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

“I think many offices aren’t practices. They’re just a bunch of doctors working behind the same door.” -RonSterling #EHRSummit

November 17, 2011 7:29 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

“What’s the difference between EMR and EHR……One letter!” -Ron Sterling #EHRSummit #HBMA HITECH gave a lot of jobs to copywriters.

November 17, 2011 7:33 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

We’re seeing a huge land grab since so many people want to have access to the health data. #EHRSummit11

November 17, 2011 7:36 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

It’s amazing the lack of support a hospital system often provides when they provide the EHR to clinics #EHRSummit11

November 17, 2011 7:39 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

Someone was sold a certified EHR that in the contract had it specified as the “non-meaningful use edition.” Ummm..???!?!? #EHRSummit11

November 17, 2011 7:45 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

“I had a practice lose 70,000 immunization records and the EHR vendor said they were using it wrong and to reenter the data.” #EHRSummit

November 17, 2011 7:53 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

EHR Implementation put on hold thanks to Costco card that said $400/month for EHR. #EHRSummit11

November 17, 2011 7:57 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

Are we going to have a bunch of people not know how to use the EHR cause they don’t want to do a little training? Not a good idea #EHRSummit

November 17, 2011 8:01 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

A look at the way most vendors do EHR Implementation, they do training and then say, go for it. (No strategic advice) #EHRSummit11

November 17, 2011 8:02 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

The best thing you can do for your clients is to limit the number of EHR software they look at. #EHRSummit Hmmm…Ummm…Hmmm

November 17, 2011 8:07 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

If that EHR record is not properly maintained. I have a legal problems. I have professional problems. #EHRSummit11

November 17, 2011 8:10 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

Can a healthcare billing service be relevant if they don’t do EHR? Great question. My answer: no. #EHRSummit #HBMA

November 17, 2011 8:20 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

Just described a high priced emr, the mid-level priced emr, and the asp/hosted EMR. #EHRSummit Too funny.

November 17, 2011 8:23 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

I’m working with a client today where the EHR vendor said the office had to shut down for 5 days. #EHRImplementationAbuse #EHRSummit11

November 17, 2011 8:32 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

“We’re ready for an EHR, because we got rid of the people we think we won’t need once we have an EHR.” -Ron Sterling #EHRSummit11 #NotGood

November 17, 2011 8:33 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

Best practices is an intimidating word. You better have something in your quiver if yur going to challenge someone that says it #EHRSummit11

November 17, 2011 8:35 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

“We implemented an EHR, we saw a 25% drop in productivity. Is that good?” No Answer needed. #EHRSummit11

November 17, 2011 8:40 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

Interesting separation between a strategic advisor, tactical advisor, and product specialist when it comes to EHR implementation…

November 17, 2011 8:46 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

“I don’t know of EHR vendors that provide EHR training customized to the practice that’s being trained.” #EHRSummit11 I know of 1.

November 17, 2011 8:47 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

I saw a practice that was 4 versions behind on upgrading their PMS. They were chiseling on rocks for their billing. #EHRSummit11

November 17, 2011 8:50 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

Just like an EHR is sticky, so is helping an EHR sticky. #EHRSummit11

November 17, 2011 8:58 am via HootSuiteReplyRetweetFavorite

@ehrandhit

EMR, EHR and HIT

I don’t know about the rest of you, but ever since David Blumenthal left ONC he’s had plenty of interesting things to say. I think he’s still somewhat cautious, but you can tell he’s given himself more freedom to comment on the state of EHR software and how it could be improved.

One example of this was in Andy Oram’s writeup of David Blumenthal’s speech in Boston a little while back. Here’s one section of Andy’s write up that really hit me (emphasis mine):

Perhaps Blumenthal’s enthusiasm for putting electronic records in place and seek interoperability later may reflect a larger pragmatism he brought up several times yesterday. He praised the state of EHRs (pushing back against members of the audience with stories to tell of alienated patients and doctors quitting the field in frustration), pointing to a recent literature survey where 92% of studies found improved outcomes in patient care, cost control, or user satisfaction. And he said we would always be dissatisfied with EHRs because we compare them to some abstract ideal

I don’t think his assurances or the literature survey can assuage everyone’s complaints. But his point that we should compare EHRs to paper is a good one. Several people pointed out that before EHRs, doctors simply lacked basic information when making decisions, such as what labs and scans the patient had a few months ago, or even what diagnosis a specialist had rendered. How can you complain that EHRs slow down workflow? Before EHRs there often was no workflow! Many critical decisions were stabs in the dark.

Lots of interesting discussion points there, but the one I take away from it is that there’s no such thing as the perfect EMR. Blumenthal is dead on that many doctors have this abstract ideal of what an EMR should be and it will never be that way. Certainly there are benefits to implementing an EMR, but there are also some challenges to using an EMR as well. No amount of programming and design are going to ever change that.

I wish I could find a description I read 4-5 years ago from an EHR vendor talking about the doctors they liked to work with. In it they described that they liked working with doctors who had reasonable expectations of the EHR implementation. They wanted to work with doctors who wanted to go electronic. They wanted to work with clinics that understood that some change was required as part of any IT implementation. From what I can tell, that EHR vendor has basically done just that.

Reminds me of trying to force my kids to do something they don’t want to do. Never seems to end well. Instead, it’s a much more satisfying experience for all when I help them understand why we’re doing what we’re doing. They still don’t like some of the details in many cases, but at least they understand the purpose for what we’re doing.

As long as doctors cling to some abstract ideal of EMR perfection, no EMR vendor will ever be able to satisfy them. A perfect EMR is not reasonable. Just because an EMR doesn’t offer everything that you could dream, doesn’t mean it’s not an incremental improvement over what you’re doing today.

Don’t let the quest for perfection get in the way of incremental improvement. Perfection is more nearly obtained through many incremental improvement than giant leaps.