The American Health Information Management Association’s (AHIMA’s) annual show is right around the corner. HIM professionals will gather in Salt Lake City next week for a few days of educational sessions, exhibits, networking opportunities and even off-site visits to local healthcare facilities such as Intermountain Medical Center and the University of Utah and Cancer Registry.

It will be my first time at an AHIMA show, and truth be told, I couldn’t be more pleased that I’ll get to see Salt Lake City in the Fall. I’ll of course be on the lookout for the latest and greatest healthcare IT, particularly those technologies related to electronic medical records (EMRs). I’m also hoping to chat with AHIMA’s new CEO, Lynne Thomas Gordon, about how AHIMA will be helping its members transition through healthcare reform in the near future. (Look for a wrap up in next week’s post.)

Most of my time will be spent on the show floor, learning about these new technologies and finding out what health information management challenges and solutions providers are dealing with. James Watanabe, Director of Healthcare Business Development at Perfect Search Corp. – a first-time exhibitor this year, recently shared with me his thoughts on what’s he’s expecting and hoping to get out of the event.

What health information management challenges are your customers currently facing?
JW: “At Perfect Search, our clients are typically utilizing our unique indexing and search technology to deal with the challenges associated with extreme data growth and complexity. One of the challenges in the industry is that in addition to the explosion of digital data, there seems to be no clear direction in terms of standardization and policy. Given this uncertainty, vendors must not only help facilitate compliance now, but be nimble enough to support changes in the future. We see Perfect Search as a core technology that can be utilized to help organizations deal with these challenges as they come, and believe that the implications for such a technology are truly deep and profound.”

How does your team plan on addressing these challenges at the AHIMA show?
“We will be demoing our deep data-mining tools and highlighting some of our key strategic partnerships that showcase how the technology is being utilized today. We are able to provide at least a 10x improvement in indexing and search speed, be much more comprehensive in terms of the data we search (structured EMR, unstructured clinical notes, lab data, DICOM radiology images, etc.), and operate on up to 90% less hardware. Using our solution, clients gain real time insight into their data to improve quality scores, help mitigate fraud, improve billing processes, better facilitate clinical trials, and any other deep data mining they might require.”

What does Perfect Search hope to get out of the show as a whole?
“Despite some key partnerships such as Dell, Fujitsu, CA and Nuance, Perfect Search is relatively unknown in the healthcare space. We intend to use AHIMA as a way to raise awareness of our unique technology, it’s many applications in healthcare, move business deals forward, and seek out new partnerships in the space.”

How does Perfect Search’s Medical Record Search technology integrate with providers’ interoperability efforts?
“Perfect Search is the only indexing and search technology that is able to deal with both structured EMR content and unstructured clinical notes data equally well, to produce true semantic search. There is currently a disconnect between what most EMR vendors are pushing and what physicians and other users are wanting. EMR vendors push structured data, and clinicians are interested in utilizing their existing business practices, which for many means producing and utilizing unstructured clinical notes data. We believe that the ability to connect to all critical data needs to be a component of any good EMR or health information exchange (HIE) solution and is something that we can provide today.”

Can this technology search or be integrated into EMRs or HIEs?
“Absolutely.”

It would also seem that this technology might be useful from a business intelligence perspective – a much-needed solution in terms of providers determining what healthcare IT systems might be right for their facility.
“Definitely. 80% of business intelligence reporting and analytics is connecting to data. In large pharma and research, the deep data-mining tool we have created enables users to create and run complex ad hoc queries in real time and without IT. This tool is the difference between getting data now versus 12 hours from now, tomorrow, next week, or even next month, which is standard for most companies of significant size.”

How do you see Perfect Search technology evolving to meet the needs of healthcare providers?
“The Perfect Search team continues to work with industry experts to build new applications around the technology and strengthen existing products. Ours is a unique technology that enables users to connect to critical data at least 10 times faster, be much more comprehensive in terms of the content we search, and operate on up to 90% less hardware. “

I’m looking forward to speaking with the Perfect Search folks from the show floor. Know of any other exhibitors I should check out? Salt Lake sites I should see? People I should bump into? Let me know in the comments below.

John’s Comment: Along with Jennifer, I’ll be at AHIMA as well. I’m definitely happy to meet with people at AHIMA also and enjoy attending the event for the first time.

Time for the second entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I hope you’re enjoying the series.

70. Hard coded work flows CAN be your friend
EMR vendors are constantly playing the game of out of the box functionality versus unlimited workflow design. This is one way to look at hard coded work flows. Sometimes they have benefits since it’s one less thing that you have to configure on your system.

The other way to look at the above EMR tip is when it comes to reporting. Often if you’ve customized a workflow in your EMR, then you lose out on the benefit of the reporting that’s available with a hard coded work flow. Sometimes you can get the benefit of both, but some advanced reports really benefit from a hard coded work flow.

69. Social Media integration – the way business is done today
No EMR system has really deep social media integration….yet!? Although, it’s worth checking with your EHR vendor to see their views of the future of social media integration. Especially if you’re in a market that has a lot of physicians. You can be sure that future patients will want some sort of social media integration as part of their visit.

68. Determine how the EMR vendor encourages innovation
This EMR tip can be taken a number of different ways. The first is how does your EMR vendor innovate internally. Take a look at their last 3-5 release cycles to get an idea of how quickly they release features and how innovative those features are. It will tell you a lot about future releases of their EHR software.

The second way to take this is by asking the question, how do they take feedback and innovation from their community? Do they have an open API that would allow you (or some developer you pay) to be able to extend their EHR functionality? If you’re someone who likes to tinker with your practice, then an open API that will let you do that would be essential.

67. Determine how innovation is actually put into the practice
This EMR tip highlights the subtle difference between an EHR vendor that talks the talk and the EHR vendor that walks the walk. Every time your EHR vendor says, “That feature will be in the next release.” a red flag should go up in your mind. Maybe this company thinks and talks big, but can’t actually perform big. Although, age of the EHR vendor should play some part in this evaluation as well.

66. Is the patient portal comprehensive
Meaningful Use has almost made patient portals a requirement. It’s hard to say exactly what future meaningful use stages will require, but I won’t be surprised if a patient portal plays a large part in the future of healthcare. Plus, the new digital generation is going to be very interested in using a patient portal. You’ll want to make sure your EHR vendor is ready for both of these trends.

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.

This is the first in a series of EMR, EHR and Healthcare IT interviews that will be done on EMR and HIPAA and EMR and EHR. The full EMR interview with Dr. West can be found on the new EMR, EHR and Healthcare IT interviews website. The following is a summary of that interview written by Kathy Bongiovi.

If you’re a doctor, nurse, practice manager, EHR consultant, CEO or executive of an EHR vendor, etc with EMR experience that’s interested in being interviewed, let us know on our Contact Us page.

In a recent interview with Dr. West, an endocrinologist in Washington D.C. and blogger at Happy EMR Doctor, the doctor discussed his experience in finding an EMR capable of fulfilling the needs of his specialized practice and, at the same time, saving him time. Dr. West discussed the arduous process of going from a failed to a successful EMR system.

His first experience with EMR was frustrating and he ultimately ended his relationship with the vendor. West heard other horror stories regarding failed EMRs and was convinced if he kept trying he would find an EMR that would fit his needs.

Dr. West advises other doctors and healthcare professionals to avoid rushing into any relationship with an EMR vendor and to make sure that when they sign a contract, first make sure the contract has a “satisfaction and money-back guarantee”. He suggests that anyone searching for an EMR, should find a vendor willing to let them try out their product for at least a month with no strings attached. Dr. West adds that the doctor or healthcare professional should also make sure there are not a lot of very specific hardware requirements in case the provider needs to change vendors.

Although some studies suggest a decrease in productivity with EMR systems because of a lack of customization for given specialties, West is not suffering from any of those issues and gives the credit to his EMR, Practice Fusion which is free and web based. The doctor has been able to customize templates to fit his specialty in endocrinology and is therefore able to see patients faster and complete their notes by the close of business. The benefits of customized templates, in his practice, allow “a more uniform approach to common problems, such as diabetes and thyroid nodules.” He goes on to explain that the result is a “well-defined path of questions designed to gather the most meaningful and relevant information” from the patient.

An EHR thorn in Dr. West’s side is his decision to not participate in the government’s EHR incentive plan. He thought he’d pursue the path to meaningful use, but after a great deal of frustration he abandoned his pursuit of the government’s EHR incentive money. West stated he may blog about his inner struggle with this issue. If so, his comments will appear in his blog Happy EMR Doctor.

The interview also touched upon Medicare’s recent practice of eliminating consultation codes and the consequences of this practice. By eliminating codes, Medicare has restricted providers’ ability to bill in certain instances. This has led to Dr. West and others turning away Medicare patients thereby restricting some patients’ access to care.

Dr. West’s EMR success should give all doctors and healthcare professionals the incentive to conquer the EMR puzzle and regain some of their personal time now spent handling and maintaining paper charts.

Full Disclosure: Practice Fusion is an advertiser on this site. However, they didn’t know we were doing this interview with Dr. West. Also, Happy EMR Doctor, Dr. West’s blog, is part of the Healthcare Scene blog network.

As you know, I regularly like to highlight some of the best and most interesting comments on my various websites. Especially since I know many of you don’t read all the comments (shame on you). This comment on meaningful use comes from someone who identifies themselves as SoftwareDev and works for an EMR vendor:

Coincidentally, I actually came up with the exact same conclusion [see original post] when reviewing the specs the other day. What I mean is, I identified that the way that we track “problems” in our software serves our customers well, but doesn’t really meet the measurement method of Meaningful Use.

In my app, I can record a “problem” using an ICD-9 code on the patient record (chronic) as well as on the visit (acute/episodic, based on Dx attached to the charges posted for that encounter). I also track descriptive (non-standardized) phrases in our Medical History. The former is good because it meets the standardized terminology requirement, but it fails because I don’t keep a “history” of active, or inactive problems. The latter is good because it is more “all encompassing”, including problems that the patient isn’t actually being seen by this particular doctor for, but also fails because it isn’t recorded by ICD-9 code and descriptor.

Either way, I have to revise the software’s method of recording “problems”, both for historical purposes and for proper coding, and ONLY to meet the Meaningful Use requirement. Not a single customer has ever voiced a request remotely like this to me in my 12 years of handling software in this sector.

Descriptions like this is why I’m concerned about the impact of meaningful use. There’s little doubt that the EHR incentive money has stimulated interest and even purchasing of EMR software. I just wonder what unintended consequences will come from meaningful use and EHR certification. Sadly, the above description may meet meaningful use, but doesn’t sound like meaningful patient care.

A day or two ago I came across an article talking about a new company ready to enter the EMR software market. Ok, technically they call themselves an EHR, but you get the point. The new EMR company is called iPractice.

From what I read, it looks like they’re planning to launch their EHR product in January of 2011. It’s just absolutely amazing to me how many companies are launching their own EHR product. Check out this crazy long list of EHR Vendors (close to 400 I believe) that I posted back in early 2006. Yet, we still get more and more companies entering the market to crack the EHR nut.

I wish iPractice the best of luck. Their website is basically a boiler plate Joomla template with some basic information. I can’t fault them too much for their website since they should be focusing their time and effort on creating a killer EHR product. I just wonder how they’re going to set themselves apart above the fray of EMR companies that are out there.

Of course, it’s hard to hold down the entrepreneurial spirit. I’m not complaining about the new entrant. It’s one more company that can advertise on EMR and EHR. I just feel bad for the doctors that have to sift through all the EMR choices.

In the late spring of 2009, I got this crazy idea of opening up my own practice as a solo practitioner. I was sitting in my Friday morning clinic block at Hopkins, seeing somewhere between 8-10 patients a week, when I came into a room to see an interesting young woman with slightly buggy eyes. Turns out, she was a specialty physician working in private practice for her thirteenth year in a row and she later in the visit would tell me private practice was the best thing she ever did. I, on the other hand was in my first year of junior facultyship at an academic pressure cooker and still trying to come to a conclusion about being overworked and underpaid compared with my private practice colleagues. But I will save the rest of that conversation for another day. My doctor-patient turned out to be a pivotal figure in my life and soon I was carefully planning to open my very own practice in downtown Washington.

One of the things my practice manager and I wanted to do from the very beginning was to get away from paper charts and all the pitfalls I had previously experienced. From lost charts, to missing test results, to needing to constantly refile charts after visits, our motivation was pretty clear. In August of 2009, we started combing through blog after blog and website after website trying to find that perfect combination of price, form and function. We finally settled on a moderately-priced, middle of the road model and signed the contract on the dotted line. A server was bought. Thin-client dummy terminals were installed. And life was going to be organized and GOOD without paper charts!But the best laid plans of mice and men are, of course, not always so easily pulled off. For three months from November 2009 until the beginning of February 2010, we struggled with unfinished training sessions, broken software links, and a multitude of things just plain not working. These issues were followed by an outsourced team in India telling us that all problems would be solved to our complete satisfaction. We tried to be patient, listening to the software vendor’s excuses and promises. Day after day of frustration went by, and soon it was up to month after month. At the beginning of February 2010, we decided to fire the company and go with a different one. We initially demanded all of our money back for product misrepresentation. Fortunately, depending on how you look at it, we had only paid half of the complete bill earlier on, citing that payment would only be completed when we had a completely functioning product. This never happened. And so we finally settled for a partial refund minus $2000. Talk about insult to injury! But we needed to move on as quickly as possible, and we had patients to see and take care of, after all. Could we have won in court? In a nanosecond.

As far the company we fired, we agreed to sign a gag order in order to get any money back, and so they remain carefully hidden in the shadows. But if you can read the details above, it probably won’t be difficult to stay away from this one. In retrospect, nevertheless, we should not have let our EHR disaster get so far. As soon as promises were made and not kept more than once, we should have read the writing on the wall and gotten out. Lesson learned!

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.

I must admit that I don’t post that often about healthcare reform and the changing doctors practice. Not to mention things like the Accountable Care Organizations (ACO) and other trends in healthcare. Although, I do watch them peripherally and in many cases these changes are important in relation to EMR since they impact what the future of EMR might look like.

So, I was pretty interested in a post by Barbara Duck about the impact of Healthcare Reform on medicine as we know it today. Barbara has a quote which describes the change:

“Healthcare reform will usher in a new era of medicine in which physicians will largely cease to operate as full-time, independent, private practitioners accepting third party payments.”

Then, she quotes a study which describes how medicine will change and the four possible courses that physicians will take amidst all this change.
• Work as employees of increasingly larger medical groups or hospital systems
• Establish cash-only practices that eliminate third party payers
• Reduce their clinical roles by working part-time
• Opt out of medicine altogether by accepting non-clinical positions or by retiring.

This information isn’t all that new. I also have read many people who just see this as the same cycle that we’ve seen before. I think that’s probably true, but it’s still a cycle that should be considered going forward.

Assuming the above assumptions are correct, does that spell the end of the small practice EMR software? Essentially it would leave only EMR software that supports larger medical groups or hospital systems and EMR software that handles cash only practices (something every EMR vendor would probably love to do).

Personally I don’t see it as the end of small practice EMR software. Although, it definitely will see a shrinking of the market for that software. At least temporarily.

In a new series of posts (or maybe this will be the only one…we’ll see), I ask the question, Is this a conventional EMR or not?

This question comes from my post about Unconventional EMR software and the responses I receive. Now it’s up to you to look over the description I got of an EMR software and decide if it’s unconventional or not. I have a feeling the comments on this post are going to be very interesting.

First up is the BennPen EMR software by Bennethum Computer Systems.

BennPen sent me the following major advantages to their EMR software:

There are many Electronic Medical Records programs on the market. Ours is different because:
- BennPen is much simpler and easier to use than other EMR programs. Our goal in developing
BennPen was usability. A major reason why many Doctors are not using EMR is that most EMR
Programs are difficult and time consuming to use.
- BennPen is customized for each Doctor whereas other programs are not. This means BennPen
can be used for any specialty. BennPen is less expensive than other EMR programs initially and
ongoing because we do not charge an annual maintenance fee.
- BennPen has a 60 day free trial. To fill out your templates and letters you can use voice, drop
down lists, or a combination of both. A choice of an item on a drop-down list can automatically
bring up another list of items pertaining to that choice. A Medicare approved RX module is
available.
- E-mailing of patient chart information to other Doctors and/or to patients. Insurance
verification can be done thru BennPen. BennPen has a recall system.
- The BennPen data-base is stored on the server in your office. You have more control over your
data compared to a web-based program. There is no worry about the internet communication
going down. You do not need to purchase a separate server for EMR.

I then sent them this response to really have them try and make a case for their EMR being unconventional and to be able to get information on whether it’s unconventional or not:

I think that a few of your major advantages could be differentiators, but it seems like some of the things need more proof. Otherwise, it just sounds like marketing hype.

For example, it’s one thing to say that your EMR is “much simpler and easier to use than other EMR programs.” The question is, how can I know that this is the case? Do you have some examples that illustrate how it’s much easier and simpler? Do you have some doctors who have been on other EMR software that can support the claim?

Creating a customized EMR for a doctor is another example. If all you do is add in 5 or so customized template, that’s not really a differentiator. Now, if your EMR is modeled so that every step in the process is customized for the doctor to meet their practice needs and you have a couple examples of 2 doctors with drastically different work flows. Then, we’re talking.

Do you see what I’m trying to say? Maybe you really do have an unconventional EMR, but you really need to make the case for me (and my readers) to believe. I’d love to see the case made.

I then got the following response to my comments.

Thank you for reviewing our information. I’ll try to respond to your questions.

EASE OF USE: The fewer the screens the easier a program is to use. There are 8 descreet screens in BennPen but a Doctor would only need 5 screens to do his/her charting. I would think that a Doctor would have his staff do things like set up recalls, check eligability, etc. I have seen Doctors use other EMR’s and there appears to be a lot more screens used. Our screen have been designed to be uncrowded and easy to use. The EMRs I’ve seen have crowed screens.It takes me only 15 or 20 minutes to completly demonstrate BennPen. My guess is that other EMR demos would run alot longer than that.

CUSTOMIZATION: We put into our program the templates, forms, letters that the Doctor currently uses now. He or she then does electronic charting with the same forms they are used to using with voice and drop-downs. Among other things this means we can offer our program for any specialty.

Our program is much less costly than many others – $3,000 and no annual fees. If you would be interested I’d be happy to send you a demo of BennPen. If you’d like to speak with me our number is 800-982-2623.

So, I ask you…

Is This EMR Unconventional?

UPDATE: In the comments and online I was asked to get some screenshots of this EMR for people to evaluate. I got the following message and screenshots for people to see. Just click on the image to see a larger version.
There are 6 of these, one more than I previously said. I decided to include the screen for sending patient chart notes to another provider because the Doctor can send only selected notes that he/she desires rather than all medical history and that would be the Doctor’s decision rather than a staff member. There are other screens for printing reports, checking eligibility, setting recall appointments, etc. which functions I believe the staff would do.

I always love creativity and so I have to give credit to the marketing people at meridianEMR. They’re providing an interesting price reduction in their EMR that keys off of many physicians anger over the potential 21.9% Medicare reimbursement cuts. Here’s a few portions from the meridianEMR offer:

In order to provide physicians with relief from Medicare fix uncertainty, meridianEMR is offering a special “meridianEMR Doc Fix.” This includes a 21.9% reduction on all new meridianEMR system orders for new Urology customers starting November 10, 2010 and ending December 31, 2010. This unprecedented offer during these uncertain times directly reflects one of the core values of meridianEMR, which is partnership with clients.

“If the government does not rescind the “Doc Fix” of 21.9%, our offer still stands. We encourage our potential new clients to move forward with confidence that they will be receiving the market leading Urology EHR at the most affordable price ever offered by meridianEMR. This is our way of standing by their side in a challenging economic environment,” commented Lawrence Drappi, Executive Vice President, meridianEMR.

I’m sure that many doctors will appreciate the gesture. Pretty creative to key off of cuts that have been seen as such a negative thing. I wonder if other EMR vendors will follow their lead. Many of the EHR software out there could use at least a 21.9% cost reduction.

I was passing through my LinkedIn account and saw this message from @GrandRounds4ODs which seems to have come from his Twitter account:

Appoint a single point of contact for project/contract compliance. Keep the consultants + vendors honest!

This is some great advice. One point of contact can really help to cut through the lies…err…EMR sales mis communications.