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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.

How Many Doctors Take Time to Explore New Practice Innovations?

Posted on April 22, 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.

Over the 10 years I’ve spent blogging about healthcare IT, I’ve had the chance to talk to more doctors than I can count. For the most part, I’ve been impressed by how incredible these doctors are and their desired to provide amazing care to their patients. Their desire to do the right thing for their patients is powerful and gives me a lot of hope for the future of healthcare.

While I think that most doctors hearts are in the right place, I fear that most of them don’t spend enough time thinking and planning for the future of their practice. When does a doctor spend time exploring new innovative opportunities to improve their practice? When does a doctor have time to try out new approaches or to think deeply about how they could improve the patient experience?

There are a few doctors that can spend time thinking about these types of things. They work for large health systems as employed doctors. Sure, they’re busy too, but do generally have less to worry about. However, these doctors have almost no power to implement or test and changes to the way they practice medicine and the patient experience.

I’m not really blaming doctors for this problem. I realize that they’re super busy people. I’m sure many of them would love the opportunity to spend time reinventing the practice of medicine and the patient experience. If they had the opportunity, they’d happily take it. The problem is that most of them don’t think they can get off the proverbial hamster wheel that requires them to see patients in 15 minute increments.

I think this is a problem and I don’t see any easy fixes.

If you’re a small practice, when was the last time you implemented something that really transformed the way you practice medicine for the better? When was the last time you implemented something that wasn’t part of a government mandate? When was the last time that you spent time talking with your patients about their experience at your clinic and ways that you could make it better?

I’m sorry to say that I think the answers would all reflect the reality in healthcare that we don’t spend enough time on progressing the practice of medicine. I’m sure that some doctors would argue that they’re fine with the status quo. They don’t see a reason to change. Short term that strategy could work. Long term I think that approach will come up wanting.

Healthcare Hype Cycle Graphic

Posted on September 8, 2015 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 is a lot of really interesting things happening in healthcare. Many are trying to change healthcare as we know it today. Many have the promise of lowering costs, improved care, and better health. However, each of these movements, initiatives, or trends are at different points of the famous maturity lifecycle.

Bonnie Feldman shared the following graphic which shows many of these healthcare changes on the hype cycle:

Here’s a larger version for those who can’t read the smaller Twitter embedded image:
Healthcare Hype Cycle

I should mention that this graphic is focused on Autoimmunity, but you could see how this applies to so many areas of healthcare. A few minor changes and it would be all of healthcare. What other items would you add to this hype cycle? Would you move anything on the chart above farther along the line or backwards on the line?

The Key to Healthcare Innovation

Posted on April 20, 2015 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.

As I’ve thought through my own entrepreneurial journey, I think this is the biggest key differentiator between me and many others. Ideas are so easy. Everyone has them and great entrepreneurs have thousands of them. The really really hard thing is to do something about them.

I hate to think about the millions of ideas that have come to people in healthcare and nothing’s been done about them. They lie dormant in someone’s mind since someone doesn’t feel empowered to do something about it. They never see the light of day because someone is afraid to share the idea with someone else who could help them make it a reality.

While we love to tell stories of innovation that get wrapped up really nice with a pretty bow on top. The reality is that every innovation I’ve seen in healthcare is always much messier than a story portrays. This is why making an idea happen is so hard. Having the idea is easy. Actually acting on an idea is messy and often extremely difficult.

Thank you Dr. Shrestha for the challenge coming out of HIMSS where a lot of ideas are thrown around. Now’s the time to help make those ideas happen.

Jonathan Bush Loves Health Data–But How Will We Get As Much As He Wants?

Posted on September 24, 2014 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The fervent hope of health care reformers is that someday we will each know as much about our bodies–our vital signs, the health of our organs, the contents of our genomes-as corporations know about our marketing habits. One of the recent expressions of this dream comes in Jonathan Bush’s engaging and readable account of the healthcare system, Where Does It Hurt?.

Bush is a tireless advocate for bottom-up, disruptive forces in healthcare, somewhat in the same camp as Vinod Khosla (whose Health Datapalooza keynote I covered) and Clayton Christensen (who wrote the forward to Bush’s book). What Bush brings to the discussion is hands-on experience at confronting the healthcare behemoth in an explicitly disruptive way (which failed) as well as fitting into the system while providing a bit more light by building athenahealth (which succeeded).

Bush’s book tours the wreckage of the conventional health care system–the waste, errors, lack of communication, and neglect of chronic conditions that readers of this blog know about–as well as some of the promising companies or non-profits that offer a way forward. His own prescription for the health care system rests on two main themes: the removal of regulations that prevent the emergence of a true market, and the use of massive data collection (on physicians and patients alike) to drive a rational approach to health care.

Both government and insurers would have a much smaller role in Bush’s ideal health care system. He recognizes that catastrophic conditions should be covered for all members of society, and that the industry will need (as all industries do) a certain minimum of regulation. (Bush even admitted that he “whined” to the ONC about the refusal of a competitor to allow data exchange.) But he wants government and insurers to leave a wide open field for the wild, new ideas of clinicians, entrepreneurs, and software developers.

Besides good old-fashioned human ingenuity, the active ingredient in this mix is data–good data (not what we have now), and lots of it. Bush’s own first healthcare business failed, as he explains, through lack of data along with the inconsistency of insurance payments. A concern for data runs through this book, and motivates his own entrance into the electronic health records market.

What’s missing from the Where Does It Hurt?, I think, is the importance of getting things in the right order: we can’t have engaged patients making free choices until an enormous infrastructure of data falls into place. I have looked at the dependencies between different aspects of health IT in my report, The Information Technology Fix for Health: Barriers and Pathways to the Use of Information Technology for Better Health Care. Let’s look at some details.

Bush wants patients to have choice–but there’s already a lot of choice in where they get surgery or other procedures performed. As he points out, some of the recent regulations (such as accountable care organizations) and trends in consolidations go in the wrong direction, removing much of this choice. (I have also written recently about limited networks.) One of Bush’s interesting suggestions is that hospitals learn to specialize and pay to fly patients long distances for procedures, a massive extension of the “medical tourism” affluent people sometimes engage in.

But even if we have full choice, we won’t be able to decide where to go unless quality measures are rigorously collected, analyzed, and published. Funny thing–quality measures are some of the major requirements for Meaningful Use, and the very things that health IT people complain about. What I hear over and over is that the ONC should have focused laser-like on interoperability and forgone supposedly minor quests like collecting quality measurements.

Well, turns out we’ll need these quality measures if we want a free market in health care. Can the industry collect these measures without being strong-armed by government? I don’t see how.

If I want a space heater, I can look in the latest Consumer Reports and see two dozen options rated for room heating, spot heating, fire safety, and many other characteristics. But comparable statistics aren’t so easy to generate in health care. Seeing what a mess the industry has made of basic reporting and data sharing in the data that matters most–patient encounters–we can’t wait for providers to give us decent quality measures.

There’s a lot more data we need besides provider data. Bush goes into some detail about the Khosla-like vision of patients collecting and sharing huge amounts of information in the search for new cures. Sites such as PatientsLikeMe suggest a disruptive movement that bypasses the conventional health care system, but most people are not going to bother collecting the data until they can use it in clinical settings.

And here we have the typical vicious cycle of inertia in health care: patients don’t collect data because their doctors won’t use it, doctors say they can’t even accept the data because their EHRs don’t have a place for it, and EHR vendors don’t make a place for it because there’s no demand. Stage 3 of Meaningful Use tries to mandate the inclusion of patient data in records, but the tremendous backward tug of industry resistance saps hope from the implementation of this stage.

So I like Bush’s vision, but have to ask: how will we get there? athenahealth seems to be doing its part to help. New developments such as Apple’s HealthKit may help as well. Perhaps Where Does It Hurt? can help forward-thinking vendors, doctors, health information exchanges, entrepreneurs, and ordinary people pull together into a movement to make a functioning system out of the pieces lying around the landscape.

Healthcare Innovation – #HITsm Chat Highlights

Posted on May 18, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Before we get to the regular #HITsm recap, John got together with a couple of other members of the #HITsm community and did a Google Plus hangout during this week’s chat. It’s a little random, but there were some good discussions about the #HITsm chat topics. We’d love to hear feedback about what we did. We’re considering doing something similar in the future, but with a little more focused discussion.

Topic One: What does #healthcare innovation mean to you? How do you define it?

Topic Two: Do you see innovation in #medicine different than in public health, if so how?

 

Topic Three: What are effective methods of globally diffusing innovative ideas/tech when it comes to getting healthcare user buy-in?

Topic Four: Can you name any examples of tech & innovations developed in U.S. that have translated elsewhere, & vice versa?

Google EMR, Healthcare Innovation, and EMR Social Media

Posted on March 24, 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.

We have a wide range of tweets today, but so many of them offer interesting insights and discussion points. I think you’ll agree.


I think the reply to the original tweet is a great response. I honestly can’t imagine Google getting back into the healthcare game through an EMR. They might do something with discovery of health information. They might do something cool with their image recognition technology and healthcare, but they’re not going to build an EMR. EMR is enterprise software, and Google won’t be going there.


I’m a huge supporter of API’s and the innovation they can create. I just don’t see many healthcare IT vendors ready to open up their systems like that. This is possibly because there’s too much money to be made by selling their product as is. Thanks EHR Incentive money.


It’s pretty provocative to consider, but the simple answer is yes it will. Although, it might be the HIE more than the EMR. I guess we’ll see how that plays out. However, I think control of when and where your information is shared will be a feature. Of course, most people won’t ever use that feature. They’ll just leave the default settings.

Medical Care and Primary Care without Insurance Allows Technology to Flourish

Posted on June 30, 2011 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’ve previously posted that I believe the real EMR innovation will likely have to come together with healthcare innovation. The basic premise being that our current insurance reimbursement system is a weight on the backs of EMR software. The insurance requirements cause much of the unwieldy interfaces that are put out by EMR software and insurance requirements and limitations are a huge limiter on the technology innovation that could occur in healthcare.

Imagine how much more streamlined the EMR interface could be if EMR companies worried about patient care and not reimbursement. Imagine the new technologies that would be implemented if you weren’t so worried about the office visit reimbursement model we have today.

This premise is why I was so intrigued by this post on the popular Tech Startup blog, Techcrunch, called “The Most Important Organization in Silicon Valley That No One Has Heard About.” In the article, Dr. Samir Qamar has been putting together a different model for healthcare. “For only $49 per month and $10 per visit, MedLion is able to provide high quality medicine at a price point nearly any family can afford.”

How is he able to do this? Here’s a quote for part of how he’s able to accomplish it:

Part of MedLion’s value proposition has been availability to its patient base. Like many direct primary care practices, they find more than half of their patient interaction is via electronic means, as they aren’t forced by reimbursement rules to have a patient come to their office for something that could be done simply over phone or email. We want to be available for our patients whether they are in the Bay Area, Bali or Boise.”

I’m not sure if Dr. Qamar has found all the healthcare Innovation secret sauce, but I’m grateful for pioneering entrepreneurs like Dr. Qamar that are willing to try something different. Plus, there’s no better place for the application of technology than in these new models for healthcare. It’s exciting to consider what technology could really do when it’s not shackled by the 100 pound gorilla.