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Could Clinicians Create Better HIE Tools?

The following is a guest blog post by Andy Oram.His post reminds me of when I asked “Is Full Healthcare Interoperability a Pipe Dream?

A tense and flustered discussion took place on Monday, August 11 during a routine meeting of the HIT Standards Committee Implementation Workgroup, a subcommittee set up by the Office of the National Coordinator (ONC), which takes responsibility for U.S. government efforts to support new IT initiatives in the health care field. The subject of their uncomfortable phone call was the interoperability of electronic health records (EHRs), the leading issue of health IT. A number of “user experience” reports from the field revealed that the situation is not good.

We have to look at the depth of the problem before hoping to shed light on a solution.

An interoperability showcase literally takes the center of the major health IT conference each year, HIMSS. When I have attended, they physically arranged their sessions around a large pavilion filled with booths and computer screens. But the material on display at the showcase is not the whiz-bang features and glossy displays found at most IT coventions (those appear on the exhibition floor at HIMSS), but just demonstrations of document exchange among EHR vendors.

The hoopla over interoperability at HIMSS suggests its importance to the health care industry. The ability to share coordination of care documents is the focus of current government incentives (Meaningful Use), anchoring Stage 2 and destined to be even more important (if Meaningful Use lasts) in Stage 3.

And for good reason: every time we see a specialist, or our parent moves from a hospital to a rehab facility, or our doctor even moves to another practice (an event that recently threw my wife’s medical records into exasperating limbo), we need record exchange. If we ever expect to track epidemics better or run analytics that can lower health case costs, interoperability will matter even more.

But take a look at extensive testing done by a team for the Journal of the American Medical Informatics Association, recently summarized in a posting by health IT expert Brian Ahier. When they dug into the documents being exchanged, researchers found that many vendors inserted the wrong codes for diagnoses or drugs, placed results in the wrong fields (leaving them inaccessible to recipients), and failed to include relevant data. You don’t have to be an XML programmer or standards expert to get the gist from a list of sample errors included with the study.

And that list covers only the problems found in the 19 organizations who showed enough politeness and concern for the public interest to submit samples–what about the many who ignored the researchers’ request?

A slightly different list of complaints came up at the HIT Standards Committee Implementation Workgroup meeting, although along similar lines. The participants in the call were concerned with errors, but also pointed out the woeful inadequacy of the EHR implementations in representing the complexities and variety of patient care. Some called for changes I find of questionable ethics (such as the ability to exclude certain information from the data exchange while leaving it in the doctor’s records) and complained that the documents exchanged were not easy for patients to read, a goal that was not part of the original requirements.

However, it’s worth pointing out that documents exchange would fall far short of true coordinated care, even if everything worked as the standards called for. Continuity of care documents, the most common format in current health information exchange, have only a superficial sliver of diagnoses, treatments, and other immediate concerns, but do not have space for patient histories. Data that patients can now collect, either through fitness devices or self-reporting, has no place to be recorded. This is why many health reformers call for adopting an entire new standard, FHIR, a suggestion recognized by the ONC as valid but postponed indefinitely because it’s such a big change. The failure to adopt current formats seems to become the justification for keeping on the same path.

Let’s take a step back. After all those standards, all those certifications, all those interoperability showcases, why does document exchange still fail?

The JAMIA article indicated that failure can be widely spread around. There are rarely villains in health care, only people pursuing business as usual when that is insufficient. Thus:

  • The Consolidated CDA standard itself could have been more precisely defined, indicating what to do for instance when values are missing from the record.

  • Certification tests can look deeper into documents, testing for instance that codes are recorded correctly. Although I don’t know why the interoperability showcase results don’t translate into real-world success, I would find it quite believable that vendors might focus on superficial goals (such as using the Direct protocols to exchange data) without determining whether that data is actually usable.

  • Meaningful Use requirements (already hundreds of pages long) could specify more details. One caller in the HIT Standards Committee session mentioned medication reconciliation as one such area.

The HIT Standards Committee agonized over whether to pursue broad goals, necessarily at a slow pace, or to seek a few achievable improvements in the process right away. In either case, what we have to look forward to is more meetings of committees, longer and more mind-numbing documents, heavier and heavier tests–infrastructure galore.

Meanwhile, the structure facilitating all this bureaucracy is crumbling. Many criticisms of Meaningful Use Stage 2 have been publicly aired–some during the HIT Standards Committee call–and Stage 3 now looks like a faint hope. Some journalists predict a doctor’s revolt. Instead of continuing on a path hated by everybody, including the people laying it out, maybe we need a new approach.

Software developers over the past couple decades have adopted a range of ways to involve the users of software in its design. Sometimes called agile or lean methodologies, these strategies roll out prototypes and even production systems for realistic testing. The strategies call for a whole retooling of the software development process, a change that would not come easily to slow-moving proprietary companies such as those dominating the EHR industry. But how would agile programming look in health care?

Instead of bringing a doctor in from time to time to explain what a clinical workflow looks like or to approve the screens put up by a product, clinicians would be actively designing the screens and the transitions between them as they work. They would discover what needs to be in front of a resident’s eyes as she enters the intensive care ward and what needs to be conveyed to the nurses’ station when an alarm goes off sixty feet away.

Clinicians can ensure that the information transferred is complete and holds value. They would not tolerate, as the products tested by the JAMIA team do, a document that reports a medication without including its dose, timing, and route of administration.

Not being software experts (for the most part), doctors can’t be expected to anticipate all problems, such as changes of data versions. They still need to work closely with standards experts and programmers.

It also should be mentioned that agile methods include rigorous testing, sometimes to the extent that programmers write tests before writing the code they are testing. So the process is by no means lax about programming errors and patient safety.

Finally, modern software teams maintain databases–often open to the users and even the general public–of reported errors. The health care field needs this kind of transparency. Clinicians need to be warned of possible problems with a software module.

What we’re talking about here is a design that creates a product intimately congruent with each site’s needs and workflow. The software is not imported into a clinical environment–much less imposed on one–but grows organically from it, as early developers of the VistA software at the Veterans Administration claimed to have done. Problems with document exchange would be caught immediately during such a process, and the programmers would work out a common format cooperatively–because that’s what the clinicians want them to do.

August 13, 2014 I Written By

Rep. Phil Gingrey Comes After Healthcare Interoperability and Epic in House Subcommittee

On July 17th, the House Energy and Commerce Committee’s subcommittee on Communications and Technology and Health (that’s a mouthful) held a hearing which you can see summarized here. Brought into question were the billions of dollars that have been spent on EHR without requiring that the EHR systems be interoperable.

In the meeting Rep. Phil Gingrey offered this comment, “It may be time for this committee to take a closer look at the practices of vendor companies in this space given the possibility that fraud may be perpetrated against the American taxpayer.”

At least Rep. Gingrey is a former physician, but I think he went way too far when he used the word fraud. I don’t think the fact that many EHR vendors don’t want to share their healthcare data is fraud. I imagine Rep. Gingrey would agree if he dug into the situation as well. However, it is worth discussing if the government should be spending billions of dollars on EHR software that can’t or in more cases won’t share data. Epic was called out specifically since their users have been paid such a huge portion of the EHR incentive money and Epic is notorious for not wanting to share data with other EHR even if Judy likes to claim otherwise.

The other discussion I’ve seen coming out related to this is the idea of de-certifying EHR vendors who don’t share data. I’m not sure the legality of this since the EHR certification went through the rule making process. Although, I imagine Congress could pass something to change what’s required with EHR certification. I’ve suggested that making interoperability the focus of EHR certification and the EHR incentive money is exactly what should be done. Although, I don’t have faith that the government could make the EHR Certification meaningful and so I’d rather see it gone. Just attach the money to what you want done.

I have wondered if a third party might be the right way to get vendors on board with EHR data sharing. I’d avoid the term certification, but some sort of tool that reports and promotes those EHR vendors who share data would be really valuable. It’s a tricky tight rope to walk though with a challenging business model until you build your credibility.

Tom Giannulli, CMIO at Kareo, offers an additional insight, “The problem of data isolationism is that it’s practiced by both the vendor and the enterprise. Both need to have clear incentives and disincentives to promote sharing.” It’s a great point. The EHR vendors aren’t the only problem when it comes to not sharing health data. The healthcare organizations themselves have been part of the problem as well. Although, I see that starting to change. If they don’t change, it seems the government’s ready to step in and make them change.

July 30, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Is Full Healthcare Data Interoperability A Pipe Dream?

It’s always been very clear to me that healthcare interoperability is incredibly valuable. I still wish most organizations would just bite the bullet and make it a reality. Plus, I hope meaningful use stage 3 is blown up and would just work on interoperability. I think there are just so many potential benefits to healthcare in general for us not to do it.

However, I had a really interesting discussion with an EHR vendor today (Side Note: they questioned if interoperability was that valuable) and I asked him the question of whether full healthcare interoperability is even possible.

I’d love to hear your thoughts. As we discussed it more, it was clear that we could have full interoperability if the data was just exported to files (PDFs, images, etc), but that’s really just a glorified fax machine like we do today. Although it could potentially be a lot faster and better than fax. The problem is that the data is then stuck in these files and can’t be extracted into the receiving EHR vendor.

On the other end of the spectrum is full interoperability of every piece of EHR data being transferred to the receiving EHR. Is this even possible or is the data so complex that it’s never going to happen?

The closest we’ve come to this is probably prescriptions with something like SureScripts. You can pull down a patient’s prescription history and you can upload to it as well. A deeper dive into its challenges might be a great study to help us understand if full healthcare data interoeprability is possible. I’m sure many readers can share some insights.

I’m interested to hear people’s thoughts. Should we trim down our interoperability expectations to something more reasonable and achievable? We’ve started down that path with prescriptions and labs. Should we start with other areas like allergies, family history, diagnosis, etc as opposed to trying to do everything? My fear is that if our goal is full healthcare data interoperability, then we’re going to end up with no interoperability.

July 11, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Next Week’s Guest Blogger – Julie Maas from EMR Direct

Next week, it’s going to be a little different around here. Next week, I’m going to be spending the week at Zions National Park as part of a family reunion. We did this a couple years back and unless things have changed, I’ll be stuck completely off the grid with no wifi or even cell coverage (Although, I may slip into town one day to check my email). Should be quite the experience.

I’ve actually done this a few times before and you probably didn’t know it. I just schedule the posts to appear and no one even realized I was gone. In fact, when I’ve done it in the past, I’ve had some of my highest traffic days on the blog. Don’t ask me how that works.

Next week, I decided to do something a little bit different. When I first started blogging, I remember a blogger “turning over the keys” to his blog to another blogger for the week. I always thought that was a kind of cool idea. Usually the person who “drives” the blog for the week enjoys it, the readers get another perspective, and the blog keeps humming while I’m wrestling 4 children and 12 cousins in the wilderness.

While I’m away, I’m handing the keys over to my favorite HIMSS 2014 discovery, Julie Maas. Before HIMSS this year, I’d certainly interacted with Julie a number of times on Twitter, but I’d never really gotten to know her and what she did. Needless to say, once I met her in person and heard her story I was utterly impressed with her and what she’s doing in healthcare IT. Side Lesson: Don’t judge a person solely by their Twitter account or Twitter interactions. There’s usually a lot more to them.

As I consider who I trusted with the keys to this blog, I wondered if Julie would be willing to share her knowledge, expertise and perspective. For those who don’t know Julie (shame on you), she’s been living, eating, breathing and sleeping the Direct Project for the company she started EMR Direct.

I’ve heard really promising things about Direct Project, but have never dug into it like I should have done. So, I’m as excited to read Julie’s series of posts next week as any of you. She’s also going to throw in a little Health Datapalooza commentary as well. I’ll be interested to hear what you think of Direct Project after reading Julie’s posts.

I hope you’ll give Julie a warm welcome to the blog next week. If you like this idea, maybe we’ll do it again. If you hate it or Direct Project, then we’ll be back with our usual snark the week after.

Now, what’s the ICD-10 code for internet withdrawal?

June 6, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Meaningful Use is On the Ropes

We’re entering a really interesting and challenging time when it comes to meaningful use. We’ve often wrote about the inverse relationship between incentive and requirements that exists with meaningful use. As meaningful use stage 2 is now becoming a reality for many organizations and EHR vendors, the backlash against it is really starting to heat up.

If you don’t think this is the case, this slide from the HIT Policy Committee presentation says it a lot when it comes to organizations’ view of meaningful use stage 2.

Meaningful Use Stage 2 Attesatation - May 2014

For those that can’t believe what they’re reading, you’re reading it right. 4 hospitals have attested to meaningful use stage 2 and 50 providers as of May 1st. Certainly it’s still relatively early for meaningful use stage 2, but these numbers provide a stark contrast when you think about the early rush to get EHR incentive money during meaningful use stage 1.

This article by Healthcare IT News goes into many of the strains that were seen in the HIT Policy Committee. Sounded like the healthcare IT version of Real Housewives. However, the point they’re discussing are really important and people on both sides have some really strong opinions.

My favorite quote is this one in reply to the idea that we don’t need EHR certification at this point: “Deputy national coordinator Jacob Reider, MD, disagreed. Ongoing certification is required to give physicians and hospitals the security they need when purchasing products.”

Looks like he stole that line from CCHIT (see also this one). What security and assurance does EHR Certification provide the end user? The idea is just so terribly flawed. The only assurance and security someone feels buying a certified EHR is that they can get the EHR ID number off the ONC-CHPL when they apply for the EHR incentive money. The EHR certification can’t even certify EHR to a standard so that they can share health data. EHR Certification should go away.

I’m also a huge fan of the movement in that committee to simplify and strip out the complexity of meaningful use. I wish they’d strip it down to just interoperability. Then, the numbers above would change dramatically. Although, I’ve learned that the legislation won’t let them go that simple. For example, the legislation requires that they include quality measures.

No matter which way they go, I think meaningful use is in a tenuous situation. It’s indeed on the ropes. It hasn’t quite fallen to the mat yet, but it might soon if something dramatic doesn’t happen to simplify it.

May 9, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

McKesson, Meditech Chosen As EHR Test Systems for Meaningful Use

Here’s an interesting situation which is just popped up on my radar screen.  CMS and the ONC have chosen the first two vendors to serve as designated test EHR systems, and they’ve gone with McKesson and Meditech.

These test vendors are there to help eligible providers meet the requirements of Meaningful Use Stage 2.  To meet MU Stage 2 requirements, providers must successfully conduct at least one exchange test with a CMS-designated test EMR. (The providers can also meet the requirements by performing one electronic exchange of a summary of care document with a recipient using a different EMR technology.)

What intrigued me about this is that CMS and ONC are starting out with only two vendors for use as test EMR providers.  Given the diversity in the marketplace, you’d think that CMS would want to have fuller stock of vendors lined up before it went forward announcing its plans.

If I were an eligible provider going this route, I’d want to have the choice of a wider range test EMRs. Given how little real interoperability there is between EMRs, I’d like to know that I had a fallback position if my original tests didn’t work out.  After all, nothing I’ve read here suggests that EPs won’t have a chance to try again if the initial testing doesn’t go through, and if I were a provider, it’d be good to know that I could take the shot with other test EMRs. But I could be wrong, and that could have an effect on whether vendors see this as a win.

Let’s see if other substantial EMR vendors take up the ONC’s call to serve as test EMR participants.  It will be interesting to see whether vendors see participation as a credibility-raiser or a chance to get pantsed publicly if interoperating with their systems is a pain.

January 23, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

CommonWell Announces Sites For Interoperability Rollout

Nine months after announcing their plan to increase interoperability between health IT data sources, the CommonWell Health Alliance has disclosed the locations where it will first offer interoperability services.

CommonWell, whose members now include health IT vendors Allscripts, athenahealth, Cerner, CPSI, Greenway, McKesson, RelayHealth and Sunquest, launched to some skepticism — and a bit of behind-the-hand smirks because Epic Systems wasn’t included — but certainly had the industry’s attention.  And today, the vendors do seem to have critical mass, as the Alliance’s founding members represent 42 percent of the acute and 23 percent of the ambulatory EMR market, according to research firms SK&A and KLAS.

Now, the rubber meets the road, with the Alliance sharing a list of locations where it will first roll out services. It’s connecting providers in Chicago, Elkin and Henderson, North Carolina and Columbia, South Carolina. Interoperability services will be launched in these markets sometime at the beginning of 2014.

To make interoperability possible, Alliance members, RelayHealth and participating provider sites will be using a patient-centric identity and matching approach.

The initial participating providers include Lake Shore Obstetrics & Gynecology (Chicago, IL), Hugh Chatham Memorial Hospital (Elkin, NC), Maria Parham Medical Center (Henderson, NC), Midlands Orthopaedics (Columbia, SC), and Palmetto Health (Columbia, SC).

The participating providers will do the administrative footwork to make sure the data exchange can happen. They will enroll patients into the service and manage patient consents needed to share data. They’ll also identify whether other providers have data for a patient enrolled in the network and transmit data to another provider that has consent to view that patient’s data.

Meanwhile, the Alliance members will be providing key technical services that allow providers to do the collaboration electronically, said Bob Robke, vice president of Cerner Network and a member of the Alliance’s board of directors.  CommonWell offers providers not only identity services, but a patient’s identity is established, the ability to share CCDs with other providers by querying them. (In case anyone wonders about how the service will maintain privacy, Robke notes that all clinical information sharing is peer to peer  – and that the CommonWell services don’t keep any kind of clinical data repository.)

The key to all of this is that providers will be able to share this information without having to be on a common HIE, much less be using the same EMR — though in Columbia, SC, the Alliance will be “enhancing” the capabilities of the existing local HIE by bringing acute care facility Palmetto Health, Midlands Orthopaedics and Capital City OB/GYN ambulatory practices into the mix.

It will certainly be interesting to see how well the CommonWell approach works, particularly when it’s an overlay to HIEs. Let’s see if the Alliance actually adds something different and helpful to the mix.

December 13, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

Interoperability vs. Coordinated Care

Andy Oram asked me the following question, “Is the exchange of continuity of care documents really interoperability or coordinated care?

As it stands now, it seems like CCDs (continuity of care documents) are going to be the backbone of what healthcare information we exchange. We’ll see if something like Common Well changes this, but for now much of the interoperability of healthcare data is in CCDs (lab and radiology data are separate). The question I think Andy is asking is what can we really accomplish with CCDs?

Transferring a CCD from one doctor to the next is definitely a form of healthcare interoperability. Regardless of the form of the CCD, it would be a huge step in the right direction for all of the healthcare endpoints to by on a system that can share documents. Whether they share CCDs or start sharing other data doesn’t really matter. That will certainly evolve over time. Just having everyone so they can share will be of tremendous value.

It’s kind of like the fax machine or email. Just getting people on the system and able to communicate was the first step. What people actually send through those channels will continue to improve over time. However, until everyone was on email, it had limited value. This is the first key step to interoperable patient records.

The second step is what information is shared. In the forseeable future I don’t seeing us ever reaching a full standard for all healthcare data. Sure, we can do a pretty good job putting together a standard for Lab results, Radiology, RXs, Allergies, Past Medical History, Diagnosis, etc. I’m not sure we’ll ever get a standard for the narrative sections of the chart. However, that doesn’t mean we can’t make that information interoperable. We can, are, and will share that data between systems. It just won’t be in real granular way that many would love to see happen.

The idea of coordinated care is a much harder one. I honestly haven’t seen any systems out there that have really nailed what a coordinated care system would look like. I’ve seen very specific coordinated care elements. Maybe if we dug into Kaiser’s system we’d find some coordinated care. However, the goal of most software systems haven’t been to coordinate care and so we don’t see much on the market today that achieves this goal.

The first step in coordinating care is opening the lines of communication between care providers. Technology can really make an impact in this area. Secure text message company like docBeat (which I advise), are making good head way in opening up these lines of communications. It’s amazing the impact that a simple secure text message can have on the care a patient receives. Secure messaging will likely be the basis of all sorts of coordinated care.

The challenge is that secure messaging is just the start of care coordination. Healthcare is so far behind that secure messaging can make a big impact, but I’m certain we can create more sophisticated care coordination systems that will revolutionize healthcare. The biggest thing holding us back is that we’re missing the foundation to build out these more sophisticated models.

Let me use a simple example. My wife has been seeing a specialist recently. She’s got an appointment with her primary care doctor next week. I’ll be interested to see how much information my wife’s primary care doctor has gotten from the specialist. Have they communicated at all? Will my wife’s visit to her primary care doctor be basically my wife informing her primary care doctor about what the specialist found?

I think the answers to these questions are going to be disappointing. What’s even more disappointing is that what I described is incredibly basic care coordination. However, until the basic care coordination starts to happen we’ll never reach a more advanced level of care coordination.

Going back to Andy’s question about CCDs and care coordination. No doubt a CCD from my wife’s specialist to her primary care doctor would meet the basic care coordination I described. Although, does it provide an advanced level of care coordination? It does not. However, it does lay the foundation for advanced care coordination. What if some really powerful workflow was applied to the incoming CCD that made processing incoming CCDs easier for doctors? What if the CCD also was passed to any other doctors that might be seeing that patient based upon the results that were shared in the CCD? You can start to see how the granular data of a CCD can facilitate care coordination.

I feel like we’re on the precipice where everyone knows that we have to start sharing data. CCD is the start of that sharing, but is far from the end of how sophisticated will get at truly coordinated care.

August 19, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

New Nursing Journey, Healthcare Interoperability, and EMR Productivity

This is a great post by a nurse heading back into nursing. My suggestions for Jen is to dive in head first and learn the product in and out. Every EMR has issues, but you want to get to know those issues and the workarounds for those issues as soon as you can. Once you do, then at least they’re issues you know about and know how to deal with.


Depends on the vendor. More importantly, many institutions don’t want interoperability either. A number of times just this week people have told me that healthcare organizations don’t want to share with “their competitor.” Many are going to be taken kicking and screaming into interoperability.


This is the fear for many. I hope they just calculate in how fast paper charting was.

June 23, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

@HealthcareWen (Dr. Wen Dombrowski) – #HITsm Spotlight

I thought it would be fun to get to know some of the various personalities in the #HITsm community. @HealthcareWen is one of the great ones. With HIMSS 2013 started today, I think it’s perfect timing to highlight Dr. Wen. There is no one better to follow than her if you want to learn what she’s learning at HIMSS.

TELL US ABOUT YOURSELF:

I love the intersection of technology, business, policy, healthcare & social services. I enjoy figuring out high-level policy and strategic business goals, and then translating them into operational processes and product designs. I’m always thinking about “what is the best way to leverage technology?” for each situation, but realize that technology alone is usually an insufficient solution.

WHAT ARE YOU WORKING ON?

Lately I’ve been working on several small projects while completing a Global Executive MBA program at IE Business School — a program I highly recommend to others, by the way. I’m working with a hospice and homecare agency on EHR vendor selection and culture change to value decisions based on real-time data. I’m advising several medical software startups on product development—particularly on issues related to user experience, data structure, and strategy. I’m also helping several large nonprofit organizations that serve seniors and other underserved populations with understanding and adapting their strategy to the implications of healthcare reform, data availability, technology, and social media. And ever since Hurricane Sandy, I’ve been actively discussing how can technology and new media be leveraged to better prepare and respond to future emergencies with various community based organizations, government representatives, and medical providers.

Additionally, I see patients part-time by doing house calls. I love house calls because one can reach the sickest of patients – the patients who have the toughest time getting to their doctors’ offices. Seeing how patients live provides important clues about barriers to health and ways to personalize solutions. House calls and technology may seem like an odd combination of interests, but as Atul Gawande’s Hot Spotters article pointed out, the two complement each other in the goal to help the highest risk patients.

WHEN DID YOU GET INVOLVED IN SOCIAL MEDIA? WHAT GOT YOU STARTED WITH IT?

I’ve been on Facebook casually for years, mostly to share vacation and hobby photos with my family and to keep in touch with old friends.

I joined LinkedIn a couple years ago and it has been an invaluable tool to keep in touch with and find professional contacts. The search tool is especially useful when I am looking for people with specific expertise or geographic base. There are many interesting discussion Groups on LinkedIn, but I haven’t had time lately to read and interact with them.

Meetup has likewise been a useful site to find and create local affinity groups for in-person networking.

I didn’t consider myself “active” on social media until I started to actively use Twitter. I began using Twitter in 2011 to raise public awareness of the need for innovation in healthcare delivery, payment policy, patient engagement, and senior services. There seemed to be a lack of understanding about healthcare and aging, so I wanted to share some ideas as food for thought about tough topics.

WHAT BENEFITS HAVE YOU RECEIVED FROM SOCIAL MEDIA?

When I first started using Twitter, I really wasn’t expecting to get much out of it – I thought it would just be a chore to find and broadcast an article every once in a while. But then I realized it’s an incredibly powerful tool to find and engage other people that are likeminded or have different perspectives. It amazes me how Twitter brings together strangers and disparate stakeholders (such as patients, clinicians, technologists, and business executives) to dialogue about the evolving challenges of healthcare, technology, and society.

Personally, I have learned so much from the Twitter community – about topics that I was already passionate about – and introducing me to “new” concepts such as crowdsourcing, open data, and social enterprise. I love how Twitter enables serendipitous discovery of new gems, and appreciate the generosity of my Twitter friends who forward me interesting articles.

Beyond sharing articles and conversations, I’ve seen how Twitter and LinkedIn have been vital at connecting people with needs to relevant resources. For example, I remember the day after Hurricane Sandy I was volunteering in a shelter – the most needed item was dry socks, so I tweeted about it; I was stunned to learn an hour later someone anonymously dropped off a box of hundreds of brand new socks. This is just one small example of the larger potential that social media has to share info and resources.
socks
Twitter and LinkedIn have also led to the unexpected benefits of job offers, project collaborators, and speaking engagements. So Social Media has been indispensably valuable to me personally and professionally.

LOOKING AT THE WORLD OF HEALTHCARE IT, WHAT DO YOU SEE AS THE MOST IMPORTANT THINGS HAPPENING TODAY?

Lack of true data interoperability among different EHR’s and other healthcare applications is a key problem hindering health innovation and creating wasteful spending. Also, managed care utilization data, user-generated sensor data, and genomic data haven’t been integrated with provider clinical data. I think real-time, user-friendly views that combine these data sources are needed to optimize day-to-day clinical decisions, long term business planning, and operationalizing new payment models such as ACO’s.

Besides data interoperability and integration, usability and workflow are super-important in health I.T. but often neglected by vendors. EHR’s, patient apps, and other software programs need to be designed with a user interface that is intuitive and convenient to use. Any software or technology implementation needs to consider the impact on workflow and redesign processes to avoid new bottlenecks.

AS A DOCTOR, WHAT’S YOUR VIEW ON THE IDEA OF “PRESCRIBING” MOBILE HEALTH APPS?

I think there is potential for some mobile health apps to be very useful to patients and physicians. However, most physicians and patients find it overwhelming to choose the “best” app for their patient’s situation. There are too many apps right now that do similar things, or only have a partial set of features, or only target one specific disease. If a patient has Crohn’s, diabetes, and headaches – what is the best app for him? App developers should think about how to make apps better than what already exists by including comprehensive features that are easy to use for patients, caregivers, and providers… this may mean partnering with and enhancing existing products instead of separately developing the 101st medication tracker app, pain tracker app, diet app, etc.

AS SOMEONE WHO FOCUSES ON THE AGING POPULATION, WHAT’S IT GOING TO TAKE TO BRING HEALTH IT TO THE OLDER GENERATION OF PATIENTS?

Contrary to popular misconception, age is not the biggest barrier to technology adoption: usability is. Software and physical products need to be intuitive, user-friendly, and make people’s lives easier by solving real problems. Technology needs to integrate into the “workflow” of people’s daily lives, or else it’s a nuisance to use. Some special considerations when designing for older adults is keeping in mind some may have trouble with limited vision, tactile sense, or physical range of motion. These don’t preclude older adults from using technology – if technology is designed with these users in mind. I think companies designing for seniors have a lot to learn from the field of developmental disabilities that has a long tradition of inventing assistive technology. The good news is that increasingly more companies are taking human centered design approaches more seriously.

IF YOU COULD WAKE UP TOMORROW AND HAVE ONE PART OF HEALTHCARE SOLVED, WHAT WOULD IT BE?

I would change the way that healthcare gets paid for so that good care gets rewarded. Instead of paying hospitals for how many tests and surgeries are done, payments should reflect smart clinical decision making and coordination of care.

I would also love to see different data sources integrated into one application that can display the data in ways that are meaningful to different users, e.g. data views for patients, clinicians, and administrative users.

ANY FINAL THOUGHTS?

I hope policymakers, administrators, and developers always keep in mind the end-users’ needs and perspective (whether that’s a patient, caregiver, clinician, or anyone else).

March 4, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.