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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 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently 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.

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 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently 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.

@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 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently 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.

One Database Has Distinct Advantages for Data

I recently was talking with an EHR vendor and they made the comment that having their EHR all on one database was a distinct advantage over the EHR vendors who install a new database with every new EHR install. I was intrigued by the idea and could easily see some of the benefits of an EHR vendor having all of the EHR data in one database. When you think some of the future quality programs that could come out, I think there could be some advantages there as well.

Considering this advantage, I started to think about ways that multiple database EHR vendors could level the playing field with their single EHR database comrades. One idea I had was using interoperability to level the playing field. If all the EHR vendors have access to all of the data, then not only will single database EHR vendors not have an advantage, but they’ll be at a disadvantage if they don’t work to exchange the EHR data as well.

When I think about this, it makes me wonder why multiple database EHR vendors aren’t accelerating the exchange of health information. This seems like it would be to their strategic advantage to exchange information.

February 18, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently 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.

EHR Interoperability Benefits Not Related to Physician Data Sharing

I always love when someone can take a subject and expand my thinking on that subject. Whenever I thought about EHR interoperability I always thought about it from the perspective of a physician sharing that data with another physician. In this case it would be one EHR sharing with another EHR (possibly with an HIE in the middle). In a recent post, Dr. Doug Fridsma from ONC, (I love that ONC blogs) expanded my thinking when it comes to the possible benefits associated with data standards and EHR data sharing when he shared the following list:

  • Patient safety advocates may want to use EHR systems to collect patient safety information, leveraging existing standards like the AHRQ “common format” for patient safety reporting
  • Providers and researchers may want to use the EHR systems to collect data for clinical research, including patient-centered outcomes research, and to identify patients who could benefit from participating in a research study
  • Providers may want to give referrals to their patients for community services, like smoking cessation or weight management programs, after discussing these topics with them during an office visit
  • Providers working with disease surveillance case report forms may wish to collect additional information about reportable conditions, such as infectious diseases
  • Provider’s office staff can use EHR’s to gain pre-authorization of certain kinds of medical devices where health payers may want to leverage clinical information collected in EHRs to support additional review of expensive medical equipment.

After just publishing my recent post about The Coming Physician EHR Revolt, I can’t help but ask what any of the above items do to help a doctor. The last one could help a physician’s workflow, but the rest of them have limited specific value to a physician. This is one of the challenges with EHR data sharing. Doctors don’t buy and implement an EHR because they want to give better referrals to their patients for community services. There’s a mismatch between providers’ needs and healthcare data exchange desires.

February 5, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently 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.

From #AMIA: Interoperability Held Back By Politics

When a recent AMIA panel was asked why health IT interoperability was still in its infant stages, members’ responses were the same we’ve been hearing for, I don’t know, a decade or more.  Let’s say that there didn’t seem to have been a lot of hope in the room.

According to Healthcare IT News, true interoperability between health systems is still beyond us due to the same-old, same-old reasons:  Hospitals with hundreds of systems, vendors with proprietary databases, varied standards, health systems that don’t want to share data and a lack of interoperability support from policymakers.

Ultimately, the fact that these obstacles haven’t been overcome is as much a matter of politics as integration problems, the magazine reports:

Charles Jaffe, MD, CEO of standards development organization Health Level Seven International (HL7) described a “circle of blame” involving government agencies and regulators, hospitals and healthcare systems, technology vendors, clinicians, academicians like those at AMIA and, yes, standards development organizations (SDOs), such as HL7. “The policy always preempts the technology,” said Jaffe.

My feeling is that this circle of blame would dissolve in a millisecond if a compelling financial case could be made for interoperability.  Anything might help at this point.

Hey, just prove that interoperability saved a health system $2 a patient somehow, and they might be made to invest in needed changes. Or convince vendors that they’d move even a few units of their product if their systems were freely interoperable, and they’d probably be more cooperative.

At this point though,  you’ve got cross-cutting turf wars going on, with vendors and health systems and standards organizations each pursuing an agenda of their own. And honestly, why shouldn’t they?

With plenty of financial and institutional risk involved, and questionable rewards, I’m not sure how gung-ho I’d be on interoperability if I were a healthcare CIO or vendor exec.

Bottom line: If you want interoperability, it’s got to have a more tangible payoff for everyone involved.

November 12, 2012 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.

An Interview with Dr. Nan Nuessle (@DrNanN) – #HITsm Spotlight

For the past few months we’ve been doing a summary of the #HITsm chats that happen each Friday. I once heard Michael Gaspar, who does social media at HIMSS, describe Twitter hashtags as a community of users. I think this is definitely true when it comes to the #HITsm hashtag. With that in mind, I thought it would be interesting to learn more about the members of the #HITsm community and to learn from the members of the #HITsm community.

The first in this series of #HITsm spotlights is with @DrNanN (Nanette Nuessle, MD). She gives some amazing insights. Enjoy!

When did you get involved in social media? What got you started with it?
I got started in social media 2 years ago. I was at a national meeting of pediatricians. One of my colleagues said I needed to be on Twitter. I told her I didn’t know anything about it. She grabbed my phone, asked how the kids in my practice address me, then handed the phone back and said, “you’re on twitter.” I didn’t do anything but follow for 2-3 months. I didn’t really try to build a following until about 18 months ago. Now, I have nearly 4,000 followers.

What benefits have you received from social media?
Social media has given me a way to talk with patients outside the 10-20 minute office visit. I can post information that is specific to my practice, or tell them of late-breaking news. It gives me a vehicle for discussing that late-breaking news with other professionals. My attention to these 2 things has greatly improved my ongoing education. Finally, it has opened career paths that allow me to help other physicians who are transitioning to the use of electronic health records and social media.

Looking at the world of healthcare IT, what do you see as the most important things happening today?
The single most important thing in healthcare today is the budding widespread use of electronic health records. We must remember that this practice is in it’s infancy. It is still the most powerful tool to reach physicians since the development of the stethoscope.

As a doctor, what’s your view of the current EHR world?
The EHR world is in it’s infancy. I have been sending prescriptions electronically since 2005, and using electronic health records for even longer. Many providers are just starting into this world. The potential to change the face of medicine is obvious. We can get the record of a walk-in patient before the front desk finishes registering them for their visit. We have access to all visits and all studies done in-house at all times. However, there are still kinks being worked out that will improve efficiency for providers. This includes day-to-day ease of using an ehr, as well as sharing between different clinical entities (interoperability).

What is the most promising technology for pediatricians?
We live in a mobile society. Most adults don’t live in the same neighborhood or town where they grew up. Most children don’t stay with the same pediatrician from birth to their 18th birthday. For the pediatrician, the HIE is going to be crucial. This will allow us to track immunizations and routine labs for all children as they move through their childhood.

If you could wake up tomorrow and have one part of healthcare solved, what would it be?
I have 2 wishes, Magic Genie. One is to solve interoperability. The other is to see prenatal care and immunizations made free for all people living in the US. The first will revolutionize healthcare in the US, the second will revolutionize health itself.

What health IT issue do you see out there that not enough people are talking about?
Efficiency. Everyone is talking about Meaningful Use and Interoperability. These are certainly important issues. However, without efficiency, providers are going to continue to fight the use of ehrs. Before using an EHR, I routinely saw 30-32 patients a day. Now, I am exhausted at 20-25, depending upon the EHR. My staff complain that it takes over 10 minutes to “room” a new patient because of all the data entry involved. Rooming a new patient used to take 2-4 minutes. Consequently, we are working harder but seeing fewer patients. This translates to less money. Unless we address the issue of efficiency, EHRs will never reach their full potential.

Where or to whom do you look in order to stay up with all that’s happening in healthcare IT? What’s part of your daily routine?
I keep up with healthcare IT in 2 ways. One is by reading daily electronic newsletters, particularly HealthCareITNewsDay.The other is by networking with others in the field.

Any final thoughts?
Electronic health records are in their infancy. For them to grow, we need to nurture providers into this field. There has to be more dialogue between physicians, nurses and IT professionals. We speak different languages. We need to sit down at the table together and share our thoughts without letting our personalities get in the way. I think if this is done the potential in the field of healthcare IT is limitless.

October 31, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently 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.

Specialist EMRs: Pros and Cons

Right now, the bulk of well-known vendors are fighting for hospital and multispecialty/primary care group business.

But specialist EMRs are a thriving market, too, and one analysts like myself don’t cover often enough. To get an idea of how many specialist EMRs are out there, check out this list of EMR specialties my colleague John Lynn compiled. Though it’s from 2009, it should give you an idea of what we’re dealing with here.

Is it really necessary for specialty physicians to buy an EMR dedicated to their profession?  One specialty vendor offers a thoughtful argument as to why their approach is better:

 Clinical content is required to sufficiently document exam findings, diagnoses, and medical plans. To be truly effective, an EMR must possess a comprehensive library of information that alleviates the need for physicians to document from scratch. Otherwise, both the workflow efficiencies and the documentation improvements touted by EMR vendors suffer.

But, according to [Peter] Waegemann, “most medical specialty societies simply are not ready to ‘come up with the data’ around which vendors can design specialized systems.” Therefore, most generalized EMR vendors put the responsibility for developing clinical content on the shoulders of their customers. But, therein lies the problem.

Writing a comprehensive, usable library can take up to 400 hours of a physician’s time – time that is already in very short supply and very expensive. The sheer amount of time required for such a task oftentimes delays implementations, frustrates users, and is one of the top reason behind EMR failures. Some vendors rely on third party resources to sell libraries to specialty customers, but doing so oftentimes raises the overall cost and complexity of the solution to unacceptable levels.

On the other hand, I can think of at least a few reasons why a specialty EMR might not be the best choice for a practice:

* Interoperability:  If your practice joins a health information exchange (and let’s face it, that day is coming for most physicians) will your specialty EMR be able to link up comfortably with mainstream systems?

* Connections with hospital systems:  Another interoperability issue. If the hospital where you do most of your business is an Epic shop, and you’re using, say, the

* Workflows that don’t fit with major systems:  It’s all well and good to be really comfortable with your specialty EMR, but how will that work when you’re forced to “switch gears” and use mainstream systems in settings outside your practice.

So folks, which side do you come down on in this discussion?

March 19, 2012 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.