Welcome to EMR and EHR

HHS has put up an interesting new part of their website called “Health IT Journey: Stories from the road.” Here’s their description:

Have you, your practice, or your organization been through a health IT implementation? We’d like you to share your story with us. After internal review, your story may be published to inspire other providers and organizations to become meaningful users of Electronic Health Records (EHRs). Let’s learn together.

Of course, it also comes with the following disclaimer:

Disclaimer
Posting of the articles on this Web site does not necessarily constitute HHS or ONC endorsement of the procedures followed; vendors, products and services named; or overall performance of the facility’s delivery of care. We do hope you find these narratives insightful and useful in your efforts to adopt health information technology and improve patient care.

It seems like ONC is mostly looking for stories that have been published somewhere. They link to 3 articles already, but only one of those is actually available without paying for the service or signing up. This was an article about using an EHR to quantify the number of patients you’re seeing in the New England Journal of Medicine (NEJM).

Of course, you can probably imagine how high the bar is to get your story shared in the NEJM. With that said, I’m always interested in posting interesting stories on this site about people’s use of an EMR or experiences with the EMR selection and implementation processes. So, if you have a story you want to share, just send it to me on the EMR and EHR Contact form. It will be interesting to see how HHS/ONC will look at publications on blogs like this one, but they’ve been pretty open to bloggers in the past.

It will be really interesting to see what other stories are submitted, approved and published by ONC. I do applaud their efforts to try and spread the stories of EMR success. That’s a very good thing. It’s just too bad they’re promoting these stories that are stuck behind a pay wall. That’s not the way to spread good stories of HIT success.

Joe from Healthcare IT today wrote an interesting post highlighting 5 signs why the healthcare IT (which I translate as EMR) job market is heating up. Here’s a summary of his 5 reasons:
-His Healthcare IT friends that were unemployed are starting to find jobs
-The Healthcare IT and EMR job boards are overflowing with good jobs (I’ve seen lots of jobs on these boards myself)
-The number of projects at clients and potential clients has risen dramatically. Meaningful Use and ICD-10 initiatives are finally starting to happen
-Headhunters are starting to call
-Bloggers, columnists and reporters are writing about “the recovery” and how to get ready for it

Not a bad list. I’m seeing a large number of jobs listed on my EMR and HIPAA job board and even more click throughs to those jobs. I think that’s another really good sign. Although, I think we still have a ways to go, the healthcare job market and healthcare IT in particular has got to be one of the best ones out there right now.

In the vast amount of information that comes through my email, Twitter account, RSS feeds, etc one of them recently caught my eye. It was a webinar called, “Insane Ideas in Healthcare IT” by Christine D. Chang; Ovum, Analyst of Healthcare Technology (you can find the archived webinar here if you click around a bit). Here’s the description for the presentation:

All great ideas sound “insane” at first. This presentation will describe three insane ideas that Ovum believes will transform healthcare in the future including:
• Telehealth is for everyone, not just the elderly.
• Patient self-diagnosis is good and should be promoted.
• Personal health records are not just a passing trend, they are the solution.

I really love the concept of considering “insane ideas.” So, my question is what EMR ideas do you have that most people would consider insane?

On EMR and HIPAA, I wrote about an EMR platform which I think some might classify as an insane idea. Sometimes I wonder if becoming a full time entrepeneur doing mostly EMR blogging is an insane idea;-) I think that many might consider the Free EMR software an insane idea.

I had one EMR vendor recently ask me to write about them. He hoped that people’s response to my post would be that they all think it’s crazy to try and build an EMR company that way. I guess he prescribes to the best ideas sounding “insane” at first.

Let’s hear what ideas you think might be insane.

Anyone that works in Healthcare IT knows who John Halamka is and so of course I was interested in his post of his top 10 impressions after HIMSS. It’s an interesting list and I think he does a pretty good job of looking at things from a very high level. Here they are as posted on his blog:

1. Meaningful Use is everywhere. Vendors are promising EHRs, modules, appliances, and services to help clinicians achieve it. I had dinner on Monday night in a small Indian vegetarian restaurant. Sitting next to me were 3 engineers from Bangalore who were arguing about the details of Meaningful Use in between bites of vegetable curry. I could not escape Meaningful Use anywhere!

2. Certification is everywhere. It’s particularly ironic that many vendors claimed their systems were certified, even though the certification NPRM was just released today, making compliance with the new certification process in time for HIMSS impossible.

3. Cloud computing, Software as a Service and ASP models are popular tactics to accelerate EHR rollouts. There are still lingering concerns about how to ensure privacy in a cloud environment.

4. Several firms such as Intersystems, Axolotol, and Medicity are offering HIE platforms that include many of the standards noted in the IFR. The marketplace for HIE products is just emerging and it’s hard to predict who will become the market leader.

5. The Continuity of Care Document is gaining traction. I found many vendors supporting CCD exports from their EHRs. A company called M*Modal , has developed natural language processing technology that captures dictated content in its original context (ontology-driven
rules) as a CDA document.

6. Consultants abound. It’s clear that Regional Extension Centers and Health Information Exchanges will require expertise and staffing from professional firms. They all had large booths at HIMSS.

7. 30,000 people attended, including 10,000 I did not recognize (just kidding). It’s clear to me that many IT professionals, even those with limited healthcare domain expertise, attended HIMSS to better understand how they could participate in the euphoria of HITECH stimulus dollars.

8. Self service kiosks for patient identification and self-registration are now mainstream. Just as we print our airline boarding passes, we can now use credit cards or biometrics to check into ambulatory care appointments and automatically settle all co-pay balances.

9. Image exchange in the cloud is being offered by several vendors. As I mentioned in Monday’s blog, Symantec announced an appliance for small clinician offices that cloud enables all imaging modalities using a facebook-like social networking invitation to share/view images.

10. PHRs and patient engagement are becoming more mainstream. Google and Microsoft continue to innovate in the non-tethered PHR marketplace.

Today at HIMSS, the findings of a research study by the FCC was released.  I find it pretty interesting that the FCC is looking at healthcare IT.  The research study did an analysis of the healthcare IT infrastructure and its ability to support the growth of helathcare IT. Here’s a short summary of their findings:

FCC research has found that the current broadband available to physicians is cost prohibitive and can be a barrier to important developments in health IT.

• Physician offices with less than 5 doctors can have their needs met by currently available commercial offerings, usually at a reasonable cost. Even so, roughly 3,600 small practices lack access to even the basic broadband services they require to achieve Meaningful Use.
• Practices with more than 5 practitioners face a larger challenge. They need a higher level of broadband, and tens of thousands of offices in this category face prices that differ significantly, often by $45,000 or more per year for the same level of service. The gap is substantially larger for rural providers

These disparities offset meaningful use incentives and can prove to be a barrier to health IT adoption.

The FCC plans for a major expansion in its efforts to bring high-speed broadband service to healthcare providers. The program is authorized to spend up to $400 million per year, making it the largest sustainable fund for healthcare connectivity. Currently the FCC only spends approximately $70M per year of the $400M due to limitations in how it is authorized to spend the funds. Funds can currently be let through:

–   The Rural Healthcare Support Mechanism subsidizes telecommunications expenses of rural non-profit and public healthcare providers that face higher broadband prices than their urban counterparts. Also covers 25% of the internet service fees

–   Rural Healthcare Pilot Program—a one-time program with 63 projects (totaling $417M) to build dedicated healthcare broadband networks

National Broadband Plan Recommendations:

The FCC would like to substantially expand broadband subsidies to healthcare providers where service is unaffordable, including in urban areas. FCC is requesting a change to improve the health IT infrastructure, including:

• Allowing private institutions to be eligible for funding (not just non profits and public institutions)
• Supporting deployment of new broadband networks where they are insufficient by creating a permanent infrastructure program
• Linking FCC funding to outcome metrics such as “Meaningful Use” to ensure support goes to locations that use health IT in support of guidance from the Office of the National Coordinator for Health IT

I did a pretty controversial post over on EMR and HIPAA which compared the adoption of IT in banking with adoption in healthcare IT. I guess a lot of people have opinions on why healthcare IT hasn’t adopted technology as quickly as other industries. From that post, I got an email from Rod Bennett, MBA, MMIS, that included some interesting questions and answers about the healthcare IT industry with some other comparisons to banking. I found them insightful and so I thought I’d share them with you:

1. What factors are driving the emergence of the healthcare information technology market?

In the last few years the integration of technology is being driven by the increase in technology such as MRI’s, CT’s, PET scans, and digital radiology. Also, the health care industry is adapting like all other industries using email, websites, and building some form of semblance of a fundamental knowledge management system for information distribution within their organization. What we are seeing in the healthcare industry is what we were seeing during the tech-boom. Healthcare is slow to change for the simple fact they don’t have to, until now. They have always utilized a paper based system simply because it was working for them and saw no real reason to do anything different, it would cut into their profits.

Today however, their suppliers, pharmaceutical companies, etc., are moving into the electronic age and now healthcare is finally beginning to catch up simply because they are being forced to. Their philosophy is if it isn’t broke don’t fix it. One additional factor is the next generations of physicians are more computer literate and understand the value of computers in accessing information. Many of our physicians use the Internet on a regular basis to search for information on specific disease management research for better and more accurate diagnosis.

2. Why did banking industry spend a higher % of budget on IT than the healthcare industry?

One of the key factors is “money is a finite object” it has a definitive predictable value. It can be easily interpreted in the digital world in the terms of ones and zeros. It is a mathematical based system with a predictable outcome. People can be replaced by a computer to make a simple comparison. It is predictable and identifiable.

Healthcare on the other hand is a subjective environment. It requires the integration of humans to make a determination based on subjective information to make an outcome based decision. At this point in time the development of a new system would have to have the analytical ability of a physician, a nurse, the diagnosis process, etc. That is going to require a more advanced computer system based on artificial intelligence rather than on ones and zeros. So, there is a void in the market space simply because of the technological infancy of the knowledge required to develop it.

3. Historically, why did the healthcare industry not spend money on IT?

In their world they did. They spent money on data collection systems, not on intelligent systems simply because they don’t exist yet. The status quo still has value. However, when someone is able to capture what a physician can do based on an artificial intelligence system, we could see the shift in healthcare as we know it. The computing capacity would take a super computer to drive the system. For right now it is dependent on the medical professional’s expertise. It’s more cost effective to have a medical professional than it is a computer. How do you define a numerical value to a cough?

4. Who spent more money on IT – Insurers, hospitals, nursing homes, physicians, or employers?

I would have to agree with Ray, insurance companies by far; again it is because it is easier to measure dollars and cents. The data collection is a much simpler system because everyone is identified by a number, it’s definable. They have also spent more on providing an insurance card to the member and providing them with a numerical number for identification, again definable as a numerical value identified in an operating system.

Hospitals are spending money on data collection systems because they can identify a person in their system as a number. That’s basically what an EMR system is. It is used to track a person in the hospital system by a medical record number, assign a numerical value to a lab test, and assign a numerical value to an x-ray result. You can manually add data input by typing descriptive information. This is the current state of the EMR system and can be collected for value in the form of a numerical charge or fee.

5. What barriers existed that prevented health information from being shared among the healthcare stakeholders?

The main barrier at this point is the proprietary systems being built by providers to ensure profitability. The main barrier is the data base it is built on might be different from other data bases. It boils down to a proprietary systems equal money and profitability. Who cares about the healthcare stakeholder, they get what they get and like it, or else!

At the same meeting where Google’s CEO, Eric Schmidt, commented about healthcare IT, there was another interesting comment by Eric Lander about the state of researching EMR and healthcare IT. Here’s his comment:

“My sense is that we don’t respect this stuff,” said PCAST co-chair Eric Lander. “We respect the cancer genome, but not checklists. What do we need to do to send a signal to the next generation of researchers that this is a high-class, worthy thing to do? What would it take to move the needle?”

I agree. I’ve done the searching through the journals for well done EMR research and found very little. Not that research is the end all be all, but it can provide insight that can’t be found other ways.

There are a couple things going on in this country which are troubling. Two of them have to do with healthcare and the third has to do with our overall economy which is closely linked to healthcare.

Government is getting too involved with healthcare. First, they are rushing to mandate information technology (IT) which is not “ready for prime time”. Second, they are going to set up a government option for healthcare which will be subsidized by our tax dollars. This option will drive other insurance companies out of business (you can’t compete with a significantly subsidized competitor). There will then be a one payer system so we will no longer have choice. This system will be designed and run by government beurocrates (which I am not excited about) who we will be supporting through our tax dollars (higher taxes on everyone). Healthcare will be more expensive and less effective (See Medical Economics July 10, 2009, Critical Mass) AND this system will have a negative effect on small business and big business and our economy. Finally doctors will be affected in all sorts of ways (see Medical Economics July 10, 2009, Top-down, bottom-up, and medicine in the middle).

As we watch Obama and his advisors change our basic healthcare system and our basic economic system (from a small business model to a big government model), everyone should take some time to read Atlas Shrugged by Ayn Rand. The book is very long, so read the Cliff Notes!

What are your thoughts on all the changes going on right now, from the changes in our healthcare system to the mandates for electronic medical records. Who is going to pay for all this? Who is going to implement all of this? Is it going to work? Are we doing a big experiment (with our whole healthcare system and our whole economy) without doing smaller experiments to see what will happen?

Everyone in the healthcare IT world is sitting and waiting to know the fate of the words “certified EHR” and “meaningful use.” Yes, only a few billion dollars of EHR stimulus money are riding on those 2 terms.

Well, after the Health IT Policy Committee came out with their initial set of recommendations, it was reported that David Blumenthal, National Coordinator for Health IT, said “lively discussion (on the criteria) and considerable input on meaningful use, we decided to send the work group back to work on another set.”

Looks like the new date for more guidance from the Health IT policy committee will be their July 16th meeting.