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#HIMSS14 Highlights: the Snail’s Pace of Interoperability

Ah, HIMSS. The frenetic pace. The ridiculously long exhibit hall. The aching feet. The Google Glass-ers. As I write this, day three for me is in full swing and I’ve finally managed to find some time to reflect on what I’ve seen, which includes a ridiculously long taxi queue at the airport, more pedicabs than I can count, beautiful weather and lots of familiar faces, which is what makes HIMSS so much fun. I’ve heard lots of buzzwords and sales talk, and seen only about an eighth of the exhibit hall, barely scratching the surface of what’s out there on the show floor.

Several common themes stand out based on the sessions and events I’ve been to, and the passions of those I’ve encountered. Whether it’s vendor breakfasts, social networking functions, exhibit elevator pitches or educational sessions, interoperability and engagement are still the buzzwords to beat. This particular HIMSS has given me a different perspective on each, and offered new insight into what’s happening with the Blue Button Connector. I’ll cover each of these in HIMSS Highlights posts over the next several weeks, starting with interoperability.

The industry seems far more realistic this year regarding interoperability – downright frustrated by the slow pace at which such a lofty goal is proceeding. Industry experts Brian Ahier and Shahid Shah perhaps expressed it best during a lively panel discussion at the Surescripts booth:

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Putting vendors’ feet to the fire will certainly initiate a quick and painful reaction, but probably not a sustainable one. True momentum will occur only when providers get singed a bit, too. Panelist comments at a Dell / Intel breakfast on analytics for accountable care brought this into sharper focus for me. The fact that too many disparate EMRs (and thus too many vendors poised to cause inertia) are making it hard for analytics to successfully be adopted and utilized at an enterprise level, highlights a bigger problem related to hindsight and strategy.

From my perspective – that of an industry observer and commentator – it seems many providers felt compelled to purchase EMRs because the federal government offered them money to do so, and hopefully just as many were optimistic about the role technology would play in positively affecting patient outcomes. Vendors saw a great business opportunity and moved quickly to develop systems that met Meaningful Use criteria (not necessarily going for best-fit as related to workflow needs and usability). Neither group truly knew what they were in store for, especially regarding longer term plans for health information exchange.

Providers now find themselves wanting to move forward with health information exchange and greater interoperability, but slowed down by the very IT systems they were so insistent on purchasing just a few years ago. Vendors (some more than others) are hesitant to crack open their products to allow data to truly flow from one system to another, and who can blame them? The EMR market, in particular, is poised to shrink, which begs the question, who will survive? What companies will be around at HIMSS 15 and 16? Those who keep their systems siloed, like Epic? Or those who are trying to break down the silos, such as Common Well Alliance members like athenahealth and Greenway?

It makes me wonder if providers wouldn’t have been better served with just had a handful of EMRs to choose from around the time of HITECH, all guaranteed to evolve as needed and play nicely with each other in the interest of health information exchange. Too many options have caused too many barriers. That’s not just my opinion, by the way. I’m willing to bet that a sizeable chunk of the 37,537 HIMSS 14 attendees would agree with me.

Do you disagree? Are providers (and patients) better served by more IT options than less? Let me know your thoughts, and impressions of interoperability advancement at HIMSS, in the comments below.

February 26, 2014 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

CMIOs Bridge the Clinical & IT Gap

It’s been interesting to see the evolution of conversation around healthcare IT at the provider-focused events I’ve attended over the last two years. Panels of hospital executives at first spoke about the benefits they were likely to see as a result of the HITECH Act and their facilities’ subsequent plans for EMR implementation. One-year later, it was all about best practices for go lives. Today, conversation has reached the “now what?” phase.

This was definitely top of panelists’ minds at the recent Georgia HIMSS Lunch & Learn, which offered attendees a hearty Italian meal and the chance to hear area CMIOs converse around the topic of “CMIO 2.0 – Leading Healthcare Transformation.” While “transformation” tends to be a bit overused, I think it was an apt word based on the remarks from moderator Debbie Cancilla, Senior VP and CIO at Grady Health System; Julie Hollberg, MD, CMIO at Emory Healthcare; Daniel Wu, part-time CMIO at Grady; Roland Matthews, MD, physician champion at Grady; and Steve Luxenberg, MD, CMIO at Piedmont Healthcare.

I hate to play favorites, but Wu was my favorite panelist. Calling himself the “least tech savvy CMIO in the country,” he was engaging and a good sport when it came to verbal sparring with his Grady colleague, Cancilla. No one in the audience was fooled by his self-deprecation, of course. Wu, who is also Assistant Medical Director at Grady’s Emergency Care Center, and Assistant Professor of Emergency Medicine at Emory University’s School of Medicine, knows a thing or two about healthcare IT, having put in an EMR for Grady’s emergency department. He continues to serve as a physician champion for the hospital.

Several telling themes emerged from panelists’ comments and audience questions, which I’ll share in part 1 of this post. I’ll cover challenges specific to each panelist and their facility next week in part 2.

gahimssCMIOpanel

Left to right: Julie Hollberg, MD, CMIO, Emory Healthcare; Roland Matthews, MD, Physician Champion, Grady Health System; Steve Luxenberg, MD, CMIO, Piedmont Healthcare; Daniel Wu, part-time CMIO, Grady; and Debbie Cancilla, CIO, Grady. Photo courtesy of Georgia HIMSS

Shining a Light on CMIOs
This was the first all-CMIO panel I’d ever seen, which may be indicative of their general reluctance to be put in the spotlight, and perhaps the increasingly important role they play in HIT implementations of all kinds. (I also wonder if the title of CMIO is growing. If anyone has statistics on that, please share.) Cancilla noted it was time for CMIOs to get in the healthcare transformation conversation, and while these four seemed at no loss for stories to tell and pain points to share.

CMIOs Don’t Play Favorites
When it comes to the clinical side of the house versus the IT side of the house, the panelists agreed that sometimes the two just don’t understand each other. And that’s where the CMIO steps in, acting as interpreter, smoother of ruffled feathers, and occasionally spokesperson for both departments to the higher ups. In describing his role, Luxenberg described himself as an objective third party, coming in to finesse sticky situations between clinical and IT staff. I got the impression from him that CMIOs often have more success in resolving disputes because they don’t have allegiance to one particular department, but rather the hospital as a whole.

(Sidenote: Wu mentioned a hilarious cartoon by Atlanta-based anesthesiologist Michelle Au that highlights the delicate verbal dance CMIOs must do when talking with various medical specialties. Check out “The 12 Medical Specialty Stereotypes.” It’s worth noting Wu would be considered a “cowboy.”)

Getting it Done for the Patient’s Benefit
Because they represent the interests of the hospital, these CMIOs ultimately hold themselves accountable to the patient, and benefiting the patient is a big part of the message they have to convey to clinical and IT folks, especially during times of implementation. Luxenberg noted that he gets better EMR buy in from different departments when he highlights the benefits to patient care, rather than focusing on details specific to one department in particular.

Talking with different departments does mean, however, that CMIOs must step out of their comfort zones and really get familiar with the pressures of each area within their facility. Conveying this information is where a great relationship with the CIO comes in. For the CMIO’s objectivity to truly be valuable, that assessment must be meaningfully discussed with the CIO. As Cancilla mentioned, CIOs need to step up and strengthen relationships with their CMIOs. All the panelists and Cancilla agreed the communication from the top down and bottom up is key to successful adoption of healthcare IT.

February 27, 2013 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

EMR, EHR, and Health IT Jobs

In our current economic client, it’s been quite interesting for me to keep an eye on the EMR, EHR and Health IT job market. While many in the country are out of work, those with healthcare and IT experience are usually in very high demand across the country.

I recently heard this quote from Michael Dell (founder of Dell):

“If we set up a new site to hire 100 software or storage or networking engineers, we have to go find them one at a time and seek them out and convince them and cajole them to come work for us. If we set up a warehouse or distribution center and we have 100 jobs there, we will have a line of 10,000 people waiting outside to try to get those jobs.”

I think we’re seeing something similar in healthcare IT. As long time readers will probably know, we have our own EMR, EHR and Health IT job board. Here are two of the jobs that were recently posted on the job board:

Senior Healthcare IT Project Manager
Senior IT Systems Analyst

Watching that job board and also seeing the jobs that are submitted on the Healthcare Scene LinkedIn group is interesting. You definitely see the trend that Michael Dell mentions. There are a lot of skilled jobs available, and not enough skilled people to fill those jobs.

I’ll be interested to see how this evolves in a post-HITECH era. Right now if you have EHR experience and expertise, there are a wide variety of jobs available to you. I’m sure there are pockets and communities where this isn’t the case, but across the country there are people looking for people who know and understand EHR. Many of the top EHR consulting firms can’t get enough people on board to support their projects. Plus, we’re only at about 50% adoption (depending on whose numbers you prefer).

I expect the above trend to continue at least through the end of meaningful use and likely well beyond that. As I often tell people, healthcare is going to be around forever and using technology to improve healthcare isn’t going anywhere either.

January 31, 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.

The Story of the Colorado Beacon Consortium’s ACO Plans

There are a lot of aspects of the HITECH act that don’t get much attention. Sure, the majority of the spending is the EHR incentive money and meaningful use. So, we should focus on what’s happening with that money. However, much less attention gets paid to the other parts of the HITECH act since it’s only a few hundred million dollars (yes, I laughed when I typed that).

I do find it ironic that the “beacon” communities part of the HITECH act haven’t gotten much exposure at all. The whole idea of a beacon is to be seen by everyone, no? I’m sure each beacon community has had to submit some sort of lengthy reporting to ONC about their beacon community. I’m all about government holding people accountable for the money that they spend, but wouldn’t it be better if the beacon communities had to become true beacons in healthcare?

This rant comes on the heels of me watching this video from the Colorado Beacon Consortium. The video is professionally done and does a good job trying to capture the provider viewpoint of what they’re doing. It’s a little dry to watch, but really tries to show how the physicians and patients have benefited from technology.

Have you seen other examples of what the beacon communities are doing? I’d love to see more.

January 28, 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 Benefit, Goodhart’s Law, and EHR Interoperability


Thanks to Sherry for pointing us out to this example of the benefit of EHR. I hope that Sherry’s dad does well in surgery and recovers well.


I think that Charles might be on to something here. The interesting thing to me is that it’s very likely that looking back on the HITECH act, the most valuable part will just be shining the spotlight on EHR. It’s woken a lot of healthcare organizations up to EHR and what was happening with EHR that were in a cozy slumber. I think that’s the most important thing we can do to move healthcare IT forward.


I don’t see this getting better any time soon. Check out the entire Twitter thread for this message to get the full context of the discussion. I’m still bamboozled by why we can all see the value of exchanging data, the technical details have been solved (see HIMSS interoperability showcase) and yet we’re still not sharing data.

January 27, 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.

Hardest Meaningful Use Measure

There was a great piece a while back by Benjamin Harris that looked at the 5 not-so-easy pieces of meaningful use stage 2. In the article he suggests the following 5 challenges:

1. Structured Lab Results
2. Patient Access to Health Information
3. Ongoing Submission to Registries
4. Computerized Order Entry (CPOE)
5. Summary of Care Referrals

I started asking around my network to see what readers of my site and those in my social media groups thought was the hardest meaningful use measure for them. Some of them match the list above, but I thought I’d highlight a few of them I found interesting.

One person told me that the multi-lab scenario might be one of the most challenging parts of meaningful use and one that doesn’t get talked about much.

A CIO named Renee Davis told me that ePrescribing and monitoring compliance were the hardest meaningful use measures. I think the ePrescribing part can be a huge challenge depending on your EHR vendor, your physician users, and your location (ie. Do your local pharmacies participate?). Plus, any CIO will definitely have challenges with compliance.

Patty Houghton suggested that Clinical Summaries and Problem Lists were her hardest meaningful use challenges.

Obviously when you say the word “hardest” it’s something that’s unique to an individual practice or institution. With that disclaimer, from the large number of people I’ve talked to I think that most people consider the 60% CPOE meaningful use measure the hardest.

I still remember the day when I heard Marc Probst, CIO of Intermountain Healthcare (IHC), say that IHC was doing ) CPOE. This was when he was first working on the committees in Washington to create EHR certification and meaningful use requirements. It was a shock to me that IHC, who is touted for its use of IT in healthcare, could have 0 CPOE (I think Meaningful Use has helped encourage them to remedy this number). It illustrated well how much of a challenge CPOE will be for many institutions.

What’s your experience and the experience of the doctors and hospitals you work with? Which meaningful use measures are most challenging?

December 21, 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.

Could Meaningful Use Be Axed In Fiscal Cliff Battle?

In past items, my colleague John and I have weighed in on the issue of whether a change of administration could endanger the Meaningful Use program.  We concluded, in summary, that the program has too much momentum to fall to the budget axe that easily.

Now, in the light of an article by a colleague, I’m rethinking my view a bit. In an excellent column for Health Data Management, Joseph Goedert suggests that the so-called “fiscal cliff” has changed everything for the Meaningful Use program. Though the still-sitting president who backed HITECH’s $20 billion spend stayed in office, the House of Representatives remains controlled by the opposition party.

Goedert argues that during the debate over the fiscal cliff negotiations, someone’s going to look at the fat, juicy $20 billion allocated to health information technology — probably the Republicans who have already slammed the program publicly — and target it for budget cutting.  He argues that Democrats are unlikely to push back too hard, given that HITECH is hardly a “sacred cow” that legislators fear to touch.

And then, he says, comes a disaster for the health IT community:  “Whatever federal funds are left to support electronic health records, meaningful use, health I.T. workforce training, health information exchanges, best practices dissemination, regional extension centers and anything else in the HITECH Act will be gone.”

In Goedert’s view, the only way to save HITECH is for individual physicians hospitals to go on a lobbying tear, pounding their representatives and senators, if they don’t want to see Meaningful Use become a casualty of party politics.

I think Goedert has a point.  As he reminds us, eight Republican leaders in the House and Senate finance and health committees have already demanded proof that Meaningful Use is worth the money. And a recent House hearing held to investigate the subject suggests that some members still aren’t satisfied.  Things could get ugly.

November 20, 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.

AT&T/IBM Deal Pushes Cloud Back into the Healthcare Spotlight

I remember 2010 as if it were yesterday. I was somewhat new to the healthcare industry, attending my first Healthcare IT Summit, and trying to make sense of all the buzzwords flying around as a result of the HITECH Act being passed the year before. Cloud computing was definitely a hot topic – one that seems to have stood the test of time in the intervening years. Granted, I think its popularity has been somewhat superceded by phrases like mobile health, accountable care, patient engagement and electronic medical records (of course) over the last 18 months, but a recent flurry of cloud-related headlines may forecast a resurgence.

A report released earlier this year from MarketsandMarkets predicts that conditions are ripe for cloud computing to grow at an annual rate of 20.5 percent from this 2012 to 2017. (Bloomberg Businessweek puts the current market for cloud services at $14 billion.) The forecast makes a lot of sense when you look at it from the healthcare angle of Meaningful Use and EMRs. Providers, despite a few legislators’ recent objections, will likely continue to implement and attest during the next few years, leaving healthcare IT vendors – including those who put their EHRs in the cloud (Allscripts, NextGen and athenahealth are just a few that come to mind) – with no shortage of business opportunity.

And there are even more vendors behind those – the infrastructure folks like Verizon (See their recently announced HIPAA compliant cloud service) and Dell that provide the cloud’s backbone, so to speak. You may by now have seen headlines announcing that AT&T has partnered with IBM to offer a new model whereby “IBM … will provide the data-storage facilities and services, and AT&T will … offer the global network that clients will use to retrieve the data,” according to the Bloomberg write up. It is the closest relationship IBM has ever had with a phone carrier.

Undoubtedly, this new model will be tapped for healthcare purposes, but it’s still speculation as to just how it will be adopted for secure exchange of patient health information. I sent out a few feelers via my social networks to see if anyone related to either IBM or AT&T could provide more detail, and got back this statement from an IBM representative: “I would assume that there will be a HIPAA compliant component. It goes without saying that the healthcare industry is a HUGE segment for IBM.”

“Huge” just might be an understatement, as IBM has stated it wants to attain $7 billion in cloud revenue by 2015. In today’s terms, that’s just one vendor making up the current market value for cloud services.

I’ll be interested to see how this plays out, especially as previously lower profile (at least in the healthcare space) technology companies like Dell and IBM, and companies like AT&T and Verizon that are more widely known in the consumer market, continue to make healthcare IT headlines.

October 10, 2012 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

Purpose of Meaningful Use

Lately I’ve been quite disturbed as I’ve read all sorts of commentary about the “Purpose of Meaningful Use.” Here’s one such comment on meaningful use that I read recently:

My impression is that EMRs and meaningful use were about getting Americans to practice evidence-based and comparative effectiveness medicine towards a more streamlined and cost-effective US Healthcare System

Some of you might remember when I questioned the “meaning” of meaningful use as described by Farzhad Mostashari. So, this is not a new subject for me to consider.

Here’s the problem:

The purpose of meaningful use was to be sure the ARRA money was spent on software that doctors actually end up using. Everyone has then taken meaningful use whatever direction they want.

We can certainly talk about the possible impacts and unintended consequences of meaningful use, but let’s not confuse the possible impacts with the purpose of the legislation.

It turns out that meaningful use is actually accomplishing its purpose as I describe it above. At least in Medicare where meaningful use is a requirement there aren’t EHR companies gaming the EHR incentive money like they are in Medicaid. Sure, with self attestation you could lie about your “meaningful use” of an EHR, but I have yet to see it and think it is very unlikely.

You may have noticed that I don’t write about meaningful use as much here on EMR and EHR. That’s because on EMR and HIPAA I (with some great help) have been doing a weekly Meaningful Use Monday series over the past year. Check it out if you’re interested in the details of meaningful use.

August 8, 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.

Would Meaningful Use Go Away Under A Romney Presidency?

We’re now in the final stages of a very closely fought presidential battle, and it’s possible that Republican challenger Mitt Romney will unseat incumbent Democrat Barack Obama.  Usually, I stay far away from such issues, but this time around, the healthcare business as we know it could change depending on who takes the prize.

So far, Congress hasn’t shown much stomach for rolling back the HITECH act.  However, in Mitt Romney, you have a candidate who plans to do whatever he can to repeal President Obama’s health reform legislation. That doesn’t relate directly to HITECH, which is of course the source of the funds that fuel the Meaningful Use program.  However, HITECH is associated with reform nonetheless and could possibly suffer a similar fate.

Given the Republican party’s traditional “hands off business” stance, it wouldn’t surprise me much if a President Romney tried to put a stop to HITECH as well, given that it imposes penalties eventually on organizations that don’t get on board. What’s more, you could potentially label MU an “unfunded mandate” (actually, something both parties target, but seemingly more of a Republican touchpoint) given that incentives don’t come near covering the long-term costs of managing most EMRs.

That being said, Meaningful Use has some genuine momentum at this point, and EMR penetration among physicians is starting to crest. Given that the program does reward those who have already spent (or are committed to spending) on a system,  it might be an unpopular move to stop MU in its tracks.

Also, it’s useful to remember that Meaningful Use is ultimately controlled by HHS, a battleship controlling the most popular federal program in existence (Medicare).  Even a president might think twice before trying to push around the agency that controls the fabled “third rail” of politics.

All told, I think MU is likely to last, even if Romney wins and attempts to roll back health reform. There’s just not enough of an upside for him in this fight, I think. ( John seems to agree.) What about you, folks?

August 7, 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.