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PA Group Kicks Off Direct Project-Based Data Sharing

Posted on July 13, 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 @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

You know, the whole Direct Project approach seems brain-dead simple compared to the elaborate EMR rollout we’re suffering through in this county. I don’t know why we didn’t try something like it first, before we consumed the resources of HIT CIOs from sea to shining sea. Really, the convolutions we’ve gone through seem so unnecessary! (climbing down off soapbox)

Anyway, I thought you’d be interested to hear that the Pennsylvania eHealth Collaborative is doing its part to move the direct approach forward. The group has issued a grant encouraging providers to use Direct Project-based approaches to exchange patient health information. The idea is to capture providers who haven’t yet had the funds, time or willingness to roll out an EMR. Not only will this make life easier for providers, it will help them meet a portion of Stage 1 Meaningful Use requirements, definitely an added blessing.

How the grant money will flow is as follows. The group has selected an approved health information service provider, whose job it is to actually handle the direct messaging traffic. The intermediary gets $250 for each provider which uses them to send direct messages.

According to Information Week, which spoke to the group’s officials, as many as 8,000 providers could potentially sign up for the program. This includes both providers that do and don’t have EMRs in place already. As state HIT coordinator Robert Torres told the magazine, providers with EMRs already in place can simply select out data and send it using the direct protocols, which support patient care records, referrals, discharge summaries and other clinical documents.

Bottom line, the Direct Project model rolls on. I say, more power to ‘em.

Information Week Cover Story on Selecting an EHR

Posted on February 3, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today I came across a link to this cover story for Information Week about selecting the right EHR. Unfortunately, the site requires registration to access the article, but you can also get a login for the site without registering on this great website called BugMeNot. Now to the content of the article.

The article starts off properly in describing that selecting the right EHR is a tough and challenging task. The biggest challenge is of course the 300+ EMR and EHR vendors out there. Sadly the advice they give in the article doesn’t do much to actually help individuals that are trying to select an EHR. Here’s the list of steps they offer (and my commentary):
The state of your infrastructure – No doubt this is an important part of an EHR implementation, but why they list it as a first step is a bit beyond me. The fact is that you really can’t properly assess the state of your infrastructure until you know which EMR software you want to use. Do you need a server room? Do you need a faster internet connection (ie. SaaS EHR)? Do you need tablets, ipads, desktops, etc? These answers aren’t known until you know which EHR vendor you select. So, this is an important step, but it’s done mostly during implementation instead of selection.

Features, functions and usability – The problem with this item is the order. Most doctors who are selecting an EHR don’t really know what features and functions are available in an EHR system. Sure, they have some idea of some of the features, but it is amazing how many new features they come across once they start demoing EHR systems. Remember, they’ve been focusing on patient care and not the latest EHR features and functions.

The other challenge for this area is that at a base level (which the article above mentions as well), the features and functions of most EHR software is pretty close. It is the more nuanced functions that differentiate one EHR software from another. So, this isn’t a first step in the EHR selection process. It’s a later step after doing the EHR demos. Instead of starting with features and functions, doctors should focus on the benefits they want to receive from an EMR as I describe in my EMR selection e-Book. These benefits will help to provide a guide for narrowing down your EMR options.

As far as usability, this is incredibly important. Just this is assessed at demo time as well. Although, I find this even better assessed when you either 1. do a test run of the software yourself and/or 2. talk to existing users of that software. That’s how you evaluate an EHR’s usability.

Networking and interoperability capabilities – Certainly you want to make sure it interfaces with your existing systems. This is barely worth mentioning since this is top of mind for most people selecting an EHR.

Technology knowledge – Another important aspect of an EHR implementation. Although, this isn’t very important in the EHR selection stage. I’ve never known someone to switch which EMR software they like best because they think their staff isn’t technical enough for one software but would be fine with another software. Technical skill can be overcome through training. It shouldn’t influence which EMR software you select.

Partner systems – This is the same as the interoperability capabilities mentioned above.

Deployment options – Finally something that’s a real differentiator. Knowing the pros and cons of an in house EMR and a SaaS (hosted) EHR software is very valuable and a great way to start narrowing down the field of possible EMR vendors.

Maintenance and support – Your ability to support the selected EMR matters and should be part of the selection process. Just most of the time this will really influence your decision to go with an EMR hosted on site or a SaaS based EMR mentioned above.

Now you can see why I wasn’t all that impressed with their list of EMR first steps. I won’t rehash my list of first steps. You can find them in my EMR selection e-Book. It’s free so go check it out.

The article does provide a list of best practices which is more valuable (with my commentary as usual):
1. Look for vendors that know your practice – Of course they won’t really KNOW your practice. However, there’s some real benefit in going with an EMR software that has 100 clients that are from your specialty. Don’t underestimate the value of them knowing your type of practice’s needs.

2. Evaluate the costs to acquire, deploy, maintain and support the hardware and software – Including all of the costs in your comparison of EHR vendors is really important. Don’t forget the hidden costs of training, interfaces, ongoing support, extra hardware, etc.

3. Consider a cloud-based or hosted EHR setup – Definitely worth considering. Just be aware of the benefits and challenges with going “to the cloud.”

4. Get the right training for your staff – Probably as important as getting the right training is choosing to make the time for that training. You can pay all you want for the right training, but if your doctor says he’s too busy to attend, then it won’t do much good.

This reminds me of a comment Dr. West made on a recent post:
“I know an orthopedic surgeon who bought an EMR for $25,000 but then didn’t have the time to waste in learning it, so they just use it for the scheduling calendar now. A $25,000 calendar!?”

5. Use a certified EHR – If you’re a new reader, you missed out on some of my amazing rants about certification. I’ll keep it short for this post. Basically, EHR certification provides no value to the doctor. The only exception is that it now is necessary if you want EHR incentive money. Other than that, it provides no assurance of anything of value to a doctor. Don’t focus on it. Don’t give yourself the false impression that it’s better because it’s certified. Evaluate the benefits of the various EMR software based on your needs and requirements.

6. Invest for the future – This isn’t meant to be interpreted “spend more money on an EHR system cause then you’ll be getting a better product.” In fact, the opposite case could be made that the more you spend on your EHR the more likely it’s a legacy system which is hard to upgrade and improve and won’t be great for your future needs.

The real message of this point is described pretty well in the article:
1. Assess the future viability (financial and directional) of the EHR company
2. Assess the scalability of the EHR software (do you plan to expand your practice? Can it support that?)
3. Will the EHR software be able to support meaningful use stage 2 and 3 (especially if you want to get the EHR incentive money)?
4. How much is the company investing in new features and releases? Will they be able to quickly adapt to your changing needs (ie. new interoperability requirements and needs)?

Conclusion
Obviously I think the article left a lot to be desired. It’s nice to see EMR selection as a cover story. I also think it’s hard in an article to try and cover everything that’s needed to be able to select an EMR properly. I also think it is really funny that for the article they sent out 20 RFP’s for a fictional company. Then, they compiled and analyzed information from the seven vendors that responded. Where are the other 13? Or maybe I should ask, where are the other 293 EHR vendors?

iPad in Health Care

Posted on January 13, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Last month Information Week reported on a study by HIMSS of iPad use in health care.

Data showed that nearly 70% of the attendees were from hospitals or healthcare organizations with more than 1,500 employees, and 15% of attendees were executive-level staff or physicians.

More than 25% of the HIMSS respondents plan to deploy the iPad and other iOS devices immediately and nearly 70% plan to deploy the devices within the next year.

I must admit that I have been amazed at the uptake and power of the iPad. After attending the CES conference in Las Vegas last week, you can see a whole slew of iPad copy cat’s that are working to provide the same benefits of the iPad. There’s no doubt that health care will be a major user of this type of device.

The information week article does point out the two biggest challenges with the iPad in health care:

Nearly 75% identified secure configuration and deployment as the number one iPad IT management challenge, and 53% identified mobile application deployment as a key issue.

Security is definitely an important concern that will be ongoing, but is definitely manageable. Then, it’s just getting software vendors to actually leverage an iPad device and it’s unique interface as opposed to just porting their current interface to the iPad. This will take some time.

Now I just need to find a way to get me an iPad. I bet they’ll have a bunch of free iPad giveaways at HIMSS. Maybe I’ll get lucky.

iPad EMR Eases Doctors Concerns

Posted on October 27, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

At least the above is the title of the Information Week article on ClearPractice’s iPad EHR interface called Nimble. You might remember that I did a short review of the Nimble iPad EMR previously. I still stand by my comments of the Nimble iPad interface not being perfect for the iPad. The keyboard was clunky and slow to appear and the boxes were surprisingly small for a native iPad app.

Here’s the doctor in the article’s take on the iPad EMR:

Having a small office, there’s no space for a desktop in the exam rooms, so prior to recently using Nimble on the iPad, Dr. Lianna Lawson, a solo-practitioner, wheeled a laptop on cart to exam rooms.

“Laptops on carts — I don’t like that, it seems impersonal,” said Lawson, whose practice, Lawson Family Medicine and Aesthetics is based in Daleville, VA. Lawson has been using ClearPractice’s web-based EMR on a laptop for about a year. Lawson added Nimble to her practice in September.

Nimble running on the iPad, “has the feel of a [paper] chart,” Lawson. “Many doctors are traditionalists, so the comfort level with technology is difficult,” she said. “But for physicians not particularly tech savvy or reluctant of about how they’ll meet the meaningful use requirements, this gives a little more comfort and confidence,” she said.

It’s true that laptops on carts are a mess. As I recently argued in a post on healthcare mobile devices, the iPad does seem to have the right size and feel. That combined with the 3G connection helps to change the game. Although, I think we’re going to see more devices that build on top of the iPad’s innovations and provide an even better user experience for doctors.

Here’s another quote from the Doctor about the use of the Nimble iPad EMR:

Now Lawson said she brings the iPad with her wherever she goes, responding to patients “24 by 7,” when they have questions over weekends, or other after-hour concerns. In the office, she can use Nimble “while scooting around” in her exam rooms caring for patients.

There’s been other surprise perks to using the iPad-based product, namely engaging patients while using the EMR, she said. “I didn’t expect this to be the result, but patients can see” and talk about what’s on the EMR as she uses the iPad near them. The interactions can help in building a more solid dialogue between physician and patient — and can even help make records more accurate.

While Lawson was using the iPad during a patient exam recently, the patient saw that an entry on the list of medications in her health record was incorrect, and the patient reminded Lawson that she was no longer taking a particular drug. Lawson updated the information.

The first paragraph highlights what some doctors hate about an EMR. They want to leave the office at the office. They don’t want to be proverbially chained to the office since it’s all literally at the touch of their fingertips. Maybe this is why there were so many work life balance sessions at the AAFP conference I attended recently.

Patients seeing what you’re doing in your EMR has often been seen as good and bad. Some doctors love it and embrace the participation with the patients. Other doctors hate having the patients look over what they’ve done and have to answer more questions because a patient saw something on the screen which they didn’t understand. I think we all know which doctor we’d rather see. Although, we can all appreciate the uneasy feeling of someone looking over our shoulders.

The article did remind me of the images that the Nimble EMR makes available to a doctor. That part is actually really cool and the iPad is the perfect way to display and navigate those images as a doctor describes something to a patient.

I should also remind people, the iPad still doesn’t print. Although, that should be remedied relatively soon. Or there are a few hacks out there to make it happen.

Complex Reimbursement Real Driver in EHR Adoption

Posted on September 1, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

A recent Information Week article on EHR adoption had the following quote:

“I think the number one driver [of ambulatory EHR adoption] is the change in reimbursement, the fact that it is becoming so complicated to document the process of care to get paid by the government as well as commercial payers,” said Nancy Fabozzi, a senior industry analyst at Frost & Sullivan and the report’s author. “Everybody thinks that fee-for-service is doomed and we have to have a new system of reimbursing physicians for the quality of care instead of the quantity of care because costs are exploding.”

In an interview with InformationWeek, Fabozzi said another reason for the adoption of ambulatory EHRs is that many providers have practice management systems that are old and need to be updated as they move to ICD-10 and HIPAA 5010 requirements.

It won’t be news to most of you that it’s not government incentive that is driving adoption of EHR software. The market forces are much stronger than any sort of stimulus. Although, the retarding forces of an unknown stimulus are starting to wear off and we should see EHR adoption pick up again soon.