Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and EHR for FREE!

Reply to Dr. Jacob Reider on NIST Dissects Workflow: Is Anyone Biting?

One comment on my latest post, NIST Dissects Workflow: Is Anyone Biting?, deserves a more than casual reply.

Here’s the comment from Jacob Reider (Note: Dr. Reider is ONC’s Acting Principle Deputy National Coordinator and Chief Medical Officer. He has made major contributions to the HIT field and is one of its significant advocates.)

Carl, ONC’s UCD requirement references ISO 9241–11, ISO 13407, ISO 16982, NISTIR 7741, ISO/IEC 62366 and ISO 9241–210 as appropriate UCD processes.

We also require summative testing as defined in NISTIR 7742.

Might “Refuses to incorporate NIST recommendations” be a bit of an overstatement?

We solicited public comment in our proposed rule for 2015 certification and would welcome specific suggestions for how we can/should improve user experience of health IT products for efficiency and safety.

Dr. Reider, thank you for your comment – it certainly falls into the category of you never know who’s reading.

Let’stake a look at your last comment first, “Might ‘Refuses to incorporate NIST recommendations’ be a bit of an overstatement?”

Obviously, I don’t think so, but I am not alone.

I based my comment on ONC’s statement in its rule making that refers to NIST’s usability protocols. It says:

While valid and reliable usability measurements exist, including those specified in NISTIR 7804 “Technical Evaluation, Testing and Validation of the Usability of Electronic Health Records,” (21) we are concerned that it would be inappropriate at this juncture for ONC to seek to measure EHR technology in this way.

Sounds like a rejection to me, however, don’t take my word. Here’s the AMA’s response to this decision. First, they demur and quote ONC:

We disagree with ONC’s assertion in the Version 2014 final rule that, “[w]hile valid and reliable usability measurements exist, including those specified in NISTIR 7804 ‘‘Technical Evaluation, Testing and Validation of the Usability of Electronic Health Records,’’ we expressed that it would be inappropriate for ONC to seek to measure EHR technology in this way.”

It then says:

To the contrary, we believe that it is incumbent upon ONC to include more robust usability criteria in the certification process.  The incentive program has certainly spurred aggressive EHR uptake but has done so through an artificial and non-traditional marketplace.  As a consumer, the physician’s choice of products is limited not only by those EHRs that are certified but also by the constraint that all of these products are driven by federal criteria.  The AMA made several detailed recommendations for improving Version 2014 certification in our Stage 2 comment letter, which were not adopted, but still hold true, and we recommend ONC consider them for the next version.  Testimony of AMA’s Health IT Policy Committee’s Workgroups on Certification/Adoption and Implementation, July 23, 2013, pp. 5-6

I recognize that ONC says that it may consider the protocols in the future. Nevertheless, I think the plain English term rejected fits.

In the first part of his statement, Dr. Reider cites several ISO standards. With the exception of the Summative Testing, all of these have been referred to, but none have been adopted. Reference to a standard is not sufficient for its inclusion under the operation of the federal Administrative Procedure Act, which governs all federal agency rulemaking. In other words, these standards are important, but ONC simply calls them out for attention, nothing more.

I think two factors are at work in ONC’s reluctance to include the NIST usability protocols. The first is that the vendors are adamantly opposed to having them mandated. However, I believe there is a way around that objection.

As I have argued before, ONC could tell vendors that their products will be subject to a TURF based review of their product for compliance and that the results would be made public. That would give users a way to judge a product for suitability to their purpose on a uniform basis. Thus, users looking at the results could determine for themselves whether or not one or more non compliance was important to them, but at least they would have a common way to look at candidate EHRs, something they cannot do now , nor under ONC’s proposed approach.

The other factor is more complex and goes to the nature of ONC’s mission. ONC is both the advocate and the standards maker for HIT. In that, it is similar to the FAA, which is vested with both promoting and regulating US aviation.

It’s well established that the FAA’s dual role is a major problem. It’s hard to be a cheerleader for an industry and make it toe the line.

With the FAA, its dual mandate is exacerbated when the highly respected NTSB investigates an incident and makes recommendations. The FAA, acting as industry friend, often defers NTSB’s authoritative and reasonable recommendations to the public’s determent.

I believe that something similar is going on with ONC. NIST’s relationship to ONC is roughly analogous to that of the NTSB’s to the FAA.

NIST is not an investigative agency, but it is the federal government’s standards and operations authority. It isn’t infallible. However, ONC dismissing NIST’s usability protocols, in one word, inappropriate. It did this without explanation or analysis (at least none that they’ve shared). In my view, that’s really inappropriate.

ONC has a problem. It’s operating the way it was intended, but that’s not what patients and practioners need. To continue the aviation analogy, ONC needs to straighten up and fly right.

March 31, 2014 I Written By

When Carl Bergman’s not rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

NIST Dissects Workflow: Is Anyone Biting?

Psst. Hey, Buddy, wanna see an EHR, visit’s workflow? Here it is, thanks to the National Institutes of Standards and Technology’s (NIST) new report, NISTIR 7988, Integrating Electronic Health Records into Clinical Workflow, etc.

Returning Patient Ambulatory Workflow NIST

What It Represents

NIST wants to make EHRs usable and useful. It first took aim at patient safety EHR functions that endangered, confused users or were error prone. To counter these, it developed and recommended EHR usability protocols.

Now, in an extensive report, it’s tackled EHR workflow to determine where problems occur. The result is a comprehensive work with significant findings and recommendations. The question is: Is anyone listening?

NIST’s Analytical Approach

NIST decided to create a typical workflow by interviewing knowledgeable physicians, who it calls Subject Matter Experts, SMEs. The physicians had different specialties and used different EHRs, though who they were, NIST doesn’t say.

From their discussions, NIST’s analysts created the above chart, NIST’s Figure 2. NIST’s authors recognize that actual workflows will vary based on setting, sequences, staffing, etc., but that it provides a useful way to look at these issues.

What They Did With It

Working with their physicians, NIST’s analysts broke down the workflow into three sections: before, during and after the visit. Then, they broke down, or decomposed, each of those sections, like opening nested Russian dolls. For example, they segmented the physician’s encounter, below, and once again, broke each down into its functions.

Returning Patient, Physician Encounter - NIST

What They Found

It was at this stage the analysts found significant variations among the EHRs used by their physicians,

[T]here appeared to be high variation in whether and how the EHR was used during this period, how extensive each of the activities typically were for each SME, different based upon the type of patient, how complex the patient was, context of how busy the day was, and other factors. NSTIR 7988, p 18.

Despite these differences, the physicians identified two issues that crossed their EHRs:

  • Working Diagnoses. The physicians wanted systems that let them create a working diagnosis and modify it as they worked until they made a final diagnosis. Similarly, they wanted to be able to back up and make changes as needed, something current systems make hard.
  • Multiple Diagnoses. Diagnoses usually involve multiple causes, not single factors. They wanted their EHRs to support this.

These types of issues aren’t new to those familiar with EHR problems. What’s new is NIST, as an independent, scientific organization, defining, cataloguing and explaining them and their consequences.

What They Recommended

From this work, NIST’s analysts developed extensive and persuasive recommendations, in three categories:

  • EHR Functions
  • System Settings, and
  • System Supports

EHR Functions

NIST’s recommends reducing practitioner workload, while increasing their options and supports. For example, they suggest:

  • Workload Projections. Give practitioners a way to see their patient workloads in advance, so they can plan their work more effectively
  • Notes to Self. Let users create reminder notes about upcoming visit issues or to highlight significant ,patient information. These would be analogous to their hand written notes they used to put on paper charts.
  • Single Page Summaries. Create single page labs summaries rather than making users plow through long reports for new information.
  • Single Page Discharge Summaries. Eliminate excessive boiler plate with more intelligent and useful discharge sheets.
  • Highlight Time Critical Information. Segregate time critical information. Often they get mixed in with other notices where they may be overlooked or hard to find.
  • Allow Time Pressure Overrides. When time is critical, EHRs should allow skipping certain functions.
  • System Settings

NIST recommendations echo the familiar litany of issues that characterize poor implementations:

  • Allow Patient Eye Contact. Exam room designs should put the doctor and patient in a comfortable, direct relationship with the computer as a support.
  • Login Simplification. Allow continuous logins or otherwise cut down on constant login and outs.

System Supports

The physicians recognized they often caused workflow bottlenecks. NIST recommended off loading work to medical assistants, nurse practitioners, physician assistants, etc.. For example, physician assistants could draft predicted orders for routine situations for the physician to review and approve.

Progress Note Frustrations

In the thorny area of clinical documentation, the report details physician frustration with their EHRs. All experienced excessive or missing options, click option hell, excessive output, puzzling terms, etc. These were compounded by time consuming system steps that did not aid in diagnosis or solving patient problems. The report discusses their attempts at improving documentation:

Several of the SMEs had attempted and then abandoned strategies to increase the efficiency of documentation. One SME reported that copying and pasting and “smart text” where typing commands generate auto-text had a “vigilance problem.” The issue was that it would be too easy to put the wrong or outdated information in or in the wrong place and not detect it, and then someone later, including himself, could act on it not realizing that it was incorrect.

One physician described an attempt to use automated speech recognition for dictation for a patient with scleritis, which is inflammation of the white of the eye. He stopped using the software when what was documented in the note was “squirrel actress.”

Another SME described that colleagues relied upon medical assistants to draft the note and then completed it, but they did not like that approach because it was too tempting to rely upon what was typed without reviewing it, and he felt the medical knowledge level was not high enough for this task.

One SME described a reluctance to use any scribe, including a medical student, because the risk would be too high of misunderstanding and thus not correctly documenting the historical information, diagnosis, and treatment plan. This was particularly problematic if the physician had information from prior visits, which contributed to these elements, which were not discussed in detail during the visit. NSTIR 7988, p. 28

Coding their diagnoses into progress notes also came in for criticism:

All SMEs described frustration with requirements to enter information into progress notes, …, which were applied to the notes in order to have sufficient justification to receive reimbursement for services. Although all of the SMEs acknowledged the central importance of receiving reimbursement in order to function as a business, this information was often not important for clinical needs. NSTIR 7988, p. 28

Role Based Progress Note

Unlike other areas of the report, the doctors could not agree on what to do, nor does NIST offer any specific cures for documentation problems. Instead, NIST recommends using a new, role based, progress note:

[T]he progress note for a primary care physician would have a different view from a specialist such as a urologist physician, who might not need to see all of the information displayed to the primary care physician. Similarly, the view of the note for primary care providers could differ from the view of a billing and coding specialist. … NSTIR 7988, p. 28

Will ONC Respond?

In this and its prior reports, NIST covers a lot of EHR issues making sensible recommendations that not only improve functionality, but more importantly improve patient safety. However, NIST’s recommendations are just that. It’s not a regulatory agency, nor is supposed to be one. Instead, its role is to work with industry and experts to develop usable, practical approaches to tough technical, often safety related, problems. To its credit, it’s done this in a vast number of fields from airplane cockpits, nuclear reactors, and atomic clocks to bullet proof vests.

However, its EHR actions have not gained any noticeable traction. If any EHR vendor has implemented NIST’s usability protocols, they haven’t said so. They are not alone.

Notably ONC, one of NIST’s major EHR partners, refuses to incorporate any of NIST’s usability recommendations. Instead, ONC requires vendors to implement User Centered Design, but does not define it, letting each vendor do that for themselves.

NIST has many answers to common EHR workflow and usability problems. The question is, who will bring them to bear?

March 26, 2014 I Written By

When Carl Bergman’s not rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

Physician Designed EHR, EHR MU Documentation, and Top EHR Ratings Lists


I really hate this discussion. It reminds me of the republican-democrat debates. They always go too far and both sides (in this case Physicians and EHR vendors) often only see their side and miss the opposite viewpoint. It’s very polarizing. The best situation is the mix of both sides of the equation. Plus, you usually need someone who can help translate and moderate between the two viewpoints. That’s much easier said than done. You can definitely learn a lot about an EHR vendor when you learn if they’re more physician designed or tech designed.


Many people unfamiliar with these standards probably don’t undstand this tweet from Mandi since they assume it’s a standard and so the ONC documentation should be good enough, no? The reality is that every implementation of the ONC standard is different and you have to have documentation of how that EHR vendor implemented the standard.


I appreciate Chandresh’s tweet more than most. I’ve often considered the idea of starting an EHR rating site. They are a dime a dozen and I don’t think any of them are very good. The best ones use some high level filters to help you narrow the search. This has some value, but isn’t really an EHR rating site. The problem with an EHR rating is the sheer scale of responses that you need to collect for it to be valuable. There are 300+ EHR vendors. There are 40+ specialties. There are practices from solo doctor up to hundreds in a multi specialty clinic. There are 50 states. There are hundreds of insurance plans. You get the picture. The number of randomly collected quality ratings you would need is impossible. I enjoy a good list as much as the next person, but just remember what I mention above when you see the next list of Top EHR vendors.

Then again. Maybe Chandresh and I should get together and do an EHR rating service based on if the EHR was a physician designed or tech designed EHR.

March 16, 2014 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.

An Eclectic Gathering of EHR Usability and Project Resources

Here are a few resources that I use to solve a variety of design, project management and other problems. Some, such as NIST’s protocols, are directly EHR related; others aren’t, but easily apply to EHR problems.

So here, as was once said, are a few of my favorite people and things:

  • Dan Bricklin. Hopper and Jobs are gone. Woz is a sage. Gates, Kapor and Norton long ago stopped being systems innovators in favor of being philanthropists. Bricklin, however, the electronic spreadsheet’s inventor, soldiers on. His personal site has much to offer, especially his video on interface development for different types of devices and users.
  • Donald Norman. If you only read one of Norman’s many works on usability, make it The Design of Everyday Things. When you do, you’ll find one of the most cogent, funny and thoughtful studies of user centered design. From his account of slide projectors from hell, to post office doors that trap the unwary, to the best ways to arrange light switches, Norman has good advice for all of us. I first read this twenty years ago, but the advice still resonates. He’s recently revised it and added a free on-line course. After Norman, you won’t look at doors, appliances, much less screens the same way again.
  • Jakob Nielsen. There are people who think if you know Nielsen’s usability approach, you need little else. Then, there are those who think if you know Nielsen’s approach, all hope is lost. No one has a monopoly on good interface design, but Nielsen’s site is a place to stop for tons of notable examples.
  • NIST Protocols. NIST works with the private sector to solve major, operational problems. After Three Mile Island close call NIST redesigned all US nuclear power plants’ control rooms. Recently, they’ve developed EHR usability standards. These are the best, most comprehensive treatment of what not to do. You’ll find them in an appendix in their publication, NISTIR 7804.
  • ONC Repository. Most those in the EHR field know ONC, for better or worse due to its Meaningful Use standards. There’s a lot more. Buried on ONC’s site is its Implementation Resources. The repository has dozens of videos, guides, white papers, toolkits and templates all centered on improving EHR selection, implementation and use.
  • Ross Koppel. Koppel is a grouch. He grouches about the dozens different ways EHRs record simple things, such as, blood pressure. Writing often in JAMA, he notes how health IT systems spawn workarounds, confusion and give users choices that are false, misleading or illogical. In short, he’s produced a treasure trove of frightening observations, embarrassing questions and pointed observations, but his bête noire findings also include correctives. All of this is written in a careful, thoughtful style that makes the subject compelling and chilling.
  • Tom Demarco. Demarco of the Atlantic System Guild has produced a wealth of insightful books, lectures and articles on project management. In the 60s, DeMarco asked himself, if a civil engineer can build a bridge from requirements to operation, why can’t we do the same thing with software. His first take was Structured Analysis and System Specification. It’s still in print and full of practical advice and approaches for project managers. Other works include Peopleware: Productive Projects and Teams, where he takes the odd position that you should treat your staff like people and help them be productive. I especially love his The Deadline: A Novel About Project Management in which the main character is kidnapped and forced to manage a project under threat of death. It’s a comedy.

Interested in EHR usability? Join my LinkedIn group: EHRUsability.

March 10, 2014 I Written By

When Carl Bergman’s not rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

ONC Releases Findings on Study of Patient-Matching Practices

The ONC has released findings from its study of patient-matching practices in the private sector and federal agencies.

Its conclusion: standardizing specific demographic fields within health IT systems and broad collaboration on industry best practices are two of the key steps the industry needs to take to make advances in patient matching.

In its study, ONC was looking to describe common data attributes, processes, and best practices to assess the industry’s current capabilities in this area. To do so, it did an environmental scan to get a look at current industry capabilities, literature review, feedback received at public meetings, collaboration with federal partner agencies and written comments stakeholders.

Problems it found include differences in the way names and addresses are formatted in various systems which can lead to high rates of unmatched records.

According to a story in FierceHealthIT, the study’s key recommendations include the following:

* Certification criteria should be introduced that require certified electronic health record technology to capture the data attributes that would be required in the standardized patient identifying attributes
* The ability of additional, non-traditional data attributes to improve patient matching should be studied
*Certification criteria should not be created for patient matching algorithms or require organizations to utilize a specific type of algorithm
*Work with the industry to develop best practices and policies to encourage consumers to keep their information current and accurate is necessary

With these me just at the suggestion stage, it’s evident that patient matching needs more attention.

In the past, the ONC has suggested hospitals create a standardized patient identifier during data transactions to make sure the right patient is matched with the correct information. But that won’t address the problem higher-order problem.

Simply being aware that data mismatches on patients a problem is a good first step, but it looks like we have a long way to go before data can be shared from institution to institution accurately without duplicate records and other errors of this type. Interoperability between institutions which allows for accurate patient matching is the real brass ring.

February 28, 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.

Finding #BlueButton at #HIMSS14

I am having trouble believing HIMSS 14 is just a few days away. I am really looking forward to getting out of Georgia’s erratic weather and into Florida’s warmer temps. At least Orlando weather isn’t erratic. Check out the forecast:

weather

While I don’t think I’ll have time to lounge by the pool, I do anticipate having some fun playing tennis with a few #HITchicks early Monday morning. I hope Orlando’s daily rain shower holds off until later that afternoon.

I’m also looking forward to the Siemens Media Breakfast, a Lunch and Learn with ePatient Dave, HISTalkapalooza, the #HITsm tweetup, a session on health information and the Disney experience, the Georgia HIMSS networking reception, and of course the New Media Meetup (where you can meet many of your favorite Healthcarescene.com bloggers).

As I’ve been so focused on Blue Button news lately, I thought I’d see how many HIMSS sessions will be devoted to the topic. A quick search at HIMSSConference.org yields three:

sessions

The last session seems the most consumer-friendly, and right up my alley based on its objective of covering the current state of Blue Button, and its general description:

“Join experts from the from the Office of the National Coordinator for Health IT (ONC) in an interactive session to learn more about several major developments in the world of consumer and patient engagement enabled by technology, and how you can participate. This session will cover policy initiatives, standards development, and resources available to members of the private and public sectors from ONC and our many collaborators.”

In other Blue Button news, it appears that “Blue Button healthcare technologies [are] primed to explode in [the] private sector,” according to a brief article at FederalNewsRadio.com. This is basically a rehash of last week’s news that several pharmacy associations and large retailers like Kroger, Walgreens and CVS are working to “standardize their prescription data based on Blue Button policies,” but it serves as a good reminder that Blue Button started out as a VA initiative. Is it just me or does it seem that much of today’s healthcare IT started out via government development or government mandate/incentive?

Feel free to drop me a line if you know of more Blue Button-related activities at HIMSS, or have other interesting events you think I (and my readers) should check out next week.

February 18, 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.

Interview with ICSA Labs About EHR Certification

After hearing the news about CCHIT shutting down it’s EHR certification business, I thought it would be interesting to interview ICSA Labs, the EHR Certification body that CCHIT recommended to its users. The following is an interview with George Japak, Managing Director at ICSA Labs.

Is there a backlog of EHR vendors that want to schedule test dates with ICSA labs?  

A: There is no backlog. Since ICSA Labs received its ONC authorization, it has been our intent to grow our healthcare programs and offer the best testing and certification program in the industry. Over time we have ramped up our testing team and we have a deep pool of very experienced testers on staff. We have been getting a steady stream of news customers and inquiries and expect the CCHIT announcement will accelerate the pace.  At this point we have the capacity to test applicants as they are prepared to do so.

Is ICSA Labs able to support the onslaught of EHR companies that will come over from CCHIT?  Will that cause any delays on getting EHRs certified?

A: ICSA Labs at this point does not anticipate any delays. The ONC program was designed so that vendors and product developers would have a choice when it came to testing and certification. We were not the first lab to be authorized, but we knew that given the opportunity we would be able to deliver a program where customers would experience high satisfaction.

In my post, I suggested that the economics of EHR certification aren’t all that great.  Especially if you have a legacy cost structure like CCHIT.  Is the secret to ICSA’s success having a broader certification business beyond just EHR?

A: ICSA Labs has been in business since 1989, we have a number of accreditations to support an array of certification and testing programs, such as the IHE USA Certification program which just kicked off its second year at the 2014 IHE North American Connectathon. Our business is diverse and we leverage our capabilities across our business. We are used to doing business in competitive markets, so it has always been important for our programs and cost structure to emphasize efficiency and effectiveness and those benefits are passed onto our customers. Our testing and certification programs have always been competitively priced and efficient yet rigorous and done superior quality.

How much more complex is 2014 EHR certification compared with 2011 from an ONC-ACB perspective? 

A: As any recently certified company can attest to, the 2014 Edition criteria are significantly more complicated than the 2011 Edition. There are more test tools to maintain; more test data sets to review; frequent revisions and updates to the criteria and additional types of attestation to review. The time to complete testing has close to doubled and there are more requirements as they pertain to surveillance. After the 2011 Edition criteria, ICSA Labs asked for ONC to raise the bar, and they did. For ICSA Labs the added complexity was not unexpected.

The timelines for meaningful use stage 2 are starting to get squeezed.  Will the majority of EHR vendors be 2014 certified and ready in time?

A: There will always be stragglers, but I believe a majority of EHR vendors will be 2014 certified and ready in time for Meaningful Use 2. There has been an uptick in the vendors getting certified over the last few months. Providers and hospitals however are a different story, and they may feel the squeeze in terms of the timeline to purchase, implement and begin meaningfully using their EHR system. ONC extended the Stage 2 timeline to relieve some of that pressure.

I’ve heard that in some cases the ONC-CPHL has been slow at putting up newly certified EHRs.  Have you seen this?  Do you have a bunch of 2014 certified EHR vendors that haven’t been listed on ONC-CPHL yet?

A: The ONC-CHPL is generally responsive to our concerns and we work with them as they continue to refine new features like links to the public test results summary.

January 31, 2014 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 State of the Meaningful Use

UPDATE:
If meaningful use were gone (ie. no more EHR incentive money or penalties requiring meaningful use), which parts of meaningful use would you remove from EHR immediately and which parts would you keep?
Responses:
*Michael Sherling, MD – Modernizing Medicine
*Shahid Shah – Influential Networks
*Joel Kanick – interfaceMD
*Michael Brozino – simplifyMD
*Dr. Michael Koriwchak
*Karen Knecht – Encore Health Resources

I recently wrote what’s been a really popular article on EMR and HIPAA called “Meaningful Use Program a Success…Depending on How You Measure Success.” I think we’re at an interesting point in the meaningful use program and it’s worth taking a step back and seeing where we’re at with meaningful use.

As I state in the other article, there’s no doubt that the EHR incentive money has moved the needle on EHR adoption. Those of us who believe that EHR holds lots of potential benefit to healthcare have to be happy about the amazing EHR adoption rate that has occurred thanks largely to $36 billion of EHR incentive money (we’ll save the question of whether we’ve gotten our money’s worth for another post).

While we could Monday Morning quarterback (appropriate football reference the week of the Super Bowl) the EHR incentive program and meaningful use, that won’t change the fact that it’s here and it’s not going anywhere. So, instead of asking whether we should have spent the money on EHR and whether we should have done meaningful use, I decided to take a deeper look at meaningful use and how we could improve the program. Which elements of meaningful use are really adding value and which parts of meaningful use should be removed? Or maybe it’s all great and we should just continue on the path we’re on.

I decided to use a simple approach to identify what’s good and what’s bad with meaningful use. I reached out to EHR vendors, doctors, practice managers, hospital executives, and other EHR experts and asked them a simple question. The answers to this question should provide a solid understanding of what’s meaningful in meaningful use and what’s not.

Here’s the question I asked:
If meaningful use were gone (ie. no more EHR incentive money or penalties requiring meaningful use), which parts of meaningful use would you remove from EHR immediately and which parts would you keep?

The concept is simple. If there wasn’t some outside influence (ie. government money) influencing the requirement to do meaningful use, which elements of MU actually provide value to the users of an EHR. Those that provide value will continue to be embraced by an EHR vendor and those that don’t will be removed. Plus, this is the reality of what’s going to happen once the EHR incentive money runs out, so let’s find this info out now.

I originally thought that this question would lead to a blog post with quotes from a variety of people offering their unique perspectives. However, every person who’s answered so far had so much to say on the topic, that each of their responses was worthy of a blog post of its own.

With that in mind, over the next couple of weeks, I’ll be posting all of the responses as separate posts across the network of Healthcare Scene blogs. I’ll link each of these blog posts at the bottom of this post as they are published.

Open Call for Participation
As I considered this, I realized that hundreds of other people might want to participate as well. As a health IT community I think we can make a real impact. So, I encourage everyone who reads this to publish their response to the question above.

If you have your own blog, publish it there and link back to this post so we can add your post to our list below. If you don’t have a blog, wish to remain anonymous, or would just rather have us publish it, we’re happy to publish it for you. Drop us a note on our contact us page and we can work out the details.

I believe this will become an incredible resource of information to better understand how to improve meaningful use. Once I’ve gathered a good number of responses, I’ll be reaching out to ONC and CMS to make sure they take in the body of contributed work as well. Hopefully this simple approach will be effective at gathering a response from more people than the convoluted rule making process was able to do.

Meaningful Use will go down as one of the most impactful things to hit healthcare IT and EHR in my lifetime. It behooves us to do what we can to make the most of meaningful use.

January 30, 2014 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.

My #BlueButton Patient Journey: Where Are the Smiley Faces?

Smiley faces and patient payment barriers were on my mind yesterday as I spent a few minutes in the patient portals I use (powered by Cerner, and athenahealth, in case you’re interested). I’ll get to my thoughts on user experience in a sec.

First, an update on the Blue Button Connector, which I may have explained in an earlier post. The Connector is an ONC-powered website that will offer consumers an easy way to find providers, payers and other healthcare organizations that participate in the Blue Button initiative. It will also offer developers a way to access Blue Button + technology, “a blueprint for the structured and secure transmission of personal health data on behalf of an individual consumer. It meets and builds on the view, download and transmit requirements in Meaningful Use Stage 2 for certified EHR technology,” according to the ONC.

Originally slated for debut in mid-January of this year, ONC has let it be known that it will delay the release so that when it does go live, it will work well. I’m sure I don’t have to point out the recent events that likely prompted this decision. I’m all in favor of delay to ensure everything works well. A beta version is expected to launch just before or at HIMSS. I may have to reach out to the folks at ONC to see about getting an invite to participate. Stay tuned.

Now, back to my user experience with one of my patient portals. I recently logged into the athenahealth-powered portal to cancel an upcoming appointment. It seemed easy enough to schedule a new appointment, but there was no button or quick link to cancel. I sent a secure message through the portal to the appointment department noting my need to cancel. Because it was less than 24 hours until said appointment, I also called the office as a point of courtesy to make sure they knew of my request. The receptionist who answered told me that sending a message to cancel an appointment is the best option through the portal, as that prompts staff to get back in touch with patients to see if they need to reschedule. A valid point, I thought. I realized not long after that call that I’ll need to reschedule an appointment with a different provider, as my current one is during HIMSS. Hopefully rescheduling will be just as painless.

My recent encounter with the Cerner-powered portal was almost just as painless, leaving me with three observations to share. The first being that I messaged my provider and was pleased to get a response back first thing the next morning. The second being that I attempted to look into a payment balance through said portal, but was put off by the fact that the portal directed me to a third-party site for which I have to set up another account. I wonder why the payment/billion function isn’t embedded into the portal. I’m sure there are underlying reasons patients aren’t aware of, but it sure would be a nice value-add. Unfortunately, I’m the type of patient who, when I encounter a barrier to payment, will set the bill aside and let it languish far longer than it needs to.

And the third being that I, as someone with no medical training, would far prefer smiley faces to numbers when it comes to lab results. Let me explain. Here is what I’m greeted with when I first log into the portal:

portalstats

These numbers don’t mean much, as I’m not aware of what levels are appropriate for my age, weight, height, etc. I think it would be much easier to understand if a smiley or frowny face were placed next to each number, with a small link to some sort of resource that could help me better understand each figure. I think perhaps we tend to overcomplicate things since we have so much technology at our fingertips. At the end of the day, as a patient, I want fast access to my portal and easy to understand information within it.

What are your thoughts on patient portal user experience? Have you seen any emoticons used in clinical settings? Let me know your thoughts via the comments below.

January 22, 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.

New Year’s Resolution: Take the #BlueButton Pledge

I rarely make New Year’s resolutions, but 2014 finds me ready and willing to finally take the Blue Button pledge. Perhaps my impetus stems from the healthcare I received in 2013 (more than I would have liked), and the fact that I have logged onto to at least two different patient portals (not including my kids’) that of course can’t communicate with one another.

bluebuttonpledge

I’m even more anxious to give Blue Button a go after reading that the ONC has recently announced it is working towards incorporating the following Blue Button features:

  • the Blue Button Connector: a tool that will help patients find out which providers, health plans, and others offer Blue Button
  • OpenNotes, giving patients access to their providers’ notes
  • images such as EKGs
  • lab, medication and patient-generated data
  • vaccination records
  • Explanation of Benefits forms from payers and
  • a tool that will match eligible patients to clinical trials.

bluebuttonthankyou

As a patient, I decided to take the non-data holders’ Blue Button Pledge, whereby I “pledge to engage and empower individuals to be partners in their health through information technology.” I’ll do this by actively trying to bring all of my health data into one digital repository, and blogging about it along the way. Hopefully, I can paint a picture of how having this information at my fingertips benefits my care in some way. I already foresee it helping me to become more engaged.

I’ll also make it a point to bring up the Blue Button initiative with all of my providers. I’ll be interested to see who has heard of it, who thinks it’s a good idea, and who is so overworked they don’t have much time for it. Look to future posts for the nitty gritty of what it takes to actually gather disparate health data and put it in one place.

Have you taken the Blue Button pledge? How has it impacted your care, or that of your patients? Let me know in the comments below.

January 3, 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.