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Allscipts Views on KLAS Conflict of Interest

Posted on September 30, 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.

HISTalk posted an interesting comment from Allscripts about KLAS and why Allscripts stopped working with KLAS to rate their EHR software:

We agree that there is a conflict of interest in having vendors pay large fees to the same company that is producing the ratings. We reached the same conclusion a few years ago and discontinued the practice. After our recent merger with Eclipsys, we inherited an existing Eclipsys contract that was in place with KLAS, so the information reported by the writer was technically correct. However, we have now canceled that contract and we do not currently pay KLAS anything. We realize that is counter-intuitive as we currently are and have consistently been highly rated across many product categories by KLAS, but ultimately we didn’t feel it was right to pay a firm that was also rating our products.

I’ve never really understood why so many people have put so much value in KLAS. I’ve never found it to be that value (at least on the EHR rating side).

The problem is that SOOO many people are looking for a source of information on how to rate and rank the various EHR vendors. They’re looking for some way to differentiate the 300+ EMR companies out there. Unfortunately, there’s no ranking, certification, JD Power like or consumer report like service that does this for EHR software.

I think there’s a huge opportunity there, but it’s a nearly impossible task to do it effectively (ie. it provides value to the doctors) and without any sort of conflict of interest. Thus we end up with services like KLAS.

Great Meaningful Use Short List

Posted on September 29, 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.

Seeing the legislative process first hand I must admit that it’s a bit overwhelming to see the volume of legislation that they put out which is all done in this pretty cryptic legalese and full of pages of useless recaps and other fluff. I guess that’s why I found this abbreviated list of meaningful use criteria so nice:
The 15 core criteria, presented in an abbreviated format, are:

1. Use computerized physician order entry (CPOE);
2. Implement drug-drug and drug-allergy interaction checks;
3. Generate and transmit permissible prescriptions electronically;
4. Record demographics;
5. Maintain an up-to-date problem list of current and active diagnoses;
6. Maintain active medication list;
7. Maintain active medication allergy list;
8. Record, chart changes in vital signs;
9. Record smoking status for patients age 13 or older;
10. Implement one clinical decision support rule;
11. Report ambulatory clinical quality measures;
12. Provide patients with an electronic copy of their health information, upon request;
13. Provide clinical summaries for patients for each office visit;
14. Demonstrate capability to exchange key clinical information;
15. Protect electronic health information.

Five additional criteria, of the provider’s choosing, must be selected from a menu of 10 that include entering test results into an EHR as structured data, maintaining lists of patients with specific conditions, and submitting information to immunization registries electronically.

Each of the 15 criteria have their nuances that will need to be understood to meet meaningful use, but this is the type of list I think most providers would want to see to understand generally what the meaningful use criteria requires.

Exclusion Help for Specialists Interested in the EMR Stimulus

Posted on September 28, 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 this point, I’m guessing that most people have heard of meaningful use and many likely know about the 25 meaningful use criteria (15 core MU measures and 10 menu). I’m not sure how well communicated the exclusions that are available for most of the meaningful use criteria. Elizabeth Woodcock explains some of the details in her Modern Medicine article:

For the 13 of the 25 criteria that have exclusions, CMS designates narrow windows for physicians to report that the objective or measure does not apply to them because “They have no patients, or no or insufficient number of actions that would allow calculation of the meaningful use measure.” For example, a physician who has no patients age 65 or older or age 5 or younger would not have to meet the requirement to send an appropriate reminder to 20 percent or more of all patients in those age groups during the EHR reporting period.

Also of some comfort to dermatologists is that CMS lowered thresholds for many of the meaningful use measures. For example, the measurement for electronic prescribing will be for more than 40 percent of all permissible prescriptions written by the physician to be transmitted electronically using certified EHR technology. CMS backed off from its initial proposal setting the minimum e-prescribing threshold at 75 percent of all permissible prescriptions.

Some are still saying that specialists are still left out of the meaningful use and EMR stimulus programs. They rightfully note that meaningful use was and is focused on primary care and not specialists. In fact, ONC hasn’t been shy about generally making the same observation.

The question is whether exclusions like the one mentioned above does enough to encourage specialists to implement an EHR. I’m inclined to lean with many of the specialist medical societies that are saying that it doesn’t.

I’d make an even bolder prediction. Don’t be surprised to see specialists still leading in number of EMR implementations done despite not being stimulated to do so by the government.

Physician Income Lowering – EMR as the Solution or Problem

Posted on September 24, 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.

Evan Steele, CEO of SRSsoft has an interesting post called “Preserving Physician Income in a Low-Margin Environment: EMR Strategy up on his blog which does a great job summarizing a physician’s income with a nice graph. In it he shows the 3 main drivers of expenses and income for a doctor: Reimbursement, Overhead and Income. Then, he offers this interesting analysis:

Given that physicians have no control over reimbursement rates, the only way to positively impact that green line is by effecting fundamental changes to practice operations—and the right EMR is critical to this end.

First, it is imperative to significantly reduce overhead—the orange line. Government programs that may, or may not, deliver short-term financial incentives do not address cost structure. What is needed is an EMR that delivers sustainable and significant reductions in the staff-to-physician ratio and more efficient management of all resources—depressing the orange line. Increasing revenue—the blue line—requires increases in physician productivity and patient volume. The challenge here is to wade through EMR marketing hype to identify the EMR that will actually shift the orange line [overhead] down and the blue [reimbursements] and green [income] lines up.

I read today of one physician’s concern over the GOP’s Pledge to America taking away the EHR stimulus money in the HITECH act. Luckily, this physician was wisely counseled that someone buying an EHR solely for the government handout better think twice.

Instead, the analysis above is a much better gauge for measuring an EMR software. Will it increase productivity? Will it increase reimbursement? Will it decrease staff-to-physician ratio? or will it do any of these other EMR benefits?

All of these questions will help you answer the question of whether a certain EMR software will help to improve Physician income or not. For those that think this doesn’t matter, go visit some more docs.

InfoGard Laboratories to Start Certifying EHR Vendors as an ONC-ATCB

Posted on September 20, 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.

InfoGard Laboratories, the nation’s first accredited IT security testing laboratory, is approved by the Health and Human Services, Office of the National Coordinator for Health IT as an ONC-Authorized Testing and Certification Body (ONC-ATCB) for the certification of Complete EHRs and EHR Modules for both ambulatory and inpatient settings. –Source

And now there are three official ONC-ATCB for EMR vendors looking to get their EHR software certified. Looks like InfoGard has been doing NIST certifications for a long time now and EHR certification will just be another certification for them.

Info Gard will be the third officially approved ONC-ATCB alongside Drummond Group and CCHIT which were announced previously. There’s also been rumors that Weno Healthcare is trying to become an ONC-ATCB as well.

Maybe I’m just missing it, but I wasn’t able to find other details on InfoGard’s EHR certification plans, pricing, and timeline. If someone else finds it, please let me know. It’s a little disappointing that their press release didn’t include a link to this type of information like Drummond Group and CCHIT did.

iPad Won’t Transform Hospital IT, But Has Potential With EMR

Posted on September 17, 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.

i Medical Apps recently posted an article about Apple’s iPad falling short of transforming hospital Medical Care, but says it may have potential with EMR. We’ve discussed the iPad and EMR quite a few times on this blog with interesting responses.

The above article offers 3 reasons why their skeptical that the iPad will transform the way EMR software is done:
1) For a healthcare provider’s day-to-day use, the iPad doesn’t do anything better than an iPhone or a laptop/desktop.
2) Big hurdles face development of peripherals for more advanced healthcare functions
3) Safety

I guess for me the most important thing I’ve seen was a conversation I recently had with a doctor. This doctor is a HUGE Apple fan boy and always has the latest Apple gadget (like the iPad). I asked him now that he’s had the iPad for a while, what he thought about it.

He responded, “It’s a great toy.”

I think that basically summed it up for me. It is a great tool for doing a lot of things, but EMR is not likely one of them. I’ll still go back to my initial projection that the methods of input that the iPad are providing might be the basis for the future of data input. However, the iPad device itself isn’t what’s going to see the widespread adoption in healthcare IT and EMR.

It does make a great giveaway at conferences though.

Physicians vs. Health IT: The EMR Culture War

Posted on I Written By

Dr. Michael J. Koriwchak received his medical degree from Duke University School of Medicine in 1988. He completed both his Internship in General Surgery and Residency in Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center. Dr. Koriwchak continued at Vanderbilt for a fellowship in Laryngology and Care of the Professional Voice. He is board certified by the American Board of Otolaryngology-Head and Neck Surgery. After training Dr. Koriwchak moved to Atlanta in 1995 to become one of the original physicians in Ear, Nose and Throat of Georgia. He has built a thriving practice in Laryngology, Care of the Professional Voice, Thyroid/Parathyroid Surgery, Endoscopic Sinus Surgery and General Otolaryngology. A singer himself, many of his patients are people who depend on their voice for their careers, including some well-known entertainers. Dr. Koriwchak has also performed thousands of thyroid, parathyroid and head and neck cancer operations. Dr. Koriwchak has been working with information technology since 1977. While an undergraduate at Bucknell University he taught a computer-programming course. In medical school he wrote his own software for his laboratory research. In the 1990’s he adapted generic forms software to create one the first electronic prescription applications. Soon afterward he wrote his own chart note templates using visual BASIC script. In 2003 he became the physician champion for ENT of Georgia’s EMR implementation project. This included not only design and implementation strategy but also writing code. In 2008 the EMR implementation earned the e-Technology award from the Medical Association of Georgia. With 7 years EMR experience, 18 years in private medical practice and over 35 years of IT experience, Dr. Koriwchak seeks opportunities to merge the information technology and medical communities, bringing information technology to health care.

The recent financial incentives offered by the government (HITECH) for EMR implementation are somewhat helpful but are also misleading.  Most fail to recognize that the biggest obstacles to EMR implementation are not financial, but are cultural.  EMR adoption will require cooperation between two disparate cultures:  the Health IT (HIT) culture and the medical culture.  One needs only to read a few of the EMR debates in any health care blog to discover that these two cultures view the health care system differently.  Until the differences are reconciled, EMR implementation will continue to struggle despite the HITECH incentives.
Buoyed by its success digitizing other parts of the economy, the HIT industry sees in health care an untamed wilderness of inefficient workflows and slow, outdated data exchange.  HIT folks envision a world where standardized workflows and rapid data movement ensure, for example, that a patient never has to wait 30 minutes in an exam room for test results and where day-to-day management of chronic diseases can be done remotely.  An IT revolution in medicine would bring lower costs, better efficiency and improved care.
But there is a dark side to the HIT perspective. After successfully bringing so many other parts of our economy into the information age, some believe they have learned all they need to know to do the same for health care.  The benefits are so clear and so obvious that anyone who would oppose EMR must be either clueless or just “protecting their turf.” I have heard HIT consultants brag about walking out on their physician the minute they saw a paper prescription pad.  They mistakenly believe that health care is no different than banking or grocery stores – that there is nothing else to health care besides documentation, workflow and data exchange.
The medical culture sees it differently.  To us health care is all about the doctor-patient relationship.  In the physician’s world workflows and data exist only to support and execute the decisions patients and doctors make together regarding care.  The art and science of medicine defy, to some degree, traditional software structure and data capture techniques. Our decisions may depend as much upon the look on a patient’s face as on any objective data.  That is how it should be.  The type of personality who is attracted to this kind of work is interpersonal, not technical. We got into medicine to interact with people, not machines.
The doctor-patient relationship gets attacked from all sides. Since the doctor-patient relationship drives one-sixth of our economy that comes as no surprise. The government just passed a huge piece of legislation that will have profound effects on the doctor-patient relationship.  Pharmaceutical companies tell us we need to use their latest drug.  Device manufacturers push the next great Magic Wand for performing a tonsillectomy, sinus surgery or other operation.  Consultants tell us to run our practice like a business.   When we make sound business decisions, we are accused of abandoning our moral obligation to medicine.  To us the folks trying to sell us EMR are no different.  They are just another group that thinks they know how to do our job better than we do.
But the medical point of view has its dark side as well.  We act as if the doctor-patient relationship is so sacred as to be perfect and infallible, privileged from the need to evolve and improve, immune to the economic and performance pressures lurking just outside the exam room door.  If the treatment we prescribe is not the most cost effective choice, let the system deal with it.  If our paper prescription is illegible or non-formulary, that’s the pharmacist’s problem.  If EMR is too inconvenient because of the learning curve, then it doesn’t matter how much more efficiently the system would run with EMR in place.
Bringing information technology to health care will be slow and painful until these 2 points of view are reconciled.  The first step is to realize that both doctors and Health IT are right – and they are both wrong.  Both sides need an attitude adjustment.
Health IT must acknowledge that the doctor-patient relationship is a major part of the health care machine.  Workflows and data are the means, not the end.  Nothing like the doctor-patient relationship exists anywhere else, so the experience gained bringing IT to other parts of the economy is not enough to write good software for physicians.  Little wonder that doctors find EMR software “clunky”, inefficient and difficult to use.   As one physician responding to a survey stated, “in order to contain the subtleties of the medical thought process, these systems have to be complex, flexible, and very nimble.”  Health IT needs to invest time and effort developing a greater understanding of how doctors and patients interact and make decisions.  Only then will the software get better.
The medical culture must understand that while the doctor-patient relationship is unique and special, it is not entitled to be rigid and inflexible.  Over the past several decades the way we do our job has evolved; the evolution must continue.  The doctor-patient relationship is not perfect.  The shortcomings we impose on the rest of the system play a part in the inefficiency and the waste.
Remember when managed care came along 20 years ago?  We dug our heels in and fought against it.  We declared our methods and our high price tag to be above criticism.  So the rest of the health care system created managed care without us.   We are still living with the consequences.
With the impending IT revolution in health care we face a similar choice. If we refuse to accept change, the result will be the same as it was 20 years ago.  If we want a better result this time we must take a leading role.  We must voluntarily leave our comfort zone and bring EMR to the practice of medicine.
Can both cultures admit their shortcomings and meet in the middle?

Sill Unanswered EHR Stimulus and Meaningful Use Questions

Posted on September 16, 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.

NOTE: I had this post sitting ready to be posted back in July and never got around to it. I think it’s still pretty relevant even though we are a few months farther along. Some of the time frames might not be quite right now, but the sentiments are interesting.

DKBerry sent me a passionate email in reference to this Modern Healthcare article about the EHR subsidies unanswered questions and the possibility of EHR Stimulus money flowing in May 2011. While I don’t agree completely with DKBerry, I have to admit that it’s quite disturbing that an 800 page meaningful use final rule later and we still have lots of questions. The following is DKBerry’s reaction/summary of the article:

Trudel makes it sound like a doc could validate his meaningful use on 30 April (end of the first possible 90 day period for reimbursement) … and would get paid by CMS in May.  Wonder how long she has worked for CMS?

I especially like this line …

John Halamka, committee co-chairman, asked whether the reimbursements paid to office-based physicians would be counted by the Internal Revenue Service as taxable income. Trudel said that question was out of her purview.”

Of course its taxable income Dr. Halmaka!  It’s based on Medicare reimbursement payments … and that’s revenue.  Had the bozzos who set up this idiotic incentive program provided tax credits instead of partial reimbursements for meaningful use adoption of a certified EHR … then maybe they would have gotten more than 15 docs to sign up.

You will love the dialog between Judith Faulkner (Epic Systems) and Doug Fridsma (ONCHIT).

Faulkner asked whether he thought “we’re going to make” the Jan. 1, 2011, start date by having both these certification and testing organizations and vendors with tested products in place by then.

Fridsma made no promises.”

He said his hope is that having multiple testing and certifications organizations authorized will “eliminate some of the bottlenecks.” Still, he said, there will be “challenges” to get systems certified if providers “bundle” pieces of EHR systems together to achieve meaningful use, a common scenario at many hospitals.

We are working as hard as we can to meet those timelines and get the capability in place,” Fridsma said.

I appreciate that you are working as hard as you can … but that’s not good enough.  ONC has to get it done now.  Any date after 30 September and its costing hospitals money.  They are going to be still screwing around with this in January … 2 years after they put it out in ARRA.  If I were a doc I would just say screw it … I’m closing my panel to Medicare patients.  This isn’t worth the pain and effort.

Drummond Group EHR Certification FAQ

Posted on September 15, 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.

Drummond Group has recently published an FAQ about EHR certification. I’m guessing that the FAQ will continue to grow over time. They do cover some important topics. Here’s one of the FAQ that I found particularly interesting (and pretty sad too).

Q: My software is developed for a specialty practice (e.g. dental, etc.) and some criteria are not relevant for my customers. To be a Complete EHR, do I still need to certify over all the criteria?

A: There is not a specialized criteria set beyond the general categories of ambulatory or inpatient, and thus specialized software are required to satisfy the same criteria as general EHRs. The concept is that even if a user will not utilize all the features of a certified EHR that the certified EHR must still have this functionality present within it. Regarding criteria that do not fit a specialty’s typical use, ONC address this type of situation in their Standards and Certification Criteria Final Rule. They talk more of the situation with ED/inpatient settings and comments that growth charts are not needed. Here are the relevant sections that show the aggregated comments they received and their response.

Comments.  A few commenters noted this certification criterion applies more

directly to specialties that predominantly treat children.  For other specialties, this criterion would add unnecessary cost and complexity to many HIT products that they would use.  Many commenters suggested that a growth chart component should not be required for EHR technology designed for an inpatient setting, as it is not feasible to track this data in a meaningful way over a long enough period of time in an inpatient setting (which is typically of a short and infrequent duration).  A couple of commenters suggested that non-traditional forms of growth charts should be accepted.  One commenter suggested that the certification criterion establish a baseline, but should not limit the expansion of this capability to other ages.  Other commenters made specific suggestions for different age ranges, such as including children under the age of two and lowering the upper age to ages less than 20 years old (e.g., 18).

Response.  As we stated above with respect to the calculation of BMI, we believe

that Certified EHR Technology should be capable of performing this capability

regardless of the setting for which it is designed.  Moreover, with respect to whether growth charts should be applicable to Complete EHRs and EHR Modules designed for an inpatient setting, we remind commenters that children’s hospitals qualify as eligible hospitals under the Medicaid EHR incentive program and will also need to demonstrate meaningful use of Certified EHR Technology.  We do not preclude Complete EHR and EHR Module developers from designing novel approaches to displaying growth charts.  Finally, we concur with the commenter that suggested this certification criterion should be a baseline.  We reiterate that this certification criterion establishes a floor, not a ceiling, and we encourage Complete EHR and EHR Module developers to include additional functionality where it will enhance the quality of care that eligible professionals and eligible hospitals can provide.

EMR Integration with PACS Software

Posted on September 14, 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.

Today I got the announcement from SRSsoft that they have integrated their EMR software with the Medstrat PACS software. As I think about it, I’m a little surprised that I haven’t seen more integrations with PACS software. Is this because most doctors wouldn’t really use this? I know that SRSsoft does a lot of work with orthopedics and related specialties where PACS is essential. I’d love to hear what other things are happening with PACS and EMR integration.