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Do Primary Care Physicians Have A Bigger Stake in EMR Adoption?

Posted on April 30, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Here’s a theory I’ve been working on — one which I’ve come to doubt — but I’ll put it out there anyway and see what readers think. As I’ve watched the slow, painful process of physician EMR adoption, I’ve had the sense that primary care physicians were under the most pressure to move ahead and were likely to lead the parade.

Sure, everyone has their eye on HITECH incentives, but primary care doctors have even more to worry about. For starters, they have a more challenging  population management task at hand.  Now, they’re under even more pressure, being expected to provide a “medical home” for patients, do more monitoring of their condition, coordinate specialist care and check up on patients’ compliance with preventive health measures.

In theory, PCPs can do such monitoring on paper, and some actually do.  But one can only assume that it’d be easier to manage these increasing levels of responsibility  — and to provide the extensive quality data health plans demand — if they get an EMR in place quickly.

Sure, I hear plenty about specialist EMR adoption, and technology for specific specialty niches, but my gut feeling has remained that primary care doctors have the most to lose if they don’t move quickly.

However, search though I might, I can’t find any anecdotal or statistical data to support my conclusion, so maybe I’m way off here.  Folks, what are you hearing?  Are primary care doctors adopting EMRs at a faster rate than their specialist colleagues, or are specialists picking up the ball at a similar pace?

Good Advice: Three Things Practices Should Do After Buying An EMR

Posted on April 29, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Here’s a handy little blog item from health IT consulting firm Entegration.  While many bloggers focus on big-picture issues, firm president Art Gross has offered three easy-to-understand, concrete suggestions on how medical practices should protect themselves when they’re first rolling out their EMR.

Gross suggests they consider the following steps:

*  HIPAA security:  Gross recommends hiring HIPAA security services to help train employees and implement protocols which will make sure protected patient information isn’t compromised.

* Off-site data backup:  Few medical practices do more than back up their existing files to tape, but as he notes, data gets corrupted, backups are sometimes overwritten by mistake and disasters (fire, floods and more) can destroy on-site archives.

* Disaster recovery:   To be prepared for all contingencies, practices must have more than one copy of current data available, methods for accessing that data and detailed procedures in place for accessing the duplicate data.

Sure, companies with big IT staffs would do these things as a matter of course, but many small physician practices don’t even have a single full-time IT employee, relying instead on consultants to do basic maintenance.  That drive-by consultant is unlikely to be evaluating the practice’s overall readiness to keep an EMR up and running securely.

Reminding doctors that they must be careful custodians of their new digital data is a good idea.  Let’s hope more consultants )and vendors) dealing with small practices are preaching this gospel.

Types of EMR Reporting

Posted on April 28, 2011 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com.For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manager 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, a role he recently repeated for a Council member.

Guest Post: Carl Bergman of SilverSoft, Inc. is a principal of EHRSelector.com.

My wife and I play a game called Write Only Files. The only rule is who’s first to notice that something’s been stored never to be retrieved. They come in all sorts of places. I once visited a nursing home that dutifully kept all the residents jewelry in a closet, but without any IDs. It didn’t matter; the owners never came back to claim them.

EMRs are not as dismal, but sometimes I think all we talk about is how to put data in an EMR without dealing with how to get it out. You’d think that the entire function of an EMR is to put in and retrieve single patient records.

Yet, a versatile, intuitive reporting system is absolutely necessary. Not only can it answer questions that paper systems cannot approach, but it also can produce insights into both medical and financial issues fundamental to a practice.

Stage 1 has changed some of this by requiring reporting on populations, not just retrieving single patient records. To deal with this, vendors have put on a full court press to modify their systems for Stage 1 reports. Their efforts, which often required new capacities, point out how neglected EMR report writers have been.

The need for more sophisticated and user oriented report writers is only going to increase. Stage 2, ACOs and other HIE initiatives will make even greater demands not to mention increased use of EMRs.

These external demands will be complimented by user demands for more information about the practice both medically and financially. Meeting these demands are a mixed bag of current systems. Some products will grow into these new roles while other vendors will need to rethink their approach or fail.

Current EMR report writers fall into three basic groups, of which only one can fulfill their role. These are:

•      Wired Reports. These EMRs don’t have a real report writer; instead, they have single purpose “push button” reports for specific purposes. Users have little or no control over what they find or present. A typical report might show no show patients for a day.

•      Parameter Reports. A step up from wired reports, these allow users a fair degree of control over what the report finds and some control over formatting. For example, the user may choose sorting order. These are often built in a tools such as Crystal Reports. Depending on the development effort, the result may be a robust tool. However, the use of third part tool can have major drawbacks. These include:

     o   Rigidity. Modifying a report may require an on site programmer or paying the vendor

     o   Cost. The user often has to pay for the tool, its annual license and maintenance. If there are problems, the user may be caught between the EMR vendor and the tool vendor.

     o   Conflicts. These tools are generalized applications designed to work on many different systems not just the particular EMR. Problems can range from not having the desired function to the tool ending support for the application type.

     o   Learning Curve. Users will have to master both the EMR and the tool’s way of doing things.

•      Built In Report Writers. These are designed as an integral portion of the system. These overcome the problems of the other two classes; assuming they are built to meet a variety of reporting tasks. Even if a report writer can carry find and sort the desired data, it must also meet other requirements. For example, if the FDA issued a bulletin requiring practices to notify all their patients who have Crohns disease and take acetaminophen. The report writer should be able to identify these patients, email or prepare letters to them.

Even if an EMR has a crackerjack system, its mission can still fail if it does not have access to all practice financial data. Systems with a single database can do this. Those that link or coordinate the EMR database and the practice management db have a harder, but possible task. Those systems that have separate, uncoordinated, datatbases are out of luck regardless of how good the individual report writers may be. If a report writer can’t cross the EMR and PM line, it is not taking full advantage of practice data. Each time it can’t produce the needed reports it’s creating write only files for my collection.

Is Hospital Consolidation Being Driven By HIT Issues?

Posted on April 27, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

As just about any reader would know, Community Health Systems is engaged in a $3 billion hostile bid to take over Tenet Healthcare Corp.  As I noted on another blog, this may or may not be a good idea, but hospital consolidation is clearly in the air.

Just look at the past year. Not only has CHS attempted to take over Tenet, Tenet moved to gobble up Australian hospital chain Healthscope, private equity firms have been  sinking big bucks into regional systems and local chains are merging with big ones.

All told, according to Irving Levin Associates, 77 hospital-related M&A deals took place during 2010, the highest number since 2001. We’re talking a monumental $12.6 billion in deals, according to Irving Levin research.

The question is, why last year as opposed to any other?  Commonly-cited factors include:

*  Attempts to batten down the hatches to prepare for health reform

*  Opportunistic buying by chains and venture firms, as hospitals continue to struggle with the aftermath of the 2008 market crash

* Hospital willingness to close or merge in the face of rapidly-changing times

What you don’t see mentioned often — in the mainstream business press at least — is the staggering cost of upgrading health IT infrastructure to the levels needed for enterprise-grade performance.

During the process of implementing an EMR, IT costs can shoot up 80 percent, according to Accenture, driving up hospital costs 200 basis points or more.

And that’s just the beginning.  Health IT leaders must address database management, workflow integration, upgrades to communication infrastructure and much, much more.

The bottom line is that if all of these systems don’t work together smoothly, hospitals won’t be able to collect the quality data they must produce to survive in the new era.

Given these pressures, it’s hardly surprising that hospitals and systems hope to stare down their massive IT costs by throwing their lot in with bigger partners.  Hey,  it’s certainly worth a try.

ONC Healthcare IT Blog

Posted on April 26, 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.

I’m extremely biased in this opinion, but I love that ONC has a healthcare IT blog. I’m sure it still has to go through the government filter, but I love that the members of ONC have a place where they can put out comments and thoughts and receive feedback from the greater community.

One thing that’s beautiful about a blog is that the community of readers often provide as much value in the comments as the writer provides in the commentary. I think that’s a hard shift for many journalists to make since they’ve been so well trained that they are suppose to provide the font of information, cover all angles, research out the facts, etc.

Since I’m not a journalist, this hasn’t been hard for me at all. In fact, one of the main reasons I started this blog was for me to share the information that I had learned and I learned very quickly that when I was wrong that the good people reading my site would be happy to correct me. I’m not sure I’d call all of those corrections a fun experience, but once I put my pride behind me I’m always grateful to be smarter after than I was before.

I imagine that ONC has seen the same thing. They’ve probably heard some comments that were hard for them to hear. However, once they get over those hard things, I’m sure they were grateful to have access to some candid feedback. Argue what you may about the value of meaningful use, certified EHR, and , all of the people from ONC that I’ve met have been very good people trying to do the best they can. I imagine the blog helps them do that even better.

Great Little EMR Related Cartoon

Posted on 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.

Something to make those who enjoy the EMR world laugh.


“I can’t wait until we convert to electronic health records. Carry these is giving me backache.”
Bacall, Aaron

Want People To Use PHRs? Try Making Them A Game

Posted on April 25, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

I’m embarrassed to admit this, but over the last week I’ve become addicted to a hideously cute little iPhone app called Shopkick.  The app locates where you are geographically, spits out a list of retailers for you, and when you click on the retailer’s name, typically rewards you with “kickbucks.”

The more kickbucks you get, the higher “level” you’re at, whatever that means — and when you collect, say, thousands of points you can get a $25 gift card. (Yippee!)  In truth, the rewards Shopkick offers probably average out to about 3 cents an hour. Who cares?  I keep playing with the stupid app until I’m out of offers to click.

Now can anyone tell me why the same type of scheme wouldn’t motivate at least some consumers to add data to their PHR on a regular basis?  Small cash rewards are already proving effective at improving medication compliance, after all, and for most people, updating their PHR would be no harder than taking a pill.

In the past, I’ve scoffed mightily at online schemes which reward people for participating in communities, filling out forms or otherwise doing what they’re told.  After all, why should anyone care if a site names them an “explorer” or a “champion” or a “grand poobah”?  But there I am, getting psyched when Shopkick promotes me from level 3 to level 4.  Hey, I can’t help it — every time you level up you get such a cute little chime and a big green bubble to pop…  (Yes, I am otherwise a mature, responsible adult.)

But I’m being taught, by playing with this app, that rewarding people — even with very small incentives — can do an amazing job of getting them to repeat behavior.  Offer patients relevant reinforcement and patients are likely to take the PHR maintenance job more seriously.   What if, for example, a health plan teamed up with a pharmacy retailer to offer discounts on products if patients maintained their data? It could be huge.

But don’t make the rewards too exciting. Hey, you might have to keep releasing new, updated versions of your gaming system to satisfy fans.

Intuit Health to Make the Next Major EMR Vendor Acquisition?

Posted on 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.

Medical Software Advice has an interesting look at why Intuit Health might be the next company to acquire one of the 300+ EHR vendors on the market. The initial analysis of Intuit Health’s current healthcare IT offerings is really good and does point to them possibly acquiring an EMR company. It also does make a lot of sense for them to acquire a web based EMR software vendor that has a lot of traction. I think the Mint.com acquisition by Intuit points to the direction they’re taking the company when it comes to SaaS based products (which would include a SaaS EMR company).

My only issue with the article about Intuit Health and their potential acquisition choices is that it’s a pretty casual consideration. The idea of listing AdvancedMD after they were just acquired is pretty funny. Although, Intuit Health acquiring an EMR vendor would be a similar new EMR consolidation as Neil Versel called it.

Same actually goes for Practice Fusion after their recently announced $23 million financing round from Founders Fund. I don’t think Intuit Health is looking for a $200+ million acquisition which is what that type of financing round would likely require. Unless they did a DST style transaction, but I think that’s unlikely. In fact, I think Mitochon Systems might actually be more to Intuit Health’s liking than Practice Fusion. Smaller user base, but could likely acquire them for much cheaper than Practice Fusion.

With the 300+ EHR vendors out there, I guess it was brave to mention any EMR vendors. One thing they definitely got right though, Intuit Health has plenty of interesting companies to choose from. It’s definitely a great time to be an EHR vendor.

Can Paraprofessionals Solve The Health IT Talent Shortage?

Posted on April 23, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

As anyone reading this blog knows, there’s not enough HIT specialists available to  manage  the massive wave of EMR implementations under way.  In fact, many CIOs fear that they won’t be able to find enough EMR help to get stimulus funding, according to a CHIME survey from late last year.

More than 70 percent CIOs responding to the survey said that they might not be able to bring enough staff on board to get HITECH incentives, CHIME reports.  Many are turning to third-party consultants to get the job done, but as we all know, outsourcing the implementation of a mission-critical system like an EMR comes with problems of its own.

So, wouldn’t it be nice if there was a way to reduce the need for scarce health IT veterans and fob off at least some of the work on paraprofessionals?  It seems that at least one organization has exactly that in mind.

A group of impressive HIT experts, led by Steven Lazarus of the Boundary Information Group, have come together to offer a series of certification courses which train students to handle some EMR management functions.   The certifications include:

*  Certified Professional in Electronic Health Records (CPEHR)

*  Certified Professional in Health Information Technology (CPHIT)

Certified Professional in Health Information Exchange (CPHIE)

The organization, known simply as Health IT Certification, has already partnered with three Regional Extension Centers. It’s also working with several trade organizations, including the MGMA and WEDI.

The group frankly acknowledges that these certifications are no substitute for in-depth health IT expertise, but argues that people who meet its certification requirements can be a big help nonetheless.

My guess is that such paraprofessionals would be especially attractive to small medical practices, which seldom — if ever — have a traditional IT expert on staff and can ill-afford high-end EMR consulting.

However, I don’t know if they’d make a dent in a hospital or health system’s staffing problems, as I doubt that even the best-informed paraprofessional could handle the implementation of high-end enterprise EMR systems.

That being said, it’s hard to tell what will and won’t work as the EMR juggernaut descends upon the industry.  Maybe these certified folks — call them HIT extenders? — can make a real impact.  What do you think?

Great Analogy for Cutting Healthcare IT Investment

Posted on April 22, 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.

The real problem here is that when done right, healthcare IT and EMR can be a real benefit to a clinic. Done wrong and it can be a weight around the neck of the hospitals and doctors that are implementing it. Long term, I think the analogy is even more true. You can only glide so long without an engine to propel you.