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ICD-10 Controversy in Wall Street Journal

Posted on September 30, 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.

In case you missed it, I wrote an entertaining (at least I thought it was) post about some of the amazingly specific ICD-10 codes that are out there. I’m headed to AHIMA which starts on Sunday and I’ve had a preview of a vendor, @coniferhealth, capitalizing on some of these codes with some stickers they’re handing out. I’ll embed a picture of one of these stickers at the bottom of this post.

Turns out that not everyone is happy with this light hearted approach to discussing what amounts to a major major shift from ICD-9 to ICD-10. The Wall Street Journal posted some of the responses they got to their original article. Here’s one sample response:

Having a different code for every single artery or the specific bone that’s fractured helps improve continuity of care. A patient who is hemorrhaging can get lifesaving care more quickly when the physician can immediately identify precisely where the broken suture is located. In addition, including the specification that the patient was “bitten by turtle” justifies the patient receiving additional tests or treatments, as turtles carry different bacteria than, say, parrots or turkeys. This and other tidbits of information will support more efficient and effective reimbursement processes.

The benefits we will derive from our global health-care community are tremendous. Once the U.S. finally transitions to ICD-10, we will again be able to share important data with every other civilized country

Although, not everyone is so serious. Arthur Broaderick, M.D. offered the following question, “Doctors closing their practices in droves; is there a code for that?”

Actual Debates on Stage Planned for Connected Health Symposium in Boston

Posted on September 29, 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.

UPDATE: I’m also going to be doing a healthcare IT event in Boston with ScratchMM if you’re not going to the conference and still want to come meet me. Just register for the event here so we know how many are coming.

Many of you might remember that I posted about the Connected Health Symposium in Boston (and a $400 discount code for the event) that I’ll be attending. Well, today I got an email about the event that was incredibly intriguing.

The email said that they’re going to have people on stage that actually disagree with each other. What a novel concept! To be honest, that is one of my pet peeves about many panels. It’s like this huge love fest. I don’t think I’ve ever sat on a panel where I was like that. Maybe it’s just not my nature as a blogger, but I like to discuss all angles of a conversation. Even if I agree with something someone is said, I’m happy to explain why other people might disagree with our thinking. I call it playing devil’s advocate. Obviously, I have nothing to sell, so it’s easy for me to do it, but I understand why others can’t do it as well.

Either way, I’m excited that Connected Health Symposium is making an effort to provide all angles of a conversation. Here’s a list of example sessions that will be “debates:”

  • Resolved: Current Approaches to Patient Self-Management Do Little to Improve Quality or Lower Costs.   In full agreement with the resolution is Shahid Shah, CEO of Netspective and analytic mastermind behind the HealthCareITGuy blog.  Disagreeing is Joseph Kvedar, MD, Director of Partners Center for Connected Health.   Cynthia Bouthot of the Collaborative Innovation Group moderates and promises a spirited exchange.
  • Resolved: ACOs – Nice Idea, Won’t Work!   Agreeing is Jeff Goldsmith, PhD, President, Health Futures, and Associate Professor of Public Health Services at the Univ. of Virginia.  Disagreeing is Timothy Ferris, MD, MPH, Medical Director, Mass. General Physicians Organization; Senior Scientist, Partners/MGH Institute for Health Policy.  Lawrence Vernaglia, JD, Healthcare Industry Chair at Foley & Lardner, moderates the discussion and maintains the peace.
  • Resolved: For Telehealth and Remote Patient Monitoring, the Business Model of the Future Isn’t Direct Reimbursement; It’s Bundled and Global Payments.  Agreeing is Vince Kuraitis, JD, MBA, Principal of Better Health Technologies.   Disagreeing is Jasper zu Putlitz, MD, President of Robert Bosch Healthcare.  Setter of the pace and keeper of the clock is moderator Joan Lebow, JD, Principal at Lebow, Malecki & Tasch.

I hope to meet some other people at the event in Boston. I always enjoy a good friendly debate. My favorite people in the world are people who can have an educated disagreement and still be friends after.

Epic, Cerner Best For ACOs? Say What?

Posted on 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 don’t know about you, but I’m not exactly sure what an Accountable Care Organization is. In fact, I’m betting nobody is — there’s a bunch of harrumphing and throat clearing out there, but I haven’t seen any crystal-clear descriptions out there.  Shall we say that ACOs are more honored in the breach than in the observance and leave it at that?

Now, we come to the puzzling part of this piece. If nobody’s managed to define an ACO clearly, how can any particular EMR be a better ACO tool than another?  We’ll have to ask KLAS about this one, since they’re the ones that discovered this “fact.”

Today, KLAS announced that it had interviewed 197 providers at 187 organizations to see how ACOs are forming up. A third of the respondents said that they were pursuing a formal Medicare ACO designation, and the majority were felt ACOs were the future, KLAS reported.

Sure, considering that ACOs are just risk-taking organizations with a capitated feel, some people already have a sense of what to expect. But throw an EMR into the mix and we’re in new territory — hopefully good territory, but new nonetheless.

So, tell me how providers know that Epic and Cerner are the most ACO-ready? Apparently, respondents believe that Cerner already has many of the IT pieces needed to run ACOs; moreover, they say Cerner is working closely with providers interested in the ACO model.

Survey takers also gave a nod to Epic, which they see as being close to ready (though behind in analyics and ability to share data with non-Epic users).

Wait a minute — let me get this straight.  Respondents know Cerner has the right pieces, even though the ACO doesn’t exist yet?  They like Epic, even though it doesn’t share data outside of its walled garden?  KLAS is kidding, right?

At this point, I’ll be kind and say that Epic and Cerner users are a bit brainwashed, which I too might be if I’d spent the kind of money those folks have on an EMR.

But the voice in my suggests that KLAS might have had its finger on the scales just a little bit. I will not publicly state that Allscripts, CPSI, GE Healthcare, McKesson, MEDITECH, QuadraMed and Siemens scored worse because they didn’t pay for play…but something sure isn’t right here.

 

 

 

Investors Put $20 Million in CareCloud EHR for a Total of $27.3 Million Raised

Posted on September 28, 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.

Back in October of 2010 I wrote about the CareCloud financing of $5 million to add to their initial $2.3 million round of financing. Now the news is out that CareCloud has closed another $20 million in funding. The latest round of funding comes from Silicon Valley based Intel Capital and Norwest Venture Partners. It’s interesting to see them investing in a company based in Miami.

I won’t rehash all my thoughts on CareCloud since I’ve posted about them more than a couple times.

Needless to say, I think CareCloud is a really interesting company and I’m going to keep an eye on what they’re doing. Proof is in the pudding. Now they definitely can’t use lack of money as an excuse for their ability to achieve their Healthcare IT Platform vision.

Searching for the Perfect AHIMA Experience

Posted on 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.

The American Health Information Management Association’s (AHIMA’s) annual show is right around the corner. HIM professionals will gather in Salt Lake City next week for a few days of educational sessions, exhibits, networking opportunities and even off-site visits to local healthcare facilities such as Intermountain Medical Center and the University of Utah and Cancer Registry.

It will be my first time at an AHIMA show, and truth be told, I couldn’t be more pleased that I’ll get to see Salt Lake City in the Fall. I’ll of course be on the lookout for the latest and greatest healthcare IT, particularly those technologies related to electronic medical records (EMRs). I’m also hoping to chat with AHIMA’s new CEO, Lynne Thomas Gordon, about how AHIMA will be helping its members transition through healthcare reform in the near future. (Look for a wrap up in next week’s post.)

Most of my time will be spent on the show floor, learning about these new technologies and finding out what health information management challenges and solutions providers are dealing with. James Watanabe, Director of Healthcare Business Development at Perfect Search Corp. – a first-time exhibitor this year, recently shared with me his thoughts on what’s he’s expecting and hoping to get out of the event.

What health information management challenges are your customers currently facing?
JW: “At Perfect Search, our clients are typically utilizing our unique indexing and search technology to deal with the challenges associated with extreme data growth and complexity. One of the challenges in the industry is that in addition to the explosion of digital data, there seems to be no clear direction in terms of standardization and policy. Given this uncertainty, vendors must not only help facilitate compliance now, but be nimble enough to support changes in the future. We see Perfect Search as a core technology that can be utilized to help organizations deal with these challenges as they come, and believe that the implications for such a technology are truly deep and profound.”

How does your team plan on addressing these challenges at the AHIMA show?
“We will be demoing our deep data-mining tools and highlighting some of our key strategic partnerships that showcase how the technology is being utilized today. We are able to provide at least a 10x improvement in indexing and search speed, be much more comprehensive in terms of the data we search (structured EMR, unstructured clinical notes, lab data, DICOM radiology images, etc.), and operate on up to 90% less hardware. Using our solution, clients gain real time insight into their data to improve quality scores, help mitigate fraud, improve billing processes, better facilitate clinical trials, and any other deep data mining they might require.”

What does Perfect Search hope to get out of the show as a whole?
“Despite some key partnerships such as Dell, Fujitsu, CA and Nuance, Perfect Search is relatively unknown in the healthcare space. We intend to use AHIMA as a way to raise awareness of our unique technology, it’s many applications in healthcare, move business deals forward, and seek out new partnerships in the space.”

How does Perfect Search’s Medical Record Search technology integrate with providers’ interoperability efforts?
“Perfect Search is the only indexing and search technology that is able to deal with both structured EMR content and unstructured clinical notes data equally well, to produce true semantic search. There is currently a disconnect between what most EMR vendors are pushing and what physicians and other users are wanting. EMR vendors push structured data, and clinicians are interested in utilizing their existing business practices, which for many means producing and utilizing unstructured clinical notes data. We believe that the ability to connect to all critical data needs to be a component of any good EMR or health information exchange (HIE) solution and is something that we can provide today.”

Can this technology search or be integrated into EMRs or HIEs?
“Absolutely.”

It would also seem that this technology might be useful from a business intelligence perspective – a much-needed solution in terms of providers determining what healthcare IT systems might be right for their facility.
“Definitely. 80% of business intelligence reporting and analytics is connecting to data. In large pharma and research, the deep data-mining tool we have created enables users to create and run complex ad hoc queries in real time and without IT. This tool is the difference between getting data now versus 12 hours from now, tomorrow, next week, or even next month, which is standard for most companies of significant size.”

How do you see Perfect Search technology evolving to meet the needs of healthcare providers?
“The Perfect Search team continues to work with industry experts to build new applications around the technology and strengthen existing products. Ours is a unique technology that enables users to connect to critical data at least 10 times faster, be much more comprehensive in terms of the content we search, and operate on up to 90% less hardware. “

I’m looking forward to speaking with the Perfect Search folks from the show floor. Know of any other exhibitors I should check out? Salt Lake sites I should see? People I should bump into? Let me know in the comments below.

John’s Comment: Along with Jennifer, I’ll be at AHIMA as well. I’m definitely happy to meet with people at AHIMA also and enjoy attending the event for the first time.

Intel Healthcare Hosting Webcast Featuring Top Health IT Thinkers

Posted on September 27, 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.

In this free webcast series the panels feature heavy-hitters in the health IT arena, including Todd Park, chief technology officer for the Department of Health, and include live Q&A sessions with the panelists. Other participants include:

· Eric Dishman, Intel Fellow
· Dr. Bill Bria, CMIO, Shriners Hospitals for Children
· Michael S. Blum, MD, associate clinical professor of medicine, medical director of information technology, UCSF Medical Center
· John Mattison, MD, chief medical information officer, Kaiser Permanente, Southern California

To register, click on this link and reserve your spot. The dates are Oct. 4-6 at 2 p.m. Eastern Time.

101 Tips to Make Your EMR and EHR More Useful – EHR Tips 36-40

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.

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I hope you’re enjoying the series.

40. Do NOT let the finance department drive the EMR choice or deployment
I’m far too much of a physician advocate to even imagine a finance department driving the EMR choice and deployment plan. Ok, I understand that it happens, but it’s a travesty when it does. Considering the finance department will almost never use the system, it should make sense to everyone to have the users of the system help drive the EMR choice and deployment. After all, they will have to use the system once deployed.

Let’s not confuse what I’m saying. I’m not saying that finance shouldn’t be involved in the EMR choice. I’m not saying that finance can’t provide some great insights and an outside perspective. I also am not saying that users of the EMR should hold the hospital hostage with crazy demands that could never be met. It’s definitely a balance, but focus on the users of the EMR will lead to happy results.

39. Ensure work flow can be hard coded when necessary, and not hard coded when necessary
Related to this EHR tip is understanding when the EHR company has chosen to hard code certain fields or work flows. You’ll be surprised how many EHR have hard coded work flows with no way to change them. In some cases, that’s fine and even beneficial. However, in many other cases, it could really cause you pain in dealing with their hard coded work flows.

Realize which parts of the EHR can be changed/modified and which ones you’re stuck with (at least until the next release..or the next release….or the next release…).

38. You can move to population based medicine
You’re brave to do population based medicine on paper. Computers are great at crunching and displaying the data for this.

37. Safety is created by design
Just because you use an EHR doesn’t mean you don’t need great procedures that ensure safety. Sure, EHRs have some things built in to help with safety, but more often than not it’s a mixture of EHR functionality and design that results in safety. Don’t throw out all your principles of safety when you implement your EHR.

36. Medication Reconciliation should be a simple process
I’m not sure we’ve hit the holy grail of medication reconciliation in an EHR yet, but we’re getting closer. It’s worth the time to make this happen and will likely be required in the future.

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.

Practice Fusion Unveils iPhone, Android Apps

Posted on I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

Practice Fusion continues to aggressively market to its ever growing user base, this time with the announcement of iPhone and Android apps under development.  These were previewed in prototype form at the Health 2.0 conference just today.  As of my writing this post, their press release was issued only three hours ago.  Seems like they must be close to unveiling the apps since it’s been known for a while that these were on the back burners in beta but now a PR newswire press release was just issued today.  We’ll have to stay tuned to see if they can last until Practice Fusion Connect 2011, on 11.11.11, before making the apps public.  Given PF’s mantra, I’m sure the apps will both be free to the public.  Can’t wait to have a native iOS app on my iPhone!  It’s the next natural step in their aggressive attempts to dominate the EMR market.

Dr. West is an endocrinologist in private practice in Washington, DC.  He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine and opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at doctorwestindc@gmail.com.

 

EMR Software and EHR Audit Trails

Posted on September 26, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

This morning, I read about a case that engaged me on many, many levels. On the Health Care Renewal blog, blogger InformaticsMD has a fascinating post on a medical malpractice and how EMRs allow this to happen. Here are the key points noted by the blogger:

  • Samuel Sweet, a health 62 year old, was admitted to University of Pittsburgh Medical Center (UPMC) with a headache. It turned out to be a treatable amount of bleeding in the brain. He died three days after he was admitted, on May 16, 2009, much to the surprise of his family with whom he had been conversing only six hours earlier.
  • Apparently, Mr. Sweet had been intubated. His breathing tubes were removed on the day of his death, and it was soon apparent that he could not breathe on his own. Doctors tried to intubate him again, but could not do so, and this resulted in his death.
  • At UPMC, difficult intubations cases must be flagged as such in the EMR. The patient’s record from the EMR then displays a bright yellow banner on top, noting the intubation problems. This is done so that when physicians change, the attending physician is alerted to the problem, and consults with prior notes in order to fix the problem. “Difficult intubation” was not noted in Mr. Sweet’s record.
  • A civil case against UPMC was filed by Mr. Sweet’s family. Some detective work later, their defense team alleges that a full three days after Mr. Sweet’s death, after a post-mortem meeting, Dr. Simmons, a QA official from UPMC “accessed” the UPMC EMR system, and apparently entered data stating that Mr. Sweet was a patient with difficult intubation. The defense has audit trail evidence from the EMR to back their claims. They further allege that when that action failed to post-facto flag his existing records with yellow warning banner, Dr. Simmons tried to retract the “diff intub” entry, and unfortunately for him, even that cancellation of status was logged.

While I am fascinated by InformaticsMD’s write-up, I don’t fully agree with the apparent conclusion reached – namely that “EMR’s can detract from a clear narrative, and facilitate spoliation and obfuscation of evidence presented.”

I would argue to the contrary – that because there is an EMR, there is even an audit trail possible. And rather than facilitating “spoliation and obfuscation of evidence”, the EMR audit trail has shown up whatever tampering was involved. If UPMC simply had a paper based system, think about how much easier it would be to create paper records on official stationery, without date/time stamps I may add, post-facto.

EMRs can also be designed to meet certain additional needs – for example, a lock-down feature that locks down patient records from editing once a patient is flagged as deceased. There is no real counterpart for such a feature in the paper records world. Other lessons learned: If you’re springing for an EMR, it makes sense to know what metadata is being logged, and how you can access them – a pickle Dr. Simmons would have clearly avoided had he been IT savvy enough.

But a word to the wise: even an audit trail isn’t fool-proof. And if you’re in the market for an EMR, here’s a key difference between a “free” EMR somewhere on the cloud, or a pricier product on your own servers, administered by a savvy IT administrator on your payroll. Who administers the data makes a huge difference – if you own the database and your IT administrator has access to the database itself, you *can* manipulate any audit records generated from the EMR front end. Conversely, you must research what your vendor administered EMR is doing with your data, and what checks the vendor has on its IT staff.

Read more about the Sweet case on the Health Care Renewal blog.

Who Owns Patient Data?

Posted on I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

Recently, on The Healthcare Blog, there was a really interesting post by Dr. Marya Silberberg about why patient lab data should be liberated. She recommends lab results be sent to patients at the same time that they’re sent to doctors. Dr. Silberberg does an admirable job of looking at the patient data issue from both sides. From the patient’s perspective, it is really not that hard to understand. If you’ve ever transferred your (paper) records from one doctor to another, or you’ve spent a month or more waiting for your doctor’s office to call you with their interpretation of lab test results, you’ve known the pain. It’s your data, about your body, your health, and you really have no way to access it if you have something of a grinch gatekeeping the records at your doctor’s office.

I’m no doctor, but I get you too. There are way too many paranoid, entitled people in the world, and chances are they’re your patients. Handing patients their lab records is the best way to make sure your office is inundated with callers demanding to talk to the doctor right now, and many of them will just be non-emergency calls.

Having said that, I wasn’t a huge fan of commenter Dr Mike’s response to the post:

“If I ordered the test, the results should be returned to me first, if you ordered the test, the results can come to you. So go order your own lab tests and then you won’t have to wait for me to get through that mountain of paper on my desk. Not sure your insurer will want to play along as you play doctor though

Part of the problem is that patients don’t understand that I am not on retainer for them. In the good ol’ days the docs cared for their friends and neighbor’s and community, and had a personal and financial interest in each individual. But today I don’t have a contract with you, I have one with your insurer, and together the two of us have pretty much locked you out of the decision process, and you have allowed this to happen.”

 

Whoa, them’s fighting words. Patient data access doesn’t have to be an adversarial experience. If you, the doctor, are spending an inordinate amount of time explaining lab results to patients, it’s only fair you be compensated for your consultancy in some way. And you, the patient, must stop thinking of access to patient data as a zero-cost right you can exercise. A tiered insurance plan offering could very well take care of phone-consultancy and patient-lab-reporting costs. If I or a loved one had a condition that required me to look over lab reports and such, I would happily pay a few dollars extra a month for that privilege. And for all the concerns about how the average user can’t understand what the lab results say, it’s surely not impossible in this day and age that lab reports sent to non-medical recipients be in human readable form.

Check out the post here.