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Deep Thoughts from the Meaningful Use Mountain Top

Posted on December 30, 2011 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.

In some ways I am grateful to see 2011 end.  Several extracurricular projects have drained the life out of me, including our Meaningful Use (MU) project.  As near as I can tell we survived.  Our 90 days of compliance for phase 1 / year 1 are completed.  Last night I completed my attestation on line uneventfully.  We will get attestation completed for the rest of our physicians within a couple of weeks.  Then we will join the few (1%) of “eligible providers” that have complied with MU.  One would think that folks would be breaking down the doors of these “one-percenters” to learn the secrets of their success.  Yet a brief Internet search reveals no doctor testimonials on MU success beyond the second hand accounts offered by EMR vendors and consultants.  These are of little value.  So I am writing my testimony.

Over the past several months I have repeatedly criticized MU, with good reason.  But perhaps now that I have climbed the MU Mountain and my check will soon (hopefully) be on its way, I should soften my view a bit.  Sort of like final exam week…exams looked awful before you took them, but when you got done and you were somehow still alive, well, maybe it wasn’t so bad.

Well, sorry, it’s still that bad.  It took about 150 man-hours of work to complete this project.  And our EMR use, our quality of patient care and our practice efficiency is for the most part no better.  In some ways it is worse.  As a result of MU:

  1. We now take blood pressures on children.  This is almost never medically relevant in an ENT practice.  We can’t exempt ourselves from this requirement because of our adult patients, in whom blood pressure is often relevant.
  2. We waste volumes of paper printing clinical visit summaries that no one reads.  While the concept of a visit summary is OK, the document itself must include so much extra data it is useless.  Our web portal, which we are in the process of replacing, does not support this requirement so we have to use paper visit summaries for now.
  3. Patient waiting time is increased while we process data on pneumovax status, smoking status and body mass index on every patient.  In our practice these data are medically relevant for many patients, but not everyone.  Doing it for everybody is a waste.

To be fair, a couple of good things did happen:

  1. Use of EMR-based prescriptions and true e-prescribing (e-Rx) improved with those physicians that were still hanging on to paper scripts and/or were not using e-Rx.
  2. We were not maintaining true ICD-coded problem lists in the EMR before MU.  We had problem lists and diagnoses of course, and we were using ICD codes for billing.  But we had never combined the two processes before.

The entire process is complicated, confusing, and intimidating.  Not only are the guidelines themselves a mess, but also there is a surprising amount of inaccurate and misleading information out there.  Even the CMS publication Attestation User Guide is missing a page compared to the actual attestation web site.  After reading the User Guide I lost an entire night’s sleep thinking that the “children with pharyngitis” quality measure had been deleted because it is missing from that document.  I have 17 years of medical practice experience and 37 years of IT experience.  If I can’t figure this out there is something wrong.

The view from the top of the MU Mountain looking down is no better than the view from the bottom looking up.  Meaningful Use remains an expensive distraction that forces the true benefits of EMR to be overlooked in favor of regulatory compliance.  MU also creates an unhealthy alliance between government and the health IT community.  The government wants to own health IT just like it wants to own the rest of health care.  Don’t fall for it.

Costco Begins Selling Allscripts EMRs To Doctors

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.

A little earlier this month American Medical News had an article about Costco selling EHR software. This doesn’t come as a big surprise since Walmart had been selling an EHR out of Sam’s Club for quite a while. Although, that program was discontinued shortly after the initial launch. Here’s a piece of the Allscripts MyWay EHR offering in Costco for those that missed it:

Costco has partnered with Etransmedia Technology to sell Allscripts MyWay EHR and practice management systems at Costco stores nationally. The store hopes physicians looking to collect incentive money for meaningful use of electronic medical records will take advantage of the deal.

Costco executive members can implement the integrated EMR/practice management system for $499 a month. For nonexecutive members, the price is $599 a month. The pricing is based on a 60-month contract, according to, a website Etransmedia launched to promote the deal.

The Allscripts MyWay system offered by Costco is an integrated, Web-based EMR and practice management solution that includes e-prescribing, electronic claims and a patient portal. The monthly fee includes maintenance, support and hosting as well as online training. Allscripts advertises the EMR and PM systems separately on its website for $375 and $225, respectively, per full-time physician, per month.

Costco is not offering a deep discount for the systems, but the company said it is “simplifying the buying process” by offering a product it “carefully” selected.

Despite this having been done before, I’m still seeing a lot of people on social media sites that are asking why Costco would offer an EHR. The answer to me is simple: marketing. I remember reading the story of a practice that had gone through a thorough EHR selection process that was de-railed thanks to a Sam’s Club ad about EHR software. Something’s wrong with that practice in my opinion, but the reality of EHR sales is that the sale often hinges on the littlest thing. Even if that little thing is a Costco ad.

Yes, Costco EHR just doesn’t make sense, but when you consider it as a relatively inexpensive way to market your product to doctors, maybe it’s not that strange. Although, I could think of other more targeted ways to market EHR software.

While you’re at Costco purchasing your EHR, be sure to pick up a pack of those Fat Boy ice cream sandwiches. I’m sure they’ll make a great addition to your EHR implementation. It’s amazing what food will do to enhance staff morale.

Healthbox Announces New Class of Health Startups

Posted on December 29, 2011 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Healthbox recently announced its latest class of healthcare startup companies. The three month program starts on January 9th provides $50,000 in seed capital a long with a shared workspace and access to mentors and other startup resources.

The most interesting thing I note in this list is that the companies come from all over the US and even one from Europe. I guess this makes sense since Chicago isn’t necessarily the healthcare capital of the world, but I think it’s great that companies across America are willing to move to Chicago for the 3 months. I’ll have to reach out to some of these companies (or I’d love to hear from them) about what motivated them to leave their home base for Chicago and whether they plan to stay in Chicago after the 3 months.

Without further ado, here’s the list of 10 healthcare startup companies in the latest Healthbox class:

PUSH Wellness (Chicago) is an outcomes-based wellness incentive provider that drives behavior change in health factors that are meaningful, measurable and modifiable, producing tangible benefits for participants and employers.

PaJR-Patient Journey Record (Dublin, Ireland) uses a cloud-based system with machine learning capabilities to identify patients at high risk of readmission using patient and caregiver self-reported health status.

SwipeSense (Evanston, Ill.) is hand-washing 2.0, arming healthcare providers with a portable hand-sanitation device in combination with real-time data analytics in order to increase compliance and reduce hospital-acquired infections.

CareWire (Minneapolis) is a patient engagement solution that utilizes automated patient text messaging to increase billable appointment yield, visualize patient satisfaction in near-real-time and improve provider performance.

The Coupon Doc (Atlanta) provides an easy-to-use, centralized platform that allows consumers to access manufacturer discounts on their prescription and OTC medications.

Corengi (Seattle) connects qualified patients with ongoing clinical research studies through a comprehensive online platform. Patients are able to quickly distill relevant studies, trial sponsors are able to reduce costly delays and medical innovation is accelerated.

Iconic Data (Norcross, Ga.) delivers a cloud-based patient list manager solution that provides physicians access to near-real-time snapshots of clinical care episodes across disparate, non-integrated facilities, resulting in increased charge capture and reduced inefficiencies.

UnitedPreference (Princeton, N.J.) offers employers a Tailored Spend™ payments network that allows health plans to improve participation in preventative health initiatives via branded prepaid cards that can be used to purchase items determined by the health plans.

DermLink (Atherton, Calif.) is a cloud-based, HIPAA-compliant application that enables remote diagnosis of dermatology cases, dramatically reducing wait times for patients while driving increased revenue and flexibility for providers.

CareHubs (Beaverton, Ore.) is a healthcare enterprise social platform that offers dynamic, innovative tools to help patients and healthcare providers better connect, coordinate and engage.

I’d love to hear from any of these Healthbox companies to hear more about what you’re doing. Just leave a comment on this post.

Occupying Healthcare One Muppet or Lego at a Time

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.

‘Tis the season to inject a bit of well-informed levity into my weekly blog post. For those of you who might stumble upon this week’s entry, I’m keeping things light.

My household is no stranger to the Occupy movement – whether it’s following the Occupy Wall Streeters in Zuccotti Park, similar protests around the country, or learning how the movement can be applied to healthcare, it’s been a topic of dinner conversation at our house for some time. In fact, my husband made his first trip to New York City a few months ago to take it all in for himself. Santa even brought him, ironically, an Occupy sweatshirt.

Though the movement seems to have died down – or least gone underground – I believe its principles should not be forgotten, especially when it comes to healthcare. I’d go so far as to say that is was one of the most impactful events/trends in 2011. It changed people’s way of thinking about our economy, our citizens, and what we believe we’re entitled to – whether that be multimillion dollar paychecks or socialized healthcare.

The #occupyhealthcare off-shoot is certainly a bit more underground, and not fully understood by some. There are several websites and tweet streams devoted to it, each with their own unique agenda. Whether you pass it off as a bunch of hippies in white coats and stethoscopes or not, I’ll tell you what the phrase means to me – the effort by those with a voice – big or small – to make quality healthcare accessible and affordable to all. I’ve seen first-hand what sort of assistance government healthcare programs can provide, and I’d like to think that everyone should at the very least have access to this sort of semi-funded care. The healthcare IT community certainly has its part to play in this effort, and fortunately we’re already seeing efforts made in this direction. I’d like to think that we’ll see more of this continue in 2012. Time will tell, of course.

So where’s the levity, you ask? Where’s the humor I promised? You know a movement has really “made” it when it becomes the subject of satire, or when active participants know how to have a good laugh at themselves. Take a look at the Occupy Sesame Street movement, or Occupy Lego Land. Who better to bring attention to financial gluttony on Wall Street than Cookie Monster?

If you happen to know of more humorous healthcare videos, please share them in the comments below. Let’s start off 2012 with a healthy dose of laughter. Happy New Year’s y’all.

Health Data Breaches: Hazy HIPAA Laws, Crazy Outcomes

Posted on December 28, 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.

You’ve no doubt heard it. The healthcare industry has the dubious distinction of having had the three of the top six IT related security breaches this year. This article in the Healthcare Finance News quotes figures published by the Ponemon Institute, a research organization. According to the article, there’s been a 32 percent increase in frequency of data breaches, in other words, the frequency has increased by almost a third.And it has cost the industry $6.5 billion.

But a similar story in the NY Times shows us how woefully inadequate our existing data protection laws are (This story also quotes the numbers from the same Ponemon Institute study). An employee from a Massachussetts eHealth Collaborative lost a laptop containing 13,687 records. Each of those records contained some combination of a patient’s name, SSN, birthdate and other identifying information. Now, by law, healthcare organizations are required to report breaches involving 500 or more patients and the Department of Health and Human Services.

However, says NYT, Micky Tripathi, the non-profit’s president and CEO, soon figured out “just how many ways there were to count to 500. The law requires disclosure only in cases that “pose a significant risk of financial, reputational or other harm to the individual affected. His team spent hours poring over a backup of the stolen laptop files. Of the nearly 14,000 patient records on the stolen laptop, most records did not warrant disclosure. In 2,777 cases, for instance, a record listed only a patient’s name.”

The NYT story also points out another strange loophole that came to the aid of the non-profit – the entities responsible for protecting patient health are the providers, not contractors such as Mass. eHealth.

“In the eyes of the law, Mr. Tripathi’s nonprofit is a contractor that acts on behalf of health providers. The legal burden of protecting patient data actually falls on his clients: the physicians and hospitals who entrusted his nonprofit with their files.”The laws create a perverse outcome,” he says. “It was our fault, but from a federal perspective, it wasn’t our breach.””

So of the 14,000 or so patients affected, Micky Tripathi’s non-profit only needed to notify 998 people. Of these, only one organization had patients more than 500 in number, requiring a mugshot report on the HHS wall of shame, and an offer of free credit monitoring from Mass eHealth.

In the end, the cost of credit monitoring services to Mass eHealth was a mere $6000 though the article says the non-profit ended up spending close to $300,000 in the aftermath. I wonder if this includes the cost of the necessary sleuthing involved and so on. If this is the case, the numbers are incidental expenses; the money spent directly on the breach itself was a fraction of that.

Compare this to the $1 million fine incurred by Mass. General Hospital for the loss of 192 patient records left by a negligent employee on a subway train.

With these numbers in mind, here are my takeaways from these stories:
Who is responsible for what breach is not clear enough. I had to re-read the definition for covered entities to make sure that Mass eHealth doesn’t fall under it. If the law takes such a lax attitude to IT contractors – who BTW provide the bulk of the IT infrastructure at many hospitals – where’s the incentive for anyone to do things differently?
There’s a crazy penalty structure in place. A hospital losing 192 records resulted in a million dollar fine. A non-profit losing 998 records incurred $6000 in expenses. So if you’re a hospital, you’re better off with contractor negligence than your employees/equipment being the responsible party.
Rules can be creatively interpreted.
There’s not enough negative fallout for data breaches for healthcare/HIT organizations to do things differently. Say, if in addition to the notice on the HHS wall of shame and fines, there were other repercussions like, I don’t know, a digital time-out of sorts for both contractors and healthcare organizations, maybe healthcare and IT would begin to care more.

John’s Comment: This is definitely an interesting case. With the new HITECH laws I can’t imagine how this doesn’t fall under the Business Associate agreement which would require that they follow the HIPAA laws just like any provider. The article does say that contractors aren’t responsible, but that seems like bad legal advice given by the contractor’s lawyer. I’m not a lawyer, but I’ll have to email a healthcare lawyer friend of mine to have him comment on this case as well.

It’s also worth noting that all of the breaches mentioned above have been through laptops or other devices left behind. None of the major breaches have been a hacker getting into an EMR or EHR system. Everyone likes to blame the EHR software for privacy issues, but so far they haven’t happened. They will one day, but the bigger privacy issue is still unsecured devices and human breaches (ie. staff looking at inappropriate records).

Google Health Creator Raises $6.5 Million for Healthy Lifestyle Game, Keas

Posted on December 27, 2011 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Techcrunch recently did an interview with Adam Bosworth who is likely best known as one of the creators of Google Health (yes, Google Health is gone now). The video interview has some interesting tidbits about Google Health and why Adam Bosworth thinks it failed. I think it’s interesting to see what else is happening in the health IT investment market. Adam Bosworth makes some interesting points about ways to add gaming to healthcare.

In this case, Keas, a Healthy Lifestyle Game company has raised another $6.5 million from Atlas Venture and Ignition Partners bringing the total investment to $16.5 million. That’s a HUGE bet on healthcare IT. Although, I guess you could classify this as a gaming investment as opposed to a mobile health investment.

The interesting thing is that the Techcrunch article highlights the corporate use case for this type of mobile platform. I wonder if the majority of the projections are more of the corporate health revenue model or more of the consumer health. Either way, I’ll be interested to know what $16.5 million of investment can do in this area. The problem is that at that funding level they can’t just build a cool app. They have to do a lot more than that to be successful and exit in a reasonable matter. This will be fun to watch.

Accountable Care Organizations Becoming Action Thanks to Pioneer ACO Awardees

Posted on I Written By

John Lynn is the Founder of the 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 and 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 thought this blog post on the 3M blog made a good point about ACO’s finally having some action behind them thanks to the Pioneer ACO awards that were announced recently. Until now, we’ve basically just had people talking to each other about the idea of an ACO, how an ACO should take shape, etc etc etc. It’s nice to see us starting to move beyond discussion of ACO models and now starting to see some real people and companies that have to start taking some ACO action to see what they can create.

I have a feeling that much of this initial ACO work is going to be like most startup companies: failures. In the startup world, it’s just expected that at least 9 of 10 companies will fail. That’s part of the algorithm of innovation that has worked so well in the entrepreneurial environment we know as tech startup companies. I imagine we’ll see the same with a bunch of these ACO models in healthcare as well.

One major problem I do have with this comparison is that the ACO programs that we see now aren’t entrepreneur or market driven, but instead are driven by some sort of government money. This means that those that participate have a bunch of perverse incentives.

The blog post mentioned above provides some interesting suggestions on how to improve healthcare. In response I offered these thoughts in their comment section:

The suggestions you make are reasonable and interesting, but they seem to ignore the idea that what people are really going to do with ACO legislation is find the simplest way to extract the most amount of money out of the regulation. There will be some exceptions, but this is how it works with most government programs.

I imagine some will see this as a bit cynical. I personally just see it as realistic. If we want to talk about real solutions we have to talk about the stark realities that face us and not the idealized models that could happen “IF…” ACOs are no different. Enough with the IFs and let’s talk about action.

Doctors Selecting an EMR Getting Hung on Small Details

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

One day, recently, I took a phone call from a local general practitioner who wanted to ask me more about a particular EMR system he was interested in trying.  He wanted to ask if the system would allow his staff to search for the next available slot on the calendar when scheduling a patient. While this EMR software  allows one to look at a weekly view of a doctor’s calendar, the particular function in which the computer searches for you, thus replacing a function of the front desk ancillary staff, does not exist.  When I said that, no, the particular system he was considering would not do that, but that the EMR has a lot of other great features, he said, well, it would be a major problem for his staff to have to search on their own, and so he would look for another EMR system.

I do hope that this doctor finds what he is looking for in an EMR system, but I also wonder if doctors aren’t getting hung up on EMR features that they imagine to be essential and it results in their failing to try or to adopt a particular EMR system.  However, it is certainly understandable that a doctor would want to start with the EMR system that meets as many of their needs as possible without causing a workflow change.  Knowing when to say when in the world of EMR selection is probably one of the hardest things currently facing doctors wanting to go digital.

Happy Holidays!

Posted on December 23, 2011 I Written By

John Lynn is the Founder of the 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 and 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 was preparing to write another post on EMR and EHR before running out to finish some last minute shopping. I think I’m going to splurge and buy my wife an iPad. Shh…don’t tell her. Good thing she’s long since stopped reading my blogs (I have far too many). Anyway, I was getting ready to write a post and realized this is the Friday before the Christmas weekend.

Merry Christmas for those who celebrate it like I do. Happy Holidays for those who don’t celebrate it.

If you still want something more as you try to make the time pass quicker, go and read this post I did on EMR and HIPAA about all the Healthcare Scene writers.

Otherwise, enjoy your weekend and we’ll catch you on the other side. Also, let’s not forget the true meaning of the season and life: taking care of others. I think that’s something we can all embrace.

How do ACOs Deal with Non-compliant Patient?

Posted on December 22, 2011 I Written By

John Lynn is the Founder of the 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 and 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 have been thinking more and more about ACOs coming together and the ACO movement in general lately. Everything seems to be heading straight towards the ACO reimbursement model and so I think we all better start to consider what that’s going to mean to a clinic. Plus, in my case I’m particularly interested in how EHR software will enable the ACO to work properly.

It is quite clear to me that EHR software and technology in general will be one of the core pillars to a successful ACO.

As I thought about ACOs, the question came into my head: How will an ACO deal with a non-compliant patient?

Since the ACO reimbursement is tied to the health of the patient, then patient non-compliance becomes a really important issue. Plus, patient non-compliance is an incredible challenge since the physician only has so much control over a patient once they leave their office. In fact, they only have so much control of their patient even within their office.

I certainly don’t have all the solutions to this problem, and I’m not sure how reimbursement will handle a doctor who did everything right to improve the healthcare of a patient and they chose not to comply. However, this makes me start to think of ways that technology could help a doctor to improve patient compliance.

I’ve written before about some really great mobile health applications for people with diabetes. It was amazing to see how simple text message reminders could improve compliance by patients with diabetes. There are probably dozens and maybe even hundreds of other models where mHealth could improve patient compliance.

One of the real challenges I see with this is that much of this compliance could best be served by an EHR software connected to the patients. Unfortunately, most EHR software is so busy helping the doctor do what he needs to do in the office and meeting government guidelines that EHR software doesn’t have the focus to create these types of connections with the patient which could improve patient compliance. I’m not sure they will ever have this focus.

This is why EHR vendors need to fully embrace the idea of creating an ecosystem where smart “app developers” can create these patient compliance apps that connect directly into the EHR software. This won’t be easy for EHR companies to embrace, but those that do and do it well will be wildly successful. Plus, they’ll improve healthcare in the process.

Are there other ways that ACOs will deal with non-compliance by patients? I’d love to hear what people think.