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5 Questions with EHR Executives at HIMSS12

Posted on February 20, 2012 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.

As some of you know, I’ve toyed with videos on my site for a while now. HIMSS is definitely the place where I’ve done the most video and that will be true again this year. I decided to take a pretty simple approach to video at HIMSS12. Since a large portion of my meetings at HIMSS will be with EHR vendor executives, I thought it would be fun to ask all the EHR vendors the same 5 (I don’t mind doing more or less if they’re good questions) questions.

Since I love the idea of involving the community and kind of crowdsourcing the questions, I’m going to put a few questions out there and listen to feedback from the community on other questions I should ask or modifications to the questions which will get EHR executives to provide some useful information.

1. What differentiates your EHR today?
2. In what ways has the EHR stimulus money and meaningful use had an impact for good or bad on the EHR industry?
3. What are the top reasons why doctors are adopting EHR software?
4. What are the main reasons doctors aren’t adopting EHR software?
5. What will differentiate your EHR 5 years from now?

I’m looking forward to hearing any suggestions you have on how to improve or modify the questions. I suspect I’ll do quite a bit of editing of the questions before I start asking the questions tomorrow. Watch for the videos to be posted on this site, EMR and HIPAA, and EMR and EHR Videos.

EMR Consultant Selection Service and EHR TV

Posted on February 19, 2012 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 recently was interviewed by someone interested in helping doctors understand the various dynamics of EHR selection and in particular the impact of hugely discounted and Free EHR models on the selection process. The discussion reinforced a long held belief of mine that EHR Selection is the most important part of the EHR selection process. In fact, my final comments to her were that doctors need to take the time that’s necessary to filter through the 300+ EHR vendors out there.

A few years back I wrote an e-Book on EMR selection that I believe has provided some benefit to those selecting an EHR. In the book I suggest that you need to narrow down the number of EHR companies you’re going to look at since very very few doctors can look through all 300 EHR companies. One website I suggest in the book is EMR Consultant.

EMR Consultant is now an advertiser on this site, but I’ve been recommending the service they provide since long before they became an advertiser. It is an EMR Selection service built by a doctor for doctors. They’ve streamlined much of the process for those doctors who don’t want to go through a full analysis, but I suggest you don’t skimp on the EHR selection process. If you do the full process, EMR consultant matches against 100,000 parameters and looks over 600+ EMR listings (That’s a broad definition of EMR which is why I say about 300 full EMR).

One challenge doctors are facing today is that a whole bunch of less qualified EHR selection services have popped up and have been flooding the market. At the end of the day, that shouldn’t have that HUGE of an impact on the EHR market. Just because a selection service recommends a particular EHR doesn’t mean you have to go with that EHR. In fact, I suggest looking at about 5 EHR and if none of them fit, then look at 5 more.

The most important message is spend the time and effort necessary to select the right EHR. It will be worth the extra effort on the front end. If you’re going to rush any part of the process, don’t rush the selection.

Since I mentioned EMR Consultant, it’s worth also mentioning that one other part of the company behind EMR Consultant is a website called EHR TV. Eric, founder of EHR TV, has invested a lot of money and staff to create a really solid video product around EHR and Healthcare IT videos.

EHR TV will have a whole crew at HIMSS again this year as they’ve done the past couple years. They worked really hard to bring in some big name people they can interview on camera. I expect they’ll create some of the most interesting content for those not able to make it to HIMSS. My only complaint is that they don’t have a way I can embed some of their videos. Maybe one day they’ll open that up.

On a HIMSS note, I had my first HIMSS networking event last night and it was fantastic. This week is going to be busy but great.

Thoughts on ICD-10 Delay

Posted on February 17, 2012 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.

Yesterday, HHS dropped the bomb that ICD-10 has been delayed. Everyone is still trying to figure out what that means exactly. The reason there are questions is that it seems that HHS can’t just unilaterally delay the compliance date. I’ll admit that I’m not an expert in the regulatory processes, but as best I can tell HHS intends to go through the regulatory process to delay ICD-10.

The part of the press release in question says, “HHS will initiate a process to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10).”

My gut feeling is that the process for postponing implementation of ICD-10 is more of a formality that HHS has to go through, but maybe there’s something that could hijack that process. I’m guessing there won’t be any issues or HHS wouldn’t have made the announcement yet.

The words “certain health care entities” in the above quote have a lot of people wondering what it means. Does that mean ICD-10 will be delayed for certain entities and not others? This would be odd if it were the case, but it seems that it could be a possibility.

This ICD-10 delay announcement comes shortly after HHS met with AMA who it seems is one of the major voices behind delaying implementation of ICD-10. A voice with a decent amount of money and lobbying power in Washington. HIMSS quickly published a press release calling for HHS to Maintain the ICD-10 Implementation Deadline. HIMSS cites that the health industry has been prepping for ICD-10 for the past 3 years. I’d add that the October 1, 2013 deadline is still 20 months away. You’d think that would be plenty of time to implement ICD-10, no?

After this delay some voices are starting to ask if HHS should consider just bypassing ICD-10 altogether and go straight to ICD-11 which comes out in 2014. Keith Boone wrote a post on this and highlights what I believe is a key reason why HHS won’t skip ICD-10 and go straight to ICD-11: investment in ICD-10. As I said in the comments of Keith’s post:

What a terrible thing to consider when making policy (although, sadly the stark reality): what’s the investment companies have made in ICD-10?

In business they’d call this a sunk cost and choose the best path forward. Unfortunately politics doesn’t quite work that way and you’re right that it’s quite unlikely that HHS will jump directly to ICD-11 and anger all those who’ve invested so heavily in ICD-10.

Tom Sullivan adds to the discussion for why we should move to ICD-11 in the comments of that post as well:

When I started covering ICD-10, I was a proponent. But given that ICD-10 really is antiquated — as Dr. Chute explained to me on Monday it’s based on thinking about medicine and technology from the 1980’s — it seems a shame for the U.S. to spend literally billions getting there, only to reach what is essentially a classification system at least approaching the end of its lifecycle, or perhaps what ought to be the end of its lifecycle rather than the beginning. And it’s not just the linkages to SNOMED that make ICD-11 attractive (though they certainly do); a system that is semantic web-aware, with rich information spaces, definitions of terms, genomic underpinnings, a foundational fabric, and I’m sure there will be more in there, just makes so much more sense than ICD-10.

At any rate, I view the delay as an opportunity to re-evaluate our approach and maybe, just maybe, put politics aside and opt for the system that has the most potential to improve public health with data.

So perhaps adopting ICD-11 is not really idealist, after all, but pragmatic!

One discussion on the #HITsm chat today on this subject was around the real benefits of ICD-10. As with many things in healthcare, the arguments seem to center around benefits to healthcare in general and to public health. As a doctor advocate myself, I can see why they wouldn’t want to add the burden of ICD-10 on their shoulders when it doesn’t help them directly provide better care. I’m not saying that doesn’t mean we shouldn’t do things anyway, but it’s not surprising that we’re seeing resistance from doctors to ICD-10.

One other comment people are making about the ICD-10 delay is that it could be politically motivated in a year when Obama is seeking reelection. I’m not sure how much influence delaying or not delaying ICD-10 will have on the presidential campaign. Seems like a pretty small deal in the grand scheme of things. I can’t imagine the major media people and the regular voters ever even getting wind of the delay. However, maybe there’s some important donors and influencers that I don’t know about that this appeases.

My heart goes out to all those HIMSS exhibitors that’s major strategy was based around ICD-10. Every PR person that pitched me an ICD-10 discussion I replied that I’d gotten enough ICD-10 at AHIMA. Now I’m getting some pitches from these same companies saying they’d like to discuss the ICD-10 delay. So, they’re trying to make the most of it.

Hidden Legal Risks For Doctors In EMR Use

Posted on I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Medicine is a risky business, and malpractice suits one of the nastier part of the trade. Whenever something major changes in the way medical care is delivered — including, say, the use of EMRs — it makes sense to expect the worst.

That’s exactly where Dr. Sam Bierstock stands. Bierstock, an interesting guy whose act includes a blues band performing songs on the perils of managed care and EMRs, is going national with his view that EMRs are opening up  bigger med mal liabilities than doctors realize.

“What few people realize is that using an EHR exposes physicians to an Orwellian level of analysis of every single act while doing their job,” writes Bierstock, who nonetheless sees himself as an EHR advocate.  As he rightfully notes, EHRs can be audited to see how long it took a physician to respond to an abnormal lab finding, to find out what doctors said in internal e-mails or even whether they scrolled down an entire screen before closing a document.

To my (admittedly limited) knowledge, there have not yet been any major lawsuits based actions doctors took which can be pinned specifically on the use of an EMR (other than, perhaps, HIPAA breaches). But it does seem credible that such suits are on the horizon. After all, not to be too cynical, but medical malpractice lawyers do work on commission, and if I were them I’d see this as an opportunity.

In his commentary, Bierstock argues that there must be “meaningful tort reform” before physicians can safely use EMRs. The question is what reforms are the right ones.  To date, I haven’t seen model legislation, much less a live bill, which directly addresses this issue.  Do any of you have more information to share, readers?

P.S.  OK, I was wrong about there being no case law on this subject. Here’s at least one example where a physician allegedly altered an EMR audit trail to make it appear that a problem had been flagged.

Physicians Say iPad Not Ready For Clinical Computing

Posted on February 16, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Doctors love them, but don’t think the iPad is ready to play a major role in clinical practice, as Apple hasn’t done enough to optimize it for healthcare, according to a new study by Spyglass Consulting Group.

According to a new report by Spyglass,  doctors don’t feel the iPad is ready to have an impact on care delivery. While 80 percent of physicians responding predicted that the iPad will have a positive impact on future care, it’s just not ready today, they said. (Most doctors I’ve talked with agree, noting that while it’s great for reading data, it’s extremely difficult to use for data entry.)

We’re not at all surprised to hear this given some of the iPad horror stories traveling around. For example, when Seattle Children’s Hospital pilot-tested iPads for its doctors, the result was a complete flop. Doctors there complained that that it was just too awkward to enter data into the otherwise sexy device. Shortly thereafter, IT switched its plans and rolled out a zero-client set-up.

So, what will it take to make the iPad clinically useful? To be successful in healthcare, Apple and its partners need to rewrite and optimize clinical apps to include gesture-based computing, natural language speech recognition, unified communications and even video conferencing, Spyglass research concludes.

I’d add that EMR/EHR vendors need to create native front ends for the iPad; given its penetration among doctors, I’m baffled by vendors who demand that doctors use their system via Citrix or the Web.

Unfortunately, with the exception of Epic’s Canto, few vendors offer a fully-fledged iPad app as a front end to their system. (One of few examples of a native iPad app from a smaller EMR vendor comes from Dr. Chrono, which, perhaps not so coincidentally, just got $2.8 million in venture funding.)

What’s more, Apple will have to do something about iOS security. It’s little wonder that 75  percent of doctors said that hospital IT departments weren’t eager to support mobile devices on corporate networks. While any device exposes networks to additional threats, Apple seems to have some particularly difficult problems, especially where its Safari browser is concerned.

Like the doctors surveyed by Spyglass, I have little doubt that iPads will end up assuming an important role in healthcare.  But given the snail’s pace at which native iPad apps are being launched, it may be a long time before that happens.

Numbers for HIMSS 2012 in Las Vegas

Posted on February 15, 2012 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.

If you’re in the healthcare IT world, then you’ve no doubt heard all about HIMSS. It’s next week and thanks to the PR people who keep emailing me it’s constantly on my mind (Note to PR People: My HIMSS schedule is now full. Sorry!)

Modern Healthcare put out some numbers on HIMSS 2012 that I thought were really interesting:
-Estimated 35,000-37,000 estimated attendance
-Provider registration is up 16-17%
-Vendor registration is up 18-19%
-Vendor space was sold out 3 weeks ago
-275 companies are exhibiting for the first time

I also love that Steve Lieber says that they’re at more hotel rooms booked than they’ve ever done before. Although, since it’s in the lovely Las Vegas there are still plenty of hotel rooms for people. This quote is the reason why HIMSS should be in Las Vegas every year: “It actually makes it a whole lot easier. We’re dealing with 12 to 15 hotels rather than the 70 or 80 needed to house conventioneers at any other city.”

Be sure to sign up for the New Media Meetup at HIMSS 2012 sponsored by simplifyMD. We only have a couple spots left and then we’re going to turn on a waiting list.

Lots of other excitement at HIMSS. I’ll be doing a Meet the Bloggers session on Wednesday and be part of the Genius Bar at the social media center each day. I look forward to seeing everyone else there.

Also, if you’re looking for some evening networking events at HIMSS, Jennifer Dennard has posted a bunch of them up on HITR.

Love it or Hate it, Meaningful Use Stage 2 is Fast Approaching

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.

Valentine’s Day may be behind us, but I still wonder how many providers would be willing to write love notes to their EHR vendors, especially with rumors swirling that CMS will release Meaningful Use Stage 2 requirements in the next few weeks. (John Moore at Chilmark Research is apparently taking bets via Twitter, if anyone’s interested in doing a bit of gambling in preparation for the big HIMSS event in Vegas next week. He predicts it will be the Friday after HIMSS. I think it might just make good fodder for Farzad Mostashari’s keynote next Thursday morning, as he has been vocal about delaying the start of Stage 2 until 2014.)

Whether they’re released during or after the show, I decided it would be a good idea to bone up on Stage 1 versus Stage 2, and how what may or may not be included in Stage 2 will lead providers to love (or hate) their systems all the more.

I fortunately came across a very well written and comprehensive (though not too long) report from CSC entitled “Moving Ahead with Stage 2 of Meaningful Use,” which provides a very clear-cut picture of the challenges providers found with Stage 1, and what they are likely to encounter as challenges in Stage 2. It’s a brief, informative read that I highly recommend folks take a look at before they head to HIMSS in just a few days.

My biggest take away from the report was that the providers surveyed had done very little in Stage 1 to engage patients and coordinate care, which is not surprising given that most were concentrating on getting their EHRs up and running in time to fully attest for Stage 1. Combine this with the fact that formal ACO rules weren’t released until late last year, and I can understand why engaging patients and coordinating care just wasn’t on the radar of most healthcare facilities.

But oh what a difference a few months can make! The CSC report notes “Stage 2 is coming soon and a full year of operational use of capabilities will be required (rather than three months for Stage 1). Waiting until the final rule is issued to start moving is simply not an option.

“Now is the time for organizations to work in earnest to build capabilities to engage patients, coordinate care and electronically report on quality.”

And finally, the report notes that:

Three essential areas where organizations need to start now are:

  1. Providing patients with access to their health information electronically through patient portals or directly from EHR systems.
  2. Electronic capture of physician notes, including diagnosis and treatment, plus rationale for excluding patients from treatment recommendations.
  3. Exchange of patient information at transitions in care.

I’d be interested to hear from our readers that have successfully attested for Stage 1 how they view these predictions for Stage 2. Are they manageable? Do they fit with your organization’s current strategy? Please share your thoughts in the comments below.

Do Privately-Owned EMR Vendors Offer Better Customer Care?

Posted on February 14, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

When a company like Greenway Medical Technologies (NASDAQ: GWAY) goes public, most of the post-IPO talk centers on what its leaders will do with the money.

Ideally, the newly-rich EMR vendor will do customer-friendly stuff like improving their product and strengthening their technical support organization. In reality, though, public companies have a different focus; their job is keeping the Wall Street folks who own their shares happy.

Since happy largely means only one thing — increasing profits and earnings per share — that vendor isn’t likely to take on new expenses. No, it’s more likely to find ways to charge more and sell more, rather than doing a better job of showing love to its existing customers.

SRSsoft’s Evan Steele has shared a nice analysis of  how KLAS customer support ratings (for companies serving the 6 to 25 physician practice) compare with the vendor’s financial status.  While they’re not exactly scientific, Steele’s conclusions are still striking; he concludes that five of the top six vendors are privately owned.

Now, I’m not sure how that correlates with another KLAS data point, in which publicly-held EMR/practice management vendor athenahealth (NASDAQ: ATHN) was named as top-ranked provider for its cloud-based EHR in December. Its stock has also been on a generally upward climb for the past 12 months, ranging from $39.87 to $72.70 per share.

Is it possible athena is managing to please both its customers and its investors? Well, if the typically nasty gossip you see on athena’s discussion board is any indication, no. It looks like grouchy insiders are shorting the stock, which some expect to plunge below its starting price to $30/share or so fairly soon.

That being said, one particularly intriguing comment suggests that Cerner (NASDAQ: CERN) is eyeballing athena, which observers think would be a good fit.

Cerner fits the profile I’ve outlined: it’s huge, profitable and what’s more, in need of a product to fill the physician niche it doesn’t own. If you think Cerner could just build its own physician presence, look at GE’s decision to drop doctor-oriented Centricity Advance. Clearly getting doctors to buy was  much harder than it looked at first glance.

Cerner doesn’t need athena to build its margins: analysts expect it to see sales growth of 13+ percent this year, to $2.5 billion or so. It should also see earnings growth of 22+ percent to $2.25 per share.

Buying athena would give Cerner a critical medical practice presence, and at the same time, let athena keep its customers happy without forcing it to play only for a Wall Street audience. In this situation, at least, maybe an EMR vendor can have its cash and eat it too.

Electronic Medical Records Cleaned My Desk

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.

For the past few weeks, several patients have commented to me how remarkably clean my desk is.  Usually the flavor of the comments range from amazed to inspired, but I think some people have been downright flabbergasted and just don’t know what to think of it.  For all of statements, I think in general there was an agreement that “Wait a minute, something is definitely different in here.”   They seem to be used to being in offices piled high with papers, charts, and other disheveled things of the like.

Even though I began my private practice in 2009 based on the use of electronic medical records, for a long time I had a lot of things that I just didn’t put things away after I took them out to read.  Textbooks look up clinical guidelines and recommendations on how to address complex patient issues, recommendations for new products left behind by sales reps, mail that was opened but not filed appropriately, etc.

Then, one by one, day by day, my desk got a bit less busy.  Less papers needed to be printed out, more could be done, signed, and faxed back without ever touching ink to paper.  In short, efficiency came to town in the form of digital records and faxes.  My inner child that loves the look of clean showroom furniture took over and I just got rid of the clutter, bit by bit, until nothing remained except the computer.

I largely credit the digital age for this.  During the workday these days, a few pieces of paper come across my path, but in the end none seem to survive anymore.  The simplicity of a clean desk in a doctor’s office illustrates a beautiful symbiosis between the practice of age-old medicine and the modernization of the electronic work force.

Glucose Meter to iPhone

Posted on February 13, 2012 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.

A few weeks ago Techcrunch announced the $3.5 million in funding that Glooko received to connect Glucose meters to iPhones for tracking diabetes. Here’s a description of Glooko:

Launched last year, Glooko is a digital logbook for people with diabetes who have to check their blood sugar every day. There are dozens of glucose logbooks in iTunes, but almost all of them require manual entry. What makes Glooko different is that the company designed a $40 cable (sold separately) that works with seven of the top glucose meters. You just plug it into both devices and it downloads your daily readings.

This is an interesting approach because it allows someone to use the Glucose meter that they’re use to using all of the time. Although, I don’t know many people that want to carry around a glucose meter with their phone and a cable to connect the two. I’m sure that Glooko would argue that the problem is that the glucose meters don’t support a wireless (bluetooth or NFC I suppose) technology for the exchange of that data. They’re right that it is a limitation of the traditional glucose meters.

The solution is to go down the path that AgaMatrix has gone down with their blood glucose meter that attaches to the iPhone. Basically it makes your blood glucose meter the size of a thumb drive. If you don’t want to carry your phone, you can just carry the small meter and some strips (yep, I don’t know if we’ll ever get away from the strips). Then, when you hook the meter back up to your iPhone it uploads all the data. Or, just leave it attached to your phone since it’s not that big.

I’ll be interested to see how well Glooko does with their $3.5 million in investment. There’s a lot of people focusing on the diabetes market.