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Pinteresting EMR Thoughts

Posted on April 30, 2012 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.

I heard about Pinterest maybe a couple of months ago and if my slow uptake of Facebook is any indication, I have a good two years to go before I add another website to the pantheon of websites I must check daily.

However some early adopters are already talking of how the healthcare world can make use of this site. I came across one such article today via the Healthworks Collective site where Mike Wilton shows us a bunch of different healthcare related Pinterest uses. Some doctors or hospitals are using Pinterest to market their services, one hospital is using Pinterest to request donations for children, yet others are targeting certain demographics (parents, cancer patients) by becoming their go-to resources on some topics.

Since I’ve sworn fealty to all things EMR, I went searching for EMR related boards on Pinterest, and I must say I was underwhelmed. I did come across one slightly interesting one called Healthcare Infofraphics that was the source of the widely pinned Top20 EMR Softwares pie-graph. You can also find other Healthcare IT Infographics.

I know if you’re related to EMRs, a) your world isn’t as interesting or visual as say cupcakes, or quilts b) Pinterest is relatively new (hell, you can’t just sign up, you need an invite to register). But, seriously, do you think people are going to find screenshots of your software interesting enough to pin to their boards and share with others? And yeah, don’t bother scanning the tri-fold handout that you shoved into people’s hands at the last tradeshow. It might have worked great on paper but it looks cluttered and unimaginative on Pinterest.

I’m going to offer some tips here for anyone with any Pinterest interest, but more so for EMR vendors:
– it’s still early days. If you’re not on Pinterest and none of your nearest competitors are there too, maybe you can increase your cool cache instantly by signing up and creating a much viewed board.
– Make us see things. Instead of reams of text, maybe we need one pic of a happy client, a speech bubble and a super short compliment.
– Play to Pinterest. It’s a highly visual site. So what works for you on FB or Twitter might not work for you here.
– Approach it sideways. Yes, you want to sell your product and make money. But if you answer questions that your target demographic typically asks, your content will probably get pinned a lot more.

– don’t be square
. Dare to do something out of the box. I would prefer my cartoon strip slightly funnier but I give Dell props for this attempt at making an unboring visual about EMRs.

Or maybe you should wait out. Pinterest has a lot of buzz. But so did Myspace and Foursquare. I even wrote a cringe-inducing article on Foursquare back in the day.

Shifting Healthcare Venture Capital Investment

Posted on April 27, 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.

Change is in the air when it comes to venture capital (VC) investment in healthcare. I wrote about this a few days ago on a post on EMR Thoughts called VC Investment in Healthcare. The final paragraph is a nice summary of my thoughts:

I think we’re seeing a shift in healthcare investment into a large number of smaller companies who can innovate as opposed to larger sums of money into medical device and biotech companies. In some ways we’re seeing the costs associated with a startup company in healthcare starting to come down the way they did in the IT side of things.

I was amazed by the timing of a post from my favorite venture capital blogger, Fred Wilson, called Can The Crowd Be More Patient?. His first paragraph provides a similar sentiment:

One of the most noticeable changes to the VC business over the past decade is the movement of investment allocation from capital and time intensive sectors like biotech and clean tech to capital efficient and fast moving sectors like internet and mobile.

Although, Fred offers an interesting twist on where sectors like biotech might get their funding in the future: crowd funding.

The idea of crowd funding is definitely beginning to take shape. Websites like Kickstarter and IndieGoGo have started the trend with no equity involved and the latest jobs act has opened up the door to allow crowd funding to happen with equity involved. For those who don’t know what crowd funding is, it could be 1000 people all “investing” $100 into a company that needs to raise $100,000. That means that 1000 people are all at very little risk, but the company gets a relatively large sum of money. Those who invest the $100 would own a very small part of the company and benefit in any upside the company experiences. It’s going to be a game changing way to fund entrepreneurship and will be an incredibly important investment trend.

The interesting thing is that we’ve seen this funding trend in healthcare for a really long time. Ok, they haven’t gotten equity for the investment, but how many of you have supported cancer research or diabetes research through a donation? That’s basically an investment in the companies that are doing that research.

Will “Open Notes” Change EMR Design?

Posted on April 26, 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.

Today I read about a very interesting project focused on improving relationships between physicians and patients. I suspect the concept would make some doctors’ skin crawl — anytime you’re asked to give up over control of information, it smarts a bit — but I suspect we’re seeing a glimpse of the future.

The  OpenNotes project, which is being conducted at Beth Israel Deaconess Medical Center, Geisinger Health System and Seattle’s Harborview Medical Center, lets patients review the notes, e-mails and phone calls primary care doctors make after their medical appointment. Patients access the information via a secure Web interface.

In July 2010, researchers published baseline findings prior to the OpenNotes kickoff in the Annals of Internal Medicine. Since then, the project seems to have attracted a lot of interest, with more than 100 doctors and 20,000 patients participating.   It’s also gotten a lot of support from foundations;  the group has received grants from the Robert Wood Johnson Foundation Pioneer portfolio, the Drane Family Fund, the Koplow Family Foundation and the Katz Family Foundation.

Wondering how participants feel about this level of medical intimacy? Check out the OpenNotes site, where you’ll find a video  offering impressions from patients and doctors on how they feel about their level of communication.  As you’ll see, OpenNotes volunteer patients seem to enjoy having a closer relationship with their doctor, and more importantly, feel empowered to comment or even contradict the doctor if they see something that seems to be out of line.

“You can look at the comments that Bob writes down and sometimes you agree with him and sometimes you don’t,” says one patient. “Sometimes we clash on it, but then we work things out.” (Note the familiar title “Bob” the patient uses to address his doctor, which I doubt he would have otherwise.) Sounds like a better working relationship than I have with most of my providers!

Of course, there’s always questions as to whether approaches like these would work outside the confines of a grant-funded, academically-minded group of institutions and doctors.  Certainly that’s hard to tell. But it seems clear that at minimum, something worthwhile is going on here that might force vendors to think about patient facing data more deeply.  I’m impressed by what I see here and hope that we continue to learn from these efforts.

VC Investment in Healthcare

Posted on April 25, 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.

There’s a real change happening right now in the venture capital healthcare investment world. In a recent article on NPR they highlight one piece of the change that’s happening with VC investment in healthcare:

The share of venture dollars flowing to seed and early-stage investments in biotechnology and medical devices has plummeted since 2007, when investors pumped $3.6 billion into 332 deals in which a price was disclosed, according to data compiled for Kaiser Health News by FactSet Research Systems. Overall venture investing declined by nearly one-third as the economic recession set in.

Many might look at this and say that this is a bad thing for healthcare. I think this this is a good thing for healthcare. One reason why is described in the same article:

“If you come in with [a device] that’s 10 percent better and twice as expensive, it’s hard to get anyone to care,” said Bryan Roberts, a Palo Alto, Calif.-based venture capitalist at Venrock, a Silicon Valley company that invests in firms working on health services, medical devices and drugs.

I think it’s healthy that we’re no longer investing twice as much money in something that delivers only partially better care. Sure, we still need companies innovating and looking at how that 10 percent better care can have an extra 0 on the end and be 100% better care.

Plus, I think we’re seeing a shift in healthcare investment into a large number of smaller companies who can innovate as opposed to larger sums of money into medical device and biotech companies. In some ways we’re seeing the costs associated with a startup company in healthcare starting to come down the way they did in the IT side of things.

Will Rip and Replace EHR Software Ever Be a Thing of the Past?

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.

I heard an interesting statistic a few days ago during a very informative webinar – “The Future of Meaningful Use, EHRs and Accountable Care” – hosted by Greenway Medical’s Justin Barnes. He shared a huge amount of information during the hour-long presentation, but the fact that most stood out to me was that, according to Barnes, between 35 and 50 percent of EMRs will eventually be replaced after just one year of use. (Don’t quote him on the “year,” but I’m pretty sure that’s what he said.) His point being, of course, that providers need to think long and hard about what type of solution they need to fit their workflows before they spend time and money implementing an EMR.

This sentiment was echoed by Kimberly Harding of BCBS Florida in a panel at the iHT2 Summit in Atlanta. As part of a greater discussion on Meaningful Use, she made the comment that just because a healthcare IT product is certified doesn’t mean it’s the best fit for a particular facility.

My takeaway from both of these statements is that providers looking to adopt new healthcare IT tools like EMRs need to take a long, hard look at what their current needs are and what their future needs might be before they even think about demoing products.

They also need to adopt technologies that fit their workflows, not necessarily technologies that have a ton of bells and whistles. Added features won’t do anyone any good if they’re never used properly, never used at all, or used to the detriment of a physician’s productivity.

I kept this sentiment in mind when I read the results of a recent study of 250 hospitals and healthcare systems by consulting firm KPMG. The survey found that “71% of respondents’ organizations are more than 50% finished with their EHR adoptions. Will this 71% be satisfied with their EMRs once fully installed and adopted? How many will realize their product of choice wasn’t the right call? If we apply the Greenway statistic, that could be as many as 125 facilities!

So where is the disconnect? Why are providers making poor choices with presumably the best of intentions? Why has the term “rip and replace” become so well known in healthcare? Are physicians misinformed, or not educated enough? Are they feeling so rushed by Meaningful Use deadlines that they don’t perform proper due diligence? Are vendors part of the problem? If so, shouldn’t they be part of the solution? What role do regional extension centers have to play in all this?

If you have answers, please let me know in the comments below.

Moral Obligation and Tweets

Posted on April 24, 2012 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.

I must say this headline from Fierce Health IT gave me a great many giggles today: Healthcare social media a ‘moral obligation’. No shred of irony in the article either, which quotes Farris Timimi, M.D., medical director for the Mayo Clinic Center for Social Media, thusly:

“Our patients are there. Our moral obligation is to meet them where they’re at and give them the information they need so they can seek recovery,” Timimi said. “You’ve got to be ready for it. You build it for the patients; not for yourself.

“This is not marketing,” he added. “This is the right thing to do.”

Are you sure it’s not just a way to log in to Facebook while you’re on the clock, Dr. T?

Not to come down too hard on Dr. Timimi, but I can think of plenty of other medical things which are “moral obligations”: saving patient lives, or low cost accessible healthcare for all. Being able to find a condesed tweet about bunions – um, not so much. I mean, healthcare is already quite a messpool to be in without doctors and hospitals flogging themselves over not being social media savvy enough. And not everyone can be a social media rockstar John D Halamka.

I know I’m being wilfully dense tonight. And the esteemed Dr. Timimi probably had stuff like Facebook pages and cancer blogs in mind when he talked about healthcare info via social media. But I scoured Twitter for “medical advice” and “cancer” and found that there’s some accidental giggles to be had:

Tim Brookman ‏ @T_Brookman
Next person that texts me for medical advice is getting told to apply icyhot directly to their genitals

nicole west ‏ @NicNac19
I love when friends come to me & ask medical advice & I actually know the solution… just don’t quote me, lol.

saintseester ‏ @saintseester
will not be giving free medical advice on anonymous social media. You’d be an idiot to take advice like that anyway.

Official Cancer Page ‏ @Cancer69_
#Cancer is big on trust and if you lie to them they will make sure you regret it
(yeah, yeah, I getit.. they’re talking about the sun sign)

Top EHR Adoption By State – Which States Lead?

Posted on April 23, 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.

The Doctor’s Company, a medical malpractice insurance firm, surveyed 5,105 doctors nationwide about EHR adoption. According to the report, here’s the top 5 states leading EHR adoption:
* 41% EMR Adoption by Oregon’s Physicians
* 39% EMR Adoption by Georgia’s Physicians
* 37% EMR Adoption by Florida’s Physicians
* 35% EMR Adoption by Washington’s Physicians
* 34% EMR Adoption by Virgina’s Physicians

Another interesting stat from the study said that 17% of doctors surveyed said they had no plans to use an EHR in their practice.

I’m sure we could talk about ~5,000 doctors not being a representative sample for 50 states, but the numbers are interesting. I think it’s also worth noting that the highest EHR adoption they found for a state was 41%. So much for all those people who say that EHR adoption has topped 50%. I still put it at the 25-30% range for overall EHR adoption.

I think it would be interesting to do a little digging and see how good the HIE efforts are in each of these states that have higher EHR adoption. While EHR isn’t an absolute pre-requisite for an HIE, it is in my book.

The 17% of doctors not wanting to adopt an EHR isn’t that surprising. In fact, I could have imagined it higher. Although, that’s going to change over the next 5 years. Sure, there will always be that 5% that won’t change, but most of the rest won’t have much choice.

Working Offline When Your EHR Isn’t Available

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.

Many of you will likely remember my series of posts on EHR down time: Cost of EHR Down Time, Reasons Your EHR Will Go Down, and SaaS EHR Down Time vs. In House EHR Down Time. Needless to say, it’s pretty much inevitable that sooner or later you’re going to encounter EHR down time. The key to EHR down time is to think ahead about how you’re going to deal with your EHR being inaccessible.

I started thinking about this a bit more when I came across this FAQ item on Practice Fusion’s EMR user forums.

When there’s a planned maintenance ahead:
•Print your daily calendar for the next day’s schedule
•Know your offline alternatives for handling labs and prescriptions
•Have a plan to document your patient visits so you can input them in the EMR later
•Clear out your To do list and complete any pending Rx refill requests the day before
•Update your web browser and Adobe Flash to the current version

Preparing your office:
•Have a prepaid wireless 3G hub or other back-up internet system ready to go in the event your main internet is down
•Use laptops with good batteries and connect computers to surge protectors and battery back-ups for short term power interruptions
•Identify a second location that you could use temporarily in the case of a serious, long-term outage such as a fire or flood

I’ll always remember the reaction of the director of the health center where I first implemented an EMR to the discussion about “What do we do if the EMR is down?” She basically said, “We can still take care of the patient. We just might have to ask a few more questions.”

Now I’m sure there are cases where a physician might choose not to treat a patient without access to their EHR. There are certainly also cases where you can treat a patient better, faster and with more information with an EHR, but those can either be rescheduled if that’s the case. It’s certainly bad customer service and you should employ techniques to minimize EHR downtime as much as possible. My point is that it’s usually not life or death when the EHR is down. Think about how many patients are treated in an ER every day with no access to the patient’s medical record.

With that said, it is a disruption to the clinic and will be a BIG disruption to your clinic if you don’t have a solid plan of attack for when (not if) your EMR is inaccessible.

I’d focus your efforts in two areas:
•Minimize EMR Down Time
•Plan of Action for When Your EMR Goes Down

Most people do a pretty decent job with the first part. The second part people don’t often give much thought. You can start with some of the comments from Practice Fusion above to build out your plan. I also think it’s worth making a plan for short down time versus long down time. It’s quite different to deal with 5 minutes of down time than 5 days. You should consider both options.

To compute or not to compute in front of patients, that is the EMR question.

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.

Rarely do I become accosted by a patient with a preconceived notion that doctors should not be using computers, at least not in front of patients.  However, I’ve had at least two instances in my recall in which patients told me they were not being paid enough attention.  I find that these patients are usually what most professionals would refer to as “special”  and that this usually manifests itself in some aspect of the visit or later.

About two years ago, I recall a young, approximately 30 year old gentleman who never said anything out of the ordinary during our initial visit but later on the phone told me that I had rudely “shushed” him during our visit and that I had also said to him a whole cadre of other bizarre things that I don’t recall ever saying to any patient.  When I spoke to him on the phone about why he had not completed any of the recommended testing, my blood ran a bit cold and I seriously wondered if he was an undiagnosed schizophrenic person who had heard bizarre voices and supposed that those were mine.  To this day, I remain in question of it.

A few weeks go, a 60 year-old woman whom I saw suddenly lit into me, mid interview, when I was typing in her responses while talking with her across my desk.  My face was admittedly not on hers at that exact moment but at an angle of about 30 degrees off.  “You know I have to say this is the second time this week that I have been to see a doctor where the doctor’s face is on the computer and not mine.  Frankly, I find it very disconcerting!”  Of course, I apologized and immediately turned to her and said, “It’s okay, how about we just talk like this?”  I finished the interview professionally and felt that she was safe to follow up with her primary doctor since only an explanation of her mild lab abnormalities was necessary.  During the rest of our visit, she told me that she was not fond of doctors at all lately since they weren’t doing her any good, just reassuring her that her conditions could be monitored periodically without treatment.  I seriously looked at her with raised eyebrows and put it back on her a bit, asking, “Do you really want me to tell you something is seriously wrong with you?”  She finally broke a grin and chuckled (as I briefly thought about kicking her out of my fourth floor window).  Normally, I would have offered to follow her for an annual visit, but under the circumstances, I felt it would have been more pleasant for both of us if I didn’t see her again.  As she checked out and said she hoped I wouldn’t hold her comments against her, I smiled and said that this was becoming the norm and she should not be surprised if all of her visits eventually came to this.

Luckily, these examples are very rare.  One patient recently wrote about her negative experience with EHR charting at the time of the visit in one of my favorite magazines, Physicians Practice.  I would hope that patients understand that computers are here to stay, and I’m not going to hold off on documenting all of their related medical notes until after they’ve left.  But I do try to at least face patients during our visits.  My computer is in my office, where I conduct interviews, and not in the exam room, where I am only examining patients.  I already spend far too much time calling people back, sending in scrips and filling out paperwork outside of my normal office hours.  To add extra time in this area of routine documentation during nights and weekends would not be time well spent.

Medical Billing Software Lost in EHR Mix

Posted on April 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.

One of the many things that seems to be getting lost in the mix of all the noise about EHR software and the EHR incentive money is medical billing software. As I think through all of the presentations from EHR vendors and discussions I’ve had with doctors, consultants and other professionals in the Healthcare IT industry, I think the practice management system is getting lost in the EHR shuffle. Let me ask some important questions:

Does anyone care about the billing software now? What if the billing software that comes packaged with your EHR sucks?

A regular reader of my sites John Brewer often talks about how many of the benefits we like to talk about with technology in a practice are coming from the practice management system, not the EHR. These days most people seem to consider the EHR and PM one package. Yet, I’ve seen people spend little time really understanding whether the billing side of the EHR is going to work for their practice.

In contrast to this comment though is that I haven’t seen an uproar of people complaining about implementing an EHR and their billing going down the tubes. Does this mean that medical billing software has basically become a commodity that every EHR vendor has done to a reasonably sufficient level that no one has a problem? Or maybe we don’t hear about it much because most doctors aren’t business people.

While I don’t have anything but anecdotal evidence of the disregard to medical billing software, I think this is going to eventually come back to bite us. Although, in our generally provider driven world the EHR matters more in the daily workflow and so this isn’t a surprise that we see the EHR bias during medical software selection. Once the physician sees the reimbursement levels lower, they’ll likely wake up to the reality that you need both a solid EHR and a solid PM.