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Survey Says Few Americans Want EMRs

Posted on August 31, 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.

I don’t know what to make of the following survey, which suggests that EMRs have a very long way to go before they’re accepted by the public.  Let’s lay out the numbers and see what you think.

According to new research from Xerox, only 26 percent of Americans would like to see their medical records digitized, despite otherwise having a love affair with all things digital.

Xerox, which hired Harris Interactive to do the study, did an online survey of 2,147 U.S. adults in May, asking them several questions related to their perceptions of EMRs. Forty percent said that digital medical records could deliver better and more efficient care, true, but 85 percent said they were concerned about the use of EMRs, Xerox reported.

Whatever is generating their resistance — and I’ll speculate on that in a minute — it’s not because they’ve never seen digital medicine. When asked how their providers recorded digital information during their last visit, 60 percent said data was entered into a tablet, laptop or in-room computer.

So, if Americans love online banking, Internet gaming and ordering from restaurants via the Web, why would medical records concern them so?

My guess is that the results we see here may be a result of the approach the researchers took.  If someone asked me: “Do you want something delicious and cool to eat during hot weather?” I’m pretty sure I’d say yes. On the other hand, if I was asked “Would you like to try this brand new ‘ice cream’ thing you’ve seen your neighbors eat?” I’m not as sure I’d be high on the idea.

If we’re going to forward the dialogue on EMRs with consumers, we’re going to have to help them understand why EMRs matter, and how they get the job done. Sure, the more esoteric stuff we discuss here might fly over their heads, but if you explained, for example, that EMRs can protect them from medical errors and and coordinate care better, they’ll get it.

Will Hospital Ownership of Small Practices Kill Ambulatory EHR Vendors?

Posted on August 30, 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 are a lot of interesting trends in the EHR and healthcare industry right now. One trend that everyone is seeing and talking about is the trend of hospitals buying up ambulatory practices. There are a number of reasons that we see this happening. Not the least of which is the move to Accountable Care Organizations. While I still think that this trend is cyclical, there’s some possibility that the small ambulatory practice might be in long term danger.

If the small ambulatory practice is in danger, what does that mean for EHR software vendors?

One of the first projects that hospital acquired practices experience is the move to the hospital owned EHR. In fact, I know of many cases where the move to the hospital EHR was part of the contract. I’m not sure all of the reasoning, but many hospital systems are moving their recently acquired practices onto EHR before they move their existing practices.

I have yet to see a hospital system use anything but a large EHR vendor. In many ways it makes sense. The hospital system is buying practices across dozens of specialties. Many of the smaller EHR vendors focus on a few different specialties and so they just aren’t an option for a big multi specialty environment.

Then, there’s the issues of scale and control. Can a smaller EHR vendor support such a large implementation? Can a smaller EHR vendor provide the hospital system the control they want of their EHR environment? The first one is an interesting challenge since I’ve seen some hospital owned ambulatory environments having scaling issues with some of the largest EHR vendors. The problem as I saw it from the outside was that the hospital system couldn’t get the attention of the right people at the large EHR vendor. This wouldn’t have been an issue at a small EHR vendor.

With that said, I do think that small EHR vendors will have a huge challenge getting into the large hospital owned clinical practices. Will enough small practices remain for ambulatory EHR vendors to survive? I enough will survive, but in the short term there could be some shrinking of that market.

Bringing up Your EMR in an Era of Meaningful Use

Posted on August 29, 2012 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.

By now I assume most of you have read the recently released final rules for Stage 2 of Meaningful Use – or at least the plethora of synopses available online. (It wouldn’t hurt to read what Lynn Scheps wrote about meaningful use stage 2 over at EMRandHIPAA.com.)

Whatever level of knowledge you may possess about these rules and how near or far they deviate from those proposed, I think we can all agree that the EMR industry (developers and end-users) is suffering immense growing pains as vendors and physicians adjust to the Meaningful Use scheme. (I use that term in the British sense, by the way.)

Julie McGovern, CEO of Practice Wise, cleverly equated implementation of an EMR to being pregnant in a recent blog:

“In the beginning, you are tired and often feel like you have morning sickness. The first trimester is the hardest. In the second trimester, you start to get your legs under you, your energy starts to return, and you feel less beaten down by the EHR. By the third trimester, you start to see the light at the end of the tunnel, it’s starting to be second nature, the product is making more sense (hopefully), you’ve got good workflows and everyone is starting to forget how hard the first trimester was.”

I’ll go one step further and equate utilization (i.e. the regular use of an EMR after go-live) as relates to the various stages of Meaningful Use with bringing up that baby. I might even disagree with her – pregnancy is often the easy part (provided you’ve had no complications along the way, of course, be they IT, managerial, administrative, cultural or otherwise). You’ve got the PR-friendly ribbon-cuttings, parties and press releases that hospitals often initiate around their go-lives. Well-deserved events, to be sure. But then come the hard parts, when you and your colleagues integrate that new bundle of joy into your daily lives (i.e. workflows).

Eventually the EMR will develop its own personality, form bonds with its users, bring joy to many for the clinical outcomes it improves, and hopefully not cause too many tears of frustration along the way. Hopefully it will gossip with its peers at other hospitals, and even aspire to interoperate in the same circles as its distant cousin – health information exchange. You can bet that it will end up costing more money than you had anticipated – upgrades, add-ons, etc.

The years will go by – 2014 and 2016 will be here before you know it. Hopefully, the EMR that caused so much joy when it was first brought into this world shiny, new and virus-free will still bring a smile to the face of its users, and better care to the patients whose information it so closely guards.

Having Already Failed Once, DoD Snubs Open Source For Second EMR Try

Posted on August 28, 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.

In theory, the VA now has everything it needs to standardize and upgrade the open source VistA EMR, especially after forming the Open Source Electronic Health Record Agent (OSEHRA) organization.  But when it comes to bringing that expertise to the DoD’s EMR projects, it seems OSEHRA alone can’t do the trick.  Sadly, it’s no surprise to find this out, as the DoD has an abysmal track record on this subject.

OSEHRA, an independent non-profit open source group, was launched about a year ago. The group is working away at improving compatibility between versions of VistA at the 152 VA medical centers.  According to an InformationWeek piece, there’s now about 120 different versions of VistA ticking away within the VA system.  OSEHRA hopes to create a common core — a “minimum baseline standard”  for 20 VistA modules — which will make it easier for the medical centers to deploy enterprise-wide apps.

The DoD, meanwhile, is hacking away at a joint system with the VA, called iEHR, which is due for initial testing in 2014.  A few months ago, DoD told Congress that while open source technology will be part of iEHR, the agency will also include commercial and custom applications, using a service-oriented architecture.

What that means, in practical terms, is that OSEHRA will be cooling its heels waiting for DoD contractor Harris Corp. to build an Enterprise Service Bus and open source APIs to allow for open source development on the project.

Now, that wouldn’t raise my suspicions so much if DoD hadn’t proven to be a collosal failure at developing an EMR.  Did anyone else here catch the major slap GAO delivered to DoD a couple of years ago, noting that its 13-year, $2 billion AHLTA application was a near-complete fizzle?  If anyone at DoD had humility, or if their bosses were held accountable for AHLTA’s staggering losses, nobody would let them drive the technical choices on this project.

Am I the only one who sees a recipe for billions more in DoD losses here?

$100k Investment for Every Rock Health Company

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.

It’s been a busy week for the people at Rock Health. First, they had the Rock Health Boston Demo Day. Yesterday and today they’re doing the Health Innovation Summit in San Francisco. And now Rock Health is announcing that Kleiner Perkins Caufield & Byers alongside longtime supporters Aberdare Ventures, Mohr Davidow Ventures, and the Mayo Clinic are upping their investment in Rock Health startup companies from $20k to $100k per company.

This is a good move by Rock Health. Just yesterday I was reading a Ycombinator founder describe how the added investment that each Ycombinator company got relieved some of the pressure that was associated with the program. Basically, he could make good long term decisions as opposed to forcing decisions because the funding and time frame were so short. I’m sure we’ll see that in Rock Health as well.

For those interested in Rock Health, they just opened their 3 week application period for their Fall cohort in San Francisco. I assume that they’ll be going back to the 5 month program again after doing only 3 months in Boston.

It’s worth noting that NYDHA (New York Digital Health Accelerator) offers $300k to health startup companies. I’m sure there’s going to be a lot of competition to get the best healthcare startups to participate in the various health IT accelerator/incubator programs.

Increasing Revenue Through Clinical Connectivity

Posted on August 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.

As most of you know, I’ve been working hard to create more content related to revenue in healthcare. My interest in this has grown even more since I had the chance to attend the ANI 2012 conference in Las Vegas where I got the chance to talk to people like Rishi Saurabh from GE Healthcare. It’s amazing how many people (myself included) don’t think that revenue cycle management is sexy since there are so many opportunities in healthcare.

One example of missed healthcare revenue management opportunities has to do with connecting clinical content with the financial data. From my experience, it’s quite rare to see a healthcare institution that does a great job of connecting these two pieces of data. The clinical data is in a silo of its own and it’s only looked at by the clinical people. The financial data is in its own financial data silo and only ever looked at by the financial people.

These silos are a problem and present a really big opportunity for healthcare organizations to increase the revenue of their organization. Although, doing so in an organization is not always easy. It takes great leadership to bridge the two content silos. Plus, you need someone who’s effective at understanding both the clinical and financial point of view. So, it’s not hard to understand why this doesn’t happen more often.

I think the most basic example of what I’m talking about can be seen in the annual checkup. I was talking with a colleague the other day when I told him that I couldn’t remember the last time that I’d been to my doctor. In fact, I honestly don’t even know my doctor’s name (which might beg the question of whether he’s really MY doctor). Why hasn’t my doctor sent me a reminder about the need to do an annual physical exam? Why don’t I have a regular connection with my doctor that helps me to take better care of my health?

I think at least part of the answer to this is that the clinical is not tied to the financial. If the clinical were tied to the financial, then the doctor could provide a care plan for me and my specific health needs. Then, the financial could ensure that I’m following that care plan. Imagine the revenue implications of me visiting the doctor regularly as part of a well defined care plan.

I’m sure that many of you out there are likely skeptical about whether patient reminders will actually change behavior. Certainly in many cases, these reminders will be discarded or ignored. However, a certain percentage of those reminders will be followed. This will mean your patients get better care and your clinic increases their revenue. Plus, maybe we need to take a deeper look at the care plans that we offer patients. If large percentages are ignoring the suggestions, then maybe we need to rethink the plan or how we’re communicating that plan to the patient.

There are certainly plenty of other medical examples where a follow up doctor visit would make sense and improve the health of your patients. In fact, you could get really sophisticated with how you reach out to your patient population.

I believe the key to success of this type of program is to integrate the clinical data with the financial data. It creates tremendous power and amazing opportunities.

EMR Security, Afghanistan EMR, and Regina Holliday EMR Video

Posted on August 26, 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.

Time once again for our roundup of interesting tweets from around the EMR twittersphere. We really go around the world with one of these tweets. Hopefully you find them useful and interesting.

I don’t think most of you know that I’m also working on a redesign of my websites. It’s still got a little ways to go, but I think it’s coming together nicely. It’s going to add some features I’ve wanted for a while and make the design look a lot better. I’ve had the current design for more than 6 years, so it was time. One of the best features of the new website is Twitter embeds. I can’t wait!

Without further ado, a few EMR and health IT tweets with some of my own commentary:


I always love when people talk about the huge EMR security risk. When you look at the breach list and the healthcare data security issues, EMR barely shows up. There are so many other security issues with medical practices that are much more vulnerable. Not that we should give EMR security a pass, but EMR security is likely one of the most secure things in a medical office. So, this is good advice.


I always love to hear how the military uses EMR. They use EMR in some of the most challenging places imaginable. I think we can learn a lot from their experiences.


I think this is a really interesting contest by ONC. I’m looking forward to see more of the videos that are created. My fear is that most of the videos will be EHR companies that push their power EMR users to make something. We’ll see how it turns out.

ICD-10 Delay Finalized with New Unique Plan Identifier

Posted on August 24, 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.

Another big week for healthcare IT and HHS. First, we got the meaningful use stage 2 final rule and now we have the official ICD-10 delay (See our previous post about the proposed ICD-10 delay). Here’s a quote from the announcement:

By delaying the compliance date of ICD-10 from Oct. 1, 2013 to Oct. 1, 2014, we are allowing more time for covered entities to prepare for the transition to ICD-10 and to conduct thorough testing.

This will be a welcome announcement for many in healthcare. Edifecs sent me the following comment about the delay which I think sums up most people’s feelings.

Edifecs commends HHS for finalizing its ruling on the ICD-10 one-year delay. We believe HHS has made the right decision and that a delay of this length strikes a fair compromise in meeting the needs of those healthcare entities that have already started down the ICD-10 path and those that have failed to either begin or show much progress. This one-year delay will give more time to those who need it and will also help those who were on track avoid the excessive costs an even longer delay would have created. Edifecs is encouraging its customers, and the entire healthcare industry, to continue moving forward with their ICD-10 implementations in order to meet the mandate ahead of schedule or on time.

That’s a pretty good word of caution. 2 years seems pretty far away, but that time will pass quickly.

Bigger news might even be the New national unique health plan identifier (HPID) that is being put in place. Sebelius explains, “These new standards are a part of our efforts to help providers and health plans spend less time filling out paperwork and more time seeing their patients.” I’ll be interested to learn more about this identifier and what insurance plans think of it.

We Know What’s Right, but It’s Hard

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.

In perusing various blogs, I came across Matthew Gibson, MD’s blog and this really compelling article titled, “It’s So Easy, and Yet…” Here’s one especially poignant section:

What I see day in and day out is complications of simple, easy to manage problems like diabetes, high blood pressure, asthma, etc. These are things that we KNOW how to treat. We know how to prevent complications. And yet, I just had a man last week who required half of his foot to be amputated as a complication of untreated diabetes. I had a woman this week who came in seeing snakes on people’s clothing, because her blood pressure was so high it was affecting her mind. Last month, I saw a man who had large amounts of yeast growing in his mouth and groin because his blood sugar (and thus urinary sugar) was so high.

This morning, I’m caring for a truly pleasant gentleman with COPD (bad chronic lung disease usually caused by smoking). He hasn’t smoked in the last 15 years, but he smoked quite heavily before that. Even though he’s been doing things all right as far as his lungs are concerned for the last 15 years, he has to live with the consequences of his actions prior to that. For the last several days, I’ve seen him decompensate and gasp for air, feeling like he’s drowning, because he can’t get the air to move through his lungs like he should. How did this kind old man get to this point?

At the core of his comments is the idea of how do we motivate ourselves to do something we know we should be doing. This is a really hard question to answer and something we probably will never solve completely. However, I think there’s plenty of room to improve even if we never become perfect at it.

Over on Smart Phone Healthcare we’ve spent a lot of time reviewing various mobile health applications. I’d say that the large majority of mHealth applications are about trying to help solve this problem. Plus, I think the mobile device connected with good data about ourselves is one method that will help us be healthier.

Related to this idea, is what I’ve called treating healthy patients. This is a concept that won’t leave me since I think it will be a fundamental part of the future of healthcare. I believe we’re on the brink of a series of devices and technology that will help us monitor our bodies in such a way that we can identify sickness within us before we feel sick. This information won’t make everyone change their behaviors, but it will help many.

We’re in the very early stages of monitoring our bodies and connecting all that data with action. However, it’s exciting to see that now many of these things are possible thanks to powerful computing and a new generation of devices.

Meaningful Use Stage 2 Final Rule Published

Posted on August 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.

UPDATE: For those not wanting to go through all 672 pages of the meaningful use stage 2 final rule, ONC has put out this summary PDF.

Today, CMS publishes the meaningful use Stage 2 Final rule in the Federal Register. The MU stage 2 final rule is 672 pages long.

The HHS press release announcing the EHR incentive money stage 2 final rule also offered these important points to note:

  • Make clear that stage two of the program will begin as early as 2014. No providers will be required to follow the Stage 2 requirements outlined today before 2014.
  • Outline the certification criteria for the certification of EHR technology, so eligible professionals and hospitals may be assured that the systems they use will work, help them meaningfully use health information technology, and qualify for incentive payments.
  • Modify the certification program to cut red tape and make the certification process more efficient.
  • Allow current “2011 Edition Certified EHR Technology” to be used until 2014.

The second point annoys me a little after hearing about some of the EHR certification fraud and issues it could cause providers that attest to meaningful use.

The press release also offered the following EHR incentive participation numbers:
-120,000 Eligible Health Professionals have participated
-3,300 Hospitals have participated
-More than half of all eligible hospitals and critical access hospitals and 1 out of every 5 eligible health care professionals

Watch for more detailed coverage of the meaningful use stage 2 final rule in our ongoing Meaningful Use Monday series.