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Retail Clinics Buddy Up with HIT and MU Lessons from a 3 Year Old

Posted on August 23, 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.

It seems I can’t read a blog, tweet or even old-fashioned newspaper these days without coming across some headline having to do with retail health clinics buddying up to healthcare IT. Announcements from two companies come to mind.

The first involves SoloHealth – developer of health and wellness kiosks. It received FDA approval for its product earlier this summer, and followed that development up with news of financial investment from benefits company WellPoint. It also has announced plans for a national rollout of its kiosks sometime this fall. Assuming its website is up to date, there are SoloHealth Stations across the country at retailers like Walmart, Safeway, Publix, Sam’s Club and Schnucks. CVS appears to be its only traditional retail clinic customer at the moment.

The second involves Greenway Medical – well-known developer of electronic health records for a variety of healthcare organizations, including Walgreen’s Take Care Clinics. It currently has placed its PrimeSuite EHR in more than 700 Take Care pharmacies, and just this week announced plans to implement a custom EHR – WellHealth – to coordinate other types of care in Walgreen’s locations. I’m assuming the two EHRs will play nice with other from an interoperability standpoint. Implementation of all WellHealth systems is expected to be finalized by the end of next summer.

I can’t help but point out that both of these companies are based in Atlanta, and I know for a fact that their team members congregate at similar networking events, so I wonder if we’ll see some synergy between them in the near future.

In any case, if predictions of retail clinic growth prove to be true – a recent Rand Report notes that use of retail health clinics quadrupled between 2007 and 2009, and will continue to grow – it seems likely that we’ll see HIT companies popping up in clinics across the country.

On a completely unrelated note, my daughters and I joined the rest of my company’s team members at the annual Lekotek Run 4 Kids last weekend. We had a great time and enjoyed helping out a great cause. I was a bit apprehensive that my youngest would enjoy it. Before the race began, she came up to me with number in hand and asked, “Is it okay if I lose?” Happily, she declared herself a winner after crossing the finish line and receiving a medal along with her sister and all the other kids.

I wonder if this is a sentiment physicians in smaller practices sometimes have as they consider implementing an EHR in the hopes of receiving Meaningful Use incentive money. Do some just want to throw in the towel and “lose?” Do some not want to even start the race? I’m always looking for additional Meaningful Use wisdom from the under-6 set, so please enlighten me in the comments below.

ONC Plans Mobile Device Security Guidance For Smaller Practices

Posted on August 22, 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 an effort to help them avoid joining the long list of mobile device-based security failures, ONC has set plans to release guidance for small- and mid-sized providers on securing mobile devices. The agency, which has projects underway studying how mobile devices are used by smaller providers, expects to release its conclusions in the spring, reports HealtcareInfoSecurity.com.

If you read medical business trades, it’s hard to miss that slip-ups with mobile devices and mobile data sources (such as flash drives) have been a major source of security breaches.  In fact, it seems that 54 percent of the 464 HIPAA breaches affecting 500 or more individuals reported to HHS between September 2009 and July 2012 involved the loss or theft of unencryped mobile devices.

To see how smaller medical practices are doing in this area, ONC is conducting an effort dubbed the Endpoint Security Project, for which it has built a health IT implementation typical of mid-sized and small doctor practices, including tablets, laptops, smartphones, storage devices and desktops. When the project is done, ONC plans to release configuration settings which should help these smaller practices protect their mobile device data.

This is all well and good. After all, smallish practices seldom have an IT staffer to advise them on such things, and a simple set of best practices can go a long way.

Still, what strikes me is that time and again, it’s the larger providers whose data breaches are making the news.  That’s no surprise — big providers and hospitals simply have more data endpoints to control — but given this, ONC might make slapping larger organizations into shape more of a priority.

Of course, it’s also true that we don’t want small providers being the “weakest link” in HIEs, or compromising even a comparatively small amount of patient data in their practices. But if ONC’s assuming that big practices and hospitals can take care of themselves, they’re ignoring a truckload of evidence that it ain’t so.

Creating The Intelligence-Based EMR

Posted on August 21, 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.

Given today’s trends, I’m betting most of us would agree that EMRs need to evolve from transaction-based to intelligence based systems. They need to do better leveraging “big data,” make context-based care recommendations and support smart processes.  John likes to call them “Smart EMR,” but what would such an EMR look like?

In a recent issue of Hospitals & Health Networks, Dr. John Glaser, Ph.D.,  lays out a long– but useful– explanation as to why EMRs are stiffly focused on transactions such as documenting a visit or writing a prescription. (Very short summary: That’s just where they are coming from historically.)  Then he offers a take on the “intelligence-based EMR” and what it will take to get there.

Glaser, CEO of the Health Services Business for Siemens Healthcare, was formerly VP and CIO for Partners HealthCare, so he’s got both the vendor and the care provider view, which I think proves very useful for this discussion.

In his article, he argues that the next-gen EMR needs to offer the following:

  • foundational sets of templates, guidelines and order sets that reflect the best evidence or established best practice;
  • a process-management infrastructure that supports basic transaction checking such as drug-drug interactions, as well as asynchronous alerting like panic lab reporting and process monitoring and guidance;
  • team-based care support such as shared work lists, as well as tools for patient engagement and health information exchange;
  • novel decision aids like predictive models that can tell us if a particular patient is likely to be readmitted because he or she is fragile or has a substandard social situation at home that may negatively impact healing;
  • context-aware order sets and documentation templates that guide the physician and help infer what types of orders should be placed and what types of documentation should be done
  • intelligent displays of data, intelligent correction and identification of data, and extraction of structure by going through free text and pulling out quality measures or problems that were not previously in a patient’s problem list, for example.

The question is, are these functions science fiction (i.e. many years away from being standard) or just an evolutionary leap from today’s systems?  What are you seeing out there?

Nurses Raise Alarm Over Epic-Related Safety Errors

Posted on August 20, 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.

EMR transitions are difficult — if not excruciating — for just about every hospital that undertakes them. But one Epic installation at a California hospital seems to be having more than its share of problems, to the point where a med administration recommendation allegedly could have killed a patient.

Recently, nurses at at the prison clinic run by the facility, Contra Costa County Hospital, were about to give a dose of heart medication to an inmate as recommended by the EpicCare system.  Unfortunately, the dose recommended by the EMR might have killed the patient, say the nurses involved.  One nurse caught the error and adjusted the dose before the inmate received the potentially fatal dose.

These nurses are so concerned about the system, which, according to nurse Lee Ann Fagan, won’t let them document medication administration properly, that they’ve gone the county board of supervisors which oversees the hospital’s operations.

According to Jerry Fillingim, a labor representative for the California Nurses Association, “the Epic system decision support technology interferes with the RN’s duty and right to advocate in exclusive interest of their patients,” reported HealthLeaders Media.

Anna Roth, RN, CEO of hospital operator Contra Costa Health Services, told the board of supervisors that the 164-bed county hospital and ambulatory services had just switched to Epic on July 1st, and that the hospital had prepared well in advance for the workflow changes EpicCare would bring.

Nurses don’t seem to agree. According to HealthLeaders, 142 nurses have filed complaints with the labor union, many of which allude to their getting inadequate or incomplete training.

Other executives told Health Leaders that fixes have been made to the system since the go-live date, but that some of those fixes hadn’t been communicated adequately to some staff members.  OK, that may be true, but if the system’s churning out dosing information which is just dead wrong, giving nurses the 411 won’t solve the problem by itself.

Wow.  Just wow. I obviously don’t know how well this county hospital has been run historically, but I’d definitely question whether the workflow planning was all that robust or training even close to adequate.  Meanwhile, I have to wonder what EMR they dumped to bring in a multi-million dollar EpicCare install, and why. Could things have actually been worse before?

Can We Talk? Challenges of SaaS Type EMR User Interfaces

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.

Forget about EMR interoperability between doctors’ offices and hospitals for a moment.

One of the recent developments in the ever-expanding SaaS (software as a service) world of electronic medical records must be the challenge of making all the individual software components talk together correctly.

There is (1) the EMR itself, (2) the programming platform/language, and the (3) internet browser.  Forgive the novice in me if I don’t get all my nomenclature correct.  I’m just a doctor.  If one component gets upgraded (and they always do), then the house of cards can come tumbling down in one fell swoop, at least temporarily.  We’ve experienced this recently at our office with our own EMR system and so I have a few thoughts on the matter.

In our office, first it was Firefox stopped working with the EMR.  Then we all switched over to Internet Explorer, which seemed to work for a time, but then that stopped working well and frequently froze up.  Chrome is working for now, but it seems to be only a ticking timebomb before this no longer works.

To make matters more complicated, different browsers have different ways of displaying information bars at the top, sides and bottom of the EMR window, and so some bars can get in the way of viewing different parts of the screen depending on which browser is used.  There are ways around this (conveniently called “workarounds”), but yet again, not so simple or straightforward and thus suboptimal.  I have to admit that it sort of feels like jiggling the handle on an old toilet to get it to stop running.  In other words, yes, you can do it, but, no, it doesn’t feel like it should work that way ideally.

We’ve been given the explanation that Adobe Flash is having problems interacting with the EMR system, or vice versa, since both the EMR and Flash have gone through successive, iterative upgrades to improve and add functionality to both services.  I can totally buy this explanation.  However, at what point will it just get too difficult to keep everything going?  Is it impossible?  Probably not.  But it’s a heck of a pain watching the EMR go through roadblocks as we forge into the future together, as vendor and provider.

This will undoubtedly affect any EMR system that is dependent upon other, third-party software.  It is a common situation that will change over time, and I’m almost certain that this is going to be a challenge, all around, for any EMR system on the market today.  As such is the case, I look forward to the day when it can be solved permanently by adopting a new standard for all platforms.

Collecting Bills, Wifi Install, Decrease HIPAA Violations, and Cash For Clunker EHR’s

Posted on August 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.

We’re back once again with our weekly roundup of EMR and health IT tweets. I found some really interesting tweets and a couple responses to tweets or blog posts that I wrote. I think you’ll find them interesting and get some value.

By the way, if you have tweets that you think I should mention in this weekly roundup, be sure to let me know. I’m always on the lookout for great content. Despite what some people believe, I don’t spend all day on Twitter.


Ok, so this link is to what I think is a pretty terrible article. However, the tweet raises a pretty interesting question. Will you need an EHR to be able to do medical billing in the future? I’m sure some would argue that it’s a practice management software that you’ll have to have, but in most cases these two software are coming together. I’m not sure which is which anymore.

My answer to the question is that unless you’re going pure private pay, concierge or some alternative payment model, I think the day will come that you’ll need an EHR. I’m sure this is scary for many doctors to consider.


Doesn’t this tweet get under your skin? I know it does mine. Think about the groundbreaking tech that’s happening long term care: Wi-fi. Welcome to the state of IT in healthcare.


This is a post I did on EMR and HIPAA and it really is as the tweet says. I wish that every healthcare institution did the two items outlined in that post. If they did, a lot less HIPAA violations would occur.


I’m sure most of you saw this post, but I loved Steve Sisko’s extension to the idea of Cash for Clunker EHR’s. All I could do was roll my eyes at the thought. I guess one could argue that with the existing EHR program they decided to pay for a bunch of clunker’s instead of replacing them.

Price Transparency, ROI of Health IT, Technology Training, and Social Media Acceptance – #HITsm Chat Highlights

Posted on August 18, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Every week, HL7 Standards, hosts a #HITsm Tweet Chat and poses four questions “on current topics that are influencing healthcare technology, health IT, and the use of social media in healthcare.” It’s always a great discussion and also a great chance to meet a wide variety of people that are passionate about healthcare IT.

In case you missed it, or are curious about what went on this week, we’ve put together the list of topics with some of the best responses for each topic. There were some interesting topics this week, as well as some great responses. If you have any opinions on any of these topics, feel free to continue the discussion in the comments. This chats take place every Friday at 11AM CST. You’ll find members of Healthcare Scene regularly participating in the chat under some of the following Twitter accounts: @techguy@ehrandhit@hospitalEHR, and @smyrnagirl.

Topic One: Considering costs with mobile technology: How can mobile technology apps and crowdsourcing approaches be used to enable price transparency?

 

 

 

 

Topic Two: ROI of health IT: How will moving away from a fee-for-service model in healthcare affect the substantial price tag of health IT?

 

 

 

Topic Three: How can technology be used to train future caregivers to consider costs before ordering tests and treatments?

 

 

 

 

Topic Four: Can social media acceptance and use among younger caregivers lead to lower patient costs?

 

Grab Bag of Tweets:

 

Debating Gender’s Role in Healthcare Leadership

Posted on August 17, 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.

Some of you may have noticed a new hash tag popping up in healthcare’s tweet stream – #HITChicks was coined earlier this summer by Julie Moffitt, Regional Affairs Coordinator at HIMSS and @HIEChick on Twitter. To me, it was a fun and playful way of bringing together women who actively tweet about various aspects of healthcare.

Men, or #HITDudes, if you will, also joined the conversation:

And let’s not forget:

The article that Michael Gaspar references above, “Healthcare Lacks Female Execs,” pulls stats from a RockHealth report (whose founder, by the way, is a woman), which relates that women account for 73 percent of medical and health services managers, but only 4 percent of healthcare organization CEOs and 18 percent of hospital CEOs. According to the 100 women surveyed for the report, we lack enough self-confidence and simply don’t have enough time to take on executive roles.

Is self-confidence really that much of an issue that it would prevent a woman from taking on a leadership position? I find that particular statistic very surprising, especially considering the number of female healthcare executives in my home state of Georgia – Donna Hyland of Children’s Healthcare of Atlanta, Dee Cantrell of Emory Healthcare, Gretchen Tegethoff of Athens Regional Medical Center, Deborah Cancilla of Grady Health System, Carol Burrell of Northeast Georgia Health System …. We certainly aren’t experiencing a dearth down here.

Of course, anytime you have an article (or a hash tag) that differentiates women from men, you have to consider whether you’re promoting a “problem” that doesn’t really exist anymore. Do we really even need to make distinctions between male and female when it comes to climbing the corporate ladder? Do we owe it to young women to ensure that they have proper role models to look up to – and do those role models have to be the same gender?

It’s a loaded question that I’ll put to you, dear readers. Should we continue to point out the differences between men and women in healthcare leadership positions? Why or why not? Please discuss amongst yourselves in the comments section below.

Switching EMR and EHR Software

Posted on August 16, 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’ve long been concerned about the challenge of switching EHR software. I’ve recently got into some discussions with people asking why EHR certification and meaningful use didn’t require EHR data portability as part of the requirement.

I’d forgotten that Jerome Carter had pointed out in a previous EHR switching post where HHS asked for comments on EHR data portability in the proposed certification rule for EHR (PDF) under the section “Request for Additional Comments”. Here’s his comment with the page number that addresses it:

John, this series of posts on changing EHR systems is interesting. The data issues that arise when switching EHRs can catch providers off guard. In reading through the proposed certification rules for EHRs, I found a section on data portability that you might find interesting. It is on page 13872.

Link: http://www.gpo.gov/fdsys/pkg/FR-2012-03-07/pdf/2012-4430.pdf

It’s an interesting section to read. The key is that they acknowledge the need to have some EHR data portability if you’re a doctor. Then, they look at these 4 questions:
1. Is the consolidated CDA enough?
2. How much EHR data do you need to move to the new EHR?
3. Could they start with an incremental approach that could expand later?
4. What are the security issues of being able to easily export you EHR data?

These are all good questions. I’d answer them simply:
1. Is the consolidated CDA enough?
No, you need more.

2. How much EHR data do you need to move to the new EHR?
All. Otherwise, you have to keep the old EHR running and what if that old EHR is GONE.

3. Could they start with an incremental approach that could expand later?
I think they need to go all in with this. The consolidated CDA is basically an incremental approach already.

4. What are the security issues of being able to easily export you EHR data?
I always love to follow it with the opposite, what are the issues of not having this EHR data portability available? You do have to be careful when you can export all of your EHR data, but the security is manageable.

What are your thoughts on EHR data portability? I’d still love to find a way to help solve this problem. It’s a big one that would provide amazing value.

Can Health IT Reduce Readmissions?

Posted on August 15, 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.

We who work around health IT know it can do some great tricks, but it’s always nice to see examples of how it can actually save money.  One example of how health IT can be a cost-saver is in helping to reduce readmissions, according to a new study from CSC.  Here’s a summary of how it might work, courtesy of CMIO magazine:

Reducing readmissions will require identifying patients at risk for readmission, carefully orchestrated care management programs and patient-specific transition pathways. While this type of patient tracking, collaboration and patient-centeredness has been historically difficult to achieve, health IT should enable more organized care management through tools such as e-prescribing, master patient indexes and electronic clinical communication.

The report notes, however, that this works much better if hospitals and health systems have integrated EMRs that extend from the facility into community medical practices.  And that’s just common sense. After all, hospitals aren’t equipped to check on patients regularly once they’re discharged, aside perhaps from a few that are experimenting with remote monitoring.

The thing is, given that hospitals and medical practices are seldom running the same systems, it’s unlikely (OK, almost impossible) that they’ll be able to share much in the way of digital information. Sure, they’ll get faxes galore, but if that was an efficient way to share docs we wouldn’t be having these conversations.

Oh well. It’s always good for deep thinker types to point the way ahead. Unfortunately, I think we’ll have to wait a while for coordinated care planning via health IT to really find its place. Maybe John’s predictions for Direct Project will help us get part of the way there.