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One Database Has Distinct Advantages for Data

Posted on February 18, 2013 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 talking with an EHR vendor and they made the comment that having their EHR all on one database was a distinct advantage over the EHR vendors who install a new database with every new EHR install. I was intrigued by the idea and could easily see some of the benefits of an EHR vendor having all of the EHR data in one database. When you think some of the future quality programs that could come out, I think there could be some advantages there as well.

Considering this advantage, I started to think about ways that multiple database EHR vendors could level the playing field with their single EHR database comrades. One idea I had was using interoperability to level the playing field. If all the EHR vendors have access to all of the data, then not only will single database EHR vendors not have an advantage, but they’ll be at a disadvantage if they don’t work to exchange the EHR data as well.

When I think about this, it makes me wonder why multiple database EHR vendors aren’t accelerating the exchange of health information. This seems like it would be to their strategic advantage to exchange information.

Health Data Hacking, Population Health Help, and Childhood Obesity — Around Healthcare Scene

Posted on February 17, 2013 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.

EMR and HIPAA

Health Data Hacking Likely To Increase

One aspect of EMRs and medical technology many people — physicians and patients alike — are nervous about, are security breeches. Unfortunately, it seems as if this fear is justified, and will continue to be for the time being. Redspin, an IT security firm, gathered data about security and data incidents since 2009, and it has only increased since then. Some of the other findings are rather frightening as well.

Can The Benefits of Hospitals Acquiring Practices Be Achieved By Other Means?

There is a current trend of hospitals acquiring practices. Is there any way for groups of physicians to achieve these results other ways? This post goes into the details of this situation, and different loopholes involved.

Hospital EMR and EHR

Mostashari Asks EHR Vendors to Do What’s “Moral and Right”

Farzad Mostashari, ONC National Coordinator, recently made comments at the Health IT Policy Committee. He didn’t cut any corners when it came to talking about what he is seeing in the EMR world, and encouraged EHR vendors to do the moral and right thing. This post highlights some of his statements.

ACOs Need Population Health Help From EMRs

EMRs, in large part, don’t assist with ACOs and population health help. This is unfortunate, because they definitely need the help. In the future, EMR vendors need to be aware of this, and tweek their EMRs to offer tools to help.

Meaningful Health IT News

My HIMSS Will Be All About Quality And Patient Safety

Because of his experiences in 2012, Neil Versel has a new focus for 2013. He is now dedicated to “bringing news about efforts to improve patient safety and reduce medical errors.” Read this post for more about his goals, and how you can get involved.

Smart Phone HC

Health IT Positively Affects Childhood Obesity

Childhood obesity is on the rise, and the big question is — how can we prevent it? While many experts may be quick to weigh in on the situation, a recent study published in Pediatrics has suggested that Health IT may prove to have a positive affect on the problem. There are many companies and websites working to create ways for children to get involved and proactive about their health, and this post highlights a few of them.

Advanced Analytics, Big Data, and IBM Watson: #HITsm Chat Highlights

Posted on February 16, 2013 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.

Topic One: @janicemccallum defines #BigData broadly as: “Advanced analytics for complex problem solving.” Do you agree?

 

Topic Two: Is the current base of evidence strong enough to support #BigData models? What additional data sources do we need?

Topic Three: IBM Watson was recently deployed at Memorial Sloan-Kettering for CDS. Will IBM dominate healthcare #BigData?

Topic Four: What will help advance & what will delay the use of #BigData models in healthcare?

Topic Five: Is the current hype surrounding #BigData good or bad for the future of evidence-based medicine?

Another View of the Coming Physician EHR Revolt

Posted on February 15, 2013 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 a LinkedIn response to my post on The Coming Physician EHR Revolt, Barry Schechter offered the following candid comments:

First off I feel bad for the Drs. Then as we had in another thread the big red flag is the medical billing aspect of EMR and who benefits from that billing data. Then we have the difficulties in sharing the pertinent data allowing patients to get comprehensive care, sometimes in the same building. Then we have HIPAA which has become a greater boondoggle and less effective than TSA at airports or Homeland Security. Small wonder that Drs want to revolt. Then we can add the singleness of opinions about what an ICD really means and whether it is or isn’t ethical to copy and paste. The billing engine drives this bus and the EMR is nothing more than an auditor’s or payer’s window in to being able to justify rejections. It’s also a way for payers to eliminate the errors that come up through paper billing and given that make it easier for payers to “check up” on billing practices when auditing EMR. The bigger backlash will be from the patients as they realize that EMR is not being used to provide better medical care and that all the data is being zealously protected and not shared among their care providers. Patients will have even more cause to scream when insurers use the billing engines to eliminate CPT and ICD that are below a threshhold of service (I see that coming).

I think Barry is right that many doctors fear that EHR is just a way to track their billing and screw them over in the end. Whether this fear is founded or not, I’ve heard it expressed by a number of doctors.

ONC Encourages Emergence Of E-Patients

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.

Throughout the Meaningful Use rollout, there’s been discussion of how to best use all of these new health IT toys to get patients more engaged in their care.  But as far as I know, the following is the first time ONC has officially launched an initiative to cultivate the emergence of health IT-smart e-patients.

In a new article in Health Affairs, ONC national coordinator for  health IT Farzad Mostashari has shared plans to use health IT to reach patients and encourage their involvement with their care. The ONC is already working with 17 Beacon communities to test ideas such as text-messaging for diabetes risk assessment, but the idea now is to expand things to much higher level.

ONC now hopes to encourage patients to participate in e-patient activities such as secure e-mail messaging with doctors, use of EMRs that patients can add to and transmit, as well as use of mobile health apps for chronic disease monitoring and wellness promotion, reports Politico.com.

I’m excited to see ONC jump on this bandwagon enthusiastically. While there is an e-patient movement afoot, and a growing list of doctors interested in “participatory medicine,” it’s unlikely that the run-of-the-mill patient with few self-advocacy or technical skills would get involved on their own.

And the truth is, if ONC truly wants to build a nation of engaged patients, Meaningful Use requirements are too modest by far. Sure, there’s new requirements afoot that will make it easier for patients to e-mail doctors and transmit their health information, and that’s fine. But the truth is that few patients will take advantage of these features without a great degree of encouragement.

As something of an e-patient myself, I’m eager to see the movement blossom, as I believe it’s good for both the clinician and ordinary citizens receiving medical care. Let’s see how much effort Dr. Mostashari and his team put into cultivating patient engagement.

Physician Guidance for EHR Success

Posted on February 14, 2013 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 want to take a look at the complaint I hear over and over and over again when it comes to EHR software. I’ve heard this comment said about every single EHR vendor out there. I’ve also heard it from doctors in every specialty and from every size organization. It comes in a few different forms, but all communicates the same idea. This is the doctor complaint I’m talking about:

Did the EHR vendor even talk to a practicing doctor when they developed this EHR?

Yes, the complaint is usually voiced as a question, but the question is lathered up with an unbelievable shock that an EHR vendor could misunderstand a doctor’s workflow needs so terribly. Plus, it’s reinforced with the belief that if the EHR vendor had somehow just talked to a doctor, any doctor, that this wouldn’t be the result.

Of course, the situation is much more complicated than that statement supposes. In fact, there’s a great thread on the HIMSS LinkedIn group that has a bunch of deep discussion on how to create a healthy partnership between providers and EHR companies.

One key to understanding this relationship is first that every single EHR company has consulted doctors (usually many many doctors) in the development of their EHR software.

Many doctors will then wonder how they could have an experience like the one I described above if the EHR vendor consulted a practicing doctor (and I assure you many many doctors have had the experience above). The answer to that question has multiple layers. The first layer that most practicing doctors see is that “most doctors that consult EHR companies aren’t really practicing doctors.” In many cases, this is definitely the case. Many Chief Medical Officers at EHR companies have made EHR their full time job and no longer practice medicine. Many physician founded EHR companies have a physician leading the company that no longer practices medicine. Certainly some portion of the EHR workflow disconnect could be related to non-practicing providers driving the EHR development process, but that’s just one layer.

The second layer is that in every case I’ve seen there’s always been practicing providers involved in the EHR development process as well. They are active in user groups. They sit in focus groups. EHR vendors go to the practicing physician’s office to learn from them first hand. Most EHR companies really do make a sincere effort to understand the practicing physicians and not just try and guess at what the practicing physicians want.

Another layer to this problem is translating what the practicing physician requests into the EHR workflow. Now imagine that two practicing physicians request the polar opposite feature (yes, this happens a lot too). How then do you translate that feature into something that’s going to satisfy both physicians. That’s not an easy thing to accomplish.

The next challenge to consider is that many physicians aren’t technically astute enough to know what they want. When this is the case, they don’t know what they should even be asking for. I’m sure many doctors will scoff at this idea, but it’s the same concept for programmers. Many programmers aren’t technically astute enough to understand the medical world well enough to develop what the doctor wants. It’s a two way street and is why it’s so important for EHR companies to create an amazing collaboration between the right doctors and the right programmers. That’s a special breed of person that is not easily found.

Of course, I haven’t even mentioned the specialty layer. A technically astute practicing physician in cardiology will likely do a terrible job designing an EHR workflow that works well for pediatrics, OB, and general medicine. If you thought it was hard creating an EHR workflow that works for all the doctors in one specialty, now try and do that across 40+ medical specialties.

If you remember back to the paper chart world (which many of you are still living in), how come we didn’t have a standard paper form that every doctor used to document the visit? In fact, it was pretty rare that any 2 non-affiliated clinics used the same form at all. Sure, some forms were exchanged at the medical societies, but in most cases each clinic wanted to modify the form to fit their own clinic’s needs and desires. This happens in the EMR world to some extent, but it takes more training and skill to modify an EHR workflow than the Word document you got from your colleague. Plus, many don’t want to invest the time to make those modifications.

I’m not trying to put the blame for this on anyone in particular. Plus, I don’t want to make this sound like an excuse for EHR vendors to be lazy in how they approach their EHR development. We can be sure that some of the issues I describe above aren’t because the doctors didn’t provide good requirements and not because the programmer didn’t know how to meet those requirements. Some of the problems we see have to do with a combination of rushed release times or lazy programming (which are related). When this is the case, EHR vendors should take it on the chin and deal with the issues rather than trying to blame someone else.

With that said, hopefully I’ve made clear that it’s not enough for an EHR vendor to just consult a practicing physician. If that was the case, then all 300+ EHR companies would have beautifully designed EHRs that physicians’ love. Instead, I think the fact that so many of the 300+ EHR vendors have this issue, it illustrates how hard it is to get a technically astute practicing physician that can get programmers to make a beautiful interface that applies across all specialties.

From now on, I hope to hear physicians who have this problem change their question to, “Did the EHR vendor even talk to a technically astute practicing doctor in my specialty that works the way I like to work and practices medicine the way I like to practice medicine and bills the way I bill and in the region I live when they developed this EHR?” Then, we’ll all be able to easily answer “No, it seems like not.

Breaking up with Your EMR is Hard to Do

Posted on February 13, 2013 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.

In light of this week’s “holiday,” I thought I’d take a look at the current love/hate relationship the healthcare industry seems to have with electronic medical records and Meaningful Use.

EMRtweet2

Thanks are due to @mdrache and @EHRworkflow for their inspiration for the title of this week’s post: EMRtweet1

EMRtweet3

The nay sayers seem to have become especially vocal lately, which may be due in large part to the passing of time. Those that have implementations under their belt now feel qualified to talk about the efficacy of the solutions they selected. Negative EMR press may also have bubbled up to the service in light of the recent RAND report, which backpedaled on previous predictions of cost-savings associated with healthcare IT adoption. That study broke the ice, so to speak, and perhaps made providers more comfortable with voicing their discontent.

In any case, if current healthcare IT press is any indication, EMR technology currently on the market has often left providers dissatisfied for a number of reasons. No doubt this dissatisfaction will be a subject of many show-floor conversations at HIMSS in a few weeks. I wonder how EMR vendors are preparing their responses. What will be their top three talking points when it comes to EMR benefits? It seems Meaningful Use incentives have lost their luster, and in fact have left many providers disenchanted with healthcare IT in general.

John Lynn posted a very telling reader comment over at EMRandHIPAA.com from a provider who used his Meaningful Use malaise to create a new independent practice business model. Is this an indication that more providers may “revolt” against Meaningful Use and the trend towards hospital employment? If so, what will the private practice landscape look like in three to five years?

Just how easy is it for providers to truly “break up” with their EMRs? We’ve all read the multi-million-dollar rip-and-replace horror stories – talk about a bad breakup. And then there are the providers that stay in dysfunctional relationships with their EMRs because they can’t afford a new one, instead developing copious amounts of workarounds potentially at the expense of clinical care and accurate reimbursement.

As of last summer, KLAS reported that a whopping 50% of providers were looking to replace their ambulatory EMRs, compared to 30% in 2011. A recent Health Data Management webinar noted more than 30% of ALL new EMR purchases are made to replace an existing EMR.

To me, these numbers beg a number of questions. Were first- and perhaps even second-generation EMRs just not mature enough for providers’ needs? Did providers simply not do enough due diligence before making their purchases? Will these impending replacement EMR purchases stick? If you have updated EMR breakup statistics or a crystal ball, please send them my way.

ONC Google Plus Hangout Hosted by Doug Fridsma

Posted on February 12, 2013 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.

Looks like the government has chosen Google Plus as the best platform to be able to reach out and stay in touch with the larger community. I just read that Obama will be doing a Google+ hangout a few days after the State of the Union address. In similar fashion, today Doug Fridsma from ONC hosted a Google Plus Hangout discussing some of the projects that ONC is participating in. Plus, the beautiful part of a Google Hangout by ONC is that it’s automatically recorded and published to YouTube. So, if you missed the hangout, you can watch the ONC Hangout video embedded below.

Here’s who participated on the ONC Hangout:
Doug Fridsma, M.D., Ph.D. – Chief Scientist at ONC
Arien Malec – VP Strategy and Product Marketing at RelayHealth, Former Coordinator for the Direct Project
Deven McGraw – Director of the Health Privacy Project at CDT
John Moehrke – Principal Engineer: Interoperability and Security at GE
Vince Kuraitis – Principal, Better Health Technologies, LLC
Brian Ahier – Health IT Evangelist
John Travis – Senior Director and Solution Strategist, Regulatory Compliance at Cerner
Alice Leiter – Policy Counsel at Center for Democracy & Technology

Turns out that I’m actually planning my first Google+ hangout as well with some of the people from HIMSS. Watch for more details on that soon.

Physician Skills Profile

Posted on February 11, 2013 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.

Today I was cruising around LinkedIn and took a second to look at my LinkedIn profile. Turns out I still need to add a few things to my profile. It’s hard to keep up with stuff like that. However, what I found most intriguing was the somewhat recently added Skills section on LinkedIn profiles. I’ve known about them since the beginning, but I hadn’t really looked how skills were being described by other members of the community. In fact, I purposefully tried not to influence people’s recommendations of my skills. I wanted to see which skills they would identify. Here’s what the results are as of today:
LinkedIn Skills Profile
I find the results quite intriguing and I’m happy to say that the people on LinkedIn did a pretty good job profiling and endorsing my skills. The top skills are: Healthcare Information Technology, SEO, Blogging, EMR, and Social Media. That’s a pretty fair representation of my top skills. I live, eat, sleep and breathe those things every day. I am sad that Entrepreneurship wasn’t on the list, but maybe that’s not a skill people think about. I’m surprised that compassionate and caring didn’t make the list either;-)

As I think about that skills profile and the post about Physician Ranking Websites I did on EMR and HIPAA, I wonder if it would be valuable to allow people to endorse physician’s skills. I wonder if any doctor has tried to do this on LinkedIn and what that would look like. I know for example I could endorse my wife’s OB/GYN for a number of things that she did really well.

I like the idea of endorsement rather than ranking or review. In many ways it’s a subtle difference, but it’s an important difference. Besides the fact that the endorsements are simple to do and so there’s a greater chance that you’ll get more people involved, it also avoids some of the flame wars that can occur with physician review sites. Plus, the idea of physician rankings assumes that one is better than another when the fact might be that both doctors are great.

I also love the idea of having someone’s profile linked to their endorsement. This is partially where it can break down in healthcare. Some people with cancer might not want to endorse their oncologist if they haven’t told people they know about their cancer. Not to mention the potential big brother issues.

However, this isn’t the case with many doctors. For example, I don’t know how many times people haven’t asked my wife and I for a recommendation of a pediatrician or primary care doctor. We of course tell them which ones we’ve liked and which ones we didn’t like so much and why. Now imagine you could do something similar across all of your friends and associates.

I’m sure there’s potential for gaming this system and there’s other unintended consequences to this as well. Although, it intrigued me how well my LinkedIn contacts were able to identify my skills. I wonder if something similar could be done with doctors. Maybe Doximity could do something like this, but only doctors would be able to endorse other doctor’s skills. Although, as I said in my article linked above, even many doctors don’t know how good other doctors are. Depends on how often and in what ways they interact with the other doctors.

S.Y.S.T.E.M.

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 my post on points of differentiation for EHR companies, Charles Webster MD MSIE MSIS recently created an acronym to talk about how EHR’s should save you time, effort and money. The acronym is S.Y.S.T.E.M.

An EHR should…

Save You Substantial Time, Effort, and Money.

SAVE

Minimize encounter length, wait times, staff idle time, mental and physical effort, and Total Cost of Ownership.

YOU

You serve your patients; your EHR should serve you. (OK, its portal serves your patients, too)

SUBSTANTIAL

Lots of:

TIME

Save time: see another patient; spend more time with each patient; go home on time.

EFFORT

Minimize mental and physical effort to learn and use.

MONEY

Time is money. Save time, save money. Shift tasks from expensive personnel to less expensive personnel (but monitor task progress so nothing falls between the cracks).