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Developing Safety Critical Healthcare Software

Posted on June 21, 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.

The Healthcare IT Guy, Shahid Shah, has a great post up on his blog about writing safety critical software using an agile, risk-based approach. Here’s a portion of the blog post where Shahid really hits the nail on the head:

Much of that [every software being custom] changed in the 90’s and then upended even further in the early part of the 21st century; we should no longer weighed down by the baggage of the past.These days even our hardware is agile and extensible, real-time operating systems are plentiful, software platforms are malleable, mHealth is well established, and programming languages are sophisticated so we need to be open to reconsidering our development approaches, especially risk-based agile.

Why should we use “risk-based” agile? Because not every single line of code in software can or should be treated equally – some parts of our medical device software can kill people, many parts merely annoy people, but most other parts simply aren’t worth the same attention as the safety-critical components. When you treat every line of code the same (as is often true in a plan-driven approach) and you have a finite amount of resources and time you end up with lower quality software and less reliable medical devices. It’s not fair to blame the FDA for our own bad practices.

I’m always amazed by Shahid’s knowledge and ability to describe something in simple terms. I should know since I’m often on calls with Shahid since he’s my partner in Influential Networks and Physia.

The irony is that in the EHR and mHealth world you could argue that many have taken too much of a lean approach to building their applications while the medical device world treats every part of the software as a patient safety issue. Now if we could just bring the two together into a more reasonable balance of what’s important from the safety side and what’s not.

As far as I can tell, the FDA is planning to mostly stay out of regulating the general mHealth and EHR side of healthcare IT and will stick to the medical devices and mHealth devices that fit under the medical device term. I think this is generally a good thing for a number of reasons. Not the least of which is that the FDA doesn’t have the expertise needed to regulate EHR software. However, I wouldn’t mind a touch more patient safety concern from EHR vendors. Maybe the EHR Code of Conduct will help add a little more to this concern.

Of course, as Shahid points out, you don’t have to sacrifice agile software development to develop safety critical software. This is true in medical device development, EHR development, and even mHealth development.

Specialty EHR Speaks that Specialty

Posted on June 19, 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’ve long been a proponent of the role of specialty specific EHRs. In fact, at one point I suggested that a really great EHR company could be a roll up of the top specialty specific EHRs. I still think this would be an extraordinary company that could really compete with the top EHR vendors out there. For now, I haven’t seen anyone take that strategy.

There are just some really compelling reasons to focus your EHR on a specific specialty. In fact, what you find is that even the EHR vendor that claims to support every medical specialty is usually best fit for one or a couple specific specialties. Just ask for their client list and you’ll have a good idea of which specialty likes their system the most.

I was recently talking with a specialty EHR vendor and they made a good case for why specialists love working with them. The obvious one he didn’t mention was that the EHR functions are tailored to that specialty. Everyone sees and understands this.

What most people don’t think about is when they talk to the support or sales people at that company. This is particularly important with the support people. It’s a very different experience calling an EHR vendor call center that supports every medical specialty from one that supports only your specialty. They understand your specialties unique needs, terminology, and language. Plus, any reference clients they give you are going to be in your specialty so you can compare apples to apples.

Certainly there can be weaknesses in a specialty specific EHR. For example, if you’re in a large multi specialty organization you really can’t go with a specialty specific EHR. It’s just not going to happen. With so many practices being acquired by hospitals, this does put the specialty specific EHR at risk (depending on the specialty).

Another weakness is when you want to connect your EHR to an outside organization. Most of them can handle lab and prescription interfaces without too much pain. However, connecting to a hospital or HIE can often be a challenge or cost you a lot of money to make happen. Certainly the meaningful use interoperability requirements and HL7 standards help some. We’ll see if it’s enough or if the future of healthcare interoperability will need something more. For example, will specialty specific EHR be able to participate in CommonWell if it achieves its goals?

There’s a case to be made on both sides of the specialty specific EHR debate. As with most EHR decisions, you have to choose which things matter most to your clinic.

EHR Consolidation and EHR Investment News

Posted on June 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.

A couple big announcements came out this week that are continuing to shake up the EHR market. Most people consider this a really good thing when you look at the 300+ EHR companies in the market today. Most see this as unhealthy and a real issue for healthcare. No doubt it causes problems, not the least of which is the paradox of choice.

The first announcement was that Vitera Healthcare Solutions acquired SuccessEHS. Vitera is the new name for the SAGE EHR which they bought from Sage Software in 2011 for those tracking the EHR histories.

In the press release it says that the combined organizations serve “more than 10,500 medical organizations and over 415,000 medical professionals nationwide — including more than 85,000 physicians.” I was also interested to see Vitera’s emphasis on expanding their customer base in CHCs, Student Health Centers, HIV/AIDS Clinics, and FQHC.

I asked the company if there were any plans to sunset one of the competing EHR software platforms. They responded that they “plan to keep both EHR systems and keep developing both of them.” Of course, the acquisition was just announced, so that doesn’t mean in 3-6 months they may compare the EHR systems and make a different decision in the future.

The second announcement was CareCloud EHR raising $20 million. That brings CareCloud’s total funding to $44 million. Ever since I first met Albert Santalo, CEO of CareCloud, he said that he wasn’t looking for the early exit. Instead, he wanted to build CareCloud into a long term company. I expect this extra $20 million will let him and CareCloud really swing for the fences.

Also, I literally just got an email from another EHR vendor that’s in the process of being acquired. I can’t say who the company is until it’s official, but it seems that EHR consolidation is happening. Either that or the companies are taking on funding to try and last for the long term.

Online Won’t Ever Replace Face-to-Face, It Will Enhance It!

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.

I was drawn in by the title of this blog post on The Healthcare Blog: Online Won’t Ever Replace Face-to-Face. Or Will It? It’s a powerful question and we all know the answer to the question is no, we won’t ever replace face to face interaction. Although, the title seems to indicate that it should be an either or proposition. From my experience, not only does online not replace Face-to-Face interaction, but it enhances it in really dramatic and beautiful ways.

A simple example of this happened yesterday. I was downtown filing some paperwork for my business at the county clerk’s office. As I was waiting for the paperwork to be processed, I got a tweet from someone saying they were in Las Vegas and would love to meet. I checked out his profile and didn’t recognize the name, but it said the magic words “healthcare startup” and so I was intrigued.

I quickly sent him a direct message on Twitter that I was in downtown Las Vegas and gave him my number if he wanted to connect while I was downtown. By the time I walked to my car I had a text from him saying he was 2 minutes away. So, I called him and we planned to meet at the local coffee shop where we had a nice 1-2 hour chat about healthcare startups.

Without technology I would have never known that Pete Kane was 2 minutes away from me, and I would have never learned about the amazing work he’s doing bringing together the Healthcare IT startup scene in Minnesota. He made me want to visit Minneapolis despite my current attempts to avoid traveling.

Turns out in the article linked above Katherine Leon realizes the same thing. Technology doesn’t get in the way of Face-to-Face meetings. It enables and enhances the face to face meetings. In fact, technology makes many more face to face meetings possible.

One thing I’ve found recently is that so many people are starving for social interaction in a community of peers. Many people blame technology for this and no doubt a generation of couch potatoes doesn’t help. However, even TV, video games, online interactions are all becoming very social experiences. These social interactions lead to offline interactions.

One of the greatest powers of the internet is its ability to bring together peer groups. We see this for every healthcare disease. We see this in the #HITsm and #HCsm communities. My best memories from those communities isn’t the online chats or watching that hashtag. It was the offline meetups that were facilitated by the technology.

Healthcare as much as any other industry can benefit from these connections. Plus, we’re just getting started with connecting people. Indeed, the online interactions won’t replace Face-to-Face interactions, but instead will dramatically enhance our offline connections to people.

A Private HIE is a Vendor Neutral Archive Applied to EHR

Posted on June 17, 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’ve been really fascinated by the work many hospital systems are doing to create a private HIE in their organization. As I wrote, I think that private HIE could lead to a nationwide HIE. It’s still a bit of a long shot, but I think it has more promise than the other HIE initiatives I’ve seen in action.

Along with my interest in private HIEs, I’ve also been fascinated by the switch to Vendor Neutral Archives (VNA) in the radiology space. In a VNA, you can store any medical image in the archive and it doesn’t matter what device you use to capture or view the image. Think about the flexibility that this provides. You’re no longer locked into a certain piece of imaging equipment or to a certain viewing application. Instead, you can switch as needed.

As I consider these two areas, it seems that a private HIE is the first step to having a vendor neutral archive. In fact, I’m not sure why more people haven’t applied the principles of vendor neutral archives to the EHR world. I imagine the challenge is in the complexity of the data. Sure, DICOM isn’t a simple piece of data either, but at least there are some DICOM standards that most medical imaging companies follow. The same can’t be said in the EHR world.

The problem now is that the term HIE has so much failure associated with it. I imagine that’s why we moved from RHIO to HIE as well. However, I think that the change from creating an HIE to a vendor neutral archive for EHR data would be a dramatic shift in thinking. This could be an important decision for a large hospital system. Instead of just trying to share data from EHR to EHR, what if they created a vendor neutral archive of all their EHR data such that your future EHR was built around that VNA instead of around a specific piece of software. I’m not sure there are many hospital CIOs brave enough to look this far out.

What do you think of the VNA concept applied to EHR? Is a private HIE the start of a VNA for EHR?

Epic’s Reputation, Datapalooza, and Interoperability — #HITsm Chat Highlights

Posted on June 15, 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: Do you honestly believe, when the clock runs out, CMS will dock non-#MeaningfulUse docs’ reimbursement? Why/Why not?

 

Topic Two: Explain in technical terms why Epic has such a bad reputation for interoperability.

What’s the data roadblock? How to fix? #HITsm — CapSite (@CapSite) June 14, 2013

 

 

 

Topic Three: In your opinion: Coolest thing coming out of D.C. last week with Datapalooza and the other health IT conferences/meetings?

Topic Four: Congress blaming EHRs & #MeaningfulUse for “upcoding” is like blaming screwdrivers for burglaries. Agree/Disagree/Your take?


Topic Five: Will ICD-10 be a non-problem we blew out of proportion like Y2K, or will it be a pretty rough transition? Explain.

Hospital Mergers Complicate EMR Transition

Posted on June 14, 2013 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.

Getting an EMR up and running in a hospital or health system is complicated enough. But managing EMR implementations in the midst of hospital mergers is even more difficult.

Like it or not, though, hospital CIOs are increasingly facing the likelihood that they’ll be facing a merger in the midst of their EMR rollout, notes a new piece in the Wall Street Journal. With reimbursements from both Medicare and private insurers falling, hospitals’ margins are growing perilously thin, and the pace of hospital mergers is likely to increase, according to a March report by Moody’s.

Right now, for example, two of New York’s biggest hospital chains — NYU Langone Medical Center and Continuum Health Partners — have agreed to discuss a possible merger. Continuum CIO Mark Moroses is in the process of moving his chain of hospitals to its GE Centricity EMR, in a move which will allow the chain to collect $20 million to $30 million in Meaningful Use incentives.

If the merger between Langone and Continuum goes through, Moroses will have to stitch together dozens of billing,  procurement and patient care systems over the next few years, the WSJ notes. But more than that, the hospital chains will have to synchronize their clinical information management, a formidable job which, as Moroses says, leaves no room for error.

It’s not just systems integration that merging systems will face, however. As the WSJ piece notes, when North Shore-Long Island Jewish Health System took over Lenox Hill Hospital in 2010, the systems’s CMIO Michael Oppenheim had to bring Lenox Hill’s data to a new version of its Allscripts EMR.  The system used currently by Lenox Hill is an old one which isn’t certified for Meaningful Use.

Ultimately, hospitals’ urge to merge makes sense on a lot of levels. Given their tremendous capital costs (including EMR spending) it only makes sense to achieve economies of scale.  Unfortunately, the commonsense desire to save money and be more efficient is going to subject HIT leaders to an even rougher ride then they might have expected.

Must-See Sessions, Exhibitors at HFMA #ANI2013

Posted on June 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.

It’s that time of year again. The Healthcare Finance Management Association’s annual ANI conference is just days away. I’ve come to associate the month of June with all things revenue cycle and the anticipation of learning more than I ever wanted to know about financial risk, reimbursement strategies, RACs, coding … the list could go on and on. I do enjoy the show, almost more than HIMSS, because it is smaller, shorter and so much more manageable from a logistics standpoint. HFMA puts out a great mobile app each year, and this year marks the first time I’ll be able to take advantage of it thanks to a (finally) upgraded phone.

Last year in Las Vegas, the show floor and educational sessions were largely focused on ICD-10 and ACOs. Flipping through this year’s brochure, I see that health insurance exchanges, Stage 2 of Meaningful Use and payer relationship strategies will also see a bit of the limelight. Personally, I’m looking forward to learning what healthcare finance folks think of this surge in healthcare consumer cries for price transparency. Are they paying attention? Will charge masters ever change (for the better)?

I thought I’d share some of the sessions I’m most looking forward to attending. I admit that I’m a big fan of panel discussions. Solo presenters can turn into sleep-inducing monologues far too quickly.

To Merge or Not to Merge: Hospital Executive Panel Discussion (Monday, 6/17)
What are the advantages and challenges of maintaining stand-alone status? What factors could influence a decision to see affiliation partners? What various affiliation strategies have worked for others?

Living in Atlanta, which has seen its fair share of hospital mergers and partnerships, I’ve often wondered why some facilities choose to go it alone and some choose to affiliate. I’m looking forward to hearing some inside scoop from the four scheduled hospital executives.

Transitioning to Value: Barriers, Solutions and Opportunities (Tuesday, 6/18)
Former CMS administrator Don Berwick will give this keynote address, which promises to “identify the barriers that must be overcome to reform the delivery system, the outcomes of successful delivery models, and the signals of progress within provider organizations.”

I can’t help but wonder how his stage presence will compare to Farzad Mostashari’s, and what sort of neck attire he’ll don.

Physician/Hospital Revenue Cycle Integration: a Panel Discussion (Tuesday, 6/18)
This session will cover the “opportunities and challenges of unifying the revenue cycle to reduce overall costs while increasing collections and patient satisfaction.”

I think it will be interesting to hear from providers just how important patient satisfaction (and presumably referrals) are to a provider’s bottom line. I expect at least one of the panelists will bring up Stage 2, as I’m learning that patient engagement and satisfaction are closely intertwined.

Women as Leaders: Charting the Course (Tuesday, 6/18)
As I mentioned in a recent post, I’m looking forward to learning how the HFMA board members (dare I call them #RevCycleChicks?) on this panel manage careers, families and communities.

Quiet: Harnessing the Strengths of Introverts to Change How We Work, Lead and Innovate (Wednesday, 6/19)
This keynote from author Susan Cain seems tailor-made just for me. Until social media came into my life, I’d always considered myself an introvert. But social networks have turned that idea on its head in unexpected ways, and so I wonder if Cain will touch on digital media in her presentation.

Best Practices for Managing Consumer Payments in the Current Environment (Wednesday, 6/19)
This “late-breaking session” promises to share best practices on improving collections and patient satisfaction.

I hope they’ll touch on the “future” environment, as it seems reasonable to assume that 2014 will likely make a number of current best practices out of date.

Then, of course, there is the exhibit hall, which I always enjoy roaming around without plan or purpose. A few recent postcards have piqued my interest in several companies:

sock

I’m not even sure what the name of this company is, but the idea of a singing sock intrigues me.

emdeon

I fared poorly at Emdeon’s Cash Stacker games last year, and am determined to do better this time around. Plus, the company always seems to be doing interesting things in the revenue cycle space, so I look forward to catching up with several of their team members to get the inside scoop.

relayhealth

I’m very intrigued by the idea of provider benchmarking at the moment, so I’m planning to learn more about what RelayHealth is doing in this area.

athenahealth

While this postcard doesn’t allude to athenahealth’s recent claims of guaranteed ICD-10 compliance, it will definitely be my main talking point when I stop by their booth.

Good works are always a good idea, and several companies are making charitable contributions in lieu of giveaways:

optum

jpmorganbnymellon

What sessions and exhibitors are you looking forward to? Let me know what I shouldn’t miss via the comments below.

Highlights for the eRx Incentive Program

Posted on June 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.

I’m a numbers kind of guy and so I love all of the data that’s being put out by ONC, CMS and HHS about the incentive money they’re paying. Granted, they’re a little late with some of the data, but at least they’re working towards the goal of more transparency.

CMS just released the data for the 2011 PQRS and eRx incentive program. In 2011, the PQRS and the eRx Incentive Program paid a combined total of $546,782,339. Here are some other report highlights:

Report Highlights for PQRS

  • In the 2011 program year, 280,229 eligible professionals participated individually in PQRS
  • CMS paid a total of $261,733,236 in PQRS incentive payments for the 2011 program year

Report Highlights for the eRx Incentive Program

  • In the 2011 program year, 282,382 eligible professionals participated in the eRx Incentive Program, a 116 percent increase from total participants in 2010
  • CMS paid a total of $285,049,103 in eRx incentive payments for the 2011 program year
  • 135,931 eligible professionals were subject to the 2012 eRx payment adjustment because they either did not qualify for an exemption, did not meet exclusion criteria for the adjustment, or did not meet eRx reporting requirements in the first half of 2011

To review the full report, visit the CMS PQRS website. For more information about PQRS, eRx, and other eHealth initiatives at CMS, visit the CMS eHealth website.

KLAS: Strong Support Distinguishes Top EMR Vendors

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.

Wth EMR usability still shaky at best, it’s the developers that offer hands-on support that score highest when EMR usability gets rated, according to HIT researcher KLAS Enteprises, reports Modern Healthcare.

KLAS, which just completed its report “Ambulatory EMR Usability 2013, More Nurture than Nature,” spoke with 163 providers, specifically leaders of practices with more than 25 physicians.  In nearly every case, the magazine said, providers’ greatest frustration was related to vendor relationships, not the software itself, KLAS told MH.

As part of its research, KLAS ranked nine vendors on how well “the typical physician” could efficiently and effectively perform six common EMR tasks/functions, including e-prescribing, medication reconciliation, physician documentation, problem lists, viewing patient information  and supporting mobile devices.

Coming out on top was athenahealth, a Web-based vendor, which topped the list for getting providers to usability at first use, and second for having strong handholding relationships with customers.

Epic, which came up second in the overall composite ranking, was number one when respondents asked whether their vendor gave them good support in guiding them to usability.  This was true despite the fact that Epic is also well known for usability complaints by physicians, and that Epic is built on configurable modules that lead to a steep learning curve.

GE Healthcare and Greenway Medical Technologies tied for third in the composite scoring.

Meanwhile, Allscripts’ Enterprise EHR and McKesson Corp.’s Practice Partner got low scores for initial usability, the magazine said. Allscripts got higher grades for getting customers situated over time; 74 percent ranked the vendor good or okay as compared with 54 percent of McKesson customers.

McKesson had the most customers of any vendor in the survey reporting that the company was “not good” at helping users with its technology.

So, we have an interesting conclusion here: even if vendors turn out a difficult-to-use product, strong customer support can largely erase that disadvantage. Now, let’s see what happens when a big vendor turns out a product which is easy to use without a lot of handholding…