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Hospitals Still Struggling With HIE Data Sharing

Posted on September 30, 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.

Hospitals are trying hard to make HIEs work, but establishing robust data exchange remains a major challenge, particularly given the difficulty involved in processing paper records, a new study by HIMSS Analytics suggests.

The report, sponsored by ASG Software Solutions, draws on a survey of 157 senior hospital IT executives.

More than 70 percent of respondents to the survey reported that they participated in an HIE with other hospitals and health systems.

The thing is, the facilities reported that they’re having difficulty exchanging patient information in meaningful, powerful ways. Also, survey respondents noted that sharing information outside of HIEs is held back by budget concerns and staffing problems.

Juggling electronic and paper-based data is still a major issue, the study suggests:

* 64 percent of health information organizations reported that they shared data with nonparticipating hospitals via fax
* 63 percent of the same organizations converted faxed information into digital form via scanning
* 84 percent of respondents integrated their output/print environment directly into their EMR/HIS system
* 42 percent of survey respondents said their output/print environment was “high effort”

Unfortunately for HIE fans, coordination and management of paper records is far from the only issue standing in the way of making them work acceptably in a hospital environment.

According to a study by Chilmark Research, the focus of most HIEs is still on secure clinical messaging, which doesn’t do the job for cross-enterprise care coordination. The Chilmark research estimates that queries of databases for patient information needed at the point of care account for just 2 percent to 10 percent of HIE transactions overall.

As Chilmark CEO John Moore recently told Information Week, the problem is particularly acute in ambulatory care. Most ambulatory EMRs haven’t been able to generate CCDs that other EMRs can consume or execute queries using a record locator service. This is a pretty serious weakness in the HIE space, given that 80 percent of care takes place in ambulatory setting.

Given their importance, it’s troubling to see how many obstacles remain to robust HIE use by hospitals and physicians. Let’s hope the next 12 months see some breakthroughs.

One Physician Ready for the EMR Revolution – #EHRBacklash

Posted on September 27, 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 my post about the Coming Physician EHR Revolt (some are calling it the #EHRBacklash), I got the following comment from Rick Spencer, MD.

Let alone the extreme inefficiency of EMR, the generated documents are a waste of time to read. I’ve not found one EMR generated document from an ER or speciaty office that is worth any more than throwing in the trash can. An ER will send you 8 pages on your patient, and you’re lucky if you find one paragragh where a human being actually took the time to enter something useful. God forbid that doctors and nurses should actually see their patients and give good clinical descriptions of their observations and examinations. You can’t fit a round peg in a square hole, and that’s exactly what EMR is all about. What really gripes me is who is all of this for?–insurance companies?– they seem to run every thing else. And, really, what interest does the government have in mandating how helath care providers see their patients?– don’t tell me that it’s for better patient care because I’m sure they could care less. Finally, the medical school professors that taught me 25 years ago would roll over in their graves if they knew how the medical profession just rolled over and let government and insurance companies tell them how to conduct a doctor-patient relationship. I’m eager to be part of any revolution that would put health care providers back in the driver’s seat where they belong. Thanks for this opportunity to get this off my chest!!!!

Is this an isolated case or an example of a larger trend. I personally think it’s part of a larger trend. I’m not sure most doctors are ready for a revolution, but they would certainly welcome a revolution in the way EMR’s document care. I’ve heard hundreds of doctors complain about the spew of data that many EMR vendors push out to satisfy billing.

Along with this pressure, I talked to someone today who said that many doctors are looking at the meaningful use stage 2 requirements and thinking that it may not be worth the effort. The requirements are higher and the EHR incentive is lower. Don’t be surprised if many doctors revolt against MU stage 2 as well.

Mulling Over EMR Market Consolidation

Posted on I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

I had the pleasure of attending a Technology Association of Georgia Health Society event last week on mobile health. It offered me a chance to chat with colleagues, and hear from a panel of payers, providers, startups and vendors on the current state of and predictions for mobile health. While networking beforehand, I found myself trying to succinctly answer a colleague’s question of, “Where do you see the EMR market heading in the next few years?”

My short answer was, “It is consolidating and will continue to consolidate.” I had more details and theories on the tip of my tongue, but didn’t get the chance to back up my statements before we were ushered in to the evening’s presentation. It was a big question – one that I think has only one correct answer, but also one that potentially has a variety of explanations behind that answer. Needless to say, I mulled it over that night and into the next day, when, coincidentally, I awoke to news of the Vitera/Greenway Medical deal.

If I had the chance to do it over again, I’d break my response down like this: Meaningful Use obviously provided incentive for businesses to get into the EMR game. Some were already in healthcare, while others were on the fringes. Combine those new industry entrants with companies that have provided EMRs since before HITECH, and you’re left with a crowded market.

Implementations and go lives coinciding with Stage 1 left many providers dissatisfied with the EMR experience thus far, but still willing to forge ahead. As they look to Stage 2, some realize their vendors – whom many are already disenchanted with – will not be up to the task of helping hospitals meet digital patient engagement quotas, among other Meaningful Use guidelines. And so began the rip and replace movement.

Vendors deemed not up to par looked at their options. Many took a step back and reassessed product development and strategy, deciding to either: get out of the healthcare game, close up shop altogether, merge with a competitor, or make themselves available for possible acquisition.

That’s one wave of consolidation. I’m fairly confident we’ll see another wave in the next 12 to 18 months, if it hasn’t already started. (I don’t think we’ll see too many Phoenix-type situations like Google.) As providers dive deeper into using technologies around Stage 2 engagement requirements, they’ll experience a second wave of acceptance or denial. At some point, the EMR replacement market will die down, providers will settle into the technology they’ve settled on, and purchases of new systems will stagnate. EMR sales will thus dry up a bit, forcing vendors to again look at their options. I would think that many will turn into consulting services once the demand for new software has died down.

Now that I’ve put pen to paper and laid out my thoughts, I wonder what readers predict. I encourage you to let me know whether I’m on the mark, totally off base, or somewhere in between.

Anatomy Eye Candy – Blausen

Posted on September 26, 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 following the progression of a company called Blausen for over a year now. Some of you might remember my post about the Blausen Medical Content Google Chrome Extension.

Previously, the home page of Blausen did little to illustrate the really amazing work they’d done creating various medical related animated videos. However, they’ve gone through a redesign that really captures the beauty of what they’ve created. If you enjoy amazing animations of anatomy and physiology, then you’ll really enjoy the Blausen videos.
Blausen Medical   Medical Animations
I’ll be interested to see what Blausen does with all of these videos. I’m still skeptical that this will work as a standalone website. I feel like it needs to be integrated with another product to be really valuable. With that said, I’m told that they’ve already had 2 million hits and 50,000 videos watched in last 30 days. So, maybe there is a business that can be built around high quality anatomy videos.

I’d be interested to hear what doctors think of these videos. Would you use them with your patients? Could these be useful in medical education?

Almost 3 Million EMR and EHR Pageviews

Posted on September 25, 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 just checked the stats for EMR and EHR and realized that we’re about to top 3 million pageviews since we first started the blog back in April 2009. That’s pretty exciting since the first year of the blog I really didn’t do much with it. Over the life of EMR and EHR we’ve posted 1057 posts and had 2927 comments (not counting the 95,665 spam comments we’ve filtered).

A big thanks to Anne Zieger (244 posts) and Jennifer Dennard (114 posts) for all their contributions over the years as well. They’ve both made amazing contributions to the site and likely don’t get the credit they deserve. I’m lucky because not only are they great writers who know the industry well, but they’re wonderful people. I’m proud to associate with them.

If you’ve made it this far through the blog post, then hopefully you’ll take a few minutes to take a look at the new and renewing EMR and EHR advertisers below. Without them, none of this would be possible. I’m really blessed to have their support.

New EMR and EHR Advertisers
Clinithink – I’ve often heard doctors proclaim NLP as the perfect balance between clinical narrative and structured data. Clinithink is focused squarely on this challenge. How do you take your healthcare data and extract the value out of it? Clinithink’s answer is preserving the context and meaning intended by the narrative while structuring and encoding it with rich, granular data.

DrChrono – An EHR created with the iPad tablet interface in mind. You can see the difference between a native iPad EHR application and some sort of remote desktop EHR application on the iPad. DrChrono offers a free basic version so you can try it out before you buy.

gMed – A specialty specific EHR focused on Gastroenterologists. I was excited to work with gMed on a mix of advertising across the Healthcare Scene blog network together with some whitepaper distribution that should work well for their specialty specific EHR. Any gastro doctor should consider gMed and compare it with the non-specialty specific EHR out there. There’s usually a vast difference in focus.

The Breakaway Group – A Xerox company, The Breakaway Group is doing some really interesting things in the area of EHR training. I worked together with them to provide some coverage of their Healthcare Forum event. Plus, I’m excited that we just closed a deal for them to create a series of blog posts on the Healthcare Scene network.

Renewing EMR and EHR Advertisers
I can’t thank the following advertisers enough for their support. As you can see, many of them have been supporting EMR and EHR for 2 or 3 years. I’m glad they still see value in supporting the work we do.
Ambir – Advertiser since 1/2010
Amazing Charts – Advertiser since 5/2011
Cerner – Advertiser since 9/2011
Quest Quality Solutions – Advertiser since 9/2011
SimplifyMD – Advertiser since 9/2012
Canon – Advertiser since 10/2012

Check out our EMR and EHR advertising page for more information on supporting EMR and EHR.

ONC Health IT Infographic

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.

These are some really interesting numbers. The one that hit me is the percentage of doctors and hospitals which were meaningful users of an EHR. We’ll see how that percentage changes over time. No doubt EHR has made huge progress since the EHR incentive money was put in place.

ONC Health IT Infographic

Will We See More Free EMRs?

Posted on September 24, 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.

Wondering what’s up in the free EMR world? In a recent article in the redoubtable KevinMD.com, an author described three current EMRs which are free to physician users:

* Hello Health, which collects fees from patients ranging from $36-$120 per year but charges no fees to physicians. (Patients who pay for Hello Health get various privileges, including online appointment scheduling with blocked out periods of time reserved for Hello Health patients, the article reports.)

* Kareo, which gives away its EMR in hopes that medical offices will buy its other products, including practice management and billing services.

* Practice Fusion, whose business model allows physicians to use its EMR for free in exchange for tolerating ads on screen.

To me, what’s interesting about these models is that there are so few of them. When Practice Fusion first emerged years ago I assumed that there would be tons of other free EMR plays emerging to compete with it. That has not been the case.

To me, this fits in with John’s observation that the Golden Age of EMR Adoption is over, or as he puts it, that “we’re now getting ready to enter the nasty, ugly, dirty, swamp – filled waters of EMR adoption.”

Five years ago or so, free EMRs were just one of the neat new EMR business models emerging as vendors went after Meaningful Use money. Fast forward, to today, and you find that things have gotten a lot simpler and clearer. While early players like Practice Fusion may have seen good adoption of their free EMR, I don’t think they’re going to have much competition for that business model in the future. The market just isn’t as open to new ideas as it was.

While there may be other viable free EMRs not mentioned in the blog item, I think the industry has concluded that at best, pay-for-play EMRs are more viable over the long run than most free EMR models floating around the vendorsphere. Although, Practice Fusion’s new $70 million round of funding will keep them in the game for a while to come. What do you think?

Thoughts on Practice Fusion Raising $70 Million

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.

Today, Practice Fusion announced that they have just closed a $70 million round of funding. This series D round of funding brings Practice Fusion’s total funding to $134 million and a valuation estimated at $700 million. The round was led by Kleiner Perkins Caufield & Byers, OrbiMed Advisors, and Deerfield Management Company.

We’d heard that this round was close almost 2 months ago. I’m not sure what took them so long to finally close the round. I also found it interesting in this Forbes article about the funding round that “Practice Fusion leads vendors this year in acquiring Allscripts’ former customers.” I have a feeling Aprima might have something to say about that.

In that same article, Practice Fusion declined to disclose revenues, but Ryan Howard suggested that he expects Practice Fusion revenues to triple next year. Then, it was suggested in the article that payments from labs connected to Practice Fusion customers would make up a significant source of revenue. You might remember that Practice Fusion lost one revenue stream when Kareo decided to launch their own free EHR. Practice Fusion has since rolled out 3 new billing companies and so they could have made up that revenue.

The article also suggests that revenue is available from Pharma for mining the Practice Fusion data for insights. Then, they’ve always talked about the potential for pharma advertising in the Free EHR. I also had someone suggest to me recently that Practice Fusion could be making money off of selling leads to the various healthcare education companies out there. Considering the number of emails I get from these healthcare education companies, they definitely have money to spend on targeted leads.

The question I’ve asked for many years isn’t whether Practice Fusion has created value. No doubt their current user base and data set has value. The question that remains is whether they’ve created a company that merits a $700 million valuation and whether the $134 million investment will yield a quality return. Plus, can Practice Fusion build the company’s revenue while still maintaining physicians’ trust in Practice Fusion. They now have $70 million in funding to find out.

Simpler EMRs Lower Physician Stress

Posted on September 23, 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.

When it comes to EMRs, simpler may be better, according to a new study. 

Researchers have concluded that doctors who use EMRs with a moderate number of functions are more stressed out and have a lower level of job satisfaction than those who use EMRs with fewer functions.

The study also suggested that doctors who used highly functioning EMRs are especially challenged providing care if they feel the time allowed to do so isn’t adequate.

The study, which was reported in Healthcare Informatics magazine, originally appeared in the Journal of the American Medical Informatics Association. In the study, researchers examined variables including doctor-reported stress, burnout, satisfaction and intent to leave the practice, then used these variables to compare decisions before and after EMR systems were implemented.

To gauge how physicians react to EMR features, the study authors looked at 379 primary care physicians, along with 92 managers at 92 clinics from New York City and the upper Midwest.

The physicians and managers were participating in the Minimizing Error, Maximizing Outcome study, a 2001 – 2005 study assessing relationships between the structure and culture of the primary care workplace, physician stress and burnout, and the quality of care experienced by their patients, Healthcare Informatics reported.

The researchers actually found the job stress went down slightly for physicians using sophisticated EMR system compared to physicians with moderately complex EMRs. However, time pressure during examinations was more highly associated with adverse physician outcomes in the high EMR function group, the study authors wrote.

It’s worth remembering, however, that EMR complexity isn’t the only factor which determines how comfortable physicians are with their system.

Ultimately, seeing to it that doctors are comfortable with EMR features and functions before they’re installed and set in stone is the best way to see to their satisfaction, according to health IT expert Mark Olschesky.

Amazing Transforming Healthcare Conference Logo

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.

Props to @healthcarewen for pointing out this awesome healthcare conference logo for the 2013 Oklahoma Association for Home Care and Hospice Annual Conference & Trade Show:
Transforming Healthcare - Transformers Conference Logo

If you love that logo, you’ll love the conference brochure even more.