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Interview with ICSA Labs About EHR Certification

Posted on January 31, 2014 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.

After hearing the news about CCHIT shutting down it’s EHR certification business, I thought it would be interesting to interview ICSA Labs, the EHR Certification body that CCHIT recommended to its users. The following is an interview with George Japak, Managing Director at ICSA Labs.

Is there a backlog of EHR vendors that want to schedule test dates with ICSA labs?  

A: There is no backlog. Since ICSA Labs received its ONC authorization, it has been our intent to grow our healthcare programs and offer the best testing and certification program in the industry. Over time we have ramped up our testing team and we have a deep pool of very experienced testers on staff. We have been getting a steady stream of news customers and inquiries and expect the CCHIT announcement will accelerate the pace.  At this point we have the capacity to test applicants as they are prepared to do so.

Is ICSA Labs able to support the onslaught of EHR companies that will come over from CCHIT?  Will that cause any delays on getting EHRs certified?

A: ICSA Labs at this point does not anticipate any delays. The ONC program was designed so that vendors and product developers would have a choice when it came to testing and certification. We were not the first lab to be authorized, but we knew that given the opportunity we would be able to deliver a program where customers would experience high satisfaction.

In my post, I suggested that the economics of EHR certification aren’t all that great.  Especially if you have a legacy cost structure like CCHIT.  Is the secret to ICSA’s success having a broader certification business beyond just EHR?

A: ICSA Labs has been in business since 1989, we have a number of accreditations to support an array of certification and testing programs, such as the IHE USA Certification program which just kicked off its second year at the 2014 IHE North American Connectathon. Our business is diverse and we leverage our capabilities across our business. We are used to doing business in competitive markets, so it has always been important for our programs and cost structure to emphasize efficiency and effectiveness and those benefits are passed onto our customers. Our testing and certification programs have always been competitively priced and efficient yet rigorous and done superior quality.

How much more complex is 2014 EHR certification compared with 2011 from an ONC-ACB perspective? 

A: As any recently certified company can attest to, the 2014 Edition criteria are significantly more complicated than the 2011 Edition. There are more test tools to maintain; more test data sets to review; frequent revisions and updates to the criteria and additional types of attestation to review. The time to complete testing has close to doubled and there are more requirements as they pertain to surveillance. After the 2011 Edition criteria, ICSA Labs asked for ONC to raise the bar, and they did. For ICSA Labs the added complexity was not unexpected.

The timelines for meaningful use stage 2 are starting to get squeezed.  Will the majority of EHR vendors be 2014 certified and ready in time?

A: There will always be stragglers, but I believe a majority of EHR vendors will be 2014 certified and ready in time for Meaningful Use 2. There has been an uptick in the vendors getting certified over the last few months. Providers and hospitals however are a different story, and they may feel the squeeze in terms of the timeline to purchase, implement and begin meaningfully using their EHR system. ONC extended the Stage 2 timeline to relieve some of that pressure.

I’ve heard that in some cases the ONC-CPHL has been slow at putting up newly certified EHRs.  Have you seen this?  Do you have a bunch of 2014 certified EHR vendors that haven’t been listed on ONC-CPHL yet?

A: The ONC-CHPL is generally responsive to our concerns and we work with them as they continue to refine new features like links to the public test results summary.

HIMSS Healthcare Provider Innovation 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.

Today, HIMSS and AVIA released the 2013 Healthcare Provider Innovation Survey, which cites reduced costs, improved patient care and increased patient safety as the primary priorities for healthcare providers when implementing innovative initiatives.

They put together this infographic to display some of the results of the survey:
HIMSS Avia Innovation Survey Infographic

The State of the Meaningful Use

Posted on January 30, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

UPDATE:
If meaningful use were gone (ie. no more EHR incentive money or penalties requiring meaningful use), which parts of meaningful use would you remove from EHR immediately and which parts would you keep?
Responses:
*Michael Sherling, MD – Modernizing Medicine
*Shahid Shah – Influential Networks
*Joel Kanick – interfaceMD
*Michael Brozino – simplifyMD
*Dr. Michael Koriwchak
*Karen Knecht – Encore Health Resources

I recently wrote what’s been a really popular article on EMR and HIPAA called “Meaningful Use Program a Success…Depending on How You Measure Success.” I think we’re at an interesting point in the meaningful use program and it’s worth taking a step back and seeing where we’re at with meaningful use.

As I state in the other article, there’s no doubt that the EHR incentive money has moved the needle on EHR adoption. Those of us who believe that EHR holds lots of potential benefit to healthcare have to be happy about the amazing EHR adoption rate that has occurred thanks largely to $36 billion of EHR incentive money (we’ll save the question of whether we’ve gotten our money’s worth for another post).

While we could Monday Morning quarterback (appropriate football reference the week of the Super Bowl) the EHR incentive program and meaningful use, that won’t change the fact that it’s here and it’s not going anywhere. So, instead of asking whether we should have spent the money on EHR and whether we should have done meaningful use, I decided to take a deeper look at meaningful use and how we could improve the program. Which elements of meaningful use are really adding value and which parts of meaningful use should be removed? Or maybe it’s all great and we should just continue on the path we’re on.

I decided to use a simple approach to identify what’s good and what’s bad with meaningful use. I reached out to EHR vendors, doctors, practice managers, hospital executives, and other EHR experts and asked them a simple question. The answers to this question should provide a solid understanding of what’s meaningful in meaningful use and what’s not.

Here’s the question I asked:
If meaningful use were gone (ie. no more EHR incentive money or penalties requiring meaningful use), which parts of meaningful use would you remove from EHR immediately and which parts would you keep?

The concept is simple. If there wasn’t some outside influence (ie. government money) influencing the requirement to do meaningful use, which elements of MU actually provide value to the users of an EHR. Those that provide value will continue to be embraced by an EHR vendor and those that don’t will be removed. Plus, this is the reality of what’s going to happen once the EHR incentive money runs out, so let’s find this info out now.

I originally thought that this question would lead to a blog post with quotes from a variety of people offering their unique perspectives. However, every person who’s answered so far had so much to say on the topic, that each of their responses was worthy of a blog post of its own.

With that in mind, over the next couple of weeks, I’ll be posting all of the responses as separate posts across the network of Healthcare Scene blogs. I’ll link each of these blog posts at the bottom of this post as they are published.

Open Call for Participation
As I considered this, I realized that hundreds of other people might want to participate as well. As a health IT community I think we can make a real impact. So, I encourage everyone who reads this to publish their response to the question above.

If you have your own blog, publish it there and link back to this post so we can add your post to our list below. If you don’t have a blog, wish to remain anonymous, or would just rather have us publish it, we’re happy to publish it for you. Drop us a note on our contact us page and we can work out the details.

I believe this will become an incredible resource of information to better understand how to improve meaningful use. Once I’ve gathered a good number of responses, I’ll be reaching out to ONC and CMS to make sure they take in the body of contributed work as well. Hopefully this simple approach will be effective at gathering a response from more people than the convoluted rule making process was able to do.

Meaningful Use will go down as one of the most impactful things to hit healthcare IT and EHR in my lifetime. It behooves us to do what we can to make the most of meaningful use.

Staying Safe (and Healthy) During #GeorgiaSnow

Posted on January 29, 2014 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.

You may have heard about the #Snowmadgeddon taking place in the South this week. As a resident of Georgia who commutes into Atlanta, I can safely say our fair city is in no way prepared to handle driving in such weather. We’re just not cut out for it. I tend to think in Twitter terms, so I’ll call it an #AtlantaFail. But, I must point out that situations like this, thankfully, bring out the best in most people. I saw many good Samaritans attempting to help stranded motorists during the four and a half hours it took me to get from the office park I was visiting to the closest friend’s house I could find. The friend, a fellow #HITchick, graciously opened her home to me and a friend I made at the networking event I attended earlier in the day.

snowtweet

How does this tie into healthcare? I want to say a big thank you on behalf of patients everywhere to the ambulance drivers and EMTs that attempted to drive through the icy conditions last night to help those in need. I saw several ambulances on our drive last night, and heard many more sirens. Like the new friend I made, there were many folks in Atlanta that assumed they’d be traveling to their home states at the end of the workday. For those out-of-state residents that had health incidents during the #Snowpocalypse (another popular euphemism that has popped up on Twitter), I sincerely hope that digital tools helped their caregivers treat them more quickly and more effectively.

I also want to say a huge thank you to the school staff, teachers and bus drivers who did their best to help ensure Georgia’s school children remained safe and warm, even though it meant spending the night at school for some.  As a room mom, my next move will be showering our teachers with gratitude. As has become so evident over the last few years, healthcare starts at home and in our communities, and it definitely does my heart good to think that our kids were being taken care of while many of us were stuck in cold cars on treacherous roads.

I’ll be back on track with healthcare IT-specific topics next week. Stay safe and warm out there, folks!

Major EHR System Downtime Causing Issues

Posted on January 28, 2014 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.

For many years, I’ve been writing about the potential damage that EHR down time can have on an organization. I’ve also been writing a number of things to try and help organizations battle against EHR downtime. For example, here’s a few of the articles I’ve written: Cost of EHR Down Time, Reasons Your EHR Will Go Down, and SaaS EHR Down Time vs. In House EHR Down Time. The reality is that EHR down time is going to happen and as more organizations adopt EHR it’s going to happen more frequently.

The past week I’ve gotten a number of people emailing me about the pain it’s been having their EHR down. Here’s one message I got from a doctor:

Today, the whole system ground to a halt and froze screens for 10 to 15 seconds at a time, which made it impossible to get our documentation done on time when trying to see 15 to 20 patients each in a day. Both myself and my colleague weren’t able to finish any of our work. My colleague called the system “unbearable” today. Hence, we get to spend the weekend working to catch up.

I guess it could be worse. We could be paying for it.

Another doctor on the same system wrote:

I have had nothing but trouble with my EHR the last two days. I can’t enter new notes. Their Help Desk takes 10 minutes to get respond on line. Not happy at all.

The former doctor had a similar complaint about the EHR helpdesk, but described the help desk’s response as “denying any problems exist even though it’s obvious when the problems do exist.”

Sometimes it’s not even the EHR vendor’s fault that the EHR is down, but it still illustrates the pain of not being able to access your EHR. HIStalk broke the news of the Epic EHR downtime (caused by a network issue) that occurred at Martin Health System in Florida. Here’s the CIO’s response to HIStalk’s inquiry:

Martin Health System had a hardware failure that has resulted in our network being down. The failure occurred the evening of Jan. 22 and we are continuing to work on rectifying the situation. Epic is among the systems being impacted by this hardware failure, however, it was not the genesis of the problem. We are continuing operations as scheduled, while strictly monitoring any potential patient safety concerns or issues that would require appropriate care determinations to be made. Our patient care teams are following downtime procedures and protocols to ensure patient safety and proper documentation is provided.

HIStalk offered more insight on the downtime a few days later:

From Scooper: “Re: Martin Hospital. You scooped the main media on their EHR crash.” I just happened to have a reader with a friend who was admitted at the time and he passed the information along to me. CIO Ed Collins was nice to provide a response. The contact said it was chaos in the hospital, with confused employees assigning random numbers to patients, runners delivering paper copies of everything, medication errors occurring, and unhappy family members threatening to sue everything that moved (all unverified, of course.) The hospital says the problem was hardware, not Epic, and claims (as hospitals always do) that patient care wasn’t impacted. Of course patient care was impacted – the $80 million system that runs everything went down hard. It would be interesting for Joint Commission or state regulators to show up during one of these hospital outages anywhere in the country to provide an impartial view of how well the downtime process works. All that aside, downtime happens and the key is preparing for it, just like Interstate Highway construction and lane-closing accidents. It’s not a reason to drive a horse and buggy.

It amazes me that it took them from Wednesday night until Friday morning to recover from the downtime. That seems like a failure of downtime procedures. I do find all of this EHR downtime really interesting in light of the recent video interview I did with Jason Mendenhall discussing healthcare in the cloud and data centers. They guarantee 100% uptime for power and connectivity. However, even in a 100% uptime data center, that doesn’t mean the application software might not have its own issues. Although, it does remove some points of failure.

HIStalk is right that EHR downtime happens. The key really is being prepared for when it does happen with proper downtime procedures. Although, that doesn’t mean healthcare and EHR vendors can’t do more than we’re doing now to make it happen less often.

My issue isn’t with EHR downtime, but with preventable EHR downtime. Plus, let’s own up to when it happens and learn from the experience. I know how hard it is on a call with EHR support to explain when a software is “down.” Sure, the server might be up and running, but end users know when something isn’t running smoothly in their EHR. Trying to convince low level EHR support people that it’s indeed an issue is a real challenge. It’s so much easier to point fingers than to try and fix the problem.

Final Day for Advanced Registration Pricing for HIMSS 14

Posted on January 27, 2014 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’s the final day to get the advanced registration pricing to attend HIMSS 2014. I thought many of you might be interested to know this in case you haven’t registered to attend yet. We’ll be at the event again and hosting the 5th Annual New Media Meetup at HIMSS.

Here’s the HIMSS notice about the final day to register at the discounted price.

Time’s running out to save on registration fees for HIMSS14.Advanced registration discount ends Monday, January 27.

Don’t miss this opportunity — to save and to be there — when health IT professionals from around the globe converge on Orlando for the best in educationnetworkingsolutions and more.

Be sure to check out the latest HIMSS14 brochure for a preview of the education sessions and the activities that can help you and your organization take advantage of the value gained from health IT.

Register by January 27 and save!

KLAS Names Top EMR Vendors For Mid-Sized Practices

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.

A new report by KLAS has designated Epic, athenahealth and Greenway as the top three EMR vendors among mid-sized healthcare practices.  The report, which also identified unpopular EMRs in the space, drew its conclusions based on analysis of ability, workflow and integration capabilities, according to iHealthBeat.

To do the study, KLAS interviewed clinicians and IT personnel at practices with 11 to 75 doctors.

Researchers named the top three mid-sized EMR vendors as Epic Systems, which scored a 85.3 points out of 100; athenahealth, which scored 83.5 points; and Greenway, which scored 81.3 points.

Each of the top three vendors distinguished themselves in unique ways.  For example, researchers found that practices liked Epic’s consistent delivery in large hospital-based practices, athenahealth’s “nimble deployment” and system updates, and Greenway’s exceptional service to smaller, independent practices.

Meanwhile, KLAS noted that Allscripts, McKesson and Vitera had the highest percentage of dissatisfied customers, practices which felt stuck with their current EMR system but would not purchase it again.  Reasons for their dissatisfaction included upgrade issues, lack of support, and a perceived lack of vendor partnership, iHealthBeat said.

When it comes down to it, it’s pretty clear when these practices need from their vendors, and a feeling of partnership and mutual support seems to top the list of matter which researchers is doing the study.  But it’s clear that these characteristics can be pretty hard to come by, even from companies you’d think had plenty of resources to deliver a sense of support and availability to their customers.  Allscripts, McKesson and Vitera (although it is Greenway now) had better get their act together quickly, as mid-sized medical practices are a major market, even if they don’t spend quite as much as hospitals.

Epic EMR Training, Glucometer Workflow, New Media Meetup & MU Success

Posted on January 26, 2014 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 think this is true for all EMR software, but particularly so for Epic. It’s always amazing how many skimp on EMR training and then pay the price for it later.


It’s a little hard to see, but illustrates the challenge associated with connecting these external data devices. It’s going to take a while for this to be commonplace and normal. I do find it interesting that they’re using Direct and the hardest interface to build (sending info to the EHR) is “Out of Pilot Scope.” I guess they don’t want to take on the hard stuff in the pilot.

These next 2 tweets are a little self serving since they point to posts on my EMR and HIPAA site. If you’re not subscribed to that site, you should go and do that now. Plus, one of these tweets is about a party at HIMSS, so I don’t imagine I’ll get any complaints there.


I hope to see many of you at HIMSS 2014!


I appreciate Dr. Webster recognizing this as a good one. While I’m biased, I think it’s a really important topic that needs more discussion. Although, I’m pretty sure it won’t be getting me an invite to any ONC dinner parties.

Will Healthcare Ever Solve These Issues?

Posted on January 24, 2014 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.

On James Ritchie’s post on EMR and HIPAA extolling the virtues of Patient Portals, Bill made the following comment:

I visited an ENT practice today for the first time. I was referred by my primary care physician. Guess what? NO PATIENT PORTAL! And this is a large multi-location group. Here’s the really strange part…they bought an EHR 10 years ago and are still using paper charts!!! Flabbergasted!

A couple of days ago, I went to their website, downloaded and filled out the forms. (Yes, I typed them). I then called the practice to ask if they wanted me to fax them so they could get my info entered into their system, the girl replied “no, that’s ok, we don’t create your chart until you get here”. That’s how I found out they are still using paper charts. Unreal!

When I arrived for my appointment today, (NOT 30 minutes early) I could tell the girl at the window was ready to jump on me for being “late”, until I handed her my completely filled out forms. She looked at me in utter amazement. She took my drivers license and insurance card (no, they did not have a scanner for either) so I didnt get them back until I was called back and the nurse gave them back to me. So I had to ask the doctor, “why are you not using your EHR”, he replied, “yeah, we need to start using it” He even commented that he couldnt remember any of his patients that actually typed and then printed the PDF forms. Am I the weirdo here?

Earlier, while in the waiting room, I sat and watched patient after patient go up to the window and get the “high tech” clipboard. They then sat down to fill out their forms…all the while stopping from time to time to text or perhaps reply to an email on their smartphones. The irony. I watched sadly as an older woman was trying to get the forms filled out with what appeared to be great difficulty because it was obvious she didn’t have all of the information with her that she needed. But she had a smartphone. More irony.

Just think if my primary care provider and this ENT group were both using EHR and PP. Perhaps I would of had to fill out NOTHING!! All of my info would of been readily available to the ENT doc. I could view the notes from both of the docs..see my reports and tests results and even forward it to another provider of care if necessary. The study is encouraging, but there are going to be so many benefits once PP’s become mainstream.

I responded to Bill with the following comments:

Such a sad story and far too repeated in healthcare today.

I’ve often said if someone could figure out a way for patients to not have to fill out those dang intake forms, they’d have a golden business. Turns out, it’s a really complex problem to solve because of how many parties are involved and the non-standard way they do it.

Yes, we still have a long way to go to solve even some of the most obvious healthcare issues.

McKesson, Meditech Chosen As EHR Test Systems for Meaningful Use

Posted on January 23, 2014 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.

Here’s an interesting situation which is just popped up on my radar screen.  CMS and the ONC have chosen the first two vendors to serve as designated test EHR systems, and they’ve gone with McKesson and Meditech.

These test vendors are there to help eligible providers meet the requirements of Meaningful Use Stage 2.  To meet MU Stage 2 requirements, providers must successfully conduct at least one exchange test with a CMS-designated test EMR. (The providers can also meet the requirements by performing one electronic exchange of a summary of care document with a recipient using a different EMR technology.)

What intrigued me about this is that CMS and ONC are starting out with only two vendors for use as test EMR providers.  Given the diversity in the marketplace, you’d think that CMS would want to have fuller stock of vendors lined up before it went forward announcing its plans.

If I were an eligible provider going this route, I’d want to have the choice of a wider range test EMRs. Given how little real interoperability there is between EMRs, I’d like to know that I had a fallback position if my original tests didn’t work out.  After all, nothing I’ve read here suggests that EPs won’t have a chance to try again if the initial testing doesn’t go through, and if I were a provider, it’d be good to know that I could take the shot with other test EMRs. But I could be wrong, and that could have an effect on whether vendors see this as a win.

Let’s see if other substantial EMR vendors take up the ONC’s call to serve as test EMR participants.  It will be interesting to see whether vendors see participation as a credibility-raiser or a chance to get pantsed publicly if interoperating with their systems is a pain.