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EHR Regulation Vs. Innovation

Posted on February 19, 2014 I Written By

The following is a guest blog post by Marina Simonian, Product Manager and Jessica Naftaniel, Sales & Marketing Coordinator at gMed. Check out gMed’s whitepaper on Independent Gastroenterology.

In the past few years EHR technology vendors and healthcare providers alike have struggled with a myriad of regulatory requirements, from PQRS and eRX incentive programs, to ASC quality reporting, to Meaningful Use, ICD-10 and beyond. The next few years are set to bring even more challenging requirements for interoperability, patient engagement, quality metrics and clinical decision support. Being a technology and services vendor, we always strive to provide the most efficient, innovative and high quality products to our clients.

But how innovative can you get in this era of regulatory overload?

On one hand, innovation on a deadline is almost an oxymoron. Especially with such restrictive guidelines. One could only imagine what type of innovative, amazing solutions could be developed with the amount of time and resources that have been thrown in to meeting regulatory requirements.

On the other hand, necessity is the mother of invention.

As a direct result of numerous new regulatory measures and government requirements, many EHR providers are simply throwing components together to meet requirements and pass a certification.  Features which are put together hastily may make life more difficult for the people using their products, and might not last long on the market.

However, keeping your eye on the long term goal and looking beyond regulation helps to see some of the great benefits that can still arise from this race. When, for example, the DirectTrust and similar organizations come together to facilitate sharing of patient information securely across various healthcare entities, this may be a huge step to, perhaps, someday in the future, being able to tap into a centralized patient record and get the data you need, exactly when you need it, regardless of your location or affiliation.

And while for some vendors it makes perfect sense to focus on a limited number of features and bring value with those few, there are some others who choose to bring the value of integration and are a one-stop-shop for all of their users’ Electronic Health Record software needs. It is not an easy task by any means. And the best attestation to that is in the astounding difference in complete certified EHRs between 2011 and 2014.  In the end, whichever path one chooses, only those who are able to keep the long term focus on innovation above regulation, to put efficiency and ease of use above merely meeting a requirement, and to remember that improvement of patient care and overall population health is the ultimate goal, will be able to withstand the regulatory storms.

For more information on gMed’s innovative technology, visit us at gmed.com. gMed provides the gastroenterology industry with a fully integrated platform consisting of an Electronic Health Record, Endoscopy Report Writer, Practice Management solution, Patient Portal and a Data Analytics tool. Fully scalable through the cloud or using an on-site server, gMed’s products are all Meaningful Use Certified and ICD-10 ready.

Full Disclosure: gMed is an advertiser on this site.

Finding #BlueButton at #HIMSS14

Posted on February 18, 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.

I am having trouble believing HIMSS 14 is just a few days away. I am really looking forward to getting out of Georgia’s erratic weather and into Florida’s warmer temps. At least Orlando weather isn’t erratic. Check out the forecast:

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While I don’t think I’ll have time to lounge by the pool, I do anticipate having some fun playing tennis with a few #HITchicks early Monday morning. I hope Orlando’s daily rain shower holds off until later that afternoon.

I’m also looking forward to the Siemens Media Breakfast, a Lunch and Learn with ePatient Dave, HISTalkapalooza, the #HITsm tweetup, a session on health information and the Disney experience, the Georgia HIMSS networking reception, and of course the New Media Meetup (where you can meet many of your favorite Healthcarescene.com bloggers).

As I’ve been so focused on Blue Button news lately, I thought I’d see how many HIMSS sessions will be devoted to the topic. A quick search at HIMSSConference.org yields three:

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The last session seems the most consumer-friendly, and right up my alley based on its objective of covering the current state of Blue Button, and its general description:

“Join experts from the from the Office of the National Coordinator for Health IT (ONC) in an interactive session to learn more about several major developments in the world of consumer and patient engagement enabled by technology, and how you can participate. This session will cover policy initiatives, standards development, and resources available to members of the private and public sectors from ONC and our many collaborators.”

In other Blue Button news, it appears that “Blue Button healthcare technologies [are] primed to explode in [the] private sector,” according to a brief article at FederalNewsRadio.com. This is basically a rehash of last week’s news that several pharmacy associations and large retailers like Kroger, Walgreens and CVS are working to “standardize their prescription data based on Blue Button policies,” but it serves as a good reminder that Blue Button started out as a VA initiative. Is it just me or does it seem that much of today’s healthcare IT started out via government development or government mandate/incentive?

Feel free to drop me a line if you know of more Blue Button-related activities at HIMSS, or have other interesting events you think I (and my readers) should check out next week.

Post-Acute Facilities Behind On IT Use

Posted on February 17, 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.

A new report from research firm Black Book concludes that smart technology use will be essential to the health of post-acute facilities, which are struggling with Medicare reimbursement changes, more Medicaid patients and newly covered patients from insurance exchanges.

At present, post-acute facilities are still “stuck in a volume-based care mindset,” said Doug Brown, president of Black Book’s parent company, Brown-Wilson Group, in an announcement. “It is going to take a willingness to adapt and commit to using technology to confront the challenges ahead.”

Black Book surveyed 464 providers of long-term and post-acute care, including nursing homes, hospitals, short-term rehabilitation facilities, skilled nursing facilities and hospices in an effort to determine what strategic responses these facilities should make in response to a challenging reimbursement environment and higher demand for post-acute services.

The study, which focused on post-acute IT use, attempts to determine whether there are more efficient ways to improve such care using IT tools. The survey reported on health information exchanges (public and private), quality reporting, health analytics, workflow and care coordination, and patient engagement software/systems.

As things stand, 63% of all post-acute providers report extremely poor or non-existent use of information systems, technology and patient data exchanges, including 79% of all nursing homes and skilled nursing facilities. This is the case despite the fact that 92% of post-acute providers agree that IT platforms for patient data sharing a comprehensive care coordination would improve their organizations’ financial health, as well as improving their ability to function under accountable care systems and lower fee-for-service reimbursement.

To better manage the transition between inpatient care and post-acute environments, it will be necessary to connect physician practices, home health agencies, hospices, outpatient settings, skilled nursing facilities, rehabilitation centers, DME firms, and hospitals, said Brown.

From 5 EHR to the Cloud, EMR Is Just a Tool, Startups to Improve EMR Usability

Posted on February 16, 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.


This is a big preview of coming attraction. EHR vendors are going to have to be ready for this type of EHR purchase going forward. Well, maybe not 5 EHR, but it could be close to as complex. Add in all of the practice acquisitions and the EMR switching is happening.


This is a good reminder. EMR is a tool and how you use it determines its real value.


The real question is whether the EMR systems will allow it or at least which EMR vendors will support it. If they don’t, startups won’t be able to do much. Even if they do open it, I’m still not confident that a startup built on top of today’s EMRs can solve what pains EMR.

Six Years Later, What Has Meaningful Use Accomplished?

Posted on February 15, 2014 I Written By

Dr. Michael J. Koriwchak received his medical degree from Duke University School of Medicine in 1988. He completed both his Internship in General Surgery and Residency in Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center. Dr. Koriwchak continued at Vanderbilt for a fellowship in Laryngology and Care of the Professional Voice. He is board certified by the American Board of Otolaryngology-Head and Neck Surgery. After training Dr. Koriwchak moved to Atlanta in 1995 to become one of the original physicians in Ear, Nose and Throat of Georgia. He has built a thriving practice in Laryngology, Care of the Professional Voice, Thyroid/Parathyroid Surgery, Endoscopic Sinus Surgery and General Otolaryngology. A singer himself, many of his patients are people who depend on their voice for their careers, including some well-known entertainers. Dr. Koriwchak has also performed thousands of thyroid, parathyroid and head and neck cancer operations. Dr. Koriwchak has been working with information technology since 1977. While an undergraduate at Bucknell University he taught a computer-programming course. In medical school he wrote his own software for his laboratory research. In the 1990’s he adapted generic forms software to create one the first electronic prescription applications. Soon afterward he wrote his own chart note templates using visual BASIC script. In 2003 he became the physician champion for ENT of Georgia’s EMR implementation project. This included not only design and implementation strategy but also writing code. In 2008 the EMR implementation earned the e-Technology award from the Medical Association of Georgia. With 7 years EMR experience, 18 years in private medical practice and over 35 years of IT experience, Dr. Koriwchak seeks opportunities to merge the information technology and medical communities, bringing information technology to health care.

In Atlanta we are recovering from one of worst winter storms in many years. Weather events are financially devastating for a medical practice.  Revenue completely stops while expenses continue without interruption.   Today for the first time we saw patients in the office on a Saturday to recover a little.

During our 3 snow days this past week I decided to take on John Lynn’s challenge regarding what I would do if the Meaningful Use (MU) incentive money disappeared.  There has been a range of responses including one person who wouldn’t change a thing about MU.  However, recent data continue to support my long-held opinion that MU has been harmful to health IT and the EMR cause.

Think about where we were before MU was conceived.  Six years ago the NEJM study cited by the designers of MU showed a 4% EMR adoption rate.  Among EMR users the vast majority (72%-96%) reported a positive effect of EMR on patient care.  Among EMR users physician satisfaction was 93%.  Among EMR non-users, the major reasons for not getting an EMR included cost (66%), uncertainty regarding the return on investment (50%), and loss of productivity during implementation (41%).

Six years later, what has MU done for EMRs?  Medical Economics recently released an EHR survey of 967 physicians polled in late 2013 with very disturbing results:

  • 70% did not feel their EHR investment was worth the cost and the effort
  • 73% would not re-purchase their current system
  • 69% report coordination of care has not improved
  • 65% do not believe EHR has improved quality of care.  45% believe EHR has made patient care worse
  • 66% report financial losses resulting from EHR.  38% report significant losses.
  • Lack of system functionality was the most common complaint among EHR users (67%)
  • 45% of all physicians spent over $100,000 on EHR and 77% of the “largest” practices spent over $200,000.  It is unclear whether this is the total practice cost or cost per physician.  Increased staff costs and loss of productivity were also cited as major issues.

Also telling are data reported by CMS last May that a staggering 17% of all providers who attested for the 90 day period required for MU Stage 1 / Year 1 (2011) did not participate the following year.  A CMS survey of these “non-returning providers” (NRPs) showed many of them gave up for reasons related to the MU program as well as reasons related to dissatisfaction with their EMRs.

Analysis of these 3 studies suggests that the satisfaction rate among EMR users has fallen from over 90% to about 30% over the past 6 years.  The proportion of providers that believe EMR improves quality of care has fallen from 82% in 2008 to 35% in the 2013 ME survey.  The misgivings of non-EMR-users in the NEJM 2008 study were proven valid among the dissatisfied EMR-users in the ME 2013 survey: high cost, poor return on investment and loss of productivity.  Even 5 figure financial incentives can’t get MU / EMR participation beyond a very short time of 90 days.

How could EMR’s reputation among EMR users fall so far?  The Meaningful Use program is solely responsible.

Go back to 2008 for a moment.  Had the health IT market been left undisturbed, EMR vendors would have engaged their existing base of satisfied customers in order to improve their products and sell to new customers.  This base of early EMR adopters was unique and special.  Our practice was among those that had a fully functional EMR in 2007-2008.  We shared a vision and saw the potential for information technology to improve health care.   We had both the IT resources and the will to work hundreds of extra hours to build effective EMR systems from products that were almost useless as they came “out of the box.”  We willingly accepted that proposition.

In 2008 the early adopters would have gladly offered their own practices as examples to demonstrate the value of EMR and help their vendors sell to new customers.  This slow, evolutionary growth would have created a stable environment that allowed the health care system to safely assimilate the cultural and operational changes that EMR brings.  This environment would have also supported stable evolution and improvement of EMR products.  The result would have been modest but steady growth in the EMR market for decades to come.

But thanks to MU this never happened.  Replacement of stable, natural market forces with MU incentives drove immediate, explosive short-term growth in the EMR market.  But these MU-driven EMR purchasers are not like the practices before 2008 that freely chose to purchase a system. These practices had decided against EMR initially, at least partly because they lacked the IT resources to make EMR work for them.   MU coerced them to purchase EMR against their better judgment.

I have spoken with many of these physicians.  They do not share the inspiration and vision of the early adopters.  They are rightly unhappy and cynical, forced by MU to spend huge amounts of money on unproven, underdeveloped EMR products that they did not want and were not prepared to properly use. To these practices the question of EMR’s potential is irrelevant.  In their minds MU (and by association EMRs) lives next to HIPAA, SGR and RAC audits as another method for the government to intimidate doctors and intrude upon their practices.

The MU program gave EMR vendors what they wanted – legislation requiring hundreds of thousands of providers to buy EMR products, with no need to prove that those products do anything useful.  But here’s the bad news: the Feds got what they wanted as well.  Through MU they created an EMR industry that is dependent on government incentives and penalties to maintain a stream of new customers.  This gives them complete control of the EMR market.  There is more bad news.  MU also destroyed the base of satisfied EMR customers from 2008, replacing it with a much larger base of unhappy, resentful customers.

So what happens as MU payments decrease with each passing year as MU requirements go up?  Who can argue that the market won’t collapse without another EMR stimulus package?  John Lynn’s question is appropriate and timely.  MU incentives will indeed disappear over the next couple of years.  How the EMR market will survive is not clear.

Most Healthcare Programs Are Focusing on the Wrong Populations

Posted on February 14, 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.

It’s been a crazy busy day. In fact, make that a crazy busy month. I can barely keep up as I prepare for HIMSS, finish planning for the Healthcare IT Marketing and PR Conference (early bird registration ends tomorrow), and work on all of the other balls I have in the air. Luckily, all of these things and many more are really great things.

With that excuse out of the way, I wanted to do a really simple blog post today asking an interesting question. I can’t remember where I heard this idea, but I wanted to get your ideas. Here’s the question:

Are most healthcare programs focusing on the wrong populations?

That’s a pretty broad question that could have a lot of different answers depending on which program we’re talking about. However, I think it’s a discussion worth having.

Are the current healthcare programs just making the healthy healthier? Are we transgressing the populations that could most use healthcare? Are we designing applications and devices that could be really beneficial, but they’re not being adopted by those who could benefit from them most?

I’d love to hear your thoughts.

Survey Takers Show No Love for EMRs

Posted on February 13, 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.

Just in time for Valentine’s Day … in case it hasn’t crossed your device or desk, Modern Economics – a self-described web community for health professionals – recently released the results of a survey that attempted to gauge physicians’ satisfaction with EHRs. Of the nearly 1,000 folks polled, nearly 70% concluded their investment in EHRs had not been worth it. Other stats included:

  • 67% are dissatisfied with system functionality
  • 65% indicated systems resulted in financial losses
  • 45% indicated patient care is worse
  • 69% indicated care coordination has not improved
  • 73% of largest practices would not purchase current system

These numbers certainly reflect what many in the industry have been saying for the last few years, but I find the statistics related to care incredibly high. My friends over at HISTalk.com reported that survey takers were “self-selected,” so I have to wonder if the entire field of respondents was skewed to the negative from the beginning.

I came across an interesting tweet exchange about the survey results:

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I’m no expert, but I definitely think the horse has left the barn, and that if a more impartial survey were done, we’d find more providers satisfied with EHRs and their impact on patient care.

In Blue Button news, I came across several articles this week announcing that leading pharmacies and retailers have joined the Blue Button movement. According to HealthIT.gov, these organizations are “committing to work over the next year towards standardizing patient prescription information to fuel the growth of private-sector applications and services that can add value to this basic health information.”

It’s encouraging to see businesses like Walgreens and Kroger – two places I shop at –  pledge to bring more awareness of health data to their customers. Perhaps my next post will shed light on how these businesses will accomplish their Blue Button goals.

Healthcare IT Pulse 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.

The people at eFax did a survey to look at the pulse of Healthcare IT. They have some interesting findings from their survey that they turned into an infographic. Not surprisingly, we still trust faxing in healthcare.

Healthcare IT Pulse Infographic

Meaningful Use Payouts Hit $19 Billion

Posted on February 12, 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.

The pace of meaningful use payouts has stayed strong of late, with CMS disclosing that it has disbursed more than $19 billion in EMR usage incentives. While hospitals have been particularly prone to stay on the meaningful use train, eligible providers are collecting their payouts too, according to Healthcare IT News.

According to CMS data, there were 440,998 registered providers participating in the federal EMR incentive program as of the end of 2013, who have to date received 19.2 billion in incentives.

About 88 percent of all eligible hospitals have been given EMR incentive payment so far, according to CMS officials.  Also, about 60 percent of Medicare eligible providers are meaningful users of EMRs, the agency reports.

And the meaningful use programs for Medicare and Medicaid are both active, with more than 340,000 eligible providers having received an incentive payments to their program. Medicaid eligible providers are distinctly less likely to be involved in the meaningful use program; only 20 percent of Medicaid EP’s are meaningful users.

What the Healthcare IT News article doesn’t discuss, but ought to, is that there is considerable evidence that many doctors are not willing to push beyond Stage 1 of meaningful use. Stats suggest that these doctors have little financial incentive to move ahead with Stage 2, and can’t afford the time or money to push through the MU 2 obstacles.

In other words, before CMS runs a victory lap, it might do well to see what’s happening with the doctors walking away from the program.

Value of Meaningful Use – Perspective from EHR Executive at simplifyMD

Posted on February 11, 2014 I Written By

The following is a guest blog post by Michael Brozino, in response to the question I posed in my “State of the Meaningful Use” call to action.

If MU were gone (ie. no more EHR incentive money or penalties), which parts of MU would you remove from your EHR immediately and which parts would you keep?

Michael Brozino
Michael Brozino
Michael Brozino, CEO of simplifyMD

If Meaningful Use were no longer a requirement, we would keep our software the same. I say this because there is nothing in our system that was built within the requirements of Meaningful Use that weren’t deployed with the intent of improving patient engagement, enhancing public health, promoting health record portability and improving software interoperability. The fact that 100 percent of our users who have chosen to attest for MU have been successful is certainly a benefit, but we don’t see much reason to remove any functionality unless the user’s benefit diminishes significantly and it becomes too expensive to support and implement.

Rather, if MU disappeared, we would hope that the entire healthcare industry or government would implement centralized, universal healthcare data exchanges and/or hubs to ease interoperability and promote uniformity. Features such as personal health records, electronic delivery of labs and receipt of orders, syndromic surveillance data, state immunization records, clinical decision support rules, secure patient messaging, and many others could have been easily implemented if the government fully committed to putting them in place. By only going halfway, standardization is left to a group of players that by their very nature are opinionated and independent.

ePrescribing, for example, has thrived because a central hub exists to allow competitors to quickly join the network. Competition between these organizations is now about who delivers the best user experience, the best customer support, and who adds the most value to their product. If such a central exchange were created for the interoperability requirements in MU, we would have already surpassed the goals of Stages 2 and 3 by 2014.

See other responses to this question here.