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Impact of EHR and Technology on Nurses’ Wellbeing Infographic

Posted on August 29, 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.

Who doesn’t like an informative infographic? I don’t think we’ve talked enough about the ergonomics of EHR. This is going to become a really big issue for nurses, doctors, front desk staff, etc. It’s good news for the chiropractors though.

ergotron_hospital_infographic

Do We Really Like the JASON Recommendations for Interoperable Health Data?

Posted on August 28, 2014 I Written By

Andy Oram is an editor at O’Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space.

Andy also writes often for O’Reilly’s Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O’Reilly’s Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The health IT community has been abuzz over the past few months about a report released by the Agency for Healthcare Research and Quality. Although the report mostly confirmed thoughts that reformers in the health IT space have been discussing for some time, seeing it aired in an official government capacity was galvanizing. The Office of the National Coordinator has held several forums about the report, known by the acronym JASON, and seems favorably inclined toward its recommendations.

Even though only four months have passed since its publication, we can already get some inkling of how it will fare at the ONC, which is going through major realignment of its own. And to tell the truth, I don’t see much happening with the JASON recommendations. In this article I’ll look at what I see to be its specific goals, and what I’ve heard regarding their implementation:
Read more..

One Physician’s Experience Seeing an Ophthamalogist Pre and Post EHR

Posted on August 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.

I always love to hear doctor’s perspectives on EHR and how they’re impacting their day. You can be certain that they’ll lead with a long list of complaints. Many of the initial complaints are minor things that can be easily resolved with workflow or by a small enhancement by the EHR vendor. Once you get past the initial complaints, then you get to the heart of what they really think about the EHR software. I’ve had this experience hundreds of times and it’s always insightful.

However, this time a doctor shared something even more interesting. This was a doctor visiting another doctor as a patient. Rather than put words in his mouth, I’ll just share with you what he shared with me (EHR vendor name excluded since this could apply to many different EHR vendors):

I was in my ophthalmologist today. He is a really nice, busy doctor. He is in group practice and used to run his wing with one long time nurse with no hassles. He could previously see a patient in 10 min finish refraction, move from room to room and breeze through cases jotting what he needed to write down on one clean ophthalmology SOAP note. Since 2011 they have had EHR Vendor A. (because a consultant sold them on it and promised rewards from CMS)

Today, It took them a total of 1.5 hours to get my refraction, eye exam done. The workflow seemed to be in a complete disarray (remember this is an installed cloud based software since 2011, supposed to the be cream of the crap for Ophthalmology). What shocked me the most was that he now has 4 ladies doing inane things with EMR, trying to help him. I can also see why errors can creep in because he was reading out numbers for the assistant/ Nurse to enter into EHR Vendor A. Distraction fatigue, EMR ennui can cause errors of entry. So the cost of running crappy software far exceeds the physical costs / monthly service costs of the product. It amplifies personnel costs. It took the lady 20 minutes to take totally pointless history and do ROS!

I did not tell her I was a physician and she was clicking away to glory. I counted more than 50 clicks before anything of substance was even gathered. Based on the EMR prompts she made me do finger counting and asking me if I can see her face etc..>! I had clearly indicated to her that I just wanted a retinal exam and prescription for glasses because I wanted to buy new lenses and that I had not required change of prescription for glasses in 10 years!

Then I walk out with mydriatic in my eyes…and saw a hazy illusion of one of my ex-patients, a severe schizophrenic waiting for his turn to be checked in. He was talking about meeting Jesus and asked if I have had a “meeting Jesus moment” in my life.. I assured him I just did…

In those 1 hr and 45 min, the good doctor had seen just 4 patients and 6 more were still waiting impatiently on one arse looking irate, checking their iphones and smart watches …spreading anxiety.

I’m always torn on sharing these type of stories. I know that this doesn’t have to be the case since I know many EHR users who don’t have these issues. However, far too many of them do that it’s worth keeping this perspective in mind. Plus, regardless of how efficiently someone has incorporated the MU requirements, it’s had a huge impact on everyone that’s participating.

I guess it’s fair to say that the above ophthamologist doesn’t agree that meaningful use saves a doctor time.

Trying to Regulate Twitter

Posted on August 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 recently saw a bunch of people tweeting about a conference in Milan which was supposedly trying to regulate the use of Twitter at the medical meeting. It turns out that the post about what you should tweet about at the meeting was mostly a joke and the comments that were highlighted were largely taken out of context. Plus, it wasn’t the organizer of the event that did the post, but just a participant in the conference. Because of the stir up, the post was taken down, but Dr. Bryan Vartabedian captured a piece of the post in his commentary:

The social side of any conference is important, and Twitter, being part of the social media, will naturally show that side. There is, however, a danger that the orchestra’s symphony will be drowned out by foot-shuffling, program brandishing, and a general clucking and chattering.

Ironically, this story ends up being a case of where Twitter can go wrong. It’s easy to misconstrue what people mean in a blog post or on Twitter. I have it happen all the time with the blog posts I write. I’m often amazed at people’s responses to my blog post since they either miss the point of my post or they think I’m making a point which is definitely not the case. Over time I think I’ve gotten better at this, but with thousands of readers over thousands of blog posts there’s bound to be a miscommunication. The great thing is that once I engage them, there’s usually clarity. But I digress…

Regardless of the particular situation at the medical meetings in Milan, the discussion of regulating Twitter (feel free to insert other social media as well) is a really good one. Although, it doesn’t just apply to meetings. I’ve seen many people try and regulate what’s done on all sorts of hashtags or other social media. I find the efforts people make to control other people on social media entertaining.

I’m sure this says a lot about me, but when someone tries to regulate what’s said or done on a hashtag on Twitter (meeting or otherwise), it just makes me want to do the opposite. While I have that innate need to not be controlled (some might call it rebellion), the reality is that I take a much more pragmatic approach to people’s suggestions about what should be said or done with a hashtag. I use a simple measure: “Will their suggestion make me a better part of the community?” (Yes, communities come together around hashtags) If I think that someone’s suggestion is a good one that will make me a better part of that community, then I usually listen. If I don’t think their suggestion matters or actually detracts from the community, then I ignore. Do I make mistakes? Absolutely, but this is my approach to it.

My personal approach aside, the reality is that even if you want to control what happens on Twitter and with certain hashtags, you can’t! If someone wants to be a bad actor in a hashtag community, then they’re going to do it. Bad community actors aren’t usually listening to the other people in the community anyway. So, trying to police it usually just leaves you dirtying the conversation stream even more.

Personally, I love the diversity and freedom that’s seen by participants in a Twitter stream. It tells me a lot about the person or company. Plus, I like the human elements of Twitter as well. I love to see that someone’s excited about a conference, their puppy, a great meal, a certain vendor, etc. Those that only talk about these things I can easily block if needed, but the reality is that a tweet is so easily consumed I can skip over any that don’t interest me.

I know many people hate when a Twitter stream is overwhelmed with vendor tweets at a conference as well. This doesn’t bother me much. It tells me a lot about the vendor as well. If they don’t care enough to be thoughtful in their tweeting, do they also not care enough about their product? Plus, if they’re spamming the stream with sales tweets, is that how I’ll be treated as a customer? This is good for me to know and so I don’t mind seeing their true form on Twitter.

With that said, I have found that the quality of a hashtag Twitter stream is directly proportional to the number of humans that are tweeting on that hashtag. Social media is about connecting people and so it makes sense that when more people (as opposed to no personality companies) are participating, then it’s a better experience.

I’m sure many will still try and influence what’s done on a Twitter stream. More power to them, but it’s a losing battle. Instead of trying to regulate Twitter, I think we’re better served encouraging and promoting those people and tweets that are adding value to the hashtag community. Plus, we can contribute value to the stream ourselves. There are bad actors in every community in the world. However, if enough good people are on board adding value, then the bad actors fade into the background.

Ten-year Vision from ONC for Health IT Brings in Data Gradually

Posted on August 25, 2014 I Written By

Andy Oram is an editor at O’Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space.

Andy also writes often for O’Reilly’s Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O’Reilly’s Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

This is the summer of reformulation for national U.S. health efforts. In June, the Office of the National Coordinator (ONC) released its 10-year vision for achieving interoperability. The S&I Framework, a cooperative body set up by ONC, recently announced work on the vision’s goals and set up a comment forum. A phone call by the Health IT Standards Committeem (HITSC) on August 20, 2014 also took up the vision statement.

It’s no news to readers of this blog that interoperability is central to delivering better health care, both for individual patients who move from one facility to another and for institutions trying to accumulate the data that can reduce costs and improve treatment. But the state of data exchange among providers, as reported at these meetings, is pretty abysmal. Despite notable advances such as Blue Button and the Direct Project, only a minority of transitions are accompanied by electronic documents.

One can’t entirely blame the technology, because many providers report having data exchange available but using it on only a fraction of their patients. But an intensive study of representative documents generated by EHRs show that they make an uphill climb into a struggle for Everest. A Congressional request for ideas to improve health care has turned up similar complaints about inadequate databases and data exchange.

This is also a critical turning point for government efforts at health reform. The money appropriated by Congress for Meaningful Use is time-limited, and it’s hard to tell how the ONC and CMS can keep up their reform efforts without that considerable bribe to providers. (On the HITSC call, Beth Israel CIO John Halamka advised the callers to think about moving beyond Meaningful Use.) The ONC also has a new National Coordinator, who has announced a major reorganization and “streamlining” of its offices.

Read more..

Health IT Gets Into the ALS Ice Bucket Challenge

Posted on August 22, 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.

The ALS ice bucket challenge has finally made its way to heatlhcare IT companies. I’m sure at some point I’ll get tired of seeing these videos, but it hasn’t happened yet. There’s something really enjoyable about watching someone get a bucket of ice water dumped on them. Especially people you wouldn’t expect to do it.

Here are two of the latest Health IT people to take part in the challenge.

Neal Patterson, CEO of Cerner accepts the ALS Ice Bucket Challenge

Neal challenges John Glaser, CEO of Siemens Health Services, and he accepted

John Glaser has nominated the whole Simens Health Services employees to take the challenge. So, there are more videos to come. What could bring a company together more than all dumping a bucket of ice on each other?

What an amazing effort for ALS too. The ALS site just noted that donations have reached $53 million. I want to see Judy Faulkner take part.

Digital Health: How to Make Every Clinician the Smartest in the Room

Posted on August 21, 2014 I Written By

The following is a guest blog post by Dr. Mike Zalis, practicing MGH Radiologist and co-founder of QPID Health.
Zalis Headshot
Remember the “World Wide Web” before search engines? Less than two decades ago, you had to know exactly what you were looking for and where it was located in order to access information. There was no Google—no search engine that would find the needle in the haystack for you. Curated directories of URLs were a start, but very quickly failed to keep up with the explosion in growth of the Web. Now our expectation is that we will be led down the path of discovery by simply entering what’s on our mind into a search box. Ill-formed, half-baked questions quickly crystalize into a line of intelligent inquiry. Technology assists us by bringing the experience of others right to our screens.

Like the Internet, EHRs are a much-needed Web of information whose time has come. For a long time, experts preached the need to migrate from a paper-based documentation systems – aka old school charts—to electronic records. Hats off to the innovators and the federal government who’ve made this migration a reality. We’ve officially arrived: the age of electronic records is here. A recent report in Health Affairs showed that 58.9% of hospital have now adopted either a basic or comprehensive EHR—this is a four-fold increase since 2010 and the number of adoptions is still growing. So, EHRs are here to stay. Now, we’re now left to answer the question of what’s next? How can we make this data usable in a timely, efficient way?

My career as a radiologist spanned a similar, prior infrastructure change and has provided perspective on what many practitioners need—what I need—to make the move to an all-electronic patient record most useful: the ability to quickly get my hands on the patient’s current status and relevant past history at the point-of-care and apply this intelligence to make the best decision possible. In addition to their transactional functions (e.g., order creation), EHRs are terrific repositories of information and they’ve created the means but not the end. But today’s EHRs are just that—repositories. They’re designed for storage, not discovery.

20 years ago, we radiologists went through a similar transition of infrastructure in the move to the PACS systems that now form the core of all modern medical imaging. Initially, these highly engineered systems attempted to replicate the storage, display, and annotation functions that radiologists had until then performed on film. Initially, they were clunky and in many ways, inefficient to use. And it wasn’t until several years after that initial digital transition that technological improvements yielded the value-adding capabilities that have since dramatically improved capability, efficiency, and value of imaging services.

Something similar is happening to clinicians practicing in the age of EHRs. Publications from NEJM through InformationWeek have covered the issues of lack of usability, and increased administrative burden. The next frontier in Digital Health is for systems to find and deliver what you didn’t even know you were looking for. Systems that allow doctors to merge clinical experience with the technology, which is tireless and leaves no stone unturned. Further, technology that lets the less-experienced clinician benefit from the know-how of the more experienced.

To me, Digital Health means making every clinician the smartest in the room. It’s filtering the right information—organized fluidly according to the clinical concepts and complex guidelines that organize best practice—to empower clinicians to best serve our patients. Further, when Digital Health matures, the technology won’t make us think less—it allows us to think more, by thinking alongside us. For the foreseeable future, human experience, intuition and judgment will remain pillars of excellent clinical practice. Digital tools that permit us to exercise those uniquely human capabilities more effectively and efficiently are key to delivering a financially sustainable, high quality care at scale.

At MGH, our team of clinical and software experts took it upon ourselves some 7 years ago to make our EHR more useful in the clinical trench. The first application we launched reduced utilization of radiology studies by making clinicians aware of prior exams. Saving time and money for the system and avoiding unnecessary exposure for patients. Our solution also permitted a novel, powerful search across the entirety of a patient’s electronic health record and this capability “went viral”—starting in MGH, the application moved across departments and divisions of the hospital. Basic EHR search is a commodity, and our system has evolved well beyond its early capabilities to become an intelligent concept service platform, empowering workflow improvements all across a health care enterprise.

Now, when my colleagues move to other hospitals, they speak to how impossible it is to practice medicine without EHR intelligence—like suddenly being forced to navigate the Internet without Google again. Today at QPID Health, we are pushing the envelope to make it easy to find the Little Data about the patient that is essential to good care. Helping clinicians work smarter, not harder.

The reason I chose to become a physician was to help solve problems and deliver quality care—it’s immensely gratifying to contribute to a solution that allows physicians to do just that.

Dr. Mike Zalis is Co-founder and Chief Medical Officer of QPID Health, an associate professor at Harvard Medical School, and a board certified Radiologist serving part-time at Massachusetts General Hospital in Interventional Radiology. Mike’s deep knowledge of what clinicians need to practice most effectively and his ability to translate those needs into software solutions inform QPID’s development efforts. QPID software uses a scalable cloud-based architecture and leverages advanced concept-based natural language processing to extract patient insights from data stored in EHRs. QPID’s applciations support decision making at the point of care as well as population health and revenue cycle needs.

An Image Worth 1000 Words Offers a Great Healthcare Perspective

Posted on August 20, 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 have no idea where this picture comes from, but it’s a pretty interesting look into some of the history of medicine. As @notasmedicina points out, it’s pretty disturbing to see them working on someone without gloves. Take a look below to see what I mean.

As I saw this, I thought about how far we’ve come with EHR software. I wonder if 20-30 years from now we’ll look at a picture of a paper chart and feel disturbed. I imagine my children will look at it and wonder how a doctor could practice medicine with a paper chart.

Could Population Health Be Considered Discrimination?

Posted on August 19, 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.

Long time reader of my site, Lou Galterio with the SunCoast RHIO, sent me a really great email with a fascinating question:

Are only the big hospitals who can afford the very expensive analytics pop health programs going to be allowed to play because only they can afford to and what does that do to the small hospital and clinic market?

I think this is a really challenging question. Let’s assume for a moment that population health programs are indeed a great way to improve the healthcare we provide a patient and also are an effective way to lower the cost of healthcare. Unfortunately, Lou is right that many of these population health programs require a big investment in technology and processes to make them a reality. Does that mean that as these population health programs progress, that by their nature these programs discriminate against the smaller hospitals who don’t have the money to invest in such programs?

I think the simple answer is that it depends. We’re quickly moving to a reimbursement model (ACOs) which I consider to be a form of population health management. Depending on how those programs evolve it could make it almost impossible for the small hospital or small practice to survive. Although, the laws could take this into account and make room for the smaller hospitals. Plus, most smaller hospitals and healthcare organizations can see this coming and realize that they need to align themselves to survive.

The other side of the discrimination coin comes when you start talking about the patient populations that organizations want to include as one of their “covered lives.” When the government talks about population health, they mean the entire population. When you start paying organizations based on the health of their patient population, it changes the dynamic of who you want to include in your patient population. Another possible opportunity for discrimination.

Certainly there are ways to avoid this discrimination. However, if we’re not thoughtful in our approach to how we design these population health and ACO programs, we could run into these problems. The first step is to realize the potential issues. Now, hopefully we can think about them going forward.

Hospital M&A Cost Boosted Significantly By Health IT Integration

Posted on August 18, 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.

Most of the time, hospital M&A is sold as an exercise in saving money by reducing overhead and leveraging shared strengths. But new data from PricewaterhouseCoopers suggests that IT integration costs can undercut that goal substantially. (It also makes one wonder how ACOs can afford to merge their health IT infrastructure well enough to share risk, but that’s a story for another day.)

In any event, the cost of integrating the IT systems of hospitals that merge can add up to 2% to the annual operating costs of the facilities during the integration period, according to PricewaterhouseCoopers. That figure, which comes to $70,000 to $100,000 per bed over three to five years, is enough to reduce or even completely negate benefits of doing some deals. And it clearly forces merging hospitals to think through their respective IT strategies far more thoroughly than they might anticipated.

As if that stat isn’t bad enough, other experts feel that PwC is understating the case. According to Dwayne Gunter, president of Parallon Technology Solutions — who spoke to Hospitals & Health Networks magazine — IT integration costs can be much higher than those predicted by PwC’s estimate. “I think 2% being very generous,” Gunter told the magazine, “For example, if the purchased hospital’s IT infrastructure is in bad shape, the expense of replacing it will raise costs significantly.”

Of course, hospitals have always struggled to integrate systems when they merge, but as PwC research notes, there’s a lot more integrate these days, including not only core clinical and business operating systems but also EMRs, population health management tools and data analytics. (Given be extremely shaky state of cybersecurity in hospitals these days, merging partners had best feel out each others’ security systems very thoroughly as well, which obviously adds additional expenses.) And what if the merging hospitals use different enterprise EMR systems? Do you rip and replace, integrate and pray, or do some mix of the above?

On top of all that, working hospital systems have to make sure they have enough IT staffers available, or can contract with enough, to do a good job of the integration process. Given that in many hospitals, IT leaders barely have enough staff members to get the minimum done, the merger partners are likely costly consultants if they want to finish the process for the next millennium.

My best guess is that many mergers have failed to take this massive expense into account. The aftermath has got to be pretty ugly.