Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and EHR for FREE!

Integrating Devices, Patients, and Doctors: HealthTap Releases an App for the Apple Watch

Posted on April 16, 2015 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.

Doesn’t HealthTap want the same thing as all the other web sites and apps crowding into the health space? Immediate and intimate connections between doctors and patients. Accurate information at your fingertips, tailored to your particular condition. Software that supports your goals where automation makes sense and gets out of the way at other times.

HealthTap pursues this common vision in its own fashion. This week, its announcement of an app for Apple Watch pulls together the foundations HealthTap has been building and cleverly uses the visceral experience that the device on your wrist offers to meet more of the goals of modern, integrated health care.
Read more..

Annual Evaluation of Health IT: Are We Stuck in a Holding Pattern? (Part 3 of 3)

Posted on April 15, 2015 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 previous installments of this article covered major regulatory initiatives and standards projects. Some of the same questions have a direct impact on technological advances.

Medical Devices: Always With You, But Neither Here Nor There

One ad I saw compares a fitness device to a friend whispering in your ear wherever you go. Leaving aside control freak issues, what could be better for a modern patient with a condition that responds to behavior change than a personal device? Through such devices, we can implement a 24/7 cycle of medical care. We can also save enormous sums of money by treating the patient in his natural environment instead of a hospital or rehab facility.

The rapid spread of health devices was a foregone conclusion even before Apple thrust it into the mainstream with HealthKit. Last month’s launch of ResearchKit suggests that Apple will do the same for the big data revolution in health care championed by the Personal Genome Project, 23andMe (now back in the business after being reined in by the FDA), PatientsLikeMe, and other pioneer organizations. Apple Watch, an indulgence expected to grab the hearts of the affluent, might pull off the paradigm shift in how we interact digitally that Google Glass aimed at.

For these devices to make the leap from digital pets to real medical intervention, including a strengthening of the bond between clinicians and patients, they must satisfy stringent requirements for safety and accuracy. Current FDA regulations distinguish (in very rough terms–I am not a lawyer) between devices that make diagnoses or recommend treatments and other devices that merely measure vital signs or deliver reminders. If you make a diagnosis or recommend a treatment, you need to undergo a complex and expensive evaluation. People can also submit problems they find about your device to FDA’s medical device database.

Safety, accuracy, and transparency are goals well worth pursuing. The problem is not the cost of certification techniques, but the vast gulf between the development model assumed by certification and the one followed by modern developers of both software and hardware.

Development methods nowadays are agile. Developers incrementally release versions of software or hardware and upgrade them every few months. But certification processes require retesting every time the smallest change is made. And that’s reasonble because any tweak (even a configuration change out in the field) can cause a working device to fail. Such certifications work well for embedded systems in airplanes and nuclear facilities, and even critical medical devices that may live in patients’ bodies for decades. But they slow innovation to a crawl and raise prices precipitously.

Oddly enough, the tension between agile development and certification affects medical devices and electronic health records (EHRs) equally, and EHRs are equally prone to errors or misleading interfaces. Yet medical devices are regulated while EHRs are not. This contradiction must be resolved–but perhaps not by dropping the anvil of safety certification on all software used in medicine. The FDA can search for a more supple regulatory process that blesses certain classes of hardware and software while allowing for variation within them, backed up by guidelines for robust development and testing.

The FDA understands that it’s in an untenable situation but doesn’t know what to do. They have shaved off certain devices and marked them for lower levels of scrutiny, such as devices that transfer or display data collected elsewhere. The FDA has also led a muddled discussion over a national “test bed” for medical devices. More regulatory clarity in the area of both devices and EHRs, along with a push by regulators and users for better development practices, could help the field take off and realize the promise of personal devices.

Conclusion

I’m excited about the possibilities of health IT, but concerned that the current environment is insufficiently friendly for its deployment. On top of all the other factors I’ve cited that hold back the field, consider the urgent shortage of health IT staff. Providers and development firms have been bidding up salaries to steal each other’s employees, and attempts to increase the pool have shown disappointing results.

What I hear is that IT experts would love to get into health care, knowing that it can help the public immensely as well as pay off financially. But they have balked at the technical and working conditions in the field: hide-bound institutions, 50-year-old standards and tools, and of course the weight of standards and regulations to study.

How many of these topics will be covered at HIMSS? FHIR will be widely considered, I know, and the buzz over Meaningful Use is always strong. The question what will prod change in the system. Ultimately, it may come from a combination of consumer demand and regulatory pressure. Progress for the sake of progress has not been a prominent trait of health IT.

Annual Evaluation of Health IT: Are We Stuck in a Holding Pattern? (Part 2 of 3)

Posted on April 14, 2015 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 previous installment of this article was devoted to the various controversies whirling around Meaningful Use. But there are lots of other areas of technology and regulation affecting the progress (or stasis) of health IT.

FHIR: Great Promise, But So Far Just a Promise

After a decade or so of trying to make incompatible formats based on obsolete technology serve modern needs such as seamless data exchange, the health IT industry made a sudden turn to a standard invented by a few entrepreneurial developers. With FHIR they pulled on a thread that will unravel the whole garment of current practices and standards, while forming the basis for a beautiful new tapestry. FHIR will support modern data exchange (through a RESTful API), modern security, modern health practices such as using patient-generated data, and common standards that can be extended in a structured manner by different disciplines and communities.

When it’s done, that is. FHIR is still at version 0.82. Any version number less than 1, in the computer field, signals that all sorts of unanticipated changes may still be made and that anyone coding around the standard risks having to rip out their work and starting over. Furthermore, FHIR is a garment deliberately designed with big holes to be filled by others:

  • Many fields are defined precisely, but elements of the contents are left open, such as the units in which medicine is measured. This is obviously a pretty important detail to tie down.

  • Security relies on standards in the OpenID/OAuth area, which are dependable and well known by developers through their popularity on the Web. Still, somebody has to build this security in to health IT products.

  • Because countries and medical disciplines vary so greatly, the final word on FHIR data is left to “profiles” to be worked out by those communities.

One health data expert I talked to expressed the hope that market forces would compel the vendors to cooperate and make sure these various patches are interoperable as they are pieced into the garment. I would rather design a standard with firm support for these things.

Some of the missing pieces can be supplied relatively painlessly through SMART, an open API that predates FHIR but has been ported to it. An impressive set of major vendors and provider organizations have formed the Argonaut project to carry out some tasks with quick pay-offs, like making security work and implementing some high-value profiles. Let’s hope that FHIR and its accompanying projects start to have an impact soon.

The ONC has repeatedly expressed enthusiasm for FHIR, and CMS has alerted vendors that they need to start working on implementations. Interestingly, the Meaningful Use Stage 3 recommendation from CMS announces the opinion that health care providers shouldn’t charge their patients for access to their data through an API. An end to this scandalous exploitation of patients by both vendors and health care providers might have an impact on providers’ income.

Accountable Care Organizations: Walls Still Up

CMS created ACOs as a regulatory package delivering the gifts of coordinated care and pay-for-value. This was risky. ACOs require data exchange to effect smooth transfers of care, but data exchange was a rare occurrence as late as 2013, and the technical conditions have not changed since then so I can’t imagine it’s much better.

Pay-for-value also calls for analytics so providers can stratify populations and make rational choices. Finally, the degree of risk that CMS has asked ACOs to take on is pretty low, so they are not being pushed too hard to make the necessary culture changes to benefit from pay-for-value.

All that said, ACOs aren’t doing too badly. New ones are coming on board, albeit slowly, and cost savings have been demonstrated. An article titled “Poor interoperability, exchange hinders ACOs” actually reports much more positive results than the title suggests. There may be good grounds for ONC’s pronouncement that they will push more providers to form ACOs.

Still, ACOs are making a slow tack toward interoperability and coordinated care. The walls between health care settings are gradually lowering, but providers still huddle behind the larger walls of incompatible software that has trouble handling analytics.

I’ll wrap up this look at progress and its adversaries in the next installment of this article.

Annual Evaluation of Health IT: Are We Stuck in a Holding Pattern? (Part 1 of 3)

Posted on April 13, 2015 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.

I don’t think anyone has complained of excessive long-term thinking among health care providers. But an urgent lack of planning has worsened in the past few months as key drivers of the health IT field search for new directions. Given today’s issues with Meaningful Use Stage 3, the FHIR data exchange standard, Accountable Care Organizations, medical device regulation, and health IT staffing, I expect the next several months to be a time of waiting.

This article will look over what has happened during the past year and try to summarize large-scale trends. I used to report annually from the HIMSS conference, the largest health IT gathering in the US, but stopped going because my articles were always cynical, cantankerous, and depressed. So I figure I just write up a cynical, cantankerous, and depressed summary of what’s happening in health IT from home.

Meaningful Use Stage 3: Shoot the Moon?

There are clear indications that the Meaningful Use program has gone off the tracks. I don’t consort with those who disparaged Meaningful Use from the start and claimed that it held back progress in the IT field. What little progress has occurred can be credited to Meaningful Use, because frankly, the health care industry was totally mired before. Choose your favorite metaphor: deer in the headlights (of oncoming disruptive competitors), ostrich in the sand, even possum in the road.

And no one can challenge that Stage 1 met its (very limited) goals. Centers for Medicare & Medicaid Services (CMS) just reported that the vast majority of hospitals have attested to Stage 1 (with rural and children’s hospitals lagging significantly). In fact, while defining Stage 3, CMS could remove some of its requirements because they have “topped out,” meaning that almost everybody already does them.

All the sharper is the contrast between Stage 1 and Stage 2, which was supposed to be incremental but apparently broke the camel’s back for many EHR vendors as well as providers, a lot of whom have thrown in the towel.

Interoperability was certainly a big stumbling block. Two different EHRs can claim to support a standard (such as the C-CDA) while not actually being able to exchange data in a useful manner, for reasons ranging from outright errors to differing interpretations of a fuzzy standard.

But the most whining from providers in Stage 2 arose over a requirement that patients view, transmit, or download (VDT) data from a patient portal. Even though providers needed only 5% of their patients to take a look at the site, they complained bitterly that they were being judged for something that relied on somebody else’s behavior (their patients).

The VDT measure is indeed a responsibility that depends on the behavior of outsiders (as are the interoperability requirements). But health providers seem slow to grasp the whole idea of “pay-for-value,” which means they won’t be rewarded in the future for doing stuff–they’ll be rewarded for results. Not that patients will get healthier just by viewing or transmitting data. But we need something measurable to mark progress, and since everybody issues paeons to patient engagement, the VDT measure is a natural one.

Calls have come from around the industry to water down or otherwise “simplify” Meaningful Use for Stage 3. A common request is to eliminate clinical quality measures (such as how many patients smoke) and focus on interoperability, which I oppose.

To muddy the Meaningful Use landscape further, Congress has started weighing in with complaints that the Office of the National Coordinator (ONC) hasn’t done enough to achieve its goals. One proposed bill overrides ONC and CMS to mandate changes in health care policy. There are rumors that Congress (who of course created the Meaningful Use provision in the first place) will take it back and do some serious micromanagement, perhaps as part of a bill on a totally different topic, the “doc fix” that is supposed to regularize Medicare payments.

In the midst of this turmoil, the ONC and CMS recently released Stage 3 recommendations, and it looks like they haven’t pulled their punches on a single thing. Interoperability is central, but the clinical quality measures still appear in full force. The requirement that patients engage with the technology has been softened, but still requires patients to take some action such as using a portal or uploading their own data.

Perhaps the boldest stake that CMS put in the ground was to force all providers onto a single schedule in Stage 3, a tremendous departure from the gentle steps offered by the first two stages. This has touched off a provider frenzy. They’ve been lobbying for years to slow Meaningful Use down, and notoriously ran to Congress to delay adoption of ICD-10 disease coding. But putting everyone on the same track makes eminent sense, particularly at this stage. If you’re really serious about data exchange and coordinated care, everybody has to equally capable. Otherwise we’re back to finger-pointing and claims that technology lapses have prevented compliance.

So what are ONC and CMS up to? Are they shooting the moon–hoping to make the big leap to their maximal goals in one bold play? Are they floating an audacious wish list that they know will be cut back in the course of negotiation? Are they even taunting resistant industries to go to Congress, knowing that Congress recently has been making even more radical noise than the Administration about the drawbacks of health IT? Something along these lines seems to be in the works.

To return to the theme of this article, I’m afraid that health care providers, insurers, EHR vendors, and all their business associates will freeze up while waiting for Congress and the various branches of Health and Human Services to determine which behaviors to prescribe and which to punish. So that’s my take on meaningful use–more on other developments in health IT in the next installments.

Rule to Change MU Reporting Period to 90 Days is Issued

Posted on April 10, 2015 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, CMS issued a new proposed rule for the Medicare and Medicaid EHR Incentive Programs to align Stage 1 and Stage 2 objectives and measures with the long-term proposals for Stage 3.

The modifications would allow providers to focus more closely on the advanced use of certified EHR technology to support health information exchange and quality improvement.

The new rule proposes a change in the reporting period for meaningful use from one year to 90 days in 2015.

Proposed Changes for EHR Incentive Programs
Together with the proposed Stage 3 notice of proposed rulemaking (NPRM) issued on March 20, 2015, the proposed rules align and merge the “stages” of meaningful use requirements.

The proposed rule changes the programs by:

  • Streamlining reporting by removing redundant, duplicative, and topped-out measures
  • Modifying patient action measures in Stage 2 objectives related to patient engagement
  • Aligning the EHR reporting period for eligible hospitals and CAHs with the full calendar year
  • Changing the EHR reporting period in 2015 to a 90-day period to accommodate modifications

A Look at the Recurring Revenue Model for Patient Services

Posted on I Written By

The following is a guest blog post by Oleg Ganopolskiy is VP of Operations at Aria Systems.
Ganopolskiy
A few years ago, a global manufacturer of medical equipment developed a new line of CAT scan and MRI machines.

Sales executives soon hit a wall, however, because of the limited number of customers who could pay for these machines, which cost hundreds of thousands of dollars.

Smaller regional hospitals wanted the machines but couldn’t afford them, so what to do?

The manufacturer began leasing the equipment to the regional hospitals on a pay-per-use basis. Pay-per-use, by the way, is one of the many iterations of recurring revenue, a payment model that’s quickly gaining adoption in the marketplace, even down to the level of the small clinic and solo practitioner.

Thus, in going from direct sales to pay-per-use, the manufacturer opened a new market and everyone benefited, including front-line providers of care.

The manufacturer shifted from selling devices to selling a service, and added smaller, regional hospitals to its market for CAT scan and MRI machines.

Regional hospitals preserved their capital and patients received care locally without the additional time and expense of traveling to distant facilities.  Everyone won.

Medical care is at the leading edge of industries embracing innovative delivery of services through the recurring revenue model.  But medical organizations must protect the privacy of both front-line providers and patients with secure, cloud-based technology.

That’s why we recently went through the rigorous HIPAA certification process for our monetization platform, so that our customers migrating to recurring revenue models can continue to protect patient privacy.

That new level of protection couples with our PCI DSS v.3 certification for protecting credit and debit card transactions. As a result, we exceed the administrative, physical, and technical safeguards required to protect patient privacy.

Security becomes increasingly critical as entrepreneurs pursue ideas to build new patient services using mobile healthcare and the Internet of Things (IoT), which links billions of devices to a vast, interconnected network, to unlock recurring revenue.

Monetizing the Internet of Things & New Healthcare Services

Market research firm Gartner predicts that by 2020, 26 bil­lion devices will connect to the IoT, providing a vast array of services worth $300 billion-plus in annual sales. For example, the automatic monitoring of biometric and other devices will soon become pervasive as companies like Apple pioneer new technologies.

Apple’s much-anticipated Apple Watch will include the ability to collect medical research data on a large scale, including data from clinical trials involving thousands of patients. This capability is expected to revolutionize how trials are conducted. Apple said its new ResearchKit for application developers, to be launched as the Apple Watch goes on sale April 24, is a game changer.

Research organizations such as Cornell University, Dana-Farber Cancer Research Institute and Stanford Medical Center are planning to target asthma, breast cancer, cardiovascular disease, diabetes and Parkinson’s disease with new programs enabled by the data-collecting devices.

In the near future, doctors and hospitals will be able to do consultations with “health kiosks” via video conference and access patient monitoring devices securely and quickly for vital signs and recent history. These new businesses will often leverage recurring revenue models to cover the costs of providing these services.

Another possible recurring revenue application: providers offering new services to patients based on their medical histories, such as physical therapy. Cloud-based case management systems could generate recurring payments for the providers during the course of treatment. For instance, a provider could recommend physical therapy through medical records, and recommend facilities where the patient could go for therapy. The provider generates revenue by managing subscriptions to the health club facilities.

With the proper security measures in place, the rush to recurring revenue is on in the healthcare sector. Wall Street rewards it, the competition is doing it and customers and patients are beginning to embrace it.

About Oleg Ganopolskiy
Oleg Ganopolskiy is VP of Operations at Aria Systems where he ensures that all systems provide the highest level of security, compliance, performance, capacity and reliability. Oleg joined Aria Systems from Nokia, where he was responsible for operational capacity, planning, analytics, and modeling across the company’s Global Services Platform. Previously, he managed technology operations at AOL, spent eight years in operations at eBay, and has held senior technical roles at Oracle Corporation and Nordic Systems, Inc.

Where Will We See Analytics in Ambulatory Medicine?

Posted on April 9, 2015 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.

As I prepare to head to the mecca of healthcare IT conferences, I’m getting inundated with pitches. Much like last year, analytics is still a really popular topic. It seems like every healthcare IT vendor has some analytics offering. Many abuse the term analytics (which is fine by me) and that term has come to mean analyzing your health data in order to provide value.

As I think about analytics, I wonder how much of it will apply to the small physician practice. I should do this survey, but I bet if I asked 5 physicians working in small group or solo practices about their analytics strategy they’d all give me blank stares. Small physician practices don’t have an analytics strategy. They’re not looking for new ways to leverage analytics to improve their practice. That’s not how a small practice thinks.

So, does analytics have a place in small ambulatory medicine?

The short answer is that it absolutely does. However, I think that it will be delivered in two forms: packaged or purchased by the borg.

In the packaged approach, analytics will be part of a small practice’s EHR system. Much like a doctor doesn’t have a mobile EHR strategy (it just comes with the EHR), they won’t have an analytics strategy either. They’ll just take the analytics solutions that come with the EHR.

In some ways, the reporting capabilities in an EHR have been doing this forever. However, very few organizations have been able to use these reports effectively. The next trend in EHR analytics will be to push the data to the user when and where they need it as opposed to having to pull a report. Plus, the EHR analytics will start trying to provide some insights into the reports as opposed to just displaying raw data.

One key for ambulatory EHR vendors is that they won’t likely be able to build all the EHR analytics functions that a doctor will want and need. This is why it’s so important that EHR vendors embrace the open API approach to working with outside companies. Many of these third party software companies will provide EHR analytics on top of the EHR software.

In the purchased by the borg scenario, the small practice will get purchased by the borg (You know…the major hospital system in the area). This is happening all over the place. In fact, many small practices cite the reason for selling out to the local hospital is that they don’t think they’ll be able to keep up with the technology requirements. One of those major requirements will be around analytics. We’ll see how far it goes, but I think many small practices are scared they won’t be able to keep up.

Ok, there’s one other scenario as well. The local hospital system or possibly even a local ACO will purchase a package of analytics software (ie. purchased by the bog) and then you’ll tap into them in order to get the benefits of a healthcare analytics solution. We see this already starting to happen. I’ve heard mixed results from around the country. No doctor really likes this situation since it ties them so deeply with the local hospital, but they usually can’t think of a better option.

That’s my take on how analytics will make its way to ambulatory practices. Of course, most large hospital systems also own a large number of ambulatory practices as well. So, some of the analytics will trickle down to ambulatory in those systems as well. I just wonder how much value ambulatory doctors will get from the hospital analytics vendors that are chosen. I can already hear the ambulatory doctors complaining about the analytics reports that don’t work for them because they’re so hospital focused.

Where are you seeing analytics in the ambulatory setting?

From Around the #HIMSS15 Twittersphere

Posted on April 8, 2015 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.

Yep, I have HIMSS on the mind. What can I do? I’ll be there for a week with more meetings and events than I care to count. It’s going to be fun. I thought it would be fun to highlight some tweets (like I do regularly) and add a little bit of my own snark (another regular occurrence).


A little self serving (I know), but these hidden gems really are worth it and people don’t even know that they happen. Now you’ve been told.


Would you rather hang out with Bennett at the parties or with Chuck at the workflow tech companies? That’s a tough one. Although, you have to credit Chuck on being true to form. Plus, I hear he’s going to be displaying his robot, 3D Printing, drone, etc at the ClinicSpectrum booth. Should be something different than you’ll find at most booths.


I thought security would be really big at HIMSS as well, but I haven’t seen that to be the case. Or at least I thought it would be much bigger. Sure, the topic will be covered in most sessions and discussions, but I thought we’d see a wave of new HIPAA related vendors at HIMSS, but that doesn’t seem to be the case. Maybe I just haven’t heard from them.


People don’t go to HIMSS? (I told you I’d bring some snark). I think our HIMSS15 Twitter Tricks and Tips will help people out that aren’t attending.


Too far! Hey…they asked. I’m not complaining though. I enjoy walking. I think I lost 5 pounds at HIMSS last year. I chalk it up to all the walking, but also no time to actually eat. One of the best ways to avoid eating is to stay busy. HIMSS keeps me busy. (Look at that health knowledge I’m throwing your way).


Social vendor? How do you measure that? Who throws the best party? Who is the most friendly? Who tweets the most? Who has the best tweets?

I think he probably means which vendor best uses social media. My guess will be CDW healthcare in that regard. The people behind their social accounts (StudioNorth for those keeping track at home) are always up to something. They better not let me down now that I predicted it 😉


I’m lucky to call Shahid my partner, so I take every chance I can get to hear him speak or hear discussions he lead. The topic of getting clinical value and ROI out of data is going to be such an important one for healthcare going forward.


This has to make your heart hurt a little. Looks like Richard is from Bogota, Colombia. I hope someone can help him out. Being out $2k would stink.

I fly out Saturday and I’m there until Friday. I look forward to seeing so many of you at the event. I’ll be doing my full write up of places I’ll be and things to see at HIMSS 2015 over on EMR and HIPAA tomorrow.

Where the Jobs Are – 2015 Update: Demand for EHR/HIT Certifications

Posted on April 7, 2015 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com.For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manager doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst, a role he recently repeated for a Council member.

One year ago, I looked at the demand for EHR related certifications. I found, as the old line goes, that many are called but few are chosen. Of 30 or so certificate programs, only about a quarter had substantial demand. In fact, 1 had no demand.

Study Update

Finding Certification Programs. To bring the study up to date, I looked for new certificates or ones I’d overlooked. I found one, CEHRS, Certified Electronic Health Record Specialist Certification from the National Healthcareer Association.

Searching for Jobs. As with last year’s study, I then used Healthcare Scene’s Healthcare IT Central to search for jobs posted in the last 30 days that require an EHR or HIT certification.

Certifications Reviewed

Table I lists the 12 certifications, which had at least one job opening. Last year, I found at least 16 certifications with at least one opening. That is, this year as shown in Table II, I found no mentions for 15 certificates.

Table I
Certifications In Demand
1 CCA 7 CHTS
2 CCS 8 CICP
3 CCS-P 9 CompTIA
4 CHDA 10 CPHIMS
5 CHPS 11 RHIA
6 CHSP 12 RHIT

 

Table II, lists the 12 certifications that had no openings in the last 30 days.

Table II
Certifications Without Demand
1 CAHIMS 9 CPCIP
2 CEHRS 10 CPORA
3 CEOP 11 CPHP
4 CHTP 12 CPORA
5 CEMP 13 HWCP
6 CHTSP 14 CPEHR
7 CIPCP 15 CPHIT
8 CMUP    

 

Review Caveats

What Counts. Each certification listed in a job counts as one opening. For example, if a job listed ComTIA, CPHIMS and CPEHR, I counted it as three jobs, one for each certification.

General certifications only. For practical reasons, this review only covers general certifications that have a one word abbreviation. Where the abbreviation isn’t unique, I’ve filtered out non certificate uses.

No EDUs. I excluded certificates from colleges, universities, etc., whether traditional or on line. There are scads of these, but I’m not aware of any that are in general demand. That’s not a judgment on their value, just their demand.

Vendor Certifications I excluded product specific certifications, for example, NexGen Certified Professional.

Dynamics. The openings for these certifications are a snapshot. The job market and the openings that Healthcare IT Central lists constantly change. What is true now, could change in a moment. However, I believe it gives you a good idea of relative demand.

Certification Demand

In the past 30 days, I found 322 openings that listed a certification. See Chart I. As with last year, AHIMA’s were most in demand. Two of its certificate programs, RHIA and RHIT account for 60 percent of certificate demand.

Chart I Certification Openings

RHIA’s designed to show a range of managerial skills, rather than in depth technical ability. If you consider certifications proof of technical acumen, then the strong RHIA demand is a bit counter intuitive. Where the RHIA has a broad scope, the close second, RHIT, is more narrowly focused on EHRs.

In third place, but still with a substantial demand is CCS, which focuses on a specific ability. Compared to last year, CCS has fewer openings. This is due to a change in my methodology not demand. Last year, I counted any CCS opening. This year, I only count those with a clear HIT relationship.

Certification Location Demand

After looking at certification demand, I looked at it by state. To do this, I merged the different certification job openings into a single list. That is, I added those for RHIA, RHIT, etc., and then eliminated duplicates.

After creating a consolidated list, I sorted and subtotaled by state. I then sorted the state totals. This gave me the data for Chart II. It shows the top ten states for openings, including/ two ties.

Chart II State Demand

State Rankings. As you might expect, states with the largest populations have the most jobs. California leads, which is what you’d expect.

To account for population, I take job rank from population rank. For example, Washington State is 13th in population. It’s eight in job openings. So, subtracting job rank eight from population rank 13 is five. That is, Washington State’s job share is five ranks above its population ranking. Chart III shows the result where states stand when you account for population.

Chart III Rank Adjusted for Population

Most notable is Colorado. Colorado is 22nd in population, but fifth in certification demand. That is job openings for it are 17 ranks higher than population would account for.

Others ranking higher than their population are: Missouri, Arizona, Tennessee, Wisconsin, etc. Conversely, those states, which have openings below their rank, include New York, Pennsylvania and Florida.

Missouri’s case is interesting. Almost all its openings are from one company: Altegra. Its openings are almost all for one position type: medical record field reviewer. At first, I thought this was a case of over posting, but it doesn’t appear to be. They’re recruiting for several different locations.

Certification Demand Trends

When I stated this update, I expected there would be more jobs due to economic growth, but that hasn’t happened. There’ve been shifts among states, but overall the demand is pretty much the same. RHIA and RHIT demand last year and this year are practically identical while demand for others has dropped. I don’t have any numbers for overall openings then and now, but I suspect that they’ve grown while certification demand has either gone down or been flat. However, as I’ve said that’s just a guess.

Certifications are a response to the demand for persons with demonstrated skills. The question is whether one will reward your time, cost and effort with something that is marketable. Demand alone can’t make that choice for you. For example, working on a certificate that has little or no demand might seem pointless. However, its requirements may be a good way for you to acquire demonstrate your skills, especially if your experience is iffy.

Personal satisfaction also can’t be discounted as a factor. You might be interested in an area with low demand, but when coupled with your other skills might make you marketable in an area you desire.

If you do decide to pursue one of these certificates, I think these numbers can help you know where to look and what to look for.

Where Medical Devices Fall Short: Can More Testing Help? (Part 2 of 2)

Posted on April 6, 2015 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.

As we saw in the previous article, networks of medical devices suffer from many problems intrinsic to the use of wireless technology. But testimony at the joint workshop held by the FCC and FDA on March 31 revealed that problems with the devices themselves run deep. One speaker reported uncovering departures from the standards for transmitting information, which led to incompatibilities and failures. Another speaker found repeated violations of security standards. As a trivial example, many still use the insecure and long-deprecated WEP authentication instead of WPA.

Most devices incorporate generic radio transmitters from third parties, just as refrigerators use replaceable compressors and lawnmowers depend on engines from just a few manufacturers. When markets become commoditized in this way, one would expect reliability. Whatever problems radio transmitters may have, though, are compounded by the software layered on top. Each device needs unique software that can affect the transmissions.

The WiFi Alliance is a consortium of manufacturers that tests devices for reliability and interoperability. But because it doesn’t contain users or government representatives, some panelists thought it was too lenient toward manufacturers. The test plan itself is a trade secret (although it was described at a high level in the workshop by Mick Conley). Several speakers testified that devices could be certified by the Alliance and still perhaps fail to connect.

To my mind, testing is a weak response to design problems. It happens after the fact, and can punish a poor engineering process but not fix it. You can test-drive a car and note that the steering is a bit sluggish, but can you identify the software or the part that is causing the problem? And can you explain it to the salesman, presumably to be conveyed back to the engineers?

Cars tend to be reliable first because of widespread competition that extends internationally, and partly because lawsuits keep the managers of the automobile companies alert to engineering problems. It would be a shame to need lawsuits to correct technical problems with medical devices, but refusing to buy them might do the trick. Test beds do provide warnings that can aid purchase decisions.

Unfortunately, the forum produced no real progress on the leading question of the day, whether a national test bed would be a good idea. It was recognized generally that test beds have to reflect the particular conditions at different institutions, and that multiple test beds would be needed to cover a useful range of settings. Without further clarification of what a test bed would look like, or who would build it, a couple panelists called for the creation of national test beds. More usefully, in my opinion, one speaker suggested a public repository of tests, which are currently the proprietary sects of vendors or academic researchers.

So none of the questions about test beds received answers at the workshop, and no practical recommendations emerged. One would expect that gathering the leading experts in medical devices for seven and a half hours would allow them to come up with actionable next steps or at least a framework for proceeding, but much of the workshop was given over to rhetoric about the importance of medical devices, the need for them to interoperate, and other standard rallying cries of health care reform. I sometimes felt that I was in hearing a pitch for impressionable financial backers. And of course, there was always time taken up by vendors, providers, and regulators trying to point the finger at someone else for the problems.

Device and networking expert David Höglund has written up how the workshop fell short. I would like someone to add up all the doctors, all the senior engineers, all the leading policy makers in the room, calculate how much they are paid per minute, and add up the money wasted every time a speaker extols patient engagement, interoperability, or some other thesis that is already well known to everybody in the room. (Or perhaps they aren’t well-known–another challenge to the medical field.)

Personally, I would write off most of the day as a drain on the US economy. But I have tried to synthesize the points we need to look at going forward, so that I hope you feel the time you devoted to reading the article was well-spent.