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!

The Dawn of The Community EMR

Posted on May 29, 2015 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.

While many healthcare stakeholders would like to see clinical data shared freely, the models we have in place simply can’t get this done.

Take private HIEs, for example. Some of them have been quite successful at fostering data sharing between different parts of a health system, but the higher clinical functions aren’t integrated — just the data.

Another dead end comes when a health system uses a single EMR across its entire line of properties. That may integrate clinical workflow to some degree, but far too often, the different instances of the EMR can’t share data directly.

If healthcare is to transform itself, a new platform will be necessary which can be both the data-sharing and clinical tool needed for every healthcare player in a community. Consider the vision laid out by Forbes contributor Dave Chase:

Just as the previous wars impacted which countries would lead the world in prosperity, the “war” we are in will dictate the communities that get the lion’s share of the jobs (and thus prosperity). Smart economic development directors and mayors will stake their claim to be the place where healthcare gets reinvented.

In Chase’s column, he notes that companies like IBM have begun to base their decisions about where to locate new technology centers partly on how efficiently, effectively and affordably care can be delivered in that community. For example, the tech giant recently decided to locate 4,000 new jobs in Dubuque, Iowa after concluding that the region offered the best value for their healthcare dollar.

To compete with the Dubuques of the world, Chase says, communities will need to pool their existing healthcare spending — ideally $1B or more — and use it to transform how their entire region delivers care.

While Chase doesn’t mention this, one element which will be critical in building smart healthcare communities is an EMR that works as both a workflow and care coordination tool AND a platform for sharing data. I can’t imagine how entire communities can rebuild their care without sharing a single tool like this.

A few years ago I wrote about how the next generation of  EMRs would probably be architected as a platform with a stack of apps built over it that suit individual organizations. The idea doesn’t seem to have gained a lot of traction in the U.S. since 2012, but the approach is very much alive outside the country, with vendors like Australia’s Ocean Informatics selling this type of technology to government entities around the world. And maybe it can bring cities and regions together too.

For the short term, getting a community of providers to go all in on such an architecture doesn’t seem too likely. Instead, they’ll cling to ACO models which offer at least an illusion of independence. But when communities that offer good healthcare value start to steal their patients and corporate customers, they may think again.

The Tower of EMR Babel

Posted on May 28, 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.

It’s the sad state of interoperability. This week when I was teaching an EHR workshop I asked for those attending to define what an Electronic Health Record was in their own words. I’d say 90% of them said something about making the healthcare data available to be shared or some variation on that idea. This wasn’t surprising for me since I’ve heard hundreds and possibly thousands of doctors say the same thing. EHR is suppose to make it so we can share data.

While people pay lip service to this idea and just assume that somehow EHR would make data sharing possible, that’s far from the reality today. This is true even in some organizations where they own both the hospital and the ambulatory provider. How sad is this? Extremely sad in my book.

I’ve often wondered what would change the tide. I’ve been long hopeful that ACOs and value based care would help to push the data sharing forward, but that’s going to be a long process. The private HIEs are working the best of any HIEs I’ve seen, so maybe the trend of hospitals acquiring small practices and hospital systems acquiring hospital systems will get us to EHR data sharing nirvana. Although, I don’t think it’s going to make it there in most communities. Instead it’s just going to have a number of large organizations not wanting to share data as opposed to some large and some small ones.

Do people really have much hope for true EHR data sharing? Does FHIR give you this hope? I’m personally not all that optimistic. We all know it’s the right thing to do, but there are some powerful forces fighting against us.

What Happens When Billing Is Optimized?

Posted on May 27, 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.

In my recent EHR workshop in Dubai I talked with them about the many changing EHR business models that I’ve seen over the last 10 years. I was really trying to highlight how these new business models have generally been good for healthcare since it’s caused EHR prices to drop to a much more reasonable price point.

Take for example the Free EHR model. Whether you love it or hate it, one thing is certain: Free EHR has caused all the other EHR vendors to lower their price. I’ve seen this over and over again with EHR vendors. It’s hard to compete with an overpriced product against free. So, they had to lower their price so that the price of their EHR didn’t look as bad against free.

One model that I mentioned to those who attended my workshop was that some EHR vendors charge a percentage of billing in order to use their EHR software. athenahealth is the most famous for this approach. Their business model has worked pretty well for them because they’re able to say that not only will the practice get the EHR software for free, but athenahealth also can make the case that by having them assist with the practices billing, then they can help to better optimize the practices billing as well. So, the practice is getting more effective billing and a free EHR. This is why athenahealth could charge such a high percentage of an organization’s billing.

Turns out that there are a lot of billing companies that make a similar business case. Pay me 4-6% of your billing and we’ll optimize your billing which will actually make you more money than you’re paying us. Most of the billing management companies work off of this approach. Of course, this approach works best when you’re talking about practices that aren’t doing a good job managing their billing. This actually seems to apply to most practices.

What I’ve started to wonder is what’s going to happen once all of these practices’ billing is basically optimized? Now the percentage of billing starts to feel really expensive. Practices won’t be good at realizing the optimization that’s occurred and I’m sure that many will choose to take on the billing again. As they take on the billing, they’ll head back to a less than optimized state and then they’ll be ripe pickings for a billing company again.

I can see this cycle happening over and over again. Plus, if you’re a billing company or a company like athenahealth that makes your money off of a percentage of billing, then there’s always new practices that are at every stage of the cycle. So, there’s new business all over the place. The key for these organizations is to find the practices that are at the right place in the cycle.

Will anything happen to stop this cycle?

Bringing the Obvious to the Surface Through Analytics

Posted on May 26, 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.

Analytics can play many roles, big and small, in streamlining health care. Data crunching may uncover headline-making revelations such as the role smoking plays in cancer. Or it may save a small clinic a few thousand dollars. In either case, it’s the hidden weapon of modern science.

The experience of Dr. Jordan Shlain (@drshlain) is a success story in health care analytics, one that he taking big time with a company called HealthLoop. The new venture dazzles customers with fancy tools for tracking and measuring their customer interactions–but it all started with an orthopedic clinic and a simple question Shlain asked the staff: how many phone calls do you get each week?

Asking the right question is usually the start to a positive experience with analytics. In the clinic’s case, it wasn’t hard to find the right question because Shlain could hear the phones ringing off the hook all day. The staff told him they get some 200 calls each week and it was weighing them down.

OK, the next step was to write down who called and the purpose of every call. The staff kept journals for two weeks. Shlain and his colleagues then reviewed the data and found out what was generating the bulk of the calls.

Sometimes, analytics turns up an answer so simple, you feel you should have known it all along. That’s what happened in this case.

The clinic found that most calls came from post-operative patients who were encountering routine symptoms during recovery. After certain surgeries, for instance, certain things tend to happen 6 to 9 days afterward. As if they had received instructions to do, patients were calling during that 6-to-9-day period to ask whether they symptoms were OK and what they should do. Another set of conditions might turn up 11 to 14 days after the surgery.

Armed with this information, the clinic proceeded to eliminate most of their phone calls and free up their time for better work. Shlain calls the clinic’s response to patient needs “health loops,” a play on the idea of feedback loops. Around day 5 after a surgery, staff would contact the patient to warn her to look for certain symptoms during the 6-to-9-day period. They did this for every condition that tended to generate phone calls.

HealthLoop builds on this insight and attaches modern digital tools for tracking and communications. Patients are contacted through secure messaging on the device of their choice. They are provided with checklists of procedures to perform at home. There’s even a simple rating system, like the surveys you receive after taking your car in to be fixed or flying on an airline.

Patient engagement–probably the most popular application of health IT right now–is also part of HealthLoop. A dashboard warns the clinician which patients to perform each day, surfacing the results of risk stratification at a glance. There’s also an activity feed for each patient that summarizes what a doctor needs to know.

Analytics doesn’t have to be rocket science. But you have to know what you’re looking for, collect the data that tells you the answer, and embody the resulting insights into workflow changes and supporting technologies. With his first experiment in phone call tracking, Shlain just took the time to look. So look around your own environment and ask what obvious efficiencies analytics could turn up for you.

Happy Memorial Day Video

Posted on May 25, 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.

Happy Memorial Day to those readers who are in the US. I thought this video captured the spirit of the Holiday so well. My thanks to all the military veterans out there.

EMRs Should Include Telemedicine Capabilities

Posted on May 22, 2015 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 volume of telemedicine visits is growing at a staggering pace, and they seem to have nowhere to go but up. In fact, a study released by Deloitte last August predicted that there would be 75 million virtual visits in 2014 and that there was room for 300 million visits a year going forward.

These telemedicine visits are generating a flood of medical data, some in familiar text formats and some in voice and video form. But since the entire encounter takes place outside of any EMR environment, huge volumes of such data are being left on the table.

Given the growing importance of telemedicine, the time has come for telemedicine providers to begin integrating virtual visit results into EMRs.  This might involve adopting specialized EMRs designed to capture video and voice, or EMR vendors might go with the times and develop ways of categorizing and integrating the full spectrum of telemedical contacts.

And as virtual visit data becomes increasingly important, providers and health plans will begin to demand that they get copies of telemedical encounter data.  It may not be clear yet how a provider or payer can effectively leverage video or voice content, which they’ve never had to do before, but if enough care is taking place in virtual environments they’ll have to figure out how to do so.

Ultimately, both enterprise and ambulatory EMRs will include technology allowing providers to search video, voice and text records from virtual consults.  These newest-gen EMRs may include software which can identify critical words spoken during a telemedical visit, such as “pain,” or “chest” which could be correlated with specific conditions.

It may be years before data gathered during virtual visits will stand on equal footing with traditional text-based EMR data and digital laboratory results.  As things stand today, telemedicine consults are used as a cheaper form of urgent care, and like an urgent care visit, the results are not usually considered a critical part of the patient’s long-term history.

But the more time patients spend getting their treatment from digital doctors on a screen, the more important the mass of medical data generated becomes. Now is the time to develop data structures and tools allowing clinicians and facilities to mine virtual visit data.  We’re entering a new era of medicine, one in which patients get better even when they can’t make it to a doctor’s office, so it’s critical that we develop the tools to learn from such encounters.

Allscripts (MDRX) At Important Moment In Its History

Posted on May 21, 2015 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.

Allscripts has announced plans to move more of its software development and operations to India, while cutting 250 jobs in the U.S., or about 3.5% of its 7,200-member workforce.  While this is significant enough as it is, it’s an even more important leading indicator of how Allscripts may perform going forward. Here’s how I think things will net out.

Making a “rebalancing”:  The company has called the changes a “rebalancing” of staff which will allow it to respond more effectively and efficiently to shifts in its software design and product dev plans.

But the decision didn’t happen in a vacuum, either. Allscripts recently reported taking a $10.1 million loss for the first quarter ending March 31. That’s down from a loss of $20.7 million for Q1 2014, but the company still appears to be struggling. Allscripts’ overall revenue dropped 2% to $334.6 million for the quarter ending March 31, compared with Q1 of 2014.

What’s next? What should providers draw from these numbers, and Allscripts’ plan to shift more development work offshore? Let’s consider some highlights from the vendor’s recent past:

* Despite some recent sales gains, the vendor occupies a difficult place in the EMR vendor market — neither powerful enough to take on enterprise leaders like Epic and Cerner directly, nor agile enough to compete in the flexibility-focused ambulatory space against relentless competitors like athenahealth.

* According to an analysis of Meaningful Use data by Modern Healthcare, Allscripts is second only to Epic when it comes to vendors of complete EMRs whose customers have qualified for incentives. This suggests that Allscripts is capable of being an effective provider business partner.

* On the other hand, some providers still distrust Allscripts since the company discontinued sales of and support for its MyWay EMR in 2012. What’s more, a current class action lawsuit is underway against Allscripts, alleging that MyWay was defective and that using it harmed providers’ business.

* Partnering with HP and Computer Sciences Corp., Allscripts is competing to be chosen as the new EMR for the U.S. Department of Defense’s Military Health System, and is still in the running for the $11 billion contract. But so are Epic and Cerner.

The bottom line: Taken together, these data points suggest that Allscripts is at a critical point in its history.

For one thing, cutting domestic staff and shifting dev operations to India is probably a make or break decision; if the change doesn’t work out, Allscripts probably won’t have time to pull back and successfully reorient its development team to current trends.

Allscripts is also at a key point when it comes to growing place in the brutal ambulatory EMR market. With players like athenahealth nipping at its heels from behind, and Epic and Cerner more or less controlling the enterprise market, Allscripts has to be very sure who it wants to be — and I’m not sure it is.

Then when I consider that Allscripts is still in the red after a year of effort, despite being at a peak level for sales, that tears it.  I’m forced to conclude that the awkwardly-positioned vendor will have to make more changes over the next year or two if it hopes to be agile enough to stay afloat. I believe Allscripts can do it, but it will take a lot of political will to make it happen. We’ll just have to see if it has that will.

Meaningful Use Stage 3 Success Could Rely On Vendors

Posted on May 20, 2015 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.

Today I was reading a report on the Health IT Policy Committee’s review of pending Meaningful Use Stage 3 rules — which would ordinarily be as about as exciting as watching rocks erode — when something leapt out at me which I wanted to share with you, dear readers.

The overview, brought to us courtesy of Medical Practice Insider, noted that proposed plans for the Stage 3 rule would allow providers to attest in 2017, though attesting wouldn’t be mandatory until 2018. What this means, editor Frank Irving notes, is that it would be up to EMR vendors to be ready for providers wishing to attest a year early.

The folks overseeing this discussion, the Advanced Health Models and Meaningful Use Workgroup, seem (wisely) to have had their doubts that vendors could be relied upon to meet the 2017 deadline. At the session, workgroup members proposed a couple of alternative ways of addressing this timeline. One was to make the 2017 deadline go away, requiring instead that EMRs have full 2015 certification by 2018. Another was to allow optional attestation in 2017, but if need be, with 2014 EMR certification.

I don’t know about you, but this whole thing makes me nervous. By “whole thing,” I mean adjusting the rules to deal with the likely resistance vendors will exhibit to keeping their roadmap in synch with federal requirements.

After all, consider the history of EMR vendors’ relationship with providers. As we’ve noted, HHS has paid out about $30B in Meaningful Use incentives under HITECH without insisting that vendors provide interoperability. And what have EMR vendors done?  They’ve avoided developing shared standards for interoperability with an alacrity which amazes the eye.

In fact, some EMR vendors — including top contender Epic Systems — have been slapping providers with fees for data sharing (even if they’ve kind of dropped them for now), at prices which could leave them millions in the hole. If that isn’t dead opposite to what those in public policy hope to see happen, I don’t know what is.

Bottom line, if the good people overseeing Meaningful Use want to see Stage 3 accomplish good things, they’ll need to see to it that the new rules give regulators some leverage when it comes to controlling vendors.

As the whole sad interoperability saga has demonstrated, vendors will not take actions that advance health IT on their own. Unlike in other IT markets, where interoperability and meeting regulatory deadlines have been the signs of a winner, EMR vendors actually have strong incentives to ignore providers’ business imperatives.

With any luck, however, between tougher rules on Stage 3 and public pressure to achieve interoperability, EMR vendors will do the right thing.  They’ve certainly had long enough.

A “Collaborative Consult” Could Greatly Improve EMR Value

Posted on May 19, 2015 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.

Over the past several years, EMRs have taken some steps forward. At least in some cases, analytics have improved, vendors have begun offering cloud or on-premise install versions of their products and user interfaces have even improved.

But one problem with EMRs that seems to be nearly unfixable is the need for providers to stare at an EMR screen, leaving patients to fidget uncomfortably while they wait for a bit of face-to-face contact and discussion. Sure, you’ll see scribes in hospital emergency departments, allowing ED docs to speak to patients without interruption, but in the outpatient settings where patients spend most of their time, the EMR screen is king.

Such a focus on the EMR display isn’t unreasonable, given the importance of the data being entered, but as critics have noted countless times, it does make it more likely that the provider will miss subtle clues as to the patient’s condition, and possibly end up offering lower-quality care than they would have if they had an old-fashioned computerless encounter.

I have long thought, however, that there’s a solution to this problem which would be helpful to both the physician and the patient, one which would literally make sure that patients and doctors are on the same page. I’m speaking of a new group of settings for EMRs designed specifically to let patients collaborate with physicians.

Such an EMR setting, as I envision it, would begin with a section depicting a dummy patient of the appropriate gender.The patient would touch the areas of the body which were causing them problems, while the doctor typed up a narrative version of the problem presentation. The two (patient and doctor) would then zoom in together to more specific descriptions of what the patient’s trouble might be, and the doctor would educate the patient as to what kind of treatment these different conditions might require.

At that point, depending on what condition(s) the doctor chose as requiring further study, lists of potential tests would come up. If a patient wanted to learn what these tests were intended to accomplish, they’d have the liberty to drill down and learn, say, what a CBC measures and why.  The patient would also see, where possible, the data (such as high cholesterol levels) which caused the doctor to seek further insight.

If the patient had a known illness being managed by the physician, such as heart disease, a tour through a 3-D visual model of the heart would also be part of the collaboration, allowing the doctor to educate the patient effectively as to what they were jointly trying to accomplish (such as halting heart muscle thickening).

The final step in this patient-doctor process would come with the system presenting a list of current medications taken by the patient, and if appropriate, new medications that might address any new or recurring symptoms the patient was experiencing.

The final result would come in the form of a PDF, e-mailed to the patient or printed out for their use, offering an overview of their shared journey. The doctor might have to spend a few minutes adding details to their notes after the patient left, but for the most part, the collaborative consult would have met everyone’s needs.

Now you tell me:  Why aren’t we doing this now?  Wouldn’t it make much more sense, and take much more advantage of the powerful desktops, tablets and smartphones we have, than having a provider stare at a screen for most of their visit with a patient?

Access All of CMS’ Sessions at HIMSS15

Posted on May 18, 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.

Visit the CMS eHealth Events page to access all of CMS’ HIMSS15 program sessions. An overview of each individual session can be found below.

Sunday, April 12

  • Opening Keynote: CMS on Federal Quality Reporting (Session QU1): Dr. Kate Goodrich, Director of the Quality Measurement and Health Assessment Group, outlines 2015 clinical quality measurement and reporting requirements and how they align with quality performance and public reporting through CMS quality programs.

Monday, April 13

  • CMS EHR Incentive Programs Overview (Session 10): CMS provides an update on EHR Incentive Programs participation and gives an overview of the Modifications to Meaningful Use in 2015-2017 proposed rule.
  • CMS Meaningful Use Stage 3 Requirements (Session 40): CMS presents an outline of the proposed Stage 3 requirements.

Tuesday, April 14

  • Keynote: The Intersection of Quality and Innovation at CMS (Session 67): Dr. Patrick Conway, Chief Medical Officer, outlines how CMS envisions health IT as a key component of health care transformation.
  • CMS Quality Strategy (Session 86): Dr. Kate Goodrich presents the overall quality strategy for CMS, and explains how it will be used to achieve the agency’s vision.
  • CMS Quality Reporting Update (Session 116): CMS discusses 2015 CQM reporting requirements and provides an overview of the PQRS, IQR, HVBP, and VBM quality reporting programs.

Wednesday, April 15

  • CMS Future Directions in Quality Measurement (Session 131):Panelists discuss current challenges and the future of quality measurement and quality measure development.
  • CMS Meaningful Use Stage 3 and ONC 2015 Edition Certification Criteria Changes (Session 160): CMS and ONC provide an overview of the Stage 3 and 2015 Edition Health IT Certification Criteria proposed rules.
  • Improving Health Care Delivery through Collaboration with Lean Tools (Session 176): Industry experts outline how Lean tools have led to cost savings, increased collaboration, and provide high quality products.