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The Crazy World of Pharma – Martin Shkreli

Posted on December 17, 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.

I don’t often tread into the world of Pharma, but the story of Martin Shkreli is too unreal to not talk about it. Especially since today it came to a head with Martin Shkreli being arrested on charges of Fraud.

For those not familiar with Martin, he was blasted by social media and the regular media (you can guess which one came first) after his company Turing Pharmaceuticals AG raised the price of an anti-parasite tablet more than 50-fold. That’s taking the drug Daraprim from $13.50 a tablet to $750.

After the outcry he later said he’d cut the price of the drug as much as 50% to hospitals. He also said that there were lots of programs for people to get the drug if they weren’t financially able. That didn’t appease most people who still saw Martin as taking advantage of the health care system and vulnerable patients who needed the drug to survive. Some even called him “the most hated man in America.”

The story doesn’t end there. At the Forbes Healthcare Summit Martin Shkreli admitted that he messed up when he raised the Daraprim drug price over 5,000% overnight. “I would have raised prices higher,” Shkreli vowed on Thursday, after being asked how he would re-do the past three months. “That’s my duty.” So, he reneged on his promise to lower the price of the drug and wishes he’d raised the price higher.

As if that weren’t enough, Martin Shkreli was planning to do the same with another Leukemia drug owned by the almost dead company KaloBios. Martin bought up shares of the company and brought $3 million of investment to save the company. It seems he was looking to do the same thing with KaloBios as he’d done with Turing Pharmaceuticals AG.

You can imagine the outcry over Martin doubling down on his approach to raising the price of pharma drugs. However, many are claiming that karma caught up with Martin Shkreli (and lots of other claims including him “paying” for ripping Taylor Swift and other odd and hilarious comments) as he was just arrested on fraud charges. The charges are unrelated to the stories above, but instead go back to his time as manager for the hedge fund MSMB Capital Managment and Chief Executive of biopharmaceutical company Retrophin Inc. On news of the arrest, KaloBios stock feel 50% before trading was halted, losing Martin over $25 million.

It’s hard to ignore a story like this. It’s just kind of unbelievable and the public outcry to what Martin has done. He sees himself as the public enemy and for many he is just that. While I think what Martin is doing is despicable, I personally don’t think there’s that much value in vilifying his actions if we don’t ask the tough questions that his actions raise. I’m no pharma expert, but I can’t image that Martin is the only one employing these practices. Was he just the one that got caught and the one that caught the public eye?

Here’s some questions that I think Martin’s story raises that are worth discussing:

What do we do about pharma companies that have a monopoly on a niche drug? Should their be price controls on them?

What price is fair for them to charge to make a return on their admittedly risky investment? Is there a calculus that makes sense for the patients who depend on the drug and the drug maker who needs to make a profit off their investment?

Is it ok to overcharge for a current drug in order to reinvest that money to develop new drugs? Will the overcharge actually be used to develop new drugs and not just line the pockets of the investors? Maybe they reinvest in research for a few cycles of new drugs, but at what point does the excess stop being reinvested?

Martin calls this the “dirty truth” of pharma. They’re in it to make money. Let’s start a conversation about this dirty truth then and find reasonable solutions for patients and pharma companies. Maybe there’s some good that could come from Martin’s actions.

Update: If you’d like a good laugh, read this piece by Andy Borowitz called “Lawyer for Martin Shkreli Hikes Fees Five Thousand Per Cent.” Brilliant!

Are EMR Templates Really That Bad?

Posted on December 16, 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.

Recently, I read an interesting blog item by healthcare veteran Bobby Gladd, kicking around the notion of whether structured EMR data is killing medical practice. In the item, Gladd makes as good of a case as I’ve seen that while open text has its place, the lack of same is NOT single-handedly killing medicine.

In the blog item, Gladd ribs critics of template-driven medicine such as Margalit Gur-Arie, who has called structured data “the one foundational problem plaguing current EHR designs.” Gur-Arie argues that templated data controls clinical interviews, a phenomenon she calls “Bingo Medicine”:

“When your note taking is template driven, most of your cognitive effort goes towards fishing for content that fits the template (like playing Bingo), instead of just listening to whatever the patient has to say.”

Gladd does concede that templates for Meaningful Use can be “simply stupid,” for example in the case of the MU Core 9 measure of smoking status. But do free-written EMR entries support the care process better?  Maybe we do actually need “open-ended analytical narrative in the progress note, replete with evocative, dx-illuminating metaphors and analogies and elegant turns of phrase in lieu of blunt instrument categorical and ordinal ‘structured data,'” Gladd notes wryly.

Ultimately, perhaps critics of templates have gone overboard, the blog contends. Gladd suggests that Gur-Arie’s “bingo medicine” argument is more sound than substance: “I have to be a bit skeptical that (it) is anything more than a motivated-reasoning assertion of opinion lacking evidentiary underpinning comprised of adequate psychometrically valid studies of physicians’ cognitive processes while at work, perhaps using docs on paper charts as the differential ‘control’ group.”

As Gladd sees things, the real issue with templates isn’t their existence, as such. For one thing, as readers are likely to know, EMRs almost always come with free-text narrative options from many different points in the workflow. So it’s not that there’s no opportunity for clinicians to write detailed prose about their patient encounters.

Also, the issue isn’t necessarily that doctors are having templates forced upon them, either. As Gladd rightfully points out, at least the Meaningful Use-related data gathering requirements have been extensively vetted by the public, with each stage generating thousands of recommendations from physicians. And both CMS and ONC incorporated as much as possible from that flood of commentary.

Ultimately, the problem isn’t that physicians are being asked to adhere to digital documentation styles at times, Gladd contends. The true problem is the “productivity treadmill” requirements that push doctors to see 25-30 patients a day. “If the typical physician only had to see an average of one patient per hour…adequate documentation would be way less onerous,” Gladd concludes.

And there you have it. Overwork is the bane of any profession requiring brain work, and turning back to all narrative-style documentation does little to remedy the problem. (In fact, it could make things worse — for if doctors don’t have time to use templates, how good are their long-form notes going to be?)

Maybe templates have some downsides. In fact, if someone tried to get me to practice blogging with word templates I’d probably object. But it’s worth bearing in mind that template medicine may be a symptom rather than a cause.

Significant Articles in the Health IT Community in 2015

Posted on December 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.

Have you kept current with changes in device connectivity, Meaningful Use, analytics in healthcare, and other health IT topics during 2015? Here are some of the articles I find significant that came out over the past year.

The year kicked off with an ominous poll about Stage 2 Meaningful Use, with implications that came to a head later with the release of Stage 3 requirements. Out of 1800 physicians polled around the beginning of the year, more than half were throwing in the towel–they were not even going to try to qualify for Stage 2 payments. Negotiations over Stage 3 of Meaningful Use were intense and fierce. A January 2015 letter from medical associations to ONC asked for more certainty around testing and certification, and mentioned the need for better data exchange (which the health field likes to call interoperability) in the C-CDA, the most popular document exchange format.

A number of expert panels asked ONC to cut back on some requirements, including public health measures and patient view-download-transmit. One major industry group asked for a delay of Stage 3 till 2019, essentially tolerating a lack of communication among EHRs. The final rules, absurdly described as a simplification, backed down on nothing from patient data access to quality measure reporting. Beth Israel CIO John Halamka–who has shuttled back and forth between his Massachusetts home and Washington, DC to advise ONC on how to achieve health IT reform–took aim at Meaningful Use and several other federal initiatives.

Another harbinger of emerging issues in health IT came in January with a speech about privacy risks in connected devices by the head of the Federal Trade Commission (not an organization we hear from often in the health IT space). The FTC is concerned about the security of recent trends in what industry analysts like to call the Internet of Things, and medical devices rank high in these risks. The speech was a lead-up to a major report issued by the FTC on protecting devices in the Internet of Things. Articles in WIRED and Bloomberg described serious security flaws. In August, John Halamka wrote own warning about medical devices, which have not yet started taking security really seriously. Smart watches are just as vulnerable as other devices.

Because so much medical innovation is happening in fast-moving software, and low-budget developers are hankering for quick and cheap ways to release their applications, in February, the FDA started to chip away at its bureaucratic gamut by releasing guidelines releasing developers from FDA regulation medical apps without impacts on treatment and apps used just to transfer data or do similarly non-transformative operations. They also released a rule for unique IDs on medical devices, a long-overdue measure that helps hospitals and researchers integrate devices into monitoring systems. Without clear and unambiguous IDs, one cannot trace which safety problems are associated with which devices. Other forms of automation may also now become possible. In September, the FDA announced a public advisory committee on devices.

Another FDA decision with a potential long-range impact was allowing 23andMe to market its genetic testing to consumers.

The Department of Health and Human Services has taken on exceedingly ambitious goals during 2015. In addition to the daunting Stage 3 of Meaningful Use, they announced a substantial increase in the use of fee-for-value, although they would still leave half of providers on the old system of doling out individual payments for individual procedures. In December, National Coordinator Karen DeSalvo announced that Health Information Exchanges (which limit themselves only to a small geographic area, or sometimes one state) would be able to exchange data throughout the country within one year. Observers immediately pointed out that the state of interoperability is not ready for this transition (and they could well have added the need for better analytics as well). HHS’s five-year plan includes the use of patient-generated and non-clinical data.

The poor state of interoperability was highlighted in an article about fees charged by EHR vendors just for setting up a connection and for each data transfer.

In the perennial search for why doctors are not exchanging patient information, attention has turned to rumors of deliberate information blocking. It’s a difficult accusation to pin down. Is information blocked by health care providers or by vendors? Does charging a fee, refusing to support a particular form of information exchange, or using a unique data format constitute information blocking? On the positive side, unnecessary imaging procedures can be reduced through information exchange.

Accountable Care Organizations are also having trouble, both because they are information-poor and because the CMS version of fee-for-value is too timid, along with other financial blows and perhaps an inability to retain patients. An August article analyzed the positives and negatives in a CMS announcement. On a large scale, fee-for-value may work. But a key component of improvement in chronic conditions is behavioral health which EHRs are also unsuited for.

Pricing and consumer choice have become a major battleground in the current health insurance business. The steep rise in health insurance deductibles and copays has been justified (somewhat retroactively) by claiming that patients should have more responsibility to control health care costs. But the reality of health care shopping points in the other direction. A report card on state price transparency laws found the situation “bleak.” Another article shows that efforts to list prices are hampered by interoperability and other problems. One personal account of a billing disaster shows the state of price transparency today, and may be dangerous to read because it could trigger traumatic memories of your own interactions with health providers and insurers. Narrow and confusing insurance networks as well as fragmented delivery of services hamper doctor shopping. You may go to a doctor who your insurance plan assures you is in their network, only to be charged outrageous out-of-network costs. Tools are often out of date overly simplistic.

In regard to the quality ratings that are supposed to allow intelligent choices to patients, A study found that four hospital rating sites have very different ratings for the same hospitals. The criteria used to rate them is inconsistent. Quality measures provided by government databases are marred by incorrect data. The American Medical Association, always disturbed by public ratings of doctors for obvious reasons, recently complained of incorrect numbers from the Centers for Medicare & Medicaid Services. In July, the ProPublica site offered a search service called the Surgeon Scorecard. One article summarized the many positive and negative reactions. The New England Journal of Medicine has called ratings of surgeons unreliable.

2015 was the year of the intensely watched Department of Defense upgrade to its health care system. One long article offered an in-depth examination of DoD options and their implications for the evolution of health care. Another article promoted the advantages of open-source VistA, an argument that was not persuasive enough for the DoD. Still, openness was one of the criteria sought by the DoD.

The remote delivery of information, monitoring, and treatment (which goes by the quaint term “telemedicine”) has been the subject of much discussion. Those concerned with this development can follow the links in a summary article to see the various positions of major industry players. One advocate of patient empowerment interviewed doctors to find that, contrary to common fears, they can offer email access to patients without becoming overwhelmed. In fact, they think it leads to better outcomes. (However, it still isn’t reimbursed.)

Laws permitting reimbursement for telemedicine continued to spread among the states. But a major battle shaped up around a ruling in Texas that doctors have a pre-existing face-to-face meeting with any patient whom they want to treat remotely. The spread of telemedicine depends also on reform of state licensing laws to permit practices across state lines.

Much wailing and tears welled up over the required transition from ICD-9 to ICD-10. The AMA, with some good arguments, suggested just waiting for ICD-11. But the transition cost much less than anticipated, making ICD-10 much less of a hot button, although it may be harmful to diagnosis.

Formal studies of EHR strengths and weaknesses are rare, so I’ll mention this survey finding that EHRs aid with public health but are ungainly for the sophisticated uses required for long-term, accountable patient care. Meanwhile, half of hospitals surveyed are unhappy with their EHRs’ usability and functionality and doctors are increasingly frustrated with EHRs. Nurses complained about technologies’s time demands and the eternal lack of interoperability. A HIMSS survey turned up somewhat more postive feelings.

EHRs are also expensive enough to hurt hospital balance sheets and force them to forgo other important expenditures.

Electronic health records also took a hit from ONC’s Sentinel Events program. To err, it seems, is not only human but now computer-aided. A Sentinel Event Alert indicated that more errors in health IT products should be reported, claiming that many go unreported because patient harm was avoided. The FDA started checking self-reported problems on PatientsLikeMe for adverse drug events.

The ONC reported gains in patient ability to view, download, and transmit their health information online, but found patient portals still limited. Although one article praised patient portals by Epic, Allscripts, and NextGen, an overview of studies found that patient portals are disappointing, partly because elderly patients have trouble with them. A literature review highlighted where patient portals fall short. In contrast, giving patients full access to doctors’ notes increases compliance and reduces errors. HHS’s Office of Civil Rights released rules underlining patients’ rights to access their data.

While we’re wallowing in downers, review a study questioning the value of patient-centered medical homes.

Reuters published a warning about employee wellness programs, which are nowhere near as fair or accurate as they claim to be. They are turning into just another expression of unequal power between employer and employee, with tendencies to punish sick people.

An interesting article questioned the industry narrative about the medical device tax in the Affordable Care Act, saying that the industry is expanding robustly in the face of the tax. However, this tax is still a hot political issue.

Does anyone remember that Republican congressmen published an alternative health care reform plan to replace the ACA? An analysis finds both good and bad points in its approach to mandates, malpractice, and insurance coverage.

Early reports on use of Apple’s open ResearchKit suggested problems with selection bias and diversity.

An in-depth look at the use of devices to enhance mental activity examined where they might be useful or harmful.

A major genetic data mining effort by pharma companies and Britain’s National Health Service was announced. The FDA announced a site called precisionFDA for sharing resources related to genetic testing. A recent site invites people to upload health and fitness data to support research.

As data becomes more liquid and is collected by more entities, patient privacy suffers. An analysis of web sites turned up shocking practices in , even at supposedly reputable sites like WebMD. Lax security in health care networks was addressed in a Forbes article.

Of minor interest to health IT workers, but eagerly awaited by doctors, was Congress’s “doc fix” to Medicare’s sustainable growth rate formula. The bill did contain additional clauses that were called significant by a number of observers, including former National Coordinator Farzad Mostashari no less, for opening up new initiatives in interoperability, telehealth, patient monitoring, and especially fee-for-value.

Connected health took a step forward when CMS issued reimbursement guidelines for patient monitoring in the community.

A wonky but important dispute concerned whether self-insured employers should be required to report public health measures, because public health by definition needs to draw information from as wide a population as possible.

Data breaches always make lurid news, sometimes under surprising circumstances, and not always caused by health care providers. The 2015 security news was dominated by a massive breach at the Anthem health insurer.

Along with great fanfare in Scientific American for “precision medicine,” another Scientific American article covered its privacy risks.

A blog posting promoted early and intensive interactions with end users during app design.

A study found that HIT implementations hamper clinicians, but could not identify the reasons.

Natural language processing was praised for its potential for simplifying data entry, and to discover useful side effects and treatment issues.

CVS’s refusal to stock tobacco products was called “a major sea-change for public health” and part of a general trend of pharmacies toward whole care of the patient.

A long interview with FHIR leader Grahame Grieve described the progress of the project, and its the need for clinicians to take data exchange seriously. A quiet milestone was reached in October with a a production version from Cerner.

Given the frequent invocation of Uber (even more than the Cheesecake Factory) as a model for health IT innovation, it’s worth seeing the reasons that model is inapplicable.

A number of hot new sensors and devices were announced, including a tiny sensor from Intel, a device from Google to measure blood sugar and another for multiple vital signs, enhancements to Microsoft products, a temperature monitor for babies, a headset for detecting epilepsy, cheap cameras from New Zealand and MIT for doing retinal scans, a smart phone app for recognizing respiratory illnesses, a smart-phone connected device for detecting brain injuries and one for detecting cancer, a sleep-tracking ring, bed sensors, ultrasound-guided needle placement, a device for detecting pneumonia, and a pill that can track heartbeats.

The medical field isn’t making extensive use yet of data collection and analysis–or uses analytics for financial gain rather than patient care–the potential is demonstrated by many isolated success stories, including one from Johns Hopkins study using 25 patient measures to study sepsis and another from an Ontario hospital. In an intriguing peek at our possible future, IBM Watson has started to integrate patient data with its base of clinical research studies.

Frustrated enough with 2015? To end on an upbeat note, envision a future made bright by predictive analytics.

What Does It Take to Create the Ideal Patient Experience? – #MyIdealPtExp

Posted on December 14, 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.

This new world of social media has created so many virtual friends for me. Over time I’ve had a chance to meet so many of them in person. While sometimes it’s a disappointment meeting someone in person, I’ve also had the opposite experience. This happened at RSNA when I got a chance to meet Andy DeLaO (@CancerGeek) in person. I’d always been impressed by his insightful tweets over the years. So, I was blown away when he was even more impressive and insightful in person. I love it when that happens.

One of the most impressive things he showed me was his new effort around what he calls My Ideal Patient Experience. He even had these really cool coins to hand out which was a great way for me to remember his concept:
My Ideal Patient Experience
Andy the team behind My Ideal Patient Experience has gone through the research and defined the patient experience using these 4 pillars:

  • Time
  • Trust
  • Transparency
  • Transitions

However, it’s worth considering the connective tissue between all 4 pillars:

Time Leads To Trust, Trust Leads To Transparency , Transparency Leads To Transitions; The 4t’s Lead To Relationships And Success!

Andy and his team have been at this for a while even though they’re just now getting their official patient experience website launched. I love that they’re even keeping track of their stats:

  • 50,850 Patients Impacted
  • 878 Physicians Engaged
  • 46 Clients Worked With
  • 30 Completed Projects

If you’re looking to improve the way you engage with patients or your patient experience, take a second to look at the consulting, market research, healthcare engagement, and education resources they offer. After my experience finally meeting Andy in person, I’m excited to see the impact for good “My Ideal Patient Experience” will have on healthcare. Plus, I look forward to digging into the concepts even more in the future.

Apple EHR

Posted on December 11, 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.


I love how everyone thinks that Apple touching something will somehow make it better. Not only does this forget about the various times Apple has had product fails, but it also assumes that Apple can fix everything. It’s possible that’s what’s broken with EHR is the system and not the people creating the software itself. In fact, that’s what many innovators and startup entrepreneurs see when they look at healthcare and then choose to stay away.

I read a quote from a VC recently that said something similar to this, “When you go into a market you expect it to act in a certain way. Healthcare doesn’t act like a rational market.”

Chew on that concept a little. However, the final part of the above tweet is what really gets under my skin. “Ability to customize every single deployed copy!” People who ask for this don’t really know what they want and it’s also not fair to say that everything on the iPhone, for example, can by customized. Turns out that most people that get an iPhone or iPad do very little customization. The out of the box experience is really quite incredible with very little customization required.

We’ve written about this before back in 2010. Software vendors have to find the right balance between a beautifully simple and effective “out of the box” experience and the long term ability to customize the EHR in any form or fashion they desire.

I’m sure all the hospital CIOs reading this are shaking their heads when I talk about the “out of the box” experience being great. When they look at the millions (sometimes hundreds of millions or even billions) that they’ve spent on EHR consultants to configure and customize their EHR software, they could clearly argue that their hospital EHR has the “ability to customize every single deployed copy.” In fact, it costs them millions of dollars to get it customized. I’ve heard many hospital CIOs wonder why their EHR needs so much configuration. In the ambulatory world you can get much closer to an out of the box experience. Although, even they like to complain about there being too much EHR configuration.

This conversation is actually going to get even more complex. When you look at evidence based medicine and various care guidelines, there’s a movement to try and standardize some of the ways we practice medicine. I’m reminded of when I heard the CMIO of Intermountain say, “If we allow physicians to do whatever they want, we’re allowing them the right to take improper care of patients.” This is going to drive organizations to use a much more standards based workflow as opposed to their own unique customizations.

Finding the balance between infinitely customizable and hard coding proper workflows is an extremely hard problem to solve and will likely never be fully solved. However, it’s the challenge of any software system.

As far as Apple doing an EHR or as one person suggested, Apple buying an EHR vendor…that’s never going to happen. Just look at how simple their approach to Apple Health Kit has been. They’re not going to tackle the true problems of healthcare.

What I do think Dino was trying to say in the tweet above is “I wish I loved my EHR as much as I love my Apple products.” Now that’s a concept I can get behind and would be a great aspiration for every EHR vendor.

15 Questions to Self Assess Your Medical Billing

Posted on December 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.

Care360 has put out a great little whitepaper that looks at outsourcing your medical billing. In the whitepaper, they talk about various aspects of doing your medical billing in house or outsourced including: control, communication, cost, performance, and management style.

This is all great, but I find that many practices are still trying to figure out whether they should spend time considering outsourced medical billing or not. So, the best part of the whitepaper for me was these 15 questions that provide a good self assessment of a practice’s medical billing:

Medical Billing Self Assessment

Remember that answering yes doesn’t mean you should outsource your billing. For example, if on question #13 you say you are looking to expand your practice, then that might be a reason not to outsource your billing. From my experience medical billing generally benefits from scale. So, if you’re planning to grow your practice large enough, it might make since to keep your billing staff in house if you can grow it large enough to enjoy the benefits of scale.

There are a lot more details on outsourced medical billing in the whitepaper. I’m seeing more and more organizations outsourcing their billing as it’s become more complex. These questions provide a good framework for you to consider your current approach and how you could benefit or suffer if you outsourced your billing.

“We’re Dreaming of White Christmas” EHR Parody Video

Posted on December 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.

Maybe I’m just in a bit of a marketing mood with all my planning for the Health Care IT Marketing and PR Conference, but I really enjoyed a parody video from SRSsoft to the song “I’m Dreaming of a White Christmas.” Their version is called “We’re Dreaming of the SRS White Version.” Check it out embedded below:

Here’s a link to the webinars they mention in the video. The link also mentions their new version is going to have Smart Workflows™ amidst other product enhancements. However, they’re being kind of tight lipped about the updates.

Certainly this seems to just be the next version of the SRSsoft EHR, but I appreciated that they sent me a creative way of announcing the new release as opposed to a stale press release stating that they’re about to have a new release of their software. I like to reward that kind of creativity.

I guess we’ll have to wait until January to see if they can deliver on what the video promises.

Cost to Our Economy of Patients Waiting

Posted on December 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.

I must admit that I’d never really processed the economic value to society of patients spending so much time waiting in the doctor’s office. Sure, I was very familiar with the patient dissatisfaction with patient wait times, but I hadn’t ever thought about it from the economic cost perspective.

At least I hadn’t until I saw this study that tried to quantify the economic costs associated with patient wait times. They calculated that the total annual societal opportunity cost of patient wait times was $52 billion (Note: They used the number of visit data from 2010).

This video dives into some of the details of the study and how that number was calculated:

I understand many of the reasons that doctors have such horrible wait times. Some of them are preventable and some of them are not. Although, when you see the numbers from the study above, it helps you realize what a benefit telemedicine could bring not only to healthcare, but the economy in general. I also think it makes the case for why on demand health care could be such an amazing thing for all of us.

Can you imagine if we had wait times like we do in healthcare in other parts of our lives? Those companies would go out of business. As patients get more selective on how, when, and where they get their healthcare services (thank you high dedcutible plans), this is going to start mattering a lot more.

Side Note: I wonder if the opportunity cost should be lowered now that we have a cell phone in our pocket and can get more things done while we’re waiting. I guess it depends on if we use the cell phone to get work done while we wait or if we play angry birds (some might say that’s a good use of time too).

The State of “Direct Project” in Healthcare

Posted on December 7, 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.

Update: Here is the recorded version of this Direct Project panel:

and here’s the video of the Q&A with the audience that followed:

As part of our ongoing series of Healthcare Scene interviews (see all our past Healthcare Scene interviews on YouTube), we’re excited to announce our next interview with an amazing panel of Direct Project experts, Julie Maas, Greg Meyer, and Mark Hefner happening Wednesday, December 9th at 3 PM ET (Noon PT).

As you can imagine, we’ll be digging into everything Direct Project (See CMS’ description of Direct Project for those not famliar with it). I’m excited to learn about ways Direct Project is starting to impact healthcare, but also to learn about the challenges it still faces and how they can be overcome. We’ll probably even dip into where Direct Project fits in with other projects like FHIR and EHR APIs getting all the attention.


Here are a few more details about our panelists:

You can watch our interview on Blab or in the embed below. We’ll be interviewing our panelists for the first 30-40 minutes of the blab and then we’ll open up to the audience for questions for the rest of the hour. We hope you can join us live. We’ll also share the recorded video after the event.

The Finger Pointing Circle of Healthcare Blame

Posted on December 4, 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.


I think MS Unites is really on to something with this tweet. Earlier this week I did a webinar for Kareo about the 2016 Healthcare Business Trends (I think if you sign up you can see the recording of it). In the presentation I talk about a lot of the challenges that small practices face when it comes to all the changes happening in healthcare. As I put together the presentation I was hit by how many things are happening which really make healthcare a challenge.

Going back to the tweet, there’s a lot of finger pointing in healthcare. The reality is that the finger pointing is probably accurate. At the end of the day, everyone in the healthcare system has a finger pointing at them. Everyone has played a part in getting us to the flawed healthcare system that we have today. Of course, no one wants to take responsibility and yet we all need to take responsibility and do what we can to make it better.

I thought this tweet from Paulo Machado paralleled nicely with this discussion:

I think a tsunami of change is an accurate description of what’s happening in healthcare. I’m reminded of when I lived in Hawaii and we got the Tsunami warnings well ahead of the waves crashing on the shores. I think that’s what I see happening in healthcare. There are dozens of signs that things are changing. Some people are in denial. Others will see the shift in healthcare as an opportunity. I personally see it as the later.

What are you doing to help fix healthcare and prepare for the future?