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Leveraging New Age Technology to Overcome MACRA Challenges – MACRA Monday

Posted on August 21, 2017 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest blog post by Dr. David A. Goldman, CEO and founder, Goldman Eye and Ophthalmology Team Lead, Anterior Segment at Modernizing Medicine.  This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program (QPP) and related topics.

MACRA and the Quality Payment Program (QPP) were implemented by the Centers for Medicare & Medicaid Services (CMS) to improve healthcare by focusing on the quality of care provided to patients. There are two paths under the QPP: the Merit-based Incentive Payment System (MIPS) track which covers most clinicians, and the Advanced Alternate Payment Models (APMs) track which applies to providers who have taken on some risk related to patient outcomes (Medicare Shared Savings 2,3 and Next Gen ACO participants for example).

MACRA and MIPS are intended to advance quality based care by implementing outcome-based payment adjustments. Providers will be measured across a number of different performance categories and will be paid on a curve. By 2022, physicians who outperform their peers may receive up to a 9 percent positive payment adjustment on their Medicare reimbursements based on their performance in 2020. Those who report poor performance may receive up to a 9 percent negative payment adjustment on their Medicare reimbursements in 2022.

Specialtyspecific Measures & Bonus Points

As previously mentioned, if you perform better than your peers when it comes to MIPS, you can substantially increase your Medicare reimbursements. Conversely, reporting a score below the performance threshold could prevent you from receiving a positive payment adjustment on your Medicare reimbursements, and not reporting on MIPS could cause you to be penalized.

Some MIPS categories will be the same across all specialties such as Advancing Care Information and Improvement Activities, whereas others can be geared towards a specialty, like Quality. Quality accounts for 60 percent of your total MIPS score in 2017. As an Eligible Clinician (EC), you should select six measures, including one Outcome Measure or if an Outcome Measure is not available, a High Priority Measure. After your first Outcome or High Priority Measure, any additional ones you report will count towards your bonus points (up to six points). In addition, an EC can earn another six points by doing end-to-end reporting. More information on the measure specifications can be found here.

Under the Advancing Care Information (ACI) category, ECs have the option to earn 5 bonus points by being in active engagement with a specialized registry, which are typically specialty-specific. The third category of MIPS is called Improvement Activities (IAs) which has over 90 activities to choose from. ECs, regardless of specialty, can choose activities that apply to their practice size and way of practicing like expanded practice access and closing the referral loop. Depending on the IA selected, ECs can also earn a 10 point bonus under the ACI category.

How can we turn this change into an opportunity?

A major factor in succeeding in MIPS is the use of today’s latest technology. Innovative electronic health record (EHR) systems, which can collect and organize clinical data in a structured format, empower doctors to extract meaningful insights at the patient and population levels. Instead of relying on any one physician’s narrative assessment or unstructured data for a diagnosis or treatment, physicians who have access to an interoperable platform can reference relative findings from their peers while eliminating redundancies, automating communications and improving patient outcomes.

How Do You Track Your Performance

The answer is certainly not using pen and paper. Look for a certified EHR vendor that has technology which provides services and products that can track data in real time and provide analytics to show your progress and outcomes. You want MIPS intelligence directly built-in to your EHR system.

Modernizing Medicine offers a specialty-specific suite of products and services that gives physicians added support. modmed Ophthalmology™ helps ophthalmologists transition to MIPS by providing them with quality data and reporting capabilities with the products and services they provide. Included within the suite is the company’s flagship EHR system, EMA™. EMA provides functionality for automated quality data capture, population health registries, real patient engagement and analytical tools, plus the ability to submit MIPS right to CMS.

I have been utilizing EMA for the past few years and am also a team lead on Modernizing Medicine’s ophthalmology team. As a practicing ophthalmologist, I have gone through the process of spending countless hours documenting patient reporting following a long day in the office. Couple that with ensuring my compliance measures are in check – it adds up. Now, my measures are completed efficiently, accurately and securely, ready to be submitted to CMS at the end of my reporting period. I even led a webinar on the topic of MIPS, if you want to see it in action.

EHR System Checklist for MIPS

From my unique perspective of working for an EHR vendor and utilizing the certified technology in my practice, I’ve shared a few qualities to look for in an EHR to support your reporting needs:

  • 2014 / 2015 ONC Certified
  • Integrated MIPS intelligence
  • Built in Improvement Activities
  • Qualified MIPS Registry
  • Automated data capturing and reporting
  • Built-in, real-time analytics reporting for Quality, Resource Use, Advancing Care Information and Improvement Activities
  • A vendor with an all-in on solution, including the ability to submit MIPS right to CMS
  • Advisory services and consultation during MIPS transition and reporting

While there is much work to be done in terms of keeping up with and understanding today’s fast-paced healthcare landscape, one thing is for certain – the proper use of specialty-specific technology can help alleviate hours of extra work, stress and physician burnout. As noted above, there are certain aspects of MACRA that apply across all specialties, whereas others are specialty-specific and working with a vendor that can guide you along this MIPS journey can be crucial to your financial success.

David A. Goldman, M.D. is the Ophthalmology Team Lead, Anterior Segment at Modernizing Medicine and founder of Goldman Eye in Palm Beach Gardens, Fla.

EHRs Were Never Designed to Influence Medicine

Posted on May 4, 2017 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This is a concept I’ve been chewing on for a couple years. When you look at the history of EHR software, EHRs were not designed to influence medicine. They weren’t designed to improve care. They weren’t designed to ensure patient safety. Looking back, they were designed as big billing and documentation engines.

When you look at their feature sets, this becomes abundantly clear. EHRs were designed to better help a practice document the visit and bill the insurance company. The idea of improving patient care, better patient safety and other ideas came along much later.

As I mentioned, I’ve written about this idea before. Usually, I proceed to talk about how doctors and practices that expect their EHR to improve care have been misled. I still think that’s largely the case and that expectations need to be adjusted. However, today I realized that there’s another important lesson that needs to be learned by the history of EHR software and that lesson is for EHR vendors.

EHR vendors need to realize that their systems weren’t designed to improve care. Write as many blog posts as you want. Add whatever signage you want to your exhibit hall booth or to your email campaigns. You still weren’t designed to improve care. This is not necessarily a bad thing, but it’s important that a company knows who it is and knows its limitations.

Think about how valuable it would be for an EHR vendor to come to this realization. Once they realize this to be the case, then their approach to working with other companies would shift dramatically. Instead of seeing other companies that do improve patient care as the enemy, they could see them as partners that could enable their EHR users to improve care. That’s right. An EHR software doesn’t have to be the end all be all.

Even if your EHR software can improve care in a few ways, this concept still applies. An EHR vendor has limited bandwidth. They can’t do everything and so they can’t improve care across every medical specialty and every opportunity. Even within a specialty, there are often innovations that other companies can provide that the EHR vendor doesn’t have time, expertise, knowledge, or capability to provide. This is why an EHR vendor that has amazing partner relationships is going to be so valuable moving forward.

I actually only know one EHR company that was truly started to modernize medicine. However, even they can’t do everything. Every EHR vendor will have to rely on partners if they really want to influence medicine the way they could and the way they should.

Enterprise EHR Vendors Consolidating Hold On Doctors

Posted on September 9, 2016 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 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.

When I stumbled across a recent study naming the EHRs most widely used by physicians, I don’t know what I expected, but I did not think big-iron enterprise vendors would top the list. I was wrong.

In fact, I should have guessed that things would play out this way for giants like Epic, though not because physicians adore them. Forces bigger than the Cerners and Epics of the world, largely the ongoing trend towards buyouts of medical groups by hospitals, have forced doctors’ hand. But more on this later.

Context on physician EHR adoption
First, some stats for context.  To compile its 2016 EHR Report, Medscape surveyed 15,285 physicians across 25 specialties. Researchers asked them to name their EHR and rate their systems on several criteria, including ease of use and value as a clinical tool.

When it came to usage, Epic came in at first place in both 2012 and 2016, but climbed six percentage points to 28% of users this year. This dovetails with other data points, such that Epic leads the hospital and health system market, according to HIT Consultant, which reported on the study.

Meanwhile, Cerner climbed from third place to second place, but it only gained one percentage point in the study, hitting 10% this year. It took the place of Allscripts, which ranked second in 2012 but has since dropped out of the small practice software market.

eClinicalWorks came in third with 7% share, followed by NextGen (5%) and MEDITECH (4%). eClinicalWorks ranked in fifth place in the 2012 study, but neither NextGen nor MEDITECH were in the top five most used vendors four years ago. This shift comes in part due to the disappearance of Centricity from the list, which came in fourth in the 2012 research.

Independents want different EHRs
I was interested to note that when the researchers surveyed independent practices with their own EHRs, usage trends took a much different turn. eClinicalWorks rated first in usage among this segment, at 12% share, followed by Practice Fusion and NextGen, sharing the second place spot with 8% each.

One particularly striking data point provided by the report was that roughly one-third of these practices reported using “other systems,” notably EMA/Modernizing Medicine (1.6%), Office Practicum (1.2%) and Aprima (0.8%).

I suppose you could read this a number of ways, but my take is that physicians aren’t thrilled by the market-leading systems and are casting about for alternatives. This squares with the results of a study released by Physicians Practice earlier this year, which reported that only a quarter of so of practices felt they were getting a return on investment from their system.

Time for a modular model
So what can we take away from these numbers?  To me, a few things seem apparent:

* While this wasn’t always the case historically, hospitals are pushing out enterprise EHRs to captive physicians, probably the only defensible thing they can do at this point given interoperability concerns. This is giving these vendors more power over doctors than they’ve had in the past.

* Physicians are not incredibly fond of even the EHRs they get to choose. I imagine they’re even less thrilled by EHRs pushed out to them by hospitals and health systems.

* Ergo, if a vendor could create an Epic- or Cerner-compatible module designed specifically – and usably — for outpatient use, they’d offer the best of two worlds. And that could steal the market out from under the eClinicalWorks and NextGens of the world.

It’s possible that one of the existing ambulatory EHR leaders could re-emerge at the top if it created such a module, I imagine. But it’s hard for even middle-aged dogs to learn new tricks. My guess is that this mantle will be taken up by a company we haven’t heard of yet.

In the mean time, it’s anybody’s guess as to whether the physician-first EHR players stand a chance of keeping their market share.

What’s the Impact of MACRA on Small Practices?

Posted on July 22, 2016 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I recently had a chance to sit down and chat with Tom Giannulli, MD, Chief Medical Officer of Kareo and Michael Sherling, MD, MBA, Chief Medical Officer and Co-founder of Modernizing Medicine, to talk about the impact of the MACRA legislation on small practices. Both of these CMOs at EHR vendors rode the meaningful use wave and now they’re preparing to ride the new MACRA wave as well. So, they were the perfect people to talk about the impact of MACRA on small practices and how a small practice should prepare themselves for the new MACRA legislation. If you’re a small practice that’s wondering about MACRA (or doesn’t even know what it is), then take the time to watch the video below to see what it means for small practices.

After our formal interviews, we always like to hold what we call the “after party.” We never know how it’s going to go. Sometimes people join in and offer their insights and ask questions and sometimes they don’t. In this case, we continued our conversation about the MACRA and small practices, but we also talked about the impact that legislation like MACRA has on an EHR vendors development lifecycle. You can learn more about MACRA in the video below:

This post was a great way to wrap up the week and also for us to announce a new blog post series we’re starting on Monday called MACRA Monday. Long time readers may remember the Meaningful Use Monday series of blog posts we did every Monday for a few years. This will be similar as we dive into the MACRA legislation and help small medical practices understand the details of what’s coming in MACRA. Watch for that on Monday!

CommonWell and Healthcare Interoperability

Posted on June 27, 2016 I Written By

John Lynn is the Founder of the 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 and 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: In case you missed the live interview, you can watch the recorded interview on YouTube below:

2016 June - CommonWell and Healthcare Interoperability-headshots

For our next Healthcare Scene interview, we’ll be sitting down with Scott Stuewe, Director at Cerner Network and Daniel Cane, CEO & Co-Founder at Modernizing Medicine on Wednesday, June 29, 2016 at 3 PM ET (Noon PT). Cerner was one of the Founding Members of CommonWell and Modernizing Medicine just announced they were joining CommonWell. No doubt these diverse perspectives will provide an engaging discussion about the work CommonWell is doing to improve healthcare data sharing.

You can join my live conversation with Scott Stuewe and Daniel Cane and even add your own comments to the discussion or ask them questions. All you need to do to watch live is visit this blog post on Wednesday, June 29, 2016 at 3 PM ET (Noon PT) and watch the video embed at the bottom of the post or you can subscribe to the blab directly. We’re hoping to include as many people in the conversation as possible. The discussion will be recorded as well and available on this post after the interview.

As we usually do with these interviews, we’ll be doing a more formal interview with Scott Stuewe and Daniel Cane for the first ~30 minutes of this conversation. Then, we’ll open up the floor for others to ask questions or join us on camera. CommonWell has become a big player in the healthcare interoperability space with most of the major EHR vendors involved, so we’re excited to learn more about what’s happening with CommonWell.

If you’d like to see the archives of Healthcare Scene’s past interviews, you can find and subscribe to all of Healthcare Scene’s interviews on YouTube.

Software Is Dramatically Better Than Paper – Even if EHR Is Far from Perfection

Posted on January 14, 2016 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

After writing my piece yesterday on the reasons so many physicians are burnt out and my previous New Year’s post on physicians getting pissed off, I thought it might be good to add a little more perspective to the discussion.

In a perfect act of serendipity I came across this great article with quotes from Ross Koppel, scholar in the Sociology Department & School of Medicine at the University of Pennsylvania. First, he puts the situation many organizations find themselves in:

If I buy a toaster and my wife says, ‘It’s lousy; throw it out,’ to preserve domestic tranquility I throw out the toaster and buy a new one. If I spend $1.2 billion or $1.7, I am married and I don’t have a heck of a lot of options.

Then he offers what I think is a proper reality check:

There has been increasing rage on the part of physicians and others about the software not being responsive to their needs. That said, I would be the last person on Earth to argue we should go back to paper. The software is dramatically better than paper. [emphasis added]

I’m sure that some doctors will come on this post and start to point out the virtues of paper. No doubt, there were a lot of good things about paper. A long time ago I wrote a post that described the perfect interface that was infinitely flexible, multi-lingual, no training needed, etc and I was just describing the virtues of the paper chart. I get the paper chart was great for a lot of reasons, but it was awful for a lot of reasons as well. I’m reminded of this post called “Don’t Act Like Paper Charting Was Fast.” I won’t even mention how much time was wasted trying to read illegible charts or searching for the chart that could not be found. Oh wait, I just did.

The problem with all the benefits of EHR is that we quickly take them for granted and promptly forget about them. However, the problems and challenges stare us in the face and annoy us every day. Let’s just reconcile us to the fact that the Perfect EMR is Mythology. However, in many ways it’s better than paper and I don’t see anyone going back.

Here’s where I usually do my sidebar and say that doesn’t mean that EHR vendors can’t do better. They can and should. Hopefully the meaningful use handcuffs that we put on them will indeed be removed and they can focus their attention on making EHRs better as opposed to government regulation. Every EHR vendor I know would celebrate this as well!

If you can’t celebrate the small but powerful benefits of being able to read everything in your EHR and being able to instantly pull up every record. We’ve seen glimpses of other benefits coming to your EHR that are great. Take a second to talk to Jimmie Vanagon about how his #ProjectedEHR and patient portal has changed how he sees and cares for patients.

Want to see other innovation happening in the EHR space? Learn about what Modernizing Medicine is doing with EMA Grand Rounds and Watson. The grand rounds approach is genius and can really inform the care a doctor provides. Unfortunately, we don’t hear much about it, even from them, because I don’t know anyone who’s based their EHR buying decision on if it would improve care in their organization. Sure, they didn’t want it to decrease care, but did they really evaluate the EHR based on it’s ability to improve care? No. They ask if it would meet meaningful use. They ask if it will improve reimbursement. They ask if it will improve productivity. Where’s “Will it improve care?” in that list?

Chew on that concept for a minute. How many EHR systems were bought in order to improve care?

What would it take for a healthcare organization to be ready to make an EHR selection based on the care that an EHR system provided? Would the current crop of EHR vendors be able to adapt? Would it require a whole new breed of EHR software (or maybe a different name)? Will any of the current EHR vendors adapt enough that they could illustrate that their EHR improved care so substantially that it would be nearly malpractice for a healthcare organization to pick any EHR but there’s? Is this what we need to happen for doctors to love EHR?

As I wrote at the New Year, I’m optimistic for healthcare IT. There’s so much potential for us to better utilize technology to improve healthcare. There’s so much non-technology that could benefit healthcare as well. Sometimes it’s just baffling that we can’t get out of our own way. What is clear to me is that we’re not going back to paper.

Exploring the Role of Clinical Documentation: a Step Toward EHRs for Learning

Posted on January 19, 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 ( 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.

We need more clinicians weighing in on the design of the tools they use, so I was gratified to see a policy paper from the American College of Physicians about EHRs this week. In a sporadic and tentative manner, the paper recognizes that our digital tools for clinical documentation are part of a universal health care system that requires attention to workflow, care coordination, outcomes, and research needs.

The strong points of this paper include:

  • A critique of interfaces that hobble the natural thought processes of the clinician trying to record an encounter

  • A powerful call to direct record-keeping away from billing and regulatory requirements, toward better patient care

  • An endorsement of patient access to records (recommendation 6 under Clinical Documentation) and even more impressively, the incorporation of patient-generated data into clinical practice (recommendation 5 under EHR System Design)

  • A nod toward provenance (recommendation 3 under EHR System Design), which tells viewers who entered data and when, thus allowing them to judge its accuracy

Although the authors share my interests in data sharing and making data available for research, their overarching vision is of an electronic record that supports critical thinking. An EHR should permit the doctor to record ideas about a patient’s condition as naturally as they emerge from his or her head. And it should support other care-takers in making treatment decisions.

That’s a fine goal in itself, but I wish the authors also laid out a clearer vision of records within a learning health care system. Currently a popular buzzword, a learning health care system collects data from clinicians, patients, and the general population to look for evidence and correlations that can improve the delivery of health care. The learning system can determine the prevalence of health disorders in an area, pick out which people are most at risk, find out how well treatments work, etc. It is often called a “closed loop system” because it can draw on information generated from within the system to change course quickly.

So at the start of the policy paper I was disappointed to read, “The primary goal of EHR-generated documentation should be concise, history-rich notes that reflect the information gathered and are used to develop an impression, a diagnostic and/or treatment plan, and recommended follow-up.” What about supporting workflows? Facilitating continuous, integrated care such as in a patient-centered medical home? Mining data for new treatments and interventions? Interfacing with personal health and fitness devices?

Fortunately, the authors massage their initial claim by the time they reach their first policy recommendation under Clinical Documentation: “The primary purpose of clinical documentation should be to support patient care and improve clinical outcomes through enhanced communication.” The primary purpose gets even better later on: “As value-based care and accountable care models grow, the primary purpose of the EHR should remain the facilitation of seamless patient care to improve outcomes while contributing to data collection that supports necessary analyses.”

One benefit of reading this paper is its perspective on how medical records evolved to their current state. It notes a swelling over the decades in the length of notes and the time spent on them, “the increased documentation arguably not improving patient care.” Furthermore, it details how the demands of billing drove modern documentation, blaming this foremost on CMS’s “issuance of the evaluation and management (E&M) guidelines in 1995 and 1997.” I suspect that private insurers are just as culpable. In any case, the distortion of diagnosis in the pursuit of payments hasn’t worked well for either goal: 40% of diagnoses are wrongly coded.

The pressures of defensive medicine also reveal the excessively narrow view of the EHR currently as an archive rather than a resource.

The article calls for each discipline to set standards for its own documentation. I think this could help doctors use fields consistently in structured documentation. But although the authors endorse the use of macros, templates, and (with care) copy/forward, they are distinctly unfriendly toward structured data. Their distemper stems from the tendency of structured interfaces to disrupt the doctor’s thinking–the presevervation of which, remember, is their main concern–and to make him jump around from field to field in an unnatural way.

Yet the authors recognize that structured data is needed “for measurement of quality, public health reporting, research, and regulatory compliance” and state in their conclusion: “Vendors need to improve the ability of systems to capture and manage structured data.” We need structured data for our learning health care system, and we can’t wait for natural language processing to evolve to the point where it can reliably extract the necessary elements of a document. But a more generous vision could resolve the dilemma.

Certainly, current systems don’t handle structured data well. For instance, the article restates the well-known problem of redundant data entry, particularly to meet regulatory requirements, a problem that could be solved with minimally intelligent EHR processing engines. The interactive features available on modern mobile devices and web interfaces could also let the clinician enter data in any manner suited to her thinking, imposing structure as she goes, instead of forcing her into a rigid order of data entry chosen by the programmer.

Already, Modernizing Medicine claims to make structured data as easy to enter as writing in a paper chart. As I cover in another article, they are not yet a general solution, but work only with a few fields that deal with a distinct set of health conditions. The tool is a model for what we can do in the future, though.

The common problem of physicians copying observations from a previous encounter and pasting them into the current encounter is a trivial technical failure. On the web, when I want to cite material from a previous article, I don’t copy it and paste it in. I insert a hyperlink, I did in the previous paragraph. EHRs could similarly make reporting simple and accurate by linking to previous encounters where relevant.

The ACP recommendations are sensible and well-informed. If implemented by practitioners and EHR developers who keep the larger goals of health care in mind, they can help jump over the chasm between where EHRs and documentation are today, and where we need them to be.

Full Disclosure: Modernizing Medicine is an advertiser on this site.

Mobile EHR Use

Posted on November 14, 2014 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of the most fascinating sessions I attended recently was by Mihai Fonoage talking about the “Future of Mobile” at EMA Nation (Modernizing Medicine’s EHR user conference where I was keynote). At the start of the presentation, Mihai provided a bunch of really interesting data points about the EMA EHR use on mobiles:

  • 3,500,000 Screens Viewed Daily
  • 50,000 New Visits Each Day
  • 35,000 Photos Taken Daily
  • 12,000 New Consents Each Day
  • 8,000 Rx Prescribed Daily

The most shocking number there is the 35,000 photos taken daily. That’s a lot of photos being stored in the EHR. It is worth noting that Modernizing Medicine has a huge footprint in dermatology where photos are very common and useful. Even so, that’s a lot of photos being taken and inputted into an EHR.

The other stats are nearly as astounding when you think that Modernizing Medicine is only in a small set of specialities. 3.5 million screens (similar to pageviews on a website) viewed daily is a lot of mobile EHR use. In fact, I asked Modernizing Medicine what percentage of their users used their desktop client and what percentage used their iPad interface. Modernizing Medicine estimated that 80% of their EHR use is on iPads. This is a hard number to verify, but I can’t tell you the number of people at EMA Nation I saw pull out their iPads and log into their EMA EHR during the user conference. You could tell that the EMA iPad app was their native screen.

I still remember when I first saw the ClearPractice iPad EHR called Nimble in 2010. It was the first time I’d seen someone really make a deep effort to do an EHR on the iPad. DrChrono has always made a big iPad EHR effort as well. I’d love to see how their iPad EHR use compares to the Modernizing Medicine EMA EHR numbers above. Can any other EHR vendor get even close to 80% EHR use on an iPad application or any of the numbers above?

I’d love to hear what you’re seeing and experiencing with EHR iPad and other mobile EHR use. Is Modernizing Medicine leading the pack here or are their other EHR competitors that are seeing similar adoption patterns with their mobile EHR product lines?

Full Disclosure: Modernizing Medicine is an advertiser on this site.

Generation Who Doesn’t Know Paper Chart World – EHR Natives

Posted on November 13, 2014 I Written By

John Lynn is the Founder of the 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 and 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 loved this insight from a doctor at EMA Nation, Modernizing Medicine’s EHR user conference. When making the comment, he was talking about how many MAs in his office don’t know how to keep the clinic going in a non-EHR world (ie. the EHR is down). Obviously, that’s an example of where dependence on EHR goes too far. However, I’ve found that a great leader in a practice can easily quell and comfort these MAs (and other clinical staff) when the EHR is down or otherwise unavailable. It’s never a fun experience, but it can be managed.

While dependence on EHR has its challenges, it also illustrates where the industry is headed. Very quickly not just the MAs, but the RNs, doctors and all of your staff will be EHR natives. What’s an EHR native? It’s someone who has only practiced medicine or worked in a clinic where an EHR was present.

The number of EHR natives is still rather small, but it’s starting to grow very quickly. Soon, we won’t even be having a discussion of going back to paper charts, because a large majority of users won’t even know what it was like to practice on a paper chart. In fact, they’ll likely not even understand how someone could practice medicine on a paper chart.

This is a dramatic cultural shift that is happening right before our eyes. However, the shift is slow and gradual, so many people don’t even realize that it’s happening. While it currently is important to talk about EHR acceptance, this will be gone forever with EHR natives. Many of the paper chart culture will just disappear from healthcare.

I personally look forward to this day. That’s not to say that many of the paper chart natives can’t learn EHR as well. They can and do. Although, I know the cost of learning something new and it’s high. Trust me. I just added snapchat to my cell phone. All I longed for was to go back to SMS, Facebook, and Twitter. It’s definitely hard to teach an old dog new tricks. It’s possible, but possible doesn’t mean it’s easy.

If Meaningful Use Were Gone – Perspective from EHR Executive at Modernizing Medicine

Posted on February 3, 2014 I Written By

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

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

Michael Sherling
Michael Sherling, MD, MBA
Chief Medical Officer and Co-Founder, Modernizing Medicine

What a great question! As both the co-founder of Modernizing Medicine, and a practicing dermatologist that uses EMA, I can appreciate the amount of time and effort it goes into developing MU feature sets, as well as inputting the data in to be a “meaningful user.”

The Top 3 Measures I would remove

  1. Clinical Summaries Provided to Patient
  2. Vital Signs
  3. Clinical Quality Measures

I understand the intent for patients to receive clinical summaries of each visit- but this places an incredible burden on the end user (physicians and office staff) to make sure that each patient has access to their clinical summaries.  For instance, even though we live in the digital age, several of my older patients don’t own a computer or have access to one.  Additionally, these summaries lead to more questions by the patients after the visit has been concluded often times regarding details of the summary that are relatively innocuous.

I have a serious beef with government mandating of Vital Signs.  Health care providers know when it is medically necessary to take vital signs and when it is not.  Those who never take vital signs, because it is unrelated to their scope of practice can claim exceptions, but those who take a few are often stuck between their medical responsibilities and getting an incentive.  In the end, these dermatologists and ophthalmologists wind up taking more blood pressures or measuring the height and weight of their patients unnecessarily to achieve the incentive.  This paradoxically is medically meaningless since dermatologists don’t treat blood pressure, and ophthalmologists don’t often dose weight-based drugs (they like eye drops).

Clinical Quality Measures needs to be renamed to Cost Effective Measures.   Clearly, the goal of CQM is to change physician behavior so that physician decisions are more cost effective.  This is needed in our health care system.  What today is an incentive based on pay for reporting, will be transformed to pay for performance tomorrow.  My concern as a physician is how do we know these are the right questions to ask?  If physicians comply with these CQM guidelines, will that result in not just lower costs, but more effective care?  I’d much rather see benchmarking around actual patient clinical outcomes themselves, using tools like static global assessments of disease rather than a questionnaire about whether or not I followed a recipe for how a committee thinks I should treat every patient with condition Y.

The Top 5 Measures I would Keep

  1. Electronic Prescribing
  2. Medication List
  3. Allergy List
  4. Drug-Drug, Drug-Allergy Interaction Checks
  5. Patient Search

All of these measures are critical to patient care and have obvious benefits.  With electronic prescribing, prescription orders are standardized and LEGIBLE! No need for the pharmacist to discern my own poor doctor handwriting anymore.   Keeping the medication and allergy lists updated and the drug-drug and drug-allergy checks enabled makes for great patient care.  No physician wants to prescribe a medication that interacts with another in a negative way, nor do we want to prescribe a medication that could potentially cross-react with a known allergy. Finally, patient search is a really cool feature that allows all of us to search for patients with specific diseases and medications. This is an important first step in getting records to behave more like research databases for clinical studies and less like word-processors for just note taking.