Welcome to EMR and HIPAA

I never thought when I started this blog that it would do so well. I mostly just started it as a labor of love. It still is a labor of love, but I was really happy when a number of advertisers were interested in advertising on EMR and HIPAA.

Thanks to Medical Software Associates and emrexperts for advertising on EMR and HIPAA. I really appreciate your financial support of this blog and my wife appreciates it even more.

If there are any other advertisers interested in advertising on EMR and HIPAA, please leave a comment on this post or email john [at] emrandhipaa {.} com Visitors to this site stay an average of 4 minutes and 40 seconds and visitors are almost exclusively interested in EMR and health care related topics. A very nice targeted market for EMR vendors, EHR vendors or I would think it would work really well for pharmaceutical companies too.

Today I came across the HHS Secretary Mike Leavitt’s blog. To be honest, I saw Mike Leavitt’s picture on the blog and I felt like I was meeting an old friend. No, I don’t really know Mike Leavitt from the next person on the street. We have never met before and the closest I’ve been to him is probably when I watched him pass by in numerous 24th of July parades in Utah. However, he was the governor of Utah for many of the years I lived in Utah and so I feel like I kind of know the man.

Reminiscing aside, I find Mike Leavitt’s blog completely captivating. He currently has been writing about his trip to China. For some reason I’ve always had an inner itch whenever I heard about China. I don’t know what it is, but I find the place completely fascinating. So, you can imagine my fascination with the HHS secretary’s interaction with the Chinese government. Plus, these posts about HHS and China give Mike a real personal quality that I find real and interesting.

Of course, I couldn’t begin to read the HHS Secretary’s blog without making sure to find some post about EHR or EMR. I quickly found a post entitled Value-Driven Health Care Interoperability which I think could more aptly be entitled “Electronic Health Records (EHR) Progress Report.” Of course, he is in government so that explains the title.

I’m grateful that the HHS Secretary is willing to engage the public in a discussion about EHR and EHR adoption, but unfortunately the post I found is so filled with political rhetoric. It sounds really good, but really has very little substance.

First, I’ll start with the good.

Three years ago, there were 200 vendors selling electronic health record systems but there was no assurance that the systems would ever be able to share privacy protected data in interoperable formats.

I think the concept of a certification for interoperability is good. It just makes sense that every EMR software vendor should be able to interact with another. Establishing a quality standard for this interoperability is valuable and even worth certifying.

Unfortunately, I think the HHS Secretary has been getting bad information when he says the following:

Since then, we have made remarkable progress.

An EHR standards process is now in place, and we are marching steadily towards interoperability. We created the CCHIT process to certify products using the national standards and it is functioning well. More than 75% of the products being sold today carry the certification.

Where to begin? First, Mike has suggested that there were 200 vendors selling EHR systems 3 years ago (It’s probably a few more than 200 EHR, but we’ll let this one slide). Mike asserts that “75% of the products being sold today carry the certification.” If that’s the case, then simple math tells us that there should be 150 certified EHR software, no?

If you look at the 2006 CCHIT Certified Ambulatory EHR list I count 92 EHR software products. Let’s see, that’s only 46% of EHR products that are certified. Plus, my count of 92 EHR counts some of the software multiple times since a number of the EHR software vendors certified multiple versions of their product. That sounds like less than 75% of EHR products sold to me.

Of course, Mike Leavitt certainly could say that 75% represents a percentage of actual products sold. Certainly the certified eMD’s has a lot more installs than any of the free open source EMR products out there. However, I think it’s a bit deceptive to say 200 EHR and then 75% of products sold if they aren’t the same thing.

I also love how it says 75% of products sold. I think we’re all aware of the outrageous failure rates of so many of the EHR products out there. It’s unfortunate that we don’t have a percentage of products installed. Then, you’d have a much better idea of how many doctor’s offices really have the possibility of interoperability.

Wait a minute! I was being extra generous above when I said that there were 92 Ambulatory EHR CCHIT certified. Why? Because it was 92 EHR certified with the 2006 CCHIT Certification. Correct me if I’m wrong, but I think that interoperability was taken out of the 2006 CCHIT Certification (along with the joke of the pediatric requirements). I’m pretty confident about this, because I work on one of the 2006 CCHIT Certified EHR and I have no way of sending a chart to another clinic other than manually going through the product and printing out the chart.

What does all this mean? That means that instead of 92 interoperable CCHIT certified EHR, there are only 31 EHR CCHIT certified in 2007. That represents 15.5% (not 75%) of the 200 EHR products on the market today are interoperable according to number of certified EHR.

I’m not really blaming Mike Leavitt for this. I’m sure him or his office was given a nice executive report with a bunch of data and they made it look as nice as possible. Reminds me a lot of what I call EMR sales miscommunications. Sometimes the data just gets lost in translation. Let’s just hope my trackback to Mike Leavitt’s blog gets read.

You thought I was done. Nope. Still plenty more to say and I’m just hitting the major points.

In addition, a National Health Information Network will start testing data exchange by the end of the year and go into production with real data transmission the year after.

This concept I really find intriguing. I look forward to seeing this go public and I’m glad it’s on the agenda. However, I fear that this isn’t more than political hyperbole. I’d love to see how they plan to address any of the following: unique identifier, the ultimate hacker’s health information paradise, economic model, motivational model and that’s just the list off the top of my head.

The primary reasons for low adoption rates among small practices are predictable: economics and the burden of change.

I’m glad you pointed out the obvious. If this was so obvious, then why did you support the implementation of a certification that costs so much money that EHR will inevitably raise the cost a small practice pays for an EHR? That doesn’t make much economic sense. Not to mention you missed what I think is the biggest factor in lack of implementation: fear. Not fear of change. Not fear of the expense. Certainly those are two major factors, but I believe that adoption rates by small practices are so low because most doctors have seen too many of their colleagues fail at implementing an EHR.

Let’s start waving the CCHIT certification flag again. Many will be willing to make the case that CCHIT certification helps supplant a doctor’s fear that their EHR implementation will fail. It may even supplant some fear, but what it doesn’t do is decrease the number of failed EHR implementations. It’s a problem I’ve discussed many times on this blog. Certifications don’t certify usability. They never have and never will.

I actually have a thought about what should have been done instead of CCHIT, but I think I’ll save that for a future post.

Thanks Mike for opening up the lines of communication with your blog. Now it will be interesting to see if Mike Leavitt and HHS have really embraced new social media and participate in the discussion they started. I’m certain that Mike’s blog is going to become one of my favorite reads.

This entire week my EMR vendor had someone in our clinic going over our EMR implementation. Yes, that’s nearly 4 entire days of our health and counseling staff meeting with our EMR vendor. You can imagine after the first few meetings it’s pretty hard to keep things straight. However, this type of EMR vendor site visit is so beneficial.

The biggest benefit is that it almost forces doctors, nurses, front desk staff, lab, pharmacy, etc to sit down and think about our EMR, how it could be made better and which parts of the EMR are just causing them pains, problems, frustrations, or other discomfort. We tried to make sure that each EMR meeting went over: our current EMR challenges, features of the EMR that we aren’t using and finally discuss ideas for enhancements to the EMR software.

We’re lucky that we selected a smaller EMR vendor that’s completely focused on the college health EMR market. That means that we have a strong relationship with the EMR company. In our final meeting the EMR “trainer” said that they really are our “partner” in not just the EMR, but they’re willing to support us beyond just software. The nice thing is that our EMR vendor really does try to do this. They don’t always succeed at it, but they certainly are sincere in their effort.

Another major benefit of having someone from the EMR vendor do a site visit is that they are looking at your clinic with fresh eyes. They can see things about the way your process works that you may not see. Plus, they have usually been to hundreds of other EMR installs and so they are aware of how other clinics are using the EMR software.

Of course, you can’t expect someone from your EMR vendor to come and work miracles. In fact, many of the ideas they have just may not work for the way you practice medicine. It takes a solid filter to be able to see the benefits, problems, and workarounds that will work best for your standards of care, legal regulations, and clinical organization. The biggest problems that an EMR vendor faces is that it’s really hard to build a one size fits all EMR. Different practices act differently. However, there’s something really valuable about discussing the various options of an EMR.

I highly recommend this type of collaborative approach to working with your EMR vendor. I believe it’s paid amazing dividends for our clinic. In the end, your EMR company better be a good partner or you’ll pay the price later.

Today I was looking over some of the various statistics for this EMR and HIPAA blog. I can’t believe I started this blog about 2.5 years ago all in my quest to become an expert on EMR. I guess time will tell how much I really know about EMR. Either way, this blog has been a great way for me to learn about EMR and document some of the lessons I’ve learned.

As I was looking through the statistics for this blog, I decided to do a quick back of the napkin excel formula calculation of how much time people have spent reading my EMR and HIPAA articles. Here’s how I broke it down using statistics over the past year:

Number of Visits: 50,000
Average Time Spent on EMR and HIPAA: 2:04 minutes

Then, I took the above 2 numbers to calculate how many hours people have spent reading about EMR and HIPAA on this site and came up with the following:
1722 hours
or
71.75 days

Hopefully that was a well spent 71.75 days that helped improve a doctors use of EMR.

I’ve been following the Google Health announcements for quite a while now and today Google Health finally went live.

It’s been a long time coming and so it will be interesting to finally take a look under the hood. I haven’t personally had enough time to do a full analysis of Google Health myself, but techcrunch posted the announcement live and an initial review.

I think that techcrunch summed up a major part of Google Health and its meaning for EHR software in the following:

Google is planning to open up APIs to Google health to make it easy for other partners to tap into its health platform. And make no mistake about it. That is what this is: a platform. Health apps anyone?

Sure does make for some interesting thinking about how an EMR or EHR could integrate with Google Health. Depending on how my next couple days go, I may see if Google Health has given any sort of specifications for importing a patient record into Google Health from an EMR or EHR software program. In my previous posts it was said to use some form of CCR to integrate Google Health with EMR and EHR software. I hope this is the case. If it is, I think I’ll try to be the first to integrate Google Health with my EMR. I don’t think most of it would be that difficult.

My guess is that many of you are using an HL7 interface between your EMR and your lab. How does your EMR handle the signing of lab results?

We worked for an entire year testing, making requests, testing, more requests and more testing before we were able to launch an interface between our lab and EMR, but it’s been one of the best things we’ve done. The reason it took so long is the topic of another post, but it was for good reason.

One of the best advantages to a lab interface with your EMR is that you don’t have to worry about what to do with all those paper labs that you’ve signed. Inevitably all those signed paper labs will have to be scanned and attached to a patient in your EMR.

Really, that’s why a lab interface is so much better. The interface inserts the lab info right into your EMR so you don’t have to worry about:
1. Losing your lab results (before or after you sign it)
2. No need to scan your signed lab results into your EMR
3. You can run really cool reports on the data from those labs in your EMR (ie. blood sugar change over time)
4. Most EMR will notify you that there are lab results to read, so there’s no more waiting for the paper to somehow make it to you

In our EMR, a lab result gets easily signed off with the click of a check mark. Actually our labs our grouped into batches according to labs that were ordered at the same time. This makes it so all our lab results appear on one nice lab report as opposed to one lab report per lab. All doctors have to do is highlight all the labs and click “Mark as Read” and that whole batch of lab results are signed electronically in the EMR.

Of course, many of you will probably ask how we handle abnormal results. Well, I guess you’ll just have to wait to learn about that.

Some people have asked me how I rate the EMR I work with every day. I can’t bring myself to do it. It’s unfair to me and the people I work with. It’s not that I don’t have strong feelings about my EMR. I really do. I know the pros and cons, the ins the outs, and everything in between. However, it’s just hard rating my EMR and hopefully I can help you understand why.

My job is to implement this EMR the best way possible. That’s what I do. It doesn’t matter if it’s good bad or ugly. It’s counter productive for me to rate how good my EMR is. It is what it is. I haven’t been assigned the task of selecting an EMR. I’m not paid right now to see what other EMR vendors might be better than the one I have. I’m paid to do my very best at implementing the EMR that was chosen.

I don’t want to sound harsh here, but I think that many of the EMR failures are due to people worrying too much about what other EMR software can do and not enough about what their EMR software can do. The question shouldn’t ever be, can our EMR software do this? Instead you should ask, “how can we do this with the EMR software we’ve chosen?” This is two very different perspectives that reap very different results.

I’m not talking about someone who is in the process of selecting an EMR. I’m talking about someone who has already selected an EMR. It reminds me about one of my favorite quotes about marriage that says, “When you’re dating keep both eyes wide open, when you get married keep them closed.” You could just as easily say, “When selecting an EMR keep both eyes wide open, but once you’ve chosen an EMR keep both eyes closed and make the most of it.”

Of course, one thing I can’t help doing is answering people’s questions about EMR. I’ve had dozens of people call me about my EMR and I just love talking to them about the benefits, challenges and hassles of my EMR.

I came across an interesting idea today from the Change Now 4 Health community where they are giving away $10k for the best healthcare idea. They are calling it Innovation xChange. Here’s a summary of what they’re trying to do:

Do you want to improve the U.S. health care system? Or at least be part of the much-needed dialogue?

If you have ideas or solutions to improve the system, submit your ideas through ChangeNow4Health’s Innovation xChange and you can win up to $10,000 or have your ideas published in the e-book, Tomorrow’s Health Care.

The Innovation xChange is looking for practical ideas and suggestions for improving the health care system. All participants in the system, from providers and health plans to consumers and government, are encouraged to join in the discussion.

$10k isn’t a ton of money, but for just submitting an idea it’s not too bad. It’ll be interesting to see what happens with the contest and what kind of creative ideas come out of it. I wonder if any EMR applications or EMR features will make it into the contest.

I just completed my very last class of my educational career (I’ll graduate with my Masters in IS on Saturday. Yeah Me!). My last class was a Business Intelligence class. While I wasn’t necessarily fond of this class or the teacher, I am definitely interested in business intelligence.

Business Intelligence to me is really just about being able to look at large amounts of data in really cool ways. EMR is basically synonymous with the concept of large amounts of data. Each and every day thousands of really interesting pieces of information are being entered into an EMR. Many times this data is organized in such a way that in can be easily accessed and reported on.

For my class, we’ve been using SQL Server 2005’s business intelligence components. While Microsoft may have its downfalls, they really have put some thought and effort into SQL Server 2005’s BI components. For my final project, I decided to extract some appointment data from my EMR (yes, I guess it’s really my PMS, except for things like the room for the appointment) and run some BI analysis on the EMR data.

I actually had to anonymize all the EMR data before using it, because I was working in a group where they weren’t allowed access to all the HIPAA related information. However, it wasn’t too big of a deal in the end. Although, it does lose some of the reporting ability when you do that.

Since we ended up only pulling out simple appointment data from the EMR database, we could only really run reports about appointments. Don’t get me wrong. There is some really cool stuff you can report on appointments. We reported on appointments by date (this includes day, month, quarter, year, etc), provider, gender, birthdate, ethnicity, etc. We also uploaded the room number that an appointment used so that we could measure the utilization of our exam rooms. Luckily our EMR stored all the information about exam rooms. We also pulled in the data that described when a patient arrived at the clinic, when the nurse started the intake and when the provider finally saw them. We haven’t actually built any reports on that time study data, but it would be really interesting.

That’s really just the beginning of what we were able to do with the EMR data, but I think you get the point. The real question at this point is what other EMR data could benefit from some quality BI analysis? Here’s a few of my thoughts:

-Blood pressure - Depending on how this is stored will determine how easy it is to report. However, it would be really interesting to see trends in blood pressure across our entire population. Add in a few filters for certain medications and you could see some amazing results
-Average Charge per Patient - Could be interesting to look at this and identify which patients are the most profitable. Wait, doctors aren’t about profit are they?
-Average Number of Visits per Patient - Would be interesting to see this grouped too.

Those are just a few off the top of my head. I’m sure there are a hundred more that could be done with diagnosis, prescriptions, charges, procedures, referrals, etc etc etc. Which reports would you find interesting from the data in your EMR?

The best part of this all is that in the next couple weeks I have planned to upgrade my EMR from SQL Server 2000 to SQL Server 2005. That means that I could really easily use all th SQL Server BI tools to create the various BI reports with all the data in my EMR.

Has anyone else done this type of EMR reporting before?

Recently I’ve been reading a fair amount about the movement that many are calling Health 2.0. I think the most simple description of Health 2.0 is applying many of the Web 2.0 concepts to health care. My question is whether EMR fits into Health 2.0. My personal feeling is that most of them don’t. Most Web 2.0 projects are consumer facing projects that allow people to interact, collaborate and participate in the process. EMR software is more about facilitating a doctor’s charting.

Certainly you could make a good case that a patient portal or EHR is more Health 2.0. In fact, that really seems to cut to the heart of Health 2.0. Creating a powerful interface between doctors and patients so that patients are a part of the process. However, I think that most EMR in their current state don’t benefit from this type of interaction.

Of course, this begs the question of whether an EMR should have this type of interaction. My short answer is that it should, but until the payment systems catch up with the technology that creates these interactions we won’t see broad Health 2.0 application to EMR software.