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Not an EMR Pessimist

Posted on January 31, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It seems like from my recent post about the possible reasons Healthcare IT can’t spend $20 billion has some people thinking that it was a negative post about the funding and possibly Healthcare IT/EMR as well.

I can assure you that I am most definitely an optimist in life and EMR. I don’t think I could support and implement an EMR if I wasn’t that way. In fact, that was kind of the purpose of my post about the long term benefits of broad EMR adoption. My point in that post was to suggest that the benefits of broad EMR adoption will be incredible. Just that it’s probably hard for most of us (including myself) to see the possibilities of having an EMR in every doctor’s office.

My hope in highlighting the possible challenges is to hopefully provide a platform for a larger discussion of the issues associated with this unprecedented investment in health care. In fact, I’d say that one of my main goals with this blog is to provide those interested in EMR points to consider when implementing an EMR. I believe information and discussion is powerful and I hope that I’ve helped to make that discussion and information sharing to happen.

What is certain is that I’m very optimistic that we’ll get to broad EMR adoption. It’s inevitable. I’ve met a lot of students in medical schools and they can’t understand why every doctor doesn’t use an EMR. This digital generation of students are digital natives. It’s all they’ve known. Once they finally start entering the marketplace in droves we’re going to see a huge shift in EMR adoption and I believe far fewer failures in the process (along with other reasons).

In fact, it makes me wonder if the reason health care has been slower than almost every other industry to adopt technology is because doctors spend so long in school. These digital natives have just begun entering the health care workforce and so they’re impact hasn’t been felt yet. Just a theory, but at least interesting to consider.

Reasons Health Care IT Can’t Spend $20 Billion

Posted on 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 it’s reasonable to consider some of the reasons why health care IT won’t be able or willing to have $20 billion of government money invested in health care IT.

Not Enough Healthcare IT Professionals – It’s been widely suggested that the number of health care IT professionals might not be sufficient to support this type of invesment in health care IT.  I hope my fellow IT professionals from every field can easily make the transition to health care IT.  Certainly many will without a problem.  However, the question remains if enough will be able to do so.

Other Reasons Not to Adopt EMR – I’m certain that a study on why doctors haven’t implemented an EMR yet would not show money as the main factor preventing adoption of EMR.  There are many other reasons a doctor chooses not to implement EMR and money isn’t going to resolve those concerns.

CCHIT Requirement – Of course, this assumes that the government chooses to make CCHIT a requirement for receiving funds.  Doing so will limit the choices a doctor has in selecting an EMR.  I think it’s very likely that many doctors will forgoe government funding in order to use a non CCHIT EMR.  This could be especially true for specialists who would rather select a non CCHIT certified EMR that focuses on their specialties needs.

Paperwork Required – The government won’t just be going around handing people checks.  We’ll have to wait and see how much paperwork and reporting will be required to obtain these government funds, but many doctors will shun the paperwork and beuracracy associated with receiving the government funds.

EMR Vendor Selection Process – With over 400 EMR companies to choose from, it will take doctors some time to decide which EMR they like best.  Even if you narrow the list of EMR companies to CCHIT certified companies, you’re still looking at a lengthy evaluation process.  Most doctors want to practice medicine not learn about software.  So, evaluating EMR software often gets pushed down on their list of things to do.

We’ve all seen or heard it said that it’s harder to spend $20 billion than you would think.  This couldn’t be more true when it comes to investment in health care IT and electronic medical records.  Let me know in the comments if there were any other reasons I might have missed on why the spending in health care IT might not occur.

The Real Long Term Benefits of Broad EMR Adoption

Posted on January 30, 2009 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.

Do we really know the true benefits of EMR or can we not find them out until we have them implemented?

This is a question which has been on my mind a lot lately as I’ve been reading and writing about Obama and EMR.  There have been so many different studies describing the effectiveness of electronic medical records.  Some show the amazing benefits of an EMR.  Others have shown that electronic medical records aren’t everything we hoped they’d be.

As I think about these two differing opinions, I can’t help but think that we probably don’t know the benefits that can come from having broad EMR adoption.

Certainly many studies and those interested in EMR have evaluated the fiscal and clinical benefits of an EMR.  I just can’t help but wonder if we won’t be able to understand and measure the benefits of EMR until broad EMR adoption occurs.

Just think of a few simple things we could do so much better with aggregating EMR data:

  • Disease Tracking and Outbreaks
  • Drug Effectiveness
  • Drug Side Effects
  • Health Trends
  • Detialed Past Family/Medical History

I’m sure this list is inadequate in expressing my feeling that a broad adoption of EMR will open up a world of data that was previously stuck in the depths of a paper chart.

Free and Open Source in Healthcare Un Conference

Posted on 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 was reading the Healthcare IT guy’s blog and saw a post about a Free and Open Source Software (FOSS) Healthcare IT conference going on in Houston July 31, 2009 – August 2, 2009. According to Shahid, one of the most outspoken proponents of FOSS in Healthcare, Fred Trotter, is one of the people behind the unconference.

I’m not sure why they chose Houston for this conference. I think Las Vegas would have been a much better choice, but yes I am completely biased because I live in Las Vegas. All of that said, I love what Fred Trotter is trying to do and so I’m excited to promote those who are pushing for free emr and open source emr (see also our Open Source and Free EMR list on our wiki).

You can go and register for the event at the incredibly reasonable rate of $60 if you do it before March 1.

My hope is that Fred also embraces some great streaming video technology such as UStream and makes the conference proceedings available to those of us that can’t make it to Houston. I know I’d tune in and I’d even be willing to embed the UStream video on this blog for others to attend as well. Only challenge might be the fact that it’s an unconference. Not sure the format they’ll be using and if that will translate well to video.

Obama and Congressional Leaders Can’t Overlook EMR Failure Rates

Posted on January 29, 2009 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.

“If it’s [EMR investment and implementation] too hasty, you can create so many bad experiences that people say…’My data’s a mess and my patients are angry,'” Mr. Glaser said in a recent Wall Street Journal article on the possible wasted investment in EMR. 

The scary thing is that John Glaser, chief information officer for Partners Healthcare, is probably right.  I know that President Barack Obama wants to “wield technology’s wonders to raise health care’s quality and lower its costs.”  I want to do that too.  In fact, I think we’d all like for that to happen.  Unfortunately, I think we have to seriously ask ourselves if the current electronic medical records offerings can raise health care’s quality and lower its costs.

I think there are two points that have been proven time and time again in implementing an electronic medical record in a doctor’s office.

Point 1: A Well Implemented EMR Yields Great Results – Hundreds (possibly thousands) of doctors can attest to how happy they are using an EMR.  My personal finding is that the key to a successful EMR implementation is deeply related to how well a clinical practice is run before implementing an EMR.  In fact, I believe an EMR will exacerbate any problems a clinic may have been experiencing pre-EMR.  However, many clinics have shown that when done right there are tremendous benefits associated with an EMR.

Point 2: A Poorly Implemented EMR Causes More Harm Than Good – Blame it on the software.  Blame it on the clinic.  Blame it on the technology.  Blame it on the health care culture.  It’s probably a mixture of all of these things that has caused so many EMR implementations to fail.  Regardless of the reason, all of these failed EMR implementations have shown the damage that can be done to a practice that fails in their implementation.  Unhappy patients.  Unhappy and frustrated doctors.  Thousands of hours evaluating, learning, training, testing and implementing down the drain.

It’s no wonder that the New England Journal of Medicine found that only 4% of U.S. physicians were using a “fully functional” electronic health record system.  The huge failure rate among physicians has created a fear in doctors that’s difficult to overcome.  Sadly I think it might take a generation for doctors to overcome this bias.

The reality is that implementation of an EMR CAN increase health care’s quality and lower its costs.  The problem is that most clinics haven’t yielded these promised benefits and most are living with failed EMR implementations.  The huge numbers of failed implementations can not be ignored.  Ignoring this will lead to even more failed implementations which could set the movement to digitizing patient records back years.

It’s not enough to poor money onto something without looking at and solving the reasons why so many people have failed in their implementation of electronic medical records.

I don’t want to give the impression that I’m not for investment in EMR and health care IT.  I think that help is needed and could be beneficial to the future of health care in the US.  I also really believe that EMR does open up a whole world of opportunities that we couldn’t consider without broad adoption of electronic medical records.  However, I don’t think enough attention is being paid to understanding what factors are important to implementing an EMR successfully.  By understanding these facets of implementation we can invest in electronic medical records that are actually being used and effective.  Otherwise, we’re just lining the pockets of the EMR vendors without any benefits to health care or doctors.

Allscripts’ CEO’s Stunning Take On Obama’s EMR Plans

Posted on January 28, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In a recent Wall Street Journal article on electronic medical records, they talk about Allscripts’ CEO’s take on the governments planned $20 billion investment in EMR.  Here’s a portion of the article:

Glen Tullman, chief executive of the health IT outfit Allscripts-Misys Healthcare and an advisor to the Obama campaign on health information technology issues, argues that that any legislation should first help doctors buy and install electronic medical records, then give them financial incentives to actually use them in a way that could reduce waste and improve care. “That one-two punch would dramatically change the adoption rate for physicians,” he said in an interview with the Health Blog.

I’ve talked about Obama EMR many times before on this blog and over the next 6 months I expect I’ll talk about it a lot more.  This could be the most significant change in health care IT that we’ve ever seen.

However, it should scare all of us that Obama’s health information technology advisor is the CEO of Allscripts-Misys Healthcare any EMR vendor.  I know Obama’s from Chicago, but could this be a more blatant conflict of interest?  Why not call in the tobacco companies to see if they think that smoking will help improve the condition of America.  I’m pretty sure I know there answer.  Why would an EMR company be any different?

Even more interesting is this quote from the same Wall Street Journal article on EMR:

He[Glen Tullman] points to the success of a similar incentive program, courtesy of Medicare, to get more doctors to use electronic prescriptions — Allscripts’ other big business besides electronic health records. 

I just wanted to thank Glen Tullman for pointing out that not only does he have a huge conflict of interest in regards to EMR adoption, but he’s also had success influencing other Medicare legislation for which he would be even more biased (Allscripts being the most widely used e-prescribing software).  This sure doesn’t sound like the CHANGE that Obama’s been talking about.  Sounds like business as usual to me.

I can understand why Obama would want to talk to some of the main EMR vendors out there.  It would be interesting and insightful to hear their biased point of view.  However, I’m talking about a discussion with these EMR vendors.  I’m not talking about having them as an advisor to Obama.  Are there really no unbiased consultants that can inform Obama on the challenges of EMR implementation?  There has to be something better.

I just think that Obama and the US governemnt don’t have anyone telling him the true realities associated with EMR implementations.  Nothing proves this more than the idea that the government will probably use CCHIT certified EMR as a criteria for who will get some of the $20 billion allocated to healthcare in the economic stimulus package.

The crazy part is I feel like I shouldn’t blame Obama for these decisions.  I hope and think that he’s trying to make the best decisions he possibly can with the limited information he’s receiving on the subject.  Does anyone have Obama’s blackberry number?  I’d like to send him a short message with my thoughts on his proposed investment in EMR.

Thinking along those lines, I think I might send a tweet to John Culberson, Congressman from Texas.  Talk about someone who’s really trying to listen to the people and have an open dialog about subjects.  I’ll let you know how that goes and if he even cares about electronic medical records.

The Right Open Source (Free) EMR Model

Posted on January 27, 2009 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’ve had a huge interest in the open source EMR and Free EMR movement.  Turns out my readers are just as interested in a Free EMR as I am.  However, we probably have different reasoning.  I think the power of open source is in having a crowd of people that are all contributing and sharing in the software development.

The problem I’ve had with most open source EMR projects is that I haven’t seen any that have had a large and committed enough community to really sustain development.  Granted, it’s been a few months/years since I’ve really looked into most of the open source EMR packages, so please correct me if there are some open source EMR communities that I should consider looking at again, but I digress.  My point is that without a strong developer community, open source is not a very good alternative.

I recently came across elementalClinic which I believe is using the open source EMR development model correctly.  I’ve never used the elementalClinic EMR so I can’t comment on its featureset (although it looks like it’s a mental health EMR), but what I do find interesting is how their funding development of their open source EMR.

In a recent comment on EMR and HIPAA, Alex said that elementalClinic has 150 paying customers that are using the software with somewhere around 500 people downloading the software.  This seems like the perfect model for developing an Open Source EMR.  150 paying customers that provide a solid foundation development team for the open source project.  Now, I think that 500 is a rather small number of downloads, but is a good start to creating a vibrant community of open source developers that will build on top of the foundation 150 paying customers.

Many would wonder why the 150 paying customers would fund everyone else downloading it for free.  There are a number of different reasons as far as premium support, custom features, etc that they might be paying to receive.  However, the best reasons is because by leaving it open source they can utlize the development and feedback from those using the free, open source download of the EMR.

Plus, having the license be open source means that any one of those 150 paying customers could decide to take the code from their current EMR install and take it in another direction.  In open source they call it a fork in the development.  How easy would it be to create a foundation EMR with a fork for every specialty: pediatrics, oncology, urology, etc.  Would be pretty neat and a great reason to do open source.

EMR and EHR Vendor Information

Posted on January 26, 2009 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.

Many of you have been visiting my new EMR, EHR, Healthcare IT and HIPAA wiki. Thanks for visiting it and hopefully the content will continue to grow over time. I believe that it can become a very valuable resource for those looking at selecting, implementing and using an EMR or EHR.

In an attempt to fill out more of the EMR and EHR matrix of companies, I’m looking to get some help from EMR and HIPAA readers. Please, if you are an EMR vendor, an EMR user or are just familiar with a certain EMR software, then let me know about it.

Here’s the information I’m looking to obtain for each EMR vendor (at least as a start):
Company Name:
Software Name:
Latest Stable Version:
Architecture:
Language:
Payment Methodology:
Website:
O/S Compatability:

Feel free to sign up for the EMR Wiki and add it directly to the wiki, leave it in the comments of this post, or fill out the contact us page. If you want to see examples of what I’m looking for just look at the EMR and EHR Matrix for a few examples.

Requirements of an Efficient EMR

Posted on 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.

While browsing a thread on my favorite EMR forum, I found this intrigueing post by Matt Chase (someone who I deeply respect and the MD behind Medtuity EMR).  Matt created an interesting list of requirements for building an efficient EMR.  He created this list to dispel the notion that the government could create an EMR software and offer it to doctors for free.  I’m sure this isn’t a complete list and I disagree with some of the finer points, but if every EMR was able to do the things on this list, those using EMR would be much happier.  Take a look at the list of EMR requirements:

  • The record must be totally collaborative to allow anyone in the office to open and chart without regard to others having the chart open.
  • There must be security. An audit trail.
  • It must be very customizable for the practice. No EMR company in the world has all the medical expertise to have the latest and greatest templates for every specialty.  Customizing must be simple and intuitive but a template which is customized now, cannot in any way harm the documentation done previously with that template.  Just think of the new procedures, treatments, lab tests, medications and more than arrive daily.
  • It must be capable of collecting that information, slicing and dicing it with great discrimination,  and conveying that information to other health systems software.
  • It must be capable of running client-server or self-contained on a laptop.
  • It must be affordable.  This $25,000 or more per user is ridiculous. A government funded EMR should be affordable out of cash flow– that is, no upfront purchase of the software, but rather, turnstile pricing.
  • It must be intuitive.
  • It must be “graded” in its operational capacity.  A new user can use obvious features but as they mature in their EMR awareness, more features can be accessed.  There is nothing like “need” to inspire to user to learn another step.  That is, filling out a lab form is too slow and so if the user wishes to switch to a bidirectional lab interface, it should be available.  If they don’t care, then at least give them the option of the software filling out the lab request form.
  • It must be easy to assist users who experience difficulty. This is one of the most important items by far. The ease of assisting a user will make or break many EMR installations.  My preference is to have the ability of the user, with a single click, to show their desktop to technical support, whether that technical support is in their large facility or in another prearranged site.
  • It must be easy to update, including all the SQL schema changes,  executable versioning, new clinical content, and so much more without the use of IT staff.  If for every update, someone in the practice must go from computer to computer to update it, updates will never get dispersed. Already the bar is too high.
  • It must be relatively simple to install, not requiring a dedicated IT professional.
  • It must be capable of allowing the practice to be paperless.  To design it short of that would ignore a significant percentage of the market.  That means document management in the many forms of documents– tif, jpg, doc, txt, pdf, Outllook emails, html, and even CCR.  Additionally, it should be capable of outputing all those scripts, excuses, referrals, letters, and more.  It should handle telephone triage (as it’s called in pediatrics) without generating a sticky note for the chart.  It must have a forms feature.
  • It should have alerts, messaging, and reminders for those who wish to use them.
  • It must be fast.  You want no one complaining of speed.
  • Anything else you think should be added to the list?  Anything you see that shouldn’t be on the list?

    5 Minute EMR Install

    Posted on January 25, 2009 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’ve been really intrigued with how various EMR software has been touting how quickly they can get an EMR installed for a doctor’s office.  I’m sure that many people can tell of experiences where they spent literally years getting their EMR ready for use.  This is what makes these 5 minute EMR installs that I’ve seen recently seem so intriguing.

    Practice Fusion’s Live in Five

    Practice Fusion has a “Live in Five” marketing campaign and promise that they can get a practitioners charting in an EMR in five minutes.  Here’s their full description of Live in Five:

    Forget everything you know about software. Practice Fusion’s exclusive ‘Live in Five’ program allows you to be up and charting in less than five minutes. There are no sales contracts, no consultants to go on-site, no installation of hardware, software, and databases.

    Of course, I think that Live in Five is a better marketing tool than it is reality.  Not that you won’t be charting in 5 minutes.  You certainly will be, but that doesn’t mean that there’s not going to be a more configuration and setup needed in order to move your paper charts to EMR.  There’s just more to the process than 5 minutes allows.

    It is true that a hosted solution like Practice Fusion is much much faster to implement than a regular client server install.  However, no one should assume that they’ll be ready to ditch their paper charts after 5 minutes.

    Open Source elementalClinic 5 Minute Install

    I’m a strong proponent of open source software.  So much so that EMR and HIPAA is completely done using open source software.  I think that’s why I’m so impressed with that elementalClinic is doing to try to make installing an open source EMR in 5 minutes.  Here’s a link to install elementalClinic in 5 minutes.

    Of course, if you aren’t technical you’re eyes are going to glaze over if you look at the instructions listed on that site.  However, for someone with any experience using Ubuntu linux (which is most technical people), those instructions are about as easy as you can create.  The cool part is that it makes updating the software that easy as well.

    Install Thoughts

    Certainly installing an EMR is just one step in the implementation of an EMR.  There’s always a lot of configuring, setup, and workflow questions that must be answered when implementing an EMR.  The cool part of the 5 minute install is that it makes answering all of those questions so much easier since you can spend 5 minutes doing an install and literally test the EMR out of the box.  You don’t have to just trust what a sales person tells you it can do.  Now you can drive exactly what your EMR software will provide before spending all the money and signing long term contracts.