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Minimum EMR Functionality DOES NOT Equal Usable EMR

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Sometimes I feel like it’s my mission to combat the myths associated with EMR certification, selection and implementation. Ok, so maybe it’s mostly the EHR certification, but selection and implementation are closely tied to EMR certification. On that note…

An EMR certification that verifies “minimum EMR functionality” DOES NOT equal a usable EMR.

Yes, it’s a subtle difference, but an important one that far too many people ignore. Call it good marketing by the certification body. Call it a misunderstanding. Regardless, it’s scary how many people think that by testing for a “minimum EMR functionality” they are more likely to have a successful EMR implementation. The problem is, it doesn’t. If it did, then we’d have a lot more successful EMR implementations.

July 31, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

EMR and Newborn Babies

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This weekend I had the delightful experience of spending time hanging out in the hospital as my wife gave birth to our third child. All went well and baby and Mamma are doing well. Of course, having this fanatical EMR background that I do, I couldn’t help bet spend many moments considering on the impact of an EMR at the hospital. Certainly I was watching as the nurses spent a lot of their time at the computer entering in all sorts of granular data about what was happening in our room. It was interesting to watch how laborious it was for them to enter everything. I could see many of them dreading that part of the job.

However, the thing that hit me most was that the computer was so rarely in the middle of my wife and baby’s care. At all of the most important points the computer wasn’t even really present. Other sophisticated technical devices were there, but the computer and the EMR were no where to be seen. No EMR when they measured her contractions. No EMR when they gave her a spinal tap (don’t ask me the real technical terms). No EMR when the doctor was performing the c-section. The first time I saw an EMR was actually when we took my new born baby into another room to do all the necessary weighing, immunizations, etc.

Now the question I asked myself was if I felt like I was getting any worse care because the EMR wasn’t at the center of our care? The answer of course is no. Was the EMR probably running somewhere in the background? For most of the care, yes. However, it didn’t really matter to us, because we knew we were in the hands of professionals who were going to do the best job they could do.

Now I’ve always felt like I was a strong doctors advocate (those who’ve read me for a while can agree or disagree), but I must admit that this experience really highlighted the importance of the doctor’s skills in the level of care that’s given. No EMR can replace that. I also find it interesting that doctors are required to provide such detail when they do a procedure they’ve done a hundred times. Imagine if we required our IT people to detail every time they installed a new printer.

Sorry for a few personal musings of a tired new father. Just remember that an EMR won’t be there for me at 4 AM when the babies crying either. However, EMR and HIPAA will be, and I’ll be typing away.

July 29, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Standard EMR ROI Thrown Out The Window

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One of the things that has bothered me most about the $36.3 billion which is estimated to be spent by the government in EMR stimulus money is the affect it’s had on the decision to implement an EMR. The doctors looking at the stimulus money remind of of Scrooge McDuck from my favorite cartoon ever Ducktales. Yes, Scrooge was the one who had so much money he’d go and swim in it. That part of the story is fictional. The part of Scrooge that’s not fictional is the trance that he’d go into when there was the possibility of more MONEY!! That same look seems to have come over far too many people looking at selecting an electronic medical record.

Certainly there are exceptions, but with the announcement of ARRA’s EHR stimulus money it seems like all of the previous benefits of an EMR have been thrown out the window. All people care to think about is “How do I get that EMR stimulus MONEY from the government?” I think this is a huge mistake and will most certainly lead to major problems in the future.

I’ll continue to argue inform people that an EMR should be implemented on its own merits and not with the hopes of a government windfall of cash.

Let’s step back a second and look at a study done in 2003 about the ROI of an EMR system. Here’s a summary of their findings:

The estimated net benefit from using an electronic medical record for a 5-year period was $86,400 per provider. Benefits accrue primarily from savings in drug expenditures, improved utilization of radiology tests, better capture of charges, and decreased billing errors. In one-way sensitivity analyses, the model was most sensitive to the proportion of patients whose care was capitated; the net benefit varied from a low of $8400 to a high of $140,100. A five-way sensitivity analysis with the most pessimistic and optimistic assumptions showed results ranging from a $2300 net cost to a $330,900 net benefit.

Certainly we could discuss the details of this study, but I think the important point is that there’s an argument that can be made for implementing an EMR that doesn’t include EMR stimulus money. We can’t let the EMR stimulus money put us in a trance where we make stupid decisions. If we do, there will be a huge price to pay years later.

July 27, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

EMR Backup

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Traffic at EMR and HIPAA usually slows down on the weekend and so I try to keep my weekend posts just a little bit lighter than the rest of the week. Often that means I talk about some technical thing since at the end of the day I’m just a techguy.

Don’t worry though, I’m not planning on getting really technical here. There are plenty of technical blogs out there for that discussion.

Instead I just want to highlight what might be the most important thing you set up when implementing an EMR: your EMR backup. However, the problem with backing up your EMR is that it’s not like something you buy on TV where you simply “set it and forget it.” Well, I guess you can, but you do so at great risk.

Do you know how often your EMR backs up?
Where is your EMR backup saved and what happens if that place dies?
Do you know that it indeed did back up your EMR?
Have you ever tried to restore your EMR backup?
Is there space for your EMR backup? Will there be space as your EMR backup grows?

I could keep going for a while, but that should get you started down the path to ensuring that not only your EMR is backing up, but that you’ll be able to restore your EMR if the need ever arises. Any IT person worth their salt knows that a backup is only good if you are able to restore it. Unfortunately, the only way to know if you’ll be able to restore it is to do it.

I’ll save the discussion of disaster recovery for another time. However, becoming familiar with your EMR backup is one of the best investments you can make in your practice. In fact, the future of your practice might just be riding on it.

July 26, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Why Get a Lab Interface and Cost of Implementation

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I’m always sad when I come across an EMR implementation that doesn’t have an interface between their EMR and their lab. I can appreciate someone having just implemented an EMR not having a lab interface. However, it should be one of the first things on your list to implement. It’s such a great compliment to your EMR software.

First thing I must suggest is that you get a bi-directional lab interface if at all possible. One way lab interfaces can work, but do take more management to make it work right.

Why Get a Lab Interface with Your EMR?
Lab interfaces are so seamless. The order is made in the EMR and it’s automatically is sent to the lab. Talk about removing a lot of the possibilities for error. In our case, we have an in house lab and so this saves a ton of time for the lab rat tech as well. No more data entry into the Lab’s LIS system. As a side note, we also use the lab order in our EMR to print out the labels for the specimen. This is an unbelievable time saver and much more accurate. Small things like this are just another hard to calculate benefit to an EMR.

The largest benefit to a lab interface is receiving the results back electronically. Compare this to receiving a paper copy of the lab results. Often this paper copy is sent to a fax machine and then the hunt begins to get that result to the right paper chart/person. The time savings here are apparent. With a lab interface, you no longer have to file the lab results in the paper chart (or scan them into your EMR). The results are automatically available in the EMR and routed to the ordering provider. They can be signed electronically and no one has to then go back and refile the chart.

What’s even more important is that with the lab interface all of those lab results are now stored in discrete values. Storing the lab results this way means that you can graph lab results over time, do studies on lab results across your patient population, and eventually may be needed to satisfy the government and insurance reporting requirements.

Cost of a Lab Interface
Many people are often surprised to find out that there’s sometimes a cost associated with implementing a lab interface. In fact, there could be multiple costs involved.

The costs depend a lot upon your EMR vendor and the lab with which you’d like to interface. Some EMR vendors will offer a lab interface for free (or part of the standard cost of the EMR) while others will charge. The same is true for labs. However, more labs are willing to offer their interface for free. Often that just requires the right negotiating skills. If you’re a large customer of that lab, then if you talk to the right people you can usually get the interface for free. Labs are easier to negotiate with since a lab interface benefits the lab as well. $5,000 seems like the standard charge (from what I’ve seen) for most interfaces. Yes, that’s possibly $5,000 to your EMR vendor and another $5,000 to your lab.

July 25, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Simple Plan for Meaningful EHR Use

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Yes, I’m still on my kick of asking the question of why we’re making the definition of meaningful use so complicated. Certainly I could make an ambitious goal of every doctor having to document everything granularly and electronically and share everything with everyone so we give the best care possible to patients. The reality is that if you do that, then no one will care about meaningful use and the EHR stimulus money will go unspent.

Certainly the above is a bit of an exaggeration, but I can’t help but ask myself if the definition of “meaningful use” isn’t so ambitious that the above will be the net result (at least for small practices) of the current definition of meaningful use.

It’s a little bit wrong for me to say it’s too complex, but not offer a plan. Here’s a real simple idea that should accomplish nearly as much as the meaningful use matrix presented by the HIT policy committee. It has 2 main areas of focus:

Data Interoperability – Establish a standard (since there isn’t a really good and widely adopted one now) including the privacy requirements that should be part of healthcare data interoperability. Then, require that EMR users show you that they can share the data from their clinics with other clinics according to that standard.

Reporting – Require that doctors be able to report data to HHS. Focus on receiving data that will improve the management of Medicare (since that’s what they should be doing with all this data anyway) and also data that will improve public health. HHS should be required to have plans on how it will use this data to accomplish each of these goals. Otherwise, why report it?

Why keep it so simple? Because you have to keep it so that you can actually measure that it’s being done. If you can’t measure it, then why have it as a requirement?

Plus, try to satisfy the above requirements without some form of EMR. It’s nearly impossible. If we truly want to increase EMR adoption, then ONC better be very careful about setting the bar so high when it doesn’t need to be.

July 24, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

The Real Problem with Most EMR Companies

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HISTalk nailed it on the head in this post when they said:
“Some of the most frustrated employees I’ve seen were clinical people who went to work for vendors — they had always thought the problem was lack of company knowledge, not lack of company interest in doing anything beyond the minimum required to sell systems.”

Now that’s the real problem with most EMR companies.

You should also go check out Dr. Jeff’s answer to the question “When will Doctors Enthusiastically Get and Use EMR Software and EMR Systems?

July 23, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Will HHS Do Any Better at EHR Certification Than CCHIT?

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Now that the HIT Policy committee has marginalized CCHIT EHR certification and proposed that HHS define the EHR certification criteria, it only seems reasonable to ask whether HHS will do a much better job than CCHIT did at defining “certified EHR.”

What has me a little concerned is the process the work they’ve done in creating the meaningful use guidelines. They are too complicated and I believe will leave us with a lot of unhappy doctors. It makes me wonder if the same will happen with defining the EHR certification criteria. A few things do give me hope.

First, the HIT policy committee’s suggestion is for the EHR certification to remain focused on just those things which are applicable to the EHR stimulus money. This should provide HHS with an advantage over CCHIT since it should mean a much more simplified list of EHR certification requirements.

Second, I’m a big fan of Marc Probst who was one of the chairs of the committees that put together the EHR certification recommendations for the HIT Policy Committee. I’m not sure how much involvement he’ll have going forward, but hopefully he’ll have a good part in it.

I guess at the end of the day, I don’t think that HHS could do any worse and probably will be quite a bit better. I’m sure there will be some issues with what they create. The question is just whether they’ll be minor annoyances which can be dealt with or whether they’ll be major issues which will cause doctors to not adopt an EHR even with the $44k hanging over their head.

July 22, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Marginalization of CCHIT EHR Certification

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If you’ve read this blog for any time, you know that I’m not a big fan of CCHIT. Certainly, I can’t argue that CCHIT EHR certification isn’t a great marketing tool for EHR vendors. However, I strongly believe that the CCHIT certification gives doctors a false hope that the CCHIT certified EMR that they select will somehow have a higher implementation success rate than another EMR. If this were true, CCHIT would be certain to be proclaiming it from every channel possible. Instead, there’s no data that this is true and it’s sad that so many doctors think it’s the case.

With that background, I was quite happy to see that the HIT Policy Committee basically marginalized CCHIT into a certifying body as opposed to a EHR certification criteria creator. I’m a little disappointed that this news hasn’t gotten more play by the various news sources and blogs. Even John Halamka basically just linked to the EHR Certification presentation with no discussion on his blog about the implications of such.

Of course, CCHIT has so far gone quiet on their blog and twitter accounts. I’m sure that pretty soon we’ll be hearing some public statements from CCHIT trying to save its certification methodology. I expect they’ll start touting their certification as better, more complete and more effective than whatever criteria HHS comes up with to satisfy ARRA’s “certified EHR” criteria.

According to Iroman on EMR Update, CCHIT did send out the following email to their list of EMR vendors:
“For providers and hospitals to have any chance of meeting ARRA incentive requirements in 2011, certified EHR technologies must be promptly available,” said Dr. Leavitt. “To do that, we will launch preliminary HHS/ARRA EHR technology certification programs in less than 90 days, drawing upon our inspection and certification experience and marketplace knowledge. Our HHS/ARRA certification will be available to modular, open source, and self developed technologies as well as comprehensive EHRs. Our current, very comprehensive certification programs — though no longer the sole route to government certification — will become even more robust to serve EHR purchasers who want maximal assurance of EHR completeness and integration.”

I bet Dr. Leavitt had to run that last line by the lawyers. I think it’s pretty clear the direction CCHIT is headed. Unfortunately, we haven’t heard the last of CCHIT EHR certification.

One other interesting anecdote about CCHIT comes from PedSource who attending the recent CCHIT meeting.

Bill Zurhellen got up and said something which drew a round of applause. “If our goal is to certify to get ARRA payments, we’re doing the wrong thing. We should be focusing on improving health care.” ML replied, “We should consider changing the mission statement to reflect healthcare outcomes and improvement…” because, right now, the mission statement is focused solely on improving HIT use.

I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Dr. Jeff Joins EMR and EHR

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I’ve mentioned a blog partnership that I created with the website EMR and EHR. In fact, you’re certain to notice the striking similarities between the 2 websites. I expect over time that will change to some extent. Although, things have gone well here so why mess with something that’s working right?

Well, I’m really happy to announce that Dr. Jeff has joined on with me and will be piloting the EMR and EHR blog. He’s a passionate guy with some strong opinions about EMR and I hope he doesn’t get shy now that he’ll be sharing those opinions about EMR in public. You can read more about Dr. Jeff on the EMR and EHR About us page. I’ll be posting occassionally on that blog too, but I expect to have a number of good blog “sparring” matches between Dr. Jeff’s blog, EMR and EHR, and this blog, EMR and HIPAA.

Dr. Jeff’s already got 2 blog posts up:
Big Government, Healthcare IT, Our Healthcare System and the Economy – A look at some of the changes happening with government and healthcare.
A Patchwork Quilt of Unique EMR Software – A short discussion of a Big National Data Bank of Healthcare Information

Let’s make Dr. Jeff feel welcome by heading over to the site and posting some good comments on his posts. Also, those who want to hear a doctor’s perspective on EMR can subscribe to EMR and EHR by email or RSS feed.

July 21, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.