Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and HIPAA for FREE!!

CCD vs. CCR and Part of MU

Posted on October 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.

I’ve been a fan of the concept of CCR since it first started many years ago. However, I’ll be honest that I haven’t followed the progression of CCR much since then.

I know that Google Health was using a modified version of CCR. I also know a number of EMR vendors that have integrated CCR with their EMR. So, I’m looking to my readers to give me an update on what’s been happening with CCR.

Also, I’ve been hearing some people refer to it as CCD instead of CCR. I think that CCD stands for continuity of care document. I assume it’s basically the document that CCR uses to share healthcare information?

At one of the conferences I attended, they suggested that CCR was the standard that was going to be used to show “meaningful use.” I haven’t ever seen the standard formalized. Did I miss this somewhere?

Ok, here’s looking to you. Leave some comments on what you know about CCR.

ONC Blog – Federal Advisory Committee – Judy Sparrow

Posted on October 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.

All I can say is that it’s very cool that ONC now has a blog. This is probably right up there with when I found past HHS secretary Mike Leavitt’s blog. Ok, yes I am a complete blog nerd. At least I’m able to admit it up front.

Basically, Judy Sparrow has just done an introduction post where she talks about the Federal Advisory Committees and their role at ONC. She’s the ONC liason for these committees and so hopefully she’ll keep us updated on progress with these two very important committees. She also provides this explanation about the committees in her first ONC blog post:

“FACAs” get their name from the Federal Advisory Committee Act, which lays out the guidelines for such committees. FACAs are advisory and intended to provide external guidance to the government. Typically members of the group are not federal employees. They are also very open committees – meetings are held in public, information on the meetings is posted in the Federal Register, and all FACA records are readily available. At the very root of the FACA mandate is transparency and collaboration.

ONC has two FACAs – the HIT Policy Committee and the HIT Standards Committee. These committees were established to obtain outside advice or recommendations on key health information technology topics from leaders who represent various stakeholder groups.

I think we generally knew this, but it was nice to have a bit more background. This would have been really useful 6 or so months ago when these committees were a new thing (at least for me).

I hope that Judy is able to keep the blog up to date and that it won’t just turn into an announcement site. I hope Judy will provide real content about the process, timelines and perspectives of ONC. If she does that, then it will be really interesting and a great part of the EMR conversation which is already happening on blogs like this one.

CCHIT EHR Certification Enters EMR Usability World

Posted on October 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.

I’ve been sitting on this post for a while. I figured it was finally time that we talked an interesting development in the CCHIT EHR certification: EMR usability testing. They first presented some of the details of this testing during the CCHIT training meeting. However, they also partnered with User Centric to formulate their EHR user testing and EMR and HIPAA has had a nice connection with User Centric for a few months now.

First the good. I’m glad that CCHIT is venturing into the realm of EHR usability testing. I’ve often talked about CCHIT Certification being rather useless since just because a piece of software does a certain function doesn’t mean that it does it well or that the EMR is usable. In fact, some of the most “feature rich” EMR software is completely unusable by the majority of people. Kind of reminds me of the days of terminals. If you knew the key strokes, it was incredibly efficient. However, learning the keystrokes was so much harder than a nice graphical interface which could do the same things. Not a perfect comparison, but interesting to consider.

So, the biggest problem with CCHIT measuring an EMR’s usability is that the EMR usability rating does NOT affect the certification outcome. Also, it appears that it will be up to the EMR vendor whether they want this result published or not. I wonder if we’ll get to a place where a few EMR vendors show their usability rating and others don’t. Those that don’t we’ll have to assume scored poorly? We’ll see how all that plays out.

I admit I haven’t looked over the entire EMR usability rating process. So, I can’t say if the process is complete or effective in and of itself. Although, I do have some confidence in User Centric as a company even if they’re trying to bite off the very difficult task of measuring EMR usability.

It does look like they’ll give the EMR software a usability rating that is not just a pass fail score. A rating is a much better thing when we’re talking about a somewhat abstract concept of software usability.

I’m also concerned about the quality of the jurors that they’ll use to try and measure usability. I’m sure they’re great people with great intentions. Honestly, that’s one of the most redeeming qualities of CCHIT. They have a large base of volunteers that are very well meaning. However, I’m not sure how much confidence I have in their ability to rate a software’s usability. For that matter, I’m not sure how well I’d be able to do it and I think I’m pretty familiar with the subject.

In a related issue, when you look at the way their putting together the score, it seems pretty complicated at first look. Like I said, I don’t know the details of the methodology. However, that’s kind of the point. Even if CCHIT does post an EMR vendor’s usability score, will the listening public (Translation: doctors) be able to quickly and easily understand what that score means? Maybe it’s a simple thing to figure out. We’ll see, but the devils always in the details and if I’m selecting an EMR I want it to be usable. So, I’ll be very interested in an EMR’s usability score.

Those are just a few things I noticed with the new CCHIT EHR Usability additions. Is there some other parts of it I missed? Anything else we should know about it? Will this be a valuable addition to the CCHIT Certification? Will EMR vendors revolt against it?

EMR and HIPAA Hits Amazing Milestone

Posted on October 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.

Yes, every once in a while I like to indulge myself a little and look back at the evolution of the EMR and HIPAA blog. What most people don’t know is that this originally started out at http://www.crashutah.com/emr I was too cheap to pay for a domain. That boot strapped approach will probably never leave me or this blog. The other fun part of the story is that this website originally just started on a Christmas break whim. I was bored and decided to start this blog. Turns out it was one of the best decisions I’ve made.

Today marks what I find to be an amazing milestone for this EMR and HIPAA website. We just passed the 1.5 million pageview mark. I can barely fathom that type of number. I can’t even get my mind around it. I had to check twice to make sure I was looking at the number right. Taking a look back, my first milestone marker was when I passed 30,000 pageviews. That only took about 5 months. Now I do that each week.

Another milestone I marked was reaching 130,000 pageviews and my 150th post. That was about a year after I started this blog and I was disappointed at only having 160 comments on the site. I then marked my 400th post as well about 2.5 years into blogging about EMR.

1.5 million pageviews later is incredible. That’s 586 blog posts in just under three years. However, even more exciting is that the readers of EMR and HIPAA have contributed 2,025 comments on those posts. Let’s just say that I could go on for hours about the statistics and this blog. I’m a bit of a stats addict and love watching it all play out. However, I won’t bore you with any more details.

More importantly, I want to thank all those who have read what I’ve written and contributed to the conversation as well. I’ve learned as much from those who read this site as you’ve hopefully learned from me.

The best part is that we’re really just getting started. I was discussing this with my wife the other day. I personally predict that we’ll be lucky to reach 50% EMR adoption once the ARRA EMR stimulus money plays itself out (see 5+ years). That will still leave 50% of doctors who will need to implement an EMR. Not to mention lots of new discussions around “switching EMR software” “utilizing EMR software” “reporting from EMR software” “EMR data exchanges” etc etc etc. Yes, there will still be plenty of interest in EMR software.

I’m not promising to write as consistently and regularly as I do now. However, one problem I’ve never had is lack of content. In fact, I still have 161 draft blog posts that are just sitting there waiting for me to write them. I guess that’s why having my other blog EMR and EHR works out pretty good as well.

Once again…
Thanks to all the readers of this site
Thanks to all those who participate on the site
Thanks to the other bloggers who link to this site
Thanks to the advertisers who support the site
Thanks to my wife who puts up with me doing this site

Time to Select and Even Buy an EMR Software is Now

Posted on October 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.

Everyone and their dog seems to be telling people that “Now is the time to purchase an EMR system.” Well, maybe not everyone, but a lot of highly visible people in HIT and many bloggers. I previously posted some of my thoughts about when to implement an EMR. However, I think many people missed the point of what I was trying to say.

Now is the time for every doctor to select an EMR software. This is not a simple process (see this 300+ EMR vendor list) and every clinic should be participating in this process. Now is a GREAT time to select an EMR software.

Plus, many, many, many clinics should even buy an EMR now. A large number of clinics aren’t going to have access to any of the EMR stimulus money no matter what they do. I work for one clinic that is in this exact situation (and you’ll love the irony that this clinic uses a CCHIT Certified EHR). At my EMR stimulus presentation, I had one guy come up and ask “So, if I don’t take Medicare or Medicaid, then there’s no money for me, right?” My answer was, “No.” (Yes, I did say there could be grants or something, but you get the point). If you’re in this position, then what’s holding you back from implementing an EMR? Go look through this list of EMR benefits and you can easily make the case to implement now. Not implementing an EMR in this case is still a mistake.

Many other clinics can easily “ignore” the EMR stimulus money and focus on the other EMR benefits. By focusing on selecting an EMR that will maximize these benefits, you can create your own EMR stimulus package. Not to mention you’ll select a better piece of EMR software. EMR software that can’t provide you those other EMR benefits is not one you want in your office even if they can get you access to the EMR stimulus money. Plus, I’ve talked a number of times about the risks in relying too much on the EMR stimulus money. There’s a lot of reasons why you might want it and try to get it but end up with nothing. Essentially these doctors are ones that can treat the EMR stimulus like bonus money. If they get it, great. If they don’t, well they’ve still gleaned the benefits of having an EMR.

Now back to my original post about waiting to purchase (note I said purchase and not select) an EMR. There are a number of clinics where the EMR stimulus money could make a huge difference in the purchase of an EMR. Many of the doctors with lower reimbursements, for example, could use the EMR stimulus money. In these cases, I think people shouldn’t be rushing things. They should ignore the calls from all angles telling them to purchase an EMR NOW.

However, even in these cases, I think it’s reasonable to finish demoing and selecting an EMR right now. If you do that, once CMS finalizes the guidelines for meaningful use and certified EHR you’ll be ready to purchase an EMR and implement. If you don’t, then it’s correct that you won’t likely have time to implement an EMR and receive the EMR stimulus money. Adopting an EMR fully takes time.

No one reading this blog should think that I’m a critic of EMR software. I am a critic of hype in the EMR industry. I’m also a critic of useless certifications and other methods that don’t provide value to doctors. I am not a critic of EMR. In fact, I’m a huge proponent of EMR software use. Done well, EMR software can be a wonderful asset to any clinic. Were it not the case, I’d have stopped blogging about EMR long ago.

Great Time to Be Experienced in the EMR Industry

Posted on October 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 was reading through this blog post describing the staffing challenges that face the healthcare IT and EMR industry in the coming years. I’ve read and written quite a bit about the looming crisis in filling qualified healthcare IT and EMR jobs. However, the above blog post does a nice job of looking at it from a number of different angles. Not the least of which is the challenge of retaining staff as demand for those qualified staff members increases.

I’d love to hear more about what companies are doing to retain the good, qualified and experienced healthcare IT people in their organization.

While we’re at it, let’s hear what EMR vendors are doing to prepare for the EMR implementation/training backlog which is likely to happen. In this regard, you might read the response by SOAPware’s president to my interview question about this subject as well. I’d love to hear about other unique training and implementation models that EMR vendors are employing.

HITECH vs ARRA vs EHR Stimulus Rant

Posted on October 24, 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.

Welcome to my weekend rant about the mixing of terms in healthcare IT. If you prefer more substantial posts, come back tomorrow;-) If you like these rants, check out my previous EMR versus EHR rant.

I’ve been lucky to have been writing about the HITECH act when it first came out. In the beginning it seemed (at least from my perspective) that everyone was talking about the government stimulus money for EHR software as the “HITECH Act.” Then, shortly thereafter, a few healthcare IT conferences seemed to stop calling it the HITECH Act in favor of calling it the ARRA stimulus money. So, I shifted my language to call it the ARRA stimulus money. Although, I’d also regularly just call it the EHR stimulus money as well. Just seems simpler to me.

Then, this past week it seems that a number of people have moved from calling it the ARRA stimulus money back to the HITECH Act.

Yes, I know it’s more or less the same and that they mean the same thing. However, for a blogger who’s trying to attract more readers and communicate a certain topic, it’s kind of annoying. Certainly this isn’t an earth shattering thing, but it would nice if we were just consistent about something.

I should just start referencing it as “ARRA’s HITECH Act of EHR stimulus money.” Maybe that would cover all the bases for everyone. Unless people want me to call it the EMR stimulus money and not EHR stimulus money. *sigh*

Penguin Problem in EMR Adoption

Posted on October 23, 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.

Vince Kuraitis opened my eyes to a new term called the “Penguin Problem” and applying it to EMR adoption. Here’s the principle:

Economists call it “The Penguin Problem” — No one moves unless everyone moves, so no one moves.

Considering our paltry 15% or so EMR adoption rate, it seems like this is an apt description of EMR adoption as well. It does seem like many doctors are on the sidelines waiting for the first adopters to stick their proverbial heads out of the water and show all the other penguins the fish they’ve gotten.

The problem as I see it was that far too many doctors were coming out of an EMR implementation and showing all the other “penguins” (doctors) that there were few “fish” (money and benefits) to be found. However, about a year ago I was seeing a shift in this perspective. Doctors were starting to see a number of very successful EMR implementation and very happy EMR users. I felt about a year ago that the penguins were ready to move and adopt EMR software.

Then, the EMR stimulus money hit. It was like a big seal just swam in front of the penguins and so many of the doctors decided to just wait a little bit longer before making the jump.

What I don’t understand is why all the doctors were on the verge of implementing an EMR before the HITECH ARRA EMR Stimulus money are now so reticent to make the jump. If the EMR was going to be a benefit to your clinic before the stimulus money it will still be a benefit now. The EMR stimulus money should just be a bonus for you.

No doubt healthcare is currently missing out on the real network benefits that will be found when all the doctors “move” and implement an EMR.

This weekend I talked to a doctor who’s worked his entire career (15 or so years) in an environment with an electronic medical record. He just couldn’t imagine how anyone would practice medicine without the computer and an EMR. The clinics I work with feel the same way about EMR.

In Vince’s article, he takes a bit different angle on the “The Penguin Problem” and EMR adoption so go read hist blog post as well. I’m not quite as optimistic as Vince about the HITECH act’s effect on EMR adoption, but I am very optimistic about EMR adoption in general. Good EMR software is out there and more stories of successful implementations are happening every day.

Provider EMR Bill of Rights

Posted on October 22, 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.

Lately the comments have been hopping with interesting conversations. Oh wait, I said that just a few posts ago. Well, it’s the truth! Turns out, a really interesting idea came out of a discussion about EMR vendor’s ability to export the data out of their system.

The basic concept is to create what I’m calling a “Provider EMR Bill of Rights”

The idea is to together create a list of criteria that would ensure that the EMR vendor isn’t just trying to make a sale, but has the best interest of the provider at heart as well. Here’s just a few examples of things that a Provider EMR Bill of Rights could include:

  • Providers Always Own the Data in the EMR
  • An EMR will provide a way to easily export all of the EMR data into a usable format

It might be wise to also make specific sections of the EMR Provider Bill of Rights for things like SaaS EMR. For example, we could include the following: “SaaS EMR vendors will provide a way for clinics to have a daily download of their SaaS EMR data which they can store locally.” As you can see, I’ll need your help and suggestions to make the list useful, effective and reasonable.

I think once the list of “EMR rights” is developed, EMR vendors could choose to adopt and implement these options or not. By choosing to adopt these criteria, EMR vendors would get the benefit of saying they have the providers best interest in mind. Providers will get the benefit of EMR vendors taking a stronger interest in them. Plus, providers that come upon the Provider EMR Bill of Rights will also be more informed on some of the issues they will want to discuss with EMR vendors.

I’m currently working on a redesign of this partial list of EMR and EHR vendors which I started years ago. Part of that redesign could be having a list of those EMR vendors that have chosen to adopt the Provider EMR Bill of Rights. Who knows, maybe even an icon that indicates this status and some badges to put on their website as well.

What do you think of the idea? Do you think it would be valuable? If you’re an EMR vendor, would you consider adopting this? Are there other ideas which could make this idea better?

If you like the idea, let’s start listing out items that you think should be included in the Provider EMR Bill of Rights.

Interview with President of SOAPware EMR – Randall Oates

Posted on October 21, 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.

After my previous interviews with EMR vendor CEO’s, a couple people requested that I do an interview with Randall Oates, President of SOAPware EMR. Thanks to their help I was able to connect with Randall and the following is my email interview with Randall Oates.

**
Give us a short history of SOAPware. Why were you orginally an EMR only (no practice management system – PMS)?
**
I divide SOAPware’s history into 4 stages:
1. 1987 to 1992 – Prototype stage – I created the prototype for SOAPware using a program called Hypercard on early Apple Macintosh computers while building a very large and active medical practice in Springdale, Arkansas. I was already using a computerized billing systems, and had no interest in developing one.

2. 1992 to 1994 – Start-up – Greg Lose, a real programmer, came in to turn the prototype into a commercial product. He continues to lead the way doing research and development.

3. 1994 to 2005 – Market dominance in small practices – David Powell came on as CEO. In 2005, there was not an EMR product installed in more sites than SOAPware.

4. 2005 to present – Focus on transition to next generation, comprehensive EMR – We retreated from major marketing, and engaged a complete rewrite of the software. We are now focusing almost all resources on completing the product suite and simplifying what is presently an often an overly-complex interface.

In 2004, only 12% of new EMR customers were shopping for a combined EMR/PMS. Now, it is over 70%. This emphasizes our need to have the fully integrated product as soon as is possible. A need for integrated billing system as well as transitioning to a much more robust product has accentuated our temporary retreat. In spite of this, we have continued to experience growth in every quarter (compared to the same in the previous year). However, our dominance has briefly waned a bit.

Greg, David, and I remain as the principals in the company. One year ago, a fairly accurate summary was published at MDNG – The EHR Trailblazers. Until 2005, it was our intent to keep a focus on the EMR and links in order to interface with PMS systems. However, in 2008, it became apparent that an overwhelming majority of EMR users want a fully integrated, rather than interfaced, EMR-PMS. So, we launched into development of our fully integrated PMS that is now in an alpha-testing phase. It uses the same database as the EMR, is written in the same computer language, and does not require a separate installer. BTW, if anyone knows any good C#, .net programmers that want to join a great team, we are hiring. However, the next few need to be willing to relocate to either Fayetteville, AR. or Denver, CO.
**
Why do you think the industry shifted to integrated EMR and PMS?
**
The EMR market has passed out of the early adopter phase, and is presently in the chasm that leads up to the phase of mass adoption. Early adopters were not as intimidated by interfaces between vendors as are the masses. Even though the overall cost and hassles are often less with an interfaced EMR-PMS than with many of the currently available “fully integrated” systems, the perception by the masses is otherwise.

Even though we will soon release our fully integrated system, we will continue to work with interfaced solutions.
**
Do you still think that it’s reasonable to have a separate EMR and PMS?
**
Short term, and as long as we continue to have little of the billing information actually entered at the point of care by clinicians, interfaced systems will have utility. However, by 2013, when ICD-10 coding is required, and certainly by 2015 when SNOMED-CT coding is required for diagnoses, it will no longer be practical for physicians to delegate the task of selecting billing codes. Billing claims will be moving from including 14.000 ICD-9 CM diagnosis codes to including over 120,000 ICD-10 codes. It will not be practical for billing clerks, alone, to be able to get to the required level of specificity. The paper superbills physicians tend to use, today, will have to expand from one page to at least ten pages. This, along with the need for clinicians to perform accurate reporting of “performance measures” at the point of care, will likely render interfaced systems (with billing clerks expected to enter the data) as too cumbersome and limited to be practical.

The irony with this question is that a majority of so-called “integrated” systems are really separate EMR and PMS systems that just happen to be sold by a single vendor. With very few exceptions, the EMR and the PMS have been created by separate teams and then have been later interfaced, or glued together, in some fashion. It is not unusual for them to be written in completely different computer languages. They often even use different databases, and even require separate installers. Going forward, these can only be cumbersome, at best.
.**
Tell us about your methods for training people who purchase SOAPware.
**
We have focused on minimizing the necessity for formal classes and thus minimized the direct and indirect costs for training. Few small practices can afford the luxury of closing the practice to attend a bunch of classes. Our focus is to take a more asynchronous approach. We advocate for most of the staff in medical practices begin with a 2-3 hours introduction going through a series of free, interactive videos which are then, ideally, followed by 30-60 minute question-answer sessions delivered remotely. In order for this to be most successful, this general staff training has been preceded by a thorough practice readiness assessment and “pilot” implementation projects where much of the site-specific customization have been created in advance. We have a collection of Implementation Milestones documents to follow. General staff training is fairly late and of lesser importance than other the other implementation challenges. We are in the process of moving the Milestone documents to a SharePoint wiki in order for our implementation facilitators to be able to more efficiently monitor the implementation process and collaborate at whatever level the practice needs.

Lastly, and most expensively, one-on-one SOAPware training can be arranged both remotely and on-site in the same fashion that most other vendors offer.

We also have The Path in our online wiki called SOAPedia. It is a step-by-step implementation guide that some practices (those with good leadership and change management skills) can utilize to train/implement on a fairly independent and very inexpensive basis.
**
Are you seeing or do you anticipate having the EMR backlog (ie. long wait times for training and implementation support) that so many people are talking about?
**
We already have waiting times for our training services, and this is likely to worsen in the short term. Long term, we are engaging several initiatives in order to be able to quickly scale up for the demand. Not only are we hiring more training staff, but we are creating a new “partner” program that is fairly unique. For example, our current users will be encouraged to become certified SOAPware trainers in their own communities. (Intuit has done this with great success with QuickBooks, and disrupted an entire industry as a result.)

Ideally, after the initial 2-3 hours of interactive video training, new users will go into practices using SOAPware, live, and actually see/use the system. By doing this, a new user can take a morning to get the video introduction, spend the afternoon working with the system in action, and then be good to go live the second day.
**
Will SOAPware be participating in the ARRA EMR stimulus money program?
**
Yes, we expect a majority of our users to participate in the ARRA bonus program rewarding practices that demonstrate meaningful use of a certified EMR.
**
I see that you’re CCHIT 2007 certified. What’s SOAPware’s plans in regards to future certifications? Will you be going for HHS certification, CCHIT 2011 Certification or Preliminary ARRA Certified?
**
We will definitely be going for HHS certification so that our users can qualify for the ARRA bonus payments. Whether or not we will also go for CCHIT certification in the future remains to be determined. Presently, CCHIT is the only entity on the immediate horizon to certify for HHS, but other certifying entities are likely in the works. It is just too early to announce who we will utilize for future, HHS certification.
**
Tell us about 3 specific features which make SOAPware special.
**
1. SOAPware fully supports the use of either free-text narratives or fully structured data in almost all areas of the medical record via what we call SMARText. In contrast, most EMR’s are predominantly one or the other:
Paper Behind Glass – Most low cost, simple EMR’s are more of this type in that they simply display the familiar free-text narratives that physicians now prefer. Over 90% of systems that are actually being used at the point of care are of this type. If a physician likes the EMR, it is probably of this type. Sadly, the problem with using an EMR in this fashion is that little computer-readable information is present that can be exchanged with other systems. This will force clinicians using these systems to have to upgrade to versions with kludges allowing them to navigate to secondary screens with add-on workflows in order to click-in all the needed, structured data items. This will lower physician productivity because every time the physician hikes in to see a patient, they will have to sit down and spend a lot of time “picking off all the ticks.” So, the easy to use and more popular, “paper behind glass” EMR’s will soon be just as cumbersome and inefficient as the current generation of comprehensive offerings. However, an advantage, today, of this type is that it can be implemented with less effort, training, etc. After all, it is mostly about just moving the paper behind glass. While efficiencies can be gained in the process, the tendency is to mostly persist with often inefficient workflows.

Comprehensive Systems – are typically more expensive and require dozens to hundreds of clicks by the clinician for each patient encounter. Physicians, by a large majority, detest these systems. Surveys also confirm far less than 10% of physician EMR users (even those having access to comprehensive systems) are actually using their system in comprehensive fashions. The physicians actually using the current generation of comprehensive systems in a comprehensive fashion have usually seen significant and long term losses in productivity, or they are in low volume situations from the beginning. These systems typically handle the often necessary and important narrative, free-text in awkward fashions. Having to start EMR use in a comprehensive fashion causes training and initial customizations to be generally very complex, expensive and disruptive to overall practice efficiencies. It is sort of like forcing doctors to jump to the 10th ladder rung rather than starting on the first rung. The high failure rates with these systems is presently the key reason the EMR industry is receiving such low marks and experiencing low adoption rates.

Typically, what these systems do best is deliver great sales presentations and influence to many of the decision makers serving larger practices. Too often, the decision makers tend to be individuals who will rarely actually use the EMR while seeing patients.

SOAPware can either be used either as paper behind glass or as a comprehensive system collecting real data. More importantly, our design facilitates a gradual migration from the simple free-text narrative to as much structured data as is necessary, and in fashions that are less likely to lower physician productivity along the way.

Other than SOAPware, I only know of 2 other mainstream EMR’s, eMDs and Medtuity, that practically allow for the actual items in the medical record documentation to be linked to the multiple coding systems (i.e. can encapsulate SNOMED-CT, LOINC, RxNorm, codes etc.) that meaningful use is going to require. Some other systems might come close, but are so inflexible that typical practices can’t afford the custom programming required to change the actual items physicians use to create encounter documentation. What is truly unique with the current generation of the SOAPware EMR is that most updates of these data items can also be performed online and automatically at any time without having to purchase new versions.

2. The basic layout of the chart can be instantly individualized/switched to be most efficient for different roles (i.e. doctor vs. nurse), patient types (e.g. pediatric or diabetic), and amount of monitor space available.

3. External documents of almost any type (text, video, audio, spreadsheets, pdf, etc.) can be dragged-and-dropped just about anywhere in the SOAPware electronic chart. This is a very unique aspect that provides the equivalent of a first level (i.e. manual) interface to just about any other system.
**
Describe SOAPware’s integration with Dragon NaturallySpeaking. How many of your clients use DNS?
**
Somewhere between 10 and 30% of SOAPware users use DNS. I strongly advocate its use for those “snippets” of narrative, free-text information that are unique to each patient. For example, if a mother is stressed out because grandma-in-law is visiting again, this will never fit very well in a templated or structured entry, but may be the most relevant data item for a patient presenting with a headache. I do not advocate simply replacing dictation with DNS, as that will not meet the need to have structured, reportable information in the record. Again, dictation, alone, can only create paper behind glass, and can only leave the practice in the dark ages.

The other down side to DNS is that it does not yet function ideally in either ASP or cloud-based solutions. While the past ASP approach to delivering technology solutions to practices has not seen great success, the emerging cloud-based solutions will likely trigger the EMR revolution. For example, our hosted, cloud-based solution, allows for the practice to have their own, virtual server in the Internet cloud. This removes the expense and hassles of attempting to maintain a clinic server, network, back-ups, etc, but the practices are not just limited to only the software and solutions that the typical, more limited ASP approach can offer. I just hope the engineers can figure out how to make speech recognition more fully compatible with these hosted, virtual, or cloud-based solutions before the end of 2010.
**
What do you think is missing in the EMR world now?
**
1. What is mainly missing is an accurate perception of reality. That is… recognition that it is nothing less than insanity to expect physicians to become data entry clerks! In the future, we are going to look at the current approaches to EMR implementation in the same fashion as we now view the practice of leeching and blood-letting of the past. Data entry should rarely be performed by clinicians! Instead, it should be done via other avenues such as the patient, medical assistants, and data gleaned from information that already exists, but is siloed into some other information system. The EMR technology, as well as changes in the practice workflows, should be used to liberate physicians from most data entry, and not increase that burden. Watch for some exciting announcements in 2010 as to how that can be most effective accomplished in a practical fashion using SOAPware.
2. A proper understanding of the necessary process changes practice need to make before even considering the available EMR solutions is generally missing. Along with this is a dearth of approaches advocating tolerable, incremental evolutions. To better understand the later, see- Ten Steps to a Patient-Centered Medical Home . Instead, vendors and “decision makers” tend to advocate destructive, big bang styles of implementations, because they perceive the technologies and process changes available to them don’t really support incremental change.
3. We are missing standards allowing for the sharing of information that is patient-centric rather than industry-centric. The former tend to be easier and more practical for patients and small medical practices. The later tend to be what the current, moneyed-controlling entities in healthcare prefer.
4. EMR’s need standards in order to be more open-platform in order to support best-of-breed solutions. No single vendor can deliver a monolithic application that is ideal for almost any specific practice.
**
You’re a pretty avid blogger. Do you write all the posts or is it just your name and picture? Why do you blog?
**
Nobody else writes any of my blog posts, but I often quote/reference others. My blog is more therapy for me than anything else. It is my tool to speak out as well as communicate what I think physicians need to know regarding challenges before them.

At times, I offer periodic updates that are more specific for SOAPware users. We have a very large community of SOAPware version 4 users (i.e. paper behind glass method) that now need to begin the process of migrating to more comprehensive use of information. This needs to be properly managed via clinician leadership and practice readiness assessments in order to be most efficient. These practices need to upgrade within the next few months, because the second half of 2010 needs to be free to add in the registry (i.e. population reporting) and patient portal (i.e. electronic communications) that are to follow the release of our integrated billing system. Again, these, more comprehensive functions, need to be added only after careful planning and practice preparation.
**
Are there other blogs or websites that you visit regularly for EMR information?
**
Too many to mention, but my favorites are:
The Healthcare Blog
Chilmark Research
Histalk and HisPractice
e-CareManagement
Life as a Healthcare CIO
Change Doctor
**

Thanks to Randall Oates for taking the time to answer these questions. Some really informative information. Let me know if there are other people you’d like interviewed and I’ll see what I can do.