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HIT Projects You Can Implement Today

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Many people are sitting their on the proverbial fence waiting to see what’s going to happen with the HITECH act and meaningful use before they actually go and implement an EMR. Now, I’m not going to let those people off the hook from evaluating and selecting an EMR. That should be done anyway. However, lately I’ve been thinking that many of these clinics shouldn’t be waiting to implement technology in their offices. Sure, EMR is a game changer and a major change for any office and has tremendous upside (regardless of stimulus money). However, for those of you in the wait for HITECH act money camp, there are still a number of IT projects that you can implement today that will benefit you once you actually implement an EMR. Here’s just a few of them:

Fax Server – This is a HUGE game changer for those that have an EMR. The medical world still revolves around the fax machine and will for a long time to come. Implementing a fax server in your office is a great first step to prepare your office for an EMR. Plus, it can save a lot of paper. For example, you can just delete all those “spam” faxes that you get. Fax servers are great and by having it installed and your users trained on how to use it so that when you implement your EMR you can just directly upload your faxes into your EMR without ever printing out the fax.

IM (Instant Messaging) – I’m amazed at how useful our clinic has found IM to be in our office. It’s a great way for the nurses to communicate with the clinicians, the clinical people with the front desk and the nurses with each other. You do have to manage when to IM versus a phone call versus an email (or secure EMR message once you have an EMR), but there’s sometimes that an IM is a perfect way to communicate in a clinic.

Shared Drives – Setting up a shared drive for your office is simple to do and can save a lot of time. I’m surprised how many offices don’t use this. It’s not the best thing for patient data, but there are hundreds of other office uses for a shared drive to prove beneficial. Ideally this would be setup on active directory, but even if you just manually map a shared drive it can work well in a clinic.

IT Infrastructure – Good IT companies will come and do an analysis of your current IT setup for free. They’ll also give you an idea of what things you could do now that will prepare you for your EMR implementation. Plus, even if you don’t do some of the things until you get closer to implementing an EMR, it’s good to know the weaknesses in your IT infrastructure early so that you can make that part of your plans.

Those are just a few examples. I’m sure some will also mention ePrescribing on this list. I’m not totally sold on that idea, but would love to hear people who disagree. What other technologies can clinics implement now regardless of their EMR purchase?

November 30, 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.

Real Participation in RHIO and HIE

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Everyone seems to love talking about RHIO, HIE and all of the other various initiatives happening around sharing patient health information amongst doctors. This weekend, I want to open it up to you the readers to get an idea of what type of participation you’ve had in an RHIO, HIE or other clinical data exchange.

Are you participating in one now? Do you like it? Do you hate it? In fact, what do you like and what do you hate? Do you use an EMR to interface with the exchange? What’s the interface like? How much work is it to manage the interface?

I’d also be interested in hearing about people who are working through the process now. Where are you at in the process? What’s holding you up from making this happen?

Let’s help educate each other on what’s happening with something that I think we can all universally agree is important and INCREDIBLY challenging.

November 28, 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 Bloggers Come and Go, but EMR and HIPAA is Forever

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I always think it’s fun to think back on the last 5 or so years doing this blog. When I first started there was a lot of excitement about HIT blogging. People were just kind of getting into it and there was a lot of interaction between bloggers. Then, it seemed like interest in the subject waned for a while. For example, one of my early “EMR blog sparring partners” was a blog called Calyx. From the looks of their archive, they lasted for just under a year of blogging and then just stopped. No note of why. Just no more posts. I actually thought maybe Calyx had gone out of business, but then I found their corporate website. I wonder how their Misys EMR stuff is going now.

I also use to enjoy some fun exchanges with the good people at TempDev. In fact, I still do on occasion, but you can see that they’ve gotten busy to blog. Or at least so it seems to me. Maybe I should find something to keep me more busy too. I guess for me blogging is part of my enjoyment. Why I enjoy writing about EMR is beyond me. I find it interesting and fun or I would have given up long ago. Like so many others that I could mention.

You can find a bunch of EMR and HIT related blogs listed on HITSphere. Sadly few of them are updated regularly. Not that I need any more content to read, but it’s fun to see what people find worth blogging about.

Of course, with the $18 billion of EMR stimulus money the whole EMR world has been reinvigorated and the biggest trend I’ve seen happening is the various EMR vendors joining the blogging world. I won’t try to list them all here, because there are far too many. Obviously, I’m a huge fan of blogging and the power of blogging. So, it’s nice to see EMR vendors join the discussion. Of course, that assumes that their blog is a discussion and not just a sales page and/or place for the press releases that no one wants to read.

Now, what does any of this have to do with you? Probably nothing really. Sometimes that’s the beauty of blogging. You’ll be surprised how many people will read you writing about nothing. As long as it doesn’t become a habit.

November 27, 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 HIPAA Thanksgiving

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You know you’re a true blogger when you write a post for a holiday like Thanksgiving. Luckily, blog software is so good these days that I wrote this well before Thanksgiving and then just scheduled it to appear. So, I’m likely either: eating, watching or playing football or eating if you’re reading this on Thanksgiving Day.

I just thought that it would be fun to list a number of things that EMR and HIPAA is thankful for:
My Readers – You are all phenomenal and teach me as much as anything.
My Advertisers – Getting paid something to do this is beneficial. Hopefully it’s as beneficial for you too.
Obama’s EMR Stimulus Money (HITECH) – Let’s just say that Obama’s EMR stimulus has worked great for this site
EMR Update Forums – Really was a great way for me to learn about EMR software when I was first starting. Not to mention the traffic from that site kept this site going when I first started.
WordPress – Best blogging software out there. In fact, great for pretty almost any website. Did I mention it’s free?
Other HIT Bloggers – Most are listed here. Nothing like starting an interesting conversation between 2 blogs. Man, I’m such a nerd. Oh well…
My Wife – She deserves all the credit for letting me do this in my “spare” time.

Have a Happy Thanksgiving!

November 26, 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.

OpenEMR Success Story

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A little while back I read an interesting EMR success story using the open source EMR appropriately named OpenEMR. The story is by Joe Holzer and I got his permission to republish it here for all to enjoy. You can find more about Joe on his website (not the normal website) or at his email im@holzerent.com I think you’ll enjoy his story and some of the unique ways he used OpenEMR to address some challenging problems along with his passion for open source EMR software:

I have implemented OpenEMR in a number of sites, and I advise on its use in their forums at Sourceforge.net. My wife Lynne was my first “client”, and her use of FREE OpenEMR allowed her to eliminate all need for my services as her business office manager, as well as all clearinghouse costs, as it prepares both X12 and CMS 1500 directly.

Because she has a house call practice, and G3 dependability is a joke, I converted the Linux web-based OpenEMR to stand-alone on her windows tablet notebook. That works especially well with the VPN I used, since her biller is at another location entirely, but can do the billing whenever Lynne is at a hotspot without Lynne even having to be aware of it. And every night it backs itself up to our server, which is always accessible by the biller for looking at information which is no more than 24 hours old.

What Lynne gets in her practice is first and foremost the ability to eliminate all the lugging of paper records and the risk of their damage by the elements, etc., to say nothing of the nightly HIPAA backup security which paper could never afford. She uses the hotspots to connect to Allscripts for her FREE e-Rx so she can get the Medicare 2% incentive for 2009, which was simple to setup in OpenEMR both because it is open source, so can be made to do whatever the user wants for greatest efficiency and effectivity for their individual practice, and because it is designed for flexibility in configuration. In fact, the latest version, 3.1.0 just released, is the ONLY EMR system I am aware of which is operable in the native language of the user on a shared system with multiple users. So an inner-city clinic with primarily latino population, but also english speakers, need not have ALL its staff be bi-lingual. And yet it is STILL FREE.

You can see some of the support I have provided others as a volunteer at the OpenEMR forums at Sourceforge.net as ideaman911.

That ANY intelligent user would pay for a proprietary system merely makes me question their grades in economics. Checkout oemr.org for details.

November 25, 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.

Vista (VA EMR) Is Not Meant for Solo Docs and Small Group Practices

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The VA announced about 4-5 years ago that they would be releasing their Vista EMR as an open source package. Of course, the headline read “Government Gives Away Free EMR.” In essence, this was true. The government was making their Vista EMR available for free. In fact, I remember one of the people in HIM had an article on this subject and brought it to me when I first started working with EMR software.

I think this was a really smart move by the VA and the government and I think we’re just now starting to see some of the fruits of it being open source come to fruition. Check out this recent post about Vista on EMR and EHR. I have no doubt that the VA’s Vista EMR (err…the open source version of it) will be a player in the hospital EMR space.

The problem I have with it (and feel free to correct me if I’m wrong on this) is that Vista EMR isn’t meant for small practices like solo docs and small group practices in an ambulatory care setting. I’m not saying that it couldn’t be used that way, but it seems to me like taking a sledge hammer to a 1 penny nail. It’s overkill and is likely to cause more problems than good.

Here’s one example of a “feature” I’ve learned about the Vista EMR (and really the MUMPS database that powers it): “VistA is a multi-user system that actually can get faster with more people in the machine.”

I haven’t personally tested the statement, but it makes since why it could be the case. In fact, it’s a really cool feature for a large hospital with a large number of users accessing the same patients over and over again. Now let’s apply this to a small ambulatory practice. You only have a few people accessing a patient. Does this mean that Vista would actually be slower than other databases when you only have a small user base (ie. a small clinical practice)?

I’m not an expert on Vista (and probably never will be), but it seems to me that the marketing message for Vista should have read, “Government Gives Away Free Hospital EMR.”

November 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.

Where Meaningful Use Should Be Focused

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“”Meaningful Use” should be linked to those two things (cutting costs and better care).” -Russ Reese in the comments.

The above assertion about Meaningful Use was made in the comments and I was kind of struck by it when I first read it. What should be the components of meaningful use?

A doctor perspective:
A doctor wants the EMR to make them more efficient, more effective, increase reimbursement, lower their costs and provide their patients better care.

A patient perspective:
A patient wants an EMR to provide them better care, lower the cost for services and maintain their privacy.

A government perspective:
The government wants an EMR to lower healthcare costs, improve patient care, and provide data to lower Medicare/Medicaid costs.

I may have missed a few motivations and the order changed, but I think this is the essence of what these stakeholders want from an EMR. Can these three different perspectives be married in a way that use of an EMR is meaningful to all of them?

November 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.

Best Advice for Those Implementing an EMR

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Since it’s the weekend, I like to open it up for the readers of this site to share their knowledge. Let’s hear the best advice you could give to someone who is implementing an EMR.

I’ll admit that I had a hard time just choosing one piece of advice. My first thought was mapping your current workflows and map them to your EMR software. This is an amazing way to plan for an EMR implementation. Then, my next thought was to choose the right EMR. However, that just feels too easy. So, I’ll take…

Make sure you get buy-in for your EMR implementation in all parts of your organization. Beg, borrow, steal, mandate, grovel, or whatever it takes to get buy in before you implement an EMR.

November 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.

EMR Stimulus Money is All or Nothing

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The wonderful John Chilmark posted a short message he heard from a Keynote address by John Halamka at the PHAT conference put on by the Harvard School of Public Health. Here’s the message:

there will be no partial reimbursement for meeting just part of meaningful use. Its all or nothing folks.

I think we all assumed this was basically the case, but it’s interesting to hear John Halamka say it. Let’s not take this quote too far out of context. I don’t think that John Halamka was saying that if you don’t qualify for one year of EMR incentive, that the next year you won’t have any more chances to qualify. I think he’s saying that either you’re going to get that years portion of EMR stimulus money or you’re going to be stuck waiting for the next year.

Let me repeat my mantra:

Implement EMR because it’s the right thing to do for your clinic (and I tell you that it is the right thing to do for almost ANY clinic) and not in the hopes of getting the EMR stimulus money. Stick with the now proven EMR benefits and use the EMR stimulus money as a possible bonus and you’ll be happy you did.

November 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.

Study Shows Little Benefit from EMR in Hospitals

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People have been buzzing over a recent New York Times article (requires login, but you can get a login and password here) which discusses a Harvard study showing little benefit seen so far in Electronic Patient Records. The study is interesting and worthy of consideration. I think this part of the Times article summarizes the findings:

The new study placed hospitals into three groups: those with full-featured electronic health records, those with more basic ones, and those without computerized records. It then looked at their performance on federally approved quality measures in the care of conditions like congestive heart failure and pneumonia, and in surgical infection prevention.

In the heart failure category, for example, the hospitals with advanced electronic records met best-practice standards 87.8 percent of the time; those with basic computer records, 86.7 percent; and those without, 85.9 percent. The differences in other categories were similarly slender.

Reducing the length of hospital stays, according to many experts, should be a big money-saving payoff from electronic health records — as better care aided by technology translates into less time spent in hospitals. For hospitals with full-featured digital records, the average length of stay was 5.5 days; for those with basic computer records, 5.7 days; and those without, 5.7 days.

I’m sorry, but I have a real problem with studies like this. Just think about how many factors play into a hospital’s average length of stay. Would an EMR be on that list? I wouldn’t place it there. At least not anywhere near the top. The same could be said for the heart failure category as well.

I guess my point is that a study of hospitals like this is really hard. There are so many factors involved in the outcomes of a hospital that it is really hard to measure. Plus, no one should kid themselves into thinking that EMR is the end all be all. It is and will solve a number of major challenges, but it’s just one piece of the complex puzzle.

One could also make the argument that hospital EMR software even more than ambulatory care have basically been a substitute for paper processes. Hospitals have the extra money to customize the EMR like crazy so that it basically models the previous paper processes. The real innovation in these hospitals will start to happen now that they’re electronic. Instead of focusing on becoming electronic, they can now focus on optimizing their processes using technology.

Ambulatory practices are often faced with a reasonable amount of change when implementing an EMR since they don’t have the money or the clout to get the EMR customized. For those practices that select a well designed EMR this ends up providing a great ROI for the practice’s investment in EMR. Sadly, this is also likely the reason that the EMR implementation failure rate is so high. When done right, it’s a great experience with a great return for the practice. When done wrong it’s a disaster.

November 20, 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.