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Hospital EMR Offerings

Posted on May 31, 2010 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’ll be the first to admit that I’m not an expert on hospitals and their motivations. I have however found it very interesting to watch from the sidelines at the various methods that Hospitals use to get their outside doctors using an EMR. The hospital ambulatory EMR offerings come in all shapes and sizes. However, at the core of pretty much every offering I’ve seen is a hospital’s desire to be connected and engaged with the outside clinics. There is some real value for a hospital to be well connected to their doctors (sounds like a good topic for a future post).

The problem is that many times a hospital ambulatory EMR offering can backfire if it’s not done right.

The challenge is that a hospital has to narrow its “supported EMR” choices down to a very small list. It’s just not reasonable for hospitals to try and support a laundry list of outside EMR companies (at least with the current state of EMR data standards). Plus, this short list of EMR vendors often isn’t selected with the outside clinics best interest in mind. Instead, the short list of EMR vendors is determined based on the hospitals best interest and EMR vendors ability to schmooze the hospital C-level executive(s). Not always, but I’m just stating what other people are afraid to say.

Now let’s think about the result of a hospital providing a short list of EMR vendors who aren’t designed to meet the needs of these clinics. What was intended to be a strategy of engagement by the hospital with the outside clinics quickly becomes a disengagement strategy as physician offices shun the hospital provided EMR vendors and select a different EMR.

This could also be taken one step further for those that do select the hospital selected EMR and the EMR and/or hospital can’t/don’t provide the type of support that the physician offices expect. Yet another way that the hospital engagement strategy can quickly become a strategy of disengagement.

I’m not saying that doctors or hospitals shouldn’t consider working together on EMR. I’m just saying that hospitals should be careful in the type of EMR they offer physician offices or it might just backfire on them.

EMR, The Physician ERP

Posted on May 28, 2010 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 heard this mentioned a few times, but in all my posts I don’t think I’d ever mentioned it myself. But it’s very true that EMR is the Physician equivalent of an ERP (Enterprise Resource Planning). Wikipedia describes an ERP as such:

Enterprise resource planning (ERP) is an integrated computer-based system used to manage internal and external resources including tangible assets, financial resources, materials, and human resources. It is a software architecture whose purpose is to facilitate the flow of information between all business functions inside the boundaries of the organization and manage the connections to outside stakeholders. Built on a centralized database and normally utilizing a common computing platform, ERP systems consolidate all business operations into a uniform and enterprise wide system environment.

Basically, it’s consolidating all of your IT software in one package. However, the real key is that by implementing this broad variety of packages you’re affecting almost every part of the organization. This is why I think the comparison of EMR software with an ERP is so interesting. An EMR has the same impact on the entire organization as the ERP does in a business.

As an aside, it is also interesting to note that ERP’s have been slow to be implemented in small business and have been most popular in very large companies. So, I think it’s interesting to see that we’ve seen a somewhat similar thing happen in healthcare. Most large hospital organizations have an EMR (at least in some state) and the smaller clinics have been more resistant to implementing an EMR.

The question then is what are the lessons we can learn from ERP implementations that we can apply to EMR implementations? Turns out that they’re things that I’ve talked about over and over.

1. Get Leadership Buy-In – An ERP is doomed to failure without a strong leadership that drives the ERP initiative. Since it affects every level of the organization it takes a strong leader to implement the changes and bring everyone together. The same is true for EMR.
2. Find Great Support – When you implement an ERP, you have to create a huge budget for customizations. In fact, one of your biggest expenses will be the consulting help you need to customize the ERP to meet your organization goals and policies. The consultants you bring to help you are critical to the quality of the implementation. EMR and IT consultants can have the same impact during an EMR implementation. Every EMR needs some level of customization for your clinic and a consultant well versed in your product can be a great boon.
3. Consider Implementation Phases – An ERP never goes live all at once. They ALWAYS do it in phases. This could be a great lesson for EMR implementations. Don’t bite off more than you can chew when you’re implementing. For example, in one implementation I did we just started with entering the diagnosis and charges into the EMR. Then, shortly after that we implemented the rest of the charting in the EMR. You can’t implement EVERY EMR feature from day one. So, phased EMR implementations are a good idea.
4. Include Staff in Selection Process – I was working at a large university and was asked to participate in a presentation by each of the ERP vendors. I felt very empowered to be part of the selection process. The challenge is that you can’t be fake about this. Don’t invite people to the meeting and then not listen to them. Otherwise, it will have the opposite impact from what you want. Really listen to people’s feedback and make sure they know you heard what they said and took it into serious consideration. Turns out that this involvement also helps with the buy-in mentioned above.

I’m sure there are many more. Feel free to add some in the comments. Much can be learned from other industries that can be applied nicely in healthcare. We’re not as unique as we’d like to think we are.

Benefits of EMR Software to Consumers

Posted on May 27, 2010 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.

One of my readers emailed me about a presentation he was looking at doing about EMR software and consumers. I was really intrigued by the idea of presenting on the benefits of an EMR to the consumer (Translation: Patients). I’d spent quite a bit of time thinking about the benefits of an EMR to doctors, but I hadn’t put as much thought and effort into the benefits of an EMR to patients.

Here’s our initial brainstorm on the benefits of an EMR to patients. Feel free to add to the list in the comments:
-Online Appt Scheduling
-Online Prescription Refills
-Online Patient Information
-Online Forms (possibly pulled in from a PHR)
-e-Visits (this is a controversial one)
-Secure communication with doctor
-Recall/Reminders Electronically
-Patient participation in health record (ie. diet journals)
-Better point of care
-Clinical decision support
-Better access to your health records
-Less errors
-Lower cost
-Better collaboration and communication between primary care and specialty Drs

No doubt some of these benefits should have a ? mark by them. Although, I like the idea of looking at the EMR from the patient perspective. I do after all think that consumers might be the key to “forcing” broad EMR adoption.

Transcriptionists Becoming Medical Documentation Specialists

Posted on May 26, 2010 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.

There’s lots of really interesting transformations happening in the transcription industry (as I’ve written about before). One of those that I haven’t seen many people talking about is the transition of Transcriptionists becoming Medical Documentation Specialists.

It kind of makes sense that transcriptionists could assist doctors in doing all the granular medical documentation. Certainly the doctor will still be the center of the documentation and they’ll be the source of all the documentation. However, I can quickly see the transcriptionists job continuing to move away from the straight transcribing of voice to text and more and more into the medical documentation arena. This trend had been happening for a while, but I can really see this accelerating as transcriptionists try to find their way in an EMR world.

RECs Cart Before the Horse

Posted on May 25, 2010 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.

Sorry if you’re bored, but I’m still completely obsessed interested in the RECs and how they’re using millions of government dollars. From what I’ve seen most RECs are really getting the cart before the horse.

From what I’ve seen most (if not all) of the RECs are out their doing RFPs with various EMR vendors and they are trying to narrow down their list of EMR vendors that they’ll support. Ok, yes I know they’re going to support all EMR vendors, but there’s going to be a different level of support for those EMR vendors for whom the RECs do group purchases with and “promote” in their REC.

I just don’t see what kind of RFP a REC could be sending to an EMR vendor. How would an EMR vendor even respond? Does the RFP say, we need an EMR vendor that can support big clinics, small clinics, solo docs. We need an EMR vendor that supports every specialty. We need an EMR vendor that supports…oh wait, the RECs don’t really know what type of clinics are going to be interested in our services and so how can they select an EMR?

Should RECs ask their constituents which EMR software they should try to support instead of the RECs unilaterally making a decision?

Let me offer a simple plan that would be much more effective:
1. Educate the providers in your area on the EMR selection Process. Use vendor neutral materials (Shameless Plug: like my EMR selection e-Book) to teach physician’s offices the best way to select an EMR.
2. Let them all go through the EMR selection process with the best practices the REC provided and take a survey of which EMR software each clinic selected (possibly their top 2).
3. Based on their decisions, negotiate with the EMR vendors that have a large number of clinics interested in using their software.

Not only would the RECs be getting GREAT feedback from end users on the right EMR vendors they should be talking to, but it would also put them in a great negotiating position with the EMR vendor. They would go to the EMR vendor with a list of clinics interested in that software product.

The biggest question with this plan is will the government stimulus money allow these RECs to go through a process like this?

Limit EMR Investment Appropriately, but Don’t Skimp

Posted on May 24, 2010 I Written By

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

In a recent EMR webninar I attended, I heard some really good counsel that was worth sharing here on my blog:

Limit EMR Investment Appropriately, but Don’t Skimp

When people go into an EMR implementation I’ve seen all sorts of approaches. I’ve seen the phenomenally cheap to the no limits buying. Both of those are recipes for failure.

The problem with the phenomenally cheap is that you’re going to end up not investing in the IT products and software that will make a huge difference in your EMR implementation. For example, you might buy a cheap scanner which 2 months later you realize was a horrible idea since you’ve literally burnt through the scanner and it no longer works. Instead, if you’d spent money on the right scanner (which do feel expensive), you wouldn’t have to worry about getting another scanner for 5-10 years (if even then). (See my EMR scanner suggestions on this page.)

That’s just one example. There are many more. Interestingly, the opposite seems to happen when it comes to EMR software. Doctors will spend insane amounts of money on EMR software. I can’t figure out if doctors just don’t realize that there’s a number of very reasonably priced EMR software out there or if they just think that the more they pay for an EMR the more they’re getting.

I guess you could make the case that when you pay more for an EMR you are getting a more robust software platform. In some cases this is absolutely the case. The problem for small practices is that they don’t need or want a more robust platform. In fact, they end up buying this really robust EMR software platform which is so robust that they don’t have the time, money, or energy that’s required to configure the millions of available options and customizations that would make the software great for their clinic. This leaves them with a generally unusable EMR software and an unhappy user of EMR software.

There’s dozens of other examples where doctors need to find the balance between limiting their EMR investment, but not skimping. This is the art of an EMR selection and implementation.

Another Perspective on Meaningful Use and EMR

Posted on May 21, 2010 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.

Tom’s previous guest post about meaningful use and healthcare IT seems to have struck a chord with some of my readers. Here’s an example of one email (posted with permission) from the always passionate Al Borge, MD, I received in response to Tom’s post. The most interesting part of Al’s email is his last comment about the Medicare penalties that ARRA will impose.

>>> As for the burden of meeting Meaningful Use criteria being too stringent for small practices to meet, this is again an excuse to avoid change.

“Change” for change’s sake is not the way to go… the change that you are talking about is BAD change, and that’s not the way to go.

Look- physicians aren’t just a bunch of luddies that are ignoring high tech out of ignorance. When it comes to technology, we’re usually the first to buy tablet PC’s, the first to buy/significantly use the latest and greatest cell phones as well as have several internet accounts for our homes, offices, and for mobile apps. We buy some of the best cars on the market and cherish a whole host of other electronic “toys” that we use daily.

The problem with the EMR is that most of the EHR systems out there today are simply 1) unaffordable, 2) workflow killers, 3) are being coopted by Big Government in schemes like P4P that later are used against us to pay us less.

The vendor inspired dogma that the EHR saves money, decreases errors, and increases quality has yet to be proven in a side-to-side test against paper and against simple, basic EMRs. Until these claims are proven, most docs will sit on the sidelines. Most of us are not that stupid to believe this crap.

What we see is that a lot of lobbying money is being spent in an effort to get our politicians to enact laws to straddle physicians with the high cost and complexity of an “Obama” HITECH ready EHR, most of which have as high as a 50% deinstallation rate (based on numerous sources) and as has been recently reported by the CDC, owns only a 6% market share among practicing clinicians.

>>> Buying an EMR system and using only half the features will undoubtedly lead to the system not generating the ROI it is capable of providing.

As long as paper records or a “basic” EMR returns a good ROI, it’ll be a hard sell for vendors to force doctors into using a budget and workflow busting EHR.

>>> Being forced to meet Meaningful Use is a way of ensuring offices are using their EMR system in a way that will provide them with the benefits it is designed to provide.

This one is scary- under President Obama are we now living in such a Communist state that Big Government has the power to force its citizens, which in this case are physicians to go against their better judgements and to buy EHR systems that they do not care to use? You have to be kidding me…

This is truly a Healthcare train that is out of control. The day that I get hit with a Medicare 5% tax/penalty I’ll simply pass it onto my elderly Medicare patients as a yearly “Obama tax” thaty THEY, not I will have to absorb. No pay, no see.

Copy and Paste and EMR

Posted on May 20, 2010 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 seen a number of side comments on the challenges of Copy and Paste functions in an EMR. However, I’ve seen very few people really address the challenge that is copy and paste functions that are built into almost every program in the world.

Before I talk about the challenges, of copy and paste with an EMR I will first profess my amazing love for these 2 functions. I use them probably 100+ times a day. On a good day it’s probably a few hundred times and on a bad day it might only be 50 or so. I can’t imagine doing what i do without copy and paste. Even in this post I’ll likely using copy and paste a dozen or so times.

I’ll admit that I probably use it more than most. However, it’s amazing how many people use copy and paste. It’s really become a major part of computer use. The fact that it is almost automatically integrated with every application is a testament to this fact. When used right, those two functions are an amazing utility.

Of course, when used wrong it can cause some really ugly problems. In your personal life it might just be an email sent to someone with someone else’s name on it. Usually not a major problem, but a minor annoyance. Now apply that same situation to an EMR.

Let’s say you copy a nice physical exam assessment. Despite the very best of intentions, many times you’re going to forget to change something after you paste it. Yes, it happens all too often. Not purposefully of course. Usually something happens to distract you right after you paste it. Maybe the phone rings, your cell buzzes, you get an IM, the nurse comes to talk to you, etc etc etc. Each of these distractions often lead you to forget to change/add something that you just copy and pasted. I don’t need to describe why it’s a problem to have it say “normal rhythm” when it’s not normal or why having other pertinent positives missing is a major problem.

Now, this is just the most obvious case. It’s pretty easy to see how it’s easy to miss things when you start copying and pasting into an EMR. However, the EMR copy and paste challenges don’t stop there. However, the problems might not be as obvious.

One example, is how the length of EMR notes BALLOON with the use of copy and paste. Yes, that means that you might have more robust notes, but that also means that we’re missing out on the “minimum necessary” documentation which makes those notes really useful and functional. Sure, insurance billing has ruined notes in this regard, but copy and paste hasn’t helped either.

I also haven’t talked about the potential HIPAA issues related to copy and paste. I’ll save that for the lawyers out there.

It’s amazing how a function which can be so useful can also be so dangerous. Although, I guess this is true of most tools.

Fear of HIPAA Audits Despite 0.002% Chance

Posted on May 19, 2010 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.

Anyone that has worked in healthcare has the palpable fear of the word HIPAA. Any time the word’s mentioned, I have this visceral emotion shoot threw my body. I’m sure it’s the same for many people. HIPAA is like the nasty word that no one can argue with. Just say something is a HIPAA violation and no one can argue with you (assuming you’re right).

In the clinics I’ve worked in, there really is a desire to try and follow the HIPAA rules as best as possible. They all hate it, but they all try in good faith to follow the HIPAA rules. They likely do this because of fear of the dreaded HIPAA audit. Check out this interesting comment made on a previous post I did which puts the HIPAA audit in a new light:

Same goes for the HIPAA rules. We all spend so much effort and time to comply, yet the handful of cases arise when a disgrunted, recently fired employee becomes a whistleblower to screw their past boss and “tells all” to the feds who then pounce on the poor unsuspecting doctor to showcase their enforcement muscle. I’ve heard of anecdotal cases s.a. this, but I have never actually seen an office raided for an HIPAA violation or a major article on the subject in my medical journal reading. Considering that, if say, there are a dozen cases, then 12/780000 practicing doctors, my chances of an HIPAA audit are about 0.002%.

It’s a crazy world we live in. I agree that the risk of a HIPAA audit is pretty small and I think most people acknowledge this internally. Yet, people are afraid to say this publicly, because it sends a message that they don’t care about patient privacy. I think most clinics go through this amazing internal conflict. Basically, they want to support patient privacy, but they also don’t want HIPAA to get in the way of caring for patients and running their business.

The solution I believe most clinics employ: If I don’t talk or acknowledge it, then I don’t have to worry about it. Basically, ignorance is bliss. So, they address any privacy issues that come out and they try to maintain privacy generally, but few of them take it head on and make sure that they are HIPAA compliant. Should they? There’s only a 0.002% chance they’ll have a HIPAA audit.

Note 1: Hospitals are different than clinics. There’s other issues related to HIPAA at hospitals.

Note 2: See, I do occasionally write about HIPAA. That’s why this website is named EMR and HIPAA. Every 6 months is about right, no?

Note 3: Patient Privacy is very important to me, so this post isn’t meant as an excuse for people to not protect their patients’ privacy. It is an attempt to discuss openly what I think is really happening with HIPAA in clinics.

Reasons Why EMR Efforts Are Proceeding So Slowly

Posted on May 18, 2010 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.

David Swink wrote an interesting comment on my previous post in which he lists a number of reasons why he thinks the EMR effort is proceeding so slowly. Since many of you don’t read all the comments on this site (I’ll forgive you this time), I thought I’d highlight his comments here to see what people think of his comments and what more they might add to the list.

Thought on why the EMR effort is proceeding so slowly:

1) EMR is much more complex than a simple inventory control system. The “human resources” apps probably come closest to the mark, but there are hundreds of separate HR apps out there, but they don’t have to talk to other HR apps.

2) Government is not good at organizing complex efforts. The government-sponsored HDTV effort took some 30 years to implement, and the results were largely irrelevant in that we’d moved beyond the concept of “broadcast”.

3) The medical community has no “IEEE” standards group to represent their interests and get various vendors to pull together towards a well-defined goal. The AMA could maybe assume this role, except that it is mostly a political organization, with only 17 percent participation by physicians.

4) Large medical groups are not likely to encourage mutual cooperation in EMR development. To them, small physician groups are competition. (Likewise, Sarbanes-Oxley works to the benefit of large corporations who can afford the accounting red tape, to the detriment of Mom-n-Pop organization, where red tape is a meaningful expense.)

I think David missed a number of other important reasons. Like the 300+ EMR and EHR vendors for a start. What else do you think is slowing the EMR effort? And more importantly, what can be done to overcome these challenges?