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Real Innovation in EMR Will Come with Healthcare Innovation

Posted on March 31, 2011 I Written By

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

It seems like EMR innovation has been a strong theme on EMR and HIPAA ever since I wrote about the lack of EHR innovation at HIMSS. I of course clarified my original post with this post on the future of EMR and EMR innovation and then wrote about the challenge that doctors have to differentiate EHR software amidst all the noise. I also think it’s worth noting that EMR software can be a tremendous innovation for a practice that is using paper charts. I just don’t see an EMR software that is the must go to EMR system. There’s no “iPad” of EMR software (yet?).

After careful consideration of these ideas, I can’t help but wonder if an EMR that provides innovation in healthcare is the innovation that will have an “iPad-onian” moment. Basically the EMR facilitates a dramatic change in the way healthcare is delivered. This isn’t some feature or function that the EHR company can announce at HIMSS. EMR features and functions will never be heard above the noise. EHR vendors are already saying they can do everything, whether they can or not. Instead I’m talking about a real change to the way healthcare is provided and that’s facilitated by an EMR software.

For example, is there a doctor brave enough to have an all iPad/iPhone medical practice? Their EMR software would all be in the cloud and would facilitate online visits with patients or in house patients with visits where the EMR software was easily accessible using wireless technologies. They wouldn’t even have an office. They would do half of their visits from the comfort of their homes and half at people’s houses. Would that cause people to talk? I think so. Would the business model for the practice need to be different? I think so. Would an EMR and related technology be essential to make this happen? Yes. Could an EMR company be built to facilitate this type of a medical practice? Sounds like an interesting franchise model to me.

I’m not sure if this is a good idea or not. Plus, there are certainly people a lot smarter, more informed and innovative than me that could make this type of idea even better. However, it’s becoming quite clear that building just one more feature and function isn’t going to differentiate you from the rest of the EMR companies. That’s why I won’t be surprised if the real “innovative” EMR company will likely be a startup company. They’ll likely not know very much about how healthcare is “suppose” to work. They’ll also likely be told that their model is impossible and just won’t work. Instead they’ll just focus on using technology to connect the doctors and patients in some non-traditional manner. To me, that’s the type of companies that healthcare really needs.

EHR Incentive Q&A: Do modular certified EMR’s qualify for meaningful use and also qualify for full incentive payouts?

Posted on March 30, 2011 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.

Chris asked the following question:
Do modular certified EMR’s qualify for meaningful use and also qualify for full incentive payouts?

Answer:
Modular certified EHR software can qualify for meaningful use and the EHR incentive payouts. Although, they can’t do it on their own. Although, if you combine the modular certified EHR with other modular or full certified EHR software, then you can qualify. Clear as mud huh?

The good thing is that you can go to the ONC CHPL website and select the certified EHR software which you use and it will tell you if combined it meets the criteria.

So, for example, maybe you have a modularly certified EHR that is certified for everything but ePrescribing. You could then also purchase a certified ePrescribing software and together they would be considered a complete certified EHR that would qualify you for the EHR incentive money.

At least this is my understanding of the intent. I’m sure there are going to be lots of little intricacies without clear answers.

UPDATE: There was some discussion in the comments about whether you had to have a complete EHR or only one that had the modules you use to show meaningful use. Thanks to Jim Tate for finding the HHS reference that says you do have to have a complete EHR even for the modules which you’ve excluded or menu set objectives which you didn’t select.

Video of Meaningful Use EMR Integrations and MU Dashboard

Posted on March 29, 2011 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.

Ever since I saw my first meaningful use dashboard in an EMR, I’ve been interested to see the various ways that EMR companies are implementing and tracking meaningful use in their EMR. So, I was really interested to check out this SOAPware EHR video which walks their users through their various meaningful use features. I should mention that this is their training video and not meant as a marketing piece which is exactly why I like it. It’s 11 minutes long, but if you watch even the first couple minutes you’ll get a good idea for how they’ve attacked the meaningful use requirements for their users.

I really like their meaningful use dashboard and the access to the data. My only fear with their dashboard is that they might be providing too much data and not enough of an overview screen. I think most providers are going to want a little more of a “key indicators” dashboard which gives them a nice summary overview of all the MU requirements and how they’re doing. At least from the video, it seems like it’s showing a little too much data on the front end rather than showing a nice overview and then letting you drill down if needed. Reminds me of my Business Intelligence classes in college. The executives (the doctors) mostly want to see the overview, but they want the ability to drill down if needed or have some other staff member drill down and see what’s wrong.

I find their patient dashboard concept pretty intriguing. I love how it updates in real time your compliance with the meaningful use requirements as you see the patient. I’ll leave the discussion of whether or not compliance with meaningful use should be a central part of patient care for another day. However, I think the real time updating of compliance in the patients chart is a really nice way to fix the issues as they arise instead of trying to correct them after the fact.

In the video they show the MU patient compliance dashboard on the left side, I think that’s configurable and can be moved to the other side or hidden. At least I really hope that meaningful use compliance doesn’t become so prominent in patient visits that it deserves a spot as the left sidebar.

I’m sure I could go in and comment on each feature they demonstrate on the video, but there’s a little flavor of what SOAPware is doing to meet meaningful use. I’d love to see other demo videos of how EMR companies are helping their doctors meet the meaningful use requirements. Screenshots of their dashboards would be interesting as well.

Full Disclosure: SOAPware is an advertiser on this site.

The Meaningful Use Measures – The Basics – Meaningful Use Monday

Posted on March 28, 2011 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

John requested that the next series of Meaningful Use Monday posts explore the ins and outs of the individual meaningful use measures. To begin this process, today’s post reviews the basic requirements and the type of information that providers will report. Next Monday’s post will address the options available to some providers to exclude certain measures. Following that, I will address the measures, one by one, week by week (…although I can’t promise that I won’t digress as subjects of timely interest arise!)

By now, most people interested in meaningful use know that there are 25 measures and that they are divided into two sets—Core and Menu. Providers must meet all 15 of the core measures and any 5 of the 10 menu set measures, as long as one public health measure is included. (Another way to look at the menu set is that providers can defer—presumably to Stage 2—5 of the 10 menu measures.)

How each of the 25 measures is reported varies in a number of ways, so it is important to carefully read the requirements:

  • For some measures, providers will be asked to simply attest that “Yes”, they met the measure—e.g., implemented a particular EHR functionality or performed a test of a specific capability.
  • Other measures have thresholds that must be met, and therefore require the reporting of numerators and denominators, using data generated by the EHR.
  • Denominators vary, e.g., some are based on all patients seen, while others refer to a particular subset of patients.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

Mobile vs Computer and the Patient Interaction

Posted on March 25, 2011 I Written By

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

“It’s Friday, Friday! Gotta get down on Friday. Fun, fun, fun, fun. Looking forward to the weekend.” – Friday Music Video by Rebecca Black Dang those viral videos, but I have to admit that I’m grateful that today is Friday and I have a weekend to catch up on things. I’m sure that many of you can relate to this feeling.

As we head to the weekend, I’ll leave you with a little something to think about and discuss in the comments. Someone at HIMSS pointed this out to me and I thought it was worth sharing. Think about the patient interaction in the exam room. For some reason, doctors don’t and haven’t had any problem pulling out their mobile phone (or previously their PDA) in order to pull up Epocrates (or some other similar app) while in the room with the patient. It was perfectly natural for them to pull it up to look up a certain drug or other information.

Why are doctors comfortable with a smart phone between them and a patient, but a computer is not? Is there a relationship between this and why the iPad is so popular with doctors?

Operating System of Healthcare IT

Posted on March 24, 2011 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.

Likewise, says Allscripts’ Tullman, “today we’re building the operating system for the future of healthcare. This country can’t afford its healthcare system anymore, so something’s got to change. We can no longer buy our way out of the problem.” – Source: Information Week

The above comments sparks all sorts of interesting thoughts and questions for me. The first is “What is the Operating System of healthcare IT?” Obviously, we’re quite sure Tullman hopes that it’s the suite of Allscripts products. Although, how ironic is it that one company can have 5-10 (I lost count) different EMR software. I’ve never known an operating system to have 5-10 completely different software. Seems like something needs to change there. Unless you want to say that various segments of healthcare IT are going to have different operating systems.

I do feel like EHR software is the operating system of healthcare IT. It’s going to be the basis upon which many other software packages are built on.

I imagine the above statement is probably why Tullman made the comment and the comparison. Allscripts has an ambitious project (although I haven’t seen many results yet) to create a kind of app eco system for healthcare IT apps. There are other vendors that do the same. For example, I know that SRSsoft has open API’s that allow developers to extend their apps. I love this movement in the EMR world. My biggest challenge is identifying the application developers that are interested and willing to leverage these APIs. That part of the app ecosystem seems to be missing to me.

My next thought is that similar to how we didn’t realize how beneficial an application like Excel would be until we had the operating system that facilitated its creation. Who is going to create an Excel like app that can run on the EMR operating system and provide benefits to claims processing, clinical decision support, diagnosis help, insurance billing, etc etc etc. Certainly it’s possible that the O/S (EMR) developers will make a lot of these applications, but I won’t be surprised if the EMR is just the platform that allows other smart people to innovate on a particular subject.

In my time writing about EMR, one thing has been very clear. You can’t be all things to all people. An EMR vendor that embraces, supports and creates a strong healthcare IT application developer community would cause me to take notice above the noise.

Rising Above the EHR and Meaningful Use Noise

Posted on March 23, 2011 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 some really good comments happening on my previous post about EMR companies with an “In” with doctors. Check it out and join in with your thoughts. One of the comments reminded me of another interesting issue with all of these EMR vendors trying to vie for your attention. How does an EMR system rise above all the noise? Or if you prefer the doctor perspective, how can a doctor notice the really innovative and useful EMR companies amidst all the noise?

This is a serious problem and sadly I don’t know a very good answer. I talked with one company who was considering going into the EMR field and they said, “We know we can create a great product that works better than those that are present. Although, if we do, will anyone even notice.”

It’s a fine question that reminds me of my post about EMR software possibly being a commodity. Maybe it’s not a commodity, but the noise of 300+ EMR companies and meaningful use relegates it to a commodity because no one can tell the difference with all the noise. Bad singers sound a lot better in a noisy restaurant.

Basically, is there anything that an EMR system could say they deliver that would rise above the noise? In fact, this is essentially the question that I posted to the new Healthcare Scene LinkedIn group (You should join). I get a lot of pitches all the time running this site, and I’m not sure I’ve seen any EMR company have an iPad-onian (my new word for how the iPad revived the tablet industry) moment.

The biggest problem with this is that EMR vendors are saying everything under the sun. Including things that the EMR system can’t deliver.

So Many EMR Companies with an “In”

Posted on March 22, 2011 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 recently met with an EMR company that described an interesting situation where a clinic was confronted with being sold the following different EMR systems:

  • Current PMS EMR
  • Current Lab’s EMR
  • Current Transcription Company’s EMR
  • Current Billing Company’s EMR
  • Current IT Vendor offered an EMR as well

Many of you might remember when I talked about the benefit that a lab company would have in selling their EMR to their current lab users. I still think this is a tremendous advantage, but looking at the above list of EMR companies that are connected with this one clinic it makes you stop and think.

Yes, each of the above “EMR” companies likely feels like they have an “in” with the clinic that will help them sell their EMR. Unfortunately, with so many companies “in” with the clinic, I have a feeling this mostly just causes confusion and angst for a clinic. Plus, none of the above companies were any of the “jabba the hutt” EMR companies that you can be certain are banging on the clinic’s door as well.

Is it any wonder why so many doctors are sitting on the sidelines with all this confusion?

This list also provides an interesting commentary on the popular saying that doctors are so reticent to use technology (or substitute EMR if you prefer). Yet, their PMS is electronic. Their labs are received electronically. Their transcription is sent and received electronically. Their billing company receives and submits claims electronically. Wait, I wonder why they have an IT vendor that supports them? Makes you think a little, doesn’t it?

CMS Registration Portal: Efficiencies Coming – Meaningful Use Monday

Posted on March 21, 2011 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

Registration and attestation are detailed processes which will demand a significant amount of physicians’ time. During a CMS/ONC session at HIMSS, an audience member asked whether each of her organization’s 800 physicians had to personally go onto the CMS portal and register individually. In response to the answer “yes”, she suggested that CMS should at least allow physicians to assign a “proxy” to an administrative staff member to complete the registration process on their behalf.

I am happy to report that such a process is in the planning stages for both registration and attestation, (at least for participants in the Medicare program), according to a recently posted FAQ on the CMS website—but physicians will have to wait until at least May to take advantage of it. Physicians must still register and attest individually, (as opposed to by group), but they will be able to designate a third party to handle these administrative tasks for them. Until this system is in place, however, each eligible professional will have to register for himself or herself. So, unless a physician is planning to attest to meaningful use early this year, it might pay to wait a few months to register.

Lynn Scheps is Vice President, Government Affairs at EMR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out the previous Meaningful Use Monday posts.

A Doctor’s View of Japan Disaster Radiation Risk

Posted on I Written By

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

I very rarely republish items on EMR and HIPAA. However, every once in a while something is so good that I think it’s worth sharing so that more people can read. The following is one such case. I loved reading Dr. Rowley’s perspective on the Japan disaster and potential radiation health risks. The article was originally published on the EHR Bloggers site. As Dr. Rowley, our thoughts are with those in Japan who are suffering amidst this terrible disaster. Hopefully the following thoughts will clarify a confusing situation.

The horrific events we have seen unfold in Japan as the result of the recent earthquake and tsunami, and subsequent instability of a large nuclear facility in the disaster zone with (at least) partial melt-down of the uranium fuel, raises questions of health risks from radiation exposure.

Granted that the West Coast of the U.S. is some 7000 miles away, and disbursement of any radiation leaked into the air in Japan, carried by the jet stream eastward, would expose people here only trivially. Even close to the reactor, as nicely illustrated by a New York Times graphichere, the amount of ambient radioactivity is less than the average annual dosage experienced from all sources by Americans in a year, though spikes in exposure can be higher. The potential for a full meltdown with much larger escape of radiation still exists, with differences of opinion as to the probability of this.

The more likely health issues related to radiation exposure from this catastrophe is from people who were nearby, and leaving the highest-risk areas (see BBC article here). Because of crippled infrastructure and shortages of food in many grocery stores in a widespread area, people have been not only leaving the area, but also leaving the country. And those exiting the country may end up in the U.S., seeking medical attention.

What should practitioners do? Are there any precedents to a situation like this?

Historical experience from 35 years ago
I am reminded of an experience in the mid 1970s, when I was a medical student at UCSF. I was part of an organizing effort that included UCSF and several local community organizations, which helped with outreach to local hibakusha – survivors of the Hiroshima and Nagasaki atomic bombs, now living in the U.S. The atomic explosions (one was uranium-based, like what is now used in nuclear power plants at much lower levels; and one was plutonium-based) killed over 200,000 people and injured 150,000 more. Many of these survivors remained in Japan, but some 30,000 of them were American-born and many returned to the U.S. (see an in-depth article that appeared in People in 1990 here). They were often Japanese-Americans visiting Japan when the war broke out, were trapped there unable to return during the war, survived the Hiroshima and Nagasaki atomic bombs, and afterwards came home. During the 1970 outreach campaign I was involved with, there were about 400 hibakusha living in the Bay Area.

Nuclear survivors were often afraid to make their history known, partly due to social stigma, and partly dueto fear of losing health insurance coverage for radiation-related illnesses – an increased risk of thyroid disease and thyroid cancer was seen in this population (long-term effect), with increased risks of multiple other cancers seen (medium-term effects), and blood and immune system suppression (acute effect).

Besides the actual health risks, there was also fear and discrimination – a stigma of being “exposed” – with the unfounded belief that those exposed to radiation were themselves radioactive, and would expose others to ill effects of this imagined “radioactivity.” It took education to overcome these mistaken beliefs.

Post-war, Japan had enacted specific government-funded programs for hibakusha, and periodically assessed their health and treated their illnesses. This included sending teams from Hiroshima that would travel to the U.S. to reach out to survivors here – this was the program I was involved in. UCSF hosted the Hiroshima team, and a variety of community groups helped reach out to hibakusha, and bring them to “Hiroshima clinic day” in San Francisco.

Modern-day lessons
In the context of history, the scale of radiation exposure, and how to take care of people significantly exposed, is nowhere near what has been seen in the past. However, the issues of exposure to radioactivity from a compromised nuclear power plant should not be minimized – the risks are real, particularly for those living nearby.

Hawaii and the West Coast of the U.S. may experience some measurable increase in background radiation levels, not unlike a solar flare, or flying in an airplane at 30,000 feet. Our instruments for detecting such radiation are very sensitive. This is not likely to be the source of impact on the health care system.

More likely, practitioners may face the issue of taking care of someone who was near the disaster zone in Japan, who has now left and is in the U.S., and is concerned about radiation exposure. There is (unfortunately) much experience in dealing with such issues at orders-of-magnitude higher levels of exposure.

Based on the hibakusha experience, monitoring of blood counts (CBCs), thyroid functions and a comprehensive metabolic panel (which includes liver function tests) are about all that is indicated. For practitioners looking to code for such encounters, the ICD9-CM codes E926.8 (exposure to other specified radiation) or E926.9 (exposure to unspecified radiation) can be used.

The larger issue is reassurance and adding the calming effect of reason on a situation of fear and rumor. Unless one ingests a radioactive substance that remains in the body, being exposed to external radiation does not render one “radioactive” and there is no risk of “contaminating” others. The levels of radiation seen, even right at the nuclear power plant during times of reactor explosions, have remained less than that experienced by someone undergoing a full-body CT scan (compare the levels in the New York Times graph here).

The impact of modern health IT
Another difference in the world since the 1970s (now-vs.-then) has been the emergence of health information technology (HIT), including web-based Electronic Health Records (EHR) systems. This kind of technology is capable of capturing clinical encounter data from practices in all settings, and identifying issues among those with radiation exposure. Reporting these findings – whether to the CDC or to Japanese health authorities – can be done more systematically, and much more quickly than was ever dreamed possible in the 1970s.

In addition, the source of the health information can be much more grass-roots. Modern web-based EHR systems are used by local ambulatory clinicians in their private practices, and not necessarily affiliated with an institution. The need for travelling teams, university-to-university, is not as much of a requirement as it was in the 1970s, given modern HIT.

Our hearts go out to those who have suffered tremendous loss and upheaval in Japan. Assisting with the rebuilding of a devastated infrastructure is something everyone who can should do. The health effects seen outside the immediate area, however, should be put into their proper perspective – those leaving the disaster area will need our help. But the risk to U.S. populations – even those on the West Coast (7000 miles downwind) – is not where our attention should be.

Robert Rowley MD
Chief Medical Officer
Practice Fusion EMR