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Meaningful Use and Certified EHR’s Impact on EMR User Interfaces

Posted on May 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.

In a previous post, Anthony made this basically off the cuff comment which hit me:
“many a time, the functional requirements take priority over UI”

We see this all over the software development world. In fact, it takes a really unique company to be willing to keep UI over functionality. Ask any salesperson and they’ll tell you that new functions are easier to sell than a great UI. So, it makes sense why this happens. Unfortunate, but makes some sense.

However, this comment also had me asking myself the question, “I wonder how many meaningful use and/or EHR certification requirements caused issues with an EMR UI?

I’ve already had a few EMR demos where I said, what’s that button/function doing there. The response was, oh that was to meet meaningful use/EHR certification requirements. I’m sure many other doctors that use an EMR have seen the same thing. They wonder why an EMR has certain functions since they don’t provide better patient care. Certainly meaningful use and EHR certification is likely to blame for a lot of these possible UI issues. However, I’m sure that many more have to do with EMR software vendors that want to be all things to everyone. When you go down that path, it’s hard to maintain a great UI.

I’ve been starting to think more and more about various EMR UI. Especially with the recent launch of an EMR screenshots website. I’m grateful for the EMR vendors that have been great about sending over their screenshots. It provides an interesting view into the various EMR UI’s. I’m hoping to do some future posts where I take one or more of the screenshots and analyze some of the details. We’ll see how well that goes with an EMR screenshot.

Memorial Day

Posted on May 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.

I always love the Holidays and Memorial Day is no different. I love the idea of looking back at those people who have since passed on. I love repeating the memories and stories of these people and remembering the lessons they taught us. Plus, I love to honor the troops who make everything we have possible.

In a recent call with my mother we of coursed talked about the progress of my blogs and the Healthcare Scene blog network. My mother has very little technical prowess and is one of those people who feels a little bit scared and nervous to use technology. I think she still thinks she’s going to break something and so she sticks to her same routines every time she’s on the computer. So, needless to say, she doesn’t have a great understanding of what I really do. She understands that they’re websites and somehow I make money from advertisers on the site. That’s alright by me, her 5th grade students are lucky to have her as a teacher.

In my conversation with my mom wondered what type of conversation my grandfather and I would have if he was still around. My grandfather is someone that I knew very well, loved deeply, and I even lived and worked (in their massive yard) with him and my grandmother for a summer. Before he retired he worked with radiology equipment. I believe he’d go around to doctors offices, hospitals, etc and sale them radiology equipment.

I can imagine he’d be amazed at the advancements that have been made with digital imagining in radiology. I’m sure we could have some interesting conversations about the potential for transferring digital images electronically, storing those images in a PHR, and other related PACS technology. I imagine he’d be amazed at how far we’ve come since he was working in the field. Certainly we still have a long ways to go, but looking at it this way I have to appreciate the technological advancements we’ve made.

My brother David (who has been writing on EMR News, Smart Phone Healthcare, EMR Screenshots and EMR videos) is in the process of becoming a pilot in the Air Force. He’s always wanted to be a pilot and so I’m really happy that he’s getting the chance to live his dream.

I honor him and all of our military troops who allow us to have the freedoms we have. It’s sad to think that in some countries a blog like this (or at least other blogs) might not be possible or might be filtered. We’re lucky to live in a land where freedom of expression is not only accepted, but encouraged.

My brother, David, posted the following status on his Facebook page:
“Instead of focusing on having a long weekend or that SWEET deal at the store, try doing something that a Marine/Sailor/Soldier/Airmen who gave the ultimate sacrifice can no longer do – in THEIR memory. Go for a walk and enjoy your family because somebody has given their life so that YOU can still enjoy this precious luxury that we often take for granted. Thank you to those who have served or are currently serving.”

On that note, I’m going to go take my wife and kids out on a hike, or throw a dance party, or something fun in honor of all those troops who’ve sacrificed so that we could have that right. I hope you do the same this Memorial Day.

Healthcare IT and Active Patient Care – EMR and HIPAA Video Series

Posted on May 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.

The following is the fourth video in my inaugural run of EMR and Healthcare IT related videos. In this video I talk about some of the ways healthcare IT can help a patient be more active in their care. I’m sure there’s a number of e-Patients out there that can hop in and add a lot more to the discussion I start in this video. I must admit that as a relatively healthy individual I have a hard time really getting into the active patient (e-Patient if you like). However, I love the idea of patients being respectfully involved in their patient care.

The following video is in response to this question:
How can Healthcare IT help patients take a more active role in their care?

View the Healthcare IT and Active Patient Care Video Here

EMR Scanning and Chart Retention – EMR and HIPAA Video Series

Posted on May 27, 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.

As I mentioned in my previous post, I decided to try out some videos related to EMR, EHR and healthcare IT. I’m still not sure if it’s a good idea or not, but I created 4 videos in my inaugural experience. I just used a simple web cam to create the videos since I was also streaming it live on uStream. Maybe next time I’ll set up my HD camera and do it that way.

Either way, here’s one of the videos I recorded where I respond to the following question:
Once converting paper to digital in an EMR, how long do providers plan to keep their charts?

Full Dislaimer: I’m not a lawyer, so be sure to consult a lawyer for legal advice:-)

If you like the video, be sure to check out one of the other videos I posted on EMR and EHR about EMR Data Sharing.

Let me know what you think of the videos. Should I do more? Should my face not be on video ever again? Are there other questions you’d like me to answer?

Do You Trust the Cloud for EHRs?

Posted on May 26, 2011 I Written By

A blog post today by Microsoft’s Dr. Bill Crounse got me thinking again about the cloud.

Crounse cited a new CDW poll showing that 30 percent of healthcare organizations could be considered “cloud adopters,” and for good reason. “The flexibility, scalability and lower costs associated with moving certain line of business applications to the cloud are compelling, especially for an industry like healthcare. After all, the primary focus of hospitals and clinics is caring for patients, not running an IT empire. There’s not a CIO, CFO, CEO, COO, CNO, CMIO, or CMO who wouldn’t love to shift some of their IT spending to delivering better care to the communities they serve,” Crounse wrote.

They were more likely to turn to the cloud for “commodity” services such as e-mail, file storage, videoconferencing and online learning. “Moving your ‘commodity’ applications to the cloud is an excellent place to start,” Crounse said. “I’d suggest first reaching out to your health industry peers and professional organizations to get a better sense of who’s doing what. I think when you’ve learned about some of the best health industry practices in cloud computing, you’ll be ready to explore what might be possible in your own organization.

But the fact that 30 percent of healthcare organizations use the cloud means that 70 percent do not. I suspect a lot of hospitals and physician practices still run aging, legacy client-server management systems in-house, just because that’s how people did things when those systems were first installed. As they replace their legacy technology, expect more healthcare organizations to opt for cloud services for these commodity-type services.

And what about clinical services?

At HIMSS11 back in February, Athenahealth honcho Jonathan Bush, a longtime fan of the cloud, told me he wanted to lead the “Cloud Cavalry” into Las Vegas (there’s no better place for an over-the-top spectacle, of course) next winter for HIMSS12. (See the second video for that.) Athenahealth, which has a certified, cloud-based EHR, straddles the line between clinical and administrative, and it’s not alone. I can’t think of a single ambulatory EHR vendor that doesn’t offer at least a cloud option if not a full-fledged SaaS product.

But is the cloud truly reliable for critical applications such as inpatient EHRs? In the wake of April’s Amazon EC2 cloud outage, I can imagine more than a few CIOs, practice managers and, especially, physicians are a bit skittish now.

What do you think?

Jeopardy!’s Watson Computer and Healthcare

Posted on May 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.

I’m sure like many of you, I was completely intrigued by the demonstration of the Watson computer competing against the best Jeopardy! stars. It was amazing to watch not only how Watson was able to come up with the answer, but also how quickly it was able to reach the correct answer.

The hype at the IBM booth at HIMSS was really strong since it had been announced that healthcare was one of the first places that IBM wanted to work on implementing the “Watson” technology (read more about the Watson Technology in Healthcare in this AP article). Although, I found the most interesting conversation about Watson in the Nuance booth when I was talking to Dr. Nick Van Terheyden. The idea of combining the Watson technology with the voice recognition and natural language processing technologies that Nuance has available makes for a really compelling product offering.

One of the keys in the AP article above and was also mentioned by Dr. Nick from Nuance was that the Watson technology in healthcare would be applied differently than it was on Jeopardy!. In healthcare it wouldn’t try and make the decision and provide the correct answer for you. Instead, the Watson technology would be about providing you a number of possible answers and the likelihood of that answer possibly being the issue.

Some of this takes me back to Neil Versel’s posts about Clinical Decision Support and doctors resistance to CDS. There’s no doubt that the Watson technology is another form of Clinical Decision Support, but there’s little about the Watson technology which takes power away from the doctor’s decision making. It certainly could have an influence on a doctor’s ability to provide care, but that’s a great thing. Not that I want doctors constantly second guessing themselves. Not that I want doctors relying solely on the information that Watson or some other related technology provides. It’s like most clinical tools. When used properly, they can provide a great benefit to the doctor using them. When used improperly, it can lead to issues. However, it’s quite clear that Watson technology does little to take away from the decision making of doctors. In fact, I’d say it empowers doctors to do what they do better.

Personally I’m very excited to see technologies like Watson implemented in healthcare. Plus, I think we’re just at the beginning of what will be possible with this type of computing.

EMR and HIPAA Tries Video

Posted on May 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.

This may turn out to be the smartest or dumbest idea that I’ve ever tried here on EMR and HIPAA. Although, I’ve never been one afraid to try something and look stupid. I think that’s one of my greatest strengths. I’m willing to try something crazy even if it doesn’t work. Of course, many times it turns into something really great. Hopefully this turns out to be the later.

I’ve been seeing so many people doing video and so many people interested in video. So, I decided I’d give it a try. I’m attacking EMR video in 2 different ways. First, I’ve launched a new EHR, EMR and Healthcare IT videos website. We’ve already posted 32 different EMR and EHR videos to the site and it’s seeing some great traffic. Of course, if you know of other videos you think we should post to the site, please do let us know. We’ll keep on posting the best EMR, EHR and Healthcare IT videos that we find.

The second part of this plan is that I’m planning to make a number of EMR related videos myself. In my true boot-strapper style they won’t be huge productions. Instead, they’ll focus on the content (like I do on this blog). At first, I’m planning to do the videos in a question and answer style. I’ve already got a number of questions from Twitter and a previous post I did, but feel free to post other questions you’d like me to answer in the comments of this post.

Plus, I figured I might as well go all in and do the video live. That’s right, I’ll be broadcasting the video I create live to my EMR and HIPAA uStream channel. I’ll be starting the video tomorrow (5/24/11) at about 2 PM PST (5 PM EST). So, feel free to connect to the live streaming video of me answering questions. Plus, when you connect you can ask questions of me live. Hopefully a few of you show up so that I’m not just talking to myself. Of course, if you don’t then I’ll try to still post the video after the event as well.

In fact, I tested out the system today and recorded this video. Excuse the t-shirt and baseball cap. Tomorrow I’ll see if I can upgrade the wardrobe a little bit.

What do you think of this idea? Is it insane? Do you like it? Are you looking forward to the free advice and consulting?

Clinical Quality Measures Revisited: Who Defines Relevance? – Meaningful Use Monday

Posted on May 23, 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.

The fact that the CMS FAQ website contains 7 questions on clinical quality measure (CQM) reporting is an indication of the confusion surrounding this core meaningful use measure.

Many specialists are concerned that very few, or none, of the CQMs are relevant to their practices. According to FAQ #10144, “In the event that none of the 44 clinical quality measures applies to an EP’s patient population, the EP is still required to report [but with] a zero for the denominators.” It would be logical, therefore, for physicians to conclude that they should report a zero denominator for quality measures related to problems or conditions they do not treat.

For the purpose of meaningful use, however, it is not the physician who determines whether a particular quality measure applies—it is the EHR.  In one of the final steps of the attestation process, physicians must confirm that “the information submitted for CQMs was generated as output from an identified certified EHR technology.”

This means that, in reality, physicians will rarely be able to report a zero denominator.  Any secondary problem documented in a patient’s chart will place the patient in the denominator of all measures related to that problem—even if the physician did not treat the patient for it. For example, an ENT specialist who records vital signs, (see “The “All 3” Vital Signs Dilemma”), will have to report on whether she documented a weight management plan for patients who have a body mass index outside of the norm, even though she only treated those patients for an earache or sinusitis. An orthopaedist will have to report on how many times he provided smoking cessation guidance to patients who presented with tennis elbow—and whether he documented the blood pressure of patients he diagnosed with a sprained ankle or broken wrist, who happen to have hypertension. Pediatricians who have even a few patients over age 18, (and most do), will have to report on the core CQMs designed for adult populations, rather than on the more relevant pediatric-focused alternate measures such as immunization status or childhood weight management.

The above has no effect on eligibility for incentives—physicians will qualify for the EHR incentives regardless of the numerators they report for these CQMs, since there are no thresholds that must be met. CMS acknowledges that for now, the clinical quality measure reporting requirement is simply that—a reporting requirement.

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.

Effect of EMR Stimulus Money Flowing

Posted on May 20, 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.

Yesterday on EMR News, we posted about the first case I’ve seen where someone has collected EHR stimulus money after attesting to meaningful use.

It’s the day many have been waiting for. The first checks arrive for those showing meaningful use of a certified EHR (Medicaid had sent some EHR Stimulus checks previously). Yes, the government really is going to pay out the money. Yes, people really are getting paid. In fact, it seems that they’ve pretty much stuck to their schedule for meaningful use stage 1 and paying out the first EHR stimulus checks. Props to the people at CMS and ONC for being able to stick to that schedule (even if meaningful use stage 2 might be delayed).

I do have to say that an electronic bank transfer isn’t nearly as exciting as a check in the mail. Plus, a picture of someone checking their online banking isn’t as compelling as a picture of someone with a check. So, technology has hurt the visible image that would illustrate this occasion. However, the “shovel ready” ARRA stimulus money has started to flow (sorry I had to point out the irony of “shovel ready” or lack therof).

Since seeing the news, I’ve wondered whether the cash flowing will have the impact on doctors that one would expect. Will doctors start saying, “I want to get my EMR stimulus check!”? Certainly the cash has just started flowing and so we can’t fully assess the impact of these first checks. However, I personally think that the cash flowing will provide little momentum to EHR adoption.

First, from those I interact with, there aren’t that many fence sitters. Most have already decided to do EMR or not to do EMR. The flow of money would be great to get the fence sitters off the fence, but I don’t believe it’s strong enough to get those against EMR to finally go for it.

Second, the lack of certainty around meaningful use stage 2 and 3 is a major concern. Most people aren’t and shouldn’t be concerned with the payments for meaningful use stage 1 (unlike PQRI incentives). Why should they be? After all, it’s a self attestation process for meaningful use stage 1. Check the right check boxes and give them the right numbers and you get paid. However, the same certainty isn’t available around MU stage 2 and 3. We don’t know how it will be measured nor what it will include.

Third, it takes real time for the word of mouth discussions between doctors to disperse in the medical community. Will the message of stimulus money get out quickly enough for it to matter to most doctors who are mostly against an EHR?

It’s great to see the EHR stimulus money flowing. We’re still in a wonderful EHR and healthcare IT bubble that will continue for at least another couple years. However, EHR incentive money flowing isn’t going to contribute much to that bubble.

Medicine is Still ‘In Denial’ Over Clinical Decision Support

Posted on May 19, 2011 I Written By

Sometimes it’s better to be lucky than good.

Last month, in my very first post for EMR and HIPAA, I mentioned Dr. Larry Weed in my commentary about the general public’s perception of clinical decision support. I referred to a 2007 study in the journal Medical Decision Making, which said, “Patients may surmise that a physician who uses a [decision support system] is not as capable as a physician who makes the diagnosis with no assistance from a DSS.” I then noted that Weed has been saying for more than 50 years that physicians shouldn’t have to rely on their memory to make clinical decisions when computers can help them process an increasingly voluminous knowledge base.

As it turns out, Weed read my commentary. (I’m guessing that a computer, i.e., Google Alerts, led him to the post. See, computers really can help find the information we’re looking for. Who knew?) And, as it also turns out, Weed and his son, Lincoln, a Washington, D.C.-area attorney who now consults on health privacy issues, just had their latest book, “Medicine in Denial,” published. They both contacted me last week to share this news.

“A culture of denial subverts the health care system from its foundation. The foundation—the basis for deciding what care each patient individually needs—is connecting patient data to medical knowledge. That foundation, and the processes of care resting upon it, are built by the fallible minds of physicians. A new, secure foundation requires two elements external to the mind: electronic information tools and standards of care for managing clinical information,” reads the book’s opening paragraph.

Yep, that sounds like clinical decision support to me.

“Deep disorder pervades medical practice. Disguised in euphemisms like ‘clinical judgment’ and ‘evidence-based medicine,’ disorder exists because medical practice lacks a true system of care. The missing system has two core elements: standards of care for managing clinical information, and electronic information tools designed to implement those standards. Electronic information tools are now widely discussed, but the necessary standards of care are still widely ignored,” reads the book’s description.

The Weeds believe current EHR systems don’t measure up, and they said so in comments submitted in response to the December 2010 President’s Council of Advisors on Science and Technology (PCAST) report on health IT, which recommended against standardizing EHR formats. “Sound standards for the structure of medical records provide essential standards of care for managing clinical information.  Medical practice needs these standards no less than the domain of commerce needs accounting standards for managing financial information.  Failure of recognize this principle is a root cause of health care’s failures of quality and economy,”  the Weeds said in their comments.

It’s a principle that Larry Weed, 88, has been advocating since he developed the problem-oriented medical record in the 1950s. In 1991, the Institute of Medicine report, “The Computer-Based Patient Record:  An Essential Technology for Health Care,” (revised 1997) said that the problem-oriented medical record “reflects an orderly process of problem solving, a heuristic that aids in identifying, managing and resolving patients’ problems.”

And 20 years later, medicine hasn’t changed much. Perhaps, though, it takes longer than that. Lincoln Weed also referenced a story I wrote for InformationWeek on May 10. I noted that the Consumer Partnership for eHealth’s Consumer Platform for Health IT referred to consumers as “”the most significant untapped resource” in healthcare.

Well, wouldn’t you know, Larry Weed has written the following: “patients are the largest untapped resource in medical care today.” That was from his book, “Medical Records, Medical Education, and Patient Care”. That book was published in 1969.

Instead of ending this post on a down note, let me just add that I would have had an interview with Dr. Weed this week, but he just left the country for a speaking engagement. He’s 88 and still traversing the globe, fighting for what he believes in. Don’t we all wish we had that kind of passion?