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Best Description of the CareCloud EHR Platform

Posted on August 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 post on EMR and EHR about Social Media and EMRs, Andre Vovan, MD MBA from Mitochon Systems offered an interesting insight into the comparison between EMR and social media.

Social media and EMR are a natural fit. Think about what social media really enables. The ablity to stay connected, following different strings of info/story weaved by connected people. Say for instance you and your friends went to the Grand Canyon, one person took pictures while the other did the cooking, planning, and was responsible for entertainment during the trip. When they try to retell the story to their friends, each will be able to add different aspect of the story and with social network platforms such as facebook, this is possible.

Now take the story above, and insert 2 doctors and change the trip taken to be a patient going from a diagnosis to a surgery and afterwards trying to tell other physician providers on went on. If we design the EHR with this capability, then medicine will be improved.
A social media version of electronic medical records would have EMHR, HIE and PHR as one product not as separate.

I know that this was actually Andre’s initial vision for Mitochon Systems EHR. He wanted to create an EHR that could bring a healthcare community together in this way. I’m sure he’ll keep grinding away until he can achieve that vision. I haven’t looked at the Mitochon Systems EHR recently, so I can’t say how close they are to achieving that dream, but when I read Andre’s description I couldn’t help but remember the demo of the CareCloud EHR platform.

Many of you might remember my previous (some might call scathing) post about the CareCloud EHR and an opposing view by David about the CareCloud EHR. That post and a recent trip to San Francisco made it possible for me to see the CareCloud EHR first hand.

I had a great time meeting with Albert Santalo and Mike Cuesta from CareCloud. That was good considering my previous devil’s advocate post about CareCloud. One thing is absolutely certain, Albert has a vision of what he wants CareCloud to be and he’s dead set on achieving that vision. I like that in a CEO and founder of a company.

When it comes to their EHR, I must admit that it kind of reminded me of a lot of other EHR out there. There were a few EMR subtleties that I noticed in the demo, but I can’t say I saw any real wow features that made it a must have EHR. Maybe a full demo and experience with the EHR would create a rainbow of EMR subtleties that would change my mind, but it was a relatively short demo.

Instead, the wow factor wasn’t in the EHR software, but was instead in the CareCloud platform that powers the EHR, PMS and CareCloud Community of users. The description above about an almost “social network of doctors” and the health stream of a patient seems like an apt description of what CareCloud has created. In fact, the social elements of the platform are integrated throughout all of the CareCloud software which makes for some really interesting possibilities.

The challenge that CareCloud has is that a social network or Care Platform if you prefer is only as good as the people and organizations that use that platform. If two doctors are seeing a patient, then both doctors need to be on the same platform to really see a lot of the benefits of a patient’s health stream.

I imagine this is part of the reason why CareCloud has to provide a solid PMS and EHR solution on top of the CareCloud platform. Doing so will seed the platform with users so that with each PMS/EHR sold the platform becomes that much more valuable.

It’s hard to predict the future. Maybe CareCloud won’t get outside of its Miami base and maybe they won’t reach their vision of a CareCloud platform (Maybe Andre and Mitochon Systems or some other HIT vendor will do it instead). However, I’m willing to predict that whether CareCloud wins the healthcare platform war or not, some company will create a healthcare platform like what CareCloud has started to create that will be too valuable not to participate.

Full Disclosure: Mitochon Systems is an advertiser on this site, but they didn’t know I was going to post Andre’s comment.

Top Considerations for Transitioning to ICD-10 – Guest Post

Posted on August 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.

Chuck Podesta is Fletcher Allen Health Care’s chief information officer.

ICD-10 would not be so daunting if the deadline was not occurring during the rush to get EHRs for meaningful use. Add in value-based purchasing, bundled payments and transitioning to ACOs, and you can see why many CIOs are retiring early or migrating to the vendor or consulting world. We are just over two years away from the October 2013 deadline, and there is much work to be done. ICD-10 contains 68,000 codes, as opposed to the 13,000 currently used in the ICD-9 world. There is a code for every condition that exists on the planet.

The revenue cycle system, which includes registration, HIM and billing/AR, will be the lynch pin to ICD-10 readiness. Having a solid vendor partner and a strong product is key to a successful transition. Many solution providers – like GE Healthcare, who recently launched the 5.0 version of their Centricity Business product – are updating their systems to better comply with ICD-10. GE Healthcare also allows existing Centricity Business customers to retrofit the new ICD-10 functions to the 4.6 version of the product. Strong vendor partners take the burden off you by being ahead of the game and delivering the appropriate technology in time so you are not racing to the finish line.

By now, you should have at least a steering committee in place. Your IT shop should have completed an inventory of all applications that are impacted by ICD-10, including reporting systems. You will be surprised by the number of applications, even if you have taken the one-vendor approach for most of your IT needs. You will need to contact all affected application vendors to see what the plans are for ICD-10 compliance. Most likely, upgrades will be required that will need to be scheduled.

Training of coders will be critical, along with implementing clinical documentation improvement programs. Documentation improvement programs are difficult to implement and will be viewed by providers as more work on top of an already busy schedule. New technologies such as computer-assisted coding will definitely help, but success will be a combination of process improvements and technology.

Lastly, remember that the deadline is for Medicare and Medicaid patients only. Unless the rest of the payer industry follows the same deadline (highly unlikely), you will need to run both ICD-9 and ICD-10 systems.

Some of the Thinking Behind Meaningful Use Stage 2 – Meaningful Use Monday

Posted on August 29, 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.

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.

A great deal of work, discussion, and debate by the HIT Policy Committee and its Workgroup members went into developing the recommendations for meaningful use Stage 2 (discussed in the last two Meaningful Use Monday posts). Meetings were frequent and lengthy, but I tried to listen in on most of them to gain some insights into the thinking behind the decisions being made and the future direction of meaningful use. 

Committee members struggled with striking the right balance between aggressively pressuring providers so that adoption would be accelerated, on the one hand, and maintaining a realistic and practical view of their capabilities, on the other. Some committee members were adamant about staying on track to reach the Stage 3 end goals within the predetermined 2015 time frame, (i.e. remaining on the escalator, as the progression is often referred to), while others recognized that overburdening providers could lead to program failure, i.e., discouraging adoption by imposing unreasonable expectations that would cause providers to doubt their ability to earn the incentives and abandon the effort altogether. The debate led to an open question: does everything have to be accomplished under the umbrella of meaningful use?

 An issue that I think could have used more discussion is how to make meaningful use relevant for specialists—a subject raised frequently by Committee member Gayle Harrell. There was general agreement about the importance of having all types of physicians participate in the incentive program, and testimony from a variety of specialists was solicited. Other than suggesting a large number of new clinical quality measures, however, the basic recommendations are still predominantly primary-care focused. 

Lastly, there was a prevailing sense of frustration over the fact that the calendar did not allow time for an analysis of the experience of Stage 1 before requiring the definition of Stage 2.

Nationwide EHR and Health Care in the Cloud

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.

Time to touch on a few popular topics that I found being discussed on Twitter. First, I’ll put the tweets and then a little but of my own commentary on these hot button issues in healthcare IT.

@GovHIT
Does a nationwide #EHR lower healthcare costs? Social media reactions | #GovHIT Blog http://ow.ly/64DL1

I always love when people talk about a nationwide EHR. I actually think that it’s a bad title by Government Healthcare IT, but that it’s a very good question. To me a nationwide EHR implies that there is one EHR for the entire nation. I think a number of other countries which are much smaller and less complex than the US have proven quite well that a nationwide government run EHR is a bad idea. I think the Government HIT article actually refers more to widespread adoption of EHR. To that, I’m obviously amenable and can’t wait for that day. Although, we still have a very long way to go.

@ekivemark – Mark Scrimshire
Should Health Care Move to the Cloud – Absolutely (but carefully)! #EHR #HIT 2.healthca.mp/oMMtNA

Might as well cover the cloud in healthcare issue if we’re talking about hot topics in healthcare. Little by little, I’m really seeing the shift to “the cloud” when it comes to EMR and EHR software. There are certainly still instances where the cloud based EHR doesn’t make sense. We also can’t start counting the days to the death of the client server based EHR software. In fact, non-cloud based EHR software is going to be around for a LONG LONG time to come. There’s far too many millions of dollars invested in these systems. However, I still do sense a shift from in house servers to cloud based EHR solutions.

I do appreciate the comment in the tweet about moving to the cloud…”Carefully!”

Avoiding EHR Performance Issues in the First Place

Posted on August 26, 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 my post about the common EHR implementation problem of EHR slowness, I mentioned that I’d follow up with a post on how you can avoid the EMR slowness issue altogether. It’s better to avoid than fix problems.

The best way to approach EHR performance issues is to make them part of your EHR selection process. EHR performance issues could and should be a deal breaker for you when you’re evaluating EHR companies. How then can you identify EHR software that might have these performance issues?

Red Flag #1 – EHR Demo Slowness – Bring a red pen to your demo and every time they say something like, “It’s not usually this slow?” or “It must be slow because it’s running on my laptop.” make a BIG RED mark on your paper (or tablet if you’re advanced like that). Even one red mark should be cause for concern and investigation.

Certainly there are situations where environmental issues can cause slowness to an EHR. So, you can’t completely rule them out completely for this, but this is their demo. This is there one time to shine. If they can’t get their EHR demo running at full speed, what makes you think an EHR production environment will be much better?

You can make an extra red mark if it’s a SaaS EHR that’s providing the demo. They might say it’s just “the internet connection.” Well, guess what? Soon, that’s going to be you using that EHR and often on similar internet connections.

Of course, the message to EHR vendors is to make sure your demo runs as fast as your production system.

Red Flag #2 – Site Visit Slowness – While the demo can tell you a lot about an EHR software, it can’t necessarily tell you the speed of the EHR software. Just because the EHR is fast during the EHR demo, doesn’t mean that same EHR software will be fast in a production environment. Add this to the multitude of reasons why a site visit to a current user of that EHR is so important.

Make sure to do that site visit at one comparable in size and users to your clinic. You don’t want to look at the EHR responsiveness of a solo practice if you’re going to be a 6 provider multi clinic setup. Size matters when it comes to EHR speed.

Once on site, you can get an idea of the speed and responsiveness of the EHR software in two ways. First, observe the users of the EHR in the clinic. See if they exhibit any of the systems listed in the first section of this post. Another observation is to see how quickly they’re clicking around the EHR. If you see a lot of clicks in a row with little waiting in between clicks, that’s a great thing. If you see them click, wait, click, wait, click, click , wait. Be afraid.

The second way is to ask the EHR users. The problem with doing this is that only one response has value. If they say the EHR is slow, then you’ve gleaned some important information that’s worth checking on. If they say the EHR is fast, then you don’t necessarily know. The problem is that you don’t know what the user considers fast. What’s their frame of reference for saying it’s fast? Do they know what fast is? Have they just been using the EHR software so long that they’ve hit a rhythm that makes it feel faster than it really is? It’s a good sign if they say that it’s fast, but take it with a grain of salt.

Red Flag #3 – Use A Demo EHR System Yourself – Most EHR vendors will provide you a way to demo the product yourself. This isn’t a fool proof method to test EHR slowness, but it’s another decent test of the EHR’s responsiveness. Try it out using your internet connection and your computer hardware. Nothing like first hand experience documenting some patient visits to learn about the speed of an EHR.

EHR Speed Suggestion – Don’t Skimp on Hardware
Far too often I see a clinic skimp on the hardware requirements and regret it later. In fact, they often end up spending the money twice since they have to buy new hardware since they skimped in the beginning.

Of course, this suggestion can be taken too far as well. The computer and laptop manufacturers will try to sell you the whole kitchen and you might only need the stove and refrigerator. To put it in more practical terms, you’re going to want plenty of RAM, but do you really need the webcam, Blu-ray player, and special 100 in 1 media device?

Just because an EHR vendor says their EHR software can work on a certain hardware configuration doesn’t mean it should be used on that hardware configuration. In the middle there’s a spot between can and overkill that’s called optimal. Find that hardware configuration and you’ll be a much happier EHR user.

Conclusion
Don’t accept an EHR that’s slow. Make sure that the EHR performs at a satisfactory level. I know of nothing that frustrates a clinic more than a slow EHR.

Study Shows Value of NLP in Pinpointing Quality Defects

Posted on August 25, 2011 I Written By

For years, we’ve heard about how much clinical information is locked away in payer databases. Payers have offered to provide clinical summaries, electronic and otherwise, The problem is, it’s potentially inaccurate clinical information because it’s all based on billing claims. (Don’t believe me? Just ask “E-Patient” Dave de Bronkart.) It is for this reason that I don’t much trust “quality” ratings based on claims data.

Just how much of a difference there was between claims data and true clinical data hasn’t been so clear, though. Until today.

A paper just published online in the Journal of the American Medical Association found that searching EMRs with natural-language processing identified up to 12 times the number of pneumonia cases and twice the rate of kidney failure and sepsis as did searches based on billing codes—ironically called “patient safety indicators” in the study—for patients admitted for surgery at six VA hospitals. That means that hundreds of the nearly 3,000 patients whose were reviewed had postoperative complications that didn’t show up in quality and performance reports.

Just think of the implications of that as we move toward Accountable Care Organizations and outcomes-based reimbursement. If healthcare continues to rely on claims data for “quality” measurement, facilities that don’t take steps to prevent complications and reduce hospital-acquired infections could score just as high—and earn just as much bonus money—as those hospitals truly committed to patient safety. If so, quality rankings will remain false, subjective measures of true performance.

So how do we remedy this? It may not be so easy. As Cerner’s Dr. David McCallie told Bloomberg News, it will take a lot of reprogramming to embed natural-language search into existing EMRs, and doing so could, according to the Bloomberg story, “destabilize software systems” and necessitate a lot more training for physicians.

I’m no technical expert, so I don’t know how NLP could destabilize software. From a layman’s perspective, it almost sounds as if vendors don’t want to put the time and effort into redesigning their products. Could it be?

I suppose there is still a chance that HHS could require NLP in Stage 3 of meaningful use—it’s not gonna happen for Stage 2—but I’m sure vendors and providers alike will say it’s too difficult. They may even say there just isn’t enough evidence; this JAMA study certainly would have to be replicated and corroborated. But are you willing to take the chance that the hospital you visit for surgery doesn’t have any real incentive to take steps to prevent complications?

 

Common EMR Implementation Issue – EHR Performance Issues

Posted on August 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.

We’re back again with our ongoing series on Common EMR Implementation Issues. Seems like readers really liked my first entry in the series about Unexpected EHR Expenses. To be quite honest, I was really happy with how that post turned out myself. It’s one of the most comprehensive and useful posts I’ve written in the 5.5+ years I’ve been writing about EMR and EHR. Hopefully we can continue that trend.

Today’s Common EMR Implementation Problem: EHR Performance Issues

I have to admit that this is a really tough problem to crack. However, it’s also incredibly common. The symptoms for this problem usually are described as, “THIS EHR IS SOOOOOO SLOW!” (This is appropriate use of ALL CAPS since they are often yelling this.) Followed by a *huff* and an angry doctor or nurse leaving their computer in a fit of rage. Other symptoms might include drumming fingers on the desk while staring blankly at the screen, lots of mouse clicks that get progressively longer and more emphatic, or the sitting back in your chair staring at the screen hoping that something will happen.

Once you’ve identified that there’s a problem with EHR slowness, then begins the fun and exciting (that was written in the sarcasm font) journey to identify the real issue. The biggest challenge with identifying the slowness is that there are a multitude of places that could be the bottleneck that’s causing your slowness. Some of which you can fix, and others you have to rely on your EHR vendor to fix.

To assist you in the ugly process of improving EHR performance issues, here’s a list of possible reasons you could have a slow EHR.

EHR Slowness You’re Responsible For
Slow Computers and/or Laptops – I’ve heard of a few EHR vendors offering free iPad’s with their EHR, but for the most part, you’re responsible for buying the computers and laptops for your EHR implementation. See my “EHR Speed Suggestion – Don’t Skimp on Hardware” below for more info on buying the right hardware. Needless to say, I’ve seen many slow computers be replaced and the EHR went a lot faster.

Slow Local Internet – Your local internet (or LAN as it’s often referred) could be the cause of your EHR slowness. I could have split this point into a half dozen possible issues. Some of them might include: Bad network card, bad cabling, bad switch, bad router, bad routing configuration, bad DNS configuration, overwhelmed network, etc etc.

Of course, in most cases you’ll probably have to call your IT service provider to solve these issues. They should be able to easily test most of the above issues and prove that it works for other internet applications and so it must be some other issue causing your EHR slowness.

Slow ISP (external internet connection) – If you’re using an in house EHR server, you won’t have to worry about this as much (except for interfaces, or EHR updates). If you’re using a SaaS EHR, then this could be a major bottleneck. Good thing is that it’s easy to test your ISP speed. If you’re speed is great to other sites, but not your EHR then you can move on to another issue. If you’re speed is bad for all sites on the internet, you need to see if your ISP can make some changes to provide the speed you’ve purchases from them. Otherwise, you might just need a bigger ISP connection than you have and you’ll be able to get your EHR running much faster.

Also, be sure you don’t have employees using up all your bandwidth downloading illegal (or legal) music or videos. That can eat up your bandwidth really quickly. There’s a reason Netflix uses up 20% of bandwidth on the internet. Movie downloads/watching might be using up your internet connection as well.

Memory on Server – I see this issue most often when a clinic tries to re-provision an old server for their new EHR or when they don’t follow the suggested specs of their EHR vendor. It can also happen when you start your EHR with 1 doctor and then grow your practice to 5 doctors. More users usually requires more memory on the server. There are good tools on servers for analyzing how much memory is being used so you’ll know if this is the problem or not.

Hard Disk Space on Server – This definitely shouldn’t happen in a fresh EHR install, but often can happen over time. Servers don’t like to run out of hard disk space and can do all sorts of crazy and unexpected things if they do. Other things that cause a hard disk to run out space might be backups or large log files. I’ve also seen where the IT administrator takes a 500 GB hard drive and divides it into multiple partitions. One partition for the O/S and one partition for the data. Often they misjudge how much to give to one partition versus the other. So, the one partition runs out of space while the other one has TONS of space left.

Good planning and regular maintenance will avoid these issues.

CPU on Server – I believe this is pretty rare these days since memory is usually the bottleneck instead of CPU. However, if the EHR software isn’t written correctly, this could be an issue. Particularly on older boxes.

Complex Workstation Setup – Your IT service provider might have told you all the great benefits of a thin client setup or some sort of virtualized desktop software solution. When done right, these solutions can work fantastic and save you a LOT of money. When done wrong, they can cause you all sorts of slowness and heartache.

EHR Slowness Your EHR Vendor Must Fix
Slow Server Configuration – There are lots of ways to tweak a server to go faster with less resources. Unfortunately, most of these tweaks are likely going to have to come from your EHR vendor. In a larger hospital implementation, you might be able to work with your EHR vendor to implement some of these tweaks. In a small clinic, you’re basically at the mercy of your EHR vendor to configure the server to run fast.

Slow Server (SaaS EHR) – Yes, SaaS EHR vendor servers can go slow too. The good thing is that your EHR vendor likely has monitoring tools that are watching for any slowness so they can proactively fix it. The problem is that then you’re at their mercy to fix the slowness. Needless to say, an EHR vendor’s server support staff rarely feel the end user pain of EHR slowness. At least the pain isn’t nearly as poignant.

Of course, a chorus of calls from EHR users to the EHR support line will help them understand better and fix the slowness. One call about your in house server doesn’t resonate quite as loud.

Slow or Overwhelmed Data Center Connection – Data Center internet connections are generally quite robust and built with a lot of redundancy. However, since data centers usually host many many different systems, they can also get overwhelmed. Sometimes through spikes of traffic, but more often through other nefarious attacks on the systems in the data center. Often, it’s not even your EHR software that’s causing the issue, but it might suffer the consequence. Not very common, but possible.

A little more common could be an EHR vendor that’s growing so rapidly that they can’t keep up with the demand for their EHR software. Other times the EHR vendor just did a poor job planning to expand their EHR data center services.

Poor EHR Code – Not all code is created equal. Some programmers are good at creating code that will execute quickly, but most are not. Fixing speed issues aren’t trivial. Particularly if you have a large code base that’s been created over a long period of time.

Poor EHR Design – The design of an EHR software often determines how fast it work. Designing for speed from the beginning is crucial. Otherwise, a poorly structured EHR can almost never be made fast.

Related to this is EHR software built on old technology. To use a car analogy, you can only make a pinto go so fast without gutting the engine. Too many EHR vendors are built on engines that can only go so fast. They can keep squeezing a bit more speed out of the engine, but eventually you have no other speed benefits because of the legacy technology limitations.

I’m sure there are other possible bottlenecks. Let me know of any I missed in the comments and I’ll add them to the list.

EHR Performance Finger Pointing
Another big problem with the complex list above is that it often leads to a bunch of finger pointing. Yes, sometimes it will feel like you’re back in Kindergarten again. Your EHR vendor will point the finger at your IT setup. Your IT service provider will point the finger at the EHR vendor. Then, the EHR vendor will point the finger at the hardware vendor. You’ll never be able to talk to a person at the hardware vendor and so you’ll have to use other tricks to prove it’s not them.

Needless to say the finger pointing can get really tiring really quick. Not to mention it can be very expensive as you spend money proving to your EHR vendor that it really is their problem and not your setup.

I’ll follow up this post with another on how to avoid EHR Performance Issues during the EHR selection process. I’ll link to that post once it’s up.

Side Note: This post was much longer than expected. I guess I did have a lot to say about this issue.

EMR, EHR and MU Presentation

Posted on August 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.

I recently had the great opportunity to go to breakfast with Valerie Migliore and Karin Eichler during my visit to my in-laws in the upstate New York area (Rochester specifically). Despite being very pleasant ladies I was also happy to see they could speak EMR speak with me. I’ve met a whole lot of different people over the years and far too often I go and meet with someone who is just getting into the EMR world and so they’re still learning the ways of the EMR (excuse the Star Wars reference). I still enjoy those types of visits, but I really enjoy meeting with people like Valerie and Karin who can share with me some other EMR perspectives. In fact, they often show me new ways that I hadn’t looked at something before.

Turns out Val and Karin recently did a presentation about EMR, EHR and meaningful use in Syracuse, NY. They shared their slides with me and I thought they provides some interesting roadmaps and perspectives on EMR selection and implementation. I particularly liked the 17th slide where they show 2 staff involvement pie charts (between leadership, business, clinical and IT) for a successful EHR project and an unsuccessful EHR project (requoted from Shahid Shah’s http://www.slideshare.net/EHRoutlook/guaranteeing-successful-ehr-implementations).

I’d have liked to have been at the presentation to hear what they said with the slides, but I’ve embedded their slides below so you could learn from these smart people as well.

As a side note, I believe Valerie and Karin are working to build their EHR consulting clients in upstate NY. So, if you’re in that area and looking for someone to work with I can put you in touch with them.

More on Stage 2: Clinical Quality Measure Reporting – Meaningful Use Monday

Posted on August 22, 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.

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.

In addition to the Meaningful Use Stage 2 recommendations discussed in last week’s Meaningful Use Monday, the HIT Policy Committee proposed a new framework for the reporting of clinical quality measures that was designed by its specifically-tasked Quality Measure Workgroup. The recommended concept is depicted in the graphic below—the intention is to broaden the scope of reporting to address a wider spectrum of factors affecting care and to accommodate all types of physicians.

Providers would report on some number of the core measures, (between 5 and all 8 or 9 is the recommendation), and at least one measure from each of the 6 menu “domains”. The core quality measure set would include all of the core and alternate core measures from Stage 1 and an additional 2 measures related to care coordination. Interestingly, there was no mention of establishing required thresholds to be met on any of the quality measures.

The intention is that all physicians (including specialists) will find measures relevant to their specialty in the core set as well as in each of the domains. This seems like a tall order from a practical perspective, given the primary-care focus of the Stage 1 quality measures, (particularly true of the core, but also the additional measures.) To accomplish this, the workgroup submitted quite a lengthy “library” of measures to CMS for its consideration—some measures are carried forward from Stage 1, others are recently retooled, and many are still “to be developed”.

We’ll be watching intently to see what CMS does with clinical quality measures, since this is such a fundamental part of meaningful use.

Amazing Epic Discussion on Google Plus

Posted on August 21, 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 many of you probably know, I started a new Hospital EMR and EHR website that follows a similar pattern to EMR and HIPAA & EMR and EHR, but focused on the technology used in a hospital with the EHR being at the center (most of the times). The site has been growing like crazy with the wonderful Katherine Rourke posting most of the content.

However, one thing I found really interesting was that I took this post about Epic Possibly Being Victim of its Own EMR Success and posted it on Google Plus (UPDATE: You’ll need to add me to your Google Circle so I can add you to my EMR circle to see it. I forgot I only shared it with my EMR google circle and I can’t see how to make it public). I’ve just been dabbling around in Google Plus, and so I was surprised by the results.

In the post itself, there have been 6 comments about Epic EMR’s success. That’s really not a bad number of comments for such a new Hospital EMR blog.

However, the astounding part is that my thread on Google Plus that links to the post has already had 40 comments on it with some amazing insight from those commenting.

It’s still really early in the life of Google Plus. Maybe it’s early and the novelty of Google Plus is what’s currently providing the great discussion. I’ll have to seriously consider how I can incorporate that discussion into future blog posts.