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The Marvels of Technology Missing in Health IT

Posted on November 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’m currently on the long flight from Las Vegas to New York City. The early flight time and long flight remind me why I prefer to just stay in Las Vegas with the occasional west coast trip, but I digress. In order to not lose an entire day of work on the airplane, I spent far too much for the overpriced internet service on my flight. As I’m traveling at 30,000 feet, it’s amazing to me that I’m connected nearly as good as when I’m sitting at home. Sure, in flight internet has been around for quite a while, but it still amazes me. What will amaze me even more is when the internet is free on every flight. Maybe pharma ads could pay for this too.

While experiencing this amazing connectivity, I can’t help but think of how poor so much of the connectivity in healthcare is. That’s right. We can find a way to offer internet connectivity at 30,000 feet in an aircraft moving hundreds of miles per hour and yet we can’t get connectivity to rural hospitals and other healthcare locations?

Plus, even speaking more broadly, I can access all of my normal services from an airplane, but for some reason I have no way to connect all of my healthcare data together.

Those in the industry realize the problems. The challenge of connecting all of our healthcare data from the various EHR (or maybe in this case EMR is appropriate) data silos is an academic exercise that’s easily accomplished. Hit any of the interoperability showcases at HIMSS or other healthcare IT events and you’ll see EHR software vendors communicating with each other and sharing data. Why then can’t we make this a reality?

The challenges are still the same they’ve been for a long time now: funding and politics.

I still cringe to think of the missed opportunity that ARRA and the HITECH Act could have provided in this regard. Instead of incentivizing use of an EMR, they should have and could have incentivized interoperability of healthcare data. The great part is that you’re not going to start exchanging data in healthcare without an EHR so you’d be getting more EHR software adopted and interoperability. Water under a bridge now I guess, but it keeps eating at me.

My biggest hope now is that a grass roots movement will form that will drive what we should be doing anyway. Everyone knows and understands the benefits to healthcare and the patient of exchanging healthcare data. It’s easy to make the case for how patient care improves and how duplicate costs are avoided. We need more people that are willing to hop on board interoperability of healthcare data cause it’s the right thing to do. Sure, we need to do it in a smart and reasonable way, but the ROI of healthcare data exchange goes well beyond dollars and cents. This ROI can’t be put on a spreadsheet, but instead will help us all sleep better at night.

Are there any movements like this out there? I can’t say I’ve seen any, but I’d love to see one. Then, we’d have a real beacon community that’s set on a hill because it earned and deserved the recognition as opposed to beacon communities paid for by tax payers.

Side Note: I’ll be in NYC this week at the Digital Health Conference and at the mHealth Summit in DC next week. I’m already planning to meet a number of my readers at these events, but I’d love to meet more.

Conflicting Indications of the Move to SaaS Based EHR

Posted on November 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.

One of the really interesting things I noted while attending the NextGen user group meeting had to do with the move to SaaS based EHR and other SaaS based EHR software. I partially mentioned this in the write up I did at the conference, including a tweet where I talk about how Scott Decker really pushed the idea of NextGen making the move into the SaaS based software world.

I think there’s little doubt that NextGen sees the value of SaaS based software. I think they see the convenience to doctors of not having to manage a server. Most importantly, I think they see the value of not having the healthcare data stored in EHR in silos.

One thing that Scott Decker mentioned in his keynote was improving their coding rules engine based on the feedback and experience across all of their SaaS based EHR users. I found this really intriguing since it highlighted some of the challenges and limitations of the client server EHR model that’s so prevalent in healthcare.

After hearing these comments about NextGen’s move towards more and more SaaS based software, I wondered what users at the meeting thought about the move by NextGen to SaaS EHR. The nice part of a user group meeting is I had a chance to talk to a number of them.

One company I talked to said basically, “We have 30 Citrix servers in our NextGen EHR installation. That’s a huge investment we’ve made and I don’t see us changing that any time soon.” They’ve got an interesting point. There’s a lot of money invested in training, equipment, software, and general understanding of the current client server EHR installs that NextGen employs (or is it employed?) for its large EHR customers.

It’s quite a stark contrast to consider this entrenched client server user base that is unlikely to change even if NextGen’s direction is headed towards SaaS EHR software. To be completely honest, I’m not exactly sure how this “conflict” is going to play out.

The Low-Down on Future Meaningful Use Penalties — Meaningful Use Monday

Posted on November 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.

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.

Meaningful Use penalties—or to use the politically correct word, “adjustments”—are scheduled to begin in 2015 for providers who are not meaningful users of certified EHR technology by 2014. There’s something about the prospect of incurring a revenue reduction that seems to evoke a visceral response among providers—even among those who do not find the potential incentive money motivating.

Here’s what you need to know about the penalties:

1) Penalties apply to Medicare only.
– Adjustments will be applied as a percent of Medicare Part B Professional Fee Schedule Charges.
– They are scheduled to begin in 2015, and continue as follows:
2015: 1%
2016: 2%
2017: 3%
2018 and 2019: may increase 1%/year, at the discretion of the Secretary of HHS.

2) There has been speculation by some industry pundits that the penalties will be delayed or not implemented at all, but to rely upon that as a given would be a mistake.

3) There are no penalties associated with the Medicaid program—adjustments do not apply to Medicaid revenue. Pursuing the EHR incentives as a Medicaid provider, however, does not totally insulate a physician from the penalties. If a Medicaid provider does not become a meaningful user by 2014, the revenue he/she generates under Medicare would be subject to the adjustments above.

More EMR Software On the Way

Posted on November 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.

One of my all time favorite posts I’ve done was called “Develop Your Own EMR….Are you Crazy?” Hard to believe that was back in May of 2006. I should go back and check out the content of that post, but the title still rings very true to me. Of course, every entrepreneur that I know is a little bit crazy, so it should come as no surprised that I’m hearing all the time about new EMR software getting ready to hit the market.

Today’s encounter has to be one of the most unique. I was going to church in another state (visiting family for the Holidays) and I ran into one of my high school friends at church. We caught up and I learned that he’s the owner of a software development company. Then, as he learned what I was doing he just mentioned off hand that they were developing an EMR.

After I picked myself up off the floor, the meeting at church started so I didn’t really get a chance to talk to him. Since he’s my friend on Facebook (you know, a real friend that I know in real life type of Facebook friend), I sent him a message and hopefully we can connect. I’m really intrigued that his software development house is doing an EMR for someone. Obviously, now I have a ton of questions for him about the project. He did say before the meeting started that “it’s a BIG project.”

Of course, the message here is that there are a lot of people out there that are crazy (no offense intended) enough to start building another EMR. The problem is that there are so many doctors that are dissatisfied with the EMR software that’s out there, I’m sure until that’s resolved we’ll see more and more EMR software entrants. Oh, if only these brave souls knew what they were getting themselves into. I guess maybe that’s the beauty and key to entrepreneurship and why I love it so much.

Full of Gratitude on A Great Thanksgiving

Posted on November 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.

A beautiful Thanksgiving is nearly over, but I’d be remiss if I didn’t at least drop a few sentences of gratitude for readers of EMR and HIPAA on Thanksgiving. I live a wonderful life. I have a fantastic wife that is a wonderful compliment to me. She’s had a lot more to put up with me traveling so much lately for HealthcareScene.com and she’s been a wonderful supporter of me. I have 3 wonderful kids that are incredibly fun and bring so much joy into my life.

Lately I’ve been talking with a lot of people and they invariably ask me what I do. My simple answer is: I’m a blogger. Many times I comment how I never thought I’d be a blogger when I grew up. In fact, if you’d asked me a year and a half ago when I quit my day job if I’d be a full time blogger I probably would have laughed. I’m certainly the beneficiary of a little bit of luck, some great timing, and a decent amount of hard work. Although, I’ve had so much fun doing most of it that it’s often hard for me to call it work.

All in all, I have so much to be grateful for. I’m particularly grateful for all those who read EMR and HIPAA and my other sites and the advertisers who support my site as well. No doubt, none of this would be possible with out great readers. Thanks for reading. Thanks for commenting. Thanks for participating. Thanks to all the advertisers that have supported this site. As I’ve discussed recently with a number of advertisers, my goal is to provide really great value so we have long term relationships with our advertisers. For the most part, we’ve been able to do just that. So, Thank You!

Riskiness of Pharma Ads in EHR

Posted on November 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’ve been having a number of really interesting conversations with people about Pharma ads appearing in EHR and other clinical software. Most people’s gut reaction is that they don’t want their doctor seeing a pharma ad while he’s ePrescribing. However, most people also agree that there’s too much Pharma money for it not to happen.

In an article at Lab Soft News a few months back, they discuss the challenge and issues surrounding Pharma ads in an EHR:

Very distressing to me, however, is the clear link of the company, and its software, to the pharmaceutical industry. I have blogged on numerous occasions about some of the ethical and legal lapses of some of these companies (see, for example: On the Corrosive Influence of Big Pharma on Academic PhysiciansMerck Creates Phony Peer-Reviewed Medical Journal to Dupe PhysiciansDetails Emerge About Ghost-Written Medical Articles for Wyeth). I have also reluctantly come to the conclusion that even apparently trivial advertising connections to Big Pharma can lead to mischief. I had previously thought that inconspicuous advertisements in EMRs by drug companies might be tolerated if the companies were to bear the costs of these systems. I now believe that allowing these companies even a tangential relationship to physician-office electronic medical records is too risky.

Certainly there are some really great points made. Absolutely there’s a risk that a doctor could be influenced by a pharma ad in an EHR. Will it make them provide a lower quality care because of the ad? I’m not sure it would. Could the care cost more because of the pharma ad? Possibly so. Do we not trust our doctors to do what’s best for us regardless of the other outside influences?

Back to the initial premise, many are concerned with Pharma ads, but they’re bound to happen anyway. So, I ask you the question, is there any way to have Pharma ads without compromising the integrity of the visit? Is there a way to minimize the influence of Pharma while still allowing them a way to talk with the doctor?

No doubt this discussion is going to come up again and again. With Pharma unable to even give a doctor a pen we’re going to see new creative ways for Pharma to be seen by doctors. Advertising Pharma products to patients won’t be enough.

Does EHR Choice Matter for ACO’s?

Posted on November 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.

There’s a really interesting article on Nextgov that talks about a CSC report that looks at the role of health IT and EHR software in Accountable Care Organizations (ACOs). The most valuable part of the article is this list of items that an EHR must enable or allow to support an ACO:

  • Clinical information and point-of-care automation, with integrated ambulatory and inpatient records and a central repository for clinical data.
  • Enterprise master data management and integration, with a population management repository, a master person index and a master provider index.
  • Tools to enable participation in a health information exchange.
  • Patient engagement tools, including secure messaging, e-visits and tele-visits, social media, patient portals and mobile health applications.
  • Care management and coordination tools, including referral and request tracking, provider-to-provider communication, medication reconciliation and case- and disease-management applications.
  • Performance management tools, including integrated business and clinical intelligence and analytics.

To be honest, as I look through this list of EHR items, I can’t say that any of them really stick out to me as impossible for any EHR to achieve. In fact, I’d say that they’re quite achievable by almost all EHR software vendors.

The only partial fear I have reading through the list is that some of the points depend on an EHR vendor working with other EHR software vendors. In most of the cases, these are large hospital EHR vendors that have often worked in very closed environments.

The reason this is a cause for concern is that even the best EHR software in the world won’t be an effective ACO and won’t meet the above requirements if the large EHR software vendors don’t work with them to connect their system.

Maybe this isn’t something we should be too concerned about since the hospital client will be motivated to get their EHR vendor to work with the other even small EHR vendors in order to make the ACO happen and get access to the extra reimbursement. However, my gut tells me that this won’t be the case and there will be stories where EHR software is basically shut out of the ACO based on the large EHR vendors decision to not work with them.

Clinical Data Abstraction to Meet Meaningful Use – Meaningful Use Monday

Posted on November 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.

In many of our Meaningful Use Monday series we focused on a lot of the details around the meaningful use regulations. In this post I want to highlight one of the strategies that I’ve seen a bunch of EHR vendors and other EHR related companies employing to meet Meaningful Use. It’s an interesting concept that will be exciting to see play out.

The idea is what many are calling clinical data abstraction. I’ve actually heard some people refer to it as other names as well, but clinical data abstraction is the one that I like most.

I’ve seen two main types of clinical data abstraction. One is the automated clinical data abstraction. The other is manual clinical data abstraction. The first type is where your computer or server goes through the clinical content and using some combination of natural language processing (NLP) or other technology it identifies the important clinical data elements in a narrative passage. The second type is where a trained medical professional pulls out the various clinical data elements.

I asked one vendor that is working on clinical data abstraction whether they thought that the automated, computer generated clinical abstraction would be the predominate means or whether some manual abstraction will always be necessary. They were confident that we could get there with the automated computer abstraction of the clinical data. I’m not so confident. I think like transcription the computer could help speed up the abstraction, but there might still need to be someone who checks and verifies the data abstraction.

Why does this matter for meaningful use?
One of the challenges for meaningful use is that it really wants to know that you’ve documented certain discrete data elements. It’s not enough for you to just document the smoking status in a narrative paragraph. You have to not only document the smoking status, but your EMR has to have a way to report that you have documented the various meaningful use measures. In comes clinical data abstraction.

Proponents of clinical data abstraction argue that clinical data abstraction provides the best of both worlds: narrative with discrete data elements. It’s an interesting argument to make since many doctors love to see and read the narrative. However, all indications are that we need discrete data elements in order to improve patient care and see some of the other benefits of capturing all this healthcare data. In fact, the future Smart EMR that I wrote about before won’t be possible without these discrete healthcare data elements.

So far I believe that most people who have shown meaningful use haven’t used clinical data abstraction to meet the various meaningful use measures. Although, it’s an intriguing story to tell and could be an interesting way for doctors to meet meaningful use while minimizing changes to their workflow.

Side Note: Clinical data abstraction is also becoming popular when scanning old paper charts into your EHR. Although, that’s a topic for a future post.

REC Physician Adoption, EHR Incentive Numbers, and Quality Care Reporting

Posted on November 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.

Time again for the weekend EHR Twitter round up. Some interesting stats in this weekend roundup.


It’s an interesting thing to note that they have 100,000 physicians signed up. The real numbers we need to know is how many of those 100,000 have achieved meaningful use, how many have implemented an EHR, and how many still need to select an EHR. Then, we’d really have an idea of how well the RECs are doing.


These numbers seem a little small for me. However, I think we’re going to have a flood of meaningful use attestation at the end of the year, so these numbers are likely a bit misleading.


This is an interesting point. Plus, it’s even more interesting when you think about care teams that are part of different organizations. The inconsistency becomes even more difficult.

The Arizona REC and HIE at EHR Summit

Posted on November 18, 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.

While attending the EHR Summit by HBMA, I got the chance to learn more about the AZ REC and HIE. Here are some tweets about the things they said that worth noting with my own comments:

Arizona REC

AZ REC had trouble getting vendors to take their free EHR interns. #EHRSummit11

This was pretty interesting since they said that doctors were more than willing to take on their student interns, but vendors were reticent to take them on. I do love the education program that the AZ REC put together. Internships like this are valuable.

Biggest complaint the HIT students had was access to actual EHR software. AZ REC created a EHR software lab to solve it. #EHRSummit11

This is a really common complaint by the RECs. In fact, I just helped a REC get access to some EHR software to solve this problem. It’s amazing to me that more EHR vendors aren’t happy to provide their software for these education programs.

AZ REC has a list serv of 2500 doctors and a list for vendors. See: http://www.arizonarec.org/? #EHRSummit11

I found it interesting that they had a doctor list and a vendor list. Makes sense.

AZ REC looking at optimizing health IT for ACO’s to be sustainable. I think this will be a common strategy. #EHRSummit11

The idea of REC sustainability is an important one. I think many are looking towards the ACO requirements as one pathway to sustainability. Of course, how stable are ACO’s? One thing seems certain, the relationships the RECs create with doctors could be leveraged for good if done right.

Arizona HIE

The case for the benefits of good information from something like a HIE is easy. The problem is making it actually happen. #EHRSummit11

This was my gut response when the AZ HIE was talking about the benefits of having the information an HIE provides. I don’t think I’ve heard anyone say that exchanging information would be a bad thing and produce worse clinical outcomes. Sure, they want to ensure privacy of the data when it’s done, but the benefits of having the best information are completely apparent.

HINAz (AZ HIE) didn’t depend on grants to create the HIE. They focused on the benefits of the HIE to users. #EHRSummit11

This seems like something that’s a bit unique to AZ. Most HIE’s are so focused on the grant funding. In this sense, I think that this might give the AZ HIE a chance to be successful. Plus, I loved that they did actual research into which users benefited from the HIE.

AZ HIE, Hospitals pay 50% of costs, Plans pay 50% of costs. Physicians pay nominal fee to participate (cause nominal benefit). #EHRSummit11

This is where the real fun begins. The hospitals and plans are paying for the HIE since the AZ HIE found that they’re the ones that would benefit from it. They found that doctors received nominal benefits from using the HIE and so they shouldn’t be charged to use it. Of course, the other beneficiaries not mentioned here is the benefit to the patients. I’m sure hospitals and plans will pass the cost on to patients, so I guess that works out in the end.