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EMR and EHR Ads

Posted on January 31, 2013 I Written By

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

It seems fitting on Super Bowl week to take a second and look at the advertisers that make what we do here at EMR and HIPAA possible. None of their ads cost $1-2 million like the Super Bowl ads, but if you’re looking for some great Healthcare IT and EHR products then you’ve come to the right place. If you like what we do here at EMR and HIPAA, then take a minute and see the advertisers who like what we do as well.

Also, I have a special ad promotion for new advertisers from now through the middle of February. If you’re interested in knowing the details, drop me a note on our Contact Us page.

New EMR and HIPAA Advertisers
Canon – I can’t imagine anyone reading this needs an introduction to Canon. In the Healthcare IT space they offer a suite of scanners, printers and copiers that are found in healthcare organizations across the country. I even have the Canon imageFORMULA DR-C125 in my house and use it regularly. The need for heavy duty scanners in healthcare isn’t going to go away for a long time. I’m glad to have Canon on board as an advertiser.

iPatientCare – EHR vendors always do well as advertisers on EMR and HIPAA and so it’s great to have iPatientCare as a new advertiser. They provide the full suite of EHR, PMS, PHR, HIE, and Mobile that you could need along with all the important EHR and meaningful use certifications. I see that they’re going to be exhibiting at HIMSS at Booth #5519 if you want to check them out at HIMSS. Plus, I love that their website has an image that says they won 9 TEPR Awards. Many of you probably won’t even know what TEPR is since it’s no longer around. However, TEPR was a conference focused exclusively on EHR (although it was probably called EMR back then since it was before EHR became in Vogue). The fact that they won awards at TEPR shows how long iPatientCare’s been doing EHR.

simplifyMD – I first started working with simplifyMD when they graciously sponsored the New Media Meetup at HIMSS 2012 (The 2013 event will be announced shortly, but save Tuesday, March 5th from 6-8 on your calendar). It was a great event and they were a great sponsor. simplifyMD is a certifed EHR vendor that strives to tailor their EHR workflow to the doctor’s current workflow. Something that dotors love to hear and experience from their EHR. They’re a web based EHR. Plus, they recently came out with these great simplifyMD and EHR cartoons. I’m sure I’ll be featuring more of their cartoons in the future.

Returning EMR and HIPAA Advertisers
Sfax – I call Sfax a returning advertiser because they first started advertising on EMR and HIPAA back in December of 2009. So, they supported EMR and HIPAA back when we were just starting to get some traction. After a short hiatus, they’re back as an advertiser. What many don’t realize is that Sfax handles the faxing for a large number of the EHR vendors out there. While I generally avoid faxing as much as possible, sometimes it can’t be avoided and so I’m always grateful I can just send a fax similar to how I send an email using Sfax. Word on the street is that they have the next version of their software coming out soon. I’m excited to check it out.

Mitochon – Similar to Sfax, Mitochon first started advertising on EMR and HIPAA back in Decmber of 2010. After a short break they’re back again as advertisers. I’ve really enjoyed watching Mitochon mature as a Free EHR vendor (They do offer the full suite of free services: PM, EMR, HIE, etc). When Mitochon first started advertising with me, they were a brand new company with a big vision and lots of ideas, but still a lot of work to do. They’ve come a long way since then with their product and their company. One example of that was in their mobile EHR solution that I wrote about previously.

Renewing EMR and HIPAA Advertisers
A big thanks to all these renewing advertisers. It’s beautiful seeing so many of them supporting us for so long.
Practice Fusion – Advertising since April 2010
EMR Consultant – Advertising since July 2009
Amazing Charts – Advertising since May 2010
Cerner – Advertising since September 2011

I’m very appreciative of those advertisers who support the work we do. As I look at the stats for the advertisers, I’m really happy that we’re providing real value to their companies.

EHR Benefit – Space Savings

Posted on January 30, 2013 I Written By

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

It’s time for the next installment in my series of posts looking at the long list of EHR benefits.

Space Savings
I’ve heard many clinics use the space savings as a great way to justify the cost of their EHR. This works better in the small physician office market than it does in the hospital market, but the principles are similar. However, the scale is different.

The obvious space savings is the storage of all the paper charts. While many clinics are quite creative in how they’ve stored paper charts (see the walls around the front desk of many clinics), the most common storage is a chart room dedicated to the storage of all the paper charts. Each state has its own requirements for the retention of paper charts, but its usually somewhere in the neighborhood of 6 years. 6 years of paper charts amounts to a lot of storage space. Plus, many doctors I know keep their paper charts well beyond the required retention period (the liability of doing so is a different discussion).

There are many different approaches to dealing with your paper charts during an EHR implementation. Many continue referencing and pulling the paper chart, but just start any future documentation in the EHR. Others scan the patient charts for the following day’s appointments. Others choose to only scan parts of the paper chart similar to how they use to “thin” the paper charts. In each of these situations, the space savings will start to accrue over time, but you won’t experience a big space opening up right away.

One way that some clinics gain space is by moving the charts from a very accessible place to one less accessible. As you move to EMR, there isn’t as much of a need to access the old paper charts and so you can often optimize your space in a way to free up the previous paper chart storage space and move the paper charts to a different space in your office.

Another option many clinics are doing is outsourcing the scanning of all their old paper charts to an outside company. While not the topic of this post, the cost and quality of such outsourced scanning has made it a really attractive option for many clinics. Many chart scanning companies will even do clinical data abstraction as I’ve written about before. In this case, all of your paper charts get scanned into digital form and you no longer have any paper charts storage needed at your office. It’s always amazing to see an entire room full of paper charts sitting on a little hard drive.

I’ve heard of clinics use the previous chart storage space in a variety of ways. The most interesting is when the previous chart storage space is turned into an exam room(s). This extra exam room can allow a clinic to see more patients or even hire another provider who sees patients in their clinic. In this current fee for service environment, that translates directly to dollar signs for the clinic. If you can achieve this during your EHR implementation, it’s a great way to justify the cost of the EHR and is a tremendous financial benefit to consider.

In other cases, the chart room is turned into an office for the billing staff, practice manager, nurses, or doctor. Doing so can’t easily translate to a specific dollar amount, but can also lead to valuable benefits such as employee satisfaction, quality of care, quality of billing, etc.

Saving space isn’t always a result of implementing an EHR, but it can be in many EHR implementations. So, consider how the chart storage space can benefit your clinic.

Problems EMRs Don’t (Necessarily) Cause

Posted on January 29, 2013 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

In publications like this one, we spend a lot of time and energy clubbing EMRs and EMR vendors for the problems they cause.  That’s all well and good, but it’s also worth remembering that some of the big problems surrounding medical operations may not be due to EMR use:

* HIPAA carelessness:  When someone shouts private medical information across a room, or loses a flash drive or tablet with records on it, or leaves patient records in a public place, you’ve probably got a nasty HIPAA violation. But the EMR almost certainly had nothing to do with it.

* Clumsy office workflow:  Sure, introducing an EMR into a clinical setting can screw up existing workflow. But was it working well in the first place?  For those whose business falls apart post-EMR, I’d argue “no.”  Businesses that don’t do well after an install had jury-rigged processes in place already, I’d argue.

* Patient care slowing down:  As with staff workflow, clinical workflow can be discombobulated — badly — by an EMR installation. Learning to fit practice patterns to the system is a big job for most clinicians, and they may slow down significantly for a while. But if the patient care flow stays “broken” it’s likely that there were aspects of the pre-EMR system that didn’t work.

I realize that I might get flamed for saying this, but I’m pretty confident that a goodly number of problems that are laid at the feet of dysfunctional EMRs don’t belong there.  And that’s not a good thing.

After all, there are enough poorly designed, trouble-ridden EMRs out there to keep us busy critiquing them for a century or two.  Why distract ourselves by adding more to the pile when the real issues may be elsewhere?

Redesigning The Patient Medical Record, the Healthcare Challenge’s Results

Posted on January 28, 2013 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 a guest post by Carl Bergman from EHR Selector.

The Obama administration’s, Challenge.gov site encourages the public to submit suggestions that solve specific, public policy questions. To do this, it’s set up dozens of contests or challenges. For example, the FTC has a $50,00 challenge for a solution to illegal robo calls that often come from off shore.

In healthcare, the VA and the ONC recently ran a Health Design Challenge for a better patient health record announcing the winners a few days ago.

The challenge asked for a record that:

  • Improves the visual layout and style of the information from the medical record
  • Makes it easier for a patient to manage his/her health
  • Enables a medical professional to digest information more efficiently
  • Aids a caregiver such as a family member or friend in his/her duties and responsibilities with respect to the patient

The entries were judged by a twelve person panel ranging from Wired Magazine’s Executive Editor, Thomas Goetz to Facebook’s Product Designer, Nicholas Felton to Dr. Sophia Chang, the director of the Chronic Disease Care program of the California Health Care Foundation. They looked at several features of a revamped record from overall appeal to how readily it shows important information and how accessible it is for physicians, patients, etc.

The Winners

The judges picked three big winners and three winners in the Problem History, Medication and Lab Summaries areas. Here’s a brief look at the top entries, but the submissions should be looked at more as a resource than a race result, as I’ll discuss.
Nightingale
First place went to Nightingale an anonymous group that won $16,000. Others won smaller amounts. In the next few months, elements of the winning designs will be put together and put up on Github.

Nightingale’s design stressed that health was a continuing concern and that a user should be able to see an improving or declining trend without having to dig for the data. They did this by integrating the often disparate information in visits, exams and lab results. You can see this emphasis in their lipid panel screen. Sliders place each test result for each test’s in a range. Good results slide to green while poorer result move to red.
StudioTACK
Second place StudioTACK took a somewhat similar approach to creating a problem history, which they call a medical strategy rather than a record. They did this by bringing their findings into a body map with references to location and organ.

Matthew Sanders’ CCD scored the best Problem History section award. Sanders rearranged and redesigned the traditional note not by condition nor by past chronology, but into a timeline of past, present and future actions. While he admits that his approach is somewhat redundant for meds, he emphasizes that this arrangement helps all the users maintain a focus on the most important areas for action. Sanders presentation notably describes how he implemented his approach. To do this, he stripped out standard label text, clarified terms and gave the remaining items visual emphasis. This type of analysis makes going through the submissions worth it.
Sanders CCD
This isn’t to say that the way the contest was run and the approach of many submissions  — including some prize winners — were without shortcomings. There were some notable problems.

The Contest’s Problems

The contest’s operators needed to be far more specific about what they wanted and how they judged the results.

The challenge’s purpose was far from clear:

The purpose of this effort is to improve the design of the medical record so it is more usable by and meaningful to patients, their families, and others who take care of them. This is an opportunity to take the plain-text Blue Button file and enrich it with visuals and a better layout. Innovators will be invited to submit their best designs for a medical record that can be printed and viewed digitally.

A medical record is an on going repository of a person’s health context, status, prognosis, plans, etc. It has many contributors and users. The VA’s Blue Button is a snapshot of the person’s status for their use. However, the contest uses these terms interchangeably. Due to this muddle, many of the submissions sent in designs for a medical record, while others, a minority, only redid the Blue Button’s outline. Thus, not all submissions were developed on the same basis. Indeed, the judges seem to acknowledge this since they gave first place to Nightingale, which claims, “to be a new take on health records.” The contest would have done much better if it asked for particular types of screens putting everyone on the same page, as it were.

The contest judging panel while distinguished, had no practicing physicians, nurses or practice managers, a significant failing. While three of the twelve judges are MDs, not one is a practicing physician.

Finally, if you’re going to hand out $50,000 in public funds, you might just want to say why you thought the winners stood out.

The Submissions

The contestants almost universally got one thing right. They designed their entries for desktops/laptops, pads and phones. They showed a great understanding that we don’t work on just one platform, but move from one to the other almost continuously. In this, they deserve much praise. However, all this cross platform awareness is done in by an appalling over, under and misuse of font color, and size. As one post noted about Nightingale:

The text is too small and medium gray on light gray is very hard to see, especially for older people and people on cheap computers with low contrast displays. How can this possibly be the first place winner?

The comment is generous. Nightingale’s gray on gray font is almost unreadable. Granted their submission is a PDF of a prototype, nonetheless the possibility of staring at their screens all day would give me a headache.

They are not alone in color misuse. Second place winner, Studio TACK, goes to excess the other way with a white text on red iPhone screen. It’s more suited to public safety than health.
StudioTack Mobile
Going through the submissions, however, can be most rewarding. I found a gem of a summary page in Uncorkit’s submission. Their infographic approach puts not only labs and weight history on timelines, but also includes BP, conditions and meds. It gives you a great overview and a logical place to drive down for detail information without overwhelming your senses.

The Health Challenge submissions have much to recommend them. Just remember how they came about and what they may or may not include.
Uncorkit

Telemedicine, Accenture, and Influenza App – Around Healthcare Scene

Posted on January 27, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

EMR and EHR

When The EMR *Is* The Problem

Anne Zieger talks about a recent experience at the doctor’s office that took more time than it needed to because of an EMR. While EMRs are meant to increase efficiency and workflow, it isn’t always the case. How can these problems be addressed?

New Telemedicine Starts Bode Well For EMRs

Jennifer Dennard interviewed Sande Olson, a senior health consultant at Olson & Associates about the future of telemedicine technology. She discusses how it has changed recently, a possible trick down effect from the ACA, and integration of telemedicine into EMRs.

Hospital EMR and EHR

What Hospitals Can Learn From Hospitals

Airports are crowded, filled with germs, and just frustrating sometimes. However, there are a few things, technology-wise, that airports do well with, and hospitals should pay attention to. This post talks about three different things hospitals can learn from airports, including having kiosks and big screen displays.

Accenture: Five Questions Hospital Boards Should Ask Before EMR Buys

A study done by Accenture found that about four percent of hospitals will be making an EMR purchase in the next year. Partly because of this, Accenture has compiled a list of questions that should be asked before purchasing an EMR.  They suggest having these questions answered by an independent analysis of EMR vendors.

Smart Phone Healthcare 

CDC Release Influenza App

The CDC has released another app. This time, it focuses on the flu. Because this year’s flu season has run rampant throughout the United States, this app can be very helpful, particularly for physicians. It contains information concerning where outbreaks are happening, the vaccine, and tips on how to stay healthy.

The Next Generation of Doctors – #HITsm Chat Highlights

Posted on I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

The theme for today’s chat was “The Next Generation of Doctors.” When I read this, I wasn’t sure what to expect. It definitely sounded like an interesting topic, and it proved to be one. Here are the questions that were asked, and some of my favorite responses:

Topic One: Who are the emerging leaders you admire for their ideas in shaping the future of medicine? Why? Share resources!

 

 

 

Topic Two: Do you think new ways of learning will attract different types of personalities to the field of medicine?

 

 

Topic Three: How can the next generation of doctors learn from patients who are active through social media?

 

 

 

Topic Four: What does the next generation of doctors think of Quantified Self? How will the role of hte docotr change because of #OS?

 

Topic Five: What is your big idea or dream for the future of medicine.

 

Using Influencers to Differentiate Your Health IT Products

Posted on January 25, 2013 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.

Shahid Shah and I have been working together for the past little while on a new company called Influential Networks. It’s been a really amazing experience for me to work alongside Shahid and to learn from his amazing expertise.

As HIMSS fast approaches, Shahid and I decided that it would be helpful for us to share some tips and tricks to improve a company’s marketing and messaging strategy and how they can use influencers in that strategy. We’ll be hosting a webinar on Tuesday, January 29th at 2:00pm EST to share these tips. The tips we will be sharing apply at HIMSS or to any company looking to differentiate their product or service in the healthcare market.

For those who don’t want to wait or can’t attend on Tuesday, last Thursday we teamed up with HIMSS Social Media gurus, Cari McLean and Michael Gaspar, to do a similar webinar focused on differentiating your product and services at HIMSS. You can download a recording of that webinar here.

Much of the content in the webinar on Tuesday will be similar to the one we did with HIMSS, but with a few different twists. Plus, we’ll save time for Q&A at the end of the event where you can get your company specific questions answered. Here’s a short outline of the major subjects we’ll cover:

  • Describe the expectations of attendees and why they attend
  • Provide suggestions for how to clearly differentiate your products and services
  • Explain some of the common mistakes exhibitors make
  • Plan what to do before, during, and after the conference

You can register for the Tuesday webinar online. Everyone is welcome to attend.

If you have any specific questions you’d like to make sure we answer at the webinar, feel free to leave a comment below and we’ll be sure to answer them for you.

Tips on Dealing with Copy and Paste EMR Concerns

Posted on January 24, 2013 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 a guest post by Deborah J. Robb, BSHA, CPC. You can read more of Deborah’s work on her blog.

Deborah has served TrustHCS since 2007, where she developed the professional services department providing physician coder education related to CMS guidelines. She has also managed 34 coding staff that provide coding services to a variety of multiple specialty clinics nationwide. With over 35 years in the healthcare profession, she is a frequent speaker on Medical Coding, including appearances at State and National AHIMA conferences. Deborah is also a five time author for Direct Learning On-line courses in Medical Terminology and Medical Coding and has written numerous articles in national publications including, but limited to, For the Record, Physician Practice Magazine and Journal of AHIMA. Deborah is a graduation of Central Texas College and Columbia Southern University.

The OIG is concerned that inappropriate E/M service payments may be linked to cutting and pasting encounter notes within EMRs. As a result, their 2013 Work Plan includes the identification of redundant documentation and improper billing of multiple E/M services. Practices can mitigate their risk of OIG audits and fines by implementing the following five steps for proper E/M level documentation within an EMR.

Red Flag Redundant Documentation

Practices should conduct regular reviews of physician documentation to ensure duplication is kept to a minimum. Reviews should include a broad sample of E/M services and compare each provider’s results. Findings and anomalies can be discussed as a team with results used as a learning tool to improve documentation, coding and billing practices.

Two particular areas for review include error rate for incident-to services performed by non-physicians and the E/M coding of “new” patient for patients seen prior. The “incident-to” designation pertains to services and supplies performed incident to the professionals services of a physician. When Medicare first took a look at these billings, they discovered half of the services delivered and billed were not performed by a physician.  The OIG will review “incident-to” services to determine whether payment for such services carries a higher error rate than that for non-incident-to services; or if redundant documentation is to blame. They will also be assessing Medicare’s ability to monitor such services.

Secondly, Medicare contractors have identified the use of a “new patient” E/M code for patients seen within three years by the same provider or within the same practice as an area of scrutiny. Internal audits and documentation reviews should include both of these OIG issues.

Evaluate Cut and Paste Policies

Practices should also assess organizational policies and procedures around cut and paste functionality. Initial EMR implementations promoted copy/paste with little foresight into the downstream documentation, coding and billing issues. Policies and procedures should state what is acceptable to be brought over from previous notes. Practices are encouraged to consult the American Health Information Management Association’s (AHIMA) Copy Functionality Toolkit. It includes valuable case scenarios, sample policies, checklists and audit guidelines.

Raise Awareness of Risk

The ability to copy and paste a patient note from a prior visit into a new encounter is so easy within most EMRs, that providers may unknowingly risk patient safety. The following risks are noted within the AHIMA toolkit and should be shared with all documenters.

  • Copying information into the wrong patient chart
  • Inaccurate or outdated information
  • Inability to determine current information
  • Inability to identify the author or intent of documentation
  • Inability to identify when the documentation was first created
  • Inability to accurately support or defend E/M codes for professional or technical billing notes
  • Propagation of false information
  • Internally inconsistent progress notes
  • Unnecessarily lengthy progress notes

Implement Clinical Documentation Improvement (CDI)

Similar to hospital CDI initiatives, an effective CDI program for physician practices includes phases for assessment, education and monitoring. Findings from initial assessments and ongoing monitoring should serve to focus education and training efforts throughout.

Every Encounter on Its Own

Finally, every encounter’s documentation must stand on its own. There must be valid documentation within each note to support the visit. Questions to ask of each note include:

  • Does the documentation prove the visit was done?
  • What has changed from the previous visit?
  • Does the documentation demonstrate what was done?

Conclusion

Cut and paste saves time for clinicians, but may unintentionally skew E/M documentation, coding and billing. The review of this practice within the 2013 OIG work plan is a significant motivator for practices to tighten policies and mitigate risk.

EHR and Malpractice Lawsuits

Posted on January 23, 2013 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.

Long time reader Carl recently pointed me to this excellent AHIMA article on EHR and Malpractice Lawsuits. It’s first section sums up the current state of EHR and lawsuits quite well:

Medical records are a vital part of any healthcare lawsuit because they document what happened during treatment. Paper medical records are relatively simple aspects of litigation. HIM staff pull the requested chart, track down additional information as necessary, and sometimes provide a deposition on the record’s accuracy.

The process is far more complex with an EHR. The record of a patient’s care that a clinician views on screen may not exist in that form anywhere else. When the information is taken out of the system and submitted into legal proceedings, the court has a very different view—one that often confuses the proceedings and, in the worst instances, raises suspicions about the record’s validity.

The challenges stem from the design of the systems, which were built for care—not court. If the provider struggles in providing documentation, a trial involving malpractice can easily shift its focus from an examination of care to a fault-finding mission with the recordkeeping system. At other times, the provider’s inability to put forward the information in a comprehensible format may raise suspicions that it is missing, withholding, or obscuring information.

I’d probably modify the sentence that says that EHR’s were “built for care-not court” to say that EHR’s were “built for billing-not court”, but the idea is still the same. The big issues for EHR in lawsuits is that there’s no really good precedent for how an EHR will be treated in court. We’re so early in the process of legal cases that use EHR documentation, that we just don’t know how the courts are going to deal with EHR documentation.

Plus, when you consider that there are 300+ EHR companies out there, I’m not sure that a legal case with one EHR software is going to be applied the same way to the other EHR software. Each EHR displays data differently. Each EHR audits users differently. Each EHR stores data differently. So, I expect that each EHR will be looked at in a different way.

The AHIMA article linked above is a good read for those interested in this topic and points out a lot of other issues that could face an HIM staff that’s dealing with a case involving documentation in an EHR. Although, one of the overriding messages is that HIM staff and healthcare organizations are going to need an expert of their EHR involved in the process. In fact, I can see many HIM departments getting trained up on EHR in order to fulfill this need.

What I also see coming is a new group of EHR expert witnesses. Again, I think that these expert witnesses will have to have specific knowledge of a particular EHR to be really effective. I’m sure they’ll come from the ranks of EHR consultants, former EHR employees, and some EHR users. Considering the millions of dollars on the line in these malpractice cases, these EHR expert witnesses stand to make a lot of money.

I don’t want to make it all sound doom and gloom. I expect that there will be many cases involving EHR where a doctor or institution is covered better by an EHR than they were in the paper world. This will be even more true as EHR vendors continue to shore up their EHR audit logs and processes. There’s new legal risks with EHR, but there are also old risks that are removed by using an EHR. We just need to make sure we’re ready for the new risks.

Physician Ranking Websites – The Bad, The Worse and the Ugly

Posted on January 22, 2013 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.

On the internet, there is a website that ranks just about anything you would to be ranked, reviewed, prioritized, commented on, etc. Turns out that Physicians are no different, but as is often the case in healthcare, these websites are just getting started. I’m not sure all of the reasons why doctors weren’t being ranked and reviewed on websites before, but it definitely came later than many other industries. One reason this might be the case is that it’s a bad idea to try and create a website for physician reviews.

I realize this will be a position that many will disagree with (particularly those websites who review physicians). In fact, Jennifer Dennard wrote on the sister site to EMR and HIPAA the following comment:

Healthcare will become more affordable once consumers start making an effort to patronize providers that have a reputation for high patient satisfaction and quality scores. Get engaged via websites like Healthgrades.com to start sifting through local MDs’ scores and reviews.

While I agree with Jennifer that consumer involvement in their healthcare could eventually make healthcare more affordable, I don’t see websites like Healthgrades or similar sites as achieving that goal. The problem is that these physician ranking websites don’t have the right data to be able to rate physician’s effectively.

The first challenge is that most people don’t use these websites. The closest physician review website that comes close to having a critical mass of reviews is probably Yelp in San Francisco. That might be an interesting case study if we want to evaluate the value of user reviews of doctors. Although, I know people who have been “gaming” that system for a long time. The gaming elements aside for now, is it fair to grade a physician based on a small handful of patient reviews when the doctor is seeing 10-15 patients a day? The answer is no.

Let’s hypothetically say that we overcome the issues of not enough patient reviews. Unfortunately, the reviews still have a huge number of problems associated with them. Let’s take a look at some of the larger ones.

Patients Rate Customer Service, Not Quality of Care
One of the biggest problems with review sites is that most of the ratings and reviews reflect the customer service that a patient was offered. The ratings and reviews almost never reflect the quality of the care that the patient received. The customer service that a patient received does matter and should influence which doctor you see. A physician’s bedside manner should be an important part of the decision of which doctor you see. The problem is that most physician review sites give the impression to users that the ranking is more than just customer service. In fact, I expect many who read those sites equate a high ranking with the quality of care a physician provides. This is just not the case.

Can a Patient Rate a Physician on Quality of Care?
I can’t answer this for all patients, but I know the answer for me is no. I even work in this industry and if I’m being honest I really have very little idea of whether a doctor is providing better care than I would have gotten somewhere else. Other than really egregious stuff, how would I know? The whole reason I go to the doctor is because they know something that I don’t know. Sure, you can find a lot of info online and have some really great, informed discussions with doctors, but I expect most patients don’t know the quality of care they’re getting from a doctor.

Even many doctors and nurses don’t know how good their colleagues are at what they do. They certainly know better than patients, but unless they’ve worked with them on a regular basis across multiple patients how would they really know either? Plus, it’s amazing how little things can bias someone to how good or bad someone is at what they do. This is particularly true when you’re analysis of someone is based on only a few data points.

Positive and Negative Review Bias
One challenge with review sites in general is what I call positive and negative review bias. Take a look at any review site and you’ll see what I mean. The only people who take the time to leave a review are those who are extremely displeased with something (negative review) or those who had an extremely positive experience (positive review). That’s such a small percentage of the people who are seen that we have to be careful to interpret the skewed data.

The reality is that the majority of patients fall in the middle. They didn’t have an amazingly good or bad experience. They just got what they needed and moved on with their life. None of these people are motivated to review a doctor.

Gaming the Review Sites
Another enormous challenge to review sites is from people trying to game the reviews. I once saw the founder of Travel Advisor talk about this challenge on their site (they reviewed hotels) and the enormous amount of resources they put to combat it. They never got this perfect, but they also had enough scale that they could largely overcome this problem. Think about how hard it is for a website to know how authentic a physician review is. How do they know a positive review is not the doctor or practice manager using a fake email account? On the other side, a negative review might be a competitor using a fake email. Plus, there are a lot of other tricks to “game” physician ranking websites that are impossible for a website to detect.

Patient Perspective
Many healthcare visits are complex situations where the doctor has to inform you of something terrible. If your doctor had just told you about your STD diagnoses or just put you through a painful (albeit necessary) procedure, are you likely to go and give that doctor a high rating? In some cases you might, but most people are very emotional people and it’s hard for them to separate the situation from the person. Sometimes the treatments doctors provide might hurt in the short term in order to achieve some long term benefit. A patient suffering in the short term might not include the long term planning that a quality doctor is providing them when reviewing a doctor.

Phyisican’s Dislike Review Sites
Search Health IT recently wrote about an ACPE study where doctors almost universally thought doctor review sites were not useful. Here’s an excerpt from the article:

Only 12% of physicians believe websites where patients can review doctors are useful and should be made more available to patients, according to a study by the American College of Physician Executives (ACPE). A majority of respondents offered critical views of such review sites, with 29% saying they weren’t used enough by patients to be relevant, and 26% called them a “nuisance that provides no benefit.”

One physician explained he doesn’t check his online ratings because: “They don’t accurately reflect the competency of a physician.”

I don’t know anyone who likes to be reviewed, so the results shouldn’t be a surprise. Hopefully this post will help to add some depth to why many doctors don’t like physician review sites as opposed to the natural knee jerk reaction of not wanting to be reviewed.

The interesting challenge is that patients are going to continuing to look for ways to differentiate one doctor from another. It’s an incredible challenge. I love what Fred Trotter is doing with docGraph. It’s not a perfect model either, but at least he’s using data to try and differentiate doctors. I’d love to hear other ideas people have on how a patient can be sure they’re getting the doc that provides the highest quality care. I’ve wondered if use of technology and/or EMR choice/use could be an possible differentiator.