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A Vision for Why and How We Make the Science of Health Care Shareable

Posted on October 30, 2015 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 heard Stan Huff, CMIO at Intermountain, talk at the Healthcare IT Transformation Assembly about the Healthcare Services Platform Consortium. As he presented what they’re working on he highlighted so well the challenges that I’ve been seeing in healthcare IT. I’ve long be asking people how healthcare IT innovations that happen in one hospital or practice are going to get shared with all of healthcare. Turns out, Stan has been thinking a lot about this problem as well.

In his presentation, Stan framed the discussion perfectly when he said, “No matter what you do, you can’t teach people to be perfect information processors.” I’d also mentioned in a previous post that the human mind can’t detect the difference between something that causes errors 3 in 100 versus 4 in 100. However, with the right data, computers can tell the difference. Plus, computers can assist humans in the information processing.

These points illustrate why building and sharing clinical decision support is so important. The human mind is incredible, but medicine is so complex it’s impossible for the human mind to process it all. Ideally all of the work that Stan Huff and his team at Intermountain are doing on clinical decision support should be “plug n play interoperable” with the rest of the healthcare system. That seems to be the goal of the Healthcare Services Platform Consortium.

Many might wonder why Intermountain would want to share all the work they’ve been doing with the rest of healthcare. Isn’t that their proprietary intellectual property? It’s actually easy to see why. Stan described that Intermountain has implemented or is currently working on ~150 decision support rules or modules. Given their organization’s budget and staff constraints he could see how those 150 could be expanded to 300 or so, but likely not more. That sounds great until you think that there could be 5000+ decision support rules or modules if there was enough time and budget.

The problem is that there was no path for Intermountain to go from 150 to 5000 decision support rules or modules on their own. The only way to get where they need to go is for everyone in healthcare to work together and share their findings and workflows.

Stan and the Healthcare Services Platform Consortium are building the framework for creating and sharing interoperable clinical decision support apps on the back of FHIR and Smart Apps. This diagram illustrates what they have in mind:
HSPC for 2015 Healthcare Transformation Assembly 151026
I think that Stan is spot on in his assessment of what needs to be done to get where we need to go with clinical decision support in health care. However, there are also plenty of reasons for being cautiously optimistic.

As Stan told us at the event, “If everyone says that their workflow is the only way, we won’t get very far.” Then Stan passionately argued for why physician independence allows the opportunity for doctors to take improper care of patients. “If we allow physicians to do whatever they want, we’re allowing them the right to take improper care of patients.”

Obviously Stan isn’t saying that there shouldn’t be rigorous debate about the best treatment. By putting these algorithms out to other organizations he’s actually inviting criticism and discussion of the work they’re doing. Plus, I have no doubt Stan understands where health care is an art and where it’s a science. However, I believe he rightly argues that where the science is clear, proclaiming the art of medicine is a poor excuse for doing something different.

In my mind, the Healthcare Services Platform Consortium should be focused on making the science of health care easily shareable and usable for all of health care regardless of EHR system. That’s a vision we should all get behind.

Increasing Nursing Satisfaction through Technology Helps Improve Patient Care

Posted on October 29, 2015 I Written By

The following is a guest blog post by Karlene Kerfoot, Chief Nursing Officer at API Healthcare.
Karlene Kerfoot - API Healthcare - GE Healthcare
Technology is an undeniable force in the healthcare industry and plays a daily role in a nurse’s life. Nurses are responsible for managing devices and utilizing the electronic health records, among many other things. Whenever patient care requires a nurse, they will interact with advanced technologies. As a result, improving these digital systems to better improve clinicians’ ability to provide care is at the top of mind for most hospitals.

While hospitals and health systems work to implement and improve technologies, it is important to keep in mind how that technology can have larger implications. One consideration is how the innovation impacts your work staff’s satisfaction.

Nurses are the heart of the healthcare team and are the most patient-facing representatives. Research has shown that changes in technology, among other things, may allow for substantial improvements in the use of nurses’ time and the delivery of safe patient care. However, technology that isn’t nurse-friendly can impede the work of the nurse. When hospitals find ways to streamline processes and make things more convenient for nurses to do their jobs, it can lead to increased job satisfaction. Furthermore, nurses who feel empowered in their roles are more effective and report better patient care, which is one of the ultimate goals hospitals set for success.

In addition to how technology helps nurses during their day-to-day jobs, hospitals can also use technology to manage broader job satisfaction when it comes to things like staffing and scheduling. Nurses often face a unique set of challenges when it comes to their schedules, workflow and even things like career development – all of which requires hospitals to rethink how they enable work satisfaction through technology.

For example, because patient needs can be unpredictable, it is often times challenging for hospitals to predict their staffing needs on an hourly or daily basis, especially during spikes around the holidays that pull nurses away from families and personal needs.

If a nurse is consistently working overtime hours, situations like handling too many patients or being assigned to patients outside of their training/expertise can inhibit their ability to advance their careers. In addition, fatigue and stress as a result of nurses working extensive periods of overtime can result in serious and potentially life-threatening medical errors. In fact, the odds of making an error are more than three times higher when nurses work shifts of 13 hours or more.

Newer workforce technology systems for nurses can help to ensure a fair and equitable workload so managers can set up their staff for success, and make changes to schedules by pairing up staffing needs to things like patient acuity or census numbers by the day or hour. These technologies also give nurses the opportunity to take more control over their schedules and avoid the burnout.

The ability to use tools that help with staffing needs supports additional research that shows that nurses who work excessive amounts of overtime, produce lower quality work and their happiness levels decrease, which ultimately impacts the patient satisfaction and hospital’s bottom line.

The value technology has brought to healthcare is growing by leaps and bounds, but at the core of healthcare are the patients and the people who can help them. Technology has infinite ability to help both, and it is important that health systems have access to resources that allow them to make better staffing decisions.

About Dr. Karlene Kerfoot
Dr. Karlene Kerfoot is the Chief Nursing Officer for API Healthcare, a GE Healthcare Company. API Healthcare is a leader in healthcare workforce optimization technology and service. Dr. Kerfoot is widely acknowledged for her work in patient safety, data-driven staffing and scheduling, creating healing environments and healing sanctuaries for staff, pioneering models of shared governance, and achieving excellence in quality outcomes.

Features of the Coming “Care Management System”

Posted on October 28, 2015 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.

Back in May I wrote about the Care Management System being the next big purchase for healthcare in the same trend as PM/HIS, EHR, and now a care management system. The biggest feature of the care management system is that it would have the patient at the center. The more I talk with people, the more I think this vision of a patient centered platform is the future of healthcare.

I was also pleased the Sandeep Puri from Patientriciti is working to build such a platform. In fact, he’s outlined the 5 attributes of a robust Care Management System:

  1. Personalization
  2. Behavior Change
  3. Ease of Use for Providers
  4. HIPAA Compliant
  5. Scalability

He also outlined the 10 capabilities of a Care Management system:

  1. Patient Data Intake
  2. User and Role Management
  3. Targeting Analytics
  4. Program Development
  5. Program Administration
  6. Response Analytics
  7. Survey Analytics and Alerts Management
  8. Rewards Management
  9. Care Manager Dashboard and Workflow Tool
  10. Backward Integration of patient-generated data

I think these lists might complicate things a little bit when trying to communicate what the care management system should accomplish. However, I love that people like Sandeep are thinking deeply about what they’re working to accomplish. Plus, I’m really happy he’s sharing these perspectives with the world so that we can all work to refine them and make healthcare better.

What do you think of the concept of a care management system? How about the way Sandeep has laid it out? What would a patient centered platform look like to you?

Insights from Hospital CIO Panel on Accelerating Value and Innovation at #HCTAssembly

Posted on October 27, 2015 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.


Meaningful use definitely creating a rush to implement EHR which meant really poor planning on what data would be put in the EHR and how it would be put in.


There’s so much low hanging fruit in healthcare, I don’t think we’ll know the answer to this for a while.


These 3 tweets definitely illustrate a theme from these hospital CIOs. We focus too much on the EHR implementation as a one time event and not the ongoing EHR optimization which is 80% of the project (as one CIO defined it).


If we thought EHR was a challenge, the move to value based care is going to be so much harder.


We don’t need to throw more IT at the problem. We can throw all the IT at healthcare that we want, but if we don’t transform care in the process, then we won’t see that much impact on healthcare.


Changing the incentives are a real challenge. Plus, we know how they can go wrong if implemented poorly. However, will we really transform care given the current incentives?


I think all of us can’t wait for this day. I’m not that optimistic that we’ll just wake up to a change. If we do wake up to a change like this I have a feeling it will sneak up on the current healthcare establishment from outside healthcare as we know it today.


This is a great summary of what healthcare IT should help us accomplish.

Will Your Healthcare Analytics Solution Scale?

Posted on October 26, 2015 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 big themes being talked about at the Healthcare IT Transformation Assembly this week and particularly during my Care Performance Transformation roundtable with Midas+ has been around healthcare analytics and the solutions that will help a hospital utilize their data for population health, value based reimbursement, and improved care. This has made for an interesting discussion for me after having attended SAP Teched last week where SAP talked about the need for the right healthcare data solution that can scale to the needs of healthcare.

At both of these events it became very clear that the future of healthcare is being built on the back of healthcare data. The quantity and quality of healthcare data is expanding rapidly. There’s a lot of healthcare data being generated within the 4 walls of every healthcare organization. There’s a lot of healthcare data being generated outside of the healthcare setting. Plus, we’re just barely getting started with all of the data that’s needed for all the -omics (Genomics and Proteomics). Getting a handle on this data and ensuring the data can be trusted is of paramount concern for healthcare leaders.

What seems to be playing out is healthcare organizations are having to choose to invest in both point solutions and larger healthcare analytics solutions. Unfortunately there doesn’t seem to be one catch all solution that will solve all of a healthcare organization’s data transformation needs. None of the current solutions scale across all types of data and solve all of the current healthcare requirements. Although, some could eventually grow into that role.

In today’s discussion in particular, a number of hospital CIOs made clear that they had no choice but to have a variety of care transformation and healthcare analytics solutions. There wasn’t one integrated solution they could purchase and be done. In many ways it reminds me of the early days of PM, HIS, LIS, and EHR purchasing. Most purchased them separately because there wasn’t one integrated solution. However, over time people moved to buying one integrated system across PM, EHR, LIS, etc as the software become integrated and mature. Will we see the same thing happen with our healthcare analytics solutions?

While we’ve seen the move to more integrated healthcare IT solutions, we’re also seeing a move away from that now as well. Every EHR vendor is working on APIs to allow third party companies to integrate new solutions with the EHR. There’s a realization that it would be nice if the EHR could do everything in one nicely integrated solution, but it won’t. It’s a cycle that we see in software. I imagine we’ll see that same cycle with healthcare analytics solutions as well.

The Evolution of Encryption Infographic – Where’s Your Healthcare Organization?

Posted on October 23, 2015 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 taken a while for health care to finally get on board with encryption, but that’s basically become the standard for healthcare. That includes encrypting devices like laptops and servers, but also includes encrypting health care data that’s being sent across the internet. I’ve sometimes called encryption the “get out of jail free” card when your laptop or other device is stolen. If it’s encrypted, then it’s likely not a HIPAA violation. If it’s not encrypted, then you’re likely heading to the HHS wall of shame. Of course, there’s a lot more to HIPAA compliance than just encryption, but it’s a good start.

While health care has come a long way with encryption, we could still improve. This great Evolution of Encryption infographic from DataMotion illustrates how far encryption has come, but also how health care needs to continue to evolve its approach to encryption as well. Looking at the infographic, most of healthcare is in the 1990s-2000s with a few still using 1991 technology. I don’t know many that have ubiquitous encryption (2015), but that’s where we’re headed.
The Evolution of Healthcare Encryption

What’s your organization’s approach to encryption? Where do you fall in this evolution? Where do your vendors fall on the scale?

Hospital CFO Insights from Craneware Summit

Posted on October 22, 2015 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.

Today I had a chance to attend the Craneware Summit in Las Vegas. The Craneware Summit gives me a nice view into what’s happening in the financial world of healthcare. The Summit kicked off today with Todd Nelson speaking about the hospital CFO. Here’s a look at some of the insights he offered:


Todd Nelson is a former hospital CFO that is now a VP at HFMA.


Is this equation too simple?


I don’t think that meaningful use money will go away, but it’s worth considering. Would your organization survive if the rest of the meaningful use money were pulled out from underneath you?


This is often forgotten. It’s “easy” to get the billion dollar EHR implementation budget, but many forget to include the ongoing EHR support and optimization budget. In my experience this is often just bad planning, but in a few cases it’s done deliberately in order to allow the EHR project to go forward. They figure they can always ask for the support and optimization budget later.


This was an interesting comment coming from an accountant and former hospital CFO. He was willing to admit that he doesn’t have the skill or at least the desire to be the actuary for the hospital. However, as we shift to value based reimbursement, hospitals are going to have to become good at actuarial analysis.


Todd Nelson also extended this comment by saying that you can survive a long time even with losses as long as you have the cash. If you’ve worked with a hospital CFO, you’ve probably seen the cash focus first hand. That hasn’t and probably won’t change.


This is great advice as hospital executives evaluate how to approach the changing healthcare reimbursement environment. Hope is not a strategy.

The Healthcare Change Conundrum

Posted on October 21, 2015 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’ll be the first to tell you that there are a lot of changes happening in healthcare. At MGMA, the President said that Healthcare isn’t changing, Healthcare has changed. I agree wholeheartedly that Healthcare has changed, but I’d argue that healthcare is still changing even more. I don’t see a stabilization of things coming in the forseeable future.

What’s ironic is that while so many of the regulations and reimbursement structures are changing in healthcare, so many other parts of healthcare are resistant and even fearful of change. However, that provides what I call the healthcare change conundrum:

There’s definitely a culture of fear when it comes to changing anything that we do in healthcare. In many ways it’s a very appropriate fear and that fear has served us well. The fear can drive us to inspect the drugs and treatments properly before using them and causing more damage than good. We have good reason to be cautious in healthcare.

While caution can be valuable, that caution often paralyzes us from doing anything. As I say in the tweet above, doing nothing has its own consequences. We often don’t think about it that way, but it’s absolutely the case.

My favorite example of the problem of doing nothing is that it prevents you from even thinking 5-10 steps down the road of what will be possible. Many of the population health initiatives and value based care programs would not even be possible to consider in a paper world. How do you run a report of at risk patients in the paper world? You don’t. You couldn’t even think about the idea. Now it’s a simple query to your EHR.

We have to be leery that we’re not causing more harm than good as we change things in healthcare (As I’ve discussed multiple times.). However, we shouldn’t be so paralyzed that we’re not willing to change anything. Doing nothing has its own risk and could stop us from discovering a multitude of future benefits that we couldn’t ever dream possible.

EHR Data Hostage Wouldn’t Exist if EHR Were Truly Interoperable

Posted on October 20, 2015 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 was recently talking with Mario Hyland, Founder and Senior Vice President of AEGIS (or better known on social media as @interopguy), about various healthcare IT certifications and really a follow up discussion to our previous look at achieving continuous healthcare interoperability. Next month I’ll be launching the Healthcare Scene podcast and I’ve invited Mario to join me as a guest. So, more to come on EHR testing in the future.

However, as we were discussing my vision for what would be a “meaningful EHR certification” I suggested that it would be meaningful to doctors if an EHR vendor was certified as able to export all of the EHR data. It would be meaningful to doctors if an EHR vendor’s contract was certified to not hold EHR data hostage if a doctor chooses to go to another EHR. I think many EHR vendors would do it as a way to instill trust in the doctors who choose their EHR (Translation: We’re so certain you’ll love our EHR that we’ve made it possible for you to leave our EHR if you want to leave).

As I recounted this idea and others, Mario Hyland made a great observation: If EHR software were truly interoperable, an EHR vendor couldn’t hold a practice’s EHR data hostage.

Think about the concept. If there was true EHR interoperability, you could just buy a new EHR, connect it to your old EHR, and all the data would be available in the new EHR. We’re not even close to getting there yet, but the concept is right.

One challenge is that in practice, we’re only sharing a small subset of the data in the EHR. Even if we got the entire medical chart interoperable, there’s still a bunch of other data in an EHR that would be beneficial to retain. For example, things like audit logs from the old EHR might come in valuable if an old record comes under scrutiny in some legal case.

I still love the concept. I also think it’s one extra reason why we don’t see EHR vendors running towards interoperability. I only know a few EHR vendors that have enough trust in the EHR software they’ve built that they’d be ok building the functionality for their doctors to leave.

Let Doctors Be Doctors – If Jay Z Sang EHR

Posted on October 19, 2015 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 medical world’s comedy rapper, ZDoggMD is at again with support from athenahealth. ZDoggMD just published a Jay Z parody video he calls EHR State of Mind which also promotes a new website called LetDoctorsBeDoctors.com. The timing of the video is interesting considering my recent blog posts on meaningful use dissatisfaction and one doctor’s dissatisfaction to name a few. I guess this post is a continuation of that theme. Enjoy ZDoggMD’s latest video on EHR and don’t let it hurt too much if it hits a little too close to home: