Dr. James Coffin, VP of Healthcare and Life Sciences at Dell, has a post up on the Dell Healthcare Community site that looks at the stances of the various Republican candidates for the US Presidential nomination. It’s an interesting read if you haven’t been following the republican candidates very much.

What the article doesn’t address is these candidates stance on the HITECH Act. The key here is to realize that the HITECH act isn’t part of the Affordable Care Act which every GOP candidate is saying they will repeal if they become President. So, where does that really leave the HITECH Act should a republican president be elected?

The problem is that no one really knows. Those who argue that the HITECH Act is safe often lean on the ideas that EMR and EHR has always had bipartisan support. Many often mention that the push for adoption of EHR software was started by a republican president, George W. Bush. I actually agree that both sides of the aisle want to have widespread adoption of EHR. We could certainly argue the benefits or detriments of EHR adoption, but for a relatively uninformed senate, house and president when it comes to EHR, they’re going to easily grab on to the idea that technology can improve healthcare. We may agree or disagree with this point, but I think we’d be hard pressed to find a senator that thinks we shouldn’t have EHR technology in healthcare.

The problem with the above discussion has to do with the way that EHR is being paid for. Again, this isn’t about whether the idea of paying doctors to use EHR software is right or wrong, good or bad. This is more about the political stance of the republicans and how they want government to spend money. It seems very clear to me that Republicans are going to keep sitting on their no spending/cut spending soap box. If a republican becomes President, we’re likely to see widespread cuts. Could HITECH money be a casualty of those cuts? Absolutely. Will they be a casualty? Can anyone predict what Washington will really do?

Should doctors and practices then be afraid of going after the EHR stimulus money? Well, I’ve been advising doctors and practices for the last couple years to not implement an EHR in order to get the government hand out. Those that are doing EHR for “free” government money are going to be disappointed. Not only because the money could be cut, but because sooner or later that money will be gone. So, if you’ve followed my advice, then the loss of the EHR stimulus money will be unfortunate but not too terrible.

On the other hand, those people who only did EHR because the government was waving the carrot and the stick are likely going to be quite disappointed. Particularly if the practice focused on the governments EHR requirements instead of their own individual practice needs when it comes to an EHR. Sadly, I believe there are many clinics in this boat.

I’m sure there are other Washington DC insider workings that are in play as well. Hopefully many of you will share some of what you know in the comments.

Personally, I’m still fairly confident that the EHR stimulus money will play itself out. I’ll be a little surprised if indeed it does get cut. I think republicans will have larger fish to fry. However, there’s certainly that possibility, so doctors should take this into account when they’re selecting and implementing an EHR.

For those of you that were expecting a meaningful use monday post, I’m sorry. Don’t worry though, Lynn will be back with another Meaningful Use Monday post next week. It is Labor Day after all. Although, I saw a great tweet or Facebook status that said, “Why in America do we take the day off on Labor day?” I love plays on words. They also asked why we put a tree in our house for Christmas and not Arbor day.

I must admit that Labor day has become pretty inconsequential for me. Football has already started. My son’s been in school for a week already. Blogging for myself, it’s not like I really get a day off. Plus, we don’t live close to family, so there aren’t even any big family parties.

With that said, I am glad to have the summer behind us. Maybe that’s a function of living in Las Vegas. I’m beginning to understand why retired people come to Vegas in winter and head to cooler areas for summer. Maybe one day I’ll achieve that dream. Although, I also must admit that there’s something comforting about getting back into the routine of school and other activities. Maybe this is a function of younger kids being home all summer.

I must admit that this Labor Day my thoughts have been with many of those who are without jobs. It’s a crazy economic and political environment that we’re in now. I’m afraid we’re looking at a slow recovery and so we’re going to be in the current situation for a while to come.

My one consolation is that there are now 10 writers on the HealthcareScene.com blog network. That’s pretty good considering a year and a half ago when I quit my day job it was just me. I hope I can continue to grow the network and provide even more people income writing about EMR and Health IT. I’m lucky to be associated with such amazing writers. If you don’t know what I mean, go check out some of the other HealthcareScene.com blogs.

Now, time for a little family time. I hear making a fort with my kids is on the agenda today. I love being a kid again.

Time for my roundup of interesting topics seen throughout the interwebs and related to EHR and healthcare IT.

@Allscripts
Astounding growth in use of EHRs – 5x in 2.5 yrs – Dr. Mostashari at #ACE2011 (via Skype) – does your doc use an EHR?

I’d like to see where Dr. Mostashari got those numbers. I think there’s little doubt that EHR use is up. If we say that 2.5 years ago it was at about 15%, then that would mean that using his growth number we’re now at 75%. That seems way too high for me.

@shelleypetersen – Michelle Petersen
US are starting to standardise vendor requirements for #healthit and language used in #EHR regions, important move

Is this a misread of what’s being done with meaningful use and EHR certification? I haven’t seen standards really emerge for most of this. I guess it does say “starting.”

Hospital EMR User Tracking Bill
Don’t ask me why, but this post about a CA Bill Requiring Hospital EMR Software to Track Users came across my tweet stream as well even though it was posted back in June. I guess that’s one thing I love about Twitter. It can bring back interesting content that you wouldn’t have seen otherwise.

After reading the post, I wondered if the CA bill passed or not. I’m guessing not. Although, I’m still shocked by the article’s comments that even an expensive Epic install at Kaiser can’t meet the requirements of reporting on what data for a patient in an EHR has been deleted and who’s accessed that patient data.

MGMA Conference in Las Vegas
I’ll admit that I’ve wanted to go to the MGMA conference for a couple years now. This year I’m lucky that it’s hosted in the beautiful Las Vegas. So, I’ll definitely be there enjoying the event. I’ve been thinking about doing a New Media Meetup at MGMA like I do at HIMSS. Are any readers interested if I put it together? If there’s only a few of you, we could just do a dinner or something. Let me know in the comments or on my contact us page.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A New York City hospital has apologized for a security lapse that allowed personal information belonging to as many as 6,800 former patients to be published on the Internet.

New York Presbyterian Hospital/Columbia University Medical Center says the information included names, clinical data and a few social security numbers.

The hospital said in a statement that the data had been inadvertently placed on a server, which was accessible online. The information has now been taken down. -Source

This is a pretty sad indiscretion although it is lacking some important details. I hate that it only says personal information for 6800 former patients. Ok, putting ANY health information on an insecure web server is just dumb, but not all health information is created equal. Plus, wouldn’t it be nice to know what happened to cause this issue so that others could learn from their mistakes?

Plus, was the health information placed on the web server in an accessible location or was it just on the web server? That would be very different things.

Still something’s wrong if they’re putting patient information on an unsecured server. Makes me wonder what the rest of the story really is though.

The Physicians’ Reciprocal Insurers (PRI) recently posted the results of a survey they did of 500 physicians regarding Electronic Medical Records (EMR) software and the EMR stimulus money and penalties. Here’s one of their most interesting findings about EMR implementation:

One significant finding was awareness of financial incentives and penalties for implementing EMR systems. While 85 percent of physicians were aware of the financial incentives for implementing the systems, more than 35 percent did not know that they face government-assessed financial penalties for not complying. The penalties are equal to a one percent reduction of the physician’s annual Medicare payments per year up to five percent. However, those penalties do not seem to be having the intended effect, as more than 65 percent of physicians who were unaware of the financial penalties said this would not cause them to implement EMR.

So, most physicians are aware of the financial incentives of implementing an EMR. This was a bit of a surprise for me, but I guess not a HUGE surprise. The more interesting part is the 35% of physicians that didn’t know about the Medicare penalties and that the majority of those people didn’t think that penalties would cause them to implement an EMR.

Does this mean that doctors won’t be implementing EMR? No, I think that we’re going to see a big uptake in EMR adoption over the next two years. One thing the HITECH act and EMR stimulus money has done is increased the awareness of the good and bad of EMR. This increased awareness will be a great thing and will spur EMR adoption.

What this poll shows is that the EMR stimulus is out of touch with what physicians and medical practices think is important. The real driver for EMR adoption won’t be a government handout. The real driver for EMR adoption will be hundreds of doctors implementing EMR software which makes their life easier, increases their reimbursement and solves the physician pain points. EMR vendors that provide these benefits to their users are going to be in a great position going forward since that’s what doctors consider meaningful use.

I got the following question from Brandon about the need to have a domain controlled network in order to comply with HIPAA.

I am currently trying to implement an EMR system in a small practice. I am trying to convince the parties involved that it is necessary to transition to a domain controlled network for security reasons even though this type of network is not required for our EMR system or its server. My understanding of HIPAA is that simply having a firewall does not qualify as a “secured network”. Am I right on this?

Brandon,
You are correct that just having a firewall does not likely qualify as a “secured network.” However, that doesn’t necessarily mean that you need to have a domain controlled network to meet the HIPAA security standards. You could still manually apply the domain security policies on to individual computers and achieve the same level of security.

Of course, the key word in that statement is the word “manually.” If you have less than 10 computers, then this probably isn’t a huge deal and can be done manually. Once you pass 10 computers (or somewhere in that range) you probably want to consider using active directory to manage the security policies on your computers. It’s much easier to apply policies on a large number of computers using active directory. Plus, you can know that the policy was applied consistently across your network.

You also shouldn’t ignore the other benefits of a domain controlled network. I’ve written previously about the benefits of things like shared drives as a nice companion to an EMR. Active Directory makes adding these shared drives trivial. It’s also a nice benefit to have a universal login that’s managed by the domain and can work on every computer in the office.

Plus, if your EMR runs on SQL Server and you buy a nice but inexpensive server with Windows Small Business Server, then you already have the software for active directory. So, it’s really an easy decision to use it. I’ve implemented it at a site with 5 computers and it’s been a great thing to have even if it’s a bit of overkill.

Question: My EMR claims to have all of the capabilities they will need to demonstrate meaningful use and qualify for ARRA incentives. Does that mean I will get the EMR stimulus money?

First of all, you might want to consider another EMR vendor. If they are saying this, then they are trying to mislead you and make more sales. No EMR vendor can claim that they have “all of the capabilities” for you to show meaningful use and qualify for the EMR stimulus money.

Why can I say this? Because the details for Meaningful Use are still not final. We don’t know what you’re going to have to do to show meaningful use and so how can an EMR vendor claim to have all of the capabilities? Short answer is that they can’t. So, go and read their press release again and see if they’re just telling lies or if there was a disclaimer of some sort (ie. according to the interim final rule).

On to the other point of you getting EMR stimulus money. Certainly your EMR will have to be a certified EHR (that’s still not defined either). Your EMR will also have to have the capabilities to show meaningful use. However, at the end of the day, YOU’re the one that’s going to have to see patients and Use the EMR in a way that all of the meaningful use criteria are met. If you do this to the satisfaction of CMS, then you’ll get the stimulus money.

Certainly you can’t meet meaningful use without the EMR vendor. However, the EMR vendor alone can’t qualify you for meaningful use either. It takes 2 to tango. Just remember that it’s much easier to tango when you have a great partner. A lousy partner makes it no fun for anyone.

Check out previous EMR stimulus Questions and Answers.

In one of my many discussions with people at HIMSS 10 we started talking about EHR interoperability standards. The person I was talking to worked as an engineer for a vendor that’s entire work is interoperability of EHR data. As we talked, I made the comment that it seems like CCD has won the battle for EMR interoperability. He gave me a kind of blank stare and said, yeah. Basically his response was like yeah everyone knows that. Almost as if there weren’t any other real EMR interoperability options out there. Well, I guess someone better let Google Health know too.

As I went through the HIMSS showroom floor, I got the same feeling.

The good thing is that I think the people behind CCR are satisfied with this result since CCD is a derivative of sorts from CCR.