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Are Client Server EHR Holding Back Healthcare?

Posted on December 19, 2014 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 number one topic of debate on this blog has definitely been Client Server EHR versus SaaS EHR. There are staunch parties on both sides of this aisle. No doubt both sides have a case to make and we’ll see both in healthcare for a long time to come. Although, I think that long term the SaaS EHR will win out.

As I was thinking about this recently, I realized that while client server EHR can do everything a SaaS EHR can do, it definitely makes a lot of things much harder to accomplish.

It’s much harder to create an API that connects to 2000 client server EHR installs.

It’s much harder to make 2000 client server EHR installs interoperable.

It’s much harder to evaluate data across 2000 client server EHR installs.

I’m sure I could keep going with this list, but you get the point. Even though something is possible, it doesn’t mean that they’re actually going to do it. In fact, if it’s hard to do, then it takes extreme pressure for them to do it.

All of this has me begging the question of whether client server installs are holding back the EHR industry. Up until now, many of the things I mention above haven’t been that important. Going forward I think that all three of the things I mention above are going to be very important.

The good thing is that I see many client server EHR moving to some kind of hosted EHR solution. That solves some of the problems mentioned above. At least if it’s a hosted EHR solution, they can control the environment and more easily implement things like API access and interoperability. That’s much harder in the client server world where if you have 2000 EHR installs, you have 2000 unique setups.

Of course, as soon as a large SaaS EHR has a massive breach, healthcare will go running after the client server EHR. The battle lines are drawn and each side knows each other very well. Although, I think the SaaS EHR have the high ground right now. We’ll see how that continues over time. Client server EHR have done an amazing job battling.

Top 10 Google Searches in 2014 – What Would Be Healthcare IT’s Top Searches?

Posted on December 16, 2014 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.

Each year Google releases it’s top trending searches in the US and the world. This list isn’t the most frequently searched terms (according to Google the most popular searches don’t change) but is a year versus year comparison of what terms were trending in 2014.

US Trending Searches:
Robin Williams
World Cup
Ebola
Malaysia Airlines
Flappy Bird
ALS Ice Bucket Challenge
ISIS
Ferguson
Frozen
Ukraine

Global Trending Searches:
Robin Williams
World Cup
Ebola
Malaysia Airlines
ALS Ice Bucket Challenge
Flappy Bird
Conchita Wurst
ISIS
Frozen
Sochi Olympics

Pretty interesting look into 2014. Also amazing that a mobile app (Flappy Bird) made the list for the first time. There’s two healthcare terms: Ebola and ALS Ice Bucket Challenge. I wondered what this list would look like for healthcare IT. So, I decide to take a guess at what I think would be the trending healthcare IT terms of 2014:

ICD-10 Delay
EHR Penalties
Wearables
Meaningful Use Stage 2
Epic
Obamacare
FHIR
Cerner-Siemens
HIPAA Breaches
Patient Engagement

What do you think of the list? Would you order it differently? Are there terms you think should be on the list?

Last Day for Healthcare.gov Coverage by January 1st

Posted on December 15, 2014 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.

If you’re like me and sometime gave your email to Healthcare.gov, then you’ve probably getting the daily reminders this past week about December 15th being the last day you can sign up on the Health Insurance Exchange if you want to get health insurance coverage starting January 1st. I wish they would have made the email system a little smarter and let us click a button that said “Already got my insurance this year.” Although, I appreciate that they’re just trying to make sure that everyone knows the timelines.

Based on the news coverage (or lack therof), it seems that Healthcare.gov has survived without any major issues this year. One thing that has annoyed me about the emails is they keep telling me how many people’s health insurance is getting subsidized on the exchanges. It seems that about 8 out of 10 people who get insurance from the exchange are getting a government subsidy.

I guess that means I’m in the 20%. Maybe their marketing is working great for those who can get the subsidy. However, it has the opposite impact on someone who does’t get the government subsidy. In fact, my insurance costs have nearly doubled since pre-Obamacare days.

Turns out, that because I wasn’t getting any government subsidies for my insurance, it was better for me to just go direct to the insurance company. That’s what I did and the process was super simple. In fact, I signed up for a plan that included ZDoggMD’s Turntable Health. I’m especially excited to do e-Visits and text message my doctor as needed. Plus, I’m going to have to see about tapping into the free yoga classes and demonstration kitchen. You can sure I’ll be writing more about this in the future.

I found this piece from HIStalk to be quite interesting:

A Kaiser Health News story called “Federal defense contractors find a new profitable business: Obamacare” notes that HHS’s business purchases doubled to $21 billion in the last decade and are rising, making it the #3 contracting agency, beating out NASA, Homeland Security, and the combined spending of Departments of Justice, Transportation, Treasury, and Agriculture.

Sorry if this post was a bit of a rambling rant. I just saw the deadline and needed to get it out of my system. I think the next 5 years we’re going to see a dramatic change in healthcare as we know it. As a blogger, that means I’ll have plenty to write about. As a patient, I have some cause for concern.

NueMD’s Startling HIPAA Compliance Survey Results

Posted on December 12, 2014 I Written By

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

In a recent HIPAA compliance survey of 1,000 medical practices and 150 medical billing companies, NueMD found some really startling results about medical practices’ understanding and compliance with HIPAA. You can see their research methodology here and the full HIPAA Compliance survey results.

This is the most in depth HIPAA survey I’ve ever seen. NueMD and their partners Porter Research and The Daniel Brown Law Group did an amazing job putting together this survey and asking some very important questions. The full results take a while to consume, but here’s some summary findings from the survey:

  • Only 32 percent of medical practices knew the HIPAA audits were taking place
  • 35 percent of respondents said their business had conducted a HIPAA risk analysis
  • 34 percent of owners, managers, and administrators reported they were “very confident” their electronic devices containing PHI were HIPAA compliant
  • 24 percent of owners, managers, and administrators at medical practices reported they’ve evaluated all of their Business Associate Agreements
  • 56 percent of office staff and non-owner care providers at practices said they have received HIPAA training within the last year

The most shocking number for me is that only 35% of respondents had conducted a HIPAA risk analysis. That means that 65% of practices are in violation of HIPAA. Yes, a HIPAA risk analysis isn’t just a requirement for meaningful use, but was and always has been a part of HIPAA as well. Putting the HIPAA risk assessment in meaningful use was just a way for HHS to try and get more medical practices to comply with HIPAA. I can’t imagine what the above number would have been before meaningful use.

These numbers explain why our post yesterday about HIPAA penalties for unpatched and unsupported software is likely just a preview of coming attractions. I wonder how many more penalties it will take for practices to finally start taking the HIPAA risk assessment seriously.

Thanks NueMD for doing this HIPAA survey. I’m sure I’ll be digging through your full survey results as part of future posts. You’ve created a real treasure trove of HIPAA compliance data.

Firewall & Windows XP HIPAA Penalties

Posted on December 11, 2014 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.

Anchorage Community Mental Health Services, Inc, has just been assessed a $150,000 penalty for a HIPAA data breach. The title of the OCR bulletin for the HIPAA settlement is telling: “HIPAA Settlement Underscores the Vulnerability of Unpatched and Unsupported Software.” It seems that OCR wanted to communicate clearly that unpatched and unsupported software is a HIPAA violation.

If you’re a regular reader of EMR and HIPAA, then you might remember that we warned you that continued use of Windows XP would be a HIPAA violation since Windows stopped providing updates to it on April 8, 2014. Thankfully, it was one of our most read posts with ~35,000 people viewing it. However, I’m sure many others missed the post or didn’t listen. The above example is proof that using unsupported software will result in a HIPAA violation.

Mike Semel has a great post up about this ruling and he also points out that Microsoft Office 2003 and Microsft Exchange Server 2003 should also be on the list of unsupported software alongside Windows XP. He also noted that Windows Server 2003 will stop being supported on July 14, 2015.

Along with unsuppported and unpatched software, Mike Semel offers some great advice for Firewalls and HIPAA:

A firewall connects your network to the Internet and has features to prevent threats such as unauthorized network intrusions (hacking) and malware from breaching patient information. When you subscribe to an Internet service they often will provide a router to connect you to their service. These devices typically are not firewalls and do not have the security features and update subscriptions necessary to protect your network from sophisticated and ever-changing threats.

You won’t find the word ‘firewall’ anywhere in HIPAA, but the $ 150,000 Anchorage Community Mental Health Services HIPAA penalty and a $ 400,000 penalty at Idaho State University have referred to the lack of network firewall protection.

Anyone who has to protect health information should replace their routers with business-class firewalls that offer intrusion prevention and other security features. It is also wise to work with an IT vendor who can monitor your firewalls to ensure they continue to protect you against expensive and embarrassing data breaches.

Be sure to read Mike Semel’s full article for other great insights on this settlement and what it means.

As Mike aptly points out, many organizations don’t want to incur the cost of updating Windows XP or implementing a firewall. It turns out, it’s much cheaper to do these upgrades than to pay the HIPAA fines for non-compliance. Let alone the hit to your reputation.

“From the Heart” Documentary by Health Catalyst

Posted on December 10, 2014 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.

Health Catalyst recently showed a short healthcare documentary at their analytics conference. The documentary is called “From the Heart” and really does show some interesting work being done by a cardiologist in India and an organization in the Cayman Islands. The video is really well done and definitely provides some interesting perspectives on healthcare as we know it. You can watch the full video below.

Personally, I think it’s going to take some massive changes like some of the things they describe (ie. cheap, but high quality care) in order to change healthcare as we know it. I’m still chewing on the comment by the cardiologist about commoditizing healthcare. Many don’t even want to have that discussion. So, I’m really glad he’s raising it.

Insightful Tweets from #RSNA14

Posted on December 3, 2014 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.

If you’re not following @RasuShrestha, you’re missing out on some really good tweets. He’s sent a number of insightful tweets from RSNA that I thought were worth sharing..


I like the rhetoric of his statement, but I’d like to see more action too.


It’s interesting that they’re fans of consumerism. I know that many in healthcare don’t like to think of patients as consumers. They have good reasons for not wanting the comparison and it’s worthwhile to consider the difference. Plus, it’s worth noting that in our current system patients don’t really act like consumers. That’s why I think it’s true that consumerism is hitting healthcare.


I love plays on words. I’m going to have to chew on this one a bit more though.


Click on this image to blow it up. It definitely illustrates how important the EHR is, but also that the other health IT systems are important as well.


This is my favorite tweet. I saved it for the end so only the most faithful readers would get to see it. I’m not an expert on radiology, but this provides an interesting roadmap for some of the things that happening in radiology.

The Healthcare “Business” and Interoperability

Posted on December 2, 2014 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.

Last month I started what I think is a really important conversation about interoperability. I asked the question, “Do Hospitals Want Interoperability?” Go ahead and read the article. We’ll be here when you get back.

In response to that article and that question, Thomas Lukasik offered the following commentary on a LinkedIn thread:

Imagine one car dealer asking another car dealer to send them all of the information that they have on a customer of theirs so that they can do a better job of selling them a car. Healthcare is a business just like a car dealership, and patients are their customers, so expecting healthcare providers to support a level of health information exchange (a/k/a Interoperability) that would enable another healthcare provider to take business away from them is naive to say the least. Competition is a reality for modern hospitals.. you’ve seen the billboards. They’re more comfortable with the old school business model. Interoperabilty is a double edged sword for them.

I think that most hospitals would agree with this view, but they’ll likely only share it behind closed doors. The hospitals understand the benefits to healthcare of sharing their data with each other, but as a business it doesn’t make sense. As I mention in the article, I’m hopeful that things like value based reimbursement and ACOs can help shift that model where it does make business sense for a hospital to share their data. In fact, I think we’re heading to a day where if you don’t share data you’ll be at a disadvantage.

While we’re heading in that direction, it’s hard to face the stark reality of what Thomas says. Healthcare is still a business and healthcare leaders salaries and bonuses are based on successfully running the business. If we want to have interoperability, we have to change the incentives so that they match that goal.

Five Reasons to be Thankful for ICD-10

Posted on November 30, 2014 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 blog post by Wendy Coplan-Gould, RHIA, Founder and President of HRS Coding.

It’s Thanksgiving weekend—a time for reflection and gratitude. Thoughts typically turn to family, friends, health, and life’s many other blessings. In addition to all of these, this Thanksgiving I suggest that the healthcare industry also include ICD-10 in our list of godsends. Here are five reasons why:

Reason #1:  To Code New Diagnosis, Procedures and Devices

The current ICD-9 coding nomenclature was developed in the 1970s. The healthcare industry can’t afford for this same system to be capturing data in the 21st century. We need the ability to specifically code new diseases, procedures and devices. For example, U.S. healthcare providers are unable to precisely code Ebola in ICD-9. That’s true.

There is no specific code for the diagnosis of Ebola in ICD-9, only a general code 078.89, other specific diseases due to viruses. In ICD-10, the code is A98.4, Ebola virus disease. This is the kind of data specificity that our nation needs and ICD-10 delivers.

Reason #2: To Help Keep Patients Safe through Better Data

ICD-10 also helps the healthcare industry capture and track data, and use it to ensure the safety of our patients. The inability to have specific data at our fingertips can be crippling to an institution and result in erroneous decisions based on faulty or imprecise data. Be thankful for ICD-10’s ability to accurately pinpoint diagnoses—and support more precise, exact patient care.

Reason #3: To Reduce Costs

Hospitals are strapped for money. Costs must be reduced whenever and wherever possible. ICD-10 will help hospitals properly bill for the services they deliver. With ICD-10 fully implemented and clinical documentation more granular, hospitals will experience fewer payer denials, claims audits and reimbursement appeals. Valuable time, money and resources will be saved over the long run.

Physician practices also have reason for thanks. New data published on the Journal of AHIMA website earlier this month suggests that the estimated costs, time and resources for offices to convert are “dramatically lower” than original estimates. According to the article, the actual conversion cost for a small practice ranges from $1,900 to $5,900, which is 92 to 94 percent less than initially predicted, resulting in a faster return on investment for your ICD-10 efforts.

Reason #4: To Improve Quality Scores and Performance Rankings

Setting aside zany codes and implementation barriers, ICD-10 is a blessing for quality reporting and performance scorecards. ICD-10’s code granularity works hand in hand with improved clinical documentation across all disciplines to help organizations achieve more accurate quality scores and competitive rankings. This is good news for hospitals and physicians alike.

For example, in ICD-9-CM, there is only one code (427.31) for atrial fibrillation.  In ICD-10-CM, physicians must specify the atrial fibrillation as paroxysmal (I48.0), persistent (I48.1) or chronic (I48.2), providing the specificity for a secondary diagnosis that can affect severity of illness scores and impact quality measures.

Reason #5: To Strengthen Hospital-Physician Relationships

ICD-10 is a bull’s-eye for governmental delay. And physician groups are usually the archers behind Congressional action against ICD-10. As recently as this week, physicians were pushing legislators to delay ICD-10 yet again. However, the tide may be turning.

In an effort to help their laggard physicians, many hospitals are reaching out to assist practices and groups in four key areas:

  • ICD-10 assessments
  • clinical documentation reviews
  • technology upgrades
  • physician-coder education

Helping physician practices with ICD-10 is an olive branch that must be extended to realize the full potential of ICD-10. Savvy organizations are using ICD-10 as a pathway to better hospital-physician relationships. Finally, AHIMA, MGMA and AMA have offered resources specifically designed to clear up common misconceptions and concerns physicians have about ICD-10.

No More Delays

It is estimated that the last delay cost the healthcare industry approximately $6.8 billion in lost investments, not including the cost associated with missed opportunities for better health data to improve quality of care and patient safety as mentioned above. Everyone from CMS to AHA, AMA, MGMA and HIMSS has endorsed the move to ICD-10 on October 1, 2015.

The rallying cry from hospital executives, IT directors and clinical coders is clear—no more delays! Even payers are pushing for the October 2015 date with a new consortium featuring Blue Cross Blue Shield of Michigan and Humana leading the charge. As Dennis Winkler from Blue Cross Blue Shield of Michigan states, “ICD-10 is good for the industry. . . . It is in everyone’s best interest to work together and ensure readiness across the board.”

Be Thankful

In Mitch Albom’s 2009 New York Times best seller, Have a Little Faith, the author asks an 82-year-old rabbi to identify his secret to happiness. “Be grateful” is what the rabbi repeatedly claims to be the only true route to happiness.

So next time your executives, staff or physicians are complaining about the transition to ICD-10, remember the five reasons described above . . . and be thankful.

About Wendy Coplan-Gould
Wendy Coplan-Gould is the embodiment of HRS. She has led the HIM consulting and outsourcing company since 1979, through up and down economies and every significant regulatory twist and turn of the last three decades. Long-time clients and new clients alike are on a first-name basis with her and benefit from her focus on excellence, reliability and flexibility. She has been published in the Journal of AHIMA and other recognized publications, as well as conducted countless professional association presentations.

Prior to starting HRS, Wendy served as assistant director, then director, of Health Information Management at Baltimore City Hospital. She also was associate director of the Maryland Resource Center, which provided data for Maryland’s Health Services Cost Review Commission, an early adopter of the Diagnosis Related Group (DRG) methodology. Wendy is available via email: wendy@hrscoding.com.

6 Thanksgiving ICD-10 Codes

Posted on November 27, 2014 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 thought it fitting that AdvancedMD sent me 6 ICD-10 codes to be thankful for. Healthcare Humor…who doesn’t enjoy that? Happy Thanksgiving!

Y93.G3 Activity, Cooking and Baking
Ah, the turkey is roasting and the potatoes are boiling. And Cousin Carl just chopped the end of his finger off while preparing the veggie tray. He will earn this ICD-10 code, along with W26.0, Contact with Knife, to forever remember this year’s Thanksgiving…and that nasty scar.

W61.42 Struck by Turkey / W71.43 Pecked by Turkey / W61.49 Other Contact with Turkey
Thanksgiving isn’t Thanksgiving without a turkey. If three is a terrible mishandling of dinner’s main dish, or if a still-flapping gobbler enacts revenge, ICD-10 has three codes that are perfect for the season’s avian-related incident.

W21.01 Struck by Football
Another Thanksgiving staple is the good ol’ American sport of football. Usually, unless there is cheering for opposing teams, televised football games are safe enough. But a well-intentioned family flag-football game can result in a quick trip to the emergency room.

R63.2 Polyphagia (Overeating)
Parrots aren’t the only ones to watch out for this season. If a vampire or zombie takes their costume a bit too seriously, this code will record the chomp.

Y04.0 Assault by Unarmed Brawl or Fight
Black Friday shopping has become just as much a part of Thanksgiving as stuffing and pumpkin pie. But this mass hysteria for great deals doesn’t come without risks—especially when there are two shoppers and only one great bargain up for grabs. Get your extreme shopping skills up to snuff or Y04.0 and Y92.59, Other trade areas (mall) as the place of occurrence of external cause, may be jotted in your electronic health records.

W21.01 Lack of Adequate Sleep
No matter how we choose to celebrate Thanksgiving, few of us escape the meal prep, early morning shopping and family togetherness without a mild case of exhaustion. For those who try to do it all, there is an ICD-10 code for that.

Now I’m off to recover from my W21.01 and R63.2. Although, let me tell you, I had one of my best Turkey Bowl days ever. So much fun! Happy Thanksgiving everyone.