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CMS Listens to Those Calling for a 90 Day Meaningful Use Reporting Period

Posted on January 29, 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 think that most of us in the industry figured this was just a matter of time, but it’s nice that we were right and CMS is working to modify the requirements and reporting periods for meaningful use. I imagine they heard all the many voices that were calling for a change to meaningful use stage 2 and it’s just taken them this long to work through the government process to make it a reality.

Before I act like this change is already in place, CMS was very specific in the wording of their announcement about their “intent to modify requirements for meaningful use” and their “intent to engage in rulemaking” in order to make these “intended” changes. Basically they’re saying that they can just change the rules. They have to go through the rule making process for these changes to go into effect. That said, I don’t think anyone doubts that this will make it through the rule making process.

Here’s the modifications that they’re proposing:

  1. Shortening the 2015 reporting period to 90 days to address provider concerns about their ability to fully deploy 2014 Edition software
  2. Realigning hospital reporting periods to the calendar year to allow eligible hospitals more time to incorporate 2014 Edition software into their workflows and to better align with other quality programs
  3. Modifying other aspects of the programs to match long-term goals, reduce complexity, and lessen providers’ reporting burden

They also added this interesting clarification and information about the meaningful use stage 3 proposed rule:

To clarify, we are working on multiple tracks right now to realign the program to reflect the progress toward program goals and be responsive to stakeholder input. Today’s announcement that we intend to pursue the changes to meaningful use beginning in 2015 through rulemaking, is separate from the forthcoming Stage 3 proposed rule that is expected to be released by early March. CMS intends to limit the scope of the Stage 3 proposed rule to the requirements and criteria for meaningful use in 2017 and subsequent years.

I think everyone will welcome a dramatic simplification of the meaningful use program. The above 3 changes will be welcome by everyone I know.

In the email announcement for this, they provided an explanation for why they’re doing these changes:

These proposed changes reflect the Department of Health and Human Services’ commitment to creating a health information technology infrastructure that:

  • Elevates patient-centered care
  • Improves health outcomes
  • Supports the providers who care for patients

Personally, I think they saw the writing on the wall and it wasn’t pretty. Many organizations were going to opt out of meaningful use stage 2. These changes were needed and necessary for many organizations to continue participating in meaningful use. They believe meaningful use will elevate patient-centered care, improve health outcomes, and support the providers who care for patients. I’m glad they finally chose to start the rulemaking process to make the changes. I think many that started meaningful use can still benefit from the rest of the incentive money and will be even happier to avoid the penalties.

#HITMC Chat and Health IT Marketing and PR Conference Early Bird Registration Ends

Posted on January 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.

Today we held the first ever #HITMC (Healthcare IT Marketing and PR Community) Twitter chat. The turnout for the chat was amazing and it was so active I don’t think anyone could keep up. That’s pretty amazing for a first time chat. In case you missed it and are interested in health IT marketing and PR, here’s my tweet that links to the transcript:

I’m particularly interested to look back at the answer to question 3 on the chat which talks about the tools that people use to make their lives easier.

Here’s a look at the stats for the first HITMC chat:

All of this tells me that I should have started this twitter chat sooner. It’s amazing how a Twitter chat can really bring a community together. Plus, it always leads to interesting new connections that wouldn’t have happened otherwise. Tomorrow I’ll be participating in another new Twitter chat that’s focused on Health Information Governance. If that topic interests you, be sure to join us on #InfoTalk at Noon ET on January 28th.

We’re also 5 days away from the end of Early Bird Registration for the Health IT Marketing and PR Conference. Register now and save $500 off the registration price. Plus, as a reader of EMR and HIPAA, use the promo code “emrandhipaa” and you’ll save an extra $100. We’ve just started uploaded the speaker profiles for those who will be speaking at the event. It’s going to be a fantastic 2+ days of the best in healthcare IT marketing and PR. I can’t wait!

For those not interested in the above topics. Tomorrow we’ll be back with our regularly scheduled programming.

The Next Generation Tech Kids

Posted on January 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.

Today I had the amazing opportunity to volunteer at my kids school. They make it a big deal for dad’s to volunteer at the school and my kids absolutely adore having their dad at school with them. We have a tradition that I go and spend the day at school with my kids on their birthdays. It’s pretty awesome and I might have even shed a tear or two. (Side Note: Check out my new Daddy Blog for cute pics of my kids)

However, that’s not the point of this post. It turns out today was testing day for a bunch of my kids (I have 3 in elementary school). What was amazing is that all of the test were administered on a computer. Yes, even my 5 year old kindergartner was taking his test on the computer. In fact the teacher told me, “It’s kind of hard because they don’t even really know how to type.”

Whether this is a good idea or not, is a topic for an education blog. However, I’ve written before about the next generation of digital natives and the impact they’ll have on healthcare and EHR. If we look a little further out, my 5 year old won’t even be able to comprehend the idea of a paper chart. It will be so ridiculous to him.

I’m still processing what this will mean to healthcare IT and to society in general. As I think back on the thousands of blog posts I’ve written about adopting EHR, I can think of many that will sound ridiculous even 5-10 years from now. That has me very excited. Not that my content is no longer useful (unless you enjoy Health IT history). I’m excited that a whole sea change is going to happen in how we want technology applied to healthcare.

No doubt, it’s not without some risk. I’ve heard many argue that the next generation doesn’t care about privacy. Personally I’ve seen quite the opposite. The next generation has a very sophisticated approach to privacy. They know when and where to share something based on who and what they want to see it. It’s the older generation that has a problem knowing exactly where something should be shared and where it shouldn’t. That’s not to say that some young kids don’t make mistakes. They do, but most are quite aware of where something is being shared. It’s why so many kids use snapchat.

What do you think of the coming generations of technology savvy people? What benefits will they bring? What challenges will we face? Are you excited, scared, nervous?

Digital Health at CES Wrap Up Video

Posted on January 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.

CES 2015 is now in the headlights. One person I talked to said they thought that the event was missing some of the excitement of previous years. I disagreed with him. I thought it was more exciting than previous years. Although, my excitement comes from the entrepreneurs and the Digital Health space. If you look at the larger CES floor with the massive million dollar booths, it was lacking some luster. Of course, with the size of CES, it’s easy to understand why two people could have very different experiences.

If you’re interested about what else I found at CES, I sat down with Dr. Nick van Terheyden, CMIO at Nuance, to talk about our experiences at CES 2015 and some of the takeaways from what we saw. I think you’ll enjoy this CES 2015 video chat below:

Defining the Legal Health Record, Ensuring Quality Health Data, and Managing a Part-Paper Part-Electronic Record – Healthcare Information Governance

Posted on January 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.

This post is part of Iron Mountain’s Healthcare Information Governance: Big Picture Predictions and Perspectives Series which looks at the key trends impacting Healthcare Information Governance. Be sure to check out all the entries in this series.

Healthcare information governance (IG) has been important ever since doctors started tracking their patients in paper charts. However, over the past few years, adoption of EHR and other healthcare IT systems has exploded and provided a myriad of new opportunities and challenges associated with governance of a healthcare organization’s information.

Three of the most important health information governance challenges are:
1. Defining the legal health record
2. Ensuring quality health data
3. Managing a part-paper, part-electronic record

Defining the Legal Health Record
In the paper chart world, defining the legal health record was much easier. As we’ve shifted to an electronic world, the volume of data that’s stored in these electronic systems is so much greater. This has created a major need to define what your organization considers the legal health record.

The reality is that each organization now has to define its own legal health record based on CMS and accreditation guidelines, but also based on the specifics of their operation (state laws, EHR options, number of health IT systems, etc). The legal health record will only be a subset of the data that’s being stored by an EHR or other IT system and you’ll need to involve a wide group of people from your organization to define the legal health record.

Doing so is going to become increasingly important. Without a clearly defined legal health record, you’re going to produce an inconsistent release of information. This can lead to major liability issues in court cases where you produce inconsistent records, but it’s also important to be consistent when releasing health information to other doctors or even auditors.

One challenge we face in this regard is ensuring that EHR vendors provide a consistent and usable data output. A lot of thought has been put into how data is inputted into the EHR, but not nearly as much effort has been put into the way an EHR outputs that data. This is a major health information governance challenge that needs to be addressed. Similarly, most EHR vendors haven’t put much thought and effort into data retention either. Retention policies are an important part of defining your legal health record, but your policy is subject to the capabilities of the EHR.

Working with your EHR and other healthcare IT vendors to ensure they can produce a consistent legal health record is one strategic imperative that every healthcare organization should have on their list.

Ensuring Quality Health Data
The future of healthcare is very much going to be data driven. Payments to ACO organizations are going to depend on data. The quality of care you provide using Clinical Decision Support (CDS) systems is going to rely on the quality of data being used. Organizations are going to have new liability concerns that revolve around their organization’s data quality. Real time data interoperability is going to become a reality and everyone’s going to see everyone else’s data without a middleman first checking and verifying the quality of the data before it’s sent.

A great health information governance program led by a clinical documentation improvement (CDI) program is going to be a key first step for every organization. Quality data doesn’t happen over night, but requires a concerted effort over time. Organization need to start now if they want to be successful in the coming data driven healthcare world.

Managing a Part-Paper Part-Electronic Record
The health information world is becoming infinitely more complex. Not only do you have new electronic systems that store massive amounts of data, but we’re still required to maintain legacy systems and those old paper charts. Each of these requires time and attention to manage properly.

While we’d all love to just turn off legacy systems and dispose of old paper charts, data retention laws often mean that both of these will be part of every healthcare organization for many years to come. Unfortunately, most health IT project plans don’t account for ongoing management of these old but important data sources. This inattention often results in increased costs and risks associated with these legacy systems and paper charts.

It should be strategically important for every organization to have a sound governance plan for both legacy IT systems and paper charts. Ignorance is not bliss when one of these information sources is breached because your organization had “forgotten” about them.

The future of reimbursement, costs, quality of care, and liability in healthcare are all going to be linked to an organization’s data. Making sure your data governance house is in order is going to be a major component in the success or failure of your organization. A good place to start is defining the legal health record, ensuring quality health data, and managing a part-paper part-electronic record.

Join our Twitter Chat: “Healthcare IG Predictions & Perspectives”

On January 28th at 12:00 pm Eastern, @IronMtnHealth is hosting a Twitter chat using #InfoTalk to further the dialog. If you have been involved in governance-related projects, we’d love to have you join. What IG initiatives have shown success for you? How have you overcome any obstacles? What do you see as the future of IG? Keep the conversation going during our “Healthcare IG Predictions & Perspectives” #InfoTalk at 12pm Eastern on January 28th.

The Value of an Integrated Specialty EHR Approach

Posted on January 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.

As many of you know, I’ve long been an advocate for the specialty specific EHR. There are just tremendous advantages in having an EHR that’s focused only on your specialty. Then, you don’t get things like child growth charts cluttering your EHR when you don’t see any children. Or taken the other way, you have child growth charts that are designed specifically for a pediatrician. This can be applied across pretty much every industry.

The reason that many organizations don’t go with a specialty specific EHR is usually because they’re a large multi specialty organization. These organizations don’t want to have 30 different EHR vendors that they have to support. Therefore, in their RFP they basically exclude specialty specific EHR vendors from their EHR selection process.

I understand from an IT support perspective and EHR implementation perspective how having 30 different EHR implementation would be a major challenge. However, it’s also a challenge to try and get one EHR vendor to work for 30+ specialties as well. Plus, the long term consequence is physician and other EHR user dissatisfaction using an EHR that wasn’t designed for their specialty. The real decision these organizations are making is whether they want to put the burden on the IT staff (ie. supporting multiple EHRs) or whether they want to put the burden on the doctors (ie. using an EHR that doesn’t meet their needs). In large organizations, it seems that they’re making the decision to put the burden on the doctors as opposed to the IT staff. Although, I don’t think many organizations realize that this is the choice they’re making.

Specialty EHR vendor, gMed, recenlty put out a whitepaper which does an analysis and a kind of case study on the differences between a integrated GI practice and a non-integrated GI practice. In this case, they’re talking about an EHR that’s integrated with an ambulatory surgery center and one that’s not. That’s a big deal for a specialty like GI. You can download the free whitepaper to get all the juicy details and differences between an integrated GI practice and one that’s not.

I’ve been seeing more and more doctors starting to talk about their displeasure with their EHR. I think much of that displeasure comes thanks to meaningful use and reimbursement requirements, but I also think that many are suffering under an EHR that really doesn’t understand their specialty. From my experience those EHR vendors that claim to support every specialty, that usually consists of one support rep for that specialty and a few months programming sprint to try and provide something special for that specialty. That’s very different than a whole team of developers and every customer support person at the company devoted to a specialty.

I’m not saying that an EHR can’t do more than one specialty, but doing 5 somewhat related specialties is still very different than trying to do the 40+ medical specialties with one interface. One challenge with the best of breed approach is that there are some specialties which don’t have an EHR that’s focused just on them. In that case, you may have to use the every specialty EHR.

What’s clear to me is that most large multi specialty organizations are choosing the all-in-one EHR systems in their offices. I wonder if force feeding an EHR into a specialty where it doesn’t fit is going to eventually lead to a physician revolt back to specialty specific EHRs. Physician dissatisfaction, liability issues, and improved interoperability could make the best of breed approach much more attractive to even the large organizations. Even if it means they back into a best of breed approach after trying the one-size-fits all approach to EHR.

I’ll be interested to watch this dynamic playing out. Plus, you have the specialty doctors coming together in mega groups in order to combat against this as well. What do you think is going to happen with specialty EHR? Should organizations be doing a best of breed approach or the one-size-fits all EHR? What are the consequences (good and bad) of either direction?

Full Disclosure: gMed is an advertiser on this site.

Never Sell Your EHR Company – According to eCW Founder

Posted on January 16, 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 came across an interesting article in Entrepreneur magazine authored by Girish Navani, CEO and Co-founder of eClinicalWorks. If you read this site, you know doubt are familiar with the quite popular eCW EHR software. In this article Girish gives some interesting insight into the future of eCW as a company:

After grad school, I set out to create my own version of my father’s bridge. After working many odd jobs developing software, I created credit check software for an acquaintance’s business. This made him a lot of money, which prompted me to ask (perhaps naively) for a share of the profit. I had developed a very successful facet of the company – didn’t I deserve it? His response surprised me, but I will never forget it. He said, “If you build something you like, don’t sell it.”

Twenty years later, I still remember my acquaintance’s advice. For that reason, my company, eClinicalWorks is, and always will be, a privately-held company. I have no interest in selling it, regardless of any offer I may get. In addition, we don’t use investor cash or spend money we don’t have.

This is not a philosophy that is unique to eCW. #1 on Epic’s list of principles is “Do not go public.” I imagine that Judy Faulkner (CEO of Epic) has a somewhat similar philosophy to Girish. There are certainly a lot of advantages to not going public and most of them get down to control. I’ll never forget when I heard one of the Marriott children talk about their decision to stay a private company. He said that Marriott would likely be a lot bigger if they had become a public company, but they would have lost a lot of the company culture if they’d chose to do so.

I imagine this is a similar feeling that Epic and eCW share. However, there’s also some accountability that comes with being a public company as well. It’s not easy for an organization to assess the financial well being of a private company. During the golden age of EHR which we just experienced, that hasn’t been an issue for either eCW or Epic. However, as we exit this golden age of EHR that was propped up by $36 billion in government stimulus money, the financial future may be quite different.

As in most things in life, there are pros and cons to staying private or going public. It’s interesting that two of the major EHR players (eCW and Epic) have made it clear that they have no interest in ever going public. We’ll see how that plays out long term.

De-Identification of Data in Healthcare

Posted on January 14, 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 sit down with Khaled El Emam, PhD, CEO and Founder of Privacy Analytics, to talk about healthcare data and the de-identification of that healthcare data. Data is at the center of the future of healthcare IT and so I was interested to hear Khaled’s perspectives on how to manage the privacy and security of that data when you’re working with massive healthcare data sets.

Khaled and I started off the conversation talking about whether healthcare data could indeed be de-identified or not. My favorite Patient Privacy Rights advocate, Deborah C. Peel, MD, has often made the case for why supposedly de-identified healthcare data is not really private or secure since it can be re-identified. So, I posed that question to Khaled and he suggested that Dr. Peel is only telling part of the story when she references stories where healthcare data has been re-identified.

Khaled makes the argument that in all of the cases where healthcare data has been reidentified, it was because those organizations did a poor job of de-identifying the data. He acknowledges that many healthcare organizations don’t do a good job de-identifying healthcare data and so it is a major problem that Dr. Peel should be highlighting. However, just because one organization does a poor job de-identifying data, that doesn’t mean that proper de-identification of healthcare data should be thrown out.

This kind of reminds me of when people ask me if EHR software is secure. My answer is always that EHR software can be more secure than paper charts. However, it depends on how well the EHR vendor and the healthcare organization’s staff have done at implementing security procedures. When it’s done right, an EHR is very secure. When it’s done wrong, and EHR could be very insecure. Khaled is making a similar argument when it comes to de-identified health data.

Khaled did acknowledge that the risks are never going to be 0. However, if you de-identify healthcare data using proper techniques, the risks are small enough that they are similar to the risks we take every day with our healthcare data. I think this is an important point since the reality is that organizations are going to access and use healthcare data. That is not going to stop. I really don’t think there’s any debate on this. Therefore, our focus should be on minimizing the risks associated with this healthcare data sharing. Plus, we should hold organizations accountable for the healthcare data sharing their doing.

Khaled also suggested that one of the challenges the healthcare industry faces with de-identifying healthcare data is that there’s a shortage of skilled professionals who know how to do it properly. I’d suggest that many who are faced with de-identifying data have the right intent, but likely lack the skills needed to ensure that the healthcare data de-identification is done properly. This isn’t a problem that will be solved easily, but should be helped as data security and privacy become more important.

What do you think of de-identification in healthcare? Is the way it’s being done a problem today? I see no end to the use of data in healthcare, and so we really need to make sure we’re de-identifying healthcare data properly.

Funny Patient Engagement Meme

Posted on January 11, 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.

While I hear that diamonds aren’t required, I keep being told they make everything better.

Happy Weekend!

First Truly Gamified Health Sensor

Posted on January 9, 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.

My favorite thing I saw at CES 2015 was the Valedo medical device for lower back health. To me, it shows the start of where I think mHealth needs to and will go as the sensors and apps become more highly developed.

In the current mobile health market, we have an increasingly mature set of sensor options available. They are doing a better and better job of sensing various health data. On the other side of the equation, we have more apps that are trying to gamify our health and wellness. Basically, they’re working to make being healthy and living well into a game that’s fun for everyone to do. One problem is that these two worlds currently don’t meet.

This is what made Valedo so interesting to me. They have an FDA cleared sensor tied together with a literal game app you can use with the sensor. If we look at the evolution of this, Wii Fit certainly was the first to popularize the idea of using sensors to get us healthy. Although, the fitness part always felt like more of a byproduct and clever marketing as opposed to the actual goal of the game designers.

Valedo has taken a different approach. They started with the health result in mind first: lower back pain and have applied a sensor and game to try and solve that problem. How do we know this is true? The Valedo is FDA cleared. Last I checked, the Wii Fit wasn’t FDA cleared.

Here’s a video (a bit dramatized I admit) look at how the Valedo works:

While I’d still like to have a Valedo of my own so I could see it’s actual impact and effectiveness, I think this approach is setting the standard for the type of digital health applications we’ll see in the future. The Valedo is just first of many examples where we’ll see sensors, gaming, and health come together in an amazing way.