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E-Patient Update: Clinicians May Be Developing Strong EMR Preferences

Posted on December 8, 2017 I Written By

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

Not long ago, I wrote about a story from another publication, one which engaged in a bunch of happy talk about how EMR companies were improving their user interfaces. At the time, I expressed a great deal of skepticism about this claim, suggesting that the vendors had misled the reporter into believing that user aspects of EMRs were changing for the better across the industry.

While I stand by my original skepticism to some degree, I have to say that I got a surprise recently when I heard some nurses discussing two major EMR platforms. The one they were using, they said, was awful and awkward to use. Apparently, they missed the other terribly.

Now, at the time I was a patient in the emergency department, so I didn’t have a chance to ask them any questions about their preferences, but I was struck by the conversation because I knew which vendors they were discussing. However, they could have been talking about any enterprise EMR.

Clinicians developing preferences

I don’t mention this exchange to praise one EHR over another. I bring this up merely because this is the first time, having spent a lot of time in medical environments due to chronic illness, that I’d heard any front-line clinician express a preference for one enterprise EMR over the other.

In the early days of widespread EMR adoption, I could scarcely find a clinician who didn’t hate the system they were working with, much less one who truly liked it and wanted to use it. Eventually, I began to find that many clinicians thought the system they worked with was more or less okay, though I rarely found any screaming fans for any system in particular.

Now, I’m arguing that we may be at a new stage in clinician adoption of EMRs. The point I am making is that now, some of the clinicians with whom I’ve had contact showing some enthusiasm about one EMR or another.

No big surprise: Experience breeds preference

The truth is, when you think about it, it’s not surprising that clinicians have finally developed preferences (rather than the lists of EMRs which they truly hate). After all, it’s been going on 10 years since the HITECH Act was passed and the money started to flow into EMR subsidies.

Since then, clinicians have had the opportunity to work with multiple EMR platforms at various facilities, and informally at least, develop a catalog of the strengths and weaknesses. Nurses and doctors know which interfaces they like, whether tech support tends to respond when they have a problem with the particular system, whether any analytics tools they provide are worth using and so on.

Given this fact it’s hardly surprising that they’ve figured out what they like and what they don’t, and which vendors seem to suit those needs. After this much time, why wouldn’t they?

As I see it, this is something of a turning point in the industry, a new moment in which clinical professionals have learned enough to know what they want from an EMR. I don’t know about you, but speaking as an e-patient, I think this is a very good thing. The more empowered clinicians feel, the better the work they will do.

Inspector General Says CMS Made $729 Million In Questionable EHR Incentive Payments

Posted on June 16, 2017 I Written By

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

A new report from the HHS Office of Inspector General has concluded that over a three-year period, CMS made roughly $729.4 million in EHR incentive payments to providers who didn’t comply with program requirements.

To determine whether the incentive program was functioning appropriately, the OIG audited payments made between May 2011 to June 2014.

After sampling payment records for 100 eligible professionals, the agency found 14 EPs, who received payments totaling $291,022, who didn’t meet incentive criteria.  The auditors found that the 14 had either failed to meet bonus criteria or didn’t provide proof that they had.

Then, the OIG used the data to extrapolate how much CMS had spent on invalid payments, which is how it arrived at the $729 million estimate. In other words, given the margin of error across the sampled incentive payments, the OIG assumed that 12% of all incentive payments were in error. (The analysis also concluded that CMS mistakenly paid $2.3 million to EPs switching between Medicare and Medicaid programs.)

Not surprisingly, the OIG has recommended that CMS recover the $291,000 in payments made to the sampled providers. It also suggested that the agency review EP payments issued during the audit period to see what other errors were made. Of course, the ultimate goal is to get back the approximately $729.4 million the agency may have paid out in error.

In addition, the OIG  called on CMS to review a random sample of self-attested documentation from after the audit period, to determine whether additional inappropriate payments were made to EPs.

And to make sure the EPs don’t get payments under both Medicare and Medicaid incentive programs for the same program year, the report urged CMS to conduct edits of the National Level Depository system.

As part of this report, the OIG noted that allowing providers to self-report compliance data leaves the incentive payment program open to fraud, and recommended keeping a closer eye on these reports. CMS seems to have had at least some sympathy for this argument, as it apparently agreed partly or fully with all of the OIG’s suggested actions.

One side effect of the OIG report it brings back attention to the Meaningful Use program, which has been eclipsed by MACRA but still clings to life. Eligible providers can still report either Modified Stage 2 or Stage 3 in 2017, the main difference being you need a full year of data for Stage 2 but only 90 days for Stage 3.

But MACRA does change things, as its performance standards will test providers in new ways. This year, providers have a chance to get situated with either the MIPS or APM track, and those who jump in now are likely to benefit.

Meanwhile, the future of Meaningful Use remains fuzzy. To my knowledge, the agency has no immediate plans to restructure the current incentive program to audit provider reports in depth. In fact, given that providers are more concerned about MACRA these days, I doubt CMS will bother.

That being said, it’s fair to assume that incentive payouts will get a bit more attention going forward. So be prepared to defend your attestation if need be.

eCW (eClinicalWorks) Settles Whistleblower Lawsuit for $155 Million

Posted on May 31, 2017 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 many of my press panels and other discussions at the Healthcare IT Marketing and PR Conference, I’ve argued that there’s very little “Breaking News” when it comes to healthcare IT. Today is an example where this is not true. The news just broke that EHR vendor, eCW (eClinicalWorks), has settled a whistleblower lawsuit against them for $155 million.

The suit was filed by Brendan Delaney, a software technician formerly employed by the New York City Division of Health Care Access and Improvement, by his law firm Phillips & Cohen LLP against eClinicalWorks. eClinicalWworks and three of its founders (Chief Executive Officer Girish Navani, Chief Medical Officer Rajesh Dharampuriya, M.D., and Chief Operating Officer Mahesh Navani) are jointly liable for the payment of $154.92 million. Separately, Developer Jagan Vaithilingam will pay $50,000, and Project Managers Bryan Sequeira, and Robert Lynes will each pay $15,000. As a whistleblower, Delaney stands to receive $30 million of the settlement.

Here’s the summary of the complaints against eCW from the Justice Department’s press release about the settlement:

In its complaint-in-intervention, the government contends that ECW falsely obtained that certification for its EHR software when it concealed from its certifying entity that its software did not comply with the requirements for certification. For example, in order to pass certification testing without meeting the certification criteria for standardized drug codes, the company modified its software by “hardcoding” only the drug codes required for testing. In other words, rather than programming the capability to retrieve any drug code from a complete database, ECW simply typed the 16 codes necessary for certification testing directly into its software. ECW’s software also did not accurately record user actions in an audit log and in certain situations did not reliably record diagnostic imaging orders or perform drug interaction checks. In addition, ECW’s software failed to satisfy data portability requirements intended to permit healthcare providers to transfer patient data from ECW’s software to the software of other vendors. As a result of these and other deficiencies in its software, ECW caused the submission of false claims for federal incentive payments based on the use of ECW’s software.

Most people are writing about how eCW didn’t fully integrate the RxNorm codes, but instead hard coded the 16 codes that the certification process used. That’s embarrassing so it’s not a surprise that so many people are sharing that part of the story. However, I think the bigger part of the violation is probably around the data portability requirements. I bet a lot of EHR vendors are sweating right now as they look at the way they implemented those requirements. Not to mention the EHR audit logs which are poor in many EHR. Plus, the scariest claim is eClinicalWork’s inability to reliably record diagnostic imagine orders or perform drug interaction checks. Those are patient safety issues and exist in many EHR software.

If you want to dig into the weeds like I did, then you can see the government complaint against eClinicalWorks that was filed May 12, 2017 and the final settlement agreement with eClinicalWorks. Even more insightful was looking at the original complaint from Delaney against eClinicalWorks. Comparing the original whistleblower complaint to the government complaint against eClinicalWorks is very interesting. You’ll see that the government didn’t grab on to everything that was originally filed by Delaney. I imagine that’s a standard legal practice to file as many areas as possible and see what the government decides to use. It seems like Phillips & Cohen have represented a number of whistleblowers so I’m sure they were expert at this.

Girish Navani, CEO and Co-Founder or eClinicalWorks, offered this statement about the settlement:

“Today’s settlement recognizes that we have addressed the issues raised, and have taken significant measures to promote compliance and transparency. We are pleased to put this matter behind us and concentrate all of our efforts on our customers and continued innovations to enhance patient care delivery.”

Looking at the bigger picture, I’m certain that every EHR vendor is going through their EHR certification process and looking at all the statements they’ve made to make sure they’re not going to be in a similar situation. Not to mention the anti-kick back laws that were mentioned in the settlement. I’m sure there are other EHR vendors that are in violation of both of these items just as much as eCW.

Former ONC National Coordinator, Farrzad Mostashari seems to agree with me. Farzad tweeted, “Wow!! I hope this changes the attitude of the EHR vendor space more broadly.” Then, he later tweeted, “Let me be plain-spoken. eClinicalWorks is not the only EHR vendor who flouted certification /misled customers
Other vendors better clean up.”

Farzad then nailed it when he tweeted “There are a LOT of doctor’s office staff looking at their EHR today and wondering if there’s $30M worth of false promises hidden there”

I do wonder if Farzad Mostashari feels a little guilty of the role he played in this process since he oversaw such a porous EHR certification process. I’ve been against EHR certification for a long time because I thought it provided so little value to providers. The fact that it can be gamed by 16 codes being hard coded is a perfect example of why EHR Certification is a waste. Although, one could argue that without EHR certification, this suit would have never happened and maybe eClinicalWorks could still be selling the same product today.

I do find this quote from the US Attorney’s Office for the District of Vermont press release a little over the top (which I think is common on these things):

“Electronic health records have the potential to improve the care provided to Medicare and Medicaid beneficiaries, but only if the information is accurate and accessible,” said Special Agent in Charge Phillip Coyne of HHS-OIG. “Those who engage in fraud that undermines the goals of EHR or puts patients at risk can expect a thorough investigation and strong remedial measures such as those in the novel and innovative Corporate Integrity Agreement in this case.”

Another topic I haven’t seen anyone else cover is the impact that this settlement will have on eCW’s customers that used eCW to attest to meaningful use. Technically it shows that eCW wasn’t appropriately certified, so that means that they weren’t using a certified EHR and therefore shouldn’t have been eligible for meaningful use incentives. I asked one friend about this and he suggested that CMS had previously said that it would not hold eligible providers and eligible hospitals responsible for EHRs that calculated the meaningful use measures the wrong way. So, we’ll probably see this same approach with eCW users that got EHR incentive money on what we now know was not appropriately certified.

I was also intrigued by the Corporate Integrity Agreement (CIA) that eClinicalWorks entered into with HHS-OIG. There are a lot of details and oversight that eCW will get from OIG, but it also required eClinicalWorks to “allow customers to obtain updated versions of their software free of charge and to give customers the option to have ECW transfer their data to another EHR software provider without penalties or service charges. [emphasis added]”

Free updates is pretty clear and ironic since not wanting to update all their clients is one possible hypothesis for why they didn’t really push the proper upgrades. Hopefully all eCW users will do it now or they might be facing their own violations for using outdated software that has known clinical issues. However, the kicker in the CIA detail above is that eClinicalWorks has to give customers the option to have eClinicalWorks transfer their data to another EHR without penalty or service charges. I wonder how many will take them up on this requirement and what the details will be. I still wish this was required of all EHR vendors, but that’s a story for another day.

How many EHR vendor marketing groups are putting together their eClinicalWorks Rescue Plan to take in the downtrodden eCW users? I’m not sure these will be as successful as other EHR switching marketing efforts like those we see when an EHR is being shut down.

I’m sorry to say that I think this is likely only the beginning of such lawsuits. In fact, it’s probably already woken up a lot of potential whistle blowers. Hopefully it’s woken up a lot of EHR vendors as well.

The Impact of the 2016 Election on Healthcare IT

Posted on November 9, 2016 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 it’s pretty obvious that the Presidential is on everyone’s mind. While I don’t plan to discuss the details of the election and the specific results, it’s worth thinking about what Donald Trump in the white house will mean for healthcare IT.

Let’s start off with the easy one: Meaningful Use/MACRA. One doctor tweeted me that now that Trump is President, MACRA will be gone. I don’t think that’s further from the truth. In fact, I really can’t imagine any scenario where the EHR Incentive program (Meaningful Use, which still applies to hospitals and Medicaid) and the MACRA program would be gone. I think they’re here to stay and won’t be altered at all by this election.

The biggest reason for this belief is that Trump is going to have so many other things on the agenda. Not the least of which is ACA (Obamacare), which we’ll get to later in this post, but also a whole suite of other things that he’ll make a priority. Why would Trump want to take on a relatively bipartisan thing like healthcare IT, EHR and MACRA? I don’t think he’ll waste a second on the subject.

Plus, even if Trump wanted to go after the MACRA and EHR incentive legislation, I can’t imagine the Senate and House passing something to replace those programs either. Remember that Trump can propose all he wants, but the Senate and House have to pass it too and both of those groups seem to be firmly behind both efforts. Add this to the previous point and why would Trump go after health IT when it’s unlikely to pass and isn’t a strategic goal of his? Short Answer: He won’t.

My opinion: we’re unlikely to see any change to MACRA and other healthcare IT initiatives.

The trickier part to assess is the impact a Trump presidency will have on the Affordable Care Act (ACA or Obamacare). I live in Vegas and I wouldn’t even want to offer odds on what’s going to happen there. The rhetoric out there is to “repeal and replace Obamacare.” What’s not clear to me is if this concept is even practical and possible. There are so many issues with the idea of repealing Obamacare, that I can’t imagine it ever happening. I could see parts of it being repealed, but not the whole thing.

I also think it would be seen as very unfavorable for Trump to roll back things like the pre-existing condition exemption that allows those with pre-existing conditions to get insurance. There are probably a dozen other things like this that would likely be hard to take back without some major backlash and so I think they’ll have to preserve many of these things in whatever they do with Obamacare. Maybe that means a full repeal, but then rolling back in some of the popular pieces of the legislation so they can say they repealed it.

All of this said, I think that Trump will evaluate all options to undermine many of the things that were implemented by Obamacare including the insurance mandate and the insurance exchanges. Most people don’t realize that there’s so much more to Obamacare than just the mandate and exchanges. How he’ll undermine Obamacare and the impact it will have is anybody’s guess. I’m not sure anyone really knows and it’s certainly beyond my political punditry.

Long story short on Obamacare, I have no idea. I know that something’s going to happen because of the strict “Rip and Replace” rhetoric. I just think it’s really hard to predict which parts they’ll be able to rip out at this point and what they’ll replace it with going forward.

No doubt this will keep many in healthcare on edge. Unknowns are always a challenge. While I think the Trump Presidency will likely have a big impact on healthcare, I don’t see it having a big impact for good or bad on healthcare IT. I think the path to healthcare IT is happening and he won’t do anything to really stop it.

Side Note: Check out this interesting lessons learned post by Mr. H at Histalk which talks about the challenge of relying on data. As healthcare enters the world of data in a big way, it’s important to make sure we have a good understanding of what the data really tells us and what it doesn’t.

A Look At Nursing Home Readiness For HIE Participation

Posted on October 12, 2016 I Written By

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

A newly released study suggests that nursing homes have several steps to go through before they are ready to participate in health information exchanges. The study, which appeared in the AHIMA-backed Perspectives in Health Information Management, was designed to help researchers understand the challenges nursing homes faced in health information sharing, as well as what successes they had achieved to date.

As the study write up notes, the U.S. nursing home population is large — nearly 1.7 million residents spread across 15,600 nursing homes as of 2014. But unlike other settings that care for a high volume of patients, nursing homes haven’t been eligible for EMR incentive programs that might have helped them participate in HIEs.

Not surprisingly, this has left the homes at something of a disadvantage, with very few participating in networked health data sharing. And this is a problem in caring for residents adequately, as their care is complex, involving nurses, physicians, physicians’ offices, pharmacists and diagnostic testing services. So understanding what potential these homes have to connect is a worthwhile topic of study. That’s particularly the case given that little is known about HIE implementation and the value of shared patient records across multiple community-based settings, the study notes.

To conduct the study, researchers conducted interviews with 15 nursing home leaders representing 14 homes in the midwestern United States that participated in the Missouri Quality Improvement Initiative (MOQI) national demonstration project.  Studying MOQI participants helped researchers to achieve their goals, as one of the key technology goals of the CMS-backed project is to develop knowledge of HIE implementations across nursing homes and hospital boundaries and determine the value of such systems to users.

The researchers concluded that incorporating HIE technology into existing work processes would boost use and overall adoption. They also found that participation inside and outside of the facility, and providing employees with appropriate training and retraining, as well as getting others to use the HIE, would have a positive effect on health data sharing projects. Meanwhile, getting the HIE operational and putting policies for technology use were challenges on the table for these institutions.

Ultimately, the study concluded that nursing homes considering HIE adoption should look at three areas of concern before getting started.

  • One area was the home’s readiness to adopt technology. Without the right level of readiness to get started, any HIE project is likely to fail, and nursing home-based data exchanges are no exception. This would be particularly important to a project in a niche like this one, which never enjoyed the outside boost to the emergence of the technology culture which hospitals and doctors enjoyed under Meaningful Use.
  • Another area identified by researchers was the availability of technology resources. While the researchers didn’t specify whether they meant access to technology itself or the internal staff or consultants to execute the project, but both seem like important considerations in light of this study.
  • The final area researchers identified as critical for making a success of HIE adoption in nursing homes was the ability to match new clinical workflows to the work already getting done in the homes. This, of course, is important in any setting where leaders are considering major new technology initiatives.

Too often, discussions of health data sharing leave out major sectors of the healthcare economy like this one. It’s good to take a look at what full participation in health data sharing with nursing homes could mean for healthcare.

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.

$15+ Billion of Ongoing Meaningful Use Spending Will Change Nothing

Posted on October 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.

In case you missed it, Jeb Bush put out his healthcare plan and called for termination of the meaningful use program. Here’s that section of his plan:

Promote private sector leadership of health information technology adoption: Lead private sector collaboration, rather than government mandates, to establish national standards for electronic health record features and data interoperability; eliminate government mandates and penalties for health care providers who do not use government-approved electronic health records; protect health information from hackers and cyber attacks; and enable patient ownership of their medical history and records. Individuals should have access to their longitudinal medical records, which will help providers offer more personalized and timely treatments for individuals.

This sounds a lot like my plan to blow up meaningful use and focus on interoperability. I think it’s the right strategy and the more I think about the future of meaningful use, the more I’ve realized that it needs to end (at least in its current form).

I’ve been talking with a lot of people lately and I’ve been asking them this fundamental question: If the government chose not to spend the ~$15 billion of meaningful use money that remains would it change the trajectory of EHR adoption and EHR use at all?

There are a number of ways to look at the answer to this question. First, all of the remaining meaningful use money has basically been spoken for. I can’t think of anything anyone can do to change which companies are going to get the EHR incentive money. Everyone that’s going to get future EHR incentive money has already purchased their EHR and that $15 billion is already more or less committed to the various EHR vendors. Meaningful use has essentially locked practices into their current EHR and that’s not going to change (give or take a few hundred million).

Second, what major benefits will continued participation in meaningful use bring healthcare? This is an important question. If the government’s going to continue spending $15 billion on this program, don’t you think we should be able to trace that spending to specific benefits we’re going to receive? One way to look at this is to consider the benefits we’ve received from the first ~$20 billion (Medicare) (and another $10 billion for Medicaid) spent on meaningful use. We’ve seen adoption of EHRs. That I can’t argue. However, it’s hard for me to argue much benefit beyond it. Looking at the future meaningful use stages, I’m not optimistic of the benefits future meaningful use compliance will bring either. I’d love to hear if you have a different perspective.

I do know hundreds (probably thousands) of doctors who would argue that continuing the meaningful use program will not only not provide us any benefits, but will actually cause harm to health care. They would argue that meaningful use is a tax on their time and it provides no actual value to them or their patients. This is evident when you consider the number of doctors who have chosen not to participate in meaningful use even though they know doing so is going to cause them to incur penalties. Think about that. Many doctors think the cost to participate in meaningful use is more expensive than the guaranteed penalties for non-participation.

Returning back to the government perspective, is it wise for the government to spend another $15 billion on a meaningful use program which will actually do more harm than good?

The one challenge with the idea of discontinuing meaningful use is that it will make some organizations that were planning on the money angry. I get it. If you’re a hospital that just spent a few hundred million dollars on an EHR with the expectation that you’d be getting paid the meaningful use money, meaningful use being terminated would be quite a blow. Same goes for small practices that have invested in an EHR with the hope of EHR incentive money. I’m sympathetic to this challenge.

The solution is simple though. You find another more meaningful (pun intended) way to spend the $15 billion so these organizations can still recoup some of the investment they made in their EHR software. The meaningful way to do this is to pay them for being interoperable. Disregard all the other prescriptive elements of meaningful use and create a much simpler program that’s focused around healthcare organizations sharing data. Incentivize healthcare organizations to do something we all know is the right thing to do but which has no natural incentive. Focus the incentive on the outcome.

Am I optimistic this will happen? No. Unfortunately, I think it would take some legislative action for CMS and ONC to be able to do this. They can’t just do it on their own (I believe). Given the state of affairs in Washington, I can’t imagine congress caring enough about $15 billion here or there. It’s sad to say, because so much more could be done to improve healthcare as we know it if that $15 billion were part of the right incentive program. As it is, if the meaningful use program were cut today or the money is spent, I don’t see either action changing the trajectory of EHR and healthcare IT in a significant way.

Are We Chasing the Carrot or Afraid of the Stick?

Posted on May 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.

The other day SGC asked in my hospital EHR adoption chart post: “If there were no penalties for non-EHR adoption, what would that chart look like?”

For those that are too lazy to click over to that post to see the chart, it basically shows hospital EHR adoption being massively accelerated thanks to the government EHR incentive program. In fact, we’re approaching full adoption of EHR in the hospital space (worth noting is that the ambulatory provider space is lagging far behind that adoption). SGC asks the question about whether that adoption would have occurred without the penalties.

My personal experience is that most organizations appreciate the EHR incentive money and plan that in as part of their budgeting for an EHR, but that they were really much more motivated by the EHR penalties that would accrue if they didn’t adopt an EHR. So, I’d say that people are more afraid of the stick than they are motivated by the carrot.

This is probably more so the case because the penalties are going to exist in perpetuity. I think most hospital organizations believe (and I think rightly so) that the EHR penalties for not using an EHR are not going to stop. In fact, they could get much worse. Not to mention, other payers might start implementing similar penalties for non-EHR use as well.

What’s been your experience? Are the carrot or the stick more motivating to healthcare organizations?

Another related question would be, “If there had been no EHR incentive or penalties, what would the EHR adoption chart look like today?” That’s a topic for another blog post.

Hospital EHR Adoption Chart

Posted on May 15, 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 always love a good chart and this one illustrates what those of us in the industry have know for a while. EHR incentive money absolutely increased EHR adoption in hospitals. I think it also did in ambulatory environments as well, but not quite to the extent of hospitals.

Can we just put the discussion of whether HITECH helped EHR adoption to rest? It increased EHR adoption.

To me that’s not the question that really matters. What really matters is whether the EHR incentive money has incented adoption of the right EHR software. It’s great that we’ve adopted EHR software, but have we just locked ourselves in to the wrong software for the next 5+ years? Or have we implemented a great EHR foundation that will prove to be extremely beneficial to healthcare for decades to come?

I look forward to a deep discussion in the comments.

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.