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Has Electronic Health Record Replacement Failed?

Posted on June 23, 2016 I Written By

The following is a guest blog post by Justin Campbell, Vice President, Galen Healthcare.
Justin Campbell
A recent Black Book survey of hospital executives and IT employees who have replaced their Electronic Health Record system in the past three years paints a grim picture. Respondents report higher than expected costs, layoffs, declining revenues, disenfranchised clinicians and serious misgivings about the benefits of switching systems. Specifically:

  • 14% of all hospitals that replaced their original EHR since 2011 were losing inpatient revenue at a pace that wouldn’t support the total cost of their replacement EHR
  • 87% of hospitals facing financial challenges now regret the decision to change systems
  • 63% of executive level respondents admitted they feared losing their jobs as a result of the EHR replacement process
  • 66% of system users believe that interoperability and patient data exchange functionality have declined

Surely, this was not the outcome expected when hospitals rushed to replace paper records in response to Congressional incentives (and penalties) included in the 2009 American Recovery and Reinvestment Act.

But the disappointment reflected in this survey only sheds light on part of the story. The majority of hospitals depicted here were already in financial difficulty. It is understandable that they felt impelled to make a significant change and to do so as quickly as possible. But installing an electronic record system, or replacing one that is antiquated, requires much more than a decision to do so. We should not be surprised that a complex undertaking like this would be burdened by complicated and confusing challenges, chief among which turned out to be “usability” and acceptance.

Another Black Book report, this one from 2013, revealed:

  • 66% of doctors using EHR systems did not do so willingly
  • 87% of those unwilling to use the system claimed usability as their primary complaint
  • 84% of physician groups chose their EHR to reach meaningful use incentives
  • 92% of practices described their EHR as “clunky” and/or difficult to use

None of this should surprise us but we need to ask: was usability really the key driver for EHR replacement? Is usability alone accountable for lost revenue, employment anxiety and buyers’ remorse? Surely organizations would not have dumped millions into failed EHR implementations only to rip-and-replace them due to usability problems and provider dissatisfaction. Indeed, despite the persistence of functional obstacles such as outdated technology, hospitals continue to make new EMR purchases. Maybe the “reason for the rip-and-replace approach by some hospitals is to reach interoperability between inpatient and outpatient data,” wrote Dr. Donald Voltz, MD in EMR and EHR.

Interoperability is linked to another one of the main drivers of EHR replacement: the mission to support value-based care, that is, to improve the delivery of care by streamlining operations and facilitating the exchange of health information between a hospital’s own providers and the caregivers at other hospitals or health facilities. This can be almost impossible to achieve if hospitals have legacy systems that include multiple and non-communicative EHRs.

As explained by Chief Nurse Executive Gail Carlson, in an article for Modern Healthcare, “Interoperability between EHRs has become crucial for their successful integration of operations – and sometimes requires dumping legacy systems that can’t talk to each other.

Many hospitals have numerous ancillary services, each with their own programs. The EHRs are often “best of breed.” That means they employ highly specialized software that provides excellent service in specific areas such as emergency departments, obstetrics or lab work. But communication between these departments is compromised because they display data differently.

In order to judge EHR replacement outcomes objectively, one needs to not just examine the near-term financials and sentiment (admittedly, replacement causes disruption and is not easy), but to also take a holistic view of the impact to the system’s portfolio by way of simplification and future positioning for value-based care. The majority of the negative sentiment and disappointing outcomes may actually stem from the migration and new system implementation process in and of itself. Many groups likely underestimated the scope of the undertaking and compromised new system adoption through a lackluster migration.

Not everyone plunged into the replacement frenzy. Some pursued a solution such as dBMotion to foster care for patients via intercommunications across all care venues. In fact, Allscripts acquired dBMotion to solve for interoperability between its inpatient solution (Eclipsys SCM) and its outpatient EMR offering (Touchworks). dBMotion provides a solution for those organizations with different inpatient and outpatient vendors, offering semantic interoperability, vocabulary management, EMPI and ultimately facilitating a true community-based record.

Yet others chose to optimize what they had, driven by financial constraints. There is a thin line separating EHR replacement from EHR optimization. This is especially true for those HCOs that are neither large enough nor sufficiently funded to be able to afford a replacement; they are instead forced to squeeze out the most value they can from their current investment.

The optimization path is much more pronounced with MEDITECH clients, where a large percentage of their base remains on the legacy MAGIC and C/S platforms.

Denni McColm, a hospital CIO, told healthsystemCIO why many MEDITECH clients are watching and waiting before they commit to a more advanced platform:

“We’re on MEDITECH’s Client/Server version, which is not their older version and not their newest version, and we have it implemented really everywhere that MEDITECH serves. So we have the hospital systems, home care, long-term care, emergency services, surgical center — all the way across the continuum. We plan to go to their latest version sometime in the next few years to get the ambulatory interface for the providers. It should be very efficient — reduced clicks, it’s mobile friendly, and our docs are anxious to move to it,” but we’ll decide when the time is right, she says.

What can we discern from these different approaches and studies?  It’s too early to be sure of the final score. One thing is certain though: the migrations and archival underpinnings of system replacement are essential. They allow the replacement to deliver on the promise of improved usability, enhanced interoperability and take us closer to the goal of value-based care.

About Justin Campbell
Justin is Vice President, Strategy, at Galen Healthcare Solutions. He is responsible for market intelligence, segmentation, business and market development and competitive strategy. Justin has been consulting in Health IT for over 10 years, guiding clients in the implementation, integration and optimization of clinical systems. He has been on the front lines of system replacement and data migration and is passionate about advancing interoperability in healthcare and harnessing analytical insights to realize improvements in patient care. Justin can be found on Twitter at @TJustinCampbell

AMA’s Digital Health ‘Snake Oil’ Claim Creates Needless Conflict

Posted on June 22, 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.

Earlier this month, the head of the American Medical Association issued a challenge which should resonate for years to come. At this year’s annual meeting, Dr. James Madara argued that many direct-to-consumer digital health products, apps and even EMRs were “the digital snake oil of the early 21st century,” and that doctors will need to serve as gatekeepers to the industry.

His comments, which have been controversial, weren’t quite as immoderate as some critics have suggested. He argued that some digital health tools were “potentially magnificent,” and called on doctors to separate useful products from “so-called advancements that don’t have an appropriate evidence base, or that just don’t work that well – or that actually impede care, confuse patients, and waste our time.”

It certainly makes sense to sort the digital wheat from the chaff. After all, as of late last year there were more than 165,000 mobile health apps on the market, more than double that available in 2013, according to a study by IMS Institute for Healthcare Informatics. And despite the increasing proliferation of wearable health trackers, there is little research available to suggest that they offer concrete health benefits or promote sustainable behavior change.

That being said, the term “snake oil” has a loaded historical meaning, and we should hold Dr. Madara accountable for using it. According to Wikipedia, “snake oil” is an expression associated with products that offer questionable or unverifiable quality or benefits – which may or may not be fair. But let’s take things a bit further. In the same entry, Wikipedia defines a snake oil salesman “is someone who knowingly sells fraudulent goods or who is themselves a fraud, quack or charlatan.” And that’s a pretty harsh way to describe digital health entrepreneurs.

Ultimately, though, the issue isn’t whether Dr. Madara hurt someone’s feelings. What troubles me about his comments is they create conflict where none needs to exist.

Back in the 1850s, when what can charitably be called “entrepreneurs” were selling useless or toxic elixirs, many were doubtless aware that the products they sold had no benefit or might even harm consumers. And if what I’ve read about that era is true, I doubt they cared.

But today’s digital health entrepreneurs, in contrast, desperately want to get it right. These innovators – and digital health product line leaders within firms like Samsung and Apple – are very open to working with clinicians. In fact, most if not all work directly with both staff doctors and clinicians in community practice, and are always open to getting guidance on how to support the practice of medicine.

So while Dr. Madara’s comments aren’t precisely wrong, they suggest a fear and distrust of technology which doesn’t become any 21st century professional organization.

Think I’m wrong? Well, then why didn’t the AMA leader announce the formation of an investment fund to back the “potentially magnificent” advances he admits exist? If the AMA did that, it would demonstrate that even a 169-year-old organization can adapt and grow. But otherwise, his words suggest that the venerable trade group still holds disappointingly Luddite views better suited for the dustbin of history.

Sansoro Hopes Its Health Record API Will Unite Them All

Posted on June 20, 2016 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

After some seven years of watching the US government push interoperability among health records, and hearing how far we are from achieving it, I assumed that fundamental divergences among electronic health records at different sites posed problems of staggering complexity. I pricked up my ears, therefore, when John Orosco, CTO of Sansoro Health, said that they could get EHRs to expose real-time web services in a few hours, or at most a couple days.

What does Sansoro do? Its goal, like the FHIR standard, is to give health care providers and third-party developers a single go-to API where they can run their apps on any supported EHR. Done right, this service cuts down development costs and saves the developers from having to distribute a different version of their app for different customers. Note that the SMART project tries to achieve a similar goal by providing an API layer on top of EHRs for producing user interfaces, whereas Sansoro offers an API at a lower level on particular data items, like FHIR.

Sansoro was formed in the summer of 2014. Researching EHRs, its founders recognized that even though the vendors differed in many superficial ways (including the purportedly standard CCDs they create), all EHRs dealt at bottom with the same fields. Diagnoses, lab orders, allergies, medications, etc. are the same throughout the industry, so familiar items turn up under the varying semantics.

FHIR was just starting at that time, and is still maturing. Therefore, while planning to support FHIR as it becomes ready, Sansoro designed their own data model and API to meet industry’s needs right now. They are gradually adding FHIR interfaces that they consider mature to their Emissary application.

Sansoro aimed first at the acute care market, and is expanding to support ambulatory EHR platforms. At the beginning, based on market share, Sansoro chose to focus on the Cerner and Epic EHRs, both of which offer limited web services modules to their customers. Then, listening to customer needs, Sansoro added MEDITECH and Allscripts; it will continue to follow customer priorities.

Although Orosco acknowledged that EHR vendors are already moving toward interoperability, their services are currently limited and focus on their own platforms. For various reasons, they may implement the FHIR specification differently. (Health IT experts hope that Argonaut project will ensure semantic interoperability for at least the most common FHIR items.) Sansoro, in contrast can expose any field in the EHR using its APIs, thus serving the health care community’s immediate needs in an EHR-agnostic manner. Emissary may prevent the field from ending up again the way the CCD has fared, where each vendor can implement a different API and claim to be compliant.

This kind of fragmented interface is a constant risk in markets in which proprietary companies are rapidly entering an competing. There is also a risk, therefore, that many competitors will enter the API market as Sansoro has done, reproducing the minor and annoying differences between EHR vendors at a higher level.

But Orosco reminded me that Google, Facebook, and Microsoft all have competing APIs for messaging, identity management, and other services. The benefits of competition, even when people have to use different interfaces, drives a field forward, and the same can happen in healthcare. Two directions face us: to allow rapid entry of multiple vendors and learn from experience, or to spend a long time trying to develop a robust standard in an open manner for all to use. Luckily, given Sansoro and FHIR, we have both options.

The 4 Learning Metrics Linked to Successful EHR Adoption – Breakaway Thinking

Posted on June 16, 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.

The following is a guest blog post by Shawn Mazur, Instructional Writer at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Shawn Mazur - The Breakaway Group
There seems to be a trend in the education processes of a go-live for large EHR implementations: they’re scary. For large hospitals, the task of providing learning to hundreds, if not thousands, of employees for a go-live is daunting, and no matter how much time and resources you pour into designing the perfect curriculum and planning out a detailed schedule, you may quickly end up feeling like your learning effort is falling short. Learning metrics can play a vital role in making the task of creating and managing learning for a big go-live a little less scary.

Despite high levels of EHR implementations since the HITECH Act, many organizations still have significant go-live events in their future. A majority of learners are at least somewhat familiar with EHR systems, so education needs to be focused on making learners comfortable with a new, or advanced, EHR rather than teaching all there is to know about the systems. Since 2014, the number of buyers replacing existing EHR software has increased 59%, according to a 2015 EHR BuyerView report. It was also reported that challenges facing an organization were not overcome by the implementation of a new EHR. A lack of education for any go-live event will discount the value behind a new EHR.

Having the perfect plan for EHR education from the beginning is not the only key to successfully preparing your employees for go-live. Additionally, you should implement a plan to monitor the training process, completing learning metrics as you go, and then be flexible in how you carry out the remainder of your learning. So, you decide to be flexible in the information you provide to learners, but when do you know it’s time for a change in direction? Going beyond the summary of what your users should learn if they complete all of their learning, the following four metrics tell you how learners are reacting to the content.

1. Completion Summary
A simple but effective metric that lets you know how much progress your users have made in their learning objectives. This metric is especially important with e-learning and with self-paced learning. Collecting this data will also help you identify problems with different learning roles throughout your organization. Flagler Hospital, a regional hospital, kept completion summary metrics throughout their large switch from Meditech to Allscripts. They reported that their completion metrics began to show users were completing their learning much faster than expected. This data allowed Flagler to actualize their education plan to make remarkable reductions in training schedule, time, and cost from their original plan. Had Flagler’s completion summary shown less than satisfactory numbers, it would have also provided an opportunity for changes to be made. Low completion rates may mean that one role’s users are getting stuck at a certain point of their learning or struggling to even begin. In these cases, use completion metrics to push learning requirements along in time for go-live.

2. Assessment Summary
If your organization isn’t planning on testing users on the education they’ve received, it may be time to consider doing so. Using a step-by-step simulated assessment is the easiest way to put a solid number on how prepared your users are for navigating workflows in the live system. After implementing tests, compile metrics on them at a high level, including how many learners took their test, how many times each user attempted a test, and of course, the percentage of assigned learners who successfully passed their test. Flagler hospital also used assessment metrics alongside their completion summary. As a result, they saw that that their completion summary aligned with their assessment summary. Along with the fast pace at which they were completing learning, Flagler’s learners had average testing scores of 94 percent. The high test scores solidified their decision to make changes to the original learning schedule.

3. Assessment Audits
After implementing step-by-step testing of your user’s knowledge, dig deeper into your testing scores to pinpoint exactly where users are falling short. You will often find that a deficiency in learning curriculum leads to users missing the same steps during their test. For example, let’s say you break down your scores by step and see that over 60 percent of users clicked the incorrect button for documenting current vitals. This is an advantage over less effective traditional testing methods, like multiple choice formats. From this metric, it is clear that you should delegate additional learning resources on best practices for entering vitals before your go-live approaches.

When you test users without using the metrics to facilitate better learning, your learners will feel frustrated with their lack of proficiency. In his book, Why High Tech Products Drive us Crazy, Alan Cooper defines two types of learners. He says, “Learners either feel frustrated and stupid for failing, or giddy with power at overcoming the extreme difficulty. These powerful emotions force people into being either an ‘apologist’ or a ‘survivor.’ They either adopt cognitive friction as a lifestyle, or they go underground and accept it as a necessary evil.” Auditing your tests by step gives you the opportunity to return to your curriculum to elaborate on topics with low testing proficiency. Pinning down topics that require additional learning will eliminate the frustration and feeling of defeat among learners failing their assessments.

4. Knowledge and Confidence Level
Confident learners are a good thing, but not always the best come go-live. It is important that your learners not only have confidence, but also the knowledge to back it up. When knowledge and confidence are not aligned, the user is in a bad place for not only lacking proficiency in the system, but for their education going forward. Users who are pushed to use the live system before they feel confident enough will be far from proficient in the system, and will feel a resentment against the organization moving forward. Equally so, users confident to get in the system but lacking the knowledge to be proficient will also fail, and be quick to blame it on poor learning. In his book, Cooper also says, “Users only care about achieving their goals.” When learners can’t achieve their goals for the learning, they are quick to find a way to reach their goal, defining their own workflows and workarounds instead of sticking to best practices outlined by your organization. Collecting data from your learners, usually through a survey-like format, on how confident they are to start working in the live system and how knowledgeable they feel about the information taught, will help you gauge how ready users are for go-live. When aligning this with your other learning metrics, you will quickly see how ready your users are to proficiently use the live system.

It is often the case that the education plans you spent countless amounts of time and resources on leaves learners feeling distant with the EHR. Think about how you can use metrics to track your learning and be flexible to make changes using those metrics to benefit your learners in the long run.

Xerox is a sponsor of the Breakaway Thinking series of blog posts. The Breakaway Group is a leader in EHR and Health IT training.

A Great Look Into Healthcare Quality Improvement

Posted on June 14, 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.

As I think back on the evolution of EHR software and healthcare IT, it’s been incredible to see how EHR has moved from being something that could help improve your billing to now trying to be something to improve the quality of healthcare that’s being provided. In fact, I’ve long argued that the expectation of EHR was far ahead of the EHR reality. EHRs weren’t designed for quality and so it was a mistake for many to believe that it would improve quality.

While that’s the reality of history, going forward the new EHR reality is that they better figure out how to improve healthcare quality. In fact, the ones that are able to do this are going to be the most successful.

As we shift our focus to healthcare quality, I was intrigued by this video animation by Doc Mike Evans describing healthcare quality. It’s fascinating to look at the history and consider healthcare quality going forward.

What do you think of Doc Mike Evans’ thoughts on Healthcare Quality Improvement? Is he spot on? Is there something he’s missing?

Securing IoT Devices Calls For New Ways Of Doing Business

Posted on June 8, 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.

While new Internet-connected devices can expose healthcare organizations to security threats in much the same way as a desktop PC or laptop, they aren’t always procured, monitored or maintained the same way. This can lead to potentially major ePHI breaches, as one renowned health system recently found out.

According a piece in SearchHealtlhIT, executives at Intermountain Healthcare recently went through something of a panic when connected audiology device went missing. According to Intermountain CISO Karl West, the device had come into the hospital via a different channel than most of the system’s other devices. For that reason, West told the site, his team couldn’t verify what operating system the audiology device had, how it had come into the hospital and what its lifecycle management status was.

Not only did Intermountain lack some key configuration and operating system data on the device, they didn’t know how to prevent the exposure of stored patient information the device had on board. And because the data was persistent over time, the audiology device had information on multiple patients — in fact, every patient that had used the device. When the device was eventually located, was discovered that it held two-and-a-half years worth of stored patient data.

After this incident, West realized that Intermountain needed to improve on how it managed Internet of Things devices. Specifically, the team decided that simply taking inventory of all devices and applications was far from sufficient to protect the security of IoT medical devices.

To prevent such problems from occurring again, West and his team created a data dictionary, designed to let them know where data originates, how it moves and where it resides. The group is also documenting what each IoT device’s transmission capabilities are, West told SearchHealthIT.

A huge vulnerability

Unfortunately, Intermountain isn’t the first and won’t be the last health system to face problems in managing IoT device security. Such devices can be a huge vulnerability, as they are seldom documented and maintained in the same way that traditional network devices are. In fact, this lack of oversight is almost a given when you consider where they come from.

Sure, some connected devices arrive via traditional medical device channels — such as, for example, connected infusion pumps — but a growing number of network-connected devices are coming through consumer channels. For example, though the problem is well understood these days, healthcare organizations continue to grapple with security issues created by staff-owned smart phones and tablets.

The next wave of smart, connected devices may pose even bigger problems. While operating systems running mobile devices are well understood, and can be maintained and secured using enterprise-level processes,  new connected devices are throwing the entire healthcare industry a curveball.  After all, the smart watch a patient brings into your facility doesn’t turn up on your procurement schedule, may use nonstandard software and its operating system and applications may not be patched. And that’s just one example.

Redesigning processes

While there’s no single solution to this rapidly-growing problem, one thing seems to be clear. As the Intermountain example demonstrates, healthcare organizations must redefine their processes for tracking and securing devices in the face of the IoT security threat.

First and foremost, medical device teams and the IT department must come together to create a comprehensive connected device strategy. Both teams need to know what devices are using the network, how and why. And whatever policy is set for managing IoT devices has to embrace everyone. This is no time for a turf war — it’s time to hunker down and manage this serious threat.

Efforts like Intermountain’s may not work for every organization, but the key is to take a step forward. As the number of IoT network nodes grow to a nearly infinite level, healthcare organizations will have to re-think their entire philosophy on how and why networked devices should interact. Otherwise, a catastrophic breach is nearly guaranteed.

FHIR Product Director Speaks Out On FHIR Hype

Posted on June 6, 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.

To date, all signs suggest that the FHIR standard set has tremendous promise, and that FHIR adoption is growing by leaps and bounds. In fact, one well-connected developer I spoke with recently argues that FHIR will be integrated into ONC’s EHR certification standards by 2017, when MACRA demands its much ballyhooed “widespread interoperability.”

However, like any other new technology or standard, FHIR is susceptible to being over-hyped. And when the one suggesting that FHIR fandom is getting out of control is Grahame Grieve, FHIR product director, his arguments definitely deserve a listen.

In a recent blog post, Grieve notes that the Gartner hype cycle predicts that a new technology will keep generating enthusiasm until it hits the peak of inflated expectations. Only after falling into te trough of disillusionment and climbing the slope of enlightenment does it reach the plateau of productivity, the Gartner model suggests.

Now, a guy who’s driving FHIR’s development could be forgiven for sucking up the praise and excitement around the emerging standard and enjoying the moment. Instead, though, it seems that Grieve thinks people are getting ahead of themselves.

To his way of thinking, the rate of hype speech around FHIR continues to expand. As he sees it, people are “[making] wildly inflated claims about what is possible, (wilfully) misunderstanding the limitations of the technology, and evangelizing the technology for all sorts of ill judged applications.”

As Grieve sees it, the biggest cloud of smoke around FHIR is that it will “solve interoperability.” And, he flatly states, it’s not going to do that, and can’t:

FHIR is two things: a technology, and a culture. I’m proud of both of those things…But people who think that [interoperability] will be solved anytime soon don’t understand the constraints we work under…We have severely limited ability to standardise the practice of healthcare or medicine. We just have to accept them as they are. So we can’t provide prescriptive information models. We can’t force vendors or institutions to do things the same way. We can’t force them to share particular kinds of information at particular times. All we can do is describe a common way to do it, if people want to do it.

The reality is that while FHIR works as a means of sharing information out of an EHR, it can’t force different stakeholders (such as departments, vendors or governments) to cooperate successfully on sharing data, he notes. So while the FHIR culture can help get things done, the FHIR standard — like other standards efforts — is just a tool.

To be sure, FHIR seems to have legs, and efforts like the Argonaut Project — which is working to develop a first-generation FHIR-based API and Core Data Services specification — are likely to keep moving full steam ahead.

But as Grieve sees it, it’s important to keep the pace of FHIR work deliberate and keep fundamentals like solid processes and well-tested specifications in mind: “If we can get that right — and it’s a work in process — then the trough of despair won’t be as deep as it might.”

5 Reasons Why Canada Could Be a Hotbed for EHR innovation

Posted on June 4, 2016 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin is a true believer in #HealthIT, social media and empowered patients. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He currently leads the marketing efforts for @PatientPrompt, a Stericycle product. Colin’s Twitter handle is: @Colin_Hung

From June 5th to 8th thousands of Canadian HealthIT professionals, government representatives, hospital leaders and policy consultants will gather for the annual eHealth Conference (#eHealth2016) in Vancouver. This event is like HIMSS, but smaller and focused on Canada.

Full disclosure: I am Canadian, but I spend about 80% of my time focused on US Healthcare. I manage to stay informed about the happenings in my home country through the tweets and posts of people like Glenn Lanteigne @GlennLanteigne, Mark Casselman @markcasselman, Michael Martineau @eHealthMusings, Colleen Young @colleen_young and Pat Rich @pat_health

Ahead of the #eHealth2016 conference Pat Rich sent out this tweet:

This tweet got me thinking about the state of EHRs in my home country. After hours of catching up on the latest Canadian EHR news – a light bulb went off – Canada could be the ideal test bed for new EHR innovations.

Here’s 5 reasons why

Reason 1 – No Meaningful Use, MACRA or MIPS

Like the US, Canada did allocate government dollars to help encourage the adoption of EHRs by physician practices and healthcare institutions. However, the dollars given out to Canadians paled in comparison to the US $34B CMS program. In fact, in some provinces (like Quebec) the incentive payments were so insignificant that many choose not to fill out the paperwork to receive their funding.

As well, none of the incentive programs have attestation requirements similar to the US Meaningful Use criteria. Nor do Canadian programs have penalties for not adopting an EHR.

This combination of relatively low incentive dollars, lack of MU-style adherence programs and zero penalties means that EHR vendors in Canada are relatively free to pursue their own product roadmaps. There is less government and end-user pressure to build functionality simply to meet funding criteria. Instead, EHR vendors can focus more on what end-users really want (better user interfaces anyone?)

Reason 2 – PIPEDA vs HIPAA

Canada does have privacy legislation. It’s called PIPEDA and it places the onus on healthcare organizations to protect the personal identifiable health information of patients. At a high level the protections for health information under PIPEDA is similar to that of the US HIPAA laws.

The biggest difference, however, is in the attitude of healthcare providers towards PIPEDA vs HIPAA. In Canada PIPEDA is not thought of as a barrier to information sharing. Privacy is definitely a concern, but PIPEDA isn’t used as often as an excuse to prevent access to information.

Reason 3 – Single Payer

Each provincial government in Canada is the single payer for healthcare for its citizens. If you live in Ontario and you go to the hospital, the hospital bills the Ontario government for the care you received. There are no other payers involved, no co-pays, nothing.

For EHR vendors this makes payment processing and collection a lot simpler – giving them more time to focus on other areas of EHR functionality.

Reason 4 – Patient Identifiers

A beneficial consequence of the single-payer system is that every person in Canada has a unique patient identifier. Consolidating health information from multiple healthcare organizations is therefore much easier since every lab result, prescription, requisition and image has this unique identifier. It’s Canada’s built-in unique key.

Reason 5 – Sorry, eh.

Canadians by nature are very apologetic. We say “sorry” when people bump into us. We apologize when we feel we are inconveniencing someone else. It’s something in the water.

I’ve personally found Canadian end-users to be very tolerant and understanding of new technologies. It’s not in our nature to complain so things have to go REALLY wrong before we make it an issue. Admittedly I have a small sample size, but when I speak to HealthIT vendors doing business in Canada, I hear similar stories.

Conclusion

In combination, the 5 reasons above create an innovation-friendly environment for EHR vendors. Instead of having product functionality dictated by government legislation and financial incentives, vendors are free to incorporate real end-user feedback into their EHR platforms. They can push the usability envelop in a tolerant environment where privacy isn’t used as a blocker to progress.

Maybe I’m delusional, but I’m really hoping to see signs of EHR innovation at the upcoming #eHealth2016 conference. If you are an EHR vendor that’s doing business in Canada and you are doing something innovative with user experience or functionality I want to hear from you!

Vendors Bring Heart And Lung Sounds To EHR

Posted on June 3, 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.

In what they say is a first, a group of technology vendors has teamed up to add heart and lung sounds to an EMR. The current effort extends only to the drchrono EHR, but if this rollout works, it seems likely that other vendors will follow, as adding multimedia content to patient medical records is a very logical step.

Urgent care provider Direct Urgent Care, a Berkeley, CA-based urgent care provider with 30,000 patients, is rolling out the Eko Core Digital Stethoscope for use by physicians. The heart and lung sounds will be recorded by the digital stethoscope, then transmitted wirelessly to a phone- or tablet-based mobile app. The app, in turn, uploads the audio files to the drchrono HR.

Ordinarily, I’d see this as an early experiment in managing multimedia health data and leave it at that. But two things make it more interesting.

One is that the Eko Core sells for a relatively modest $299, which is not bad for an FDA-cleared device. (Eko also sells an attachment for $199 which digitizes and records sounds captured by traditional analog stethoscopes, as well as streaming those files to the Eko app.) The other is that the recorded sounds can be shared with remote specialists such as cardiologists and pulmonologists, which seems valuable on its face even if the data doesn’t get stored within an EMR.

Not only that, this rollout underscores a problem just been given too little attention. At present, what I’ve seen, few EMRs incorporated anything beyond text. Even radiology images, which have been digital for ages (and managed by sophisticated PACS platforms) typically aren’t accessible to the EMR interface. In fact, my understanding is that PACS data is another silo that needs to be broken down.

Meanwhile, medical practices and hospitals are increasingly generating data that doesn’t fit into the existing EMR template, from sources such as wearables, health apps and video consults. Neither EMR developers nor standards organizations seem to have kept up with the influx of emerging non-text data, so virtually none of it is being integrated into patient records yet.

In other words, not only is it interesting to note that an EMR vendor is incorporating audio into medical records, at a modest cost, it’s worth taking stock of what it can teach us about enriching digital patient records overall.

Eventually, after all, patients will be able to capture — with some degree of accuracy — multimedia content that includes not only audio, but also ultrasound recordings, EKG charts and more. Of course, these self-administered tests and will never replace a consult by a skilled clinician, but there certainly are situations in which this data will be relevant.

When you also bear in mind that the number of telemedicine consults being conducted is growing dramatically, and that these, too, offer insights that could become part of a patient’s chart, the need to go beyond text-based EMRs becomes even more evident.

So maybe the Eko/drchrono partnership will work out, and maybe it won’t. But what they’re doing matters nonetheless.

E-Patient Update: Using Digital Health For Collaborative Medication Management

Posted on June 1, 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.

Recently, I had a medical visit which brought home the gap between how doctors and patients approach to medications. While the physician and his staff seemed focused on updating a checklist of meds, I wanted med education and a chance to ask in-depth self-management questions. And though digital health tools and services could help me achieve these goals, they didn’t seem to be on the medical group’s radar.

At this visit, as I waited to see the doctor, a nurse entered with a laptop on a cart. Consulting her screen, she read off my medication list and item by item, asked me to confirm whether I took the given medication. Then, she asked me to supply the name and dosage of any drugs that weren’t included on the list. Given that I have a few chronic conditions, and take as many as a dozen meds a day, this was an awkward exercise. But I complied as best I could. When a physician saw me later, we discussed only the medication he planned to add to the mix.

While I felt quite comfortable with both the nurse and doctor, I wasn’t satisfied with the way the medication list update was handled. At best, the process was clumsy, and at worst, it might have passed over important information on drug history, interactions and compliance. Also, at least for me, discussing medications was difficult without being able to see the list.

But at least in theory, digital health technology could go a long way toward addressing these issues. For example:

  • If one is available, the practice could use a medication management app which syncs with the EMR it uses. That way, clinicians could see my updates and ask questions as appropriate.
  • Alternatively, the patient should have the opportunity to review their medication list while waiting to be seen, perhaps by using a specialized patient login for an EMR portal. This could be done using a laptop or tablet on a cart similar to what clinicians use.
  • When reviewing their medication list, patients could select medications about which they have questions, delete medications they no longer take and enter meds they’ve started since their last visit.
  • At least for complex cases, patients should have an opportunity to do a telehealth consult with a pharmacist if requested. This would be especially helpful prior to adding new drugs to a patient’s regimen. (I don’t know if such services exist but my interest in them stands.)

To me, using digital health options to help patients manage their meds makes tremendous sense. Now that such tools are available, physicians can loop patients into the med management discussion without having to spend a lot of extra time or money. What’s more, collaboration helps patients manage their own care more effectively over the long term, which will be critical under value-based care. But it may not be easy to convince them that this is a good idea.

Unfortunately, many physicians see sharing any form of patient data as a loss of control. After all, in the past a chart was for doctors, not patients, and in my experience, that dynamic has carried over into the digital world. I have struggled against this — in part by simply asking to look at the EMR screen — but my sense is that many clinicians are afraid I’ll see something untoward, misinterpret a data point or engage in some other form of mischief.

Still, I have vowed to take better control of my medications, and I’m going to ask every physician that treats me to consider digital med management tools. I need them to know that this is what I need. Let’s see if I get anywhere!