For those of you who aren’t familiar with the now a year old Hospital EMR and EHR, you should check it out and subscribe to the email list. The site has been growing like gang busters and people are loving the content on that site. I’d wanted to do a hospital EHR focused website for a long time. Certainly there’s a lot of cross over between ambulatory EHR and hospital EHR, but there are also unique differences in the hospital EHR environment that were definitely worthy of their own discussion platform. Plus, we like to cover other aspects of hospital IT.

One of the recent series that Anne Zieger started on Hospital EMR and EHR is called the Top Hospital HIS Vendors by Revenue. She’s already covered the top 3: McKesson, Cerner, and Siemens. She’ll be going through the rest of the Top 10 Hospital HIS vendors by revenue over the next weeks.

It’s really fascinating and amazing to see the enormous revenue numbers that each of these companies produce. Even more amazing is that we’re really only at the beginning of EHR adoption. There is so much of the EHR market that still is out there waiting to implement an EMR solution.

Of course, the real question is which vendor is going to capture this market share and which company will eventually be created that will take the market share from the incumbents. I’m sure it’s hard for many to believe that some upstart company could take down these large companies, but it will happen. That’s the cycle that occurs over and over again. Although, I will make the prediction that we won’t see much jostling in the hospital EHR space during the HITECH EHR incentive money time frame. The opportunity to take market share will likely happen post EHR incentive money.

For those of you who don’t follow all the inside EHR “baseball” that’s happening right now with Allscripts, you might want to check it out. If you use one of Allscripts various EHR software (do they have 6 EHR softwares now? I lose count) then you really want to pay attention. Here’s my cliff notes version of what’s happened for those who don’t want to research the details. Half the Allscripts board left and so did the CFO. It appears it was an Eclipsys departure with the previous Allscripts board members and CEO Glen Tullman remaining. After this happened the stock (MDRX) plummeted.

While to those inside the EMR world will realize that this isn’t a death knell for everything Eclipsys related, many who don’t know how important the Eclipsys software is for Allscripts could easily see this a different way. Of course, in the heartless world of publicly traded companies and CEO’s doing what they can to prop up stock price, you never know what action they might take next.

The best evaluation I saw of the Allscripts situation is that it is very likely that Allscripts and Glen Tullman will use this stock drop to start making even more drastic moves. For example, we all know that they don’t need that many EHR software and so none of us should be surprised if they choose to sunset 1 or more of their EHR software. Yes, that’s right. Your EHR software isn’t safe even if you buy it from a large EHR vendor like Allscripts (see also when GE ceased operations of Centricity Advance).

Think about it from Allscripts perspective. It takes A LOT of extra resources to ensure that multiple EHR software products are even just meeting the meaningful use and certified EHR requirements let alone actually creating innovative new EHR software features. Cutting out an EHR software will provide a huge cost savings to Allscripts going forward.

Why is this the topic of Meaningful Use Monday? I think this is an incredibly important topic related to meaningful use, because I can already see the physicians and practice managers hitting my website if Allscripts chose to cease their Allscripts MyWay EHR offering (I have no indication that Myway is gone. I’m just speaking hypothetically). I’m quite certain that many physicians and practice managers will wonder how an EHR vendor could sunset or stop developing an EHR software that is certified for meaningful use.

It’s quite simple: Meaningful Use and EHR Certification are NO guarantee of an EHR software’s long term viability.

I have a section in my EMR selection e-Book about ensuring the viability of your EHR vendor. I’ll admit that it’s not an easy task and is more art than science given our limited information about MANY EHR vendors. However, it’s worth considering the long term plans of an EHR vendor and a particular EHR software in that vendor’s quiver. Although, meaningful use and EHR certification do nothing to help you in that regard.

One final warning: we’re just at the start of EHR vendors going out of business, EHR vendors being bought by larger vendors, EHR software being closed down, EMR software being sunset. I give it another year before the Tsunami of EHR software mergers, acquisitions, bankruptcies, fire sales hit our shore. Although, the early warning signs are there and so we should prepare for the oncoming wave. The challenge is knowing where you can find high ground.

I’m traveling in what I consider the heart of healthcare IT: Boston. Everywhere you turn and look there’s healthcare all around. I’ve seen multiple vans with Partners on them. I even had a mobile health story in the Delta magazine I checked out on my flight out. Although, I’m not actually in Boston for work. I’m just here on vacation with my wife. So far I’ve done a pretty good job enjoying the vacation and not working. We’ll see how the last couple days go.

Don’t worry Boston, I’ll be back in two weeks for Health 2.0 Boston and we’ll get all the #HITsm crew together for some healthcare IT fun. Yes, bad planning on my part, but I do have an affinity for visiting Boston.

Ok, enough of the sidebar. Now to the usual round up of Healthcare IT tweets:

RT @hphealthcare: Voice recognition is gradually being implemented into #EMRs. bit.ly/JcuitK

— Nectar Plaitis (@NectarPlaitis) April 30, 2012

Is there an EMR where you can’t use voice recognition? I wrote a post on that a long time ago where the answer was no. They can all use voice recognition. Although, as I’ve written about the deep embedding of voice in some EMRs, it’s also true that not all EMR voice recognition is created equal. So, check it out if you like voice.

RT @tbtam Are EMR’s medical devices? If so let’s treat them like devices. I agree. Dr. Wes drwes.blogspot.com/2012/04/why-el…

— rlbates (@rlbates) April 29, 2012

My answer is that they’re not medical devices. I think we have more than enough regulation in EMRs and I haven’t seen that regulation actually improve EMR software. So, I’m against more EMR regulation.

T2: ACO’s may want to share data through #HIEs, but typical EMR makes that near impossible… #hitsm

— Don Rosenthal (@DonRosenthal) April 27, 2012

It’s true that many EHR vendors hold the blame for not exchanging data even if they put on nice demos at the Interoperability exchange at HIMSS. How about next year the interoperability showcase at HIMSS can only show actual implementations of real exchanges? I wonder how different it would be.

Top National Hospitals 100 Hospitals Thomson Reuters list have more #healthIT and more advanced #emr j.mp/K60Obd

— Nick van Terheyden (@drnic1) April 26, 2012

This top lists are always fun to click and rarely have much value. Although, to me it probably mostly shows a correlation by the money made and the IT implemented. The more money they have the more likely they are to implement healthcare IT.

To get MU stage 1 money you must be at Stage 4 of EMR implementation #hcsm #Convo12

— Nick van Terheyden (@drnic1) April 23, 2012

Stage 4? You have to have completed every EMR stage (ie. Full implementation).

Our next entry in Healthcare Gadget Friday is the iMPak Health Journals from Meridian Health and NoMoreClipboard. You may remember that I called the iMPak Health Journals the most creative technology I found at HIMSS 12. As such I wanted to write more about how they worked.

Here’s a picture I took of the iMPak Health Journal:

It certainly looks pretty simple and it is. That’s done by design. You basically use the iMPak health journal by pressing down on the blue and red circles. Pressing these “buttons” kind of reminds me of the musical greeting cards you get. When you’d press it down the music would start playing. This works very similar. Although, you push the red button to start and then each of the blue buttons represent a response to a healthcare question. It’s as simple as that. You hold down the buttons and it records your answers.

Then, the next time you go for an appointment or through an NFC (near field communication) connection to your cell phone (almost all new cell phones will have this technology) the data is uploaded electronically to the NoMoreClipboard website. From there all of the data can be processed and seen by yourself and your doctor.

I’d hoped to have a video where you could see the use of the iMPak journal, but I wasn’t able to get one that did a nice demo. What I found so creative was how simple it was to collect data from a patient. They didn’t need to download an app. They didn’t need to buy an expensive device that they’re only going to use for a limited time.

Turns out that there are a lot of potential uses for these journals. Some areas that might find them useful are: Insurance Companies, Hospitals / Health Systems, Pharmacy Benefit Management, Pharmaceutical Companies, Employer Benefits Management, and Retail Pharmacies. Here’s a video which shows how it can be used:

One challenge that still exists with this device is getting patients to remember to use the device. A built in alarm that would go off to remind them to answer the questions could help to solve that problem. Although, the journal is so portable, I’d hate to have the alarm go off as you carry it around in your purse or something.

I’ll also be interested to see how many patients lose their iMPak journal or just forget to bring it to the office for their appointment. This isn’t an issue if they’ve been uploading their data using their own cell phone, but would be an issue in those cases where they’re uploading the data in the office.

The biggest competitor to this product is the various mobile health apps that are cropping up. One day I can see the mobile health apps really taking over this space. However, there are still many patients who don’t carry a smart phone or that can’t/won’t go to the hassle of downloading an app to track this stuff. In those cases, I find the iMPak Health Journal a really creative solution to getting the data to be able to provide better patient care.

Full Disclosure: NoMoreClipboard is an advertiser on this site.

It looks like we’ve got a billion-dollar mismatch between rules and reality here. An established security research firm has released a study suggesting that while providers are working hard on meeting HIPAA and other security regs, their data isn’t any more secure than when it was before. 

Kroll’s 2012 HIMSS Analytyics Report: Security of Patient Data, concludes that the rate of  provider data breaches has been rising over the past six years, despite pressure on providers to conduct more security audits and otherwise tighten up their data ship.

What’s scary about this trend is that the healthcare institutions surveyed by Kroll don’t seem to be aware of the problem.  Health IT execs rated themselves at 6.4 out of 7 (seven being “extremely prepared’) on their readiness to address data security. That’s up from 6.06 in 2010 and 5.88 in 2008.

But the data Kroll gathered suggests that they’re overconfident at best. It found that 27 percent of respondents had reported a breach during the past twelve months, up from 19 percent in 2010  and 13 percent in 2008. Worse, of those who saw breaches, 69 percent of providers had seen  more than one breach.

Now, it would be easy to say that regs like HIPAA, Meaningful Use standards and the Red Flags rules are malformed, and that this is just another case of government getting it wrong to industry’s detriment. If there’s any truth to this notion, I do hope CMS leaders take notice and adjusts some of its requirements;  Heaven knows they’d get plenty of credible, carefully thought-out feedback if they ask.

Unfortunately, though, I suspect far from being that easy. We’d all love it if we could just follow the rules, get government approval then say “stick a fork in it, security’s done.”  But as readers know,  security is such a complex mix of implementing technologies and changing inappropriate behaviors that it’s hard to tease out just what went wrong sometimes.

Still, it’s good to have an organization like Kroll remind us that meeting HIPAA requirements isn’t the be all and end all.  Unfortunately, it’s really just the beginning.

For some reason I’ve been recently talking and reading more and more about patient recruitment. I’ve been fascinated by the creative ways that those doing the clinical studies use to be able to recruit patients that fit the very specific needs of most clinical studies. Plus, I’ve been amazed at how much money is required to be able to recruit patients for these studies.

There’s so many interesting quirks involved in the whole patient recruitment business. In most cases, it’s very large companies trying to recruit individual patients. Many of the chronic patients want to know about and be involved in the clinical study. In many cases, it can lead to a great mutually beneficial outcome for both the company that’s doing the clinical study and the patient who receives care that they wouldn’t have otherwise received. Of course, there are A LOT more intricacies involved in patient recruitment, but those are a few of them.

The biggest challenge with patient recruitment is usually finding the right patients for the clinical study. I think we’re on the brink of technology largely solving this problem for clinical researchers.

EHR Software for Patient Recruitment
When you think about the volume of data that’s going into an EHR system, you can see how valuable the granular EHR data could be in identifying which patients are eligible for a certain clinical study. Certainly there are plenty of nuances to when and how you can use this information. I won’t get into those in this post, but I think it’s quite clear that EHR software will be essential to patient recruitment in clinical studies.

I’m sure that some won’t like to hear this. My first response is that this doesn’t have to be a bad thing. In fact, if done right it can be a great thing. We just need to be involved in the discussion so that patient recruitment with EHR software is done the right way. My second response is that this is going to happen whether people like it or not. Instead of trying to stop it, we should focus on how to make it work well for everyone.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

When the EHR Incentive Program was first announced, many providers told me that while they might be willing to forego the potential incentive payments for meaningful use, they could never accept the 2015 penalties (AKA “adjustments”) for non-compliance. Back in 2009, 2015 seemed far in the future—but for those motivated by penalty avoidance, it’s time to make sure that meaningful use is within your grasp. 

The Proposed Rule for Meaningful Use Stage 2, (page 13771), defines the timeline for the assessment of penalties. The safest way to avoid the 2015 penalty is to successfully demonstrate meaningful use in 2013. (Yes, 2013—this is not a typo!) Failing that, a provider whose first year of participation is 2014 has until October 1, 2014 to successfully attest, which means that he/she must begin the 90-day reporting period no later than July 3 of that year. For future year penalties—that increase by 1% annually—the pattern would be the same: full calendar year reporting two years prior or 90-day reporting in the year prior to the penalty assessment.

Bottom line: You cannot wait until 2015 to be a meaningful user if you are concerned about the penalties. And if you haven’t embarked on the EHR adoption process yet, 2013 will sneak up on you very quickly!

Lots of interesting discussions happening about EMR and healthcare IT this week. Someone recently called it the golden age of EHR. It’s really hard to argue with them. I’ve only been in the healthcare IT and EHR world for the past 7 or so years, but it has never been more exciting than now. There’s an energy and excitement that is tangible. I just hope it takes us to an even more exciting time.

Now, without further ado, some of the various EMR, EHR and healthcare IT tweets that I found interesting or worth a comment:

As it is EMR is usurping Patient-Doc time already. The eye contact, the warmth etc. becoming mechanical to the detriment. #hcsm

— PDara MD, FACP (@JediPD) April 23, 2012

While I’ve certainly seen what this tweet describes, I don’t think it has to be the case. It depends a lot on how the EMR is used and how the EMR is implemented.

Not to be confused with EPIC EMR fail! lol RT @afternoonnapper: @GailZahtz Epic PR fail.#hcsm

— harriseve (@harriseve) April 23, 2012

Oh my…I’m a total nerd for loving the EMR humor.

Wyse to Present Cloud Client Computing Solutions and Virtualization for EMR Environments at Centricity Healthcare User …

— Stella Gibbs (@SantaCruzRTS) April 23, 2012

I know nothing about Wyse, but seeing this tweet had me disappointed. I asked to attend the Centricity User group meeting (hosted by a third party, not GE), and never got access. It’s too bad. I can almost understand some concern (albeit unwarranted) of having a blogger at their user group meeting, but a third party should have been glad to have the exposure. Pretty disappointing since I love going to user group meetings so I can talk to the hard core every day EMR users. Oh well, I’m sure there will be more.

EMR sales up 14 percent in 2011 | #Healthcare IT News ow.ly/apB9E

— Healthcare IT News (@HITNewsTweet) April 20, 2012

Only 14%? That number seems really low. Plus, it’s hard to believe any number unless a specific EHR company releases their growth, but even then you have to be careful understanding where they got that number. If they only have 1 EMR install, then it’s easy to grow 500%.

Many love to discuss the idea of the paperless office in healthcare. This turns out to be a dream that is (at least for now) impossible to obtain. In fact, some people argue that the amount of paper you use in an office increases because an EHR can print out a whole patient record so quickly. However, the bigger issue with paper post-EHR implementation usually has to do with all of the paper that your patients bring into the office and the paper documents that your patients need to sign. One day these issues might be resolved through HIEs and digital signatures. Until then, the most important tool a physician can have in their practice is a great scanner.

I’ve told the story multiple times about my very first EHR implementation where we used one of those cheap multi function scanners in medical records because we already had it. Fast forward a month or so and we’d literally burned through that scanner. That’s when I learned my first lesson that not all scanners are created equal.

I’ve had the powerful, but expensive Fujitsu scanners listed on my EMR Technology page for a long time. I know a lot of doctors offices that use these and they are just work horses that with some simple regular maintenance last forever. My biggest problem with these scanners has been their price. I remember how hard it was for me to convince a practice that it was worth the hefty price tag.

Ambir ImageScan Pro 820i and Ambir ImageScan Pro 930u

The good news is that healthcare now has another option in the Ambir ADF scanners. Ambir’s been in the scanner business for quite a while, but these ADF scanners are a relatively new addition to their scanner line up. I’ve had the chance to use both their Ambir ImageScan Pro 820i (See Amazon Listing) and their new Ambir ImageScan Pro 930u and can say I was quite pleased with both scanners.

I won’t bore you with all the specific specs for each scanner since you can read those on the website. I’ll just cover some of the highlights. The obvious difference between the 820i and the 930u is the speed. They do 25 ppm and 40 ppm (black and white) respectively. Seeing those numbers shows a stark contrast, but to be honest I never felt like the 820i was slow and I expect it would be fast enough for most ambulatory offices.

The 930u also has the fabulously named “Ultrasonic misfeed detection.” Isn’t that a great name? Per the websites it, “Stops jams and double-feeds before the happen.” Although, in the time I’ve been using both scanners I’ve never had problems with either scanner having a problem.

I personally love the robust scanning software that comes with both scanners. In fact, if anything there might be too many options to choose from in how you want to configure your scanner. I’m sure they could improve this with a little better interface that does a better job hiding some of the more advanced options and bringing out those options that people really care to configure most often. Although, as a techguy I loved having all the options at my disposal. The only trouble is that many practices don’t have a tech person who will wade through the options to find the best configuration. Thus my suggestion to make it feel simpler. The good part is that most people will configure it once and then not worry about it again.

The on-scanner buttons are simple and basically lean on the software in the background to do the heavy lifting. One button that I wish they had was a way to quickly switch between Front Side, Back Side and Duplex scanning. It’s pretty annoying to have to go into the software to change this setting. A button on the scanner to toggle through those settings would be ideal.

I’m not sure why, but the 820i also feels like a better designed, more sturdy product than the 930u. The 820i has the smoother edges which also adds to its visual appeal, but there’s something about it that makes it feel like a much more solid scanner than the 930u. I’m not sure if the 930u just uses cheaper plastic or something, but it doesn’t have the same well designed feel of the 820i. I wouldn’t say the 930u has a poor design, but when comparing the two side by side you can see the difference. I also love the flip up tray (820i) better than the slide in tray (930u), but that might be personal preference.

They’re both quite compact designs for an ADF scanner. I’m not sure you could really get a smaller footprint than what they’ve done with both of these scanners. Another great feature is that the scanners support ID scanning as well. Considering the number of licenses and insurance cards that we scan in healthcare, this is great.

Most EHR vendors will be glad to hear that it supports the popular TWAIN driver which I think most EHR vendors use to interface with scanners. The TWAIN driver automatically rotates pages, adjusts brightness, and autocrops images to minimize file size and increase OCR accuracy. Other features include: auto page sizing, blank page removal and auto deskew.

All in all I was quite pleased with the Ambir ADF scanners. I couldn’t find any major problems with them in all my tests and use of the scanner. I’ll be adding them as an EMR and HIPAA approved product on my EMR Technology page.

If you’ve used the Ambir scanners or other scanners, I’d love to hear about your experiences in the comments.

Full Disclosure: Ambir has been an advertiser on the site since 1/2010.

The incomparable Vince Kuraitis sent out a tweet a while back that I think is worth highlighting. It was actually a retweet of @Cerner_Network who seems to be quoting L Kolkman, Mosaica Partners, so I’ll give credit where credit is due. Here’s the core of what the tweet said:

From Memory Based Care to Information Based Care

I also love that the tweet included the hashtag #freethedata.

Vince has been a long proponent of the idea of freeing the data. Although, I think the idea of moving from memory based care to information based care is a much bigger deal than just freeing the data. Sure, freeing the data will be an important part of being able to provide information based care. In fact, it’s really quite necessary to provide proper health care.

The thing about this transition is that whether healthcare data is “free” and interoperable doesn’t really deny the fact that doctors are being inundated with more and more data every day.

Back in May of 2009 I wrote this post titled, “Body of Medical Knowledge Too Complex for the Human Mind.” If this was true in 2009, imagine how much worse it is today.

Even if we don’t take into account the wave of information that is and will be coming from those apps, devices, and quantified self-ers (which I assure you is coming. Even if we don’t consider all the data that doctors will be able to get from various HIE sources (which is also coming). Just within a physician’s own EHR software and the body of medical knowledge that’s being published each and every day, the physician’s memory is at its limit.

This isn’t a knock on doctors by any means. I was stunned when my wife went to her OB/GYN after not seeing her for a few years she was able to recount the most important salient points of my wife’s child birth history. This was all without the chart (which they’d filed away in permanent storage for some reason and didn’t have it available for the appointment).

Yep, many physicians are extraordinary people with extraordinary memories, but we all have our limits. Computers have their limits as well. We’ll never be without doctors and that’s a good thing. However, we’re slowly seeing the move to where a doctor really can’t be the best doctor without some technical assistance dealing with the overload of information. I think that’s a good thing.