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My Take on EHR in Dubai and the Middle East

Posted on September 2, 2015 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Yesterday I wrapped up a 2 day EHR workshop I taught in Dubai as part of the start of my Fall Healthcare IT conference season. This is the second time I’ve taught the EHR workshop in the middle east and it’s always a great experience for me to learn more about EHR in the middle east. This time we had attendees from Saudi Arabia, Qatar, and a few regions of United Arab Emirates (UAE) including Dubai and Abu Dhabi. Plus, this time I was lucky to have the support of Nanette from The Breakaway Group as sponsor for the workshop. It’s always great when a sponsor of a workshop adds to the quality of the workshop for attendees. The Breakaway Group definitely did that for us.
ACS and The Breakaway Group at EHR Workshop in Dubai
As I think back on the experience, the message that resonates with me most is something Nanette said in the final roundtable discussion part of the workshop. She commented that all of the challenges that attendees were sharing were the same challenges that we face in the US when it comes to EHR and healthcare IT. She commented that she’d already heard all the same challenges before. So, it’s at least nice to know that people around the world are dealing with many of the same challenges.

A simple example of this was one lady in the workshop talked about the ego of many doctors and how that was an enormous challenge for her when it came to implementing the EHR. Those of us in the US can no doubt relate to this challenge. So, we talked in the EHR workshop about how you can use a physician’s ego to your benefit in an EHR implementation. That’s a powerful concept that applies world wide.

So, I certainly echo Nanette’s comments that even though we’re literally half way around the world in Dubai, the challenges associated with implementing and adopting EHR software are largely the same. No doubt there are some different dynamics associated with who pays for the EHR and the benefits gleaned from the EHR here in the Middle East, but the EHR selection and implementation challenges are very much the same.

One other thing I found interesting in this EHR workshop was the diversity of people that attended. We had a number of gentlemen from India who were working on EHR implementations in the UAE. We had a man from Austria that was working on a long term care EHR implementation. We had a gentleman and lady originally from Iraq and Syria that were working on EHR implementations in Saudi Arabia and Dubai. Dubai is certainly a melting pot of so many different cultures and that was reflected in this EHR workshop.

If you follow @ehrandhit on Twitter, then you might have seen my Periscopes from the EHR workshop in Dubai. I was a bit surprised how willing they were to hop on Periscope. They loved the experience and were happy to share their culture with the world. I look forward to the opportunity to come back again.

Flow – A Spoken Word HIE Piece by Ross Martin

Posted on August 27, 2015 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Want to see brilliance in action? Check out this spoken word piece about HIEs by Ross Martin.

Here’s the background Ross Martin shares about the piece:

On Monday, August 17th, 2015 I begin a new chapter as Program Director for the new Integrated Care Network initiative at CRISP, Maryland’s health information exchange. We will be providing data to healthcare providers to enhance their care coordination efforts and providing additional care coordination tools to some of those providers who don’t already have these capabilities in place.

To mark the transition, I decided to make a video of this spoken word piece I wrote in 2012 (originally entitled “A Man among Millions”) for my last day consulting for the Office of the National Coordinator for Health IT while I was working at Deloitte Consulting. This piece explains why I am so passionate about making health information exchange work for all of us.

I am grateful for the opportunity to make a difference with an amazing team of collaborators and look forward to providing updates on our progress over the coming months and years.


Health Information Governance of 3rd Party Vendors

Posted on August 26, 2015 I Written By

John Lynn is the Founder of the 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 and 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 love when my eyes are opened to an issue that I haven’t heard people talking about. That’s what happened when I heard Deborah Green from AHIMA say that health information governance includes your third party vendors. I’m not sure how many organizations realize this and treat it appropriately.

What’s ironic is that we definitely do this with HIPAA. This is particularly true in the HIPAA omnibus world. Healthcare organizations have a certain expectation around security and privacy when it comes to their third party vendors. It’s a major part of every RFP I’ve ever seen in healthcare.

Why then don’t we treat information governance with third parties the same as we do with HIPAA?

My guess is that some organizations do, but they haven’t really thought about it in this way. It’s an informal part of how they deal with third party vendors. For example, how are third party vendors storing your organization’s health data? Do they dispose of it properly? etc etc etc. These are all great health information governance questions that we’re asking ourselves, but are we asking our third party vendors these questions as well? Should we be asking them?

One challenge I think we face is that we assume that if we’re paying a vendor to do something, that the vendor is going to do it the right way. We assume that a paid service is going to be done in the best way possible. I’m sure your experience like mine is that just isn’t the case. Was it Reagan that said, Trust but verify? That seems appropriate in this instance.

What’s clear to me is that health data is going to become more and more valuable to healthcare organizations. Making sure you have a handle on that data is going to be an important part of ensuring your financial future. That includes making sure that your third party vendors use good health information governance principles as well.

What do Right to Try Laws Mean for EHR Vendors?

Posted on August 24, 2015 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I recently received an email from the Goldwater Institute which outlined the passing of “right to try” laws across the country. For those not familiar with this, right to try laws basically gives a terminally ill patient the option to try a drug that’s currently in clinical trials, but isn’t yet approved for public use. There are a lot more intricacies to the law, but you get the idea. Here’s the details of which states have passed it or are working on right to try laws:

Right To Try has passed in:
Alabama, Arizona, Arkansas, Colorado, Florida, Illinois, Indiana, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Montana, Nevada, North Carolina, North Dakota, Oklahoma, Oregon, South Dakota, Tennessee, Texas, Utah, Virginia, and Wyoming

The bill is still under active consideration and could pass this year in:
California, Pennsylvania, Wisconsin, and the District of Columbia

Right To Try has also been introduced in:
Connecticut, Delaware, Georgia, Hawaii, Kansas, Kentucky, Maine, New Hampshire, New Jersey, New York, Ohio, Rhode Island, West Virginia

With 24 states having passed a right to try law, that’s almost a majority of states. As I see this unfold, I wonder what it means for EHR vendors. My guess is that most of the right to try paperwork is still done on paperwork and EHR vendors have almost nothing to do with it. I wonder if that’s the best thing. Should EHR vendors facilitate things like right to try?

One challenge with getting EHR vendors involved is that no EHR vendor wants to implement a regulation that’s essentially different in 50 states (or at least different in 24 states today). I’m sure there are some legal and political reasons why these laws are being passed by states. I have to imagine it has to do with our dysfunctional government in Washington. However, a state by state path to right to try means no EHR vendor will consider implementing a streamlines application process. It’s just too complex and won’t add enough value to their users.

It’s too bad that a national right to try law can’t be passed. Then, I could see an EHR vendor streamlining the application process. They could integrate a database of current clinical trials so that they could make doctors aware of what clinical trials are available and could be considered for their patient in this situation. I guess this piece is possible on a state by state basis, but it certainly wouldn’t be as elegant as one national standard.

As it stands, I don’t see any EHR vendor really building out this functionality on a state by state basis. Maybe that means it’s a great opportunity for a startup company. Then, they can integrate the functionality into the EHR using an EHR’s API (once those finally happen).

A Practice Fusion IPO?

Posted on August 20, 2015 I Written By

John Lynn is the Founder of the 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 and 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 just did a search on this blog and I found that I’ve mentioned the name Practice Fusion in 88 different posts over the years. Needless to say, Practice Fusion has been one of the most interesting EHR vendor stories out there. I’ve seen it first hand since they started advertising on EMR and HIPAA very early on in their life. I was even on stage talking about meaningful use at the first Practice Fusion user conference. We didn’t know very much about meaningful use at the time, but we put on a good show and shared what we knew at the time.

In the early days, many EHR vendors were really scared by Practice Fusion. Offering a Free EHR is a drastic thing to do and absolutely shook up the EHR industry. Much like Dell did in the PC market (and probably some others), Practice Fusion’s low price forced most other EHR vendors to lower their prices in order to compete. I saw the drop in price first hand as EHR after EHR dropped their price. At the same time as these price drops, EHR vendors were shifting from these massive front loaded EHR purchases to monthly price models that could compete with SaaS EHR pricing. The mix of pricing model changes and competition with a Free EHR was great for the industry.

With this as background, I definitely am intrigued by the news that Ryan Howard has been replaced as CEO of Practice Fusion. Tom Langam, Practice Fusion’s Chief Commercial Officer has taken the helm as interim CEO. The article I linked to above suggested that this and other personnel changes point to Practice Fusion possibly preparing for an IPO. In fact, they’ve had so many personnel changes over the years, most of the people I’ve gotten to know have left.

I’m not sure if Practice Fusion is preparing for an IPO or not, but I wouldn’t be surprised if they’re running out of money. Yes, it’s crazy to think that they could be running out of money after raising $70 million about 2 years ago along with $15 million more a few months later. CrunchBase has their funding to date at $157.5 million. However, I’m sure they have a high burn rate. Their leadership and investors have set ambitious goals for Practice Fusion to own the healthcare market (A goal which I’ve said is impossible. The EHR market will be heterogeneous!). I’m sure their spending habits match those ambitious goals. An IPO would be one way to fund that continued ambition. If they did do an IPO, we’d get some really interesting insights into their business model.

There’s some mystery surrounding how Practice Fusion makes money. I think you can summarize their income streams into three categories: advertising, data, and third party apps. Most people glob onto the first piece, but from what I understand it’s far from being their largest source of revenue. In fact, I wouldn’t be surprised if it was their smallest. The second piece is quite interesting. I once heard someone say that Practice Fusion made their money from selling health data, but then they were corrected by someone saying that Practice Fusion doesn’t sell data. Instead, Practice Fusion sells the insights from that data. A subtle difference, but an important one. The question remains, how valuable are insights from EHR data? Many other EHR vendors sell their EHR data. Is it just a matter of time until Practice Fusion does too? Will they be forced to in order to meet revenue goals?

The last piece of revenue is the one that most people ignore. However, it probably is the largest piece of the revenue pie. My guess is that their practice management system vendor partners are one of the most significant portions of their third party revenue. Practice Fusion doesn’t have their own PM and so they refer their users to an outside PM vendor. When they do so, Practice Fusion gets a cut. I’m sure this is not an insignificant number. It’s not hard to imagine Practice Fusion doing something similar with a whole marketplace of third party offerings that tie into their Free EHR.

Over the years, I’ve talked to a lot of investors and potential investors about Practice Fusion. I’ve always told them that Practice Fusion has definitely created value. They’ve done a good job leveraging the Free EHR to bring doctors in. What’s not as clear to me is whether they’ve created enough value to justify the $157.5 million they’ve raised. If they really are preparing for an IPO, then I guess we’ll find out soon. The revenue numbers that come out during the IPO process and how the street reacts to those numbers would be fun to watch. Yes, I know. I am an #HITNerd.

Department of Defense (DoD) EHR Project Opens Doors for HIT Vendors and Non-Vendors – Breakaway Thinking

Posted on August 19, 2015 I Written By

The following is a guest blog post by Carrie Yasemin Paykoc, Senior Instructional Designer / Research Analyst at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Carrie Yasemin Paykoc
Numerous medical advances can be traced back to development and research conducted by the U.S. military. In most instances, these developments were directly related to mitigating casualties and disease during times of war. The U.S. Civil War is seen as one of the most influential military events to advance modern medicine. Life-saving amputations, anesthesia, thoracic surgery, wound treatment, facial reconstruction, and the inception of the ambulance-to-ER transport system all originated with military intervention. While today’s medical advancements have certainly surpassed anything ever imagined by Civil War surgeons a century and a half ago, the model of healthcare innovations spurring from military initiatives remains steadfast. In fact, the U.S. military is one of the largest payers and providers within the modern day healthcare system, and the Department of Defense’s (DoD) current Electronic Health Records (EHR) project presents an unparalleled opportunity for development and implementation of an innovative solution that will inform advancement in both the military and private health systems. With this DoD decision, the contracted vendors will have opportunities and challenges to fulfill the reality of this EHR, and all other vendors will have an opportunity to innovate and capitalize on the private sector.

While the massive undertaking to update the DoD’s EHR system holds great promise, many health information technology experts have expressed skepticism surrounding the approach and associated costs of implementation via a complex public-private partnership model. Skeptics also continue to point to the failed implementation of as a litmus test for potential success. Potential pitfalls aside, the DoD EHR project does create opportunity for health information technology (HIT) vendors and start-ups across the industry who recognize that disruptive innovation can easily erupt in the private sector, and new market opportunities will arise as a result of this government-private sector partnership. Both critics and supporters should pay attention to the developments in the coming months.

The DoD contract will likely span 10 years with the aim of creating a new electronic health system to replace the DoD’s Armed Forces Health Longitudinal Technology Application (AHLTA). This collective effort, referred to as the Defense Healthcare Management System Modernization (DHMSM),  or “Dimsum” as commonly called by health IT insiders, creates opportunity for development of a commercial, off-the-shelf version of the government system. The price tag for this contracted venture is $4.34 billion, but that certainly may increase as development evolves. Compared to prior attempts by the DoD and the U.S. Department of Veterans Affairs (VA) to create an integrated electronic health record at an estimated costs of $28 billion, the $4.34 billion price tag appears to offer staggering savings; however, the two projects differ greatly. The initial integrated EHR was scrapped due to cost estimates and disagreement between DoD and VA leadership, ultimately leading to DHMSM and the VA moving forward with a separate update to that EHR, which later became known as the Veterans Health Information Systems and Technology Architecture (VistaA) program.  Despite leadership disagreements and technological difficulties, one of the goals of DHMSM is interoperability between the new DoD system and the VA system.

Dr. Jonathan Woodson, assistant secretary of defense for health affairs, articulated the need for interoperability between both military and private systems during a July 29 briefing. He stated that the goal is for the new military system and the private sector systems to become interoperable. If private sector health IT vendors – whether partners in the contract or not – figure out how to easily exchange data and communicate with other platforms, they will truly capitalize on this opportunity and improve care simultaneously.

Interoperability between private and military systems is underway. For example, the Military Health System in Colorado Springs, Colorado joined efforts with the Colorado Regional Information Organization (CORHIO) and is making progress with interoperability and data sharing through the utilization of Health Information Exchanges (HIEs). They are able to share patient information and data in both private and military health systems. As presented at this years’ HIMSS conference, the initial collaboration and efforts between the two organizations have shown promising results.

Dr. Karen DeSalvo, federal health IT coordinator, echoes further support and enthusiasm for DHMSM and private system interoperability. “[The DHMSM is] an important step toward achieving a nationwide interoperable health IT infrastructure.” As contributors to the Office of the National Coordinators Interoperability Roadmap, Dr. Karen DeSalvo and her cohorts appreciate the potential impact of establishing interoperability on such a large scale. It will be an incredible milestone in HIT history to attain true interoperability of military and private systems. Conversely, if large-scale interoperability is not achieved, it may lead to more spending and potentially the demise of the project altogether. To the chagrin of DHMSM supporters, this failure would only support assertions that the failed website was only the beginning of a litany of government HIT challenges. But given the track record of medical advances related to military research and development, the DHMSM project will likely achieve some level of interoperability and attain the goals set during the initial request-for-proposal phase.

The next opportunity and challenge is already happening. The selected DHMSM health IT vendors must maintain their private sector customer base while rapidly developing the new military system. This is no small task. Doing so will require additional resources and new partnerships to successfully manage this effort. It also means that if these vendors are not successful, their customer base may decide to switch EHRs and implement another EHR platform altogether. Either way, there are opportunities for HIT vendors and consultants to innovate and gain entry to new markets and customers.

Alternatively, the HIT vendors not selected for the DHMSM contract are positioned to innovate and create new technologies and supporting systems. Although the military is responsible for many medical advances, numerous technological advances have been developed in the private sector and can be traced to simple beginnings in a garage or dorm room without any direct military or government involvement. Those across the HIT marketplace have the opportunity and motivation to develop new, cutting-edge technology, by capitalizing upon the bright light currently being shone on new health technologies as a means of improving patient safety and health outcomes.

Data security is another area to pay attention to in the coming months. The DHMSM is an excellent opportunity to develop sophisticated systems to protect patient health information. Conversely, creating such a massive interoperable system opens up risk for data security of all integrated systems. In an age where devices, web searching, and systems leave a trail of bread crumbs and create an internet-of-things (ioT) or web of data points, the new DHMSM system must effectively protect this web of data to avoid compromising personal and national security.

We must also consider the ability to successfully implement and adopt the DHMSM system. This type of system will require a coordinated and focused effort of massive proportions. After coordinating logistics, adopting the new system will require another heroic level of effort. Difficulties may lie in establishing proper governance between the selected HIT vendors and military projects and ensuring that all companies involved have the stamina and focus for the entire life cycle of the system. The DoD began laying the foundation for governance structures during the initial proposal process, but it is yet to be seen if all involved parties will be able to adhere to the outlined parameters and work collaboratively to create their new DHMSM system. Additionally, once the system is designed and implemented, if proper funds are not available to sustain the system, the DoD would have to consider a potential redesign.

The military’s track record with medical advances positions them to successfully implement the new DHMSM system. Remarkably, this project has the potential to lay the foundation for interoperability and data security in the U.S. Despite the obvious challenges associated with the DHMSM EHR project, a system that is able to communicate and safely share data for large populations is worth the investment. From a global perspective, many countries are far ahead of the U.S. in designing and implementing national health records (e.g. Denmark, Finland, Sweden, UK, and Australia). There is also the potential for the DHMSM system to evolve one day into a national electronic health record, but doing so would require a national paradigm shift and lot more than $4.3 billion. Additionally, the challenges associated with this initial venture will surely be exacerbated due to the scale of the project and sheer importance. Health IT vendors and start-ups not directly involved in DHMSM should remain optimistic and on the lookout for new opportunities and challenges on the horizon. If the DoD and the contracted health IT vendors can successfully develop and deploy the DHMSM system, new opportunities, research and medical advances will likely follow.  It’s up to both HIT vendors and non-vendors of the DoD contract to decide whether they walk through this “door” of opportunity and make the most of this historic initiative.

Xerox is a sponsor of the Breakaway Thinking series of blog posts.

Is HIPAA Misuse Blocking Patient Use Of Their Data?

Posted on August 18, 2015 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, a story in the New York Times told some troubling stories about how HIPAA misunderstandings have crept into both professional and personal settings. These included:

  • A woman getting scolded at a hospital in Boston for “very improper” speech after discussing her husband’s medical situation with a dear friend.
  • Refusal by a Pennsylvania hospital to take a daughter’s information on her mother’s medical history, citing HIPAA, despite the fact that the daughter wasn’t *requesting* any data. The woman’s mother was infirm and couldn’t share medical history — such as her drug allergy — on her own.
  • The announcement, by a minister in California, that he could no longer read the names of sick congregants due to HIPAA.

All of this is bad enough, particularly the case of the Pennsylvania refusing to take information that could have protected a helpless elderly patient, but the effects of this ignorance create even greater ripples, I’d argue.

Let’s face it: our efforts to convince patients to engage with their own medical data haven’t been terribly successful as of yet. According to a study released late last year by Xerox, 64% of patients were not using patient portals, and 31% said that their doctor had never discussed portals with them.

Some of the reasons patients aren’t taking advantage of the medical data available to them include ignorance and fear, I’d argue. Technophobia and a history of just “trusting the doctor” play a role as well. What’s more, pouring through lab results and imaging studies might seem overwhelming to patients who have never done it before.

But that’s not all that’s holding people back. In my opinion, the climate of medical data fear HIPAA misunderstandings have created is playing a major part too.

While I understand why patients have to sign acknowledgements of privacy practices and be taught what HIPAA is intended to do, this doesn’t exactly foster a climate in which patients feel like they own their data. While doctor’s offices and hospitals may not have done this deliberately, the way they administer HIPAA compliance can make medical data seem portentous, scary and dangerous, more like a bomb set to go off than a tool patients can use to manage their care.

I guess what I’m suggesting is that if providers want to see patients engaged and managing their care, they should make sure patients feel comfortable asking for access to and using that data. While some may never feel at ease digging into their test results or correcting their medical history, I believe that there’s a sizable group of patients who would respond well to a reminder that there’s power in doing so.

The truth is that while most providers now give patients the option of logging on to a portal, they typically don’t make it easy. And heaven knows even the best-trained physician office staff rarely take the time to urge patients to log on and learn.

But if providers make the effort to balance stern HIPAA paperwork with encouraging words, patients are more likely to get inspired. Sometimes, all it takes is a little nudge to get people on board with new behavior. And there’s no excuse for letting foolish misinterpretations of HIPAA prevent that from happening.

Transferring Custody of a Chart to the Patient – Could That Drive Patient Engagement?

Posted on August 11, 2015 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I recently wrote about the concept of health information disposal and how we’re going to have to reevaluate how we approach disposing of patients charts in this new digital world. Plus, EHR vendors are going to have to build the functionality to make it a reality. However, some replied to that article that in this new world we shouldn’t ever dispose of charts.

We’ll leave that argument for that article (or in the comments) and instead discuss another concept that Deborah Green from AHIMA told me about. Deborah suggested that one possible solution for digital chart disposal would be to transfer custody of the chart to the patient. I think that terminology might not sit right with some people since the patient should have access to the chart regardless. However I think the word custody has a slightly different meaning.

When a healthcare organization is ready to dispose of an electronic chart based on their record retention laws (which usually vary by state), then it’s the perfect time to give patients the opportunity to download and retain a copy of their paper chart before it’s destroyed. In that way, the healthcare organization could worry less about deleting the electronic chart since they’ve transferred “custody” of the chart to the patient.

This removes the responsibility of storing the patient chart from the healthcare organization and puts it on the patients that want to have their entire medical chart. The perfect custodian of the patient chart is the patient. At least it should be.

I wonder if a healthcare organization informing patients that their old charts will be deleted would be enough to actually drive patient engagement and download of their electronic record. While meaningful use has required the view, download and transmit of records by patients, most people have been gaming that requirement without patients really getting the benefit. I have a feeling that patients hearing the words “deleted chart” would wake a lot of them up from their slumber. They wouldn’t know why they’d want the paper chart, but I imagine many would take action and preserve their medical record. Once they download the chart, it would be the first step towards actually engaging with their health data.

What do you think? Is transferring custody of the electronic record the right approach to health information disposal? Would this drive a new form of patient engagement? Would it wake up the sleeping giant which is involved patients?

Which EHR Are Available for Education?

Posted on August 10, 2015 I Written By

John Lynn is the Founder of the 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 and 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 remember 5 or more years ago writing about the need for EHR software to be available as part of a healthcare IT and medical education. Adding EHR education to a medical education is a much larger question we won’t discuss here (Where would you fit it?), but there’s a need for EHR software to be available for those in education.

This came to mind recently for two reasons. First, someone reached out to me to ask if there was an EHR that they could use as part of an EHR course that they’d created. It had been so long since I’d thought of the subject, I couldn’t remember the exact programs that were out there. I vaguely remembered Practice Fusion having a program (makes sense that a Free EHR would make their EHR available to education) for education and someone else (maybe Amazing Charts?). I’ve also known a number of the ONC funded community college programs using some form of Vista (the free open source EHR) in their program. However, I’d heard some bad reviews from people who had that experience. My guess is that they used a plain vanilla install of Vista and that wouldn’t likely mimic the real world.

Since the answer to my friend was pretty awful, I told her that I’d blog about it and see if there were other EHR vendors who would be willing to offer their EHR as part of an EHR course or other education endeavor. Just drop a comment on this post or let me know on the contact us page if you’d like me to connect you with my friend.

The second reason this was of interest to me is that one of my heroes (spiritual, business, and life) is now the President of a business college. I recently got a chance to have lunch with him and he asked about whether they should create a program that taught healthcare technology. They already had a medical coding course and wondered if health IT would be a good place to expand.

My answer to him was simple. If he could convince Epic or Cerner to let his students come away with an Epic or Cerner certification, then he should go for it. My only partial concern was that these graduates would come away with an Epic or Cerner certification, but only an associates degree. That might cause a problem for healthcare HR departments which often have Bachelor’s degree as a requirement to work at the hospital. I think most HR departments at hospitals would be perplexed how someone was Epic certified, but didn’t have a bachelor’s degree. However, they could probably work something out.

Having run the Healthcare IT Central job board for a number of years now, I know first hand the value of an Epic or Cerner certification. Is there another EHR certification (or experience) that’s really valuable and sought after out there? MEDITECH probably comes the closest. There is still quite a bit of demand for that expertise. Are there others you’re having problems filling?

Let me look at this another way. Which EHR systems would be valuable as part of an EHR course? Is the knowledge general enough that you could work on most of the EHR systems and switch to the next system? I’d love to hear your thoughts.

No doubt, demand for experience in these various EHR systems is going to be high. Although, what’s the right pathway for someone new to healthcare IT or new to EHR? Should we be training new health IT professionals in schools on these EHR? I’d love to hear your thoughts.

Will Personal Health Information Exchanges (PHIE) Lead the Consumer Medical Record Revolution and Bridge the Gap Between PHRs and EHRs? (Part 2 of 2)

Posted on August 5, 2015 I Written By

The following is a guest blog post by Cora Alisuag, RN, MN, MA, CFP, President & CEO, CORAnet Solutions, Inc.
Cora Alisuag, CEO, CORAnet Solutions
Be sure to check out part 1 in this series where we talked about the movement towards an empowered patient who controls their health record.

Lack of Interoperability Continues to Hamper Patient Record Access

However, it has been six years since the HITECH Act passed, yet most Americans seeking medical care are still unable to obtain their full medical records for a variety of reasons. Some hospitals will simply not release them or proprietary EHR system vendors not allowing hospitals, let alone patients, direct access.

This capability also comes at a critical time as enormous obstacles hamper the ability of people to obtain their medical records. This is documented in the ONC’s “2015 Report to Congress on Health Information Blocking” which concludes that it is apparent that some health care providers and health IT developers are knowingly interfering with the exchange of health information in ways that limit its availability and use to improve health and health care.

This situation is only going to worsen as the Centers for Medicaid and Medicare (CMS) is considering a change to the EHR meaningful use rule that requires five percent of patients must view or download or transmit their health data to only one patient; not one percent, one patient.

Blue Button Not Gaining traction

In the meantime, other PHR technology has been introduced, but has not gained popularity including forays from Microsoft and Google. The ONC and other government organizations’ initiative to adopt and use the Blue Button platform for exchanging healthcare data between clinicians equipped with electronic health-record systems and patients with mobile computing devices is stalled, according to a recent survey by the not-for-profit Workgroup for Electronic Data Interchange (WEDI).

WEDI questioned 274 providers, health plans, HIT vendors and claims clearinghouses in the Second Annual Survey of Industry Awareness of Blue Button, conducted late in 2014. Only eight percent of respondents noted that their organizations actually used Blue Button, down from 15% of survey respondents in 2013.

PHRs Largely Unpopular

PHRs joined the lexicon of medical terminology several years ago as a convenience way for consumers to have copies of their medical records. It was largely born out of EHR’s lack of interoperability and access. However, as far back as 2009, a Health Affairs article detailed the major factors behind the slow adoption of PHRs. The article reviewed some of the reasons and includes cost, access, interoperability, security concerns, and data ownership.

Because health records which include clinical data, laboratory results and medical images do not flow freely among multiple organizations due to lack on EHR interoperability, PHRs do not automatically receive data. This means that the data must often be entered manually by consumers—a time-consuming and error-prone process. For most consumers, this lack of safe and reliable automation makes it problematic to maintain a PHR, and a PHR that is not up-to-date likely will not be used. Unlike PHIEs, the API-EHR connectivity connection is the missing link in PHRs.

However, the authors of the Health Affairs article offered a challenge. They described a gap between today’s personal health records (PHRs) and what patients say they want and need from this electronic tool for managing their health information. They noted that until that gap is bridged, it is unlikely that PHRs would be widely adopted, but noted that in the future; when these concerns are addressed, and health data is portable and understandable in content and format, PHRs will likely prove to be invaluable.

“While we all agree that lack of interoperability continues to stymie patient health record access and PHRs might not be the ultimate solution, but if a PHIE can bridge the gap by accessing EHR data through an open API while offering the security and convenience of a PHR. I believe PHIEs offer a solution that should satisfy the spontaneity of millennials’ and more frequent use of middle-aged and elderly users,” says Tiffany Casper, RNC, CNM, MSN and President of EMR Consultants which helps medical organizations transition to EMR systems.

About Cora Alisuag
Cora Alisuag is the CEO of CORAnet Solutions, Inc., a health information technology company. She is the inventor of CORAnet technology, the software engine that drives CORAnet’s Personal Health Information Exchange (PHIE), allowing patients’ mobile device access to their complete medical records. She is also an MN, MA, CFP and healthcare industry speaker and serial medical entrepreneur.