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The Current EHR “Reality”

Posted on July 1, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In response to my post on EMR and EHR about specialty specific EHR, we started a nice discussion about the need for specialty specific EHR vendors and all EHR vendors to create the capability to integrate with third party vendors who can extend the functionality of the EHR. This is not a new subject for Healthcare Scene, but it is an important one.

After talking about the dream framework of a middleware provider that connected third parties with every EHR, one of the readers offered their perspectives on the current EHR “reality”:

1) EHR vendors believe they are making great progress with their evolution.
2) EHR vendors believe that the next release is going to make everything right.
3) EHR vendors don’t believe that anyone can deliver a better solution then they can.
4) EHR vendors want to restrict access to “their” data. There’s money in that thar data.

He then offered a quote from this article: “we are stuck in a perpetual midpoint” along with these insights:

Procrastination is the best defense the EHR vendors can use to protect their turf.

That is where we will stay.

Unless there is some type of congressional action we will all keep wondering why interoperability keeps stalling and UCD is failing.

Those are some stinging words. The sting is stronger because I’ve seen so many cases of what he describes. I’ve seen glimpses of change on the horizon, but they are just glimpses. We’re really talking about an entire change in culture when it comes to EHRs.

I asked him this question, “Can the current crop of EHR build an app store model that would enable this vision? Is it an opportunity for a new vendor?

2300 Blog Posts and 11 Million Pageviews Later

Posted on June 29, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

For those that don’t know the history of EMR and HIPAA, I wrote the first post on EMR and HIPAA back on December 11, 2005. It’s fun to read that first post. Short and sweet. I hit some high level points which amazingly still represent my desires 10 years later. “I will try to incorporate any aspects of EMR and HIPAA because I think best practices across the industry are important to know.” – I still try to incorporate any aspect of healthcare IT. Lately I’ve been writing even more about the business of medicine, but I still try and find best practices.

In my original post I invited people to participate in the conversation. I still desire this greatly, but I’ve found that much of the conversation has moved to social media versus the blog comment section. Plus, as I’ve refined my blogging skill, it avoids many comment threads. In the beginning I wasn’t as skilled and so there was a lot of opportunity to correct me which made for great comment threads.

The last line of that original post really expressed my understanding of EHR at the time: “This is my best knowledge from my research and is not guaranteed in anyway.” Pretty funny that I thought to put in a disclaimer from the start. When I started I knew so little. It’s amazing how much you can learn over 10 years. Yet, I’m still learning.

5 months into my EMR and HIPAA blogging journey I celebrated reaching 30,000 visitors to my blog. I was amazed by my achievement. Little did I know that less than 10 years later I’d be celebrating 2300 blog posts and 11 million pageviews. For some perspective, we celebrated 3 million pageviews in August 2010 and then last Valentine’s day we celebrated 9 million pageviews. I was nostalgic for those posts and still am today.

I’m really not sure how to process 2300 blog posts and 11 million pageviews for one of my Healthcare Scene blogs. I mostly feel to say: Thank you!

I never thought I’d be a full time blogger when I grew up, but I feel lucky to do so. Over the past 5 years as a full time blogger, it’s been amazing to see the blogging business model change. When I started blogging people were happy to buy links from my site (We stay far away from that now). We always have done some pay per click and display advertising and those both still do quite well for us. However, as we’ve matured, we’ve been able to offer a variety of email marketing and sponsored content options which really take healthcare IT marketing to the next level.

With that in mind, I want to take a second to thank those companies who are currently supporting the work we do here at EMR and HIPAA. Without their support, none of this would be possible.

EMR and HIPAA Email Sponsors
DrChrono
Stericycle

EMR and HIPAA Sponsored Content Series
ClinicSpectrum
The Breakaway Group

EMR and HIPAA Display Advertising
Ambir
HIPAA Secure Now
Colocation America
Accountable

What I love about each of these companies is that they are looking to promote their company, but they’re also interested in supporting the work we do here at EMR and HIPAA. Almost all of them are not only sponsors of the site, but also readers of the site as well.

If your company would like to support the work we do here at EMR and HIPAA, we’ve created a new landing page which outlines all of the various healthcare IT marketing and advertising options we offer across the Healthcare Scene network. We’d love to work with you on sharing your message. Just drop us a note on our contact us page.

We’ve got a lot of ideas on how to continue to make what we do here at EMR and HIPAA better. However, what won’t change is our efforts to provide valuable content that helps make our readers’ lives easier.

Does Federal Health Data Warehouse Pose Privacy Risk?

Posted on June 23, 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.

Not too long ago, few consumers were aware of the threat data thieves posed to their privacy, and far fewer had even an inkling of how vulnerable many large commercial databases would turn out to be.

But as consumer health data has gone digital — and average people have become more aware of the extent to which data breaches can affect their lives — they’ve grown more worried, and for good reason. As a series of spectacular data breaches within health plans has illustrated, both their medical and personal data might be at risk, with potentially devastating consequences if that data gets into the wrong hands.

Considering that these concerns are not only common, but pretty valid, federal authorities who have collected information on millions of HealthCare.gov insurance customers need to be sure that they’re above reproach. Unfortunately, this doesn’t seem to be the case.

According to an Associated Press story, the administration is storing all of the HealthCare.gov data in a perpetual central repository known as MIDAS. MIDAS data includes a lot of sensitive information, including Social Security numbers, birth dates, addresses and financial accounts.  If stolen, this data could provide a springboard for countless case of identity or even medical identity theft, both of which have emerged as perhaps the iconic crimes of 21st century life.

Both the immensity of the database and a failure to plan for destruction of old records are raising the hackles of privacy advocates. They definitely aren’t comfortable with the ten-year storage period recommended by the National Archives.

An Obama Administration rep told the AP that MIDAS meets or exceeds federal security and privacy standards, by which I assume he largely meant HIPAA regs. But it’s reasonable to wonder how long the federal government can protect its massive data store, particularly if commercial entities like Anthem — who arguably have more to lose — can’t protect their beneficiaries’ data from break-ins. True, MIDAS is also operated by a private concern, government technology contractor CACI, but the workflow has to impacted by the fact that CMS owns the data.

Meanwhile, growing privacy breach questions are driven by reasonable concerns, especially those outlined by the GAO, which noted last year that MIDAS went live without an in-depth assessment of privacy risks posed by the system.

Another key point made by the AP report (which did a very good job on this topic, by the way, somewhat to my surprise) is that MIDAS’ mission has evolved from a facility for running analytics on the data to a central clearinghouse for data sharing between CMS and health insurance companies and state Medicaid organizations. And we all know that with mission creep can come feature creep; with feature creep comes greater and greater potential for security holes that are passed over and left to be found by intruders.

Now, private healthcare organizations will still be managing the bulk of consumer medical data for the near future. And they have many vulnerabilities that are left unpatched, as recent events have emphasized. But in the near term, it seems like a good idea to hold the federal government’s feet to the fire. The last thing we need is a giant loss of consumer confidence generated by a giant government data exposure.

Downsides of Incorporating Behavioral and Social Data Into an EHR

Posted on June 19, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In response to my post about incorporating behavioral and social data into EHR, I got the following email from one of our readers:

My worry on the collection of such behavioral and social data is that it will get used to further prescribe people with the psychiatric drugs that have such horrendous side effects to the benefit of big pharma rather than move towards diet, health education, nutrition and other non-medical remedies that can have long lasting benefits for a lifetime.

It’s a very fine point. In my previous article I didn’t spend enough time talking about the potential downsides of incorporating all that data into an EHR. The reader pointed out the potential abuse by big pharma to sell more drugs. No doubt, pharma is trying to sell more drugs. I’m sure the creative minds at pharma will try and find ways to leverage this data and sell more drugs. That’s the nature of healthcare.

However, I think pharma would try to do this whether the data was in the EHR or not. In fact, having this data in the EHR for the doctor might mean the doctor makes better choices and doesn’t always default to pharma to treat a patient. For example, if you know they’re living in a poor area, then you can ask them if they have enough food or heat in the winter in order to avoid them returning to you a few weeks later with another cold. This would actually lead to less drugs because you’re actually treating the cause of the problem as opposed to just the presenting problem.

While this example paints a pretty picture, you could also paint an awful picture where this data is used for discrimination. This could be in the office itself or by insurance companies. Some of the new ACA laws help when it comes to insurance discrimination, but many fear that the move to ACOs will cause these organization to discriminate against the unhealthy and poor. I have this fear as well. When you pay to keep people healthy, who do you want to have in your patient population? The healthy.

When you start talking about including all this new data in an EHR, there are a lot of privacy and security questions that come up as well. We’ve always known that the patient record was a treasure trove of personal information that needed to be safeguarded and protected from abuse. Social and behavioral data makes the health record even that much more desirable to nefarious groups who want to abuse the data. HIPAA along with privacy and security will become that much more important.

I’m sure I’m just touching the surface on the challenges and problems associated with all this new data. Although, the thing that scares me most is the way people could abuse the data. I don’t think these are reasons to not use this data. We need to use this data to move healthcare forward. However, it is a call to be very thoughtful about how we collect, secure, and use the data we’re collecting.

Interoperability of Electronic Health Records– Benefits and Opportunities – Breakaway Thinking

Posted on June 17, 2015 I Written By

The following is a guest blog post by Jennifer Bergeron, Learning and Development Manager at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Jennifer Bergeron
Electronic health records (EHR) aim to improve healthcare and processes for providers and patients on a number of fronts. In an ideal situation according to HealthIT.gov, the clinician benefits by having quick access to patient records and alerts, the ability to quickly and accurately report, and a path to safer prescribing. Patients should be able to spend less time filling out duplicative forms at clinics, have prescriptions sent automatically to pharmacies, and gain easier access to specialist referrals.

The International Journal of Innovation and Applied Studies points out that interoperability can work toward a resolution to several current problems including patient record accessibility and consolidation, and healthcare costs. As far as getting patient information and all available information when it’s needed, the report “estimated that 18% of medical errors that result in an adverse drug event were due to inadequate availability of patients’ information.” Healthcare costs are reduced when different entities can share and communicate common data and could save up to $77.8 billion annually.

Given the potential benefits, there are still opportunities to achieve interoperability. For example, not all healthcare organizations are using EHRs so data isn’t being collected consistently across the board. In 2014 there was an increase in the percentage of hospitals with EHRs. However, only 39% of physicians reported that they share data with other providers. Even though the data is available to share, some EHR users may still be living in a silo and haven’t reached full adoption. In addition, existing specification standards have not promoted interoperability. Even though there is data is available to share, few providers are tapping into that information.

To help increase data sharing, more attention is being paid to FHIR, or Fast Healthcare Interoperability Resources. FHIR stems from HL7 (Health Level Seven) data exchange and information modeling standards. HL7 has been around since 1987 to develop families of standards used to automate healthcare data sharing with the goal to improve patient care. FHIR builds upon the interoperability uses of HL7 and takes into consideration the changes in technology and requirements. According to the Office of the National Coordinator for Health Information Technology (ONC), FHIR is used to enable data access, is used as the container to return query results, and will be used to build necessary security and privacy controls.

FHIR combines what are called “resources” — also known as an instance of data – that define data and are used for specific content. Within a resource are characteristics including “a common way to define and represent them, building them from data types that define common reusable patterns of elements, a common set of metadata, and a human readable part.” Collected data can be used and exchanged, searched for individually or in groupings, analyzed and examined.

Interoperability and the role of FHIR is not yet clearly defined. Going forward, the roadmap for interoperability built by the ONC will be watched closely. Guidelines are broad at this point to allow appropriate decision-making as paths are forged. A group of organizations called the Argonaut Project has committed to working with FHIR. HI7.org defines the Argonaut Project as having the purpose of developing “a first-generation API (application programming interface) and Core Data Services specification to enable expanded information sharing for electronic health records, documents, and other health information based on the FHIR specification.”

APIs are at work behind the scenes when we’re accessing information online. Although healthcare is beginning to harness the power of APIs these interfaces are present everywhere in our day-to-day lives. For example, say you are listening to Spotify and want to connect that application with Facebook. An API helps make that translation of information from Spotify to Facebook happen.  Imagine the possibilities in the realm of data and healthcare. The development of APIs by the Argonaut Project is just the beginning stages of data sharing and interoperability.

In order to reach true interoperability and efficient use of FHIR, the first step is EHR adoption. Once data is captured into an EHR system, organizations can focus on data standards and clear data management, and have the ability to measure impacts to healthcare patients, providers, costs, and communication. Without the right, accurate data input, interpretation at the end of the process is not accurate or actionable. If clinicians are aware of how their engagement with data and proper input at the beginning of this process affects their practice, their patient’s experience and health, and healthcare on a broad spectrum, they can make a difference well into the future.

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

Meaningful Use EHR Adoption Charts – EHR Market Analysis

Posted on June 12, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

ONC continues to push out more data when it comes to meaningful use, EHR adoption, RECs, and related areas. As a data addict, I could spend forever looking through and analyzing this data. So, I’ll probably do a series of posts across Healthcare Scene over the next couple weeks looking at the charts and data that ONC has made public about meaningful use and EHR adoption. I know some of the charts have been out for a while, but the analysis should still prove useful.

If you want to join in on the analysis of this data, I welcome you in the comments of each post. Plus, if you want to find your own nuggets to share, I’d suggest starting with their quick stats and dashboards pages.

First up in our look at the ONC EHR data is a look at the meaningful use participation chart for ambulatory EHR vendors (eligible providers if you prefer):
Ambulatory Practice EHR Adoption - Meaningful Use Participation
The most important part of this chart to me is that the two largest bars on the chart. The largest bar is the 749 “Other EHR Vendors” category at the bottom of the chart. It’s easy to miss this bar, but I believe it’s extremely important to note how big the long tail is when it comes to ambulatory EHR adoption. I’ve often said that it doesn’t take that many doctors to make yourself a decent EHR business. This chart illustrates how many EHR vendors are still in the game. There are only 3 EHR vendors that have over 40,000 providers. I know that many think that EHR vendor consolidation is bound to happen. Some certainly will, but I don’t see it happening at a massive scale in the ambulatory EHR world.

The second largest bar on the chart is the Epic EHR adoption. What’s important about this bar is that this totally represents that hospital owned ambulatory EHR adoption. Epic does not and will not sell Epic directly to a small ambulatory provider. All of these “eligible providers” for Epic are in hospital systems. I take away two important things from this. First, we see in plain sight how big the roll up of ambulatory practices is by hospitals. Second, this chart illustrates the opportunity that Cerner and Meditech have available to them. As you’ll see in the next chart, Cerner and Meditech have more hospital installs than Epic, but they’re much farther down on the ambulatory side. A look at history explains why they’ve had trouble penetrating the ambulatory market, but I believe it’s a huge opportunity for them going forward.

I’ll be interested to see how this chart continues to evolve over time. Will we doctors leaving hospitals to go back on their own shift the balance of power? Will we see massive EHR consolidation? I also can’t help but note that Mitochon Systems Inc shows up on the list and they don’t even sell an EHR to doctors directly any more. I assume this must be their white label business? I’ll have to follow up with them to get an update on their business.

Now let’s take a look at the chart for Hospital EHR vendors participating in the EHR incentive programs:
Hospital EHR Adoption - Meaningful Use Participation
This chart illustrates really well the 3 horse hospital EHR race which we’ve all known for a while. Although, given healthcare IT’s love affair with Epic (kind of like Apple in the IT world), I think some will be a bit surprised that Cerner and MEDITECH are both listed ahead of Epic. If you looked only at large hospital systems, I think the chart would look very different though.

It’s worth also mentioning the other horses in the race: McKesson, CPSI, MEDHOST, Healthland and Allscripts. They’ve all carved out their niche in the hospital space. We’ll see if they can continue to defend their territory. Hospital EHR switching is not easy.

My favorite observation from this chart versus the ambulatory chart is how well it illustrates the importance of secondary EHR vendors (the brownish gold color) in hospitals. I’ll never forget when Alan Portela of Airstrip told me that the EHR world will be a heterogenous environment. That absolutely resonated with me and this chart proves out what he said. Health systems are going to have multiple EHR vendors even if some EHR vendors would like it to be otherwise.

If you want to look at the potential disruptors in the world of EHR, I’d take a look at these secondary EHR vendors. Their foothold in hospitals provides them a really great opportunity to disrupt the status quo as we know it. Most of them won’t, but they’re all sitting on an opportunity. I’d start with the companies that make up the “Other Vendors” brownish gold bar. I bet there are some really interesting ones in that list.

I’d love to hear your observations from these charts in the comments. Anything I missed? Do you disagree with my observations? I look forward to hearing your thoughts.

Incorporating More Social and Behavioral Data Into an EHR

Posted on June 11, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

You all have seen the stats about how our social and behavioral data is a much bigger predictor of our health and wellness than the 15 minutes of data that’s collected during a doctors visit. When people talk about the out of control costs of US healthcare, they often point to these stats and talk about how we have to focus on factors outside of our current healthcare system if we really want to bend the cost curve.

If in fact we had a true healthcare system that was trying to treat the health of a patient and not the symptoms, then we’d take a much more serious look at the social and behavioral determinants of health. The shift in healthcare is to try and make this a reality and to shift the current reimbursement model to one that pays our healthcare organizations to keep the patient healthy and not just treat their chief complaint.

With this in mind, I was intrigued by this IOM report on Capturing Social and Behavioral Domains and Measures in Electronic Health Records. In the report (there are actually 2 phases of the report) they identify 17 areas that influence a patient’s health and wellness. Then, they narrowed it down to 11 domains to consider incorporating into all EHRs.

You can take a look at the report to find all the details of their findings. However, I found their list of 17 social and behavioral domains that influence your health and wellness absolutely fascinating. Here’s the list:

Sociodemographic Domains

  • Sexual orientation
  • Race and ethnicity
  • Country of origin/U.S. born or non-U.S. born
  • Education
  • Employment
  • Financial resource strain: Food and housing insecurity

Psychological Domains

  • Health literacy
  • Stress
  • Negative mood and affect: Depression and anxiety
  • Psychological assets: Conscientiousness, patient engagement/activation, optimism, and self-efficacy

Behavioral Domains

  • Dietary patterns
  • Physical activity
  • Tobacco use and exposure
  • Alcohol use

Individual-Level Social Relationships and Living Conditions Domains

  • Social connections and social isolation
  • Exposure to violence

Neighborhoods and Communities

  • Neighborhood and community compositional characteristics

As we start to see EHR vendors move from digital filing cabinets to actually keeping a population healthy, I’m going to be watching how they incorporate all of this social and behavioral health data into the EHR.

I think you could break out every one of these domain areas and create a company around collecting this data which could then be made to be consumable by an EHR vendor. In fact, if you look at the world of healthcare IT startups we already see a lot of companies that are working in these areas. The most obvious is the dietary patterns and physical activity domains. How many hundreds of healthcare IT startup companies are working on quantifying those areas of our lives? A wise entrepreneur might look at this list and find a less obvious area where they could improve people’s health.

My biggest takeaway from this list: Healthcare still has such an amazing opportunity to improve health. We’ve barely just begun to tap into this data.

Phase 2 HIPAA Audits Kick Off With Random Surveys

Posted on June 9, 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.

Ideally, the only reason you would know about the following is due to scribes such as myself — but for the record, the HHS Office for Civil Rights has sent out a bunch of pre-audit screening surveys to covered entities. Once it gets responses, it will do a Phase 2 audit not only of covered entities but also business associates, so things should get heated.

While these take the form of Meaningful Use audits, covering incentives paid from January 1, 2011 through June 30, 2014, it’s really more about checking how well you protect ePHI.

This effort is a drive to be sure that providers and BAs are complying with the HIPAA privacy, security and breach notification requirements. Apparently OCR found, during Phase 1 pilot audits in 2011 and 2012, that there was “pervasive non-compliance” with regs designed to safeguard protected health information, the National Law Review reports.

However, these audits aren’t targeting the “bad guys.” Selection for the audits is random, according to HHS Office of the Inspector General.

So if you get one of the dreaded pre-screening letters, how should you respond? According a thoughtful blog post by Maryanne Lambert for CureMD, auditors will be focused on the following areas:

  • Risk Assessment audits and reports
  • EHR security plan
  • Organizational chart
  • Network diagram
  • EHR web sites and patient portals
  • Policies and procedures
  • System inventory
  • Tools to perform vulnerability scans
  • Central log and event reports
  • EHR system users list
  • Contractors supporting the EHR and network perimeter devices.

According to Lambert, the feds will want to talk to the person primarily responsible for each of these areas, a process which could quickly devolve into a disaster if those people aren’t prepared. She recommends that if you’re selected for an audit, you run through a mock audit ahead of time to make sure these staff members can answer questions about how well policies and processed are followed.

Not that anyone would take the presence of HHS on their premises lightly, but it’s worth bearing in mind that a stumble in one corner of your operation could have widespread consequences. Lambert notes that in addition to defending your security precautions, you have to make sure that all parts of your organization are in line:

Be mindful while planning for this audit as deficiencies identified for one physician in a physician group or one hospital within a multi-hospital system, may apply to the other physicians and hospitals using the same EHR system and/or implementing meaningful use in the same way.  Thus, the incentive payments at risk in this audit may be greater than the payments to the particular provider being audited.

But as she points out, there is one possible benefit to being audited. If you prepare well, it might save you not only trouble with HHS but possibly lawsuits for breaches of information. Hey, everything has some kind of silver lining, right?

No Complaint vs Normal in EHR Documentation

Posted on June 4, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was recently talking to someone about why EHR documentation is so awful to read. It’s because billing requires that the doctor spew out all this useless documentation in order to justify billing at a higher level (Side Note: Be sure to check out my previous post about Documentation by Exception Being the Dredge of EHR Documentation).

As I discussed this challenge with clinical documentation, this person told me that their doctors don’t mark everything as normal. Instead, they marked all of these systems as “No Complaint” (or something along those lines). Basically, the patient didn’t complain about that system. I didn’t really check it to know that it’s normal, but I didn’t notice anything abnormal and they didn’t tell me something was wrong.

Hopefully some of my readers that are billing experts can let me know if this type of documentation would fly in the US as far as getting reimbursed. Everyone I’ve seen has always marked it as normal. My guess is that for billing in the US just saying that the patient didn’t complain about a system wouldn’t get you reimbursed for evaluating that system.

However, the person I was talking with was not in the US and so he didn’t have to worry about the billing requirements that we have to worry about. My question to him was, “Then, why in the world are you documenting that the patient didn’t complain?” It seriously made no sense to me. You can basically assume that if you haven’t documented a system, then the patient didn’t complain about any system that’s not documented. Why would you clutter the medical documentation with all of these “Patient Did Not Complain.” That feels even worse than saying that everything was “normal” (unless we’re talking from a liability standpoint).

Maybe my trusty readers can give me some idea of why it would be worthwhile to document all of the “No Complaints.” Am I missing something? Is there some clinical value to it? Seems like a negative to me. Let me know in the comments if you know something I don’t know or if you agree with me that documenting “No Complaints” is a waste of clinician time and actually is worse than not doing it. I look forward to hearing your thoughts.

Breaking Bad And HIT: Some Thoughts for Healthcare

Posted on June 2, 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, I’ve been re-watching the blockbuster TV series hit “Breaking Bad” courtesy of Netflix. For those who haven’t seen it, the show traces the descent of a seemingly honest plain-Joe suburbanite from high school chemistry teacher to murderous king of a multi-state crystal meth business, all kicked off by his diagnosis of terminal lung cancer.

As the show clearly intends, it has me musing once again on how an educated guy with a family and a previously crime-free life can compromise everything that once mattered to him and ultimately, destroy nearly everything he loves.

And that, given that I write for this audience, had me thinking just as deeply what turns ordinary healthcare workers into cybercriminals who ruthlessly exploit people’s privacy and put their financial survival at risk by selling the data under their control.

Sure, some of data stealing is done by black-hat hackers who crack healthcare networks and mine them for data at the behest of organized crime groups. But then there’s the surprises. Like the show’s central character, Walter White, some healthcare cybercriminals seem to come out of the blue, relative “nobodies” with no history as gangsters or thieves who suddenly find a way to rationalize stealing data.

I’d bet that if you dug into the histories of those healthcare employees who “break bad” you’d find that they have a few of the following characteristics in common:

*  Feeling underappreciated:  Like Walter White, whose lowly chemistry-teacher job was far below his abilities, data-stealing employees may feel that their talents aren’t appreciated and that they’ll never “make it” via a legitimate path.

* Having a palatable excuse:  Breaking Bad’s dying anti-hero was able to rationalize his behavior by telling himself that he was doing what he did to protect his family’s future well-being. Rogue employees who sell data to the highest bidder may believe that they’re committing a victimless crime, or that they deserve the extra income to make up for a below-market salary.

Willful ignorance:  Not once, during the entire run of BB, does White stop and wonder (out loud at least) what harm his flood of crystal meth is doing to its users. While it doesn’t take much imagination to figure out how people could be harmed by having their medical privacy violated — or especially, having their financial data abused — some healthcare workers will just choose not to think about it

Greed:  No need to explain this one — though people may restrain naturally greedy impulses if the other factors listed above aren’t present. You can’t really screen for it, sadly, despite the damage it can do.

So do you have employees in your facilities on the verge of breaking bad and betraying the trust their stewardship of healthcare data conveys? Taking a look around for bitter, dissatisfied types might be worth a try.