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Taking a Second Look: Accessing Your Data beyond the PM or EMR

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Editor’s Note: The following is an update to a previous EMR and HIPAA blog post titled “EMR Companies Holding Practice Data for “Ransom”.” In this update, James Summerlin (aka “JamesNT”) offers an update on EHR vendors willingness to let providers access their EHR data.

Over the years I have been approached with questions by several solo docs and medical groups about things such as the following:

  • Migrating to a different PM or EMR system.
  • Merging PM’s or EMR’s such as when a practice buys out another practice.
  • Interfacing the EMR and PM.
  • Custom reports.
  • More custom reports.
  • LOTS MORE CUSTOM REPORTS!!!

And there have been plenty of times I’ve had to give answers to those questions that were not favorable.  In many cases, it was with some online EMR or PM and the fact that I could not get to the database and the vendor refused to export a copy to me or the vendor wanted thousands of dollars for the export.  With the on-premises PM and EMR systems, getting to the data was a matter of working my way around whatever database was being used and figuring out what table had what data.  Although working with an on-premises PM or EMR may sound easier, it too often isn’t.  The on-premises guys have some tricks up their sleeves to keep you away from your data such as password protecting the database and, in some cases, flat out threatening legal action.

A few years back, I wrote a post on a forum about my thoughts on how once you entered your data into a PM or EMR, you may never get it back.  You can see John Lynn’s blog post on that here.

My being critical of EMR and PM software vendors is nothing new.  I’ve written several posts on forums and blogs, even articles in BC Advantage Magazine, about how hard it can be to deal with various EMR and PM systems.  Much of the, at times, downright contemptuous attitudes many PM and EMR vendors have towards their own clients can be very harmful.  Let’s consider three aspects:

  • Customization.  Most of the PM/EMR vendors out there would love to charge mega-bucks to write custom reports and so forth for clients.  However, this isn’t all it’s cracked up to be.  First, most clients simply aren’t going to pay the kind of money many PM or EMR companies want to charge.  Second, custom reports have to be maintained.  Eventually, you have all these clients running around needing changes to their reports and the PM or EMR vendor simply can’t get to them all in a timely manner without hiring lots of technical (read: EXPENSIVE) staff which turns what was once a money-making ordeal into a money losing one.  And, of course, the client’s suffer since they can’t fine-tune their practice to the degree needed in today’s challenging economy.
  • Interfacing.  What happens if a client wants to interface encounters and demographics from their EMR to their PM system and then interface dollar amounts and so forth from the PM system with receivables and expenditures in Quickbooks or other financial software into a series of reports that give a total view of how the practice is doing?  We are talking about the ability to, day-by-day, forecast incoming receivables from carriers and patient payments (within certain limits, of course), with expected expenditures (payroll, taxes, etc.) from the accounting software to get a financial outlook for the practice for the next few weeks or even months for long-term planning.  A PM or EMR vendor, already dealing with HIPAA or meaningful use, may not want to get involved in that kind of hard-core number crunching, yet the practice is demanding it.
  • A second part to interfacing.  Getting the EMR and PM vendors to get along.  Often what you see is the EMR vendor has a certain way they do an HL7 interface and the PM vendor has a certain way they do an HL7 interface and if they don’t line up properly, you’re just out of luck.  Either it works with reduced functionality or it doesn’t work at all and neither vendor will budge to change anything.  And that’s assuming they both use HL7!

In situations like those above, the best way to resolution is for the practice to perhaps obtain its own technical talent and build its own tools to extend the capabilities of the data contained within the various databases and repositories it may have such as the databases of the PM and EMR.  Unfortunately, as I have reported before, most PM and EMR systems lock up the practice’s data such that it is unobtainable.

At long last; however, there appears to be a light at the end of the tunnel that doesn’t sound like a train.  Some of the EMR systems that doctors use are beginning to realize that creating a turtle shell around a client’s data, in the long run, doesn’t do the client nor the PM/EMR vendor any good.  One such EMR I’ve been working with for a long time is Amazing Charts.  Amazing Charts has found itself in a very unique situation in that many of its clients are actually quite technical themselves or have no problem obtaining the technical talent they need to bend the different systems in their practices to their will.  The idea of having three or four databases, each being an island unto itself, is not acceptable to this adventurous lot.  They want all this data pooled together so they can make real business decisions.

Amazing Charts; therefore, has decided to be more open regarding data access.  Read only access to the Amazing Charts database is soon to be considered a given by the company itself.  Write access, of course, is another matter.  Clients will have to prove, and rightly so, that they won’t go spelunking through the database making changes that do little more than rack up tech-support calls.  Even with the caution placed on write access this is a far jump above and beyond the flat out “NO” any other company will give you for access to their database.  I consider this to be a great leap forward for Amazing Charts and, I’m certain, will set them apart from competition that still considers lock-in and a stand-offish attitude the way to treat clients who pay them a lot of money.

Perhaps one day other PM and EMR vendors will see the light and realize the data belongs to the practice, not the vendor, and will stop taking people’s stuff only to rent access to it back to them or withhold it altogether.  Until then, Amazing Charts seems to be leading the way.

April 14, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Getting Beyond the Health IT Cheerleaders, BS, and Hype Machine

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My friend Shahid is chairing a healthcare IT event series called HealthIMPACT (10% discount for Healthcare Scene readers with the code IMPACT10) and the first one of the year is taking place in Houston on April 3. Given his no-nonsense attitude and low tolerance for hype, it looks like it will be a great place for healthcare technology enthusiasts and buyers to get actionable advice on what’s real, what’s BS, what to buy, what not to buy, and perhaps most importantly, which guidance is worth following. Shahid tells me that the following important topics will be covered at the Houston event:

  • How IT can support the overarching financial, operational, and clinical goals of your organization
  • HIEs in your region and provider participation in them
  • Technologies that support value driven care and population health management
  • Cloud based systems in healthcare
  • Programs that drive patient engagement
  • Leadership strategies that drive innovation
  • Predictive analytics that improve care delivery
  • EHR implementation and meaningful use
  • ICD10 compliance, readiness and physician training

If you’re a buyer of technology, it’s certainly worth attending. If you’re selling technology and want to learn how to reach the buyers or need to talk to buyers directly it’s also worth attending. Shahid’s come up with an interesting “mini focus group” model that allows technology vendors to sit directly with buyers and pick their brains. A very interesting model that’s worth exploring.

Not only are the topics pretty relevant but he seems to have been able to convince some pretty well known Speakers to join him:

  • Edward Marx, Senior Vice President and CIO, TEXAS HEALTH RESOURCES
  • George Conklin, Senior Vice President and CIO, CHRISTUS HEALTH
  • Pamela Arora, Vice President & CIO, CHILDREN’S MEDICAL CENTER
  • Theresa Meadows, Senior Vice President and CIO, COOK CHILDREN’S HEALTH CARE SYSTEM
  • Chris Belmont, Vice President & CIO, UT M.D. ANDERSON CANCER CENTER

Register online here and reference code IMPACT10 to receive a 10% discount for being a Healthcare Scene reader.

March 20, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

This Geek Girl’s Singing: HIMSS 14 Social Media Finale

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As one of the inaugural crop of HIMSS Social Media Ambassadors, a second-generation native Floridian, and a former Orlando resident, it is my sworn duty to summarize, recap, and perhaps satirize the last group of Blog Carnival posts, to metaphorically sing the HIMSS opera finale. And you folks submitted some doozies! I’m very grateful to the HIMSS (@HIMSS) and SHIFT Communications (@SHIFTComm) team for providing me with links to all entries. Y’all have been BUSY!

A man after my own heart, and a frequent #HITsm participant who weathers harsh criticism with witty aplomb: Dan Haley’s (from athenahealth, @DanHaley5) piece on 3 Takeaways From HIMSS – Policy And Otherwise caught my attention with the line, “Regulators are from Mars…” He stole my favorite blog entry prize with the line: “Orlando is magical when you are a kid. Kids don’t attend HIMSS.”

First-time attendee Jeffrey Ting (from Systems Made Simple) outlined his experiences with some of my favorite topics in his piece, HIMSS Reflections By A First-Time Attendee: HIEs and interoperability. I agree with him: the Interoperability Showcase’s “Health Story” exhibit was one of the best presentations of the whole conference.

Dr. Geeta Nayyar’s perspective as a board member of HIMSS and CMIO for PatientPoint gave her a unique vantage point for her post, HIMSS 14: A Truly Inspiring Event. Take note, HIMSS conference planners – your monumental efforts were recognized, as was the monumental spirit of the closing keynote speaker, Erik Weihenmayer.

HIMSS Twitter recaps permeated the blogosphere, with my favorite being the inimitable Chuck Webster’s (@wareflo) HIMSS14 Turned It Up To 11 On And Off-Line!. Chuck also periodically provided trend analysis results of year-over-year #HIMSS hashtag traffic for each period of the conference, complete with memes for particular shapes: Loch Ness monster humped-back, familiar faces of frequent tweeters.

Health IT guru Brian Ahier’s (@ahier) wrapped up the “Best In Show” of HIMSS Blog Carnival , complete with Slideshare visuals awarding Ed Parks of Athenahealth “Best Presentation” and providing an excellent summation of must-read posts.

Interoperability was one of the most prevalent themes of HIMSS, and a plethora of posts discussing the healthcare industry’s progress on the path to Dr. Doug Fridsma’s (@Fridsma) High Jump Of Interoperability (Semantic-Level) were submitted to the Blog Carnival. Notable standouts included: Shifting to a Culture of Interoperability by Rick Swanson from Deloitte, and Dr. Summarlan Kahlon’s (of Relay Health), Diagnosis: A Productive HIMSS 2014, which posited that, “this year’s conference was the first one which convinced me that real, seamless patient-level interoperability is beginning to happen at scale.”

And who could forget about patient engagement, the belle of the HIMSS ball? Telehealth encounters, mobile health apps and implications, patient portals, and the Connected Patient Gallery dominated the social media conversation. Carolyn Fishman from DICOM Grid called it, HIMSS 2014: The Year of the Patient, and discussed trepidation patients feel about portal technologies infringing on face-time.

Quantified-self wearable-tech offered engagement opportunities, as well. Having won one such gadget herself, Jennifer Dennard (@SmyrnaGirl) gave props to organizations like Patientco and Nuance for their use (and planned use) of wearable tech in support of employee wellness programs, and posited on the applications of such tech in the monitoring and treatment of chronic disease in her piece, Watching for Wearables at HIMSS14.

Finally, if you’re able to read Lisa Reichard’s (from Billians Health Data) @billians) highlights piece,Top 10 Tales and Takeaways, without busting out into Beatles tunes, you probably wouldn’t have had nearly as much fun as she and I did at HISTalkapalooza, dancing to Ross Martin’s smooth parodies. You also probably don’t have your co-workers frantically purchasing noise-canceling headphones.

I did say I’d be singing to bring HIMSS to a virtual close.

Can’t wait to get back to the metaphorical microphone for HIMSS 2015 in Chicago!

March 14, 2014 I Written By

Mandi Bishop is a healthcare IT consultant and a hardcore data geek with a Master's in English and a passion for big data analytics, who fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

The Irony Of Healthcare Standards

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Healthcare delivery should be standardized. Medicine is, after all, primarily a science. Providers must diagnose and treat patients. Clinicians must form hypotheses, test hypotheses, and act. As providers obtain new information, they must adjust their thesis and repeat the cycle until patients are treated. Although there is an art to patient interaction, the medical process itself is scientific.

Science is based on repeatable, nullable hypotheses. Diagnostics and treatments are too.

And yet, it’s widely known that healthcare delivery is anything but standardized. Even basic pre-operative checklists vary dramatically across locations. Although some of this variation can be accounted for by physical constraints and capital limits, most of the aberrations can be attributed to management and culture. Checklists and protocols attempt to standardize care, but even the protocols themselves are widely debated within and between organizations.

It’s also widely known that most innovations take the better part of two decades to roll out through the US healthcare system. For an industry that should be at the cutting edge, this is painful to acknowledge.

There’s a famous saying that vendors represent their clients. It should be no surprise that major health IT vendors are slow to innovate and respond. Providers are used to slow changes, and have come to expect that of their vendors. Since providers often cannot absorb change that quickly, vendors become complacent, the pace of innovation slows, and innovations slowly disperse.

In the same light, health IT vendors are equally unstandardized. In fact, health IT vendors are so unstandardized that there’s an entire industry dedicated to trying to standardize data after-the-fact. The lack of standards is pathetic. A few examples:

Claims – Because insurance companies want to reject claims, they have never agreed on a real standard for claims. As such, an entire industry has emerged – clearing houses – to help providers mold claims for each insurance company. In an ideal world, clearing houses would have no reason to exist; all claim submissions, eligibility checks, and EOBs should be driven through standards that everyone adheres to.

HL7 – It’s commonly cited that every HL7 integration is just that: a single HL7 integration. Although HL7 integrations share the same general format, they accommodate such a vast array of variety and choice that every integration must be supported by developers on both sides of the interaction.

As a technologist, the lack of interoperability is insulting. Every computer on this planet – Windows, Mac, iOs, Android, and other flavors of Linux – communicate via the TCP/IP and HTTP protocols. Even Microsoft, Apple, and Google play nicely within enterprises. But because of the horribly skewed incentives within healthcare, none of the vendors want their customers to interact with other vendors, even though cooperation is vital.

Perhaps the most ironic observation is that technology is widely considered to be hyper-competitive. Despite hyper-competition, the tech giants have coalesced around a common set of standards for communication and interoperability. Yet health IT vendors, who operate within a vertical that prides itself on its scientific foundations, fail to communicate at the most basic levels.

March 13, 2014 I Written By

Kyle is Founder and CEO of Pristine, a company in Austin, TX that develops telehealth communication tools optimized for Google Glass in healthcare environments. Prior to founding Pristine, Kyle spent years developing, selling, and implementing electronic medical records (EMRs) into hospitals. He also writes for EMR and HIPAA, TechZulu, and Svbtle about the intersections of healthcare, technology, and business. All of his writing is reproduced at kylesamani.com

GAO Says Defense, VA Shouldn’t Have Separate EMRs

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The GAO isn’t satisfied with plans the departments of Defense and Veterans Affairs has submitted claiming that separate EMRs will be more affordable and quicker than their original joint plans.

The two agencies had claimed that implementing separate, interoperable EMR systems would be a better choice than developing a joint EMR usable by both agencies.  But the GAO says the two have not substantiated their claims that the separate EMRs would save money and time.

The GAO report comes after years of wrangling over how to create a joint, integrated EHR. The two agencies have been discussing creating the joint project, the iEHR, since 2009. The idea behind the iEHR was to allow every service member to maintain a single EHR throughout their career and lifetime.

However, the iEHR project came to a screeching halt in February 2013, when the two agencies announced plans to stop the project and focus instead on making their existing EHR systems more interoperable.

In follow-up, the House and Senate in December 2013 approved the funding bill that required to VA and DOD to create a plan for a single or interoperable electronic health record by January 31.

Since then the GAO has addressed the plans the two agencies made, and concluded that they have not:

  • Addressed management barriers to collaboration terms of enterprise architecture, IT investment management and other areas
  • Laid out what the interoperable EHR approach consists of, how much it will cost, or when and how it will be completed
  • Developed a joint healthcare architecture or investment management collaboration to guide the project
  • Updated their strategic plan to commit to an integrated approach

In the GAO’s view, the fact that the VA and DOD are taking separate approaches — the VA modernizing its system and the DOD acquiring a new commercially available system — is not going to work out well.

March 12, 2014 I Written By

Katherine Rourke 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.

#HIMSS14 Day 3 – Lack of Innovation

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On the bus ride home from the HIMSS14 party at Universal Studios, I sat next to a hospital CIO. She summed up the conference perfectly, “I’m tired, but also energized to go forward and do great things.” There you have the HIMSS conference in a beautiful nutshell.

It’s always a really great experience to come to HIMSS and interact with amazing people. As long as intelligent, smart, fun, wonderful people keep coming to HIMSS, it will be worth it for me to attend.

While I love attending, this HIMSS I was pretty disappointed with the real lack of major innovation that I found at the event. As is usually the case, I had a few people ask me what I found that was really interesting and innovative at the event. This year I didn’t really have an answer. Much of the progress we’re seeing with healthcare IT has been around building to government regulations along with incremental progress.

Of course, I will offer the disclaimer that I was only able to meet and talk with ~40-50 companies (of the ~1300 vendors) and talk to a few hundred people over the main 3 days. So, maybe there was a lot of innovation out there and I just missed it. Maybe it was in one of those hundreds of HIMSS press releases I got and I somehow missed it. However, I heard a similar sentiment from other attendees.

It’s also worth commenting that I’m in touch with many of these companies now on a regular basis. Maybe when I come to HIMSS I’m just seeing the next generation of something I’ve often seen and heard was already coming and so it doesn’t feel like much of an innovation to me. However, with a broader view it is an incredible innovation that I’m taking for granted.

Innovation or not, I can assure you that there is a cloud of regulation that’s hanging over every piece of healthcare IT. It’s overwhelming to vendors, providers, hospital organizations, and quite frankly everyone in the industry. Healthcare has always been a highly regulated world, but I think this is much more regulation than health IT has ever experienced before.

While I was sad to not see major innovations, I do think we’re making incremental progress towards a better healthcare IT future. Exchanging healthcare data is feeling closer than its ever been before. The changing payment model is likely going to drive this to reality. We’re starting down a really exciting path to turning healthcare data into information (to steal from an old IBM line). It’s still going to take a number of years for both of these items to become a standard, but it’s starting to march down that path.

I still have major concerns for the physician #EHRbacklash. Many EHR vendors are still naive to this coming backlash and many aren’t doing what they need to do to avoid it. I also think ICD-10 is going to be a major train wreck for a large portion of healthcare.

As is usually the case in life, there are good and bad things. Life is about learning to deal with both in the best way possible. I’m still as optimistic as ever about the potential of EHR and Health IT. We’re not where we should be when it comes to really getting the value out of the technology, but I am confident we will get there. One of my favorite quotes from the movie Remember the Titans sums up my views well:

February 26, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

#HIMSS14 Day 2 – Future of EMR and EHR Market

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As is probably going to forever be the case, much of my experience at HIMSS gets to benefit from the beauty of social media. Today was no different as their was the #HITsm chat where we played #HITsm account bingo. Somehow I ended up on stage competing against my fellow EMR and EHR writer, Jennifer Dennard, for one of the prizes. Happily she won. I cheered for her over me too. All in all it was a fun time hearing about the various people in the HITsm social media community.

The evening of day 2 was also highlighted by the New Media Meetup event. This is our 5th year organizing the event and I believe we can call it a great success. A big thanks to Stericycle Communication Solutions for sponsoring the event, and for everyone that attended. For those I didn’t really get a chance to see and talk with, let’s make up for it tomorrow. Although, as I always tell people, the best part of the event is that there are hundreds of amazing people you can meet.

Here were two comments attendees made to me about the event, “That conversation right there was more valuable to me than any of the sessions at HIMSS.” And then this one from someone who’s been to at least four of the meetups, “This is always my favorite event.” What a blessing for me to take part in such a tremendous HIMSS social media community.

Enough with my social media experience at HIMSS. Today I had a number of really interesting conversations. Some of them I’ll be saving for future posts. However, one thing stood out to me today in my discussions with a new EHR vendor called Viztek and the multiple EHR vendor, Allscripts.

When I decided to meet with Viztek, I was intrigued by the fact that they were just launching a new EHR software. I wanted to see who wave brave (or crazy depending on perspective) enough to launch a new EHR software at this point in the game. Are 300+ EHR vendors not enough? Plus, I thought the market was suppose to be contracting and not growing.

I was actually impressed by what I found at Viztek. No doubt, in the short time I had during HIMSS, I didn’t have time to dig in really deep to evaluate the breadth of the EHR they’ve created, it’s usability and feature set. Instead, with our short time I wanted to understand the why and EMR market conditions that prompted them to build and launch another EHR software.

What’s particularly interesting about Viztek is that they have a full PACS and RIS software system that they’ve already been selling for a long time. They saw offering an EHR software as a natural extension to this offering. Considering there’s still some growth available in the ambulatory market, and in specialties where they have deep PACS needs (like ortho) I could see an opportunity. One of the most compelling reasons for a practice to go with the fully integrated PACs and EHR software is that it leaves only one vendor to look to when there are issues. Don’t underestimate the value of this. I’m not sure of the pricing of their EHR, but I won’t be surprised if like many other vendors the EHR is just a way to get access to and solidify their main revenue stream (in this case PACS).

On the other end of the spectrum was my meeting with Allscripts. In my discussion, I almost got the feeling (although, they certainly didn’t state this specifically), that EHR has become almost a commodity. The idea being that everyone is going to have an EHR and that the EHR market is going to be a heterogeneous environment. I assure you that the later is true and will be for the forseeable future. So, it makes a lot of sense why much of the focus of our conversation was around Allscripts efforts with DBMotion to provide a platform that brings together all the data from the heterogeneous EHR systems.

I was really intrigued by each of these companies and how far apart they are in their approach to EHR. At the one side of the spectrum I see a new EHR that’s still trying to provide the right EHR software for the physician. On the other hand, you have a vendor that’s always been known as an EHR vendor (and quite frankly still is with so many EHR software under one roof) is now shifting much of their focus to population health and ACO technology.

I’ve previously written that the Golden Age of EHR adoption is over. We’re entering into a much bumpier and brutal period of EHR transition. We’ll see if doctors get some relief from ONC on Thursday. Word at HIMSS is that on Thursday they’ll be announcing something important in regards to meaningful use (likely during one of the ONC/CMS keynotes). At the CHIME event they said something to the effect of, “we’ve heard you and we’re going to help.” I’ll be on a plane home, but no doubt the details will be tweeted live.

There you have it. A few of my thoughts from day 2 of HIMSS. Tomorrow’s my last day at the event. I have too many things scheduled, but we’ll do what we can to discover interesting content and share more with you tomorrow.

Also, be sure to check out my #HIMSS14 Twitter Roundup – Take Two

February 25, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

#HIMSS14 Day 1 – Interoperability, HIE and Social Media

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Well, this is technically my second or third day, but this is the first official day of HIMSS. It’s a mad house like you can imagine and the vendor hall is as big as you’d expect. You need about 3 weeks to go through it. I actually decided to do a walking meeting with someone and we basically walked the whole exhibit floor twice. Luckily, the conversation was good and we dove into some interesting topics. I also told them about my future mobile strategy for Healthcare Scene. She liked it. Hopefully I can roll it out in the next few months.

My day happened to start off with a lot of discussion on interoperability and HIE with MAeHC and then Orion Health. I think it’s really interesting to see the progress we’ve made when it comes to interoperability and HIE, but I also found it interesting that Micky Tripathi from MAeHC still described healthcare interoperability as being in its infancy. I largely agree with him and it’s really too bad. Although, it was also interesting to compare that to Orion Health talking about how they’ve proven that HIE can work. Plus, they also noted something I’ve written multiple times: Private HIEs are growing faster than the Public HIEs.

I’m still really torn on the business model for interoperability and HIEs. I don’t see a clear model in most situations. I even saw one tweet yesterday that talked about taxing on a per patient basis to pay for the HIE. I heard that in NY they’re actually literally working on a tax to fund it. However, I really think that calling it a per patient tax is a really bad way to describe the funding. I’ll certainly be covering more of my interoperability and HIE discussions in the future. Watch for those blog posts in the coming weeks.

I also did a lot of social media talk today. Together with Shahid Shah and Cari McLean we had a discussion about Social Media and Influence. It was great to see so many friendly faces in the audience. I feel lucky every chance I get to hear Shahid talk. He’s really good at reframing things in interesting ways. Plus, Cari has a unique perspective to offer from her perch on top of the HIMSS Social Media tower. I previously noted that social media has just become an integral part of HIMSS. What’s interesting is that most of the companies at HIMSS haven’t created it as an integral part of their company. Many are still learning, but it’s great to see them learn. I hope many will attend the Health IT Marketing and PR Conference where we dive in a lot deeper on these topics.

As I said to someone today, social media can provide value to every company, but not every company should do social media. Some companies aren’t ready to commit to doing social media the right way. Other companies aren’t ready to be that open and transparent. Social media is just one tool in the kit. Although, it’s a really powerful one if used properly. I’ve also been touched by the power of social media to help individuals. Social media has connected me to people that would have no doubt been back at their rooms or in the corner of the event wondering why they were there, but instead they’re out having a good time and connecting with other interesting people.

There you go. I talked about a number of other things today, but I’ll cover that over the weeks and months ahead. For now I’m calling my day today HIMSS HIE, Interoperability and Social Media day.

Be sure to also check out my #HIMSS14 Twitter Roundup and my post on Hospital EMR and EHR about the real cause of hospital readmissions. I think the later post will be a post I reference over and over as people continue to talk about solutions that reduce hospital readmissions.

February 24, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Did Meaningful Use Try to Do Too Much?

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When I was reading Michael Brozino’s post on EMR and EHR about the Value of Meaningful Use, I was hooked in by his comment that meaningful use standards only went halfway. I’m not sure if this was the intent of his comment, but I couldn’t help but sick back and consider if meaningful use missed the mark because it only went half way.

When I think about all of the various features of meaningful use, it really feels to me like ONC and CMS tried to bite off more than they could chew. They tried to be all things to everyone and they ended up being nothing to no one. Ok, that’s not perfectly correct, but is likely pretty close.

Think about all of the meaningful use measures. Which ones go deep enough to really have a deep and lasting impact on healthcare? By having so many measures, they had to water them all down so it wasn’t too much for an organization to adopt. I’m afraid these watered down measures and standards render meaningful use generally meaningless.

Certainly the EHR incentive money has stimulated EHR adoption. However, could this EHR adoption have had even more impact if it would have just focused on two or three major areas instead of dozens of measures with good intentions but little impact?

In many ways, this is just a variation on my wish that EHR incentive money would have focused on EHR interoeprability. As meaningful use stands today, we’ve made steps towards interoperability, but we’re still not there. Could we have achieved interoperability of health records if it had been our sole focus? Instead, we’re collecting smoking status and vital signs which get stored in an EHR and never used by anyone outside of that EHR (and some would argue rarely inside of the EHR).

The good news is we could remedy this situation. ONC and CMS have something called meaningful use stage 3. How amazing would it be if they essentially through out the previous stages and built MU stage 3 on 2-3 major goals? The foundation is there for MU stage 3 to have an enormous impact for good on healthcare, but I don’t think it will have that impact if we keep down the path we’re currently on.

Yes, I realize that a change like this won’t be easy. Yes, I realize that this means that someone’s pet project (or should I say pet measure) is going to get cut. However, wouldn’t we rather have 2-3 really powerful, healthcare changing things implemented than 24 measures that have no little lasting impact? I know I would.

Side Note: Think how we could simplify EHR Certification if there were only 2-3 measures.

February 12, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

One Platform to Connect to All EHR Software

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I’ve talked for years with people who want to solve the problem of connecting their non-EHR software to all the EHR vendors out there. Entrepreneur after entrepeneur has asked me how they can connect their product to ALL the EHR vendors. It usually ends up being a question like, “Isn’t there just one company we could connect to that will connect us to all the EHR vendors out there?”

I’ve dreamed about this as well. In fact, I recently wrote a post on Hospital EMR and EHR titled “Meaningful Use Drove the Data Gathering” where I suggest things like “EHR data is a treasure trove of opportunity.” and “In the future, EHR vendors will be differentiated more on the marketplace of third party applications they support than on their own in house developed apps.”

The problem is that even if every EHR vendor were to open up their application to third party applications, a startup company doesn’t want to have to integrate with all 300+ EHR vendors out there. Instead, they’d much rather integrate with one company who can connect them to all the other EHR vendors.

While a simple solution to connect to every EHR isn’t available yet, In a recent chat with Thanh Tran, Founder of Zoeticx, he showed me the closest thing to this vision that I’ve seen.

This slide shows what Zoeticx has built so far and a little bit of their vision for the future. When I saw this slide, it looked very much like what I described above.
Zoeticx Data Platform

As the slide shows, it only connects to 4 EHR vendors (5 EHR software) right now. So, they still have a lot of work to do to make this model work across all 300+ EHR vendors. However, it displays a vision of what’s possible if a company like Zoeticx builds the right middleware to connect EHR software to third party software.

After talking with Thanh Tran, you could tell that he lived, breathed, and loved the middleware space. He understood what it took to build a great middleware. For example, Zoeticx has a number of applications that leverage the middleware that they’re building. Some might argue that this makes Zoeticx a product company and not a middleware company. However, those that say this don’t understand what it takes to make great middleware.

By Zoeticx having some applications which leverage their middleware, they accomplish a couple very important things. First, they are essentially “eating their own dog food” and get to see first hand the challenges of building an application that uses their middleware. This will improve the middleware product better than any other technique. Second, Zoeticx applications will serve as essentially a set of demo applications which can be used to demonstrate what’s possible. Without these essentially demo applications, it’s often hard for people to understand how an API like Zoeticx can be used.

Certainly it’s possible that the Zoeticx application business is so good that they don’t go after the middleware opportunity. However, knowing Thanh’s background makes me think that this is an unlikely possibility. He wants Zoeticx to be a middleware company.

Thanh Tran also said something really intriguing about the latest EHR that they connected to their universal patient clinical data model (Zoeticx Patient Clarity). He said that when they added the new EHR, they didn’t have to change the Zoeticx Patient Clarity side of the equation at all. I’ll be interested to see how this plays out as they connect to more and more EHR vendors.

In fact, I believe that’s the next key step for Zoeticx. They need to connect with the other EHR vendors. Although, my guess is that once they get enough momentum behind what they’re doing, then they can provide an API for EHR vendors and other software vendors to create a gateway to Zoeticx. Then, they’ll have something really powerful.

It’s still early for Zoeticx. We’ll see how they do at attracting third party applications to their platform. We’ll see how their gateways to EHR vendors go and how they’re able to scale up the number of EHR vendors they work with. However, their vision gave me some hope that we could have a simple model for entrepreneurs that want to connect their health IT software with multiple EHR software with one integration.

February 6, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.