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Interesting and Funny Insights Into EHR and Health Information Management

Posted on October 20, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

Last week I had the chance to attend the Craneware Summit in Las Vegas. It was a really interesting event where I had the chance to meet and talk with a wide variety of people from across the spectrum of healthcare. I love getting these added perspectives.

One of the sessions I attended was an E&M session which provided some really interesting insights into the life of an E&M coder and how they look at things. There’s a lot more to their job, but I tweeted these comments because they made me laugh and illustrated part of the challenge they face in a new EMR world.


I thought these immediate responses to the question were interesting. They came from a crowd of HIM and coding professionals. Overall, they were quite supportive of EMR it seemed.


Many doctors don’t understand this. That’s why so many coders still have jobs.


Too funny.


Said like a true coder.

Are You a Healthcare Data Hoarder?

Posted on October 16, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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’m thinking I need to start a new healthcare reality TV show called “Healthcare Data Hoarders.” We’ll go into healthcare institutions (after signing our HIPAA lives away), and take a look through all the data a healthcare organization is storing away.

My guess is that we wouldn’t have to look very far to find some really amazing healthcare data hoarders. The healthcare data hoarding I see happening in comes in two folds: legacy systems and data warehouses.

Legacy Systems – You know the systems I’m talking about. They’re the ones stored under a desk in the back of radiology. The software is no longer being updated. In fact, the software vendor is often not even around anymore. However, for some reason you think you’re going to need the data off that system that’s 30 years old and only one person in your entire organization knows how to access the legacy software. Yes, I realize there are laws that require healthcare organizations to “hoard” data to some extent. However, many of these legacy systems are well past those legal data retention requirements.

Data Warehouses – These come in all shapes and sizes and for this hoarding article let me suggest that an EHR is kind of a data warehouse (yes, I’m using a really broad definition). Much like a physical hoarder, I see a lot of organizations in healthcare that are gathering virtual piles of data for which they have no use and will likely never find a way to use it. Historically, a data warehouse manager’s job is to try and collect, normalize, and aggregate all of the healthcare organizations data into one repository. Yes, the data warehouse manager is really the Chief Healthcare Data Hoarder. Gather and protect and and all data you can find.

While I love the idea that we’re collecting data that can hopefully make healthcare better, just collecting data doesn’t do anything to improve healthcare. In fact, it can often retard efforts to leverage healthcare data to improve health. The problem is that the healthcare data that can be leveraged for good is buried under all of this useless data. It takes so much effort to sift through the junk data that people just stop before they even get started.

Are you collecting data and not doing anything with it? I challenge you to remedy that situation.

Is your healthcare organization a healthcare data hoarder?

8 Steps to Creating a Solid EHR Foundation – Breakaway Thinking

Posted on October 15, 2014 I Written By

The following is a guest blog post by Noelle Whang, Sr. Instructional Designer at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Noelle Whang
Implementing an electronic health record (EHR) is a huge undertaking, but the work after go live can be even more demanding. Mapping and redesigning workflows is an important aspect of EHR implementation and optimization that is often overlooked, especially after the application has been live for a while.  This seemingly simple but complex task involves diagraming and analyzing all current work processes and adjusting them to include use of a new EHR system or upgrade, or to be more effective with a current system.

Workflow mapping and redesign should occur before implementation and regularly after go live to ensure end users truly adopt the EHR and organizational benefits are realized. Following these eight steps can ease the task of mapping workflows to identify any that should be adjusted to maximize optimization:

  1. Identify what workflows will need to be mapped in detail. “Understanding the full clinical context for health IT to the level of task, resources, and workflow is a necessary prerequisite for successful adoption of health IT,” according to a Perspectives in Health Information Management article. It’s helpful to first map out the entire patient care process at a high level, such as from registration to discharge in the inpatient setting and scheduling to check-out in the ambulatory setting. Documenting how business is performed at a high-level facilitates identifying the more granular tasks that need to be mapped in detail, such as scheduling a patient appointment or placing verbal orders.  It also helps in identifying all the roles involved in each workflow, as these can vary depending on the department or patient process.  For example, discharging a patient from Labor and Delivery may include roles, such as a lactation nurse and pediatrician, not found in other departments.  Remember to also consider departments or patient processes that are often overlooked, such as Materials Management and Respiratory Therapy. Other areas of concentration should be those with lower productivity or that relate to how the organization is going to determine return on investment.
  1. Identify teams to map out each process. After identifying what workflows need to be mapped, establish the team that will do the actual mapping. Usually, individuals who perform a particular workflow or those who are responsible for implementing any redesign changes are best suited to map workflows, as they have in-depth knowledge of the process. For example, select one registrar, one nurse and one physician to map out all workflows in the Emergency Department.
  1. Determine the process for mapping the workflows. Once the team has been identified, determine how information about workflows will be gathered, documented, and visually represented. The process for gathering information can be through interviews, observation, or meetings.  The information can be documented with tools such as Microsoft Word or Visio or simply on paper.  The data can be represented in formats such as a swim lane chart, a flow process chart or other process diagrams.   In my experience mapping out workflows, the most commonly used format is a swim lane chart created through Visio.  And remember: Internal staff will most likely need to be trained on how to gather the data and use the appropriate tools.
  1. Map the workflow as actually performed. After determining how information is gathered and documented, create the actual workflows diagrams.  Document all work as it is currently being performed, including any undesirable behavior such as workarounds or inconsistencies.  For a case study on how one organization created their workflow diagrams, see the following Journal of American Medical Information Association article.
  1. Analyze the workflow. Once the workflows are diagramed, begin the analysis. If a vendor has not been selected, use the diagrams to determine if a particular application fits the needs of your organization, with the caveat that it is neither feasible nor desirable to keep workflows exactly the same after an implementation.  If the application is already in place, the diagrams can be used to determine where problems are occurring, what the root cause is, and how to fix them.  The diagrams can also be used to determine where optimization or efficiencies may be gained.
  1. Document the new workflow. Once the analysis is complete and you have determined what workflows are currently not working for your organization, document the new and improved workflow.  It is a good idea to take the new workflows through a couple of use-case scenarios to ensure that the updates are not causing other problems or unintended consequences.
  1. Update or create policies and procedures. New or updated policies and procedures may be necessary to implement and support the new workflow. This can include determining consequences for any end users that do not adhere to the new workflows.  Note that this also requires thinking about how non-adherence will be identified, perhaps through routine application audits or quarterly in-department observation.
  1. Train staff. After all the hard lifting of creating the workflow diagrams, analyzing the processes and updating the workflows, the last step is to train end users on the new workflows, policies and procedures.  Remember to convey why the changes are occurring, and if possible, tie the reasons to big-ticket items such as increasing patient safety and satisfaction.

It’s easy to focus entirely on big tasks such as vendor selection and system configuration when implementing an EHR, but neglecting workflows can have serious negative impacts, including costly reconfigurations and operational inefficiencies.  It’s like building a house where each individual room is perfect, but the doors are all in the wrong place. With poor design you end up having to go through the closet to get to the kitchen, or even worse the foundation may begin to crack.  Similarly, with poorly designed EHR workflows, you can end up with duplicate documentation, activities that take more time than they should, and workarounds or shortcuts that can lead to negative consequences. Set your healthcare organization up for success and create a solid foundation by making workflow mapping and redesign a priority.

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

Google Helpouts Tested in Google Search Results – Dr. Google?

Posted on October 13, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

It was first noticed by someone on Reddit and then confirmed by Engadget that Google has been testing a Google Helpout style feature which offers a telemedicine video visit with a doctor. You can see an image of the test Google search telemedicine integration below:
Google Helpout - Google Search Integration

This is a really interesting integration for a number of reasons. First, Google wasn’t charging for these initial test visits, but would no doubt charge for these visits in the future. Second, it takes an Act of God to get Google to integrate something into their cash cow: search results. That should tell us how serious Google is about doing these types of integrations.

I can already hear the naysayers who think this is a terrible idea. They might be right as a business. We’ll have to see how that plays out. The reimbursement model could a challenging one. Plus, there are plenty of reasons why this won’t work. Google will have to get really good at knowing when to offer a visit and when not to offer a visit. We’ll see if they want to make the investment required to understand when the visit is something that should be encouraged and when it shouldn’t be encouraged.

One thing I’ve observed with Telemedicine is that it can really work well…if you have the right situation. The reason Telemedicine has gotten a bad rap is that the naysayers have plenty of ammo they can use to explain why Telemedicine could be a terrible thing. These naysayers are correct. There are a bunch of healthcare situations where a telemedicine visit just isn’t going to work. However, just because something doesn’t solve 100% of the situations doesn’t mean it shouldn’t be used for the 30% of the time (I think it could be more than this) that it’s a beautifully elegant solution that’s just as effective as an in office visit?

As noted, this was just at trial by Google. Google is well known for trying things to see how they do and then scraping them after the trial. So, we’ll see how this goes. It does seem that Google can’t keep its hands out of healthcare. I think they see the trillion dollar industry and just can’t resist.

Patient Shark Tank at Digital Health Conference

Posted on October 10, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As most of you know, I’ve been working with NYeC to promote the Digital Health Conference since the very first Digital Health Conference 4 years ago. It’s a great event and I get a chance to meet many of you readers there. Plus, I just love spending time in NYC. If you’ve never been, you can register here (20% off your registration when you use the discount code: HCS).

I just heard about a new feature at the conference this year: The Patient Shark Tank. Here’s a description of what they have in store:

How do we ensure that the patient voice is amplified in the design, the development, or enhancement of innovations created FOR the patient? Patient communities are emerging as key influencers and disrupting the healthcare landscape. They are impacting strategies, policies, and setting the stage for new patient-centric innovations. Patients are now sought after thought leaders influencing the way healthcare systems think about and interact with patients and prodding them to improve the patient experience.

Join us as our judges rate innovations from the patient and caregiver perspective and innovators build their perspective into the innovations designed to serve them. As each innovator pitches their concept or initiative, our patient and caregiver panelists will ask targeted questions based on their experiences to understand how the innovation uniquely addresses patient needs. In addition, we will integrate clinician perspective to understand whether a doctor would prescribe the innovation to their patients.

I’m a huge fan of Shark Tank, so I love the idea. I only hope that they’ve got a line up of judges that are as entertaining as Shark Tank. Sometimes these events can get pretty bland if they choose judges who are shy about sharing their opinions on a company or product. That doesn’t benefit the companies or the audience.

Unfortunately, you won’t have much time to get your idea submitted. The deadline to apply to pitch your innovative concept or initiative is Thursday, October 16th. I look forward to seeing what ideas get pitched at the event.

Building Accountability and Consistency Into Your Healthcare Practice

Posted on October 9, 2014 I Written By

The following is a guest post by Vishal Gandhi, CEO of ClinicSpectrum as part of the Cost Effective Healthcare Workflow Series of blog posts. Follow and engage with him on Twitter @ClinicSpectrum and @csvishal2222.
Vishal Gandhi
One of the biggest challenges a leader in any organization faces is building accountability into their workflow. While we’d all like to think that we’re hiring great people that will always work at a high level, we all know that even the best people’s work improves when you build in some accountability for the work they do.

What I’ve found in the hundreds of practices I’ve seen is that the majority of people in a medical practice are working hard. Sure, there are the outliers that are just coasting through the day, watching the clock for when they can punch out, but we all can recognize and deal with those people pretty well. The harder challenge is those staff who are working really hard, but are busy working on the wrong things.

How do you make sure that someone in your practice is working on the right things? The simple answer is to track and report on the work that matters most in your office. In some cases, this report can be something as simple as a text message or email. In other cases, you might automate the reporting so that the accountability is built directly into the practice’s regular workflow.

Reporting and accountability is an extremely powerful concept for a practice. Not only does it ensure that the practice is working on the right things, but it improves productivity as well. Reports that are collected and checked regularly encourage your employees to work harder and be more productive. It’s just human nature for people to want to look good on a report. This is a powerful part of accountability and reporting.

However, let me offer a few words of caution when it comes to measuring, tracking, and reporting on productivity in your office. First, make sure that you’re clear with your staff on why these reports are important to the office. Second, be sure they understand that you’ll be working together with them to make sure that you’re tracking and reporting is accurate and focused on the right things. Accountability and reporting is a double edged sword. If you’re tracking the right things, it can lead to tremendous results. If you’re tracking the wrong things, it can lead to negative results. Don’t be afraid to make adjustments to what you’re doing. Also, be generous with your staff and understanding when something doesn’t look or feel right. Dig into the data with them to find the real story before jumping to conclusions. Then, make corrections if necessary.

Be sure to leverage technology where it makes sense to automatically track and report the data that matters. Your goal should be to work with your staff to create a consistent and expected workflow that efficiently measures and reports on the key metrics for your organization. Not only will this consistency make your staff more efficient, but it will make it much easier when staff don’t show up to work due to some family emergency or the inevitable staff turnover.

When you create a practice that is process dependent instead of people dependent, it opens up all sorts of options and flexibility for your practice. This shift in mentality provides a buffer where a strategic sourcing partner can cover any “down time” your office may experience during staff emergencies or staff turnover. Plus, your ongoing tracking and reporting is the perfect way to hold this sourcing partner accountable for the work they do for your practice.

These measurements and reports also serve as a baseline benchmark for your practice going forward. As your staff turns over, you can easily assess the health of your practice and the quality of your future hires using these benchmarks. Plus, as you improve your clinic’s efficiency, you and your staff will be able to celebrate the success of beating previous benchmarks. In future posts, we’ll look at what benchmarks matter most and comparing your practice’s benchmarks against national benchmark data.

The Cost Effective Healthcare Workflow Series of blog posts is sponsored by ClinicSpectrum, a leading provider of workflow automation solutions for healthcare. Their Productivity Spectrum product provides a simple monitoring tool that provides time clock functionality, benchmarking and compliance, performance analysis, and productivity management for clinical practices. Stop by the ClinicSpectrum booth at MGMA (Booth 330) for more info.

Meaningful Use Hardship Exceptions Reopened

Posted on October 8, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

CMS has announced its intent to reopen the Meaningful Use Hardship Exceptions filing period and set the new deadline for MU hardship exceptions to November 30, 2014. With the new hardship exception extension, providers can now choose from a number of reasons why they were unable to attest in time. Here’s the details from the CMS announcement:

This reopened hardship exception application submission period is for eligible professionals and eligible hospitals that:
* Have been unable to fully implement 2014 Edition CEHRT due to delays in 2014 Edition
CEHRT availability; AND
* Eligible professionals who were unable to attest by October 1, 2014 and eligible hospitals that were unable to attest by July 1, 2014 using the flexibility options provided in the CMS 2014 CEHRT Flexibility Rule.

These are the only circumstances that will be considered for this reopened hardship exception
application submission period.

This is a big move since the meaningful use hardship exceptions deadline for hospitals was April 1, 2014 and July 1, 2014 for eligible professionals. I imagine there are many organizations that will benefit from this extension. Although, there are probably quite a few organizations that wish they’d known about this exception before now or that think the exceptions are too narrow (ie. they can’t benefit from them).

What are your thoughts on this extension?

Patient Education, Records vs People, CareFusion Bought, and HIT Startup Story – Twitter Roundup

Posted on October 6, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

Every once in a while I like to take a tour around Twitter and share some of the interesting tweets I’ve found. Plus, I usually provide a little bit of commentary on each. Here are a few that interested me today.


Quite the imagery indeed. I’ve been fascinated with images lately. You can consume them in a few seconds and it communicates something so quickly.


Lawrence Weed, MD was way ahead of his time. The EHR can easily make us forget about the person if we’re not careful. Reimbursement and MU checkoff lists don’t help either.


Not a bad day to be at CareFusion. Bought by BD for $12.2 Billion. It is interesting that Cardinal Health created it, spun it off and then its competitor bought it. A little too inside baseball for me.


This article is a great read if you’re a health IT startup company. I love Jeff’s description of the black box of healthcare. It’s true that if you try to have them come out of the box and do something different, it’s extremely hard. If you do something that feeds the black box, then they’ll buy it. Sad, but true.

Fun Friday Video from ZDoggMD

Posted on October 3, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The famously funnier than placebo and CEO of Turntable Health, ZDoggMD, has put out a great new healthcare parody video to Garth Brooks, Friends in Low Places. The video is called “Friends with Low Platelets.”

Turns out, I just discovered that ZDoggMD and I will be sharing the same stage at the Modernizing Medicine EHR user conference, EMA Nation, as part of my Fall Health IT conference schedule. I’ll let ZDoggMD go for the funny talk and I’ll take a more emotional storytelling approach. Should make for a great event.

Side Note: It’s great that Las Vegas is finally being recognized for it’s amazing Healthcare thought leaders (ZDoggMD and myself are both in Las Vegas). Ok, Las Vegas isn’t a hub for healthcare. We’re definitely punching above our weight class, but there’s something to say about Las Vegas doing interesting things in healthcare and health IT.

Confusing HIPAA Compliance With Security

Posted on October 2, 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.

Most people  who read this publication know that while HIPAA compliance is necessary, it’s not sufficient to protect your data. Too many healthcare leaders, especially in hospitals, seem satisfied with the song and dance their cloud vendor gave them, or the business associate that promises on a stack of Bibles that it’s in compliance.

I was reminded of this just the other day when Reuters came out with some shocking statistics. One particularly discomforting stat it reported was the fact that medical data is now worth 10 times more than your credit card number on the black market (even if John has argued otherwise). Why? Well, among other things, because medical identity theft isn’t tracked well by providers and payers, which means that a stolen identity can last for months or years before it’s closed down.

Healthcare is not only lagging behind other industries in terms of its hardware and software infrastructure, but the extent to which its executives give a care as to how exposed they are to a breach. Security experts note that senior executives in hospitals see security as a tactical, not a strategic problem, and they don’t spend much time or money on it.

But this could be a deadly mistake. As Jeff Horne, vice president at cybersecurity firm Accuvant, noted to Reuters, “healthcare providers and hospitals are just some of the easiest networks to break into. When I’ve looked at hospitals, and when I’ve talked to other people inside of a breach, they are using very old legacy systems – Windows systems that are 10+ years old that have not seen a patch.”

As if that wasn’t enough, it’s been increasingly demonstrated that medical devices — from infusion pumps to MRIs — are also frighteningly vulnerable to cyber attacks. The vulnerabilities might not be found for months, and when they are, the hapless provider has to wait for the vendor to do the patching to stay in FDA compliance.

So far, even the biggest HIPAA breaches — notably the 4.5 million patient records stolen from hospital giant Community Health Systems — don’t seem to have generated much change. But the sad truth is that unless hospitals get their act together, focused senior executive attention on the issue, and spend enough money to fix the many vulnerabilities that exist, we’re likely to be at the forefront of a very ugly time indeed.