Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and HIPAA for FREE!!

Looking at EHR Internationally

Posted on August 24, 2016 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.

Today, I’m sitting in my hotel room in Dubai (Check out my full health IT conference schedule) looking out over this incredible city. This is the 3rd time I’ve come to Dubai to teach an EHR workshop and so I’ve had a chance to fall in love with some many things. Not the least of which is the people that come to participate in the workshop. Each time is a unique perspective with people coming from around the middle east including countries like Saudia Arabia, Oman, Bahrain, Qatar, and of course Abu Dhabi and Dubai in the UAE to name a few.

There’s something incredible about coming to a place that is culturally so different and yet when I talk about EHR software it’s more alike than it is different. A great example of this is the often large divide between doctors and EHR implementers. It seems that everyone struggles to get doctors to take enough time to really learn how to use the EHR effectively. Then, despite not doing the training they complain that the EHR doesn’t work properly. If you’ve ever been part of an EHR implementation you know this cycle well.

What I find interesting in the middle east is that they don’t feel suffocated by regulations like we have in the US. There’s much more freedom available to them to innovate. However, there’s not the same drive to innovate here that exists in most US markets. It’s interesting to sense this disconnect between the opportunity to innovate and the desire to innovate.

I think there’s also a bit of a misconception about the region. From the US perspective, we often see these rich middle eastern countries and think that they just have as much money as they want and they can spend lavishly on anything. When you look at some of the amazing buildings or the indoor ski slopes in Dubai it’s easy to see how this perspective is well deserved. However, that’s not the reality that most of these healthcare organizations face. This seems to be particularly true with gas prices being quite low. In many ways, this is a similar to what many doctors experience. Doctors like to drive the Mercedes, but then complain that they aren’t really paid as much as people think. That creates a disconnect between what’s seen and the reality. I think the middle east suffers from this disconnect as well.

What’s most heartening about the experience of talking EHR internationally is that there’s one core thing that seems to exist everywhere. That’s a desire to truly make a difference for the patient. That’s the beautiful part of working in healthcare. We all have a desire to make life better for a patient. It’s amazing how this principle is universal. Now, if we could just all execute it better.

Symptoms of the Healthcare Debate

Posted on August 19, 2016 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.

This healthcare cartoon seemed to capture my feelings about much of the healthcare debate that’s happening right now. It’s even worse thanks to the current presidential race.
Healthcare Cartoon - Symptoms of the Healthcare Debate

This cartoon might offer a much simpler explanation for the healthcare cost challenges we face:
Healthcare Costs in the US

A part of me just wants to turn it all off, but it’s a battle that’s too important to ignore. Have a great weekend!

Improving Clinical Workflow Can Boost Health IT Quality

Posted on August 18, 2016 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.

At this point, the great majority of providers have made very substantial investments in EMRs and ancillary systems. Now, many are struggling to squeeze the most value out of those investments, and they’re not sure how to attack the problem.

However, according to at least one piece of research, there’s a couple of approaches that are likely to pan out. According to a new survey by the American Society for Quality, most healthcare quality experts believe that improving clinical workflow and supporting patients online can make a big diference.

As ASQ noted, providers are spending massive amounts of case on IT, with the North American healthcare IT market forecast to hit $31.3 by 2017, up from $21.9 billion in 2012. But healthcare organizations are struggling to realize a return on their spending. The study data, however, suggests that providers may be able to make progress by looking at internal issues.

Researchers who conducted the survey, an online poll of about 170 ASQ members, said that 78% of respondents said improving workflow efficiency is the top way for healthcare organizations to improve the quality of their technology implementations. Meanwhile, 71% said that providers can strengthen their health IT use by nurturing strong leaders who champion new HIT initiatives.

Meanwhile, survey participants listed a handful of evolving health IT options which could have the most impact on patient experience and care coordination, including:

  • Incorporation of wearables, remote patient monitoring and caregiver collaboration tools (71%)
  • Leveraging smartphones, tablets and apps (69%)
  • Putting online tools in place that touch every step of patient processes like registration and payment (69%)

Despite their promise, there are a number of hurdles healthcare organizations must get over to implement new processes (such as better workflows) or new technologies. According to ASQ, these include:

  • Physician and staff resistance to change due to concerns about the impact on time and workflow, or unwillingness to learn new skills (70%)
  • High cost of rolling out IT infrastructure and services, and unproven ROI (64%)
  • Concerns that integrating complex new devices could lead to poor interfaces between multiple technologies, or that haphazard rollouts of new devices could cause patient errors (61%)

But if providers can get past these issues, there are several types of health IT that can boost ROI or cut cost, the ASQ respondents said. According to these participants, the following HIT tools can have the biggest impact:

  • Remote patient monitoring can cut down on the need for office visits, while improving patient outcomes (69%)
  • Patient engagement platforms that encourage patients to get more involved in the long-term management of their own health conditions (68%)
  • EMRs/EHRs that eliminate the need to perform some time-consuming tasks (68%)

Perhaps the most interesting part of the survey report outlined specific strategies to strengthen health IT use recommended by respondents, such as:

  • Embedding a quality expert in every department to learn use needs before deciding what IT tools to implement. This gives users a sense of investment in any changes made.
  • Improving available software with easier navigation, better organization of medical record types, more use of FTP servers for convenience, the ability to upload records to requesting facilities and a universal notification system offering updates on medical record status
  • Creating healthcare apps for professional use, such as medication calculators, med reconciliation tools and easy-to-use mobile apps which offer access to clinical pathways

Of course, most readers of this blog already know about these options, and if they’re not currently taking this advice they’re probably thinking about it. Heck, some of this should already be old hat – FTP servers? But it’s still good to be reminded that progress in boosting the value of health IT investments may be with reach. (To get some here-and-now advice on redesigning EMR workflow, check out this excellent piece by Chuck Webster – he gets it!)

Taking Healthcare Communication to the Next Level

Posted on August 17, 2016 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.

As most of you know, we’ve been doing an ongoing series of Healthcare Scene Interviews where we talk to top leaders in healthcare IT. They’ve been a huge success and we just passed our 50th video interview. If you’ve attended one of our live interviews, you know that we grew quite fond of the Blab platform that we used to host these interviews. Unfortunately, we just got word that Blab has been shutdown. It was a sad day, but we still have options.

While we loved Blab, we use to do our interviews on Google Hangouts and so we’re planning to go back there again to keep bringing you great content and discussion about the challenges that face Healthcare IT. Plus, Google Hangouts has been merged into YouTube Live and that brings some great opportunities for those watching both the live and recorded version at home including being able to Subscribe to Healthcare Scene on YouTube.

With that as background, I’m excited to announce our next Healthcare interview happening Friday August 19, 2016 at 11:30 AM ET (8:30 AM PT) where we’ll be talking about “Taking Healthcare Communication to the Next Level.” This is an extremely important and challenging topic, but we’ve lined up a number of incredible experts to take part in our discussion as you’ll see below:

Taking Healthcare Communication to the Next Level-Headshots

You can watch the interview live and even join in the conversation in the chat on the sidebar by watching on the Healthcare Scene YouTube page or the embedded video below:


(You’ll have to visit the YouTube page to see the live chat since the embed doesn’t include the chat.)

We look forward to learning about healthcare communication from this panel of experts. Please join us and offer your own insights in the chat or ask these amazing panelists your most challenging questions.

Be sure to Subscribe to Healthcare Scene on YouTube to be updated on our future interviews or watch our archive of past Healthcare Scene Interviews.

One Example Of Improving Telehealth Documentation 

Posted on August 16, 2016 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.

Over the past year or two, the pressure has risen for providers to better document telehealth encounters, a pressure which has only mounted as the volume of such consults has grown. But until recently, telemedicine notes have been of little value, as they’ve met few of the key criteria that standard notes must meet.

The fact that such consults aren’t integrated with EMRs has made such an evolution even trickier. I guess doctors might be able to squeeze the patient’s video screen into one corner, allowing the clinician to work within the existing EMR display, but that would make both the consult and the note-taking rather inefficient, wouldn’t it?  The bottom line is that if telemedicine is to take its place alongside of other modes of care, this state of affairs is unsustainable.

For one thing, health plans that reimburse for telehealth services won’t be satisfied with vague assurances that such care made a difference – they’ll want some basis for analyzing its impact, which can’t be done without at least some basic diagnostic and care-related information. Also, providers will need similar records, for reasons which include the need to integrate the information into the patient’s larger record and to track the progress of this approach.

All of which is to note that I was happy to stumble across an example of a telemedicine provider that’s making efforts to improve its consult notes. While the provider, Doctor on Demand, hasn’t exactly reinvented the telehealth record, it’s improving those records, and to my way of thinking that deserves a shout-out.

As some readers may know, Doctor on Demand is a consumer-facing telemedicine provider which offers video visits with primary care doctors, counselors and psychiatrists. Its competitors include HealthTap and American Well. Because the company works with my health plan, United Healthcare, I’ve used its services to deal with off-hours issues as they arise.

Just today I had a video visit with a Doctor on Demand doctor to address a mild asthma care issue, after which I reviewed the physician’s notes. When I did so, I was happy to see that those notes included a ICD-10 diagnosis code. The notes also incorporated a consumer-level summary of what the diagnosed condition was, what to do about it, what its prognosis was and how to follow up. Essentially, Doctor on Demand’s notes have evolved from a sentence of two of informal suggestions to a more-structured document not unlike a set of hospital discharge instructions.

Don’t get me wrong, I’m certainly well aware that these are just baby steps. Doctor on Demand will have to move a lot further in this direction before consult documentation offers much to other providers. That being said, adding a formal diagnosis code gives the company a better means for analyzing key patterns of utilization internally by presenting condition, which can help its leaders look at whom they serve. Doctor on Demand can also use this information to pitch deals with potential partners, by sharing data on its population and underscoring its capabilities. In other words, these changes should make an impact.

Ultimately, telehealth documentation will have to meet the same expectations that other healthcare documentation does. And it’s not clear to me how freestanding telemedicine firms like Doctor on Demand will bridge that gap. After all, generating complete documentation takes far more than a few useful gestures. Even if the company threw a high-end EMR at the problem, merging it with the existing workflow is likely to be a huge undertaking. But still, making a bit of progress is worthwhile. I hope Doctor on Demand’s competitors are taking similar steps.

Major IT Projects and Consulting – Fun Friday

Posted on August 12, 2016 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.

It’s Friday and so time for a little bit of healthcare IT humor. This one probably hits home if you’re working in a major health system and are suffering in a mess of projects. When you think about it, it’s no wonder that so many health systems have gone all in with one death star EHR.

Star Wars Enterprise Health IT Cartoon

This is humorous until you have to pay the consulting bill. This message is an old one and well worth remembering as you work with consultants. Consultants aren’t bad, but be sure you use them effectively.
Consulting Despair Graphic

Modern Day Healthcare Tools and Solutions Can Enhance Your Brand Integrity and Patient Experience

Posted on August 11, 2016 I Written By

The following is a guest blog post by Chelsea Kimbrough, a copywriter for Stericycle Communication Solutions as part of the Communication Solutions Series of blog posts. Follow and engage with them on Twitter: @StericycleComms
Chelsea Kimbrough
Digitally speaking, the healthcare market is more crowded than ever – and finding the perfect provider, practice, or physician online can quickly become an arduous task for even the most tech-savvy patient. But healthcare organizations that dedicate the time, effort, and resources to create a unique digital presence, enhance their search engine optimization (SEO), and reinforce their brand integrity can cut through oversaturated search results to acquire and retain more patients.

In today’s consumer-driven world, shopping for the ideal healthcare organization is quickly becoming the norm. More and more frequently, patients are turning toward the internet during their hunt. In fact, 50 percent of millennials and Gen-Xers used online reviews while last shopping for a healthcare provider. And with 85 percent of adults using the internet and 67 percent using smartphones, accessing this sort of information is easier than ever before.

This ease of access has led patients to adopt more consumer-like behaviors and expectations, such as valuing quality and convenience. Healthcare organizations that proactively ensure their brand image, digital presence, and patient experience cater to these new expectations could be best positioned to thrive. By providing convenient, patient-centric healthcare tools and services, organizations can help facilitate this effort throughout every step of the patient journey.

One such tool is real-time, online appointment self-scheduling, which 77 percent of patients think is important. In addition to adding a degree of convenience for digitally-inclined patients, online self-scheduling tools can support your healthcare organizations’ key initiatives – including driving new, commercially insured patient growth. By using an intuitive way to quickly schedule an appointment, potential patients’ shopping process can be halted in its tracks, ensuring more patients choose your organization over a competitor’s. And with the right tool, your search rankings and discoverability, or SEO, could be significantly enhanced.

Reaching patients where they are most likely to be reached is another way to improve your brand experience. Like consumers, patients are often connected to their phones – so much so that text messages have a 98 percent open rate. Organizations that leverage automated text, email, and voice reminders can successfully communicate important messages, boost patients’ overall satisfaction and health, and improve appointment and follow-up adherence – ultimately setting themselves apart from competitors.

Other digital tools, technologies, and communication strategies can help fortify your brand’s digital standing and patients’ satisfaction, including social media outreach, useful email campaigns, and more. Whatever method – or methods – best serve your organization, it’s important they help improve your SEO, enhance patients’ overall accessibility and experience, and support your brand values and initiatives.

The Communication Solutions Series of blog posts is sponsored by Stericycle Communication Solutions, a leading provider of high quality telephone answering, appointment scheduling, and automated communication services. Stericycle Communication Solutions combines a human touch with innovative technology to deliver best-in-class communication services.  Connect with Stericycle Communication Solutions on social media:  @StericycleComms

If MACRA Fails, It Will Be a Failure of IT, Not Doctors or Regulators

Posted on August 8, 2016 I Written By

The following is a guest blog by Steve Daniels, president of Able Health.

There has been a whole lot of mudslinging over the last month between regulators and healthcare providers over MACRA, which shifts Medicare payments further toward pay-for-performance starting January 1. On the one hand, CMS Acting Administrator Andy Slavitt is clear that CMS is ready for change. “We need to get out of the mode of paying physicians just to run tests and prescribe medicines,” he told a Senate Finance Committee hearing. Meanwhile, Dr. Thomas Eppes of the American Medical Association has called MACRA a “quantum shift” and pushed for a delay.

Yes, the Medicare Quality Payment Program instituted by MACRA should—and will—evolve based on comments made on the proposed rule. But the reality is the program provides enormous opportunity for providers to increase bonus payments, while streamlining reporting requirements across a patchwork of outdated and duplicative programs. And it’s worth noting that the potential penalties under the Merit-Based Incentive Payment System (MIPS) over the next four years are actually lower than the sum of the penalties of the programs it is replacing.

To meet MACRA goals, it will take a well-prepared team of providers and administrators—empowered by data and well-designed tools. Doctors can’t be solely responsible for achieving patient outcomes, reducing costs and documenting it all for CMS as they go. Unfortunately, the history of health IT has not been kind—or affordable—to doctors. And today, the health IT stack has a new challenge—keeping pace with the proliferation of value-based programs, from accessing data all the way through enabling new clinical practice.

We must move from a mindset of meeting Meaningful Use checkboxes toward supporting a more effective way of operating. And in the modern world of software-as-as-service, there’s no good reason left that IT needs to cost providers millions of dollars. We can do better. As things stand, if MACRA fails, it will be a failure of IT, not doctors or regulators.

Gathering all the data

For value-based care to work, patient data needs to be made available for providers to coordinate with each other, as well as to payers, to properly evaluate performance based on all known information. Those still blocking or jacking up prices for data access are complicit in obstructing the vision of a learning value-based system.

It is time to remove technical barriers through modern and open data standards like FHIR, as well as rules and unreasonable fees that prevent parties from accessing data when they need it. Thankfully, the Advancing Care Information performance category will reflect the emphasis on information exchange set forth in Meaningful Use Stage 3.

Calculating performance flexibly

The new era of performance-based pay requires continuous monitoring of quality and cost, with the ability to track progress across multiple programs on an ongoing basis. To measure quality today, we often use static algorithms hard-coded by EHRs vendors and health system IT departments, conforming to standards set by NCQA or CMS.

But providers need tools that are tailored not just to one or two programs like Meaningful Use and PQRS, but across the organization’s full range of value-based programs as these program continue to expand, evolve, and proliferate. With efforts to standardize IT for quality measures stalling, vendors need to focus less on one-size-fits-all quality measure calculations and more on flexible systems that enable measures to be rapidly constructed and customized to move with the trends. Expect change to be the norm.

Informing new behaviors

With so many health IT professionals focused on gathering and reporting data, it is not surprising that design has taken a back seat so far. But this year, not a single population health vendor earned an “A” rating from Chilmark, due to poor user engagement and clinical workflow. This is no longer acceptable. The challenge of enabling the new clinical and administrative behaviors associated with value-based care is too vast. User experience must be top of mind for any IT implementation, with representative users involved from the start. We have seen the impact of poor user experience in the fee-for-service system, from frustrated clinicians to alarming patient safety issues.

Design is even more important when the challenge is not just documenting billing codes but also achieving health outcomes for patients across a care team. Don’t bombard clinicians with notifications and force clumsy form-filling. Instead, employ best practices from cognitive psychology to inform professionals with lightweight and intelligent touchpoints. Automate documentation and interpretation of data wherever possible.

A new era of health IT

Whether or not it’s delayed, the Quality Payment Program is coming. And the healthcare industry is moving inexorably toward value-based care. Will health IT step up to the challenge of building toward a value-based future that is accessible to all providers? Or will we sit back and wait for the next list of requirements?

About Steve Daniels
Steve Daniels is the President of Able Health, which helps providers succeed under MACRA and value-based programs. Formerly the design lead for IBM Watson for healthcare and a lifelong patient advocate, he is passionate about the role of open data exchange and intuitive experience design in fostering a continuously improving healthcare system. Find him on Twitter and LinkedIn.

ZDoggMD Sings 7 Years (A Life In Medicine) – The Path to Health 3.0

Posted on August 5, 2016 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.

Rather than try to explain this ZDoggMD video, I thought this comment from Riley Mcnamara on ZDoggMD’s latest video described it best:

I’m dealing with a lot of crap right now in the clinic, we’re over booked with patients, EHR headaches, and a never ending stream of useless bureaucracy. It’s been one of those weeks that made me question if I can do this. This made me feel better even if it’s just for a little bit! It’s not easy, but I’d never dream of doing anything else! Thanks man!

There truly is a battle going on for the future of healthcare and it’s a battle worth fighting. Thanks for the excellent work ZDoggMD! Shout out to HealthISPrimary.org as well. Check out the video below:

ONC Announces Winners Of FHIR App Challenge

Posted on August 3, 2016 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.

The ONC has announced the first wave of winners of two app challenges, both of which called for competitors to use FHIR standards and open APIs.

As I’ve noted previously, I’m skeptical that market forces can solve our industry’s broad interoperability problems, even if they’re supported and channeled by a neutral intermediary like ONC. But there’s little doubt that FHIR has the potential to provide some of the benefits of interoperability, as we’ll see below.

Winners of Phase 1 of the agency’s Consumer Health Data Aggregator Challenge, each of whom will receive a $15,000 award, included the following:

  • Green Circle Health’s platform is designed to provide a comprehensive family health dashboard covering the Common Clinical Data Set, using FHIR to transfer patient information. This app will also integrate patient-generated health data from connected devices such as wearables and sensors.
  • The Prevvy Family Health Assistant by HealthCentrix offers tools for managing a family’s health and wellness, as well as targeted data exchange. Prevvy uses both FHIR and Direct messaging with EMRs certified for Meaningful Use Stage 2.
  • Medyear’s mobile app uses FHIR to merge patient records from multiple sources, making them accessible through a single interface. It displays real-time EMR updates via a social media-style feed, as well as functions intended to make it simple to message or call clinicians.
  • The Locket app by MetroStar Systems pulls patient data from different EMRs together onto a single mobile device. Other Locket capabilities include paper-free check in and appointment scheduling and reminders.

ONC also announced winners of the Provider User Experience Challenge, each of whom will also get a $15,000 award. This part of the contest was dedicated to promoting the use of FHIR as well, but participants were asked to show how they could enhance providers’ EMR experience, specifically by making clinical workflows more intuitive, specific to clinical specialty and actionable, by making data accessible to apps through APIs. Winners include the following:

  • The Herald platform by Herald Health uses FHIR to highlight patient information most needed by clinicians. By integrating FHIT, Herald will offer alerts based on real-time EMR data.
  • PHRASE (Population Health Risk Assessment Support Engine) Health is creating a clinical decision support platform designed to better manage emerging illnesses, integrating more external data sources into the process of identifying at-risk patients and enabling the two-way exchange of information between providers and public health entities.
  • A partnership between the University of Utah Health Care, Intermountain Healthcare and Duke Health System is providing clinical decision support for timely diagnosis and management of newborn bilirubin according to evidence-based practice. The partners will integrate the app across each member’s EMR.
  • WellSheet has created a web application using machine learning and natural language processing to prioritize important information during a patient visit. Its algorithm simplifies workflows incorporating multiple data sources, including those enabled by FHIR. It then presents information in a single screen.

As I see it, the two contests don’t necessarily need to be run on separate tracks. After all, providers need aggregate data and consumers need prioritized, easy-to-navigate platforms. But either way, this effort seems to have been productive. I’m eager to see the winners of the next phase.