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Taking Down Dr. Oz

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I briefly mentioned Dr. Oz in my recent post about NY Med (and the healthcare social media firing). It’s clear to anyone watching the show that Dr. Oz is there for the celebrity factor and not for the actual medical work. He’s always “partnered” with another cardiologist who provides the actual patient care. Of course, I don’t really care too much that he’s on it or not. If it gives them a boost in ratings, good. I like the show.

However, I don’t know a single doctor that likes Dr. Oz and I know many of them who hate Dr. Oz. With this in mind, I found this interview with a medical student whose trying to “take down” Dr. Oz quite interesting. Here’s a short take on what this med student is doing:

Last year, Mazer brought a policy before the Medical Society of the State of New York—where Dr. Oz is licensed—requesting that they consider regulating the advice of famous physicians in the media. His idea: Treat health advice on TV in the same vein as expert testimony, which already has established guidelines for truthfulness.

Although, this quote is really powerful as well, “DR. OZ HAS SOMETHING LIKE 4-MILLION VIEWERS A DAY. THE AVERAGE PHYSICIAN DOESN’T SEE A MILLION PATIENTS IN THEIR LIFETIME.”

This is absolutely one of the problems with social media and other medium like television. The person with the biggest voice doesn’t always have the best information. In fact, sometimes the wrong information is the best way to grow an audience. What’s popular is not always what’s right.

Mazer in his interview highlights the biggest problem with some of the things that Dr. Oz says. The movement in healthcare has largely been towards evidence based medicine. I think that movement will only grow stronger as we can prove the effectiveness of care even better. However, many of the things on Dr. Oz’s show go contrary to evidence based medicine. This leaves the patient-doctor relationship at a cross roads when a patient chooses to follow something they’ve seen on TV versus the advice of the doctor (even if the doctor is on the side of evidence).

Dr. Oz aside, the same principle applies to other information patients might find on the internet. Many doctors would like to just brush this aside and say that patients should “trust” them since there’s bad information on the internet or there’s a bigger picture. That might work in the short term, but won’t last long term.

Long term doctors are going to have to take a collaborative approach with patients. As patients we just have to be careful that we don’t take it too far. Collaboration means that the patient needs to be collaborative as well.

The other way for doctors to battle the misinformation out there is to provide quality sources of trusted information. One way this will happen is on the physician website. Instead of being a glorified yellow page ad, the physician website is going to have to do more to engage and educate patients. That’s part of the opportunity and vision for Physia. It’s an exciting time to be in healthcare…if you like change.

July 23, 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 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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.

Harnessing Open Source Technology to Drive Outcomes in Healthcare

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I’ve long been a fan of open source technologies. My blogs are run and created almost entirely on open source software. In fact, I first wrote about open source EMR on this blog back in January of 2006. We’ve come a long way since then with Vista being the top open source EHR in the hospital world and OpenEMR leading the pack in the ambulatory world.

We’re starting to see more and more application of open source technology in other areas of healthcare IT beyond EMR as well. There are some really amazing advantages to a thriving open source community. I think the key there is to have a thriving open source community behind the project. It’s not enough to just say that your software is open source. If you don’t have a great community behind the project, then the open source piece doesn’t do too much for you.

With that said, I was really intrigued by this whitepaper from Achieve Health that talks about why they are applying the popular open source Drupal framework to healthcare. While I’ve mostly used WordPress for the things I’ve done, I’ve had a chance to use Drupal for a few projects and I’m really intrigued by the idea of applying the Drupal framework to healthcare.

This section of the whitepaper describes their vision really well:

Drupal is not a replacement for legacy IT systems from EMRs, Billing, Practice Management etc., but rather an extension to these systems. Through sophisticated integrations Drupal can enhance the functionality of each system concurrently. While there is no one panacea for the trials ahead, Drupal is highly capable of rising to meet many of the existing and future challenges the industry has to offer.

In the whitepaper they mention open source success stories like Pfizer, Florida Hospitals, Amerigroup Health Services, and Alliance Imaging. I think we’ll continue to hear of more and more open source success stories in healthcare for the reasons outlined in the whitepaper Harnessing Open Source Technology to Drive Outcomes in Healthcare. It takes a bit of a different mentality to go the open source route, but those who do are usually very satisfied. I think healthcare IT could really benefit from this shift in mentality.

July 22, 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 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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.

The House Call of the Future – Breakaway Thinking

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The following is a guest blog post by Jennifer Bergeron, Learning and Development Manager at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Jennifer_web
The closest I’ve come to experiencing a house call was watching Dr. Baker on “Little House on the Prairie” visit the good folks of Walnut Grove. Today, most people have no choice but to trek to their doctors’ offices and hospitals for health maintenance, diagnoses and check-ups. But new technologies are returning the personalized attention of the house call and will need to be adopted to retain the convenience and accessibility they offer.

I haven’t met anyone with a practice like Dr. Baker’s, though I recently read a news article that highlights the comeback of the house call. Some practitioners are banding together to provide round-the-clock care to patients who benefit from the fast response and lower cost: If a deductible or copay is higher than the price of the doctor’s visit, the patient may opt for the home visit.(1) The updated versions of the house call, however, are born of the technology used for telehealth, mobile health and health stations.

Telehealth allows a person to connect with a provider via the Internet. Patient and doctor can video conference, share informational media, and experience a face-to-face interaction without either party traveling from his or her home or office.(2) This allows patients better access to specialists who may have been too far away to visit and more frequent care at the right time to reduce the chances of serious complications or hospitalization. For patients who require frequent care over time, telehealth enables them to receive the medical attention they need while staying near their support network.(4) For providers, access to networks of specialists who can provide remote consultation helps them retain and ensure the highest level of care for patients rather than refer patients to another location.(3)

Both patients and providers also save time and money when there is no commute to an office or to a patient’s home. This is especially true of patients who live in rural areas and have to travel long distances for care. The quicker a patient can connect with the right specialist to treat or prevent serious illness, the lower the overall cost of care. (3)

Mobile health, or mHealth, takes technology one step further by allowing providers to track and monitor patient health on mobile devices such as tablets or phones. This includes monitoring devices that measure heart rate, blood pressure, oxygen levels, blood glucose and body weight. mHealth can be used in the office or taken on the road the way mobile clinics do. When healthcare is mobile, the ability to bring a doctor’s office to a neighborhood gives access to communities that otherwise wouldn’t seek or know how to find care. Currently, all 50 U.S. states have mobile clinics.(4)

Another trend in the making is the health kiosk. These look like private pods, about the size of four phone booths side by side. Think of it as telehealth combined with a mobile clinic. HealthSpot, a provider of health kiosks, describes them as “the access point to better healthcare.”(5) In addition to providing interaction with healthcare professionals via video conferencing, each station has an attendant and an automatic cleaning system. HealthSpot aims to give patients a private, personal, efficient experience.

Healthcare is on the move to better accommodate our lives, schedules, family structures and communities, which have vastly evolved from the “Little House on the Prairie” days and even from a decade ago. At the same time, our industry faces challenges in making the new technologies simple to use in order for them to be effective. With telehealth, for example, people typically need help setting up a home system and technical assistance. Meanwhile, providers face communicating and documenting in a new environment.

As we enter this new, modern, faster era of healthcare, both patients and providers will need to learn how to implement and adopt new systems, technologies and ways of interacting. Easing adoption is what we are prepared to do at The Breakaway Group. Once the learning-and-comfort curve is overcome, patients can experience the convenience of Dr. Baker’s updated home visit.

References:
(1) Godoy, Maria, (December 19, 2005). A Doctor at the Door: House Calls Make Comeback.
(2) Health Resources and Services Administration Rural Health, (2012). Telehealth.
(3) Hands on telehealth, (2013). 15 Benefits of telehealth.
(4) Hill, C., Powers, B., Jain, S., Bennet, J., Vavasis, A., and Oriol, N. (March 20, 2014). Mobile Health Clinics in the Era of Reform.
(5) The HealthSpot Station.

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

July 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 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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.

The Health Insurance Demand Problem

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A family friend was recently admitted to the hospital after a traumatic motorcycle accident in Colorado. He’s not in great condition, but he’s hanging in there. In light of having just written this post about the cost of highly acute care, I couldn’t stop pondering about his health insurance.

Health insurance is a bizarre creature. Unlike other forms of insurance, people actually want to consume what they’re insured against, defying the very premise of the insurance model!

Confused? Let’s dive in.

No one wants to consume traditional insurance

People never file claims for traditional forms of insurance unless something bad has happened, like car or home accidents, natural disasters, or death (covered by life insurance). In some of these cases (like minor fender benders), the insured customer often elects not to file a claim in order to avoid a premium increase. When people do file traditional insurance claims, that means something sufficiently bad has happened, and the insurance system kicks in place to recoup the damages.

People do want to consume healthcare insurance

Healthcare insurance is a wildly different animal. Only a small percentage of total hospital admissions are highly acute, catastrophic cases. A large majority of the care delivery system services non-catastrophic cases, from preventive care to counseling, scheduled (and elective) surgeries, and skin rashes, for example. Patients want as much (non-catastrophic) healthcare as reasonably possible, and they want their insurance companies to pay for it.

This is a classic principal-agency problem. The person making financial decisions isn’t bearing the cost of those decisions; in fact, the person making financial decisions is empowered to blindly spend without thinking. To make matters worse, many healthcare providers encourage patients to consume costly diagnostics and procedures with little regard for value, knowing that insurance companies will pick up the tab.

Realigning incentives

As it currently stands, this system breaks most of the basic assumptions of capitalism: the principal-agency problem, pricing information, and ability to compare producers/providers.

Reducing demand and utilization of healthcare resources is impossible. Since patients are currently incentivized to demand unlimited care without caring about cost, supply will always find a way to satisfy demand. So, how can we realign the incentives to fix the system?

The only way to reduce demand is to make patients accountable for their own healthcare expenses. With the insurance customer suddenly conscious of the cost and value of their subacute healthcare consumption, providers will be incentivized to compete and offer lower costs.

Thus, insurance companies should provide patients “catastrophe-only” plans. These plans would fully and generously cover highly acute care needs, like trauma, cancer, or stroke care. However, like a vehicle insurance plan without comprehensive coverage, the cost of treating the medical equivalent of a keyed car (e.g. a purely speculative blood test) would fall to the individual.

As CEO of a company in the healthcare space, it pains me to know that I’m contributing to the healthcare incentive problem by providing employees with a traditional healthcare plan. But until healthcare insurers offer catastrophe-only plans, patients will continue to blindly consume. In fact, even the Affordable Care Act failed in this light; the national and state-based exchanges don’t offer a single catastrophe-only insurance plan. They are all bundled and are ripe for unbundling.

July 11, 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

Is Healthcare IT Hiring Part of the Problem with Healthcare?

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I’ve been thinking quite a bit lately about hiring in healthcare IT since Healthcare IT Central joined the Healthcare Scene family. Recently I started thinking about the way we hire people in healthcare IT. Here are two facets of what we hire in healthcare:

  • We hire those who know healthcare.
  • We hire those who know old technologies.

When you think about the health IT software world it includes things like MUMPS, Fax Machines, and lots of client server. Where else in technology do you find that combination of old technology. Or as I read on Twitter today, “Why do we think that client server is going to survive in healthcare? Didn’t Microsoft show us how that was a failed long term strategy.” Ok, that wasn’t an exact quote, but you get the gist. Plus, I don’t want to dwell on client server vs cloud systems here either (I’ve got a great post coming where we can do that). I just want to illustrate that healthcare is home to a lot of old technology (see the pager if you need added evidence).

Now think about the people we have to hire to work on these old technologies. Do the innovators and creators of the world want to work on old technologies? Of course, they don’t. Sure, there are some exceptions, but they are exceptions. As a rule, the really innovative, creative thinkers are going to want to work on the latest and greatest technology.

This tweet from Greg Meyer (@Greg_Meyer93 if you prefer) highlights the divide really well:

The reality of healthcare is that we have an industrial workforce and industrial products. Should we expect creative results? Maybe we need to switch up how we think about hiring and how we approach technology if we want to really disrupt healthcare. Or maybe healthcare will just get so bad and so far behind that it will create a gap that will allow someone from outside healthcare to enter and disrupt it all.

July 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 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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.

Unofficial 2014 #HIT100 Rankings

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Editor’s Notes: My Twitter friend, Steve Sisko (@ShimCode if you prefer), sent me his list of unofficial #HIT100 rankings and asked if I wanted to publish them. Always someone interested in a sneak peak at the final results, I was of course happy to publish his findings. Plus, it will be fun to compare them against @TheEHRGuy’s final list.

I made my feelings on the #HIT100 list quite clear in past years. I don’t feel any different now. The list as a whole is quite interesting and a great way to discover new and interesting people in healthcare IT. However, specific rank on the list is meaningless to me since it can easily be gamed. For example, if you nominate a lot of other people, then you’re very likely to get reciprocal nominations and be at the top of the list. Not to mention, with just my own Health IT related Twitter accounts I could get someone to the top 50 if I’d wanted. Although, I didn’t. I think I nominated two people who bought me chocolate shakes and cheesecake in the past. I guess you now know how to win me over.

What I think would be interesting is to dive into this list a little deeper and see who’s new, who dropped from the list and also to dive deeper into the story of the people on this list. Sounds like a good future project for my blogs. I might start with those on the bottom of the list.

Without further ado, enjoy the unofficial #HIT100 list.

For those who simply must know, here are the unofficial 2014 #HIT100 rankings.

Note: These are not the “official results” that should be coming from @TheEHRGuy. They were derived as and have the limitations listed below the table.

Unofficial Nominee 2014 Votes 2014 Rank True 2014 Rank 2013 Rank Comments
@Brad_Justus 58 1 1 3
@MandiBPro 49 2 2 9
@ahier 33 3 3 4
@EMRAnswers 33 4 3 5
@bhparrish 29 5 5 25
@Colin_Hung 28 6 6 79
@DodgeComm 28 7 7 80
@nrip 28 8 8 12
@HealthcareWen 27 9 9 1
@HITAdvisor 27 10 9 2
@PremierHA 27 11 9 #N/A
@JohnNosta 26 12 12 6
@OchoTex 24 13 13 18
@ReginaHolliday 24 14 14 7
@VinceKuraitis 23 15 15 38
@JennDennard 21 16 16 #N/A @SmyrnaGirl – 15th
@TheEHRGuy 21 17 16 30
@2healthguru 20 18 18 13
@DonFluckinger 20 19 18 66
@Brian_Eastwood 19 20 20 53
@laurencstill 19 21 20 #N/A
@CDW_Healthcare 17 22 22 19
@drtom_kareo 17 23 22 #N/A
@ElinSilveous 17 24 22 23
@HITConsultant 17 25 22 28
@ShimCode 17 26 22 29
@techguy 17 27 22 20
@ColeFACHE 16 28 28 26
@GovHITeditor 16 29 28 35
@dz45tr 15 30 30 57
@GaryPalgon 15 31 30 17
@GoKareo 15 32 30 #N/A
@nxtstop1 15 33 30 #N/A
@DSSHealthIT 14 34 34 #N/A
@gerryweider 14 35 34 #N/A
@HealthcareMBA 14 36 34 #N/A
@drnic1 13 37 37 46
@Farzad_MD 13 38 37 #N/A @Farzad_ONC – 21st
@KenOnHIT 13 39 37 36
@leonardkish 13 40 37 24
@MelSmithJones 13 41 37 #N/A
@Cascadia 12 42 42 41
@dirkstanley 12 43 42 34
@motorcycle_guy 12 44 42 10
@Paul_Sonnier 12 45 42 11
@wareFLO 12 46 42 #N/A
@westr 12 47 42 77
@giasison 11 48 48 #N/A
@healthythinker 10 49 49 70
@janicemccallum 10 50 49 39
@jennylaurello 10 51 49 #N/A
@JonMertz 10 52 49 22
@MichaelGaspar 10 53 49 #N/A
@danmunro 9 54 54 #N/A
@gnayyar 9 55 54 51
@RasuShrestha 9 56 54 #N/A
@drttsang 8 57 57 #N/A
@HITLeaders 8 58 57 #N/A
@JohnSharp 8 59 57 #N/A
@MightyCasey 8 60 57 #N/A
@Docweighsin 7 61 61 #N/A
@ePatientDave 7 62 61 47
@EricTopol 7 63 61 48
@Greg_Meyer93 7 64 61 #N/A
@HealthFusionKMc 7 65 61 #N/A
@lsaldanamd 7 66 61 #N/A
@NaomiFried 7 67 61 83
@askjoyrios 6 68 68 #N/A
@boltyboy 6 69 68 52
@dineshrs 6 70 68 #N/A
@ehrandhit 6 71 68 #N/A
@fredtrotter 6 72 68 49
@hjluks 6 73 68 89
@JBBC 6 74 68 #N/A
@jhalamka 6 75 68 42
@SusannahFox 6 76 68 45
@CancerGeek 5 77 77 #N/A
@carimclean 5 78 77 #N/A
@CyndyNayer 5 79 77 #N/A
@intakeme 5 80 77 #N/A
@john_chilmark 5 81 77 62
@kathymccoy 5 82 77 55
@KBDeSalvo 5 83 77 #N/A
@Lygeia 5 84 77 40
@mloxton 5 85 77 #N/A
@nursefriendly 5 86 77 #N/A
@nversel 5 87 77 44
@PracticalWisdom 5 88 77 31
@ShahidNShah 5 89 77 98
@skram 5 90 77 #N/A
@ThePatientSide 5 91 77 #N/A
@annelizhannan 4 92 92 65
@chasedave 4 93 92 54
@Christianassad 4 94 92 16
@cmaer 4 95 92 #N/A
@CMichaelGibson 4 96 92 #N/A
@danamlewis 4 97 92 #N/A
@DCPatient 4 98 92 #N/A
@haroldsmith3rd 4 99 92 #N/A
@HITNewsTweet 4 100 92 #N/A

 

Methodology and Disclaimers

  1. This is an unofficial list.
  2. Selected all tweets tagged with #HIT100 from 7/1/14 (12:00 EST) thru 7/8/14 (13:00 EST) that complied with the essence of the requested format and general rules.
  3. Eliminated all duplicate votes made by the same person for the same nominee
  4. Didn’t combine people with multiple Twitter accounts. Like @KathyMcCoy/@HealthFusionKMc and @techguy/@ehrandhit and
  5. Didn’t exclude anyone who had less than 6 months on Twitter. That would take a little scripting or manual effort I don’t have right now.
  6. Didn’t exclude anyone who isn’t “an active participant of both the #HealthIT and #HITsm channels” as I’m not sure how to determine that without being subjective.
  7. Also, note that comparison to 2013 rankings has a few holes in it due to people changing their handles since 2013. Like @Farzad_MD /@Farzad_ONC and a couple others.
  8. Accounts with same vote count were sorted alphabetically.

Previous #HIT100 Rankings:

2011 – #HIT100 List – http://nateosit.wordpress.com/2011/07/17/hit100-the-list/

2012 – #HIT100 List – http://www.healthcareitnews.com/news/hit100-2012-list-revealed

2013 – #HIT100 List – http://www.healthitoutcomes.com/doc/hit-100-list-unveiled-0001

July 9, 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 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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.

Is Healthcare So Complex That It Can’t Be Fixed with the Existing Parts?

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In one of my recent discussions I had someone suggest the following idea:

You can’t model a solution to fix healthcare with the existing parts.

I found this to be a really intriguing idea that is worthy of some deep consideration by those of us involved in healthcare. I’ve often talked with people about the many perverse incentives that exist in our current healthcare system. There are so many incentives that point us the wrong way that the idea that we can’t model a solution to our healthcare cost problem makes a lot of sense to me.

Of course, I don’t think that this means we shouldn’t have hope that healthcare can’t be fixed. It just means that the fix will be much harder and that it will likely come from outside of the current healthcare system. You need to change the healthcare model to really dramatically improve our healthcare system.

I’m certainly bias, but I think that technology will serve as the basis for any new model. Unfortunately, most of the technology that’s been applied to healthcare is more about trying to make the current model more efficient as opposed to disrupting the current model. A great example of this is the EHR. As I posted previously, the EHR is not disruptive and never will be.

That’s not to say that the EHR doesn’t have value or benefits. There are a lot of benefits to EHR, but it won’t be the disruptive change that healthcare needs. I’ll be interested to see what mix of technologies, policies, and pressures lead to a really disruptive change in how we deliver healthcare.

While I’m optimistic that something will come that will really change the quality and efficiency of our healthcare, it’s not going to be an easy path.

July 7, 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 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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.

Eyes Wide Shut – Patient Engagement Pitfalls Prior to Meaningful Use Reporting Period

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July 1, 2015 – the start of the Meaningful Use Stage 1 Year 2 reporting period for the hospital facilities within this provider integrated delivery network (IDN). The day the 50% online access measure gets real. The day the inpatient summary CCDA MUST be made available online within 36 hours of discharge. The day we must overcome a steady 65% patient portal decline rate.

A quick recap for those who haven’t followed this series (and refresher for those who have): this IDN has multiple hospital facilities, primary care, and specialty practices, on disparate EMRs, all connecting to an HIE and one enterprise patient portal. There are 8 primary EMRs and more than 20 distinct patient identification (MRN) pools. And many entities within this IDN are attempting to attest to Meaningful Use Stage 2 this year.

For the purposes of this post, I’m ignoring CMS and the ONC’s new proposed rule that would, if adopted, allow entities to attest to Meaningful Use Stage 1 OR 2 measures, using 2011 OR 2014 CEHRT (or some combination thereof). Even if the proposed rule were sensible, it came too late for the hospitals which must start their reporting period in the third calendar quarter of 2014 in order to complete before the start of the fiscal year on October 1. For this IDN, the proposed rule isn’t changing anything.

Believe me, I would have welcomed change.

The purpose of the so-called “patient engagement” core measures is just that: engage patients in their healthcare, and liberate the data so that patients are empowered to have meaningful conversations with their providers, and to make informed health decisions. The intent is a good one. The result of releasing the EMR’s compilation of chart data to recently-discharged patients may not be.

I answered the phone on a Saturday, while standing in the middle of a shopping mall with my 12 year-old daughter, to discover a distraught man and one of my help desk representatives on the line. The man’s wife had been recently released from the hospital; they had been provided patient portal access to receive and review her records, and they were bewildered by the information given. The medications listed on the document were not the same as those his wife regularly takes, the lab section did not have any context provided for why the tests were ordered or what the results mean, there were a number of lab results missing that he knew had been performed, and the problems list did not seem to have any correlation to the diagnoses provided for the encounter.

Just the kind of call an IT geek wants to receive.

How do you explain to an 84 year-old man that his wife’s inpatient summary record contains only a snapshot of the information that was captured during that specific hospital encounter, by resources at each point in the patient experience, with widely-varied roles and educational backgrounds, with varied attention to detail, and only a vague awareness of how that information would then be pulled together and presented by technology that was built to meet the bare minimum standards for perfect-world test scenarios required by government mandates?

How do you tell him that the lab results are only what was available at time of discharge, not the pathology reports that had to be sent out for analysis and would not come back in time to meet the 36-hour deadline?

How do you tell him that the reasons there are so many discrepancies between what he sees on the document and what is available on the full chart are data entry errors, new workflow processes that have not yet been widely adopted by each member of the care team, and technical differences between EMRs in the interpretation of the IHE’s XML standards for how these CCDA documents were to be created?

EMR vendors have responded to that last question with, “If you use our tethered portal, you won’t have that problem. Our portal can present the data from our CCDA just fine.” But this doesn’t take into account the patient experience. As a consumer, I ask you: would you use online banking if you had to sign on to a different website, with a different username and password, for each account within the same bank? Why should it be acceptable for managing health information online to be less convenient than managing financial information?

How do hospital clinical and IT staff navigate this increasingly-frequent scenario that is occurring: explaining the data that patients now see?

I’m working hard to establish a clear delineation between answering technical and clinical questions, because I am not – by any stretch of the imagination – a clinician. I can explain deviations in the records presentation, I can explain the data that is and is not available – and why (which is NOT generally well-received), and I can explain the logical processes for patients to get their clinical questions answered.

Solving the other half of this equation – clinicians who understand the technical nuances which have become patient-facing, and who incorporate that knowledge into regular patient engagement to insure patients understand the limitations of their newly-liberated data – proves more challenging. In order to engage patients in the way the CMS Meaningful Use program mandates, have we effectively created a new hybrid role requirement for our healthcare providers?

And what fresh new hell have we created for some patients who seek wisdom from all this information they’ve been given?

Caveat – if you’re reading this, it’s likely you’re not the kind of patient who needs much explaining. You’re likely to do your own research on the data that’s presented on your CCDA outputs, and you have the context of the entire Meaningful Use initiative to understand why information is presented the way it is. But think – can your grandma read it and understand it on HER own?

June 30, 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.

NY Med Social Media Firing

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Update: Katie Duke stopped by and left the following comment that’s worth noting:

Thank you for this article and review. I did not violate any aspect of the social media policy or HIPPAA and was technically fired for what my manager calls “we just don’t want you working here anymore and you’re insensitive” (as referring to the post)

I have been in the spotlight for several years and thoroughly respect the rules and regulations of our profession and it’s presence on social media. My goal is to change the portrayal of nursing in the media. We all make mistakes and we must learn from them. Do I feel it was a terminable offense? No- I feel I should have been counseled or even given some constructive criticism. After all- I am a great nurse and was with NYP for 7 years and of their motto is to put patients first then they should advocate more for the retention and growth of the nurses they have. Nurses are NOT disposable. Thank you for this venue to get the dialogue going about this rather controversial and taboo topic.

I applaud Katie’s efforts since I’ve often commented how nurses are an afterthought during an EHR selection and implementation process and that’s a pity since they’re such an important part of the organization. I imagine this same thing applies to other hospital policies. Thanks for your added comments Katie.

Last night was the premiere of the second season of NY Med on ABC. I saw the previous season and enjoyed it and so I was interested to see the new season. I like all of the show except for Dr. Oz who is obviously there because he has a big name and not because he’s actually practicing medicine. I love the quote I read online “Dr. Oz is a fake even when he’s scrubbing in. His mask isn’t on while he’s fake scrubbing.” All of the Dr. Oz parts felt very contrived so they could get him involved in the show. When real cardiology was being practiced, he called in the leading expert, or at least someone who actually could help the patient.

Dr. Oz part aside, the 3 ER nurses are my favorite part of the show. I remembered 2 of the 3 from last season and so I was really glad to see that they were back. Those are some firecracker nurses that always face interesting situations in the ER.

While the show isn’t perfect since as soon as you turn a camera on, people change, it’s still an interesting look into the challenges that many doctors and nurses face on the front lines of healthcare. While Grey’s Anatomy is a well written, entertaining drama and sometimes taps trending topics for its story, it’s not a good depiction of reality.

With the above review, I was particularly intrigued last night when Katie Duke, one of the ER nurses, got Fired from the hospital for posting a picture on Instagram. It was pretty interesting to see both the other ER nurses and Katie’s first hand response to her being fired and escorted from the building.

Since this is EMR and HIPAA, let’s talk about the HIPAA implications of what Katie did. They didn’t show the picture she posted for very long, but there were no people in the picture. Just a room after they’d had a trauma case in the ER. Basically, at quick glance I can’t imagine there’s any HIPAA violation with the picture. She did tag the picture with a number of hashtags. The only one that seemed in question was the “#Man vs 6 train” one, but that’s not a HIPAA violation either or would be an enormous stretch to make the case that it is a violation.

I think it’s fair to say she didn’t violate HIPAA with her instagram post. However, that doesn’t mean she didn’t violate a hospital social media policy. I’d be interested to see New York Presbyterian’s (the hospital who fired her) social media policy. It’s hard to guess at what the policy might include. I’ve seen really strict social media policies, really open social media policies and organizations with no policy (that’s scary). Given their policy, it might very well have been appropriate to fire her. In fact, if it wasn’t, Katie Duke seems like someone who would fight back in court if it wasn’t appropriate.

While Katie Duke was fired from New York Presbyterian, she was hired at Roosevelt on the West Side. I wonder what they said to Katie about social media when they hired her. In the NY Med episode they show her doing well. Although, they noted that she was great with patients, but was having a challenge getting up to speed on their computer system. Makes me wonder what EHR they use in their ED. Although, I think it’s safe to say that this could be said about any ER nurse in any ER regardless of the computer system they use. It just takes some time to get up to speed on an EHR.

In case you’re wondering, Katie Duke has launched a website and on July 1st she’s launching a YouTube show, she has an endorsement deal with Dickies and Cherokee scrubs, has speaking engagements around the country, and a line of merchandise around the phrase “Deal With It.” I guess that’s how she’s chosen to deal with the firing. If you look at her Twitter account, you can see a lot of nurses who really look up to her and appreciate her.

The discussion of social media in the workplace is an important one and it’s really important that you understand your employer’s views on the subject if you’re going to take part in it. Although, I think we all have to appreciate the irony of a hospital firing someone for posting a picture to instagram while that same hospital has a bunch of cameras video recording in their hospital for a TV show on ABC. Feels pretty hypocritical, do as I say, not as I do.

What do you think? Did you see the show? Where will social media sharing take us in healthcare and what will be the good and bad consequences of it?

June 27, 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 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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.

Another View of Privacy by Dr. Deborah C. Peel, MD

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I thought the following TEDx video from Deborah C. Peel, MD, Founder and Chair of Patient Privacy Rights, would be an interesting contrast with some of the things that Andy Oram wrote in yesterday’s post titled “Not So Open: Redefining Goals for Sharing Health Data in Research“. Dr. Peel is incredibly passionate about protecting patient’s privacy and is working hard on that goal.

Dr. Peel is also trying to kick off a hashtag called #MyHealthDataIsMine. What do you think of the “hidden privacy and data breaches” that Dr. Peel talks about in the video? I look forward to hearing your thoughts on it.

June 25, 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 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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.