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EHRMagic, EHR Certification, and the Great EHR Switch — #HITsm Chat Highlights

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Topic One: What lessons can be learned from the ONC’s decision to revoke #EHR Incentive Program certification of EHRMagic? #HealthIT

Topic Two: Does this action make EHR certification more meaningful or does it reduce confidence in certified products?

Topic Three: Who suffers the most from the ONC’s decision? The vendor or the physicians who purchased the product?

#HITsm T4: ”2013 is the year of the great #EHR switch.” With data migration and implementation hassles, is this truly a possibility?

May 4, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

NetPulse, HIEs, and The Importance of Reliable EMRs — Around Healthcare Scene

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Have you ever wished that all your fitness and food trackers were in one place? Well, look no further. NetPulse is trying to do just that. The new platform is working with some of the hottest apps, as well as fitness equipment makers, to make taking control of your health easier and more convenient.

A group of researchers recently published an opinion in the Journal of the American Medical Association regarding cloud-based health records versus HIEs. The verdict? They feel that the cloud-based health records might be a better way of sharing health records. What they had to say was rather interesting, so don’t miss the recap of it over at EMR and EHR.

Still looking to use HIEs, rather than Cloud-based health records? The ONC has recently released a toolkit to help different healthcare professionals use them more efficiently. This toolkit includes several guides and a spreadsheet to help determine costs and savings that are associated with implementing an EHR.

For those that missed HIMSS, check out the video that John filmed of the Metro point of care solutions. It gives you a first person perspective of what you could have seen demoed at HIMSS if you were able to attend. Plus, it’s pretty cool to see the point of care and BCMA technologies in action.

It’s important for an EMR to be usable. However, this isn’t always the case, and it can be extremely frustrating. Dr. Shirie Leng, an anesthesiologist, is someone who feels that way. In a recent piece over at KevinMD.com, Dr. Leng discusses her EMR usability wish list. Be sure to check it out, and see if you agree. What is your usability wish list?

And, how smart is your current EMR? According to John, it might just be stupid. While they may have value, most EHR software is just full of dumb data repositories. Despite the negativity of this perspective, the future of EHRs does have hope. With the help of entrepreneurs innovators, current EHRs will be turned smart.

Finally, in order for EMRs to make the changes needed, to improve usability and become more “smart,” the vendors need to get it together.  KLAS recently put several popular EMRs head-to-head, reviewing their usability and efficiency. Although names weren’t listed, they found that some EMRs were very difficult to learn, and it’s not necessarily the physician who is using its fault. Perhaps it’s time that physicians and hospitals demand higher quality products.

March 24, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

HIMSS Analytics Clinical & BI Maturity Model

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While the theme of HIMSS 2013 may have been, “How Great Is Interoperability,” the effectiveness of the many facets of interoperability are only as good as the actionable value of the shared data. The clinical insights that should be enabled by Meaningful Use Stage 2+ are expected to drive market trends in myriad areas of the healthcare system: chronic disease management, targeted member interventions, quality measures. In order to assess organizational readiness to capitalize on the promise of Meaningful Use, HIMSS Analytics began measuring the implementation and adoption of EMR and clinical documentation using a maturity model called EMRAM.

EMRAM

But, in analytics terms, EMRAM’s results are simply targeted foundational reporting, answering the question, “WHAT happened with Meaningful Use EMR adoption criteria.” So, you’ve got your clinical data in an EMR. Now what are you able to DO with it?

In 2013, HIMSS Analytics is taking a broader approach with the introduction of a new Clinical Business Intelligence maturity model, creating a framework to benchmark participating providers’ analytics maturity level.

I’ve been fortunate to know James Gaston, Senior Director of HIMSS Analytics Clinical & Business Intelligence, for many years, going back to his days with Arkansas Blue Cross. His appreciation for BI initiatives is matched only by his enthusiasm for the first day of turkey hunting season. When I ran into him at TDWI’s BI World summit in Orlando in November, he acted like a kid on Christmas morning, telling me about the brave new world of clinical data management that he was about to tackle. The excitement continued to build in the months leading up to HIMSS. James was practically glowing when we spoke about the upcoming C&BI Maturity Model release.

“Our customers are interested in not just understanding how to deploy IT applications, but how effectively they’re using those applications to support clinical business intelligence, as well as analytical pursuits,” James said. “So, HIMSS Analytics partnered with IIA to create and present a Clinical & BI Maturity Model that helps healthcare organizations measure that level of effectiveness.”

Sarah Gates, the VP of Research for IIA (the International Institute of Analytics), elaborated. “The HIMSS Analytics C&BI Maturity Model leverages the Competing on Analytics DELTA model, developed by Tom Davenport, which measures not only how well you’re using data and technology, but how well you’re building an analytical organization.” There are 5 core competency measurements in the DELTA model that will inform the HIMSS Analytics C&BI analysis: Data, Enterprise, Leadership, Targets, and Analysts. The methodology is holistic, touching on the cultural aspects of the organization as well as the technical, allowing a longitudinal view of the organization’s analytics program. A yardstick value from 1-5 will be assigned to each respondent based on Davenport’s criteria for each core competency.

Although HIMSS Analytics will eventually offer Level 1-5 certification program for those organizations with observed results for analytics, James and Sarah agreed that it is not appropriate for every provider to reach for the Level 5 gold star. Per Sarah, “Healthcare is an industry just starting to discover analytics. We’re expecting to see lots of practitioners that are emerging in use of analytics, so we believe it (survey results) will be heavy on the lower end of the maturity scale. Data warehouse capabilities and staffing career paths for data analysts will be key differentiators for mature programs.” Not all providers have the resources – financial, human, and/or technical – to attain advanced analytics nirvana, and James wants to insure that these providers don’t feel as if they’ve “failed”; the goal is to baseline against the peer group, identify opportunities for improvement, and focus on what is possible for each individual organization, working within their constraints.

What can we expect to see at next year’s C&BI survey results presentation? James said, “We want to be able to talk about benchmarking the industry as a whole, helping healthcare find its way with clinical business intelligence and begin to understand how important it is, and where opportunities lie Everyone’s talking about clinical and BI – it is the opportunity to realize savings in healthcare, to use information to empower people to make better decisions.”

So, it’s up to you, providers and technology partners. You’ve implemented your EMR, achieved a high adoption rate across your organization’s core clinical processes, attested to Meaningful Use Stage 2, achieved Stage 7 on the HIMSS EMRAM scale, perhaps even participated in multi-HIE CCD medical records sharing with other provider networks. You’ve got the data in-house and availabe. It’s time to see how ready you are to rise to the analytics challenge and maximize your return on those EMR and HIE investments.

Attempt to beat your previous Doug Fridsma long jump.

Note: for the complete HIMSS 2013 Leadership Survey Results, please download PDF here.

March 14, 2013 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.

Bringing Long Term Care Into HIEs Without An EMR

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HIEs will never achieve their full potential if all players in the healthcare process aren’t included in the network. But without an EMR to connect to the HIE, how can a provider participate?

A new software package developed by Geisinger Health System and the Keystone Beacon Community Program offers a new option allowing nursing homes, home health agencies and other long-term care facilities without EMRs to upload data to HIEs, reports EHR Intelligence.

The package, KeyHIE Transform, extracts data from the Minimum Data Set and Outcome and Assessment Information Set that nursing homes already submit to CMS. It turns that information into a Continuity of Care Document usable by any EMR which is HL7-compatible.

This approach provides a bridge to a wide range of data which currently gets left behind by most HIEs. And as EHR Intelligence rightly notes, with telehealth and remote monitoring becoming more popular ways of managing senior  health, as well as assisted living, it will be increasingly important for other providers to have access to all of the seniors’ data via the HIE.

Geisinger’s KeyHIE has already run several  pilot programs using t his technology in long-term care facilities and home health agencies. It expects to launch the technology to the market in April of this year.

As is often the case, Geisinger seems to be ahead of the market with a solution that makes great sense.  After all, finding a way to integrate new data into an HIE — especially one that draws on existing data — is likely to add significant value to that HIE.  I’m eager to see whether this technology actually works as simply as it sounds.

March 13, 2013 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.

The Marvelous Land of Oz: The HIMSS Interoperability Showcase

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As I walked the floor of the HIMSS Interoperability Showcase, listening to the tour guide’s carnie-esque pitch on the wonders awaiting me with each successive use case encounter, I ALMOST wished I hadn’t worked with so many of the organizations hawking their wares. It’s a bit sad to know the man behind the curtain, to realize that The Great and Powerful Oz is simply a man with a highly mechanized presentation. But that knowledge gives me insight that others attending the Showcase may not have had – and validation that, in the end, Oz IS Great and Powerful, even though he’s just a man.

There were 20 specific interoperability use cases represented at HIMSS this year, collectively, by 101 vendors. In order to qualify to participate, each of the organizations had to successfully demonstrate proficiency with their chosen use case at the Connectathon event in Chicago. In January. In a basement the size of a football field. Packed shoulder-to-shoulder with your closest competitors at high school-cafeteria tables. Talk about a frigid atmosphere!

Perhaps to stay warm, perhaps to pass the time, perhaps in the pursuit of the patient-centric design principles the healthcare industry espouses publicly yet so seldom seems to put into practice, cross-company collaboration occurs. Competitors converge on each others’ laptops, debugging code, refining business rules and algorithms. Functional use cases emerge, success stories are shared, everyone goes home happy with a list of enhancements to incorporate before the main event at HIMSS. The frantic rush to prep for Connectathon is amplified by the urgency and importance of HIMSS. The ONC is watching! Your competitors are watching! The 40K HIMSS attendees will be watching!

Invariably, the use cases are perfected in the weeks leading up to HIMSS, each click carefully orchestrated, each transition scripted, all parties putting forth their best effort to insure success for the spectators – many of whom are clients, prospects, regulatory officials, or journalists seeking The Next Big Healthcare Thing to go viral in the blogosphere. The yellow brick road is constructed, and as one walks its length, the carefully choreographed demonstrations come to life with compelling tales: “Keeping a Newborn Safe,” “Improving Pediatric Care,” “Optimizing Cancer Care,” “Beneficiary Enrollment.” The show goes on, and it’s a good one – albeit with the occasional glimpse of the man behind the curtain.

The perfectly nice gentleman manning the Federal Health Architecture booth seemed eager to demonstrate the capability to request and retrieve a patient’s medical record from multiple HIEs and disparate EMRs. He walked me through the provider portal view, showed me how he could see that there were multiple medical records available for this patient across providers, and talked me through each click up until the print button. Print?

“Aren’t you importing the records into the requesting EMR?” I asked.

“No. Right now, they have to print each set of records.”

“So, each time this scenario presents itself, the provider has to click on each available external record, print multiple pages, compare notes across screen and paper, and later choose whether to manually update his own EMR with the other information?”

The perfectly nice gentleman suddenly seemed uncomfortable. The Great and Powerful Oz, exposed as mere mortal, Oscar Zoroaster Diggs. You’d think I’d know when to quit.

“The standards and technology exist to do CCD discrete data import, and a couple of the large EMR vendors are implementing that capability for high Medicare population IDNs. How does it make the provider more efficient, and give the patient more face-time with his doctor, if we’re still printing and no data consolidation or reconciliation is happening prior to point-of-care? Why didn’t you extend the use case to show end state?”

He assured me that they’re working on it, and we made a deal that NEXT year, I’ll come back and he’ll walk me through their progress towards discrete data import. No printing, he promised. I’m going to hold him to it.

Aside from this specific use case, across the Marvelous Land of Oz, what I’d REALLY love to see next year: the basement Connectathon advancements made to support the use cases for HIMSS actually incorporated into the products. As part of the qualifying criteria for repeat showcase exhibitors, have them demonstrate the capabilities developed in prior years actually functioning in the marketplace under general release. That would be a substantial improvement on this year’s long jump attempt for the Interoperability Showcase.

I want to fall in love with the hard-working man behind the curtain, not the showy pyrotechnics.

March 11, 2013 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.

What Would ONC’s Dr. Doug Fridsma Do? (THIS Geek Girl’s Guide to HIMSS)

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I know you’ve all been wondering how I’m planning to spend my mad crazy week at HIMSS in New Orleans. Well, maybe not ALL of you, but perhaps at least one – who is most likely my blog boss, the master John Lynn. Given the array of exciting developments in healthcare IT across the spectrum, from mobile and telehealth to wearable vital sign monitoring devices, EMR consolidation to cloud-based analytics platforms, it’s been extraordinarily difficult to keep myself from acting like Dori in “Finding Nemo”: “Oooooh! Shiny!” I’ve had to remind myself daily that I will have an opportunity to play with everything that catches my eye, but that I am only qualified to write and speak intelligently on my particular areas of expertise. And so, I’m proud to say I’ve finally solidified my agenda for the entire week, and I cannot WAIT to go ubergeek fan girl on so many industry luminaries and fascinating up-and-comers making great strides towards interoperability, deriving the “meaning” in “Meaningful Use” from clinical data, and leveraging the power of big data analytics to improve quality of patient experience and outcomes.

On Sunday, I’m setting the stage for the rest of the week with a sit-down with ONC’s Director of Standards and Interoperability and Acting Chief Scientist, Dr. Doug Fridsma. His groundbreaking work in interoperability spans multiple initiatives, including: the Nationwide Health Information Network (NwHIN) and the CONNECT project, as well as the Federal Health Architecture. For insight into his passion for transforming the healthcare system through health IT, check out his blog: From The Desk of the Chief Science Officer.

Through the rest of the week, I aspire to see the world through Dr. Fridsma’s eyes, focusing on how each of the organizations and individuals contribute to the standards-based processes and policies that form the foundation for actionable analytics – and improved health. I’ve selected interviews with key visionaries from companies large and small, who I feel are representative of positive forward movement:

Health Care DataWorks piques my interest as an up-and-comer to watch, empowering healthcare systems to improve outcomes and reduce medical costs by providing accelerated EDW design and implementation, whether on-premise or via SaaS solution. Embedded industry analytics models supporting alternative network models, population-based payment models, and value-based purchasing allow for rapid realization of positive ROI.

Emdeon, is the single largest clinical, financial, and administrative network, connecting over 400,000 providers and executing more than seven billion health exchanges annually. And if that’s not enough to attract keen attention, they recently announced a partnership with Atigeo to provide intelligent analytics solutions with Emdeon’s PETABYTES of data.

Serving an area near and dear to my heart, Clinovations provides healthcare management consulting services to stakeholders at each link in the chain, from providers to payers and supporting trading partners – in areas from EMR implementation (and requisite clinical data standards) to market and vendor assessments, and data management activities throughout. With the dearth in qualified SME resources in the clinical data field, I look forward to learning about how Clinovations plans to manage their growth and retain key talent.

Who doesn’t love a great legacy decommissioning story? Mediquant proports adopting their DataArk product can result in an 80% reduction in legacy system costs through increased interoperability across disparate source systems and consolidated access. The “active archiving” solution allows for a centralized repository and consolidated accounting functions out of legacy data without continuing to operate (and support) the legacy system. Longitudinal clinical records? Yes, please!

Those are just a few on my must-see list, and I think Dr. Doug Fridsma would be proud of their vision, and find alignment to his ONC program goals. But will he be proud of their execution?

Can’t wait to find out, on the exhibit hall floor – and in the hallway conversations, and the client case study sessions, and the general scuttlebutt – at HIMSS!

March 2, 2013 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.

An Interview with Mitochon About Their Recently Launched EMO (Electronic Medical Office)

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The following is an interview with Mitochon about their newly launched EMO (Electronic medical Office) and a discussion of some of the various trends happening in healthcare IT like: ACOs, Meaningful Use, and HIEs.

Q: Tell us about your recently launched EMO (Electronic Medical Office) product.

A: Our Electronic Medical Office product is a complete end-to-end solution for the modern day medical practice. Allowing the practice to accomplish all their daily task in one solution. One application, one vendor, one solution….. EMO.

Q: When did you start thinking about a suite of applications beyond just EHR?

A: We have seen for years the issues the practice has had to endure when dealing with multiple vendors, products and interfaces. The finger pointing and passing the buck when many different vendors are involved. Its the old right hand left hand issue. Just over two years ago as a team we knew we had to step forward and develop an end-to-end solution and give the practice the continuity and consistency of dealing with one vendor and one solution to take care of all the practice needs from the Patient accessing their medical records and financial data from their own PC to the tracking of insurance claims and collections.

Q: Will EMO (Electronic Medical Office) be free like your past Free EHR offering?

A: Yes EMO will be a FREE offering. In addition to our FREE EMO we are offering a plus package, with EMO+ you get all the features of EMO and back office Revenue Cycle Management. With EMO plus the practice pays only 2.85% of their monthly collections and we handle all the billing and collections from a back office perspective.

Q: In this world of EHR consolidation, EHR’s closing down, etc, why should a doctor feel comfortable choosing Mitochon?

A: We started Mitochon with the belief that Health IT services are too expensive and too complex! We wanted to take away the cost barrier that many independent physicians couldn’t previously overcome, enabling them to provide better patient care while qualifying for Meaningful Use incentives. Our advertising business model is proven, sustainable and successful and is a similar model that works for TV, radio, newspaper and the web. We’re here to stay!

The Mitochon application is used in other markets on a paid basis. We are saddened by the fact that companies still pay to use systems that were closed down such as Kareo and Epocrates recent announcement, they are late and trying to resurrect a system that was closed down. We understand other free vendors have over spent on promotion and the day of reckoning is coming closer, we gain 30% of our new users from other free systems that offer poor support, when the investors get sick of running a business with scant regard to profits they will go the way of MySpace, remember them?

Q: Do you think that most of the doctors using your EHR will becoming “meaningful users”?

A: The question should really be if the physicians believe the meaningful useage criteria, as defined, really add to their patient care or do they see it more of a hassle or prying eyes of payers. The vast majority of our users have achieved Meaningful Use. We are a conservative company owned by physicians, we build a real base of users, no hype. We believe we likely have the highest percentage of users achieve MU versus any other EHR.

Q: The claims clearinghouse is a new Mitochon feature. Tell us more about that part of the product.

A: EMO would not be an end-to-end solution if we did not include medical claims clearing. There are no gimmicks or gotchya’s with our clearinghouse. The sending of medical claims as well as status updates of those claims is FREE as well! We are redefining the end the end solution

Q: What other applications aren’t part of EMO (Electronic Medical Office) that you’ll look at incorporating in the future?

A: We have appointment reminders, Statement printing, fully integrated credit card processing that is linked to a users account. We have the in built HIE that allows Physician to Physician referral as well as the soon to be launched Patient Health Record. As the market demands we will continue to add features and functionality. In office dispensing solutions can bring Physicians significant revenue, up to $7,000 per month profit depending on sub-speciality. We are also working to bring an integrated sample closet so physicians can add further value to their patient interaction. Also remember we also have free mobile access to our EHR.

Q: How do you think what you’re doing fits in with other trends like ACOs (Accountable Care Organizations)?

A: In an ACO the goal is population management, better outcomes with lower cost. As such you have to manage the 30% of chronically ill patients who are utilizing 60-70% of the health care dollars. To do so, every provider needs to be engaged, integrated and connected. So our free solution has a role to complement the other solutions so that an ACO can gather information from all their providers. The risk is very high for an ACO that has a leaky infrastructure because the management of risk will be exposed and the cost curve will not be bending, hence no savings will be generated. Our EMO solution is created for instant collaboration and coordination because of the built in HIE function. In our network physicians who care for the same patients instantly are connected and can share medication list, problem list, labs, radiology and progress notes without the additional cost of integrating. We have contracts with 3 ACO’s.

Q: What’s your take on mobile adoption by doctors, particularly when it comes to products like EHR?

A: Mobile phones are ubiquitous in the medical community. We see Physicians and Nurse Practitioners adopting our mobile solution. It is unlikely they will undertake a full clinical interaction on an iPhone but they do use our native iPad App. The key here is it is a tool for the Doc on the run. The office based PC will always be the tool of choice in the foreseeable future, many have just purchased them recently!

Q: What’s something that doctors aren’t paying enough attention to right now?

A: Connectivity. They have just paid for a stand alone EHR, now they need to coordinate care with other providers/hospitals/labs etc. These other entities are cherry picking and paying certain providers who have enough volume or contribution to the hospital or system. It is a cost that may be just as expensive as the EHR in the long term for the physician. This is a crucial part of the solution and why we have an inbuilt HIE functionality allowing physicians to immediately refer patients across our system. This is particularly attractive to the ACO market.

Also, the meaningful use subsidy will end in a few years, if a provider is using an expensive system, how will that affect the ability for the provider to sell their practice to a new physician who is already in debt from med school. We have many fat cat EHR vendors just milking the Physician who they see as an equal opportunity victim. How many EHR’s are showing 60% revenue growth since 2009? This will come to a end soon and the physician will be leveraged again unless they are using a system with an alternate revenue model. Thats where our Mitochon Patent comes in, introducing contextual clinical content into the workflow and subsidize the Physician’s cost.

Full Disclosure: Mitochon is an advertiser on EMR and HIPAA.

February 27, 2013 I Written By

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

One-Fifth Of Physician Practices Might Switch EMRs

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Here’s yet more evidence that this is the year of the “big switch” in EMRs, at least among physicians. A new survey by Black Book Market Research has concluded that about 23 percent of practices with currently implemented EMRs are unhappy enough with their current system to consider switching to a different vendor.

According to a piece in Medical Economics, doctors’ concerns include a lack of interoperability, excessively complicated connectivity and networking and problems with mobile device integration.

The survey, which reached out to 17,000 doctors, found that internal medicine docs had the highest rates of satisfaction (89 percent), followed  by family practice (85 percent), general practice (82 percent) and pediatrics.

The unhappiest specialists were nephrologists (88 percent), followed closely by urologists (85 percent) and ophthalmologists (80 percent).

So if a practice is going to switch vendors, what are they looking for? The Medical Economics piece listed five “must-have” features doctors voted for in the Black Book survey:

* vendor viability

* data integration and network sharing

* adoption of mobile devices

* health information exchange support and connectivity

* perfected interfaces with lab, pharmacy, radiology, medical billing partners, and others

Unfortunately, they won’t find it easy to find all of these features in a single EMR.  Of course, you faithful editor isn’t the be-all and end-all when it comes to EMR products (who could be?) but it seems to me that if even pricier enterprise products seldom offer all of these options, it’s decidedly unlikely that ambulatory products will. (OK, vendor viability is a judgment call, but in a world where so many practices don’t like their EMR, it’s hard to imagine that vendors are at their strongest.)

Folks, the truth is that it looks like we’re coming to a market crash of some kind. Physicians aren’t getting what they need from EMRs, but vendors aren’t keeping up, especially in the realm of specialty EMRs.

As if that wasn’t enough, the threat of fines looms for practices that don’t get their Meaningful Use act together, something they may have trouble doing if they’re in the midst of EMR shopping, installation and adoption.

Time is getting tight, and customers aren’t happy. Ambulatory vendors, what’s your next move?

February 26, 2013 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.

The Anti-ACO / Hospital Medical Practice Consolidation

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A physician, Charles Beauchamp, recently left the following comment (shown below) on my ACO and Hospital Consolidation post on EMR and EHR. This might be another example of the EHR Physician Revolt. I wonder how many other doctors will go “against the grain” like Dr. Beauchamp.

As a physician who is going “against the grain” (ie “hospital owned” to private practice” rather than in the opposite direction) I have the following model of action to become part of a patient centered rather than exploitative ACO:

1) Establish my rural practice in my house at a very low cost, including asking some of my patients who volunteered to help with construction.

2) Employ myself, a front desk person and a Medical Assistant with backups

3) Establish Telemedicine links to needed specialties (rheumatology, pulmonary, cardiology) AND use physician social networks (eg, Sermo, MedLink Neurology Forum) for informal networking

4) Use LabCorp as a reference lab with negotiated discounts on high yield labs for one of the practice’s centerpieces: preventing stokes, heart attacks, renal insufficiency, onset of diabetes and diabetes complications. Likewise have a systematic literature scan process using EMBASE rather than PubMed for enhancing the testing and intervention effectiveness of the practice’s goals

5) Embed in the practice’s patient education, instruction and self-care facilitation expertise in efficiently discussing and following up on patient-centered discussions

6) Embed in the practice’s counseling activities the ability to counsel patients about which Part-D plan to choose and which health insurance plan to purchase (minus Medicare)

7) Use a general internist centric and concept driven EMR as the practice’s EMR and optimize its functionality for delivering efficacious brief interventions

8) Participate in community groups (eg, Rotarians) and recruit community leaders interested in enhancing the value of care that is being delivered to the community

9) Intersect with the state’s evolving HIE and structure information collection so that disease classification information can be transmitted to an HIE capable of accepting that information. Constantly improve the practice’s ability to collect disease classification information and include that information within the practice’s concept driven EMR.

10) Code reponsively with the help of a viable clinical concept parser, emphasize patient communication, use evidence and experience to follow-up on disease classification information by using efficacious brief interventions and systematically track outcomes while emphasizing 24 x 7 continuity of outpatient internal medicine care.

February 11, 2013 I Written By

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

Interoperability Needs Action, Not Talk – #HIMSS13 Blog Carnival

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When you talk to people outside of healthcare about the value of healthcare IT, you will often get a response that healthcare IT is fantastic because it makes it so easy for medical data to be shared with who needs the data when they need it. Those of us in healthcare IT know that this is far from the reality of what’s possible with healthcare data today. This is really unfortunate, because the promise of technology in healthcare is to make the movement of data possible. We’re currently missing out on the benefits of this promise.

I don’t know about the rest of you, but I’m sick and tired of hearing the excuses for why healthcare data can’t be shared. We’ve heard them all: privacy, security, data governance, payment model, etc etc etc. Yet we go to the HIMSS Interoperability Showcase and see that the technology to start sharing data is there, but what seems to be missing is the willpower to push the data sharing through despite the challenges and naysayers.

Maybe Farzad is on to something when he called for EHR vendors to do what’s “Moral and Right.” There’s no more moral or right thing someone can do in healthcare than to make healthcare data interoperable. It’s not only EHR vendors that need to do this, but hospital institutions and doctors offices as well.

We need some brave leaders in healthcare IT to step up and start sharing data. No, I don’t want an announcement at HIMSS that a healthcare organization has partnered with a vendor to start sharing data. I don’t want a new organization formed to assist with healthcare data sharing initiatives. I don’t need another book on the challenges of HIE. We don’t need a session on HIEs and data sharing standards. No, we need brave organizations that say that sharing healthcare data is the right thing to do and we’re making it happen.

I’m not suggesting an organization should do anything ruthless or reckless. I’m suggesting that healthcare organization start DOing something as opposed to talking about it. The time for talking is over and the time for DOing is here. Healthcare data interoperability won’t happen until we make this choice to DO instead of TALK.

I’m not even asking for a healthcare organization to start sharing all their healthcare data everywhere. In fact, I think that’s another failed interoperability strategy that we seem to keep trying over and over. If you try to solve all of our healthcare interoperability problems in one major project, you’ll end up doing nothing and solve none of the problems.

Instead a successful interoperability strategy will focus on sharing one meaningful piece of healthcare data while still keeping in mind that this is just the start. Connect the healthcare data end points with that one meaningful piece of data. Once you make that connection, others will start to wonder why that same process can’t be used for other important and valuable pieces of healthcare data. This is exactly the push that healthcare interoperability needs. We need departments and providers jealous of other departments and providers that are sharing their data. The same principle of jealousy can apply across institutions as well.

Yes, this will take a forward looking leader that’s willing to take what many in healthcare would consider a risk. Imagine a hospital CIO whose stuck trying to explain why their hospital is sharing data that will help doctors provide better care to their patients. Imagine a hospital CIO explaining why they’re driving healthcare costs down by lowering the number of duplicate tests that are done because they already have the data they need thanks to interoperable healthcare data. I’d hate for a hospital CEO to have to explain why they’ve reduced hospital readmissions because they shared the hospital data with a patient’s primary care doctor.

Maybe implementing interoperability in healthcare isn’t such a brave thing after all. In fact, it’s a brave thing for us not to be sharing data. Why aren’t we holding our healthcare institutions accountable for not sharing data that could save lives, lower costs, and improve healthcare? Why are we ok with non-profit institutions worrying more about profit than the real stakeholders their suppose to be serving? Are we really so far gone that healthcare organizations can’t do something so obvious: sharing healthcare data?

Think of all the other major healthcare initiatives that would benefit from being able to share healthcare data where it’s needed. Meaningful Use, Obamacare (Affordable Care Act if you prefer), Clinical and Business Intelligence, Mobile Health, ACO’s, population health, etc could all benefit from healthcare institutions that embraced interoperable healthcare data.

Who’s going to take the lead and start doing what we all know should be happening? It won’t happen by #HIMSS13, but over cocktails at HIMSS I hope some hospital CIOs, doctor groups, EHR vendors, and other medical providers come together to do what they know is the right thing to do as opposed to just talking about it.

The above blog post is my submission to the #HIMSS13 Blog Carnival.

February 8, 2013 I Written By

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