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ONC Offers Two Interoperability Measures

Posted on July 14, 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.

For a while now, it’s been unclear how federal regulators would measure whether the U.S. healthcare system was moving toward the “widespread interoperability” MACRA requires. But the wait is over, and after reviewing a bunch of comments, ONC has come through with some proposals that seem fairly reasonable at first glance.

According to a new blog entry from ONC, the agency has gotten almost 100 comments on how to address interoperability. These recommendations, the agency concluded, fell into four broad categories:

  • Don’t create any significant new reporting burdens for providers
  • Broaden the scope of interoperability measurements to include providers and individuals that are not eligible for Medicare and Medicaid EHR incentives
  • Create measures that examine usage and usefulness of exchanged information, as well as the impact on health outcomes, in addition to measuring the exchange itself
  • Recognize that given the complexity of measuring interoperability, it will take multiple data sources, and that more discussions will be necessary to create an effective model for such measurements

In response, ONC has come up with two core measures which address not only the comments, but also its own analysis and MACRA’s specific definitions of “widespread interoperability.”

  • Measure #1: Proportion of healthcare providers electronically engaging in the following core domains of interoperable exchange of health information: sending; receiving; finding (querying); and integrating information received outside sources.
  • Measure #2: Proportion of healthcare providers who report using information electronically received through outside providers and sources for clinical decision-making.

To measure these activities, ONC expects to be able to draw on existing national surveys of hospitals and office-based physicians. These include the American Hospital Association’s AHA Information Technology Supplement Survey and the CDC National Center for Health Statistics’ annual National Electronic Health Record Survey of office-based physicians.

The reasons ONC would like to use these data sources include that they are not limited to Medicare and Medicaid EHR incentive program participants, and that both surveys have relatively high response rates.

I don’t know about you, but I was afraid things would be much worse. Measuring interoperability is quite difficult, given that just about everyone in the healthcare industry seems to have a slightly different take on what true interoperability actually is.

For example, there’s a fairly big gulf between those who feel interoperability only happens when all data flows from provider to provider, and those who feel that sharing a well-defined subset (such as that found in the Continuity of Care Document) would do the trick just fine. There is no way to address both of these models at the same time, much less the thousand shades of gray between the two extremes.

While its measures may not provide the final word on the subject, ONC has done a good job with the problem it was given, creating a model which is likely to be palatable to most of the parties involved. And that’s pretty unusual in the contentious world of health data interoperability. I hope the rollout goes equally well.

2 Major Problems with MACRA

Posted on May 4, 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.

Everyone’s started to dive into the 10 million page MACRA (that might be an exaggeration, but it feels about that long) and over the next months we’ll be sure to talk about the details a lot more. However, I know that many healthcare organizations are tired of going through incredibly lengthy regulations before they’re final. Makes sense that people don’t want to go through all the details just for them to change.

As I look at MACRA from a very high level, I see at least two major problems with how MACRA will impact healthcare.

Loss of EHR Innovation
First, much like meaningful use and EHR certification, MACRA is going to suck the life out of EHR development teams. For 2-3 years, EHR roadmaps have been nothing but basically conforming to meaningful use and EHR certification. Throw in ICD-10 development for good measure and EHR development teams have basically had to be coding their application to a government standard instead of customer requests and unique innovations.

Just today I heard the Founder of SOAPware, Randall Oates, MD, say “I’m grieving MACRA to a great degree.” He’s grieving because he knows that for many months his company won’t be able to focus on innovation, but will instead focus on meeting government requirements. In fact, he said as much when he said, “We don’t have the liberty to be innovative and creative.” And no, meeting government regulations in an innovative way doesn’t meet that desire.

I remember going to lunch with a very small EHR vendor a year or so ago. I first met him pre-meaningful use and he loved being able to develop a unique EHR platform that made a doctor more efficient. He kept his customer base small so that he could focus on the needs of a small group of doctors. Fast forward to our lunch a year or so ago. He’d chosen to become a certified EHR and make it so his customers could attest to meaningful use. Meaningful use made it so he hated his EHR development process and he had lost all the fire he’d had to really create something beautiful for doctors.

The MACRA requirements will continue to suck the innovation out of EHR vendors.

New Layers of Work With No Relief
When you look at MACRA, we have all of these new regulations and requirements, but don’t see any real relief from the old models. It’s great to speak hypothetically about the move to value based reimbursement, but we’re only dipping our toe in those waters and so we can’t replace all of the old reimbursement requirements. In some ways it makes sense why CMS would take a cautious approach to entering the value based world. However, MACRA does very little to reduce the burden on the backs of physicians and healthcare organizations. In fact, in many ways it adds to their reporting burden.

Yes, there was some relief offered when it comes to meaningful use moving from the all or nothing approach and a small reduction in the number of measures. However, when it comes to value based reimbursement, MACRA seems to just be adding more reporting burdens on doctors without removing any of the old fashioned fee for service requirements.

MACRA is not like ICD-10. Once ICD-10 was implemented you could see how ICD-9 and the skills required for that coding set will eventually be fully replaced and you won’t need that skill or capability anymore. The same doesn’t seem to be true with value based care. There’s no sign that value based care will be a full replacement of anything. Instead, it just adds another layer of complexity, regulation, and reporting to an already highly regulated healthcare economic system.

This is why it’s no surprise that many are saying that MACRA will be the end of small practices. At scale, they’re onerous. Without scale, these regulations can be the death of a practice. It’s not like you can stop doing something else and learn the new MACRA regulations. No, MACRA is mostly additive without removing a healthcare organization’s previous burdens. Watch for more practices to leave Medicare. Although, even that may not be a long term solution since most commercial payers seem to follow Medicare’s lead.

While I think that CMS and the people that work there have their hearts in the right place, these two problems have me really afraid for what’s to come in health IT. EHR vendors the past few months were finally feeling some freedom to listen to their customers and develop something new and unique. I was excited to see how EHR vendors would make their software more efficient and provide better care. MACRA will likely hijack those efforts.

On the other side of the fence, doctors are getting more and more burnt out. These new MACRA regulations just add one more burden to their backs without removing any of the ones that bothered them before. Both of these problems don’t paint a pretty picture for the future of healthcare.

The great part is that MACRA is currently just a proposed rule. CMS has the opportunity to fix these problems. However, it will require them to take a big picture look at the regulation as opposed to just looking at the impact of an individual piece. If they’re willing to focus MACRA on the big wins and cut out the parts with questionable or limited benefits, then we could get somewhere. I’m just not sure if Andy Slavitt and company are ready to say “Scalpel!” and start cutting.

Has MU Been Useful? A Review of MU and Merit-Based Incentives – Breakaway Thinking

Posted on March 16, 2016 I Written By

The following is a guest blog post by Lori Balstad, Learning and Development Specialist at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Lori Balstad
Is it really the end of Meaningful Use? According to Andy Slavitt, Acting Administrator for the Centers for Medicare and Medicaid Services (CMS), it’s time for a change in incentive programs and 2016 may be the year for it. Alternative Payment Models and Merit-based Incentive Payments (MIPS) as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) may be replacing the complicated layers of requirements in Stage 1, 2, and 3 of Meaningful Use.

While CMS works on rolling out a new set of regulations, you may be wondering if this will ease the lingering pain of the past years. Will the program be easier to understand, navigate, and comply with?

First, let’s do a quick review:

CMS’s Meaningful Use Incentive program was rolled out in 2011 to incentivize eligible professionals and hospitals to adopt electronic health records (EHRs).

The goal was three-fold:

  • Improve quality, safety, efficiency, and reduce health disparities
  • Increase patient engagement and satisfaction
  • Improve care coordination, and population and public health

Stage 1 dealt with data capture and sharing, Stage 2 focused on advance clinical processes, and Stage 3 was to bring us to improving healthcare outcomes.

Achieving these goals is not an easy or quick process, but there have been many noteworthy accomplishments. As of 2015, 95 percent of all eligible and critical access hospitals have demonstrated meaningful use of certified health IT through participation in the CMS EHR Incentive Programs. Ninety-eight percent of all hospitals have demonstrated meaningful use and/or adopted, implemented or upgraded any EHR. As of January 2016, more than 484,000 health care providers received payment for participating in the Medicare and Medicaid EHR Incentive Programs, according to the CMS.

There have also been bumps along the way. Clinical quality reporting is controversial due to unrefined standards and a lack of a comprehensive strategy around the measures. Providers struggle to balance healthcare reform efforts with patient engagement and education under Stage 2. Eligibility determination issues in the CMS website threatened some physicians and other eligible professionals with Medicare payment penalties in 2015. Physicians are at the point where the regulations are so difficult that they feel like they are unable to focus on patient care.

So what’s next?

CMS has been working closely with physicians and healthcare organizations to address their needs and concerns, and plans to share the new regulations this spring under MACRA. They will work towards keeping the original ideologies while establishing new critical principles. The most important improvement will be moving away from incentivizing providers for the mere use of the technology towards the actual outcomes achieved with their patients. Other goals include allowing for flexibility to customize health IT to ensure physicians are supported instead of distracted.

Meaningful Use is not going away, just the way it’s measured and incentivized. Moving toward quality outcomes instead of measuring technology adoption levels will hopefully move us closer to the original goals of Meaningful Use. It all comes back to what physicians and healthcare organizations do on a daily basis – strive to provide the best possible care for patients.

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

#HIMSS16 Mix Tape

Posted on February 5, 2016 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin is a true believer in #HealthIT, social media and empowered patients. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He currently leads the marketing efforts for @PatientPrompt, a Stericycle product. Colin’s Twitter handle is: @Colin_Hung

On February 29th the #HealthIT community will descend on Las Vegas for the annual HIMSS conference and exhibition.

One of the best parts about attending HIMSS is getting the chance to meet people in real life who I interact with through social media. There is nothing quite like meeting someone face to face for the first time yet feeling like you already know them. I think hugging and fist bumps are the official greetings at HIMSS. It’s an absolute blast to be able to share stories and laughs with likes of Mandi Bishop, John Lynn , Rasu Shrestha and Wen Dombrowski.

With an expected attendance of 45,000 this year, I’m hoping to meet even more people than ever before at the various HIMSS gatherings.

Last year, ahead of HIMSS15, I decided to do a fun blog post. I asked some friends to send me a song they thought reflected what was happening in #HealthIT at the time. I compiled everyone’s selections along with the reasons behind their choice. I called it the HIMSS15 Mix Tape. The response was amazing. I had so many people DM me and stop me at the conference to give me their song choice. Even John Lynn blogged about it.

This year, I asked an even larger number of friends to contribute a song. So without further rambling, here is the #HIMSS16 Mix Tape. Enjoy!

HIMSS16 Mix Tape

Night on Bald Mountain – Disney’s Fantasia. Chosen by Regina Holliday @ReginaHolliday. “Disney. Because although morning will come, we now walk among the terrors.”

Confident – Demi Levato. Chosen by Mandi Bishop @MandiBPro. “For a couple reasons: 1) it’s beyond time #HealthITChicks / #WomenInHIT got equal recognition and pay for their contributions to the field, and I’m seeing an increasing strength of voice supporting those efforts, 2) patients have had enough of their attempts to engage being discounted by clinicians and other caregivers, and we are all demanding respect and inclusion at the table of our healthcare decisions.”

Stronger – Kelly Clarkson. Chosen by John Lynn @techguy. “This should be the anthem of those of us in healthcare IT.  First, do no harm, but don’t be afraid to take some risks and make mistakes.  Not taking some risks is killing more people than doing something and sometimes making mistakes.  Healthcare will be stronger for the mistakes we make.”

Runnin’ Down A Dream –  Tom Petty & the Heartbreakers. Chosen by Melody Smith Jones @melsmithjones. “I got into this industry because my grandmother died of cancer in rural USA in 2003. I’ve been running down the dream of care everywhere ever since. I believe 2016 will bring us the most growth in Connected Health that we have seen to date.”

Talk to Me – Stevie Nicks. Chosen by David Harlow @healthblawg. “The chorus includes the line: “You can talk to me/You can set your secrets free, baby” which can be read as a coded message to legacy systems … One of the verses goes: “Our voices stray from the common ground where they/Could meet/The walls run high/ … / Oh, let the walls burn down, set your secrets free” — a prescient call to interoperability, to communication, to enabling broader collaboration across provider, payor and health care information technology silos. We’re almost there, Stevie.”

Heroes – David Bowie. Chosen by Nick van Terheyden @drnic1. “Because I love that track and was sad to see David Bowie leave this universe. But also: We need to be heroes for Healthcare and I hope Healthcare Technology can beat the madness of our system and Ch-ch-ch-ch-change the world:

A million dead-end streets / And every time I thought I’d got it made / It seemed the taste was not so sweet…… / We can be Heroes, just for one day / We can beat them, for ever and ever … ICYMI – I blended the lyrics from David Bowie’s Changes with Heroes”

Another Brick in the Wall – Pink Floyd. Chosen by Rasu Shrestha @RasuShrestha. “In memory of Meaningful Use ‘All in all it was just a brick in the wall…’ “

Numb – Linkin Park. Chosen by me @Colin_Hung. I think many physicians, nurses, administrators and patients are numb from all the competing priorities this past year and from the years of chasing Meaningful User dollars. I think this verse sums it up:

I’m tired of being what you want me to be / Feeling so faithless, lost under the surface / Don’t know what you’re expecting of me / Put under the pressure of walking in your shoes / (Caught in the undertow, just caught in the undertow) / Every step that I take is another mistake to you

Fire – Jimi Hendrix. Chosen by Chad Johnson @OchoTex. “The reason is simple: HL7 FHIR continues to dominate the headlines and discussions around health data interoperability, and rightfully so. FHIR will bring exciting changes to interoperability.”

Taking Care of Business – Bachman-Turner Overdrive. Chosen by Charles Webster @wareFLO. “Taking care of business in healthcare means getting sh*%$t done. Effectively and efficiently accomplishing goals is only possible with great…wait for it…WORKFLOW”

I Want It All – Queen. Chosen by Joe Lavelle @Resultant. “Because we want it all – Interoperability, “our damn data”, #mhealth, Patient Engagement, Population Health, Telemedicine. etc.”

Robot Rock – Daft Punk. Chosen by AJ Montpetit @ajmontpetit. “We’re heading to the integration of AI into healthcare to create a streamlined experience, and assist in comprehension of all the multiple factors that each patient has individually.”

Upgrade U – Beyoncé. Chosen by Cari McLean @carimclean. “I’ll go with a song that not only always makes me dance but one that reflects a growing happening in healthcare. I chose this song because the EHR replacement market is growing as the rip and replace trend continues and health information exchange is prioritized.”

Give Me Novacaine – Green Day. Chosen by Linda Stotsky @EMRAnswers. “LOL- because providers are in PAIN!!! They need something to soften the blows”

Changes – David Bowie. Chosen by Brad Justus @BradJustus. “A classic from a classic and something that is a constant in #HealthIT”

Fight Song – Rachel Platten. Chosen by Jennifer Dennard @JennDennard. “I think it encapsulates the #healthITchicks ethos – not to mention patient advocates’ – quite well :)”

 What Do You Mean – Justin Bieber. Chosen by Sarah Bennight @sarahbennight. “For SO many reasons. What do you mean MU is going away? What do you mean you need me to fill out ANOTHER demographic profile, what do you mean you don’t have my allergies? What do you mean by interoperable? I could go on all day, but we all have real jobs to do….like to figure out this healthcare IT thing :) Plus in the Justin B song…you hear a clock…do you ever feel like Health IT is running out of time? I don’t agree with JB on ANYTHING, but I agree we are running out of time.”

Shape of Things – David Bowie. Chosen by Pat Rich @pat_health. “In my mind this song evokes the futuristic world of health IT in a steampunk/sci-fi sort of way”

Hello – Adele. Chosen by Bill Bunting @WTBunting. “Because there is an emerging side of healthcare that’s trying to break free and be heard (i.e. adoption), and no one is answering the call to do so”

Under Pressure – Queen & David Bowie. Chosen by Joy Rios @askjoyrios. “There is so much pressure to get through these health IT initiatives unscathed and there’s so much at risk if they get it wrong.  I see providers across the country dealing with so much change, when they mostly just want to focus on their practice. Unfortunately, the changes are not letting up. I feel like the healthcare system is right in the middle of its metamorphosis… not a caterpillar anymore, but by no means a butterfly!”

Please Please Me – The Beatles. Chosen by Jim Tate @jimtate. “Providers want better EHRs”

New New Minglewood Blues – The Grateful Dead. Chosen by Brian Ahier @ahier. “Because I was inspired by this @healthblawg post ‘The New New Meaningful Use’ “

EHR State of Mind – ZDoggMDChosen by Andy DeLaO @CancerGeek. “Does it really need an explanation? J”

Dha Tete – Pandit Shyamal Bose. Chosen by Wen Dombrowski @HealthcareWen. “Some reasons I like this song:

  • Focus, Mindfulness
  • Flow states
  • Collaboration, Staying in Sync with each other (it is actually 2 people duet)
  • Speed, Moving fast
  • Precision, deciveness
  • Artistry, Beauty”

You Can Get It If You Really Want – Jimmy Cliff. Chosen by Steve Sisko @ShimCode. “I believe true, widespread interoperability is not that far away. The technology, standards (FHIR, OpenNotes), and group consensus (outfits like CommonWell, The Sequoia Project) are finally coming together.

You can get it if you really want / But you must try, try and try, try and try / You’ll succeed at last

Do you have a song you think reflects #HealthIT or healthcare at the moment? Add it to the comments below!

[Update: Here is a link to a Spotify playlist of the entire #HIMSS16 Mix Tape https://open.spotify.com/user/12163763158/playlist/7mO6DlpVa4MoJ7roW0bqiG or if you like videos, here is a YouTube playlist https://www.youtube.com/playlist?list=PLOxadHqniaPTYUUY5cMSmW14VZQpngUOU]

Meaningful Use Is Going to Be Replaced – #JPM16

Posted on January 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.

Big news came out today during the JP Morgan annual healthcare conference in San Francisco. Andy Slavitt, acting administrator of CMS, live tweeted his own talk at the event including this bombshell:


Technically meaningful use is not quite over, but it’s heading that way. We always read about lame duck head coaches in sports. I guess this is the version of a lame duck government program? Of course, this is just coming from the acting administrator of CMS. It’s not yet law. So, all those working on meaningful use reports, keep working.

The end of meaningful use as we know it will be generally welcome news to most in healthcare. Although, I’m sure that most will also take it with a grain of salt. Many in healthcare likely worry that the “something better” that replaces meaningful use and MACRA will actually be something worse. The cynics might argue that nothing could be worse, but I’ve never seen the government back down from that challenge.

What interests me is what levers they have available to them to be able to make changes. Can they do it without congressional action? Are doctors angry enough that congress will take action? What will happen to the remaining $10-20 billion allocated to meaningful use? What will hospitals and doctors that were counting on the meaningful use money do? Will they not get it anymore or will it be available in a new program? Obviously, there are more questions than answers at this point.

All in all, I’m glad to hear that Andy Slavitt is open to change. I suggested they blow up meaningful use a couple years ago.

Andy also did a tweetstorm to outline the 4 themes for reforming the MACRA and post-MU tech program:

These all seem surprisingly reasonable and mirror many of the comments I hear from doctors. However, the challenge is always in the implementation of these ideas. Some of them are very hard to track and reward. I can’t argue with the principles though. They highlight some of the major challenges associated with healthcare tech. It’s going to take some time to infuse entrepreneurship instead of regulation back into the EHR world, but these guidelines are a good step towards that effort.

UPDATE: Here’s the full text of Andy Slavitt’s talk at the JP Morgan Healthcare Conference.

How Will the Coming Election Year Impact Healthcare IT?

Posted on November 10, 2015 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 seems like the Presidential election should be closer since we’ve been hearing about possible Presidential candidates for the past year. However, we still have a whole year before the next Presidential election. Does anyone else think we’re going to be tired of this process a year from now? (But I digress)

In past years, there was certainly a lot to talk about when it comes to the impact a new president would have on healthcare IT. However, I don’t think that this presidential election will be the same. I think that’s true for healthcare in general as well.

On the healthcare IT side, meaningful use has basically run its course. Sure, Jeb Bush has asked to eliminate meaningful use and government mandates and penalties for EHR use. Although, John Halamka and Marc Probst have both recently asked for the same. We’ve written previously about how getting rid of meaningful use wouldn’t do much of anything to alter the current course of EHR and healthcare IT. It just wouldn’t change much of anything.

What could a presidential candidate do to impact healthcare IT? I really don’t see them having an interest in doing much of anything to impact the current course of healthcare IT. If you think otherwise, I’d love to hear why.

On the healthcare side of things we might see more changes. Certainly the topic of healthcare costing the US too much money is a very big an important topic for the president. However, I think Obamacare and those healthcare reform efforts are too far gone to be able to really go back and change them now. Sure, we could see some changes here and there, but I think it’s too late for a new President to really drastically change what’s already been done.

Related to this is the move away from fee for service to a value based reimbursement environment. Would any President condone this direction? Would any President advocate for a return to the old fee for service environment? I don’t see it happening. As many people have told me, the shift to value based care has left the building. There’s no coming back. Could they modify the approach and some of the details. Certainly! However, they’re not likely going to change the trajectory.

Long story short, I’m not sure any Presidential candidate will do anything that will drastically impact healthcare IT and healthcare as we know it. Sure there will be some tweaks that will have some impact, but nothing major like Obamacare or the HITECH Act.

Do you agree or disagree? I always love to hear other perspectives.

$15+ Billion of Ongoing Meaningful Use Spending Will Change Nothing

Posted on October 16, 2015 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.

In case you missed it, Jeb Bush put out his healthcare plan and called for termination of the meaningful use program. Here’s that section of his plan:

Promote private sector leadership of health information technology adoption: Lead private sector collaboration, rather than government mandates, to establish national standards for electronic health record features and data interoperability; eliminate government mandates and penalties for health care providers who do not use government-approved electronic health records; protect health information from hackers and cyber attacks; and enable patient ownership of their medical history and records. Individuals should have access to their longitudinal medical records, which will help providers offer more personalized and timely treatments for individuals.

This sounds a lot like my plan to blow up meaningful use and focus on interoperability. I think it’s the right strategy and the more I think about the future of meaningful use, the more I’ve realized that it needs to end (at least in its current form).

I’ve been talking with a lot of people lately and I’ve been asking them this fundamental question: If the government chose not to spend the ~$15 billion of meaningful use money that remains would it change the trajectory of EHR adoption and EHR use at all?

There are a number of ways to look at the answer to this question. First, all of the remaining meaningful use money has basically been spoken for. I can’t think of anything anyone can do to change which companies are going to get the EHR incentive money. Everyone that’s going to get future EHR incentive money has already purchased their EHR and that $15 billion is already more or less committed to the various EHR vendors. Meaningful use has essentially locked practices into their current EHR and that’s not going to change (give or take a few hundred million).

Second, what major benefits will continued participation in meaningful use bring healthcare? This is an important question. If the government’s going to continue spending $15 billion on this program, don’t you think we should be able to trace that spending to specific benefits we’re going to receive? One way to look at this is to consider the benefits we’ve received from the first ~$20 billion (Medicare) (and another $10 billion for Medicaid) spent on meaningful use. We’ve seen adoption of EHRs. That I can’t argue. However, it’s hard for me to argue much benefit beyond it. Looking at the future meaningful use stages, I’m not optimistic of the benefits future meaningful use compliance will bring either. I’d love to hear if you have a different perspective.

I do know hundreds (probably thousands) of doctors who would argue that continuing the meaningful use program will not only not provide us any benefits, but will actually cause harm to health care. They would argue that meaningful use is a tax on their time and it provides no actual value to them or their patients. This is evident when you consider the number of doctors who have chosen not to participate in meaningful use even though they know doing so is going to cause them to incur penalties. Think about that. Many doctors think the cost to participate in meaningful use is more expensive than the guaranteed penalties for non-participation.

Returning back to the government perspective, is it wise for the government to spend another $15 billion on a meaningful use program which will actually do more harm than good?

The one challenge with the idea of discontinuing meaningful use is that it will make some organizations that were planning on the money angry. I get it. If you’re a hospital that just spent a few hundred million dollars on an EHR with the expectation that you’d be getting paid the meaningful use money, meaningful use being terminated would be quite a blow. Same goes for small practices that have invested in an EHR with the hope of EHR incentive money. I’m sympathetic to this challenge.

The solution is simple though. You find another more meaningful (pun intended) way to spend the $15 billion so these organizations can still recoup some of the investment they made in their EHR software. The meaningful way to do this is to pay them for being interoperable. Disregard all the other prescriptive elements of meaningful use and create a much simpler program that’s focused around healthcare organizations sharing data. Incentivize healthcare organizations to do something we all know is the right thing to do but which has no natural incentive. Focus the incentive on the outcome.

Am I optimistic this will happen? No. Unfortunately, I think it would take some legislative action for CMS and ONC to be able to do this. They can’t just do it on their own (I believe). Given the state of affairs in Washington, I can’t imagine congress caring enough about $15 billion here or there. It’s sad to say, because so much more could be done to improve healthcare as we know it if that $15 billion were part of the right incentive program. As it is, if the meaningful use program were cut today or the money is spent, I don’t see either action changing the trajectory of EHR and healthcare IT in a significant way.

HIM Departments Need More Support

Posted on July 16, 2015 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.

As both a contributor to this blog, and an assertive, activist patient managing chronic conditions, I get to see both sides of professional health information management.  And I have to say that while health data management pros obviously do great things against great odds, support for their work doesn’t seem to have trickled down to the front lines.  I’m speaking most specifically about Medical Records (oops, I mean Health Information Management) departments in hospitals.

As I noted in a related blog post, I recently had a small run-in with the HIM department of a local hospital which seems emblematic of this problem. The snag occurred when I reached out to DC-based Sibley Memorial Hospital and tried to get a new log-in code for their implementation of Epic PHR MyChart. The clerk answering the phone for that department told me, quite inaccurately, that if I didn’t use the activation code provided on my discharge summary papers within two days, my chance to log in to the Johns Hopkins MyChart site was forever lost. (Sibley is part of the Johns Hopkins system.)

Being the pushy type that I am, I complained to management, who put me in touch with the MyChart tech support office. The very smart and help tech support staffer who reached out to me expressed surprise at what I’d been told as a) the code wasn’t yet expired and b) given that I supplied the right security information she’d have been able to supply me with a new one.  The thing is, I never would have gotten to her if I hadn’t known not to take the HIM clerk’s word at face value.

Note: After writing the linked article, I was able to speak to the HIM department leader at Sibley, and she told me that she planned to address the issue of supporting MyChart questions with her entire staff. She seemed to agree completely that they had a vital role in the success of the PHR and patient empowerment generally, and I commend her for that.

Now, I realize that HIM departments are facing what may be the biggest changes in their history, and that Madame Clerk may have been an anomaly or even a temp. But assuming she was a regular hire, how much training would it have taken for the department managers to require her to simply give out the MyChart tech support number? Ten minutes?  Five? A priority e-mail demanding that PHR/digital medical record calls be routed this way would probably have done the trick.

My take on all of this is that HIM departments seem to have a lot of growing up to do. Responsible largely for pushing paper — very important paper but paper nonetheless — they’re now in the thick of the health data revolution without having a central role in it. They aren’t attached to the IT department, really, nor are they directly supporting physicians — they’re sort of a legacy department that hasn’t got as clearly defined a role as it did.

I’m not suggesting that HIM departments be wiped off the map, but it seems to me that some aggressive measures are in order to loop them in to today’s world.

Obviously, training on patient health data access is an issue. If HIM staffers know more about patient portals generally — and ideally, have hands-on experience with them, they’ll be in a better position to support such initiatives without needing to parrot facts blindly. In other words, they’ll do better if they have context.

HIM departments should also be well informed as to EMR and other health data system developments. Sure, the senior people in the department may already be looped in, but they should share that knowledge at brown bag lunches and staff update sessions freely and often. As I see it, this provides the team with much-needed sense of participation in the broader HIT enterprise.

Also, HIM staff members should encourage patients who call to log in and leverage patient portals. Patients who call the hospital with only a vague sense that they can access their health data online will get routed to that department by the switchboard. HIM needs to be well prepared to support them.

These concerns should only become more important as Meaningful Use Stage 3 comes on deck. MU Stage 3 should provide the acid test as to whether whether hospital HIM departments are really ready to embrace change.

Meaningful Use EHR Adoption Charts – EHR Market Analysis

Posted on June 12, 2015 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.

ONC continues to push out more data when it comes to meaningful use, EHR adoption, RECs, and related areas. As a data addict, I could spend forever looking through and analyzing this data. So, I’ll probably do a series of posts across Healthcare Scene over the next couple weeks looking at the charts and data that ONC has made public about meaningful use and EHR adoption. I know some of the charts have been out for a while, but the analysis should still prove useful.

If you want to join in on the analysis of this data, I welcome you in the comments of each post. Plus, if you want to find your own nuggets to share, I’d suggest starting with their quick stats and dashboards pages.

First up in our look at the ONC EHR data is a look at the meaningful use participation chart for ambulatory EHR vendors (eligible providers if you prefer):
Ambulatory Practice EHR Adoption - Meaningful Use Participation
The most important part of this chart to me is that the two largest bars on the chart. The largest bar is the 749 “Other EHR Vendors” category at the bottom of the chart. It’s easy to miss this bar, but I believe it’s extremely important to note how big the long tail is when it comes to ambulatory EHR adoption. I’ve often said that it doesn’t take that many doctors to make yourself a decent EHR business. This chart illustrates how many EHR vendors are still in the game. There are only 3 EHR vendors that have over 40,000 providers. I know that many think that EHR vendor consolidation is bound to happen. Some certainly will, but I don’t see it happening at a massive scale in the ambulatory EHR world.

The second largest bar on the chart is the Epic EHR adoption. What’s important about this bar is that this totally represents that hospital owned ambulatory EHR adoption. Epic does not and will not sell Epic directly to a small ambulatory provider. All of these “eligible providers” for Epic are in hospital systems. I take away two important things from this. First, we see in plain sight how big the roll up of ambulatory practices is by hospitals. Second, this chart illustrates the opportunity that Cerner and Meditech have available to them. As you’ll see in the next chart, Cerner and Meditech have more hospital installs than Epic, but they’re much farther down on the ambulatory side. A look at history explains why they’ve had trouble penetrating the ambulatory market, but I believe it’s a huge opportunity for them going forward.

I’ll be interested to see how this chart continues to evolve over time. Will we doctors leaving hospitals to go back on their own shift the balance of power? Will we see massive EHR consolidation? I also can’t help but note that Mitochon Systems Inc shows up on the list and they don’t even sell an EHR to doctors directly any more. I assume this must be their white label business? I’ll have to follow up with them to get an update on their business.

Now let’s take a look at the chart for Hospital EHR vendors participating in the EHR incentive programs:
Hospital EHR Adoption - Meaningful Use Participation
This chart illustrates really well the 3 horse hospital EHR race which we’ve all known for a while. Although, given healthcare IT’s love affair with Epic (kind of like Apple in the IT world), I think some will be a bit surprised that Cerner and MEDITECH are both listed ahead of Epic. If you looked only at large hospital systems, I think the chart would look very different though.

It’s worth also mentioning the other horses in the race: McKesson, CPSI, MEDHOST, Healthland and Allscripts. They’ve all carved out their niche in the hospital space. We’ll see if they can continue to defend their territory. Hospital EHR switching is not easy.

My favorite observation from this chart versus the ambulatory chart is how well it illustrates the importance of secondary EHR vendors (the brownish gold color) in hospitals. I’ll never forget when Alan Portela of Airstrip told me that the EHR world will be a heterogenous environment. That absolutely resonated with me and this chart proves out what he said. Health systems are going to have multiple EHR vendors even if some EHR vendors would like it to be otherwise.

If you want to look at the potential disruptors in the world of EHR, I’d take a look at these secondary EHR vendors. Their foothold in hospitals provides them a really great opportunity to disrupt the status quo as we know it. Most of them won’t, but they’re all sitting on an opportunity. I’d start with the companies that make up the “Other Vendors” brownish gold bar. I bet there are some really interesting ones in that list.

I’d love to hear your observations from these charts in the comments. Anything I missed? Do you disagree with my observations? I look forward to hearing your thoughts.

Are We Chasing the Carrot or Afraid of the Stick?

Posted on May 29, 2015 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.

The other day SGC asked in my hospital EHR adoption chart post: “If there were no penalties for non-EHR adoption, what would that chart look like?”

For those that are too lazy to click over to that post to see the chart, it basically shows hospital EHR adoption being massively accelerated thanks to the government EHR incentive program. In fact, we’re approaching full adoption of EHR in the hospital space (worth noting is that the ambulatory provider space is lagging far behind that adoption). SGC asks the question about whether that adoption would have occurred without the penalties.

My personal experience is that most organizations appreciate the EHR incentive money and plan that in as part of their budgeting for an EHR, but that they were really much more motivated by the EHR penalties that would accrue if they didn’t adopt an EHR. So, I’d say that people are more afraid of the stick than they are motivated by the carrot.

This is probably more so the case because the penalties are going to exist in perpetuity. I think most hospital organizations believe (and I think rightly so) that the EHR penalties for not using an EHR are not going to stop. In fact, they could get much worse. Not to mention, other payers might start implementing similar penalties for non-EHR use as well.

What’s been your experience? Are the carrot or the stick more motivating to healthcare organizations?

Another related question would be, “If there had been no EHR incentive or penalties, what would the EHR adoption chart look like today?” That’s a topic for another blog post.