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

Happy Labor Day!

Posted on September 5, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Labor Day in Healthcare

A big shout out to all those who labor hard and do amazing things in healthcare. Particularly those who are stuck working on Labor Day to make sure patients get the care they need. Happy Labor Day!

Three Words That Health Care Should Stop Using: Insurance, Market, and Quality (Part 2 of 2)

Posted on August 23, 2016 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The previous part of this article ripped apart the use of the words “insurance” and “market” to characterize healthcare. Not let’s turn to another concept even more fundamental to our thinking about care.

Quality

The final element of this three-card Monte is the slippery notion of quality. Health care is often compared to the airlines (when we’re not being compared to the Cheesecake Factory), an exercise guaranteed to make health care look bad. Airlines and restaurants offer relatively homogeneous experiences to all their clients and can easily determine whether their service succeeded or failed. Even at a mechanical level, the airlines have been able to quantify safety.

Endless organizations such as the National Association for Healthcare Quality (NAHQ) and the Agency for Healthcare Research and Quality (AHRQ) collect quality measures, and CMS has tried strenuously to include quality measures in Meaningful Use and the new MACRA program. We actually have not a dearth of quality measures, but a surfeit. Doctors feel overwhelmed with these measures. They are difficult to collect, and we don’t know how to combine them to create easy reports that patients can act on. There is a difference between completing a successful surgery, caring for things such as pain and infection prevention after surgery, and creating a follow-up plan that minimizes the chance of readmission. All those things (and many more) are elements of quality.

Worst of all, despite efforts to rank patients by their conditions and risk, hospitals repeatedly warn that quality measures underestimate risky patients and therefore penalize the hospitals that do the most difficult and important work–caring for the sickest. Many hospitals are throwing away donor organs instead of doing transplants, because the organs are slightly inferior and therefore might contribute to lower quality ratings–even if the patients are desperate to give them a try.

The concept of quality in health care thus needs a fresh look, and probably a different term. The first, simple thing we can do is remove patient ratings from assessments of quality. The patient knows whether the nurse smiled at her or whether she was discharged promptly, but can’t tell how good the actual treatment was after the event. One nurse has suggested that staff turnover is a better indication of hospital quality than patient satisfaction surveys. Given our fascination with airline quality, it’s worth noting that the airline industry separates safety ratings from passenger experience. The health care industry can similarly leverage patient ratings to denote clients’ satisfaction, but that’s separate from quality.

As for the safety and effectiveness of treatment, we could try a fairer rating system, such as one that explicitly balances risk and reward. Agencies would have to take the effort to understand all the elements of differences in patients that contribute to risk, and make sure they are tallied. Perhaps we could learn how to assess the success of each treatment in relation to the condition in which the patient entered the office. Even better, we could try to assess longitudinal results instead evaluating each office visit or hospital admission in isolation.

These are complex activities, but we have lots of data and powerful tools to analyze it. Together with a focus on changing behavior and environments, we should be able to make a real difference in quality–and I mean quality of life. Is there anything an ordinary member of the health professions can do till then? Well, try issuing Bronx cheers and catcalls at any meeting or conference presentation where someone uses one of the three misleading terms.

Three Words That Health Care Should Stop Using: Insurance, Market, and Quality (Part 1 of 2)

Posted on August 22, 2016 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Reading the daily papers, I have gotten increasingly frustrated at the misunderstandings that journalists and the public bring to the debates of over health expansion, costs, and reform. But you can’t blame them–our own industry has created the confusion by misusing terms and concepts that work in other places but not in health. Worse still, the health care industry has let policy-makers embed the incorrect impressions into laws and regulations.

So in this article I’ll promote the long process of correcting the public’s impressions of health care–by purging three dangerous words from health care vocabulary.

Insurance

The health care insurance industry looks like no other insurance industry in the world. When we think of insurance, we think of paying semi-annually into a fund we hope we never need to use. But perhaps every twenty years or so, we suffer damage to our car, our house, or our business, and the insurance kicks in. That may have been true for health care 70 years ago, when you wouldn’t see the doctor unless you fell into a pit or came down with some illness they likely couldn’t cure anyway. The insurance model is totally unsuited for health care today.

The Affordable Care Act made some symbolic gestures toward a recognition that modern health care should embrace prevention and wellness. For instance, it eliminated copays for preventative visits. The insurance companies took that wording very literally: if you dare to bring up an actual medical problem during your preventative visit, they charge you a copay. Yet the “preventative” part of the visit usually consists of a lecture to stop smoking and go on the Mediterranean diet.

Effective wellness programs jettison the notion of insurance (although patients need separate insurance for catastrophic problems). They keep in regular contact with clients, provide coaching, and sometimes use intelligent digital interventions such as described by Dr. Joseph Kvedar in The Internet of Healthy Things (which I reviewed shortly after its release). There are scattered indications that these programs do their job. As they spread, the system set up to deal with catastrophic health events will have to adapt and take a modest role within a behavioral health model.

The term “insurance” is so widely applied to our healh funding model that we can’t make it go away. Perhaps we should put the word in quotation marks wherever it must be used.

Market

This term is less ubiquitous than “insurance” but may be even more harmful. Numerous commenters have pointed out the difference between health care and actual markets:

  • In a market, you can walk away and refuse to pay for a good that is too expensive. If the price of beef goes through the roof, you can switch to beans (and probably should, for your own health). So the best time to argue with someone who promotes a health care market may be right after he’s fallen from a ladder and is clutching at his leg in agony. Ask him, “Do you feel you can walk away from an offer of health care?” Cruel, but a lesson he won’t forget.

  • A market serves people who can afford it. It’s hard to find a stylish hair dresser in a poor neighborhood because no one can pay $200 for a cut. But here’s the rub: the people who need health care the most can’t afford it. Someone with serious mental or physical problems is less likely to find work or be able to attend a college with health insurance. Parents of seriously ill children have to take time off from work to care for them. And so on. It’s what economists–who have trouble discarding the market way of thinking–call a market failure.

  • In a market, you know what you’re going to pay for a service and what your options are. Enough said.

  • In a market, you can evaluate the quality of a service and judge (at least in retrospect) whether it was worth the cost. I’ll deal with quality in the next section.

The misconception of health care as a market came to a head in the implementation of the Affordable Care Act. Presumably, millions of “young invincibles” were avoiding health insurance because of the cost. The individual mandate, combined with affordable plans on health care exchanges, would bring them flooding into the insurance system, lowering costs for everyone and balancing the burden created by the many sick people who we knew would join. And yet now we have stubbornly rising health care rates, deductibles, and caps, along with new costs in the states where Medicaid expanded Where did this all fall apart?

Part of the problem is certainly the recession, which caused incomes to decline or stagnate and exacerbated people’s health care needs. Also, there was a pent-up need for treatment among people who had lacked health insurance and avoided treatment for some time. This comes through in a study of prescription medication use. Furthermore, people don’t change habits overnight: many continue to over-rely on the emergency room (perhaps because of a shortage of primary care providers).

But there’s another unanticipated factor: the “young invincibles” actually start using health care once they get access to it. An analysis showed that mental health needs among the young are much higher than expected. In particular, they suffer widely from depression and anxiety, which is entirely reasonable given the state of our world. (I know that these conditions are connected to genetics and biology, but environment must also play a role.)

Ultimately, until we get behavioral health in place for everybody, health care costs will continue to rise and we won’t realize the promise of near-universal coverage. Many health care activists–especially during the recent political primary season–call for a single-payer system, which certainly would introduce many efficiencies. But it doesn’t solve the problems of chronic conditions and unhealthy lifestyles–that will require policy action on levels ranging from improvements in air cleanliness to new opportunities for isolated individuals to socialize. Meanwhile, we still have to look at the notion of quality in tomorrow’s post.

Happy 4th of July

Posted on July 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.

EMR and HIPAA - 4th of July

I’m taking a break today and spending some time with family. I hope you’re doing the same. Despite the craziness that we see on the news every day, I still feel lucky to live in an extraordinary country. Having lived in a number of other countries, it gives me a great appreciation for the things we do have. It’s too bad the media seems to focus so much effort and energy on the things that divide us.

A big thank you to all those in the healthcare profession that are working on this day. I can only imagine the horrors that come from fireworks on this holiday. Thanks for taking care of us even on holidays.

Over 2500 EMR and HIPAA Blog Posts

Posted on April 11, 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.

I use to celebrate these milestones a lot more. Like any company, as you grow you forget to celebrate things. Not because you don’t care anymore, but because you’re not quite as hyper focused on the growth of your website. It’s too bad since it’s fun to celebrate.

With that in mind, I just realized that EMR and HIPAA hit a milestone of sorts: 2500 blog posts. Here’s the official numbers as of the writing of this blog post:

  • 2505 blog posts (this will be blog post #2506)
  • 16 official blog authors (many more guest bloggers)
  • 2070 blog posts written by Me
  • 10,215 comments
  • 1,456,541 spam comments blocked
  • 11,606,850 pageviews

For those keeping track at home, the full Healthcare Scene blog network just reached 9,884 blog posts. We’re going to have to plan an amazing celebration when we reach 10,000 blog posts!

When I first started EMR and HIPAA back in December 2005, I never thought I’d become a professional blogger. Even when I quit my day job April 1, 2010, I didn’t really think I’d be a full time blogger either. I quit to do my own startup company. However, the blogs kept growing and I was lucky to make blogging my profession.

I consider myself lucky to have ridden the wave of meaningful use incentive money for EHR. No one can argue that meaningful use didn’t push adoption of EHRs forward at an incredible rate. We’re now going to spend the next decade figuring out how to leverage all that data to benefit patients.

There’s plenty of challenges in healthcare, but there are plenty of opportunities as well. I still wake up every day excited to see what I’ll discover and how IT can impact a healthcare organization for good. Sure, it’s challenging when I see poorly thought out and poorly implemented EHR and health IT solutions harming an organization. It’s also frustrating to see some of the crazy things that we expect from healthcare. The double standards are brutal. However, the people inside healthcare more than make up for it’s ugly policies and perverse incentives.

This weekend at the Health IT Marketing and PR Conference Shahid Shah asked the audience if they’ve ever seen a more dramatic change in healthcare IT than we’ve seen in the past 5 years. The audience agreed that we’d seen really dramatic changes. Shahid then suggested that the next 5 years are going to make the previous 5 years look like nothing.

I’m excited that EMR and HIPAA will be along for the ride covering what’s interesting, new, unique, and innovative in healthcare IT. Plus, we’ll never forget to offer the practical, useful, and entertaining as well.

Thanks to all of you who have read EMR and HIPAA over the years and for those who have sponsored us as well. We feel lucky to be part of such an extraordinary industry that really can impact people’s lives for good.

President’s Day – The Value of Humility

Posted on February 15, 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.

Last year I started the tradition of posting some presidential quotes that I found interesting as a way to honor President’s Day in the US. I’ll keep that tradition alive with the quote below:
Truman Quote

Happy New Year!

Posted on January 1, 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.

I’m taking the day off here at EMR and HIPAA. However, over on EMR and EHR I wrote a post that looks at My Optimism for Healthcare IT in 2016. Start off your New Year the right way and go and read and comment on that post. There’s a lot to dislike about what’s happening in healthcare, but there’s a lot of great things happening too.

Happy New Year

Holiday Message

Posted on December 25, 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 more you give away, the more you receive. You make a living by what you get, but you make a life by what you give.”-Thomas Monson

I thought this was the perfect message for me on Christmas day. I hope that you enjoy it as well. I asked some kids I know what they were planning to give for Christmas. They missed the nuance in the question and started telling me what they wanted. I was surprised how much effort it took them to answer my original question. Of course, as I’ve taken my kids to shop for Christmas, they kept giving me ideas and at least a dozen times I asked them, “Is that something for your mom or something for you?” Hopefully all of this will help my children learn the concept of giving so they make a wonderful life.

Merry Christmas

Happy Thanksgiving!

Posted on November 26, 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.

Today is a day of real gratitude for me. I love Thanksgiving and the time to enjoy family and taking time out to be grateful for all the many blessings in my life. One of my greatest blessings is to be a full time blogger. I feel so lucky to be able to do something as amazing and impactful as blogging. Of course, I couldn’t live this dream if it weren’t for you the reader. So, I’m really grateful to so many of you who have supported my blogs for so long even with all my frailties and mistakes. Thank you!

Happy Thanksgiving!
Five orange pumpkins sit in a row in front of a distressed, wooden background.

Happy Labor Day!

Posted on September 7, 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.

I must admit that I know very little of the history of Labor Day. Unlike Memorial Day or Fourth of July, I’ve never really celebrated anything special on Labor Day. It was just a day off school. Although, I found this page outlining Labor Day and it has a much richer history than I think most of us appreciate. I’m not sure that’s really going to change. Plus, it use to kind of mark the start of Football season, but that’s no longer the case since we had a full weekend of football already.

I think most of these holidays are somewhat sore points in many healthcare organizations since many healthcare workers are still at work. You can’t really shut down a hospital for the holiday. I’ve heard of all the competition there is to get holidays off. So, on these holidays I always take a moment to think about all the dedicated healthcare professionals that are still working to provide amazing care for patients.

On this Labor Day I’m thinking of the value of work. It’s something I’m trying to instill in my kids. It’s something I love. My wife was talking to some of our friends about me and the work I do and one of them said, “John will never stop working. If he finishes one project, he’ll be starting up the next project.” I think they’re right. I love working on stuff and I can’t imagine I’ll ever stop. The only thing that might change is what I’ll work on.

Over the past 10 years blogging, I’ve realized that I love creating things. I’m still amazed that a nobody in Las Vegas (that’s me) could build a blog network like I’ve done with Healthcare Scene that reaches so many people. Some people would look at the 8000+ blog posts that have been done on the network and think that’s a lot of work. I guess it kind of is, but I don’t look at it that way. Looking back the numbers surprise me too since it certainly hasn’t felt like that much work. I realize I’ve been given the gift of finding joy in monotonous and mundane things. Not to mention a bullheaded determination to finish something I’ve started.

I’m kind of rambling, but that’s what I love about posts on Holidays. Long story short, I never see myself stopping as a blogger. It’s too much fun to make a difference in people’s lives. Plus, it’s now just a part of who I am. Hopefully you’ll keep reading and supporting what we do for as long as we do it. Plus, I’m really excited to see where we take all the things we’ve started doing with Periscope, Blabs, YouTube/G+ Hangouts and podcasts.

Happy Labor Day!