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The Health Insurance Demand Problem

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

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

Confused? Let’s dive in.

No one wants to consume traditional insurance

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

People do want to consume healthcare insurance

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

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

Realigning incentives

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

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

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

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

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

July 11, 2014 I Written By

Kyle is Founder and CEO of Pristine, a company in Austin, TX that develops telehealth communication tools optimized for Google Glass in healthcare environments. Prior to founding Pristine, Kyle spent years developing, selling, and implementing electronic medical records (EMRs) into hospitals. He also writes for EMR and HIPAA, TechZulu, and Svbtle about the intersections of healthcare, technology, and business. All of his writing is reproduced at kylesamani.com

Is Healthcare IT Hiring Part of the Problem with Healthcare?

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

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

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

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

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

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

July 10, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Unofficial 2014 #HIT100 Rankings

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

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

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

Without further ado, enjoy the unofficial #HIT100 list.

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

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

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

 

Methodology and Disclaimers

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

Previous #HIT100 Rankings:

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

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

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

July 9, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

EHR Incentive Market Share Charts Worth A Thousand Words

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One thing I really love about the government lately is their goal to be as transparent as possible. Certainly they still have a ways to go, but I think healthcare has done some significant things when it comes to transparency into the government health programs. A great example of this is the Health IT Dashboard which has all of the data for the various health IT programs.

I don’t want to steal Carl Bergman’s thunder, because he’s already posted some really interesting Hospital EHR market share data and his previous EHR market share data. Plus, he’s planning to dive into the meaningful use market share data next. I love the approach of multiple sources when it comes to evaluating EHR market share and so I look forward to his analysis of EHR incentive market share against the EHR adoption market share from Definitive Healthcare and SK&A.

Until then, I thought I’d give you a taste of the EHR vendor participation in the EHR incentive program. This data comes from the ONC dashboards listed above and are put into some really nice snapshots of the data by ONC.

First up is the data for EHR vendor attestations by eligible professionals (ie. ambulatory doctors):
EHR Incentive Market Share - Eligible Professionals

And the EHR vendor attestations by hospitals:
EHR Incentive Market Share - Hospitals

It’s worth noting that the above data is just the EHR incentive money data. No doubt the actual EHR adoption data would have a few differences and include some companies in specialties that don’t qualify for EHR incentive money. Not to mention specialty specific EHR vendors who likely don’t make the chart even if they dominate their specialty. These charts do serve as an interesting proxy for EHR market share that’s worthy of discussion even if it doesn’t paint the full picture. Plus, even more important will be to watch the change in these numbers over time.

With that disclaimer, we could analyze this data a lot of ways. I’ll just offer a few interesting insights I noticed. First, 711 vendors have been used in the ambulatory EHR incentive program. That’s a lot of vendors. Only 78 of those 711 supply secondary EHRs as opposed to the primary EHR. 452 EHR vendors supply a primary EHR to less than 100 eligible professionals. 200 EHR vendors supply a primary EHR to fewer than 10 eligible professionals. These observations and a comparison of the ambulatory versus hospital EHR incentive charts’ “Other Vendors” shows how fragmented the ambulatory EHR market share is right now.

I was also intrigued that Mitochon Systems, Inc. was on the list even though they shut down their Free EHR software in May 2013. They had white labeled their EHR software to a number of other companies and so it will be interesting to see how that number evolves. I assume they sold the software to those companies, but I hadn’t heard an update.

On the hospital side of things, MEDITECH certainly doesn’t get the credit they deserve for the size of their install base. The same goes for CPSI, MEDHOST and Healthland. I think their problem is that people only want to read about the Mayo, Cleveland Clinic, and Kaiser’s of the world and so the articles about Billings Montana Hospital (I made that hospital up) rarely happen. I should find more ways to solve that since the small hospital market is huge.

I do wish that there was a way to divide the ambulatory chart into hospital owned ambulatory practices and independent ambulatory practices. That would paint an even clearer picture of that market.

What do you think of these charts? What can we learn from them?

July 8, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

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

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

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

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

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

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

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

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

July 7, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

FDA EMR Regulation, EMR Jobs, and EMR Supports Fraud?

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I’ve written up my thoughts on the FDA regulating EMR. I hope the FDA stays far away from EMR.


There are lots of EMR jobs out there. If you’re looking for a better job or a first time health IT job, check out Healthcare IT Central.


This makes for a good headline, but let’s be honest about the fraud that’s happening. It was happening without EMR. Plus, I think that much of the increased reimbursement is more about doctors finally billing appropriately and not fraud. That’s something that many people don’t want to face. Certainly there is plenty of fraud in healthcare, but I think overall EMR software is going to better help track it down versus causing more fraud. What do you think?

July 6, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

What Would Make Us Not Delay ICD-10 in 2015?

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While at the HFMA ANI conference in Las Vegas, I talked to a lot of people about the future of healthcare reimbursement. Talk of ICD-10 and the ICD-10 delay came up regularly with most of us rolling our eyes that ICD-10 was delayed again. Some argued that we still need to be prepared, but from what I’m seeing the majority of the market just pushed their plans out a year and will pick them up again later this year or early next year.

With that said, we all agreed that every organization will be much more hesitant preparing for ICD-10 next year since they’re afraid that ICD-10 will just be delayed again.

As I had these discussions, I started thinking about what will be different in 2015 when it comes to ICD-10? As I asked people this question, all of the same arguments that we made in 2014 are what we’re going to have in 2015. Some of them include: the rest of the world adopted this years ago, we’re falling behind on the data we’re capturing, we need more specificity in the way we code so we can improve healthcare, etc etc etc.

Considering these arguments, what will be different next year?

All of the above arguments for not delaying ICD-10 were valid in 2014 and we’ll be just as valid in 2015. Can you think of any reasons that we should not delay ICD-10 in 2015 that weren’t reasons in 2014? I can’t think of any. The closest I’ve come is that with the extra year, we’re better prepared for ICD-10. Although, given people’s propensity to delay, does anyone think we’ll be much better prepared for ICD-10 in 2015 than we were in 2014? In some ways I think we’ll be less prepared because many will likely think the delay will happen again.

Given that the environment will be mostly the same, why wouldn’t we think that ICD-10 will be delayed again in 2015?

Personally, I’ll be watching CMS and HHS closely and see what they say. I think this year they looked really bad when they very publicly proclaimed that ICD-10 was coming at HIMSS just to be hit from the side by the ICD-10 delay. I’d hope that this time CMS will work with Congress to know what they’re planning or thinking before they make such strong assertions. Of course, this would mean that they’d have to understand what Congress is thinking (not an easy task).

What’s unfortunate is that many of the things you need to do to prepare for ICD-10 can also benefit you under ICD-9. The smart organizations understand this and are focusing on clinical documentation improvement (CDI) as the best way to prepare for ICD-10, but still benefit from the program today.

July 3, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Your EHR Vendor Isn’t Certified: Remove Barriers and Conquer Meaningful Use Stage 2

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I wrote previously about the “Triple Aim” of healthcare and even questioned if doctors really cared about the triple aim. For those not familiar with the triple aim, it includes: improving the health of our country, enabling less expensive care, and increasing patient engagement with their healthcare. All of these are noble goals and worthy of effort. Plus, even if providers aren’t moved by this goal, that doesn’t mean that much of the legislation and regulation that hits healthcare won’t be guided by this triple aim.

I was reading through this Allscripts whitepaper titled “Your EHR Vendor Isn’t Certified: Remove Barriers and Conquer Meaningful Use Stage 2” when I thought about how the triple aim is going to impact an organization’s decisions moving forward whether they like it or not.

The whitepaper underscores the shift towards more patient engagement, smart EHR tools, and population health. I think that generally summarizes meaningful use and is why it’s going to be really important that everyone in healthcare is involved in it.

Even if you don’t want to participate in the meaningful use program specifically, the overall trends that meaningful use represent are likely going to be with us for the foreseeable future. No doubt the government’s focus will continue this direction and I think payers are heading the same direction as well. They probably won’t adopt meaningful use entirely, but elements from it and other programs will likely be adopted by payers.

Check out the full whitepaper for more details on these trends and making sure your EHR is ready for them.

July 2, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

HIPAA Slip Leads To PHI Being Posted on Facebook

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HHS has begun investigating a HIPAA breach at the University of Cincinnati Medical Center which ended with a patient’s STD status being posted on Facebook.

The disaster — for both the hospital and the patient — happened when a financial services employee shared detailed medical information with father of the patient’s then-unborn baby.  The father took the information, which included an STD diagnosis, and posted it publicly on Facebook, ridiculing the patient in the process.

The hospital fired the employee in question once it learned about the incident (and a related lawsuit) but there’s some question as to whether it reported the breach to HHS. The hospital says that it informed HHS about the breach in a timely manner, and has proof that it did so, but according to HealthcareITNews, the HHS Office of Civil Rights hadn’t heard about the breach when questioned by a reporter lastweek.

While the public posting of data and personal attacks on the patient weren’t done by the (ex) employee, that may or may not play a factor in how HHS sees the case. Given HHS’ increasingly low tolerance for breaches of any kind, I’d be surprised if the hospital didn’t end up facing a million-dollar OCR fine in addition to whatever liabilities it incurs from the privacy lawsuit.

HHS may be losing its patience because the pace of HIPAA violations doesn’t seem to be slowing.  Sometimes, breaches are taking place due to a lack of the most basic security protocols. (See this piece on last year’s wackiest HIPAA violations for a taste of what I’m talking about.)

Ultimately, some breaches will occur because a criminal outsmarted the hospital or medical practice. But sadly, far more seem to take place because providers have failed to give their staff an adequate education on why security measures matter. Experts note that staffers need to know not just what to do, but why they should do it, if you want them to act appropriately in unexpected situations.

While we’ll never know for sure, the financial staffer who gave the vengeful father his girlfriend’s PHI may not have known he was  up to no good. But the truth is, he should have.

July 1, 2014 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.

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

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

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

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

Believe me, I would have welcomed change.

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

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

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

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

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

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

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

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

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

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

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

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

June 30, 2014 I Written By

Mandi Bishop is a healthcare IT consultant and a hardcore data geek with a Master's in English and a passion for big data analytics, who fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.