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ICD-10 Preparedness

Posted on May 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.

The following is some email comments from Richard D. Tomlinson, RN and Founder of Nuclei Health Consultancy, in reply to my post on ICD-10 Business Areas of Concern. They weren’t intended for posting, but I thought they were quite insightful and so Rick gave me permission to share them.

Wonderful post (as always) relative to our issues driving yet another future-state condition in healthcare, namely ICD-10. If I may, I would like to approach ICD-10 from another perspective.

While everyone knows that ICD-10 is (eventually) a reality for U.S. healthcare organizations, I convey there is much more to addressing ICD-10 CM/PCS than simply “making the conversion” or “dual coding” as benchmarks towards success. My own list of preparedness relative to ICD-10 is somewhat different than yours and designed to combine strategic as well as tactile integration to address ICD-10 CM/PCS.

1. Clinical Documentation Improvement process.
2. Roust education via clinical case studies showing the BUSINESS CASE IMPACTS downstream of inadequate clinical documentation & coding.
3. ICD-10 Gap analysis current-state to include clinical and financial gaps.
4. Validation testing of via test patient build/coding.
5. EHR optimization specific to ICD-10 (MORE is NOT BETTER).
6. Evaluation of CAC (Computer Assisted Coding).
7. Evaluation of alternative coding resources (e.g. outsourcing).
8. Viability Reporting to C-Suite (not simply “on track” reporting. It’s not a project; it’s an initiative. Establish and report on critical success factors).
9. Establishment of robust clinical documentation/ICD-10 ad hoc committees. Include CMIO or provider champion/HIM/financial/quality/informatics/IT
10. Establishment of robust analytics to reverse engineer denials (where/what/whom) and specific identification of mitigation actions (e.g. education, CDI, etc) and processes.

The bottom line in my view is this; any organization treating ICD-10 as a “conversion” is headed for significant problems in terms of denials and missed revenue capture. ICD-10 should be viewed by the C-Suite specifically as a platform to improve patient safety/care, to improve clinical documentation, improve quality measures, and a specific strategy to reduce costs and increase potential revenue capture. Properly deployed, ICD-10 initiatives can actually accomplish all of this. My suggestion to my clients is to approach ICD-10 strategically, not merely as a conversion process, and develop a plan incorporating the measures I’ve indicated above. Serious Measurement of these factors will be required, regardless of facility type or size.

Lastly, I think some organizations are mistakenly treating this not only as a “conversion” but also siloing this to the small HIM or coding backroom as a problem for the coders. This approach will paint the coders into an unfortunate corner, and may create a situation where optimum revenue capture opportunities are lost…forever. For example, improper coding of a patient acquiring bed sores while inpatient may result in denials and reduce certain quality scores inappropriately. When you consider that coding is the final life blood touchpoint of revenue generation, it’s time for the C-Suite to leverage ICD-10 as a strategy to place importance of improved clinical documentation as a business case, and measure the clinical, financial, and operational impacts to the organization.

An Important Look at HIPAA Policies For BYOD

Posted on May 11, 2015 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.

Today I stumbled across an article which I thought readers of this blog would find noteworthy. In the article, Art Gross, president and CEO at HIPAA Secure Now!, made an important point about BYOD policies. He notes that while much of today’s corporate computing is done on mobile devices such as smartphones, laptops and tablets — most of which access their enterprise’s e-mail, network and data — HIPAA offers no advice as to how to bring those devices into compliance.

Given that most of the spectacular HIPAA breaches in recent years have arisen from the theft of laptops, and are likely proceed to theft of tablet and smartphone data, it seems strange that HHS has done nothing to update the rule to address increasing use of mobiles since it was drafted in 2003.  As Gross rightly asks, “If the HIPAA Security Rule doesn’t mention mobile devices, laptops, smartphones, email or texting how do organizations know what is required to protect these devices?”

Well, Gross’ peers have given the issue some thought, and here’s some suggestions from law firm DLA Piper on how to dissect the issues involved. BYOD challenges under HIPAA, notes author Peter McLaughlin, include:

*  Control:  To maintain protection of PHI, providers need to control many layers of computing technology, including network configuration, operating systems, device security and transmissions outside the firewall. McLaughlin notes that Android OS-based devices pose a particular challenge, as the system is often modified to meet hardware needs. And in both iOS and Android environments, IT administrators must also manage users’ tendency to connected to their preferred cloud and download their own apps. Otherwise, a large volume of protected health data can end up outside the firewall.

Compliance:  Healthcare organizations and their business associates must take care to meet HIPAA mandates regardless of the technology they  use.  But securing even basic information, much less regulated data, can be far more difficult than when the company creates restrictive rules for its own devices.

Privacy:  When enterprises let employees use their own device to do company business, it’s highly likely that the employee will feel entitled to use the device as they see fit. However, in reality, McLaughlin suggests, employees don’t really have full, private control of their devices, in part because the company policy usually requires a remote wipe of all data when the device gets lost. Also, employees might find that their device’s data becomes discoverable if the data involved is relevant to litigation.

So, readers, tell us how you’re walking the tightrope between giving employees who BYOD some autonomy, and protecting private, HIPAA-protected information.  Are you comfortable with the policies you have in place?

Full Disclosure: HIPAA Secure Now! is an advertiser on this website.

The Magic of Community

Posted on May 9, 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 was the final day of the Healthcare IT Marketing and PR Conference (HITMC) which I organize. The event is a lot of work, but the community that it’s created is absolutely golden. I really happened upon a unique community that had never been brought together before. Before this conference, healthcare marketing and PR professionals really didn’t have a place to go and learn and connect with people doing the same work they do. As Brian Mack mentioned at the end of the conference “This is the first conference where I didn’t have to explain to people what I did for work.” Someone else commented on how every person they talked to at the conference was someone who spoke their same language.

There’s really something magical about growing a community of like minded individuals. There’s value in expanding your horizons and hearing people from outside of your niche as well. Both can be valuable, but when you’re dealing with challenging problems, it’s great to be able to work with people who have seen those challenges before. That’s something that’s really hard to replace and is golden when you find it.

I think that’s why in healthcare websites like PatientsLikeMe have been so successful. Last year one of the HITMC attendees described his experience like “finally finding his tribe.” Patients have that same need. For example, my wife has hashimoto’s and whenever she meets someone who has the same issue, there’s an instant bond of shared experience. It’s a beautiful thing.

What’s going to be interesting as healthcare evolves is what new online healthcare communities will come to be. Will hospitals create communities for their patients? Will primary care doctors in an area create a community of users interested in being healthy? Will an ACO require these types of healthy communities?

Don’t underestimate the power of bringing together people facing similar challenges. There’s a magic in community that’s really special. Back to the HITMC community, I feel lucky to be part of such a caring group of individuals who really want to improve healthcare.

Videos of EHR Usability Suggestions

Posted on May 6, 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.

One of my readers sent me a link to a new site they’re developing called SaveTimeMD. This website was created as a response by an internist and EHR developer that was tired of seeing so many EHR usability problems. He decided that he’d take usability problems from users and make videos explaining how he’d resolve the EHR usability issue.

I think the concept is quite interesting. Many might ask why he doesn’t just build the perfect EHR if he’s so good at solving the usability problems. That’s the way my entrepreneurial mind would work. However, some people don’t approach problems with that entrepreneurial mindset. I’m not sure this doctor’s motivation, but I think the concept is quite interesting.

Here’s one of the videos he’s created that talks about intuitively navigating an EHR:

What do you think of the video? More importantly, what do you think of the idea of someone offering answers to your EHR usability challenges which you could take back to your EHR vendor?

Healthcare Big Data Use, Real Patient Engagement, and Practice Marketing

Posted on May 5, 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 use to do these a lot more and I think people enjoyed them. So, maybe I’ll start doing them again. It’s basically a short Twitter round up of some interesting tweets and often some pithy commentary about the tweets. Let me know what you think.


This seems about in line with my own personal experience talking to people. Although, some might argue that 100% are clueless. We’re all still trying to figure out all the data.


Great article by Michelle. I agree with her that I hate patient engagement. I love engaging patients, but I think that meaningful use requirements have forever corrupted the term patient engagement. We better move on to a new term, because I assure you that what’s happening with meaningful use is not engaging patients.


This is a little self serving, but Wednesday (5/6/15) I’ll be doing a webinar on the topic of practice marketing. I’m going to cover quite a bit of ground from a high quality practice website, to search engine optimization (SEO), reputation management, and meaningful patient engagement (sorry I had to use the term after my last comment). I hope many of you will attend and then let me know what you thought of it.

Will We Be Maintaining Our Genomic Health Record?

Posted on May 4, 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.

If you’re interested in Genomic Medicine like I am, be sure to check out my article on EMR and EHR called “When Will Genomic Medicine Become As Common As Antibiotics?” That’s a really interesting question that’s worth considering. We’re not there yet and won’t get there for a couple years. However, I think that genomic medicine will become as common as antibiotics and will have a massive impact on healthcare the way antibiotics have as well.

The article mentioned links to a genomics whitepaper that talks about a person’s genomic health record. I’d never heard the term before, but I’m definitely intrigued by the idea of everyone having their own genomic health record.

We’ve talked forever about people having a personal health record which they need to collect and maintain. Some people store it in a PHR on the web and others store it on a mobile phone. However, we’ve never really seen the personal health record take off. This is true for a number of reasons. The first is that it’s still quite difficult to aggregate your entire health record across multiple providers. I even read of one PHR that was paying doctors to provide them a patient’s record. The second problem is that patients don’t know what to do with all the records once they have them. Even if they go to their doctor and say they have their full patient record, the doctor hands them a stack of health history forms to fill out. Best case, they file a copy of the patients records in the chart (usually in some sort of PDF or paper copy).

Now let’s think about those challenges from the perspective of a genomic health record. If you’ve paid thousands of dollars for genomic tests and analysis, are you going to want to pay that again to the next doctor you see? No, they’re going to ask you for your copy of their genomic record and use that as part of your care. Patients won’t want to pay for another genomic test and it will be easier to get their record, so they’ll be more motivated to get and maintain it than they were with a simple personal health record. It’s pretty compelling to consider.

Some challenges and questions I have about how this will evolve. Will your PHR start to include your genomic health record or will it be something that’s stored separately? Will their be a standard for the genomic health record so that the doctor can easily use that record in the work they’re doing? Will the genomic health record be so large that it will have to be stored in the cloud?

What do you think of the concept of a genomic health record?

The Next Major Healthcare Product – Care Management System

Posted on May 1, 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.

While meeting with a lot of people at HIMSS I started to think about what would be the next “must have” IT system that a healthcare organization would look at purchasing. When you look back at the history of IT purchases in healthcare, the Practice Management System (PMS or PM depending on your preference) was one of the first systems that most practices purchased. It was an easy buy for most people. They saw a lot of value to digitize the billing side of their practice. Adoption of practice management systems was widespread. Everyone was and is using one.

After the practice management system came the Electronic Health Record (EHR, but many could argue that EMR came before EHR, but that’s semantics in my books). Over the 10 years that I’ve been blogging about EHR software, we’ve seen the evolution of people asking if they should buy an EHR software to everyone realizing that they needed to go electronic but were trying to figure out which solution was best to $36 billion of government money which basically had the vast majority of doctors choose to hop on board EHR. While we don’t have 100% EHR adoption, we’re getting there. The market for EHR purchases is quite mature now.

With that as background, I’ve been thinking about what system or platform would be purchased next by a practice. I asked a number of people at HIMSS about this. Dr. Tom Giannulli from Kareo suggested that Care Plan Engagement could be an interesting next step. With the coming ACOs and value based reimbursement, you can see where Dr. Tom is coming from in his thinking. Plus, his term mixes the meaningful use term of patient engagement with the care plan approach that’s likely going to be required in future business models.

When I sat down with Carl Ferguson from CTG, he called the next product a Care Management System. When I heard it, I thought that this term could have staying power. The practice management system manages the practice (ie. billing). The electronic health record stores the records electronically. The Care Management System is going to be centered on the patient and the care that a patient receives.

What do you think of the term: Care Management System? There were probably a hundred products at HIMSS that have started to build a product like this. Although, I think a care management system would probably have to be a combination of a number of products out on the market today.

Regardless of what we call it, I think what will set apart the next big healthcare IT product offering is that it will be centered around the patient. A care management system by its very nature would have to be interoperable since the care is being given across multiple organizations. A care plan would make since because the patient’s at the center of the care management system and everyone could be involved in creating the care plan and ensuring that the care plan is being followed. At first take, I really like this terminology and I hope it gains some traction.

One challenge with the term Care Management System is that the abbreviation is CMS. That abbreviation is already quite popular with the government organization (CMS) and also the popular Content Management System (CMS). Although, if that’s the biggest problem with the term, then I feel pretty good about it. Although, this does make me wonder if we’ll go back to the age old integrated PM/EHR debate again when it comes to an integrated EHR/CMS. Will EHR vendors see this opportunity and offer a Care Management System module for their EHR? Some probably think they already are doing that.

13 Insights for Conquering Healthcare Challenges

Posted on April 30, 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 was recently asked to take part in a “From the Experts” series where they asked us to contribute an insight into how you conquer the healthcare challenges of the future. My response was, “The most valuable prep for #valuebasedcare is to create deep patient connections.” I think that’s still really good advice for healthcare organizations.

Check out the other 12 insights from a wide variety of experts in this embedded slideshare below:

Great Meaningful Use and Eligible Providers Chat

Posted on April 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.

I recently received an email from a regular reader, Dr. Mike, who owns a single specialty ortho group. In the email Dr. Mike talks about the challenges that Eligible Providers (EPs) are facing with meaningful use stage 2. He describes the story as falling on “deaf ears” at CMS and ONC. He also offered these stats on meaningful use to illustrate his case that meaningful use is a failure:

Only 38,472 have attested to Stage 2, My guess is that only about half actually did Stage 2 as there was the Stage 1 reprieve. Even so, that is only 18% of EPs have successfully attested which is an complete failure of MU.

Then, he asked me an important question:

Someone ask CMS and ONC the tough questions please…Now what are they going to do?

In response to him, I told him that I’d been talking about the challenge that meaningful use is for doctors for quite a while. However, I also told him that most hospitals are participating in meaningful use, so “we’ll see how that plays out.” What I meant is that in the meaningful use program we now have one group (EPs) that are not doing so well with meaningful use and their hospital counterparts that are relying on the millions in EHR incentive money (not to mention avoiding the penalties).

Then I answered his important question, “I can tell you what ONC and CMS are going to do. Spin It!”

Of course, Dr. Mike is great at engaging in conversation so he offered this reply:

1. Elizabeth Myers and the rest of CMS and ONC really did try to spin every bad number and “we cannot assess the numbers yet” was a constant theme.
2. I totally agree they will continue to try to spin the numbers or ignore them as long as possible. I’m not sure why they cannot face the truth about MU.
3. The 36K that did MU 2 are the cream of the crop. I would even argue that the other 82% are the cream also as they were the early adopters and gung ho about MU. The fact that 82% of the over achieving EPs have skipped out on MU 2 is a travesty. There is NO chance ONC and CMS is going to pull in the lagging EPs.
4. If you don’t know already, I own a single specialty Ortho group and we skipped MU completely after we saw the MU 2 rules. Proposed MU 3 just help us box it up and bury it.

I have no idea why ONC and CMS cannot let go of the program, let EHR vendors actually work with EPs for all the thing we are missing from our IT (usability, safety, security, efficiency). Right now we cannot do anything to customize our workflow or improve our experience as it will potentially decertify the EHR for MU. MU sucks all the air out of the room. EHRs right now are a billing and click box for MU system with a marginal clinical system slapped on…

Its about time ONC lets the market do its thing, instead of this constant objective, measures, menu, core, numerators, denominators, attesting, auditing disaster they created.

Once EPs leave the program, they are not coming back. So this should be a big deal for ONC and CMS.

I haven’t gone in and fact checked his numbers (I’d love to hear if you have different numbers), but the emotion in his comments is something I’ve heard from many providers. In fact, I’ve heard it from many EHR vendors. They’re tired of coding their EHR software to the test and the government regulations as well. They want to do more innovative things, but the government regulations are stifling their ability to do it. Resources only go so far.

I think we’re in the early days of provider discontent with meaningful use. However, it’s starting to boil. I’ll be interested to see what happens when it boils over. I’m predicting that will happen once many of these doctors start seeing the penalties hit their pocketbooks.

Usability Pyramid – How Does It Apply to EHR and Healthcare IT?

Posted on April 28, 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 I saw this wonderful usability pyramid come across my Twitter feed:

There’s so much we can learn in healthcare from this pyramid. I’m still chewing on whether the pyramid is the right way to display each of these 4 areas, but I love the way that it breaks it out into these 4 categories. Do they build on each other though?

As I look at these 4 categories of usability, I think that healthcare IT and EHR have done a pretty good job at the functional area. I also think that most of the advanced EHR users are able to work quickly in their EHR. In fact, it’s a complaint I often hear from EHR users that the EHR is so powerful that it takes forever to configure it. The experienced users love these extra configuration options.

I think very few EHR and healthcare IT companies have done a great job on the intuitive and beautiful side of usability. Many doctors think they can just pick up an EHR and start using it just like they did their iPad. This just isn’t the case. It requires a mix of configuration and training to make an EHR work effectively for an organization. Should it? I have yet to find an EHR where this isn’t the case.

I’d love to hear where people think various healthcare IT and EHR applications fit on this pyramid. Let’s hear it in the comments.