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The Many Faces and Facets of EHR Interoperability

Posted on December 5, 2014 I Written By

The following is a guest blog post by Thanh Tran, CEO, Zoeticx, Inc.
Thanh Tran, CEO, Zoeticx
Interoperability is the ability to make sub-systems and organizations work together (inter-operate) for attainment of a common goal. In healthcare, implementation and connection of EHR systems and the data they collect allows for us to impact patient care to become a value-driven one for all patients.

The opposite of interoperability is not the lack of connecting EHR systems, but instead the failure of healthcare systems and organizations to collaborate in an efficient, effective, safe and consistent way to support patient care. To better understand the ecosystem of healthcare, we need to look at this redefined concept of interoperability in greater depth while also considering the needs of various stakeholders and their views of the system.

Care Providers Want Care Continuum

Care Providers are not a single entity whose needs can be fulfilled with a single solution. The focus of all providers is on the patient care continuum and their role in it. The lack of EHR interoperability is fundamentally defined as the inability to share patient medical records across this continuum.

Each provider brings a unique view and delivers specialized, customized care to the patient over different time periods. The care delivered by each provider is interdependent on other providers taking care of the patient for a current encounter. To deliver care, healthcare providers must have the ability to access not only summary information about a patient, or the outcome of a prior intervention, but also be able to drill down into the specific data where they can provide meaning and insight for the patient and the rest of the care team.

Collaborative healthcare, care delivered by specialized and focus teams of providers, has become standard in medicine. Access to the information and meaning provided by various providers is essential. It must be delivered in near time, to the proper provider on the team.

For care providers it is about the ability to see the whole care spectrum; to drill into details with on-demand and near time access.

IT Pros Need Information Flow

With healthcare IT pros, interoperability begins with patient medical information flow.  As the patient transits through healthcare facilities, they are treated by different care providers using different systems. Care providers depend on the above medical flow to ensure effective and quality care delivery. Proprietary patient medical records from diverse EHR systems prohibit that flow, leaving healthcare IT crippled, along with care providers, in enabling a seamless workflow across the system.

Healthcare IT organizations impacted by merger and acquisition face the lack of EHR interoperability under another major challenge, IT integration of disparate EHR systems. Rip and replace is a costly solution to achieving integration and overcoming EHR interoperability among diverse EHR systems.

Furthermore, healthcare IT faces the continued demand for solutions to patient care effectiveness, efficiency and improving patient care quality. However, healthcare IT application developers have been bogged down by the lack of EHR interoperability as well. The EHR agnostic environment is required to seal off applications from the EHR infrastructure. Without this layer, the development would be focused on addressing infrastructure challenges instead of innovative solutions for care providers.

As any other IT organization, healthcare IT faces the challenge of doing more with less. EHR systems share a number of characteristics as its siblings, enterprise applications from other IT industries. EHR systems form the backbone of healthcare systems, but they are also complex, slow to react to care providers’ requirements and costly to maintain. That cost is already in place, leaving healthcare IT with a smaller budget to address the lack of interoperability. Any solutions to EHR interoperability must be low total cost of ownership, lightweight to deploy and portable to a variety of healthcare IT applications.

Administrators Require Compliance and Data Protection

Healthcare administration is charged with complying with patient privacy requirements (HIPAA). Solutions for EHR interoperability with additional copies of patient medical records are not optimal since they represent additional compliance activities and agreements (such as Data Service Agreement) between the data source and destination. These additional compliance activities represent complexity, cost and risk of non-compliance that would result in potential penalties, legal and IT maintenance costs. For healthcare administration, simplicity and practicability of the solution are critical.

Patients Suffer Most

The greatest impact to all stakeholders in EHR interoperability is on the patient. Being at the center of the healthcare delivery model, patients must be brought into the interoperability equation. A vital component for gaining control of increasing healthcare expenditures is engagement of patients.

Not only do we need patient engagement, but patients are demanding security and control over who accesses their medical data. These two are not independent, but are intimately connected. Without control and understanding of who accesses the data, patients will lose trust in the system leading to disengagement and disempowerment.

Patient control over medical record access must be dynamic, secure and able to occur in near time. Above all, patients have full control of who has the full access of their medical records. Current concepts of Opt-In or Opt-Out choice for medical data duplication does not address these dynamic and secure requirements and give patients the control of who has access.

The Optimal EHR Interoperability Solution

EHR systems are database oriented. To address EHR interoperability by creating an additional centralized database layer is not an optimal approach, let alone the failure to satisfy the stakeholders impacted.

The next wave of healthcare challenges needs to be addressed by innovative applications aimed at supporting care providers. The best approach is a middleware infrastructure, supporting open architecture for healthcare, capable of performing data switching and value added data redistribution capabilities from various EHR systems. The middleware solution must be lightweight, embedded as part of healthcare applications supporting on-demand, near time access to diverse EHR systems. It is where interoperability must be implemented.

Thanh Tran is CEO of Zoeticx, Inc., a medical software company located in San Jose, CA. He is a 20 year veteran of Silicon Valley’s IT industry and has held executive positions at many leading software companies. Zoeticx offers a middleware infrastructure supporting on-demand, near time access to diverse EHR systems.

Social Networks In Healthcare: Breaking Down Barriers To Change

Posted on December 4, 2014 I Written By

The following is a guest blog post by Ivo Nelson, Chairman of the Board of Next Wave Connect.
Ivo Nelson
As U.S. hospitals, professionals, and patients from coast to coast grapple with a daunting maize of healthcare challenges that’s growing more complex each day, it’s easy to forget that the solutions we need might just be sitting in someone else’s back yard.  And no matter who might own those great ideas, harvesting their value depends upon finding the best ways to share and make the most of them.

Both of these themes were at the heart of an exceptional two-day event I attended in Copenhagen recently, hosted by Healthcare DENMARK.  Called “The Ambassadors’ Summit,” each participant was invited to attend based upon his or her lifetime healthcare-industry contributions.  The Summit provided our group the opportunity to compare ideas and benchmark best practices with peers from around the world.  And while every national representative had something valuable to offer, some of the best thinking came directly from our hosts themselves.

Denmark has long stood out among nations for its health system, which is differentiated by its fundamental focus on the patient.  The Danish system functions by placing the patient in the center of its care-delivery circle.  Patients’ involvement in their own care is essential for the system to work.  And while few argue that patients should have a greater say in their own care, in Denmark they really do.

Because the Danes have made healthcare a true national – not political — priority, there’s a team mentality country-wide to support it – to improve it continuously over time.  It was this commitment that led Healthcare DENMARK to hold the Summit in the first place: they recognized that every country around the world has its own best practices to offer for consideration.  For example, Summit Ambassadors from Germany brought participants their expertise in international healthcare systems, managed care, integrated care, secure data transfer, and theoretic medicine, among others.  Colleagues from the United Kingdom shared insights from their roles in organizations like the World Health Care Congress and in subject areas such as healthcare analytics and health system financing, to name a few.

At the end of the Summit, we all agreed to return a year from now having advanced our own care systems by harnessing and developing the rich ideas we’d shared in just 48 hours.  Easily said, but what will prove the best means of connecting all the ideas in all those back yards?  The answer is social media used smartly – in a way that establishes closely defined social networks that engage communities interested in solving very specific problems.

As I left the Summit, I could already envision a new group of social communities that could invite the participation of the leaders who contributed so much to the Ambassadors Summit – effectively creating real-time conversations around the key issues that concerned each one of us.  For example, we could launch a new community with a “Danish voice” to advance our nation’s work to increase patient centricity.  Another smart social network could consider the construction of new hospitals and the consolidation of existing ones.  Other smart social healthcare communities could focus on medical homes, the roles of primary-care physicians, and the true connectivity of personal health records.

The possibilities are energizing because they are so clearly within our reach.  With the smart use of social platforms, global boundaries lose relevance, great meetings like the Ambassadors Summit never have to adjourn, and our power to drive a world of better care increases exponentially.

Insightful Tweets from #RSNA14

Posted on December 3, 2014 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 not following @RasuShrestha, you’re missing out on some really good tweets. He’s sent a number of insightful tweets from RSNA that I thought were worth sharing..


I like the rhetoric of his statement, but I’d like to see more action too.


It’s interesting that they’re fans of consumerism. I know that many in healthcare don’t like to think of patients as consumers. They have good reasons for not wanting the comparison and it’s worthwhile to consider the difference. Plus, it’s worth noting that in our current system patients don’t really act like consumers. That’s why I think it’s true that consumerism is hitting healthcare.


I love plays on words. I’m going to have to chew on this one a bit more though.


Click on this image to blow it up. It definitely illustrates how important the EHR is, but also that the other health IT systems are important as well.


This is my favorite tweet. I saved it for the end so only the most faithful readers would get to see it. I’m not an expert on radiology, but this provides an interesting roadmap for some of the things that happening in radiology.

The Healthcare “Business” and Interoperability

Posted on December 2, 2014 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 month I started what I think is a really important conversation about interoperability. I asked the question, “Do Hospitals Want Interoperability?” Go ahead and read the article. We’ll be here when you get back.

In response to that article and that question, Thomas Lukasik offered the following commentary on a LinkedIn thread:

Imagine one car dealer asking another car dealer to send them all of the information that they have on a customer of theirs so that they can do a better job of selling them a car. Healthcare is a business just like a car dealership, and patients are their customers, so expecting healthcare providers to support a level of health information exchange (a/k/a Interoperability) that would enable another healthcare provider to take business away from them is naive to say the least. Competition is a reality for modern hospitals.. you’ve seen the billboards. They’re more comfortable with the old school business model. Interoperabilty is a double edged sword for them.

I think that most hospitals would agree with this view, but they’ll likely only share it behind closed doors. The hospitals understand the benefits to healthcare of sharing their data with each other, but as a business it doesn’t make sense. As I mention in the article, I’m hopeful that things like value based reimbursement and ACOs can help shift that model where it does make business sense for a hospital to share their data. In fact, I think we’re heading to a day where if you don’t share data you’ll be at a disadvantage.

While we’re heading in that direction, it’s hard to face the stark reality of what Thomas says. Healthcare is still a business and healthcare leaders salaries and bonuses are based on successfully running the business. If we want to have interoperability, we have to change the incentives so that they match that goal.

Five Commonly Overlooked ICD-10 IT Transition Strategies

Posted on December 1, 2014 I Written By

The following is a guest blog post by Daniel M. Flanagan, Executive Consultant, Beacon Partners.
Daniel M. Flanagan, Executive Consultant, Beacon Partners
While some organizations have relaxed their approach to ICD-10 readiness given the October 1, 2015 extension, recent polls show that the majority of healthcare organizations remain woefully unprepared.  About 60% of healthcare systems and 96% of physician practices have not begun end-to-end testing according to recent surveys conducted by the College of Healthcare Information Management Executives (CHIME) and Navicure, a leading claims clearinghouse. A lack of testing puts the ICD-10 transition at the greatest risk of failure.

ICD-10 readiness planning should remain a top priority because conducting a comprehensive gap analysis and the resulting remediation work will correct system vulnerabilities that will improve revenue cycle performance today.  However, systems performance improvement is time and resource-intensive and cannot be achieved at the last minute.

Below are five often overlooked transition planning steps:

  1. Update and complete your IT system inventory. We have helped several healthcare organizations prepare for ICD-10 and a common vulnerability is the absence of a complete and accurate IT inventory. Nearly one-third of organizations do not keep an inventory, and, of those that do, most are inaccurate. Many contain systems that are no longer in use and fail to reflect new or recently upgraded applications. Only a few organizations have had a complete IT inventory that accurately reflects all systems requiring end-to-end testing.  We often discover code-sensitive “orphan” applications and systems implemented by end-users without the IT department’s review and approval, which must be added to the inventory. An accurate IT inventory is critical to determine the extent of testing required, and to budget the time and expense needed to complete it.
  1. Review the number and functionality of all interfaces. Revenue cycle interfaces often contain the most critical code processing gaps and represent an organization’s greatest transition risk. For example, workflow analysis sometimes reveals unreliable processing of ICD-9 codes by billing system or other interfaces.  Extensive remediation is needed after the readiness assessment is completed in such cases.  Highly unreliable manual systems are also often used to process code, which impacts work that should be handled electronically. When conducting a workflow analysis, we sometimes find that experienced revenue cycle system end-users disagree about the design and functionality of long-standing systems and interfaces. Friction can arise between end-users and IT application specialists when interfaces do not work or appear not to work properly. Such issues can often be resolved quickly and objectively when a workflow analysis is performed early in the readiness planning process.
  1. Enlist the support of system end-users early to identify performance gaps and devise solutions. Readiness requires that any system that stores, processes, or uses diagnosis codes be identified and tested. However, it is easy to overlook some important performance gaps. In the majority of cases, end-users can readily identify performance gaps and recommend potential, practical solutions.  End-users can also be valuable in identifying potential solutions.  Involving end-users as early as possible in transition planning can avert wasted time.  For instance CDI, case management, as well as QA operating and reporting systems are heavily code-driven, but can be tough to “see,” especially if work is performed on paper. Enlisting end-users to identify code-impacted systems is a great way to ensure nothing is missed.
  1. Set a date to begin testing and verify that payers, clearinghouses, IT vendors, and others tied to your revenue cycle are ICD-10 compliant. End-to-end testing is vital to confirm ICD-10 readiness. Without testing, problem areas are not recognized and will not get fixed, which places the transition at the greatest of failure. Request that each payer and vendor confirm system compliance in writing and set a date when testing will begin.  In addition, we always recommend that our clients call and, if possible, visit key payers to confirm their readiness.   A payer’s inability to commit to a testing date is a warning sign that warrants immediate follow-up.
  1. Align transition efforts and resources with top priority goals. Transition planning will highlight performance improvement opportunities across a range of systems — including IT, revenue cycle, clinical documentation, quality assurance, and EMR.  The variety of performance improvement opportunities sometimes results in an organization creating more goals than needed for a successful transition. Supplemental initiatives can be overwhelming to achieve with restricted resources in a limited timeframe.  The key is to identify “mission critical” transition objectives and allocate scarce resources accordingly.  Define clear objectives and create a detailed plan to monitor progress for achieving each goal.  For example:
    • Revenue cycle performance: Create benchmarks and dashboards for Key Performance Indicators (KPIs) that routinely report system performance now and after ICD-10 go-live.
    • IT: Validate system interfaces and upgrades, and perform testing to ensure confirmation of claim submission data flow. Testing results will provide valuable guidance to remediation efforts.
    • Clinical documentation: Establish a Clinical Documentation Improvement Program (CDIP) to audit provider documentation and coding. The initiative should be designed to provide ongoing training, as well as measure progress while ensuring data integrity, medical necessity, and billing compliance.

Although the deadline may have shifted, healthcare organizations need to stay on track to make the necessary IT and systems changes needed to optimize performance now and in the future.

About Daniel M. Flanagan
Daniel M. Flanagan is a seasoned healthcare executive with 28 years of leadership experience in the health system, physician practice and managed care fields. His primary interest has been performance improvement, especially in revenue cycle operations, improvement plan development and implementation and strategic planning, budgeting and implementation. Mr. Flanagan understands the challenges posed by today’s environment and is experienced in helping clients identify and capitalize upon opportunities to improve organizational performance.

Five Reasons to be Thankful for ICD-10

Posted on November 30, 2014 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 a guest blog post by Wendy Coplan-Gould, RHIA, Founder and President of HRS Coding.

It’s Thanksgiving weekend—a time for reflection and gratitude. Thoughts typically turn to family, friends, health, and life’s many other blessings. In addition to all of these, this Thanksgiving I suggest that the healthcare industry also include ICD-10 in our list of godsends. Here are five reasons why:

Reason #1:  To Code New Diagnosis, Procedures and Devices

The current ICD-9 coding nomenclature was developed in the 1970s. The healthcare industry can’t afford for this same system to be capturing data in the 21st century. We need the ability to specifically code new diseases, procedures and devices. For example, U.S. healthcare providers are unable to precisely code Ebola in ICD-9. That’s true.

There is no specific code for the diagnosis of Ebola in ICD-9, only a general code 078.89, other specific diseases due to viruses. In ICD-10, the code is A98.4, Ebola virus disease. This is the kind of data specificity that our nation needs and ICD-10 delivers.

Reason #2: To Help Keep Patients Safe through Better Data

ICD-10 also helps the healthcare industry capture and track data, and use it to ensure the safety of our patients. The inability to have specific data at our fingertips can be crippling to an institution and result in erroneous decisions based on faulty or imprecise data. Be thankful for ICD-10’s ability to accurately pinpoint diagnoses—and support more precise, exact patient care.

Reason #3: To Reduce Costs

Hospitals are strapped for money. Costs must be reduced whenever and wherever possible. ICD-10 will help hospitals properly bill for the services they deliver. With ICD-10 fully implemented and clinical documentation more granular, hospitals will experience fewer payer denials, claims audits and reimbursement appeals. Valuable time, money and resources will be saved over the long run.

Physician practices also have reason for thanks. New data published on the Journal of AHIMA website earlier this month suggests that the estimated costs, time and resources for offices to convert are “dramatically lower” than original estimates. According to the article, the actual conversion cost for a small practice ranges from $1,900 to $5,900, which is 92 to 94 percent less than initially predicted, resulting in a faster return on investment for your ICD-10 efforts.

Reason #4: To Improve Quality Scores and Performance Rankings

Setting aside zany codes and implementation barriers, ICD-10 is a blessing for quality reporting and performance scorecards. ICD-10’s code granularity works hand in hand with improved clinical documentation across all disciplines to help organizations achieve more accurate quality scores and competitive rankings. This is good news for hospitals and physicians alike.

For example, in ICD-9-CM, there is only one code (427.31) for atrial fibrillation.  In ICD-10-CM, physicians must specify the atrial fibrillation as paroxysmal (I48.0), persistent (I48.1) or chronic (I48.2), providing the specificity for a secondary diagnosis that can affect severity of illness scores and impact quality measures.

Reason #5: To Strengthen Hospital-Physician Relationships

ICD-10 is a bull’s-eye for governmental delay. And physician groups are usually the archers behind Congressional action against ICD-10. As recently as this week, physicians were pushing legislators to delay ICD-10 yet again. However, the tide may be turning.

In an effort to help their laggard physicians, many hospitals are reaching out to assist practices and groups in four key areas:

  • ICD-10 assessments
  • clinical documentation reviews
  • technology upgrades
  • physician-coder education

Helping physician practices with ICD-10 is an olive branch that must be extended to realize the full potential of ICD-10. Savvy organizations are using ICD-10 as a pathway to better hospital-physician relationships. Finally, AHIMA, MGMA and AMA have offered resources specifically designed to clear up common misconceptions and concerns physicians have about ICD-10.

No More Delays

It is estimated that the last delay cost the healthcare industry approximately $6.8 billion in lost investments, not including the cost associated with missed opportunities for better health data to improve quality of care and patient safety as mentioned above. Everyone from CMS to AHA, AMA, MGMA and HIMSS has endorsed the move to ICD-10 on October 1, 2015.

The rallying cry from hospital executives, IT directors and clinical coders is clear—no more delays! Even payers are pushing for the October 2015 date with a new consortium featuring Blue Cross Blue Shield of Michigan and Humana leading the charge. As Dennis Winkler from Blue Cross Blue Shield of Michigan states, “ICD-10 is good for the industry. . . . It is in everyone’s best interest to work together and ensure readiness across the board.”

Be Thankful

In Mitch Albom’s 2009 New York Times best seller, Have a Little Faith, the author asks an 82-year-old rabbi to identify his secret to happiness. “Be grateful” is what the rabbi repeatedly claims to be the only true route to happiness.

So next time your executives, staff or physicians are complaining about the transition to ICD-10, remember the five reasons described above . . . and be thankful.

About Wendy Coplan-Gould
Wendy Coplan-Gould is the embodiment of HRS. She has led the HIM consulting and outsourcing company since 1979, through up and down economies and every significant regulatory twist and turn of the last three decades. Long-time clients and new clients alike are on a first-name basis with her and benefit from her focus on excellence, reliability and flexibility. She has been published in the Journal of AHIMA and other recognized publications, as well as conducted countless professional association presentations.

Prior to starting HRS, Wendy served as assistant director, then director, of Health Information Management at Baltimore City Hospital. She also was associate director of the Maryland Resource Center, which provided data for Maryland’s Health Services Cost Review Commission, an early adopter of the Diagnosis Related Group (DRG) methodology. Wendy is available via email: wendy@hrscoding.com.

6 Thanksgiving ICD-10 Codes

Posted on November 27, 2014 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 thought it fitting that AdvancedMD sent me 6 ICD-10 codes to be thankful for. Healthcare Humor…who doesn’t enjoy that? Happy Thanksgiving!

Y93.G3 Activity, Cooking and Baking
Ah, the turkey is roasting and the potatoes are boiling. And Cousin Carl just chopped the end of his finger off while preparing the veggie tray. He will earn this ICD-10 code, along with W26.0, Contact with Knife, to forever remember this year’s Thanksgiving…and that nasty scar.

W61.42 Struck by Turkey / W71.43 Pecked by Turkey / W61.49 Other Contact with Turkey
Thanksgiving isn’t Thanksgiving without a turkey. If three is a terrible mishandling of dinner’s main dish, or if a still-flapping gobbler enacts revenge, ICD-10 has three codes that are perfect for the season’s avian-related incident.

W21.01 Struck by Football
Another Thanksgiving staple is the good ol’ American sport of football. Usually, unless there is cheering for opposing teams, televised football games are safe enough. But a well-intentioned family flag-football game can result in a quick trip to the emergency room.

R63.2 Polyphagia (Overeating)
Parrots aren’t the only ones to watch out for this season. If a vampire or zombie takes their costume a bit too seriously, this code will record the chomp.

Y04.0 Assault by Unarmed Brawl or Fight
Black Friday shopping has become just as much a part of Thanksgiving as stuffing and pumpkin pie. But this mass hysteria for great deals doesn’t come without risks—especially when there are two shoppers and only one great bargain up for grabs. Get your extreme shopping skills up to snuff or Y04.0 and Y92.59, Other trade areas (mall) as the place of occurrence of external cause, may be jotted in your electronic health records.

W21.01 Lack of Adequate Sleep
No matter how we choose to celebrate Thanksgiving, few of us escape the meal prep, early morning shopping and family togetherness without a mild case of exhaustion. For those who try to do it all, there is an ICD-10 code for that.

Now I’m off to recover from my W21.01 and R63.2. Although, let me tell you, I had one of my best Turkey Bowl days ever. So much fun! Happy Thanksgiving everyone.

Op-Ed: Making Electronic Health Records Right

Posted on November 26, 2014 I Written By

The following is a guest blog post by Benjamin Shibata, MPH Student at GWU.
Ben Shibata
If you want to give hospital clinicians sever heart burn and arrhythmia, talk to them about implementing a new state-of-the-art electronic health record (EHR) system.  Although EHRs may seem like an intuitive improvement over paper health records, the transition to them has been a huge headache because the process is being forced rather than being organically chosen by the professionals using them.  Spurred along by the American Recovery and Reinvestment Act (ARRA), incentives to implement EHRs in a timely manner were laid out.  Although helpful in motivating hospitals to make the change, the ARRA has contributed to an overly expedited process that needs to be more thoroughly thought out.  In order to roll out EHR systems correctly, we need to understand how health records have historically improved medicine so that we can improve upon rather than complicate an already complicated system.

From a public health standpoint, EHRs should have been something implemented years ago.  HealthIT.gov explains how EHRs stand for improved efficiency and better patient care through greater care coordination.  And why shouldn’t they?  Electronic records are more portable and can be theoretically accessed anywhere in the world.  Doctors would have better access to their records, be able to practice more efficiently, and collaborate with other physicians to achieve the best possible patient outcome.  Unfortunately this is not what is being seen in many places for varying reasons: poor usability, time-consuming data entry, interference with face-to-face patient care, an inability to exchange health information, and degradation of clinical documentation are a few of the most common complaints based on surveys from RAND.

To better understand why these complaints are happening, we need remind ourselves of how health records came to exist in the first place.  Health records were first embraced in the 1920s when health care providers saw that keeping records in detail improved safety, treatment results, and quality of the patient experience.  Even though the process of keeping written records created an added burden, the transition from no records to records provided added benefits that the medical profession as a whole could not function without.  This contrasts very differently with what is happening with the rollout of EHRs – many systems are adding burdens with no perceived benefits.   This is ultimately leading to the friction we are seeing today.

Rather than improving their workflow and the patient experience, many of the EHR systems offered today are impeding it: 70% of respondents to a Medscape survey taken last July reported decreased face-to-face time with patients due to EHR implementation.  Although it can be argued that it is only a matter of time before physicians get used to and see the benefits of EHRs, large room for improvements clearly exist.  Healthcare providers do not reject technology because they are stubborn or unintelligent; they reject technology when it doesn’t work right just like the rest of us.  If EHR systems are to be embraced, they need to fundamentally change and improve the physician-patient relationship just like the original paper records did, and that change needs to be apparent.  The following is a list of things EHR developers should be mindful of:

  • Good EHRs are more than converting a paper record to a portable digital format. Improved portability is a game changer, but the burden associated with allowing portability needs to be balanced with that benefit.
  • The patient experience with EHRs is just as important as the physician experience. Although it is important to make sure physicians are satisfied, EHRs provide patients with the ability to access their health records like never before.  Improvements with the patient experience will motivate faster adoption of EHRs.
  • Efficiency is not everything.  An EHR that gives patients and physicians useful information that improves outcomes is much more useful than an efficient EHR that is efficient but does not provide as much information.

The shift from paper health records to EHRs is inevitable, and in that process we deserve to get EHRs right.  We should be confident that this will be achieved if we improve the experience, outcome, and relationship of both the patient and the healthcare provider just as it has been since health records were created.  At the end of the day, EHRs are about improving our healthcare system and not settling for anything less than the best.

The Devil You Know

Posted on November 25, 2014 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’d recently heard a practice manager talking about their EHR and Practice Management system. We talked about the EHR they’d selected and what they thought of the setup, and then I asked which practice management (PM) system they were using. They responded that they’d been using the same PM system for so long, they didn’t have any desire to change it. Then they dropped the bomb:

“There are a lot of things we hate about our PM system, but we kind of look at it as the devil we know.”

I see this happen really often when it comes to EHR and PM systems. In fact, it happens everywhere in the world of technology. Sometimes we don’t have any desire to change because we know the system we have and it works. Does it have its pain points? Yes. Do they drive us nuts? Yes! But at least we know about them and know how to deal with them.

There’s a real fear by many to switch to a new software where they have to learn about new “devils” for which they don’t know how to handle. I’m often reminded of the concept that “change isn’t always better.” So, in many situations, it’s better to not change. Maybe what you have isn’t very good, but if you’re not careful you could change to something even worse. That’s a real healthy fear.

That said, the fear can go too far. I’m reminded of when I had my first Android phone. I’d gone pretty cheap and gotten this really inexpensive phone. It worked, but was really slow. Plus, the battery barely lasted and it had plenty of devils I had to deal with whenever I used it. Luckily, I didn’t use it that much since I mostly work from home. However, when I was stuck in the depths of a massive exhibit hall at HIMSS and couldn’t get connectivity or I was waiting on the phone to do something, it was absolutely annoying.

The devils of that phone finally got to me and I upgraded to the Samsung S3. It was night and day difference. I must admit that I really didn’t know what I was missing. In many ways that was good, because it helped me to appreciate the upgrade. However, I’d kind of gotten complacent and was fine dealing with the “devils” I knew. (Side Note: Thanks to a few cracked screens from my wife and children, I’m now on the Samsung S5 and it’s awesome. The battery life itself is so compelling.)

Unfortunately, there’s no science to when to stick with the devils you know and when to upgrade. Without incentives, penalties or other regulations, there’s almost never a financial justification to upgrade software. It’s almost always cheaper to limp along with the old technology. However, there’s an extremely important sanity portion of the upgrade decision that is key.

I’ve personally found the time to upgrade and switch is when you know that the upgrade will solve the “sanity” issues you’re experiencing. If the upgrade won’t solve those issues, then it’s better to stick with the devil you know.

Fun Friday – HIPPA Sign

Posted on November 21, 2014 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.

Only readers of this site could enjoy this pharmacy sign. Thanks to HIPAA One for sharing the picture with me. Have a great weekend everyone! Stay Warm!
HIPPA Sign - Or Should We Say HIPAA Sign?

Maybe the pharmacy thought that HIPPA with two P’s stood for Patient Privacy. Of course, a quick search through posts on my site turn up 18 posts with HIPPA. So, this might be the pot calling the kettle black. I just enjoy the humor of humanity.