I imagine that many of you have seen some people talking about HITR around the web. It’s a website backed by the people at Porter Research and Billian’s HealthData. I know that I first saw it a few months ago and wasn’t quite sure I understood what they were trying to do. I couldn’t tell if they were trying to be Sermo, a private healthcare IT social network, or something new. The lack of clear vision for me meant I set it to the side.

While attending AHIMA this year I had the chance to spend quite a bit of time with a number of different people from Billian’s HealthData and Porter Research. We had a great time talking about all sorts of things, but they of course told me that I should look more at their new HITR product. I told them I’d take a look not knowing what to really expect.

A week or so ago, Jennifer Dennard set up a demo of HITR for me. While still a nascent product, I was intrigued how they used their knowledge and experience in healthcare research and embedded it so fully in the product. I guess I could have and should have assumed as much, but I was reasonably impressed with the idea of having a hub for healthcare IT research. I know how much I and other IT people love our data.

One interesting thing about HITR is the give to get model that they’ve set up. Basically they’ve arranged it so you give your feedback on your products to get access to other information and research from your peers. I imagine they’ll be adjusting this model over time, but it kind of reminds me of the open source model where everyone contributes a little bit and everyone benefits from the other people’s efforts.

The real challenge that HITR faces is just making sure they get enough people involved and participating to make the information they collect valuable. Plus, they have to get enough people and the right people on board. I’m not sure how scientific the results will be considering it’s a basically self selected example. I can’t remember if they include qualitative results along with the quantitative, but that could be really helpful even if the results aren’t scientifically correct on the quantitative side.

One other concept that they said they were exploring with HITR is the idea of getting connected with referral sites for a healthcare IT product that you’re considering. I REALLY love this idea. In my e-Book on EMR selection I recommend finding some referral sites and visiting them to get a feel for that EHR software in practice and to talk with a doctor who actually uses that EHR software day in and day out. The problem is that if you ask the EMR company for some referral sites they’ll give you a bias list. I suggest in the book to ask for their entire client list. However, I think using HITR could be another interesting way to find a referral site outside of the EMR vendors’ pre-groomed list.

I asked Jennifer Dennard to send me a list of some of the other benefits of using HITR. This should also give you a decent feel for what they’re working on with HITR.

I’d list the benefits for everyone as:

• Ability to connect with peers
• Blogs
• Groups
• Discussions
• Job boards

Benefits to providers that take surveys would include:

• Ability to gauge how your employees evaluate the systems you’ve put in place at your facilities
• Ability to see how those same systems are rated by your colleagues at peer institutions
• Ability to start a more in-depth dialogue with HITR connections about HIT systems you may be considering for your facility, and their experiences with those same systems
• Ability to influence future HIT product development

Benefits to vendors include:

• Ability to view how their systems are evaluated by their customers
• Ability to correspond with providers for product management/development purposes
• In the near future, vendors will be able to sponsor surveys through HITR to deploy to their chosen audiences – customers, prospects, etc.

If you have a chance to sign up for HITR, I’d love to hear your thoughts and experience. Like I said, it’s a new site, but has some interesting possibilities if they execute it right.

An interesting piece of news (some might say rumor) is coming out of AHIMA as posted by Joseph Goedert on Health Data Management. Here’s an excerpt of what was said:

An idea floating around Washington could result in Stage 2 of the electronic health records meaningful use program being different in each of its two years.

That’s what Dan Rode, vice president of advocacy and policy at the American Health Information Management Association, told an audience during the AHIMA 2011 Convention & Exhibit in Salt Lake City.
…
So the scenario could be that Stage 2 starts in January 2013 with minor changes from Stage 1, such as raising meaningful use quality measures a bit. But any major changes or new requirements, such as requiring the use of SNOMED CT in certain parts of the medical record, would wait until 2014, Rode said.

I’m sure this would be welcomed by almost everyone in the healthcare IT and EMR industry. Doctors and EHR vendors in general want to do as little as possible to get the government EHR incentive money. Even if some will publicly say that they want to use meaningful use to raise the standard of care.

I purposefully created the title to highlight the irony of meaningful use stage 2 having 2 stages. I’m not sure if we’ll call it meaningful use stage 2.0 and meaningful use stage 2.5 for the second step of stage 2. Of course, they could just make meaningful use stage 2 a simpler model and then add a meaningful use stage 4 (assuming the legislation allows it). However, then we’d really confuse doctors more than they already are when it comes to EHR incentive money, meaningful use requirements and their various stages.

This to me is still just a rumor, but it will be interesting to see how they make it happen if in fact they do try and do it. I know many people who will welcome any watering down of meaningful use. Even if you won’t hear them saying it in public.

This being my first time to attend the AHIMA Annual Conference I thought I’d do a post talking about my experience for those who haven’t attended. Plus, a look at some of the major topics of discussion that I’m sure to write about in the near future.

I must admit that it feels like a very different conference for someone who’s use to attending conferences in the predominantly male driven IT world. I’m certainly not complaining about it at all, but it is interesting to see the subtle differences based upon the predominantly female AHIMA attendees. For example, I have a bottle of nail polish in my pocket from 3M. That’s definitely something you wouldn’t find at a male dominated IT conference. Although, even I as a male took one for my daughter. Can you imagine how much she’ll love me for it?

I must admit that I’m still a little torn about the AHIMA conference, because I can’t help but wonder how many of the AHIMA members really exert influence over decision makers in their organization. This was partially highlighted to me by the choice of AHIMA keynotes which focus on leadership. It seems that AHIMA is making an effort to help their members become leaders in their organization and not just “worker bees.”

I’m sure my perspective is tainted a little bit when I think back to times where I’ve seen some of my HIM friends come back from conferences that taught them about EMR. They have all this energy about the interesting technologies or new products, but they far too often say something like, “Not that anyone cares, since they won’t really listen to me about EHR.” I really hope that this is a rather broad generalization. Plus, while it might be true that many in healthcare don’t listen as highly to HIM (or doctors in many cases) when it comes to EHR, I think HIM does have more of a voice when it comes to things like managing Release of Information, ICD-10, document imaging, etc.

The micro industries that exist has been one of the interesting things I’ve found at AHIMA. For example, there’s some really interesting and relatively large companies working in the Release of Information space. It’s quite amazing to me to see something so niche be so successful.

One thing I have really enjoyed about the people at AHIMA is how supportive they are of each other. There seem to be really tight bonds and great relationships between those that attend.

Overall I’ve really enjoyed my AHIMA experience so far. I’ve only been able to attend one session (see my post on EMR and EHR about the Healthcare Social Media session I attended), but the people I’ve met have been interesting and beneficial. I guess that’s true for most conferences. It’s all about the people.

I remember when I first started my job at a healthcare facility 5+ years ago, I ran into these codes they called ICD-9. Yes, this was all very foreign to me, but I learned quickly the meaning of ICD-9. I also learned quickly that the EMR vendor which had been selected (before I was there) didn’t provide a list of ICD-9 as part of their EMR software (they do now). They did provide an upload feature and so we exported a list out of our old PMS, cleaned them up a little and then uploaded them into the new EMR. Not a fun or effective process even that way.

Obviously, we’ve come a long way in five years. There are plenty of free lists of ICD-9 codes around the net that people can use, manipulate and add to their EMR software pretty easily.

However, I couldn’t help but wonder what solutions were being offered for EMR vendors planning for ICD-10. Yes, EMR vendors do have until October 1st, 2013 (which has been moved back a bunch of times so let me know if it’s been changed again) and so maybe EMR vendors aren’t concerned about it yet. Although, I’m guessing that many have already put a lot of thought into preparing for ICD-10.

My question for EMR vendors is, how are you planning to handle the ICD-10 codes? We’re talking about going from 14,315 diagnosis codes to 69,101 diagnosis codes. The National Center for Health Statistics (NCHS), the Centers for Medicare and Medicaid Services (CMS), AHIMA, the American Hospital Association, and 3M Health Information Systems have put together some General Equivalence Mappings (GEMs) that I believe try to do some mapping between ICD-9 and ICD-10. However, like translating a language there’s rarely a one to one match. With 4+ times as many codes there couldn’t be. So, certainly there’s the question of how you’re going to make the transition from ICD-9 to ICD-10 coding?

Although, at a simpler level, how are you planning to get the almost 70k ICD-10 codes in your system? Does anyone know of a database of these codes that’s available for EMR vendors? Is each EMR vendor going to try and create their own? What’s happening in this regard?

And maybe the answer is….ask us once we’re done dealing with stage 1 meaningful use. ICD-10 isn’t until stage 2 or stage 3 meaningful use.

Neil Versel posted a list of upcoming Healthcare IT conferences (a few aren’t just IT, but IT will be a large part of it) in the sidebar of his blog. Check out his list:

Medical Device Connectivity (Sept., Boston)
Medicine 2.0 (Sept. 17-18, Toronto)
AHIMA (Oct. 3-8, D-FW)
Health 2.0 (Oct. 6-7, SF)
MGMA (Oct. 11-14, Denver)
Connected Health Symposium (Oct., Boston)
CHIME09 (Oct., Indian Wells, Calif.)
E-Patient Connections (Oct., Phila.)
NIH mHealth Summit (Oct. 29-30, DC)
Inst. for Health Tech Transformation (Nov., LA)
AMIA (Nov. 14-18, SF)

That’s a lot of conferences. Were there any that we missed? That just goes through the end of the year. How do people stay up with all these conferences? I still haven’t made it to HIMSS, but am planning to go to Atlanta in March.

I’ve always wanted to put together my own EMR conference. Basically, just bring in a lot of really smart people to have insightful discussion about topics related to EMR. You could even bring in some EMR vendors and run them through the ringer. Maybe none of them would want to come and be held accountable for their software. However, if they did that would really say something. We could always do it on some test installs or something. Maybe the conference could put 10 EMR vendors through their paces and publish a report evaluating those 10 EMR companies. Then, that report could pay for the expenses of the conference. Who knows, I’m just thinking out loud on my blog. That’s what I love about blogs.

I’m not even sure it has to be a conference. Now that I think about it, it might be even more interesting to just bring a nice group of really smart people together to meet and discuss EMR and HIT for a day. Could produce some pretty interesting content. Plus, with a small group, you could pretty easily find a place to host the event I would think. Not to mention, I live in Las Vegas and everyone loves to come visit Las Vegas.

Back to the list above, which of the above conferences will you be attending? Are there any types of conferences that you wish were available related to EMR and HIT?

We’re all still sitting here waiting for the government to finally decide two key terms in regards to gaining access to the $18 billion in stimulus money in the HITECH act (ARRA). I’ve been interested in the subject myself since before it was even settled that we’d call it meaningful use as opposed to meaningful EMR user. From the looks of that post back in February, there was still a lot of confusion about “meaningful use” and “certified EHR.”

Turns out that a few months later, we still have very little clarification about what these two terms mean. Certified EHR discussion has really revolved around CCHIT certification or some other alternative. We’ll try to leave that discussion for other posts. What has been interesting is in just the past week or two there has been a literal flood of people offering their perspective on meaningful use. Sometimes I like to be on the cutting edge of these definitions (like I was in the link above) and other times I like to sit back and let them play out. This time I’ve been letting it play out and it’s really interesting to see the multitude of perspectives.

I’m not planning on writing my own plan for how they should do meaningful use. I may do that at a later time if so inclined. For now, I’ll just focus on highlighting points from what other people have suggested and provide commentary that will hopefully enhance people’s understanding of this complicated mandate (yes, that means this post will be quite long).

I think it’s reasonable to first point you to the NCVHS hearing on “Meaningful Use” of Health Information Technology. This matters, because at the end of the days hearings like these are where most of the information are going to come. Then, with the information from these hearing decisions will be made. The other sources like blogs won’t carry nearly as much weight (although it’s unfortunate that more politicians aren’t listening).

John Chilmark on Meaningful Use
Next, I’ll go to one of my newly found favorite bloggers named John Chilmark (any coincidence we’re both named John). John from Chilmark Research commented that HHS is bringing together the “usual suspects” to discuss “meaningful use. Chilmark also states that the following criteria are what’s required for meaningful use:

1. Electronic Prescribing
2. Quality Metrics Reporting
3. Care Coordination

I’m not sure where he got this list, but this list feels kind of weak if you ask me. In fact, John suggests that these requirements will be simple and straightforward and first and then ratcheted-up in future years. Interesting idea to consider. I hope that they do draft the requirements for meaningful use in a way that it can be changed in the future if it turns out to not be producing the results it should be producing.

John Halamka on Meaningful Use
Next up, the famous John (another John) Halamka, Chief of every Health IT thing (at least in Boston), calls defining “meaningful use” “the most critical decision points of the new administration’s healthcare IT efforts.” He’s dead on here. In fact, it might not be the most critical decision for healthcare IT, but for healthcare in general as well. Here’s John Halamka’s prediction for how “meaningful use” will be defined:

My prediction of meaningful use is that it will focus on quality and efficiency. It will require electronic exchange of quality measures including process and outcome metrics. It will require coordination of care through the transmission of clinical summaries. It will require decision support driven medication management with comprehensive eRx implementation (eligibility, formulary, history, drug/drug interaction, routing, refills).

Basically, he’s predicting inter operable EMR software and ePrescribing with a little decision support sprinkled on top. I won’t be surprised if this is close to the final definition. The only thing missing is the reporting that will be required to the government. The government needs this data to fix Medicare and Medicaid (more on that in another post).

Blumenthal Comment to Government Health IT
Government Health IT has a nice quote from David Blumenthal that says: “The forthcoming definition of the “meaningful use” of health information technology will set the direction of the Obama administration’s strategy for health IT adoption, said David Blumenthal, the new national coordinator for health IT.”

I think there’s little doubt that David Blumenthal has a good idea of the importance of the decisions ahead. What should be interesting is to see how involved Obama is in these very important decisions. I’m guessing Obama won’t do much more than sign a paper to make it happen. I just hope I’m wrong.

HIMSS Definition of Meaningful Use
Here’s a short summary of the HIMSS definition of “meaningful use”

According to HIMSS officials, EHR technology is “meaningful” when it has capabilities including e-prescribing, exchanging electronic health information to improve the quality of care, having the capacity to provide clinical decision support to support practitioner order entry and submitting clinical quality measures – and other measures – as selected by the Secretary of Health and Human Services.

Basically, e-prescribing, interoperability and clinical decision support. Turns out a BNET Healthcare article suggested the same conclusion “The consensus of physician and industry representatives was that meaningful use should include interoperability, the ability to report standard quality measures, and advanced clinical decision-making.”

I think we’re starting to see a bit of a pattern here. I should say that these are all very good things, but the challenge I see is that any requirement needs to be easily and consistently measured. Interoperability and clinical decision support are both very difficult to measure. Just wait until they see the variety of software that tries to do those two things. It’s very difficult to measure it consistently across so many EHR software.

Wow!! I barely even got started on this subject. Instead of belaboring the point, let me just point you to some other interesting readings about the HITECH Act, ARRA, and “meaningful use.”

• Fred Trotter’s Open Source Perspective
• Blackford Middleton’s Comments on “Meaningful Use”
• Steve Beller’s Definition of “Meaningful Use”
• Human Factors and “Meaningful Use”
• AHIMA Comments on “Meaningful Use” (pdf)
• Markle Foundation Framework (PDF)

Please let me know if there are other good sources for perspectives on defining “meaningful use.” This really is a landmark decision for healthcare IT.