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Bringing Long Term Care Into HIEs Without An EMR

Posted on March 13, 2013 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.

HIEs will never achieve their full potential if all players in the healthcare process aren’t included in the network. But without an EMR to connect to the HIE, how can a provider participate?

A new software package developed by Geisinger Health System and the Keystone Beacon Community Program offers a new option allowing nursing homes, home health agencies and other long-term care facilities without EMRs to upload data to HIEs, reports EHR Intelligence.

The package, KeyHIE Transform, extracts data from the Minimum Data Set and Outcome and Assessment Information Set that nursing homes already submit to CMS. It turns that information into a Continuity of Care Document usable by any EMR which is HL7-compatible.

This approach provides a bridge to a wide range of data which currently gets left behind by most HIEs. And as EHR Intelligence rightly notes, with telehealth and remote monitoring becoming more popular ways of managing senior  health, as well as assisted living, it will be increasingly important for other providers to have access to all of the seniors’ data via the HIE.

Geisinger’s KeyHIE has already run several  pilot programs using t his technology in long-term care facilities and home health agencies. It expects to launch the technology to the market in April of this year.

As is often the case, Geisinger seems to be ahead of the market with a solution that makes great sense.  After all, finding a way to integrate new data into an HIE — especially one that draws on existing data — is likely to add significant value to that HIE.  I’m eager to see whether this technology actually works as simply as it sounds.

Redesigning The Patient Medical Record, the Healthcare Challenge’s Results

Posted on January 28, 2013 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 13 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 post by Carl Bergman from EHR Selector.

The Obama administration’s, Challenge.gov site encourages the public to submit suggestions that solve specific, public policy questions. To do this, it’s set up dozens of contests or challenges. For example, the FTC has a $50,00 challenge for a solution to illegal robo calls that often come from off shore.

In healthcare, the VA and the ONC recently ran a Health Design Challenge for a better patient health record announcing the winners a few days ago.

The challenge asked for a record that:

  • Improves the visual layout and style of the information from the medical record
  • Makes it easier for a patient to manage his/her health
  • Enables a medical professional to digest information more efficiently
  • Aids a caregiver such as a family member or friend in his/her duties and responsibilities with respect to the patient

The entries were judged by a twelve person panel ranging from Wired Magazine’s Executive Editor, Thomas Goetz to Facebook’s Product Designer, Nicholas Felton to Dr. Sophia Chang, the director of the Chronic Disease Care program of the California Health Care Foundation. They looked at several features of a revamped record from overall appeal to how readily it shows important information and how accessible it is for physicians, patients, etc.

The Winners

The judges picked three big winners and three winners in the Problem History, Medication and Lab Summaries areas. Here’s a brief look at the top entries, but the submissions should be looked at more as a resource than a race result, as I’ll discuss.
Nightingale
First place went to Nightingale an anonymous group that won $16,000. Others won smaller amounts. In the next few months, elements of the winning designs will be put together and put up on Github.

Nightingale’s design stressed that health was a continuing concern and that a user should be able to see an improving or declining trend without having to dig for the data. They did this by integrating the often disparate information in visits, exams and lab results. You can see this emphasis in their lipid panel screen. Sliders place each test result for each test’s in a range. Good results slide to green while poorer result move to red.
StudioTACK
Second place StudioTACK took a somewhat similar approach to creating a problem history, which they call a medical strategy rather than a record. They did this by bringing their findings into a body map with references to location and organ.

Matthew Sanders’ CCD scored the best Problem History section award. Sanders rearranged and redesigned the traditional note not by condition nor by past chronology, but into a timeline of past, present and future actions. While he admits that his approach is somewhat redundant for meds, he emphasizes that this arrangement helps all the users maintain a focus on the most important areas for action. Sanders presentation notably describes how he implemented his approach. To do this, he stripped out standard label text, clarified terms and gave the remaining items visual emphasis. This type of analysis makes going through the submissions worth it.
Sanders CCD
This isn’t to say that the way the contest was run and the approach of many submissions  — including some prize winners — were without shortcomings. There were some notable problems.

The Contest’s Problems

The contest’s operators needed to be far more specific about what they wanted and how they judged the results.

The challenge’s purpose was far from clear:

The purpose of this effort is to improve the design of the medical record so it is more usable by and meaningful to patients, their families, and others who take care of them. This is an opportunity to take the plain-text Blue Button file and enrich it with visuals and a better layout. Innovators will be invited to submit their best designs for a medical record that can be printed and viewed digitally.

A medical record is an on going repository of a person’s health context, status, prognosis, plans, etc. It has many contributors and users. The VA’s Blue Button is a snapshot of the person’s status for their use. However, the contest uses these terms interchangeably. Due to this muddle, many of the submissions sent in designs for a medical record, while others, a minority, only redid the Blue Button’s outline. Thus, not all submissions were developed on the same basis. Indeed, the judges seem to acknowledge this since they gave first place to Nightingale, which claims, “to be a new take on health records.” The contest would have done much better if it asked for particular types of screens putting everyone on the same page, as it were.

The contest judging panel while distinguished, had no practicing physicians, nurses or practice managers, a significant failing. While three of the twelve judges are MDs, not one is a practicing physician.

Finally, if you’re going to hand out $50,000 in public funds, you might just want to say why you thought the winners stood out.

The Submissions

The contestants almost universally got one thing right. They designed their entries for desktops/laptops, pads and phones. They showed a great understanding that we don’t work on just one platform, but move from one to the other almost continuously. In this, they deserve much praise. However, all this cross platform awareness is done in by an appalling over, under and misuse of font color, and size. As one post noted about Nightingale:

The text is too small and medium gray on light gray is very hard to see, especially for older people and people on cheap computers with low contrast displays. How can this possibly be the first place winner?

The comment is generous. Nightingale’s gray on gray font is almost unreadable. Granted their submission is a PDF of a prototype, nonetheless the possibility of staring at their screens all day would give me a headache.

They are not alone in color misuse. Second place winner, Studio TACK, goes to excess the other way with a white text on red iPhone screen. It’s more suited to public safety than health.
StudioTack Mobile
Going through the submissions, however, can be most rewarding. I found a gem of a summary page in Uncorkit’s submission. Their infographic approach puts not only labs and weight history on timelines, but also includes BP, conditions and meds. It gives you a great overview and a logical place to drive down for detail information without overwhelming your senses.

The Health Challenge submissions have much to recommend them. Just remember how they came about and what they may or may not include.
Uncorkit

Additional EMR Regulations – Good or Bad?

Posted on January 15, 2013 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 13 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.

Suppose the DMV added 1000 new rules to driving. Would that make driving saver? Would that help the police write better tickets? It would help the regulatory bodies better split hairs. It would allow more and bigger DMV offices.

I got the above comment emailed to me by Paul Lund who subscribes to the EMR and HIPAA email list. It’s an interesting comment and EMR and healthcare can likely learn from the rules of the road. I think the biggest challenge is that we seem to all understand about driving and the issues related to driving. In healthcare, we all think we know about the challenges of healthcare, but it’s often much more complex.

As I think of the analogy of driving to EMR, I agree with the general idea that less EMR regulation is better than more EMR regulation. For example, have we seen a measurable benefit from all of the EHR certification or meaningful use regulation>? I have yet to see it, but could point to plenty of areas where the EHR certification and MU regulations have caused a negative to healthcare.

However, just like in driving, I don’t think there should be no regulation at all of EMR and EHR software. As usual, I have a much more nuanced view. Can you imagine driving with no rules? The odd thing is that in some ways that’s what it feels like in EMR today.

A simple example is having a true standard for EMR interoperability. I’ve long wished that the EHR incentive money focused exclusively on this challenge. It’s a place where an adopted and supported standard for EHR data could really benefit the community. Plus, holding EHR vendors, hospitals, HIEs, and physician offices to that standard could be a real benefit. Right now every EMR seems to be doing what they want. Yes, we have CCD, but try transferring a CCD from one EMR to another right now. It’s a mess of multiple versions and challenging delivery. Works great in the HIMSS interoperability showcase, but somehow isn’t getting translated to real work.

Is it too much to ask for meaningful EMR regulation and nothing more?

Mobile EHR as a Solution for EHR Downtime

Posted on October 12, 2012 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 13 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.

After a couple major EHR vendors had some EHR downtime, there’s been a lot of interesting discussion about how to deal with EHR downtime. It’s also worth taking a look at my previous posts on: Cost of EHR Down Time, My EMR is DOWN!!!, Reasons Your EHR Will Go Down, SaaS EHR Down Time vs. In House EHR Down Time, and Working Offline When Your EHR Isn’t Available. Obviously, there’s a lot to think about when it comes to your EHR going down.

I recently got a demo of a new free mobile EHR app offering from Mitochon. When they asked me if I wanted to see the product, I wasn’t sure what I’d see. I’ve obviously seen hundreds of different mobile EHR apps and so I thought I knew what I’d likely see. Instead, I was quite surprised with the unique approach they’d taken with their mobile EHR app.

They warned me up front that this is the first iteration of their mobile EHR app, but I found what they had created to be a nice innovation on what I’d seen elsewhere. Instead of trying to cram the whole EHR into a mobile app, they decided to leverage the CCD documents they could already create into an EHR app that worked on the mobile, anytime, anywhere.

When you think about EHR downtime, the mobile is a perfect solution. The device can run applications without any internet connectivity. Plus, it can endure power outages better than any other computing device. I’m sure many of you are wondering how the EHR data makes it to the mobile if there’s no internet connectivity.

This is what I think makes the Mitochon mobile EHR app so unique. They securely cache your top patient info on your mobile phone so that if your mobile has no connectivity, then the data is still there and available to you. Sure, it’s not the full EHR data and you can’t do all the functionality of your full EHR, but in an emergency situation (ie. EMR downtime) it could be incredibly valuable to have the clinical summary information available to you in your mobile app. Not to mention if you’re at a hospital doing rounds and the big cement wall hospital makes it so you have no cell signal.

Now that the health data of your patients is stored on the device, security becomes a big question mark. Mitochon showed me this slide which does a good job showing the mobile security they’ve put in place with their mobile EHR app:

I think this is a pretty creative mobile EHR solution. Plus, I find it fascinating that they built a large portion of their app on the back of CCD. Makes me wonder what other cool things could be done with CCDs.

Here are some other screenshots of the Mitochon mobile EHR app (these are from the iPad):

Do you like this approach to dealing with access to your patient records even during EHR downtime? Is the CCD enough information for you to care for a patient?

Full Disclosure: Mitochon is an advertiser on this site.

Interview with Dr. David Lischner Founder of Valant Medical Solutions Behavioral Health EHR

Posted on May 4, 2012 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 13 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’ve had a somewhat unique interest in the behavioral health world ever since I started working with EHR software because the first EHR I implemented had to merge a health center together with a counseling center. As such, I was really excited to get a chance to interview Dr. David Lischner, CEO and Founder of Valant Medical Solutions. Those interested in Behavioral Health EHR software will enjoy this interview.

Can you tell us a little bit about how Valant Medical Solutions came about?
I founded Vālant with the purpose of helping behavioral healthcare providers manage their practices more efficiently. After graduating from residency in 2002 I started a group practice and became disappointed with the solutions available to psychiatrists for managing their practices. I knew that in order to successfully run and grow my practice, I was going to have to be as efficient as possible and utilize technology to my advantage. After unsuccessfully searching for software that fit my needs, I partnered with my brother who is a software developer to create the Vālant EHR.

Being a newer EHR company, what assurance can you provide psychologists and psychiatrists that your EHR is on solid footing?
First off we are the fastest growing behavioral health specific EHR on the market – and don’t plan to change that any time soon! We have been in business since 2005 and have over 1,100 providers and close to 2,000 users across the country using our product. Our product is fully certified and HIPAA compliant.

Secondly, we are 90% through a very successful round of financing, and it is clear that we have become the market leading solution for behavioral healthcare practices. We are on very solid footing.

Why do behavioral health professionals need a specialized EMR? What does Valant provide that other traditional EHR software don’t include?
It all comes down to the understanding and knowledge we have of the market. That “domain expertise” is expressed in every interaction and every feature of our product. Psychiatrists again and again tell me that we just get it, and that the product “understands how I work”, in a way that other vendors and products do not.

As an example, our new module release: Mobile NotesTM, is designed for capturing outcomes data relevant to a behavioral health clinician and using that data to not only improve care, but also auto generate narrative for the provider. That functionality is simply not present in other EHR’s and couldn’t be provided within large multidisciplinary EHR’s.

Behavioral healthcare providers want speed boats that are fast and have a very specific purpose rather than big cruise ships that have a little bit of something for everyone.

How many psychiatrists and other mental healthcare professionals do you have using your EMR?
We have over 500 psychiatrists and over 1,100 providers using our product. Including solo practices, public community health centers, mobile practices, and large group practices.

What’s Valant’s approach and thoughts on the HITECH Act and meaningful use? Do you see many mental health professionals getting EHR incentive money?
We have had over 20 providers successfully attest for meaningful use and a number of them have already received their checks. Our approach is unique in that we support “ease of meaningful use” in both our product and our support processes.

We have practice success managers that monitor the progress of our doctors and coach them along to help them achieve success. It’s not enough to simply buy a certified product. It’s important to assess the vendor and product’s ability to help you achieve success. We view the attestation process as a partnership with our doctors, treating their success as our own.

What advantages do you see for mental health professionals that have an EMR versus those that still chart on paper?
I think 3 of our biggest advantages are: greater efficiency, better patient outcomes and more revenue capture. Our newest module: Mobile Notes, delivers rapid note creation at the point of care that is faster than paper documentation. It includes automatic narrative generation from patient outcomes questionnaires and leverages an IPad’s voice recognition capability for the narrative sections of the note. It’s the perfect note creation tool for a behavioral healthcare provider and even before its release, has pried many doctors away from paper and pen.

Mobile Notes also allows practitioners to track outcomes data for their patients, providing the ability to monitor patient progress over time. This ability is not only helpful when assessing treatment plans and communicating progress to a patient, but may also become required in the future. As an example, United recently announced that over 70% of their codes would be pay for performance.

Who are Valant’s biggest competitors and what differentiates Valant from other behavioral health EMR?
I’d say that for the private practice psychiatry market, it is now mostly a race between ICANotes, Valant, and Practice Fusion.

ICANotes has been around for a number of years. I remember being impressed by a demonstration even before Valant was founded. They have had a nice system for converting check boxes into narrative. Some users are very happy with the way they can create intake notes and progress notes with just clicks. They’ve clearly developed a nice system for doing this that has generated a loyal following. It is still fundamentally a client-server product rather than a web based system. Also, when I last looked, they had not added a practice management module. [Update: Sandy Crowley commented that ICANotes does have a practice management capability.] We’ve addressed the narrative generation issue in our v5.0 release and have tied it to outcomes measures pushed from a patient portal. So we’ve combined 3 processes into one, which we think creates something much, much bigger and more powerful than check box to narrative generation alone.

The most common reason that Psychiatrists go with Practice Fusion is the price. The basic EHR without practice management is free, however the user will have to suffer through ad pop-ups and accept that your anonymized patient data is now owned by Practice Fusion. [John's Editorial Comment: Practice Fusion does have advertising, but does not use pop up ads as part of that advertising. Practice Fusion does have research rights to the data, but the doctors own the data. I'm sure many see research rights to the data as Practice Fusion owning the data, but it's worth highlighting that physicians own the data on Practice Fusion as well.] It’s an option for practices that are not bothered by this and are OK with a system that is largely text based and not optimized for behavioral healthcare.

Our big differentiator now, is our newest module release. I know that I am repeating myself. (Can you tell that I am excited about our newest release?) I really do think it is going to change the way we (clinician) practice. It will allow us (behavioral health practitioners) to get our notes done more rapidly and easily, engage better with patients, and allow us to incorporate outcomes tracking into our clinical practices.

You’ve recently launched a number of mobile initiatives, can you tell me what mobile solutions you offer mental health providers?
We were the first in our market to release a pure mobile version, which we now call Mobile Calendar. It includes a calendar with syncing to smart phones or any other calendar and key clinical information and demographic information necessary to support care when you are away from your office.

We also now have Mobile Notes, which is a more robust version of Mobile Calendar. It takes outcomes measures completed by patients on their PC or mobile devices and converts the data into narrative and then takes advantage of the iPad’s native voice recognition capabilities to support rapid note creation at the point of care.

And what mobile health options do you provide their patients and clients?
We now have Vālant Patient PortalTM. Allowing clinicians to send intake forms before the first appointment. Patients will receive push reminders to fill out intake forms before initial appointments and outcome measures before follow-up appointments. All of this is done via a secure patient platform that is branded to the practice. Patients are also able to confirm upcoming appointments, update demographic information as well as view CCDs.

5 years from now, what will differentiate Valant’s EMR?
Well it’s worth taking a step back and asking what the EHR landscape will look like in 5 years. Nearly all providers will be using EHR’s. EHR’s will be connected. Patients, hopefully, will have some control over how their data is utilized and who gets to see their data. Providers will think of EHR’s as tools that support them and work for them at the point of care. An EHR will that keep providers connected, educated and prepared. Patients will have their own set of tools that work seamlessly with EHR’s that help keep them healthy and connected to their providers. All this should be in the service of improving patient outcomes, keeping patients healthy, and improving the quality of work for healthcare providers. I believe in that vision.

By staying within the behavioral healthcare segment and not trying to be all things to all providers, Vālant will have a better chance of fulfilling this vision for our providers and their patients. It’s a big enough challenge as behavioral healthcare is 7% of the entire $2.6 Trillion healthcare market.

So in summary, we’ll be very deeply imbedded within the vertical market of behavioral healthcare and will ultimately be a platform that connects providers, patients and other areas of medicine, as they adapt to the changing healthcare landscape. We’ll continue to offer a set of tools to our providers and patients that improve provider life and work quality, the value of healthcare, and patient health.

EHR Vendors and ONC Need to Rebrand CCD

Posted on April 18, 2012 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 13 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.

A really interesting point came out of the discussion in the comments of my post titled “What Information an HIE Should Pass?” Here’s one of my responses:

I think what you describe is that the branding of the CCD isn’t right for doctors. Instead of saying that they can get a CCD document from a doctor which sounds technical and scary they need to hear that they’re going to get an “Electronic Note” transferred from a doctor. If in reality that’s a CCD document that gets converted into a beautifully displayed “note” for the doctor, they don’t really care. That’s semantics which don’t matter to them. Your “football” naming goes towards these same lines, but I think that actually naming it a “football” will confuse doctors more. It works great as a way to describe what’s happening, but they’d get lost wondering how football had to do with a note. I actually think this is an important point that’s worthy of its own blog post.

Of course this discussion is really about branding and communication. It’s not about the technical details of a CCD (Continuity of Care Document) document (That’s a topic for another discussion). I believe the problem probably lies in the fact that most of the technical people I know behind standards like CCD are more worried about the technical details and don’t realize the importance of how those technical details translate for those not entrenched in the standards creation.

Most of them know the ins and outs of CCD so well that many probably don’t realize that those outside of the standards creation really don’t have a clue of the realities of what CCD will do for them. Even just saying the name CCD starts the confusion for many. Certainly there are exceptions to this, but most doctors couldn’t care less about the standards details.

Here’s something a physician understands:
Your physician notes are being transferred to another doctor.
or
You’re receiving physician notes from another doctor.

What they have a hard time processing is:
You can send a CCD document to another doctor.
or
You’ve got a CCD document from another doctor.

Sure, there are subtle nuances between physician note and CCD, but those can be communicated as well. Maybe physician note isn’t the exact right word either, but I think it gets closer to communicating what’s really happening then saying a CCD document.

Regardless, we need to do a better job communicating what’s happening. I know a lot of doctors that would love to transfer a physician note. I don’t know many that care about CCD documents.

What Information an HIE Should Pass?

Posted on March 23, 2012 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 13 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 had a post by Dirk Stanley, MD recently pointed out to me where Dirk discusses the challenge of deciding which information an HIE should pass. Dirk is the CMIO at a hospital and also a genuinely nice guy. He frames the answer to the HIE data passing question really well:

And after a rousing discussion, the answer I heard was this :Everyone has a different opinion.

I guess it’s entirely understandable… ICU docs, PCPs, surgeons, specialists, hospitalists, and everyone else has a common goal – making the patient healthier – but they have different training and thus they all have different needs. This is why when I hear docs say “I just need the important information!“, I smile because ultimately, all of the information in a chart is important – It just depends on your context and clinical needs.

So I’m left with the ultimate Informatics challenge – How can we get the right information to the right person in the right place in the right time in the right way? Especially when everyone has a different opinion on what the right information is?

He then offers this zinger which describes the real core of the problem: “Looking at the current buffet table of documentation, it’s no wonder that every doctor has a differrent opinion of what they need. There aren’t really any hard standards for clinical documentation.”

Dirk then goes on to describe his solution to the problem which essentially revolves around the idea of a new type of note that can be transferred. You can read all the details in his post.

Reading through Dirk’s thoughts on the subject I’m reminded of the conversations that surrounded the creation of CCR back in the day. They seem to have taken a very similar approach to what Dirk describes. I wonder what Dirk thinks of the CCR (now basically merged with CCD) standards that are already out there. Do they not cover what he has in mind? Are their gaps in the CCD standard that don’t cover his “new note?” Could we just improve the CCD standard to cover those gaps? I’ll ping Dirk and hopefully he’ll join the conversation.

The real challenge when looking at what data should an HIE pass is that computers aren’t very good at understanding context. I’d be interested to hear people’s thoughts about this and how we’ll solve this problem going forward. My gut feeling is that we need to start with something that will solve a lot of problems for a lot of people. We don’t need something that will solve all things for everyone from day one. We can incrementally improve the exchange of data as we go forward.

Guest Post: The Long Term Fate of CCD

Posted on November 10, 2011 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 13 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 part of an email interaction I had with an EHR vendor about the future of CCD. Of course, I can never let strong opinions go unpublished. So I asked if I could put this on my site. I have a feeling there will be many people who have a different view of CCD and how these standards will play out. I’d certainly be happy to publish an opposing view as well. My contact page is here. I’m interested to hear other view points on the subject.

Stage 1 MU allowed either CCR or CCD. Stage 2, and the short term efforts will require CCD. The jury is still out on what Stage 3 of MU will focus upon. Many at the ONC can see that the CCD will never have the flexibility to deliver. These are largely the same people that facilitated the Direct Project initiatives.

I still predict that it is inevitable that the data will become uncoupled from unwieldy, anachronistic document structures. That will be the only means to get to true information portability that can deliver patient-centric use of the information. The CCD will still be around for a while to come, just as CD’s are still around for music sharing. For now, we have to have the CCD to preserve legacy, industry-centric control of the information.

John Halamka has a couple of recent posts that do a good job of explaining what is evolving…. http://geekdoctor.blogspot.com/2011/09/september-hit-standards-committee.html and http://geekdoctor.blogspot.com/2011/10/cool-technology-of-week.html . Both of these contain links to some very interesting information. When the ONC proceeded to issue an advanced notice of rulemaking, the industry power elites became enraged. http://www.ihealthbeat.org/articles/2011/9/22/groups-urge-onc-not-to-include-metadata-standards-in-stage-2.aspx

Technology delivering to patients will eventually win out just as the open-platform WWW won out over proprietary CompuServe. http://www.healthdatamanagement.com/news/onc-metadata-ehr-meaningful-use-43021-1.html Once we have a means to truly exchange the content without the overhead associated with the CCD/RIM crap, we will see a revolution in healthcare similar to the social networking phenomenon.

Again, the whole CCD/CDA will stick around to support legacy information needs, but it will eventually be largely eclipsed by more straight-forward solutions that don’t require a team of consultants and IT engineers to implement.

The Meaningful Use Sky is Falling

Posted on January 28, 2011 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 13 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 always opinionated Anthony Guerra has an article up on Information Week that describes why he thinks the Meaningful Use sky is falling. Add that to a recent comment I got on a previous post that links to a Healthcare Data Management article talking about the potential repeal of the HITECH act and it seems worthwhile to assess the state of meaningful use.

I’ll start with the potential repeal of meaningful use first. We’ve known for a long time that the house was going to be going after healthcare reform once the republicans took over control of the house. In fact, we posted about the potential impacts to HITECH from the new Congress before.

I personally get the feeling that not much has changed on this front. I’m going to reach out to some of the government liasons for EHR vendors that I know that follow this even closer than I do. However, I still believe that:
1. The HITECH funding or at least the Medicare and Medicaid stimulus funding is safe from Congress. I’ve read this a couple of places and so I believe it to be true.
2. Any legislation that is passed by the house still has to pass through the democratic controlled Congress and avoid the Presidential veto. These two seem unlikely.

Of course, when it’s government work you could always be surprised by some loophole in the process that impacts funding or legislation. I won’t be surprised if one of these loop holes appears and affects the HITECH act. However, I still argue that if something does happen to HITECH, it will likely be a casualty of some other political agenda (ie. cutting whatever costs they can find) and not actually because they were specifically targeting HITECH.

Long story short: I still feel like the EHR incentive portion of HITECH is likely safe. Maybe some of the other funding will be cut short. We’ll see.

Now to the points that Anthony Guerra makes in his article. He describes the challenges that many hospitals are facing in regards to meaningful use. Plus he highlights the potential difference in the number of people who “think they qualify for the money” and those who “plan to apply.”

I might argue that if EHR adoption is the goal, then this might not be such a bad result. The idea of “forcing” meaningful use on people has always bothered me a little bit. Encouraging people to show meaningful use is only as good as the meaningful use criteria. If the meaningful use criteria is not very good, then do we really want everyone showing meaningful use?

For example, imagine that a doctor or hospital decides to use an EHR based on the EHR software’s ability to improve the efficiency of their office and the quality of the services they provide to the patient, but deems meaningful use as contrary to those goals. This seems like a great outcome to me. In fact, it seems like a better outcome than a doctor trying to force themselves into the meaningful use hole.

Obviously there are parts of meaningful use that can be very beneficial. For example, having an EMR that can communicate using a standard format (CCD for example) is important and valuable. If it is beneficial, then I see most doctors implementing these features regardless of whether they showed meaningful use or not.

One thing definitely seems clear from all the surveys and other stats I have: interest in EMR has never been higher. Whether that translates to “meaningful use” of a “certified EHR” or physicians meaningfully using an EHR of their choice, is fine with me.

You know my mantra: Select and implement an EMR based on the benefits that you and your clinic want to receive from the EMR. Don’t select and implement it based on a government handout. Those hand outs will be gone after a few years, but your EMR will be with you long after.

CCD As the EMR Interoperability Standard

Posted on March 6, 2010 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 13 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.

In one of my many discussions with people at HIMSS 10 we started talking about EHR interoperability standards. The person I was talking to worked as an engineer for a vendor that’s entire work is interoperability of EHR data. As we talked, I made the comment that it seems like CCD has won the battle for EMR interoperability. He gave me a kind of blank stare and said, yeah. Basically his response was like yeah everyone knows that. Almost as if there weren’t any other real EMR interoperability options out there. Well, I guess someone better let Google Health know too.

As I went through the HIMSS showroom floor, I got the same feeling.

The good thing is that I think the people behind CCR are satisfied with this result since CCD is a derivative of sorts from CCR.