Nothing like enjoying the end of the weekend by going over some tweets from interesting people in the healthcare IT and EMR world.

The first one hit me the strongest since I think I sometimes get so wrapped up in the details of EMR and healthcare IT that I forget to stop and remember really why we’re doing all of this. Thanks Diane for reminding us.

What are the ends of medicine? To cure sometimes, relieve often, comfort always. Regardless of wealth or lack thereof.

April 3, 2011 8:22 am via ÜberSocialReplyRetweetFavorite

@DianeEMeier

Diane E. Meier

After John Chilmark from Chilmark Research skipped doing his taxes (thankfully mine are done) to read about ACO’s he provided this perspective:

Reviewing #ACO rules won out, quite amazed at level of focus on pt-centered care, MU a cakewalk in comparison

April 3, 2011 5:03 pm via FlipboardReplyRetweetFavorite

@john_chilmark

John Moore

John also offered this tweet to a Kaiser resource on ACO’s:

Best source of #ACO mat’l I’ve found so far http://bit.ly/i7eqs4

April 1, 2011 3:52 pm via TweetDeckReplyRetweetFavorite

@john_chilmark

John Moore

ACO’s are a hot topic and I have a guest post coming which will hopefully shed even more light on what’s happening in Washington around ACO’s and the new legislation.

@TheGr8Chaulupa (best twitter name) and @j_schilz reminds us of the crazy channels vendors are using to sell EHR software. Although, Costco’s only a couple years after Walmart and Sam’s Club EMR was offered (4-5 posts I did on it):

I saw that. How cool! RT @j_schilz: Via my Costco Newsletter: A #MU Certified #EHR Platform Offers Costco Members a fully hosted solution.

April 2, 2011 2:42 pm via HootSuiteReplyRetweetFavorite

@TheGr8Chalupa

Erica V. Olenski

Finally, my announcement of a new EMR and HIPAA EMR was an April Fool’s joke in case you didn’t realize it when you read it. Hopefully everyone that read it enjoyed it as much as I enjoyed writing it (with Katherine Rourke’s help).

I know I’ve talked far too much about HIMSS already, but I figured it’s the weekend and so not many of you are reading the site any way. So, I’ll take the topic du jour it seems and talk about my thoughts on making the most of your time at HIMSS.

I will offer the disclaimer that this is only my second year, so I’m interested to hear your ideas as well. However, I learned a lot my first year and so I figured I’d share a few thoughts.

Be Selective
My biggest suggestion for people is to be selective in what they want to do. 30,000 people, a ton of overlapping sessions and a ginormous (it’s not a word, but should be) exhibit hall. Yet, you have to pack that all into a couple days. It’s really important for you to be selective about who and what you want to see and make sure you make time for those important events and companies.

My mother always told me as a child that I can’t do everything. I’d always reply, “Yes mother…but I’m sure going to try.” Sadly, HIMSS is so large, that as usual, my mom is right (although, I’m still trying).

Keep Meetings Short
I borrowed this one from John at Chilmark Research. He makes a good point that you’re not really going to have time to take care of a whole lot of business at the event. However, you can get enough information to filter whether you should connect after the event. This said, be memorable enough that when you connect after the event they’ll remember who you are amidst the hundreds (or thousands) of other people they met.

Leave Roaming Time
The thing I was most sad about last year was that I didn’t leave me really any time to just roam the exhibit floor. I had my schedule so tight that I never could just enjoy the adventure of seeing something new and unexpected. Maybe some people don’t like this type of experience, but I really enjoy it. Sure, you end up talking to someone for a little bit about laptop carts or something you don’t care much about. At least they’ll give you chocolate or something and you’ll be amazed at how much thought they’ve put into carts.

Follow #HIMSS11 on Twitter
If you don’t use Twitter, that’s no excuse. You don’t even have to sign up to read the tweets coming out of HIMSS. Just follow the hashtag #HIMSS11 (or click that link) and you’ll see that people are already talking about it. If you want a few less ads than what are sure to be sent on the #HIMSS11 hashtag, you can also watch this list of New Media Meetup people on Twitter.

Free TV
Find me on Tuesday of HIMSS and you can enter to win a free TV (42 inch I believe). That’s right. More details on this coming soon. UPDATE: Full details on HIMSS TV Giveaway posted.

Enjoy a Party or Two
Nothing wrong with letting your hair down and enjoying yourself at some of the many parties out there. Some even have live bands and dance floors. That should be fun.

Health IT Venture Fair
I’m sure many of you don’t even know about the Health IT Venture Fair at HIMSS. It’s on Sunday and many of you probably won’t even be at HIMSS yet. However, I’ve heard good things about this event. It’s real companies with real investors talking about their companies. I’m totally fascinated by venture capital, other investing and entrepreneurs and so maybe I’m biased, but I think this is going to be a really interesting part of HIMSS. I’m quite certain that it will present interesting views into healthcare that I hadn’t seen before. I love any event that stretches me like that.

Here are some other cliche suggestions:
-Wear good shoes (the floor is massive)
-Bring lots of business cards (I got my new ones printed…Woot!)
-Win an iPad – If I come home without an iPad I’m going to cry. It’s the de facto giveaway for sure. Makes me wonder why HIMSS didn’t just give away an iPad to each attendee.

Let me know if you have other suggestions I missed or suggestions of your must do items at HIMSS.

As you know on the weekend, I try to do my simple posts since most of you are enjoying the weekend like you should.

Today I thought it might be interesting to point to a few different EMR and healthcare IT blog recommendations. This is far from an inclusive list. In fact, I could probably do this every weekend and not repeat the same blog recommendations. Maybe I will! Especially since then as I read various other blogs I can remember to make note of it. So, for this post I’ll start with some popular ones that many people know about.

Fierce EMR – I really like the work that Neil Versel does and Fierce is lucky to have him working on their EMR content.

HIStalk – This is often a bit too hospital focused for my tastes. They do have HIStalk Practice which is more ambulatory focused and has gotten better as Inga’s focused on it more.

Chilmark Research – I really enjoy John’s blog. He does a good job analyzing HIE, EHR and mobile healthcare. The only complaint is that he doesn’t publish enough, but that’s ok. When he does publish it’s almost always an interesting read.

The Health Care Blog – My only complaint about The Health Care blog is that often times it has a lot of posts that aren’t related to health care IT. Although, it does have a strong group of health care IT bloggers that do some great IT and EMR related posts.

Like I said, there are dozens and dozens of other ones. These are a few of the ones that have been around for quite a while doing their thing. I’ll cover some more of the other blogs I enjoy next time. Or you could just keep reading this site and my other blogs (EMR and EHR & The Wired EMR Practice) where I try to write about a lot of the major happenings in the EMR and healthcare IT world.

I previously posted about the new head of CCHIT, Karen Bell. Most of you probably know that I’m not a huge fan of CCHIT, but I’ve decided that I’d like to give Dr. Bell some advice for CCHIT. Free consulting. How cool is that? Here we go…

If Dr. Bell really wants to solidify CCHIT’s position in the EHR world she’ll find a way to show that the CCHIT EHR certification improves usability, EMR implementation success, reimbursement, etc. CCHIT has some vague terminology about the “assurances” that CCHIT certification provide. Unfortunately, they end up being empty assurances about things that doctors don’t really value.

I’d be really impressed to see an independent study done on the EMR implementation success of CCHIT certified EHR versus non-certified EHR. Or how about a study comparing the usability of CCHIT certified EHR versus non-certified EHR. Let’s see some real data on assurances that doctors actually care about. Do that and everyone will want a CCHIT certified EHR.

Unfortunately, if you do go this route, you need to be open to the possibility that an independent study would find that CCHIT certified EHR have a higher EMR implementation failure rate or that CCHIT certified EHR are less usable. What would CCHIT do then (besides try to manipulate the study to look the way they want)?

What’s more unfortunate, is that studies like this should have been performed before Congress decided to just include the term “certified EHR” without actually knowing what consequence (good or bad) that term might have on the EHR industry.

As always, Chilmark Research has a nice post up talking about the new head of CCHIT, Karen Bell. You can see the official CCHIT announcement here.

Chilmark brings up two interesting points about what he thinks we can expect from Karen Bell as head of CCHIT.

Dr. Bell knows Washington DC and HHS quite well from her many years there. She is effective in a highly politicized environment and will be able to effectively lead CCHIT through that political minefield.
…
Dr. Bell will put up a Chinese Wall between CCHIT and the HIT vendor organization, HIMSS. She is fully aware of the perceived conflicts of interest between CCHIT and HIMSS and will seek to create some distance between these two organizations.

I first must say that the first part is a really smart move by CCHIT. I’d always wondered why CCHIT didn’t have more influence and connection in Washington. That seems like a core competency that they’d want to have to survive. They should have had all the information from HHS before anyone else and they didn’t. I wonder if Dr. Bell will be able to do that for them now.

The second part seems a bit like Chilmark dreaming and hoping. I have a strong feeling that Dr. Bell does indeed realize the conflict and would desire to create that separation. However, I have serious doubts that she will change much of the structure even if she could (which I think might not be possible).

I say this first because Dr. Bell was a representative on CCHIT’s board of commissioners from 2006-2008. Why didn’t she effect this separation back then? Seems like the board of commissioners would have some reasonable control over this.

The answer might lie in the inability to make such a change. Notice I didn’t say her inability. I said the inability. It’s quite possible that there are just too many external pressures for her to break CCHIT’s strong ties with EMR vendors. Of course, nothing would make me happier than for Dr. Bell to prove me wrong. No doubt that would be a most impressive accomplishment.

With all of this said, the real question is, “Does anyone care?” As Chilmark aptly points out, “have yet to see any demonstrable proof that CCHIT certification has moved the EHR/EMR adoption needle in any statistically meaningful way” Beyond that, if ONC does there job, doctors will finally get the information that it’s ARRA EHR Certification that matters and not CCHIT certification. That will take some time to change, but it’s starting to happen. If (and when?) it happens, will anyone care much about CCHIT anymore?

John at Chilmark Research posted a note about the importance of how ONC and HHS define the terms “meaningful use” and “certified EHR.” I wanted to echo his comment so here it is:

Note: We can not emphasize enough just how important these two terms (meaningful use & certified EHRs) are to the market. These terms will literally define the HIT market for the next decade and whether you are an HIT vendor or one looking to adopt an HIT solution, having a clear understanding of what these terms mean and their implications will be critical to your success.

Basically, the $36.3 million in EHR stimulus money is dependent on “meaningful use of certified EHRs.” That’s a lot of money and influence on two terms. I hope as many people as possible will participate in today’s HIT policy committee meeting which should work to define “certified EHR.”

I posted previously a short summary of the changes to meaningful use in the final meaningful use matrix presented at the HIT policy committee meeting. As I’ve thought about these changes this weekend, I couldn’t help but remember the major problem I (and many others) had with the original meaningful use criteria being too complex.

My argument then was that the 22 meaningful use criteria as a collective whole were too much for a doctor’s office to complete in the current time frame. Unfortunately, it seems that the HIT policy committee has chosen to only make slight simplifications of the meaningful use matrix for hospitals (For inpatient CPOE, only 10% of orders must be entered electronically) and has actually added to the EMR requirements for ambulatory clinics.

I do think they’ve made a wise choice on marginalizing CCHIT for the “certified EHR” requirement, but I wonder how many doctors are going to be able to meet this lengthy laundry list of EMR requirements to show meaningful use. You should have seen the faces on the doctors I presented to as I briefly listed the meaningful use requirements. Far too many deer in headlights and people shaking their heads.

Of course, the government has one thing on their side. Many won’t look into the details of what’s required to show meaningful use and will implement an EMR not having a full knowledge of what will be required of them to actually get the EHR stimulus payments. Maybe EHR adoption will increase thanks to the stimulus money and very little of the money will actually be spent.

I read that the HIT Policy Committee meeting that happened on July 16, 2009 was a “big one” according to Chilmark Research. He said that “the committee went from hearing revised recommendations for Meaningful Use, to recommendations from the HIE workgroup and lastly recommendations regarding certification processes for EHRs.”

I was unfortunately tied up doing a presentation on ARRA EHR Stimulus money and so I wasn’t able to follow the event live (or on one of my twitter accounts). I know that Chilmark is planning to do some posts and I’m looking forward to those.

I also found this short summary from John Halamka about the changes to meaningful use in the final definition:
1. For inpatient CPOE, only 10% of orders must be entered electronically
2. For problem lists, ICD9 or SNOMED must be used
3. Advanced directives must be recorded
4. Smoking status must be recorded
5. Quality measures must be reported to CMS
6. Clinicians and Hospitals must implement at least one clinical decision rule relevant to a high clinical priority
7. Administrative transactions, including eligibility and claims, must be completed electronically

I think it was wise for them to split it out into an “eligible provider” and a “hospital” set of requirements since the needs are different, but at first glance it seems a bit like ambulatory clinics are getting a bit of a shaft in this regard. I’ll reserve final judgement until I have more time to really review the changes.

I do think this change as described by John Halamka is a good one: “The Meaningful Use Workgroup recommended use of an ‘adoption year’ timeframe (i.e., ’2011 measures’ applies to first adoption year even if HIT adopted in 2013; ’2013 measures’ applies to 3rd adoption year.”

This powerpoint about EHR certification was also presented at this meeting. There’s a lot of information in that powerpoint, but it looks like they’re proposing that CCHIT be relegated to a certifying body, but not be involved in defining the certification criteria. HHS will be defining the EHR certification criteria. I’m sure I’ll be writing much more about the content in this presentation. Lots to still digest.

I also found two draft transcripts from the meeting.

If anyone else knows of some other summaries from this meeting please let me know in the comments and I’ll add them here. Or feel free to make your own summary in the comments. I’m always interested to hear what people thought was important from meetings like this.

John over at Chilmark Research has a really good find on his blog. He quotes the new head of ONC, David Blumenthal, from an article in the New England Journal of Medicine (NEJM) where Blumenthal talks about the certified EHR requirement in the HITECH act. Here’s the quote:

ONCHIT currently contracts with a private organization, the Certification Commission for Health Information Technology, to certify EHRs as having the basic capabilities the federal government believes they need. But many certified EHRs are neither user-friendly nor designed to meet HITECH’s ambitious goal of improving quality and efficiency in the health care system. Tightening the certification process is a critical early challenge for ONCHIT.

I find it really interesting how two people can take the same quote different directions. Chilmark Research gives a nice little rant about how you can’t certify usability, quality and efficiency in an EHR. I agree with him on most points and I definitely agree that the market is much better at these three items than some government certification body.

However, I don’t feel like this was what Blumenthal meant in the above quote. I don’t think Blumenthal was trying to say that the certification would need to certify user-friendly, quality and efficient EHR software. Instead, I see the above quote meaning that the current CCHIT certification isn’t good enough, because it has certified a bunch of unusable EHR (a topic we’ve talked about many times before). Sounds to me that Blumenthal is making a case for why the government shouldn’t use the CCHIT certification. At least not in its current form. Essentially Blumenthal is saying that CCHIT isn’t good enough to meet the goals of HITECH.

This seems like a ray of hope for myself and others who think that selecting CCHIT certification as the certified EHR requirement of the HITECH act is the worst decision the government could make. Albeit still just a ray.

What Blumenthal means about “tightening the certification process” is up for debate. He could mean something like what John from Chilmark research describes. Basically some convoluted method of measuring usability, quality and efficiency of an EHR system. Or it could mean that the certification process will need to be tightened so that unneeded requirements are removed and it gets cut down to what will help an EHR achieve the ambitious goals of the HITECH act.

Of course, in the end the certified EHR criteria will probably land somewhere in between. However, this quote did give me some hope that Blumenthal realizes the impact that it will have on EHR adoption if many of the currently unusable certified EHR gain wide adoption thanks to the $18 billion in EHR stimulus money.

I do think John from Chilmark Research does make a nice conclusion to his post:

Suggesting that we tighten the certification process is heading in the wrong direction. Instead, we need to actually relax the certification process to encourage innovation in the HIT market allowing developers to create solutions that will truly provide value to their users while concurrently meeting the broader objectives of delivering better care and better outcomes. Creating light certification criteria and focusing more on what outcomes we wish to see occur as a result of broad HIT adoption is where Blumenthal and his staff need to focus their energies.