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Meaningful Use As a Requirement for Medical Licensure

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About a year ago, you might remember the article I wrote about the Massachusetts law that would require doctors to be meaningful EHR users to have a medical license. The law was shocking then and the idea is shocking to consider even now.

The good news is that it looks like the law is going to be modified so that physicians don’t have to demonstrated EHR proficiency as part of their medical license. As you can imagine the Massachusetts Medical Society has been working hard to advocate for this change. They say that the modification was “designed to prevent disenfranchising more than 10,000 physicians who, by law or other circumstance, cannot achieve meaningful use certification.” Probably took a rocket scientist to figure that one out.

I think it’s more than heavy handed to tie EHR proficiency to a medical license. The reality is that EHR’s will become mandated thanks to things like reimbursement and medical malpractice insurance. There’s not going to need to be a law that says you have to be proficient in an EHR to hold a license.

Is it any wonder why many doctors are revolting against EHR?

One of the worst thing you can do to get someone to do something is to force them to do it. Instead of these heavy handed approaches, there should be a focus on the value an EHR provides. I don’t know any provider that doesn’t want to do something that provides value to their clinic and their patients. Forcing someone to do something is the lazy approach.

May 23, 2014 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 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Going Beyond EHR Data Collection to EHR Data Use with Dr. Dan Riskin

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We had a chance to sit down and do a Google Plus hangout with Dan Riskin, MD, CEO and co-founder of Health Fidelity to discuss the challenges of EHR today and how we can reach the real benefits of EHR adoption. We had a great discussion about how the industry is so caught up just getting the data in the EHR software that we’re missing out on the opportunity to get the benefits of actually using the EHR data.

For some reason the Google hangout audio and video didn’t sink right (welcome to the cutting edge of technology), but the audio is good. Just start up the video below and enjoy listening to it like a podcast or radio show. I expect that’s what most of you do anyway with our videos.

I hope you’ll enjoy my interview with Dr. Riskin.

April 28, 2014 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 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Meaningful Use Program a Success…Depending on How You Measure Success

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The new National Coordinator of Health IT, Karen Desalvo, MD, published a blog post on The Health Care blog that proclaims that the “EHR Incentive Program Is on Track.” Of course, many would argue that it’s her job to be a cheerleader for healthcare IT, but I think this post is an important look at the measures that ONC and HHS have of what they consider a success.

If the goal of the EHR incentive money is just to get doctors and hospitals using EHR software, then indeed it’s been a big success. EHR adoption is through the roof at every level (although, I think they’d like it higher in the ambulatory space). This can’t be argued. The $36 billion in EHR incentive money got healthcare on board with EHR software.

If EHR use is your measure of success, then the HITECH act was a success. However, the goal of the HITECH act wasn’t just EHR adoption. If it was, then we wouldn’t have meaningful use. The goal was for doctors to adopt an EHR and then meaningfully use it. Of course, the jury is still out on whether doctors will follow through on meaningful use stage 2. I’m personally predicting a major fall out from those who attested to MU stage 1 and those that choose to sit out MU stage 2. Certainly Dr. Desalvo argues that this won’t be the case.

Either way, let’s assume that the majority of doctors do attest to meaningful use stage 2. Should we call the HITECH act a success? More pointedly, does meaningful use produce the results we want?

As someone who follows the EHR industry day in and day out, I think the jury’s still out on this. I’ve said many times that I fear the EHR incentive money might have incentivized doctors to adopt the wrong EHR software. The current and future EHR switching will likely prove this out. Although, we’ll see if organizations can get it right the second time.

However, choosing the right EHR is only half of the battle. Even the best tool used inappropriately won’t yield the desired results. There’s a strong case to make that meaningful use forces a doctor to use an EHR inappropriately. Every person at ONC calls this blasphemous and every doctor is likely to agree that meaningful use causes more work and does little to improve care.

I recently heard someone argue that they had “no sympathy for doctors having to accurately, legibly, and cohesively document what is happening.” I think it’s a real challenge to say that meaningful use equates the more accurate, legible, and cohesive documentation. In fact, many of the meaningful use hoops serve to make the documentation more illegible and difficult to read. Not to mention the issue of making the physician less efficient and therefore more likely to cut corners.

In this post, I’m not trying to make the case for or against EHR software. I’ve done a whole series on the benefits of EHR and so I believe that they can provide an amazing benefit to healthcare when implemented properly. My point with this post is that if our government is going to spend $36 billion on EHR software, then I wish they’d spend a little more time making sure that it’s not only implemented, but implemented well.

If they did this, then maybe we could call the HITECH act a real success. As it stands now, we’re using the only metrics we have available: EHR incentive spent and meaningful use attestation. I’d suggest there’s so much more value (both gained and lost) in an EHR implementation than either of those two things measures.

How about we track ways EHR use reduced costs, improved patient care, and saved lives? Maybe they don’t want to track that data because if they do, they won’t like the results. What would they do with meaningful use if they found out it raised costs, hurt patient care and did nothing to save lives? Would anyone want to make the case for why meaningful use should be scraped for something better? I wouldn’t want to as the new ONC chair either.

January 22, 2014 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 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

CA EMR Adoption Up, But Other Health IT Use Is Behind

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While California providers are stepping up their use of EMRs, they’re still behind on some other measures of health IT adoption, according to a new report by the California HealthCare Foundation.

First, the positives. California physicians who use EMRs grew from 37 percent in 2008 to 59 percent in 2013. The report also concluded that 50 percent of California hospitals used EMRs in 2012, compared with 13 percent in 2007, and that 65 percent of community health centers used EMRs in 2011, compared with 3 percent in 2005.

All that being said, California providers are behind when it comes to Meaningful Use. While 58 percent of them said in 2012 that they planned to participate in Meaningful Use, only 30 percent of California providers with EMRs had a system that met all of the program’s 12 objectives, notes iHealthBeat.

What’s more, California hospitals’ use of clinical support systems fell from 77 percent in 2010 to 71 percent in 2012, a pretty low number given that the national average of 97 percent use of such tools. Also, the state ranks 49th in the country for e-prescribing rates.

The researchers also note that providers seem less interested in health IT than consumers. The 57 percent of state residents who had access to their EMRs  used them to view their health records, e-mail physicians and schedule care appointments, iHealthBeat reported.

All told, the report comes as something of a surprise, given that over time, California has traditionally been at the leading edge of many healthcare industry trends. And it suggests that many California providers are missing out on increasingly well-documented opportunities to improve productivity. So let’s hope that traditionally cutting-edge providers take the nudge provided by this report seriously.

November 18, 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.

Doctor Explains Why He’s Avoiding EMR

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Dr. Peter Kambelos likes being in solo practice because he can make all the decisions.

And for now, the internist has decided to keep using paper records.

Kambelos

It’s partially an economic decision. He doesn’t feel he can afford the switch to an EMR.

Politics might play a bit of a role, too. Kambelos, who is president-elect of the Academy of Medicine of Cincinnati, likes to keep the government out of his exam room.

Still, he doesn’t rule out going electronic in the not-too-distant future. After all, he’s a mid-career physician, and it would be absurd to think of sticking with analog charts forever.

Late adopters like Kambelos represent an opportunity for health IT vendors, but one that will be challenging to capitalize on. As I wrote previously, future EMR-industry growth will require more resources and creativity to achieve.

More than 50 percent of physician offices have adopted an electronic records system, according to the U.S. Department of Health and Human Services. Among family physicians, one group of researchers found, the number is likely to exceed 80 percent this year.

In an interview, Kambelos explained why he practices — and thinks — the way he does.

Tell me about your practice.

It’s a large internal medicine practice with many elderly patients. I take care of generations of people, grandparents to grandkids. We know our patients and their families, and they know us. This has been, and remains, our patients’ “medical home.” I have two employees and they work hard.

What is record-keeping like in your practice?

I’ve practiced with paper charts for 17 years and they work fine for me. Many are very thick and chock-full of years of valuable and pertinent data. But I have my patients’ histories in my head and don’t need to be chained to a paper chart or an EMR to provide them with outstanding medical care and supervision. Most doctors who really know their patients can say the same.

Have you seriously considered moving to an EMR, and why?

Yes, for the supposed improved efficiency once fully implemented.

Are the Meaningful Use incentives much of a motivator?

Zero. The government is the biggest obstacle to health care delivery in this country.

Do vendors often reach out to you?

Periodically, we receive in-person and virtual solicitations. It happens a couple of times a month, perhaps.

Why haven’t you made the shift?

One reason and one reason only: the cost of making the transition, both in terms of my limited productivity during such a transition and the inherent labor costs in so doing.

In your view, what is the primary shortcoming of the systems out there?

Lack of interoperability. As I understand it, most EHRs don’t interface such that data across hospital systems is readily available to any given user.

What should EMR companies know about doctors like you?

We don’t fear, but rather embrace, new technology. But we work on tight budgets and cannot absorb the costs associated with transitions like this. Federal grants come nowhere near covering these costs and come with too many strings attached.

October 3, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

EMR Market is Growing, But It’s Not What It Was

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The EMR market is likely to grow at more than 7 percent per year through 2016, according to a new report.

The estimate comes from London-based research and advisory firm TechNavio. The company wrote in its analysis, “Global Hospital-based EMR Market 2012-2016,” that “demand for advanced health monitoring systems” and for cloud-computing services were major contributors to demand.

On the other hand, according to the company, implementation costs could be a limiting factor.

The TechNavio figure is actually a compound annual growth rate of 7.46 percent. That means substantial opportunity for the many companies referenced in the report, including Cerner Corp., Epic Systems Corp., AmazingCharts Inc. and NextGen Healthcare, to name a few.

Another research firm, Kalorama Information, in April reported that the EMR market reached nearly $21 billion in 2012, up 15 percent from the year before, driven by hospital upgrades and government incentives.

About 44 percent of U.S. hospitals had at least a basic EHR in 2012, up from 12 percent in 2009, according to the Office of the National Coordinator for Health IT.

In the United States, at least, future growth might require more resources and creativity to achieve. You might remember the recent post “The Golden Era of EHR Adoption is Over,” by Healthcare Scene’s John Lynn, positing that the low-hanging fruit for EMR vendors, the market of early adopters and the “early majority,” is gone, leaving a pool of harder-to-convince customers.

But the TechNavio report is broader, considering not only the Americas but also Europe, the Middle East, Africa and Asia Pacific. That’s truly a mixed bag, as while health IT is at a preliminary stage in many developing markets, it’s highly advanced in countries such as Norway, Australia and the United Kingdom, where, according to the Commonwealth Fund, EMR adoption by primary-care physicians exceeds 90 percent.

When EMR initiatives get a firmer foothold in countries such as China, where cloud-based solutions could well prevail, growth rates for those areas might exceed — several times over — the overall figure predicted by TechNavio.

And in the United States, certain pockets, such as the rural hospital market, still present huge opportunity. Fewer than 35 percent of rural hospitals had at least a basic EMR in 2012, but the enthusiasm is clearly there, as that number was up from only 10 percent in 2010, according to the Robert Wood Johnson Foundation.

It looks like it’s still a great time to be an EMR vendor. But it’s not the same market that it was even a couple of years ago, and success in the new era might require looking at new markets and approaches.

September 11, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

EMR Scribes, EMR Big Brother, Right Tool for Right Job, and MU’s Affect on EMR Adoption

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I’ve heard more and more people proclaiming the value of scribes with their EMR. Certainly many are leery of the costs associated with scribes, but I don’t know anyone who has tried a scribe and been disappointed with the choice.


Far too often when we’re in technology we think that we have to always look for a tech solution to the problem. It is often the case that technology will take part in some part of a solution, but far too often we try and over architect a technology solution. Instead of implementing more technology we need to implement the right technology. Often that means choosing simpler technology.


I think this is an important question. I’m sure cutting MU would cause a lot of shock waves in the industry, but I don’t know many people who would stop their EHR use because MU was gone. I don’t know many that are implementing an EHR that would stop if MU was gone. I don’t think MU will be stopped, but I still think a delay is likely.

September 8, 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 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Without This EMR Step, You Might Never Get It Right

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It’s not hard to find physicians and nurses who say that far from improving health care, the EMRs they use are something to work around.

Billing problems, lost productivity and even diminished quality of care are common complaints, sometimes long after the implementation kinks should have been worked out. In some cases, doctors who bought into EMRs as a way to operate more effectively and efficiently have found themselves disappointed enough to look for hospital employment, try new practice models or even close their doors, as HealthcareScene.com founder John Lynn has written.

Often the problem lies deeper than the technology, according to a recent white paper from TechSolve, a Cincinnati-based consulting group. After all, an electronic overlay does little good when it serves only to automate bad processes.

TechSolve is promoting a process-mapping approach to EMR for hospitals through its Lean Healthcare Solutions unit. It’s part of a trend toward applying the efficiency techniques of Japanese manufacturers to EMRs and other aspects of health care.

Like Toyota and other pioneers of lean, health care providers should rely on line workers to help root out waste, according to TechSolve.

“While you may be inclined to dismiss negative comments as resistance to change, staff may be aware of design issues that the design team, PI facilitator, and vendor were not,” TechSolve consultants Sue Kozlowski and Alex Jones wrote.

They offered seven steps to ensure maximum benefit from an EMR, a few of which I’ll share. I suggest downloading the full paper for a complete view.

TechSolve recommends thinking about process improvement before getting started with an EMR. Of course, if it’s too late for that, the firm and others in the space are happy to step in later, as well.

Here’s what TechSolve advises:

  • Map your current processes. This can be done with help from your process improvement team or an outside group. In some cases, it’s best to assign a team to each service line.
  • Compare current and future states. Color-coding is one way to do this, highlighting visually for staff members how their work will change.
  • Prioritize issues that affect patient care and payment timing. An “issues list” can be created and then reviewed after “go live” to make sure problems have been corrected. Also, examine how well staff members are adhering to the new processes, asking questions such as, “Where are they using work-arounds, and where have they found new capabilities in the system?”
  • Process map again. This new snapshot is the baseline going forward. It can serve as a reference for staff members when they’re in doubt and as a training tool for new hires.

We’re all looking for technology that makes our lives easier right away. But when it comes to EMRs, there’s no true turnkey solution. Making a system pay off requires investments, particularly of time, well beyond the sticker price.

Under traditional reimbursement models, though, planning is not what brings in the revenue. It’s easy enough to see why hospital employment, with guarantees of a salary and IT assistance, is becoming a more and more attractive option for physicians who want to limit expenses and risk.

Hospitals, though, have no plan B. They’ll have to marry their IT to efficient processes or else.

August 29, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

Is Your EMR Charting Accurately?

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For all the hope — not to mention time and money — being invested in EMRs as a way to improve health care, they’re still exquisitely prone to the age-old problem in IT: garbage in, garbage out.

Several writers have commented recently on whether you can believe what you read in an EMR. They raise serious questions as meaningful use Stage 2 draws near and providers’ care patterns become further enmeshed with their record systems.

One problem, wrote Dr. Rebecca Bechhold, a medical oncologist, is the information overload that an EMR can generate: “page after page of predetermined queries and stock answers that are repetitive and irrelevant after the first visit.” The truth, as in what’s really going on with the patient, might be in there somewhere, but she finds it hard to dig out.

Worse still, doctors sometimes just check “normal” for everything under the physical exam section because they’re in a hurry and entering the information is tedious, Bechhold wrote. Some pretty important history, such as an enlarged liver or an amputation, can be left out.

It might sound bad, but it’s human nature whenever there are too many boxes to check. However, for Bechhold, the key disadvantage isn’t a lack of facts, but of feelings.

“You cannot express the emotion and anxiety that is part of oncology care in a prepackaged document,” she wrote.

Software selection consultant Sheldon Needle, meanwhile, wrote about the pitfalls of taking an EMR prescription list at face value.

Take the patient who comes to the emergency room because of a car accident. If the patient’s regular doctor is linked with the hospital’s e-prescription system, a medication list might soon be forthcoming. But who’s to say there aren’t other medications in the picture, prescriptions written by a doctor who’s not tied in?

Needle’s advice: Ask a human, such as the patient or a relative.

“If something looks off on the electronic medical record,” he wrote, “question it.”

HealthcareScene.com’s own John Lynn, too, addressed the issue of trusting health care data, noting that doctors are receiving information from more sources than ever, including health information exchanges, patients and patient devices. It’s hard for physicians to know what’s reliable.

The obvious solution to trust issues seems to lie in user interface design. If the EMR is a good fit for the doctor’s workflow, the right data should end up in there.

Unfortunately, it’s not quite that simple. Bechhold noted that charts she receives from other doctors are sometimes configured to include every piece of data available for the patient, including all medications and test results.

The physicians, she wrote, want to be able to show that they reviewed all information if they’re ever sued.

Doctors and health IT companies have a way to go in understanding each other. Only then can there be full trust in EMRs.

August 23, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

The Golden Age of EHR Adoption is Over

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I’m ready to call the Golden Age of EHR Adoption Over. We’re not getting ready to enter the nasty, ugly, dirty, swamp filled waters of EHR adoption. If you’re an EHR vendor you likely already know this to be the case. That’s not to say that there’s not still real opportunity in the EHR space, but it will take on a very different form.

I think this image of the adoption lifecycle describes the EHR adoption cycle really well. I’m sure it will be familiar to many of you:
EHR Adoption Lifecycle

It’s very clear to me that we’re somewhere in the middle of the Late Majority cycle of EHR adoption. This plays out well since we’re somewhere between 50-84% EHR adoption. While the chart shows a downhill slope, the ride to get the Late Majority and Laggards on EHR is going to be anything but a downhill ride. I’d say it’s going to be more like climbing Mount Everest. It’s possible, but it’s going to take a lot of work.

The reality is that those who wanted to adopt EHR already have adopted EHR. That means we have left a group of practices and hospitals that for the most part aren’t EHR convinced. However, there is one advantage for those wanting full EHR adoption. Almost all of those who haven’t adopted EHR see the writing on the wall. They’re just going to take their time and make a deliberate choice based on the experiences of those around them.

EHR vendors will now start to focus on creating what I call Smart EHRs. Doing so will be how they battle each other in the next wave of EHR switching. Plus, this will usher in the next EHR Golden Age: Use.

Future Golden Age of EHR Use
While the golden age of EHR adoption is over, we’re entering a new EHR Golden Age. It’s the golden age of amazing EHR use. It’s still very early in this new cycle, but the innovators are going to really surprise us with the innovation that’s going to be possible on the back of an EHR.

Many of the changes will be subtle and we’ll take them for granted almost instantly, but they will be amazing in aggregate. Take for example, Jennifer’s recent post on EMR and EHR about her child’s well visit. How beautiful is it that her child’s record was available at a new clinic with no effort on her part. We’re not there yet, but we’re going to get there. Although, we wouldn’t get there if we were still at 25% EHR adoption.

Jennifer’s example is a simple, but powerful one. No doubt there are going to be much more complex and much more powerful examples to come. Many of which will actually save people’s lives.

The Golden Age of EHR Use is going to bring about dramatic benefits that would have never been possible without massive EHR adoption. The Golden Age of EHR Use will be so good that even the EHR adoption laggards will finally want to change.

June 6, 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 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.