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Meaningful Use As a Requirement for Medical Licensure

Posted on May 23, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

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.

What’s the Source of Provider Discontent?

Posted on May 14, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In the comments of my post, “Do Doctors Care About the Triple Aim?”, Dr. Randall Oates, Founder of SOAPware offers his perspective on the provider discontent we see growing:

What you say is true and largely explains the growing discontent of physicians. Multiple surveys reveal that at least 40% of physicians are not just unhappy, but manifest symptoms of burn-out. Most of them have become complicit with systems where everyone is more focused on how to get paid more. The few healthcare delivery systems achieving on the Triple Aim and who have better physician satisfaction have almost all been blessed with physician leaders who step up to the challenge of collaboratively creating the necessary cultures focused on delivering value to patients. Value = Quality/Cost. This focus is necessary in order to produce not only the highest satisfaction but the greater financial rewards going forward. Again, doctors not operating at the top of their license and who have become distracted data drones are complicit with an increasingly corrupt system. The vast majority of physicians view that being able to be part of a quality process is more satisfying than the income received. So, those that are the happiest, and thriving the most are ones who are on a pleasing path to the Triple Aim.

Sadly, the trends of the government-medical-industrial complex are increasingly filled with the hubris that value can be forced from the top-down via controlling algorithms into which patients and their doctors become data points to be plugged in and controlled.

The degree of success we will see with any true healthcare reform will be the degree to which patients become more engaged and accountable. Those will need relationships with physicians deserving of their trust within healthcare delivery systems focused more on the value equation. Success simply has to come from the bottom-up, so this will force many true physicians to have to leave the more toxic delivery systems in some locales. They will be forced to either move or more directly interact with patients minus the misguided, controlling interference in their communities.

Dr. Oates is highlighting the comment I made in the post. Not all incentives are financial and we need to find a way for healthcare to more than just a financial reward.

As most of you know I do a fair amount of work with tech companies in my home town of Las Vegas. The most famous Las Vegas tech company (casinos aside) is Zappos. If you haven’t heard, Zappos has created a unique culture. Next time you’re in Las Vegas, let me know and we can go on a tour of Zappos together and you’ll see what I mean. Everything from allowing people in their office to decorate their desk (and they are unique I tell you) to the competitions and events they run. Their blog subhead says it all, “Experience fun with a Little Weirdness.”

Why do I bring this up? It turns out that beyond Zappos tech component, the majority of Zappos employees are call center employees. I heard one person describe Zappos as a big customer service call center. That’s not far off. If you’ve never worked in a call center before, it’s not what most would consider a “fun” job. However, the Zappos culture has created a place where people love working for a company that is paying them a low wage to answer the phone. Let me assure you that their employees are fiercely loyal.

I’m not suggesting that healthcare should adapt the model of fun and a little weirdness. What I am saying is that Zappos created a workplace where the job was about much more than just your paycheck. Healthcare needs to embrace a similar notion where doctors enjoy their job for much more than just the paycheck.

Usable EMR, Post EMR World, and Impact of Meaningful Use

Posted on February 23, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.


This is an important nuance. Although, I’d argue that the biggest challenge to EMR usability is onerous billing requirements and prescriptive meaningful use requirements.


I’m really interested in the description of a post EMR world. It makes me ask myself the question, “What can we do with 100% EMR implementation?”


MU has spurred EHR adoption. No arguments there. Hard to argue against MU killing much of the EHR innovation and usability. We’ll see which exceptions emerge from the dust.

Meaningful Use is Easy

Posted on July 15, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

My readers make some of the best comments. They’re definitely engaged in what’s happening in the EHR world and provide me amazing inspiration for future posts. In this case, John Brewer commented on my post about meaningful use forcing doctors into ACOs. Here’s a portion of his comment:

MU is actually easy…depending on your EHR. Much of MU is dependent on whether you EHR is able to pull the relevant data – Oh sure, you need to change your ways to ensure you get the required “counters”, and THIS is really where many docs get frustrated.

Add to the frustration that it generally takes clicking in 3 to 7 different places within an EHR to get ONE counter, and you can see why the frustration grows.

I really find it interesting that John Brewer says that meaningful use is easy, and then illustrates what makes it not easy. I think the point he’s making is that there’s nothing that’s a real challenge to accomplish in meaningful use. You can do any of the tasks really easily. However, just because something is easy doesn’t mean that it’s not time consuming. Meaningful use really is quite easy, but it can also be a real time suck.

When I think about the meaningful use time suck, I wonder if we’re creating a generation of doctors who hate their EHR because of the meaningful use time suck. I’ve written previously about the EHR physician revolt. If I dig a little deeper into this revolt, I see a revolt against the EHR time suck and not the technology itself.

Doctors don’t want to become data entry clerks. Unfortunately, the meaningful use requirements often have this affect on doctors. I fear that this will create a cohort of doctors who hate their EHR. Most doctors won’t be able to separate the technology from the regulations. For them it will always be the software’s fault.

Are we creating a generation of doctors who hate EHR?

5 Tips for Improving Provider Productivity with an EMR

Posted on May 13, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The most recent EMR adoption numbers I’ve seen are putting EMR adoption at about 60% of doctors. When I think about the other 40% of doctors that have yet to adopt an EMR, my guess is that the biggest reason they haven’t adopted an EMR is based on their fear that an EMR will negatively impact their practice and their productivity. They fear that a change to EMR is going to be negative rather than a positive that it could be.

A whitepaper called Getting Lean with Your Practice: Five Tips for Improving Provider Productivity with an EHR does a good job looking at the issues of productivity in a practice and how to improve that productivity. One thing it points out is that if you can’t measure it, then you don’t really know how you’re doing. Turns out, an EMR is a great way to measure productivity.

Think about all the data an EMR can produce that would have never been possible in an EMR. Patient wait times and documentation times are the most obvious when we’re talking about productivity. In the paper world, you really didn’t have a good idea if a doctor had 20 charts outstanding or none other than looking at the stack of charts on the desk and checking them. In the EMR world, you can easily report on who’s staying up with their charting and who is not.

In the productivity whitepaper mentioned above, after studying 25 providers at 12 diverse practices they found that same-day encounter close rates (ie. finishing the charting the day of the visit) was the single most revealing metric about the success of patient workflow processes. They suggest that this doesn’t mean you document every patient as you seem them. Instead, they suggest documenting as much as you can with the patient when you’re with them and then you wrap up any complex patients as the end of the day. This is usually the right balance for most doctors I’ve worked with as well.

Here are the full 5 tips from the whitepaper:

  1. Start on time.
  2. Work with cross-trained staff that can handle intake and documentation.
  3. Document encounters as much as possible during and immediately after visits, but don’t document more than necessary or spend too much clinical time on complex documentation.
  4. Close all patient encounters by the end of the day – This should involve just wrapping up documentation for complex encounters.
  5. Route documents appropriately and delegate responsibility for document handling effectively.

One of the other great takeaways from the whitepaper is the idea that doctors can and should be delegating more of the documentation to their staff. A Dr. Lizabeth Riley pointed out that “the data the system provided immediately opened my eyes to the fact that I was only giving my staff 1% of charting duties! Once I saw that, I knew thing had to change. My staff now does 40%-60% of my charting for me.”

There was a lot more interesting data in the whitepaper including the 5 different physician work styles from Truly Lean to Falling Behind and Frustrated. This last group is behind the EMR backlash. Hopefully some of the tips above can help a doctor become more productive with their EMR.

EHR Backlash, Patient Interaction, Smart Phone Use, and Dell Think Tank

Posted on March 17, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.


I realize this first tweet might be controversial for many. Any time you bring a bit of politics (Obamacare in this tweet), there’s a risk of bringing out the crazies. Hopefully we can avoid that, but I was intrigued by this tweet also because it had 17 Retweets by other people. That’s a crazy number of retweets for healthcare IT. I think this view is also part of the EHR backlash that we’ve written about before. Whether you agree with the tweet or not, there are a lot of doctors that feel similar to Dr. Kris Held and they’re starting to make their voice heard.


I love how many people have a focus on increasing patient interaction. An EMR can get you away from it if you’re not careful. The article in this link has some decent suggestions to consider. The most important advice is to be aware of it. Awareness does a lot to improve it.


The killer mobile app in healthcare has been Epocrates and largely is today. A well done EHR mobile app could see similar adoption. Although, there are 300 EHR vendors that aren’t focused on mobile (many of them at least), and so that’s why we don’t hear as much about it.


I’m going to be part of the Dell Healthcare Think Tank that’s mentioned in this tweet. They are doing a live online stream of the event and are even opening it up for questions from Twitter I believe. So, it should be a great opportunity to hear from a lot of smart people on the subject of healthcare IT and to participate online as well. Check it out Tuesday if you want to participate.

The Coming Physician EHR Revolt

Posted on February 5, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

From my blogging viewpoint I’m sensing a growing discontent among doctors that is starting to really heat up. I can’t quite predict when this discontent will reach a boiling point that will start to boil over, but the fireworks are coming. As I’ve watched the past couple years, doctors were first overwhelmed with all the government regulations. They were confused by everything was coming out and really just didn’t know where healthcare IT and EHR was headed. That overwhelmed confusion is slowly turning into a reality that many doctors are realizing is changing how they practice medicine. If you’re not seeing this, then you might want to get out and spend some more time with your casual every day doctors.

One doctor emailed me today suggesting that doctors were being literally “eaten alive” as they are working harder to provide patient centered care. It would be a disservice to doctors if we don’t take the time to acknowledge and understand the enormous pressures that many doctors are feeling right now.

Here’s a quick look at what I believe is the perspective of many doctors I connect with on a daily basis.

Regulations
Everywhere doctors look they’re getting hammered by new regulations. I recently heard Shahid Shah say, “We’re experts in the industry that spend all day thinking about the market and regulations and even we have a challenge understanding what’s going on. Now think about the doctors and adminstrators which have challenging day jobs and only a small amount of time to understand the regulations. They don’t really understand the details of what’s being regulated.”

This is a reality for many doctors and practices. Is it any wonder that many are happy to sell off their practices to major hospitals? I’m sure that many do so just because they’re tired of trying to understand all the changing regulations they’re required to know.

If we look at just the healthcare IT and EHR related regulations you have: meaningful use, ACOs, ICD-10, 5010, and Obamacare/Healthcare Reform. Any one of those is a challenge to understand and implement. Yet doctors and hospitals are dealing with all five of them simultaneously. Not to mention doctors being asked to participate in HIEs, being graded and rated online, engaging with empowered patients through social media, and embracing a new technology savvy culture while reimbursement lags behind.

Is it any wonder that doctors feel overwhelmed, overworked, and unsure whether they want to continue being doctors. Is this going to lead to a real shortage of medical professionals?

EHR Discontent
Since this is an EHR blog, we should spend some time on the growing discontent with EHR software. I hate to dwell on this, because EHR is going to be the future of clinical documentation. It’s hear to stay and no amount of belly aching and moaning is going to stop EHR software from becoming the de facto standard for clinical documentation. However, just because this is the case doesn’t mean we should ignore the realities that so many doctors are facing when it comes to EHR software today.

Many doctors see EHR as a major time suck. Their EHR software requires them to work longer hours and/or see fewer patients. Overtime this usually improves, but we have to acknowledge the initial productivity hit that pretty much every EHR implementation sees. Some clinics never get back to their previous productivity. We’ve discussed the reasons for this over and over again on this blog. We’ll save the list of reasons and ways to avoid those issues for another blog post. However, until all 300+ EHR vendors solve the EHR productivity issue, we’re going to hear more and more stories of how much of a time suck an EHR is to many doctors.

Not all doctors see it this way. Many doctors can’t imagine their practice without an EHR. As we’ve been covering in our EHR Benefits Series, there are a lot of benefits to having an EHR. Many of the benefits we’ve already covered in that series are ways that a clinic can save time thanks to an EHR. However, it can take time for a new EHR user to get up to speed where they can speak the EMR language well. It’s not easy learning a new language, and so this adds to the growing discontent that many doctors feel towards EHR.

Template EHR and Copy Paste
Many EHR vendors have implemented a complex set of templates that doctors can use to be more efficient. It’s a thing of beauty to see a full template pulled into a patient’s chart with a single click. A full patient physical documented with a single click sounds like it should save the doctors a lot of time and make them more efficient. In fact, many have argued that template based EHR documentation is a great way for doctors to achieve higher reimbursement levels since they are better able to document the actual care they’re providing. In the paper world they would have passed on the higher reimbursement because they didn’t have the time or desire to document all of the items they examined and so they just accept a lower reimbursement level. EMR templates made it possible for doctors to finally be reimbursed for all of the care they provided a patient since the templates made it easy to document.

Sounds great doesn’t it? Well, it did until the government realized that EHR software often drove up their costs. This shouldn’t have been a surprise to anyone in the EHR world. I’ve been writing about the ability to increase your reimbursement rates from EHR for over 7 years. However, instead of the government choosing to acknowledge something that was apparent to many in the industry, they decided to blame the increased costs on, you guessed it, dishonest doctors.

Think about the message that we’re sending doctors. First the government tells doctors to start using EHR. Then, the government calls those doctors dishonest for using the tools that the government told them to use. A doctor recently described their perspective is like being stuck in a pit with sly hyenas all around ready to take their bite out of them.

Add in all the recent discussions about copy and paste in EMR’s, and it shouldn’t be any wonder that doctors are gun shy. When they implement technologies to try and make things more efficient they get their hands slapped or even worse.

Reduced Reimbursement and Penalties
In the midst of all the things mentioned above, doctors are also getting hit with reduced reimbursement rates. This is particularly true for those in the general medicine area. They’re being asked to do more to improve patient care, reduce hospital re-admissions, treat the whole patient, etc and they’re getting less reimbursement.

Plus, now the EHR penalties are hanging over their head if they choose to not show meaningful use of a certified EHR. I still have my doubts that the EHR penalties will be enforced. I expect there will be a whole series of exceptions offered up which make it so pretty much all of the doctors avoid the penalties. However, that’s still unknown and many doctors see those EHR penalties as just another slap into the face.

Data Data Data
Most doctors see the push for EHR as a way for someone to get at the data in healthcare. In many ways, they’re right. EHR’s were first created as big billing machines to get at the financial data. Now with meaningful use, EHR’s are repositories of other healthcare data. The data is being used to optimize reimbursement (rarely a good thing for doctors). The data is wanted for population health analysis. The data is wanted for public health needs. The data is wanted to be able to facilitate ACOs. Everyone wants a piece of the healthcare data it seems.

The problem from a physician perspective is that everyone wants that data, but it’s not often clear how that data is going to facilitate that doctor being a better doctor. In many cases it won’t and there’s the rub. Almost every doctor I know wants to improve healthcare. So, they don’t have any problems supporting initiatives that improve healthcare, but I think that most of them also sit back and wonder at what cost.

Audits
I don’t know anyone that likes audits. Yet, most doctors are surrounded by a wide variety of audits. RAC Audits are on the way. HIPAA audits are possible and HIPAA is always lingering in the back of most doctors minds. Especially when you start talking about technology and HIPAA. There are so many unknowns that there’s no place of comfort for those doctors who want to be compliant. Most make a best effort and then push it out of their minds as they try to provide great patient care. Next up our meaningful use audits. You can be sure they’re coming.

Solutions
I wish I could say that I have a bunch of really good solutions available. What does seem clear to me is that most of the challenges that doctors face revolve around the current reimbursement models that we have today. I’m not sure we can fundamentally change those. One interesting option that’s emerging is concierge medicine.

Every doctor I know loves the idea of concierge medicine. When you tell them they don’t have to worry about reimbursement, insurance companies, etc, you see this huge weight lifted off of their shoulders as they wonder what life would be like for them if all they did was provide the best patient care to those who came to their office. The problem with concierge medicine was highlighted in a tweet I saw recently that said, “Concierge Medicine – Does it really work?”

The answer to that question is: it’s still too early to know for sure. Although, my prediction is that concierge medicine will work in certain situations and communities, but won’t be able to provide the widespread change of reimbursement that we need for healthcare to alleviate doctors concerns.

When it comes to EHR, concierge medicine is quite interesting. None of the mainstream EHR vendors really work for concierge medicine since they’re all focused around reimbursement and concierge throws that out the window. Plus, think about how few of the meaningful use requirements a concierge medicine clinic cares about. In fact, implementing many of the meaningful use and EHR certification requirements gets in the way of the concierge doctor’s workflow. I expect many doctors would love a concierge focused EHR software.

The other solution is likely going to be EHR vendors yielding to the idea that they’re the database of healthcare. Once they make this decision, EHR vendors can really open up the proverbial EHR kimono and let outside developers really make their EHR useful for doctors across all specialties, all regions, all sizes, and every unique workflow. One company can’t satisfy every doctor the way a community of empowered developers can.

No One Feels Bad for Doctors
I’ve written about this idea before, but almost no one feels bad for what most people think of as “well paid doctors.” Far too many doctors are still driving around Mercedes and BMW’s for most people to feel too bad for them. Compared to many people who don’t have a job at all, I don’t feel bad for them either.

While we don’t have to feel sorry for them, that doesn’t mean we shouldn’t acknowledge the pressures that doctors are facing. Plus, I see this only getting worse before it gets better. As an entrepreneur, I see this as a tremendous opportunity. Plus, I see a number of companies that are working to capture this opportunity. However, far too many companies are blind to this physician discontent. I’m not sure if it’s purposefully blind, ignorantly blind, or arrogantly blind, but many are ignoring it. As I predicted in the beginning of this post, I see this reaching a boiling point soon which leads to some fireworks.

Let me highlight what I’m talking about using the words of a doctor’s message I literally received in my email as I was writing this post:

EMR’s are making it more and more difficult to practice medicine. They used to be fun and helped my daily work. Now, they are getting so complex that is takes much more time to do them. MU is becoming a nightmare for physicians.