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Blue Button Access to EHR Data

Posted on September 20, 2012 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.


What great news that we got this month about the Blue Button having 1 million users. That’s a big number for what really amounts to a rather simple idea. The idea being that when you click on a simple blue button you can download your patient record.

The article in the tweet above points out how the technology of the Blue Button is simple, but it’s had a much larger impact than the technology would suggest. Here’s portions of what Peter Levin, VA’s chief technology officer, said about the Blue Button:

“There was no nuclear physics here. It’s not that hard to strip out all of the things on the back end that make a bold font and a blue background and put raw health data out.” he said. “Once we got the directive from the Secretary of Veterans Affairs himself, from a technical perspective it was really simple to implement.”

Levin said the more important hurdle Blue Button wound up overcoming was ingrained cultural notion that one’s own medical information should only be available to medical professionals.

“It was a big step in terms of attitude,” he said. “Providers now understand that it’s OK to make that data available, and patients now understand it’s OK to get that data. Both parties now understand in that conversation that they should be talking.”

Within VA, Levin said, providers have mostly embraced the idea. But holdouts do exist.

“You’re going to find some providers in our enormous national system that haven’t gotten the memo yet,” he said. “They’re going to say, ‘Why would you want that data? All a patient’s going to do is go to the Internet and start asking questions that make them more anxious and use more of my time.’ Those folks exist. But they’re in the minority.”

The article also suggests that between the VA, DoD, CMS and private insurers, 100 million American have access to their Blue Button patient records.

I really like this video that I found on the Markle website about the Blue Button. Putting some names, faces and stories with something always makes it more real to me. You’ll have to visit their website to see the video since they’ve disabled embedding of the video (which is a shame).

The Blue Button has been a good initiative to help liberate healthcare data. I’m sure we’ll see more of it in the future. Although, we could still use some better tools to do something with the data we download.

What SaaS EHR Users Can Learn from the Megaupload Takedown

Posted on July 5, 2012 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.

It’s time to talk about a subject near and dear to my readers hearts: SaaS EHR. In this article, we’re going to take a serious look at some of the risks associated with the pure SaaS EHR model. I’m sure this will leave many concerned about SaaS EHR software. Before I get into that, I want to be clear that I can (and probably will) make a future post about client server EHR software that will likely leave you just as concerned.

The point isn’t that SaaS EHR or client server EHR is better than the other. I take a much more “switzerland” approach to the topic. I think both approaches to EHR have their risks, challenges, benefits and advantages. To me it’s much more important that users are educated on the risks of each so that they can address them properly.

With that in mind, I was recently reading one of my favorite venture capital bloggers, Brad Feld, who posted a guest post by Dave Jilk about what SaaS software vendors can learn from the Megaupload and its impact on the future of Multi Tenant Services. For those not familiar with the Megaupload situation, the Feds basically took down Megaupload and seized everything they had in response to copyright infringement violations. Wired has an interesting article about the case.

What then can we learn from the Megaupload case that applies to SaaS EHR companies. I think Dave Jilk describes the SaaS risks better than I could:

What this particular case illustrates is that a company that provides your online service is a single point of failure. In other words, simply offering multiple data centers, or replicating data in multiple locations, does not mitigate all the risks, because there are risks that affect entire companies. I have never believed that “availability zones” or other such intra-provider approaches completely mitigate risk, and the infamous Amazon Web Services outage of Spring 2011 demonstrated that quite clearly (i.e., cascading effects crossed their availability zones). The Megaupload situation is an example of a non-technical company-wide effect. Other non-technical company-wide effects might be illiquidity, acquisition by one of your competitors, or changes in strategy that do not include the service you use.

So again, while this is a striking and unfortunate illustration, the risk it poses is not fundamentally new. You need to have an offsite backup of your data and a way to use that backup. The situation where the failure to do this is most prevalent is in multi-tenant, shared-everything SaaS, such as Salesforce.com and NetSuite. While these are honorable companies unlikely to be involved in federal data confiscations, they are still subject to all the other risks, including company-wide risks. With these services, off-site backups are awkward at best, and more importantly, there is no software available to which you could restore the backup and run it. In essence, you would have to engage in a data conversion project to move to a new provider, and this could take weeks or more. Can you afford to be without your CRM or ERP system for weeks? By the way, I think there are steps these companies could take to mitigate this risk for you, but they will only do it if they get enough pressure from customers. Alternatively, you could build (or an entrepreneurial company could provide) conversion routines that bring your data up and running in another provider or software system fairly quickly. This would have to be tested in advance.

As many of you know, I’ve been quite interested in this topic and risk for quite a while. I’m sympathetic to those doctors that want at least a copy of their data stored somewhere that they control. Yes, most SaaS EHR vendors have a good set of backup, disaster recovery and business continuity plans. However, as the above quote points out so well, that doesn’t deal with the “non-tecnical company-wide effects.”

I’ve long considered the idea of creating a set of standards that SaaS EHR vendors could adopt. Things like making a practice’s entire EHR data available in an easily downloadable XML format. That could be the starting point. I think it would also create a real competitive advantage to those EHR vendors that adopted these type of common sense, good customer service practices.

I’d even be happy to lead the EHR agnostic team that it would take to make this happen. Client Server EHR software vendors could be involved as well. Not to mention I’d be happy to provide a voice to the movement on my network of EMR websites. I think the key to success would be getting a couple EHR vendors to get on board with the idea and fully invested in seeing this happen. The challenge is that too many EHR vendors are blinded by the meaningful use lights.

Let’s just imagine for a minute that doctors that select an EHR didn’t have to worry about their data being safe. They knew that they could have their data available to them when they needed it where they needed it regardless of what happened to the vendor. I have that with my blog data. Although, instead of that making me wanting to change blogging platforms, it’s endeared me to WordPress even more.

I wonder if Todd Park could add this idea to his concept of EHR Data Liberacion.

My 2012 EMR and Health IT Wish List

Posted on January 3, 2012 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.

As I said in my previous EMR and Health IT in 2012 post, I’m going to create some of my own lists for 2012. I decided to tackle the first one on the list: My 2012 EMR and Health IT Wish List. This was kind of fun to think about. I’m also sure that I’ll come up with other ideas once this is posted, so don’t be surprised if I add things to this list in a future post.

I should also note that I’m not sure any of these things are going to happen in 2012. In fact, I bet that many of them aren’t, but this list isn’t about what is going to happen. This list is about what I wish would happen.

EHR Companies Would Embrace Interoperability – It’s an incredible shame that in 2012 we still don’t have interoperable health records. EHR companies need to get off the stump and make this a reality. The technology is already there and has been there for a while. EHR companies need to start making this dead simple because it’s the right thing to do. Sometimes doing the right thing is more important than the bottom line. Plus, doing the right thing ends up often being the best long term strategy for your bottom line as well.

Start doing what’s right and making your EHR interoperable!

Meaningful Use Would Go Away – I’m actually certain that this one won’t be happening in 2012, but I wish it would. I guess there’s a small chance that it could go away if Republicans take control of Washington and start slashing everything Obama related. However, I have a feeling that even then meaningful use will find its way back into Washington. There’s too much invested in it.

My reasoning for wanting meaningful use gone is clear. It provides a perverse incentive to providers and often incentivizes them to choose an EHR software that doesn’t work well for their practice. As I’ve mentioned in some recent posts, far too many clinics are so focused on meaningful use and EHR incentive money that they’re ignoring the real and tangible business cases for implementing an EHR in their clinic. I think this is a bad thing for healthcare and EHR software in general. The short term bump in EHR adoption won’t be worth the cost of EHR implementations focused on the wrong criteria.

I also really hate how meaningful use has hijacked the software development cycle of pretty much every EHR vendor out there. This is a real travesty since rather than developing for user/customer requirements EHR vendors are developing for a criteria. Talk about a perfect method for destroying innovation. This is a real travesty in my opinion.

Of course, I’m a realist and realize that meaningful use isn’t going away. We have to make the most with what we’re given and live with the realities that exist. However, in this New Year Wish list, I wish that meaningful use would be a past memory.

New Healthcare Model that Provides Care, Not Reimbursement – I’m sure many of you might be thinking that I’m calling for ACO’s in this wish list item. We’ll see how ACO’s evolve, but my gut tells me that the ACO model still won’t make the fundamental change that I wish would happen in healthcare. There’s far too much focus on reimbursement the way our healthcare is structured today. I’m not arguing that doctors and other healthcare professionals not get paid what they deserve. I’m just wishing that there was more focus on care for patients and less worry on maximizing the reimbursement.

How does this have to do with health IT and EHR? I’ve long argued that the biggest bane to EHR systems is the onerous reimbursement requirements. I can’t imagine how much healthcare could benefit from fabulous EHR systems if the energy spent on maximizing reimbursement were spent on improving patient care.

Diabetes Prevention App – I’ll admit that this is a little personal. I come from a long line of diabetes in the genes and I love sweets far too much. I’m pretty much destine to be a diabetic. I think that mHealth apps can have amazing power if done correctly. My wish is for someone to create a Diabetes app that will help me overcome the seeming destiny I have in this regard. The key will probably be illustrating in a profound way the impact of the choices I’m making.

Of course, you could insert hundreds of other chronic illnesses into this wish list too. I’d love to see mobile health work to solve those as well.

A True Patient Identifier – I realize that America is a large place, but we’re also a really creative country that can figure out creative solutions to problems. The lack of a true patient identifier is a challenge and a problem in healthcare. I’d love to see this problem finally resolved. I think every EHR company would rejoice at this as well.

Real EMR Differentiation – My heart absolutely goes out to doctors, practice managers and others who have the unenviable job of trying to sift through the 300+ EMR companies. I’d love for some EMR companies to really do something so innovative to differentiate themselves from the rest of the pack.

No doubt part of this problem is what I stated above about meaningful use. Hard to create innovation and differentiation in EHR when you have to develop for a government list of requirements.

EHR Data Liberation – I’ve wanted EHR data Liberation for a long time, but I think in 2012 this is one thing on the list that could become a reality. It’s a bit of a long shot, but I think there’s potential for this to happen.

My gut tells me that if we can find a way to liberate the data that’s stored in EHR software, then we’d see a dramatic increase in adoption of EHR. One of the major concerns doctors have with selecting an EHR is that once they select an EHR they know they’re locked in with that EHR for the long run. If a doctor knew that they could switch EHR software if they made a bad choice, then they’d be much more likely to pull the trigger on EHR adoption.

We need a wave of EHR vendors that aren’t afraid of liberating their EHR data, because they:
1. Know that their EHR software is so good users won’t leave
2. Know that if someone wants to leave their EHR software it’s better that they find one that’s good for them than the few extra dollars the EHR company will make off an unhappy user.

How’s that for a wish list? I think achieving these things would do an amazing amount of good in healthcare and EHR. Of course, I won’t be holding my breathe on any of them happening any time soon. That doesn’t mean I won’t keep holding out hope.

The Meaningful Use Decision – Meaningful Use Monday

Posted on October 10, 2011 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.

What else could be written about meaningful use that hasn’t already been said? Really. I’ve been thinking this over since I think we’ve been writing about the EHR incentive money and meaningful use for almost two years now.

I still remember the first time I read about the government planning to give out incentive money for those who adopt an EMR. Some thought that they’d just give out the money to doctors who adopt an EHR kind of like they did for those who purchased a home. I guess the government assumes that when you purchase a home you’re going to use it, but when you purchase an EHR that’s not always the case. So, meaningful use was born.

One of my biggest problems with meaningful use has always been its conflict with certified EHR. I’ll never understand why the government wants to certify EHR software (ie. more expense) when they could have just built the requirements of meaningful use so that the only way for a user to meet the requirements is by using an EHR software that performed the functions required. I guess I can partially see some security checks that could be done in an EHR certification that wouldn’t show in meaningful use, but does anyone really think that EHR software is much more secure thanks to EHR certification?

Of course, much of this is water under a bridge. We have meaningful use and certified EHR and there’s no going back now.

At this point, I wonder how many doctors are still undecided on meaningful use and EHR software. Considering all the discussion and chatter, I feel like most doctors have made the decision on the subject. They’re either going to use an EHR or not. I guess there might b e a few doctors that want to use an EHR, but are waiting for the right one. Certainly there are many doctors that know that EHR is the future, but they just haven’t committed the time to evaluating the various EHR software and deciding which one is best for their office.

My gut feeling tells me that the EHR incentive money wasn’t enough for many of them to finally get down to the business of selecting and implementing an EHR. I imagine many of them are waiting and hoping for a clear EHR market leader to emerge. I’m sorry to inform them that I don’t think that’s going to happen for another 2-3 years at least. Plus, I still think we might have market leaders in each medical specialty.

I’ve heard some argue that it’s the future meaningful use stages that have people scared to implement an EHR. Basically, they believe that meaningful use stage 1 is reasonable, but they think that meaningful use stage 2 & 3 will be much harder and not worth the effort. Kind of reminds me of the arguments that businesses have made about the uncertainty of economic policy causing them not to “move” on more investments. I think many doctors are uncertain about the EHR stimulus money, future stages of meaningful use, and how private insurance companies may react in the future. This uncertainty does cause issues for their ability to plan.

One thing I think the EHR industry could do to provide more comfort to doctors is to provide doctors that adopt your EHR a pathway to leave your EHR if you don’t meet their expectations. Why vendors try to lock someone into their EHR that hates it is beyond me. Ok, I get the short term gain and why you hate losing customers. However, by locking them into a product they don’t like you’re creating an eternal enemy to your product and believe me when I say that doctors talk. Plus, if you have doctors that want to leave because your product doesn’t meet their expectations, then you have a bigger issue on your hands. Sure one or two that have work flows that don’t match your product, fine. A mass exodus from your product because you chose to make it easy for them to leave means you should probably fold up shop anyway or fix the reasons why they want to leave.

Unfortunately, the large EHR vendors won’t really care at all. They’re all about lock in whether you like it or not. I hope doctors start to kick against this and support EHR vendors that provide pathways out of their product. I’d still be happy to support a movement to “liberate” EHR data. Any EHR vendors want to join?

This brings us back to meaningful use. It’s too bad the meaningful use didn’t require practical elements that would make a lot of sense for government to institute. For example…
-Require EHR vendors to create an easy export of all patient data
-Require EHR vendors to communicate with other EHR vendors
-Require EHR vendors to send public health data (they’ve kind of done this)

I’m sure there are more, but that’s a good start.

Now the most interesting thing is going to be how this first wave of meaningful use doctors react to the EHR software they’ve chosen. Unfortunately, I’ve really only seen meaningful use doctors who’ve had an EHR software well before the term meaningful use was coined. If you are a doctor who recently implemented an EHR post meaningful use, I’d love to hear from you so we can tell your story.

Value to EMR Vendors of EMR Data Liberation

Posted on February 8, 2011 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 last post on EMR companies holding practice data for ransom was very popular and had some very interesting discussion in the comments. Honestly, every EMR vendor should be considering the impact of the choice to not liberate the data in the EMR.

No, I’m not talking about being loose with the data. HIPAA will come back to bite you if you do that. Plus, no doctor will want to use your system. What I’m talking about is making the data in the EMR available to the doctor. In fact, if your a doctor or practice manager reading this post, you should make this a requirement of the EMR vendor you select. If you already have an EMR vendor, you should work to have them incorporate this feature in their EMR ASAP.

Lest you think that I’m just being pro doctor and not considering the EMR vendor, let me provide you some business reasons why an EMR vendor would want to create a plan to make the data in their EMR available to their doctor in a liberated format.

As one EMR vendor put it:

Bottom line, its a good business practice to provide the data in an accessible manner to the client when and if he/she wishes to move on to another EHR.

Let me add the following:

If you don’t hold the EMR data ransom then you will have a better image in the community.

1. If someone wants to leave and you make it hard, word will travel that you held them ransom and others will be afraid to choose you because they know they’ll be locked in. We all know how tight the medical community is.

2. If you free the data, users will trust you more cause they know they can leave at any time. Plus, they see you’re doing what’s best for the customer. This narrow minded focus on the customer’s needs will certainly carry over into other areas of your application and lead to happy customers who can leave, but won’t have any reason to leave.

3. SaaS EHR vendors in particular should offer this service. One of doctors biggest complaints about SaaS EHR is their fear that their EMR data isn’t stored in their office. What easier way to allay this fear than to provide them a regular copy of their data?

Do NOT underestimate the power of your image with the customer. It leads to happy long term customers, but also leads to future customers. I saw a recent study (which I can’t find right now), but it was amazing to see the amount of influence that other colleagues EMR recommendations made on a doctor’s EMR selection decision. Providing doctors their EMR data which may lose you a few customers along the way, but it will retain and find more customers than you lose.