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Breaking News: Meaningful Use is Not Covering Costs

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In one of my recent interviews with a healthcare IT consulting company, they revealed some breaking news for those of us in the EHR world. They told me point blank that:

Meaningful Use is Not Covering Costs

Ok, so that’s not really breaking news. Although, it seems that very few people want to actually articulate this point. It almost feels like heresy that someone would “complain” about the fact that the government is spending $36 billion on EHR incentives and that the money isn’t enough to cover the implementation of these EHR systems.

Actually, I should clarify that last point. The EHR incentive money is covering the costs to purchase the systems. It’s not covering the costs of implementing those EHR systems and then poking, prodding and otherwise cajoling end users to show meaningful use of that system (not to be confused with meaningfully using the system).

Let me also be clear that I’m not complaining about the EHR incentive money. I’ve done enough of that previously. What I’m just trying to acknowledge is something that everyone who deals with the EHR budget already realizes, but no one seems to want to say it. Organizations are spending more money on EHR and meaningful use than they’re getting from the government.

I think this is important for a couple reasons. First, many organizations didn’t budget any EHR money beyond what the EHR incentive money. You can certainly argue this was a mistake on their part, but that’s going to leave a bunch of organizations in a lurch. We’re already seeing the fall out of this as news reports keep coming out about hospitals systems in financial trouble due to the costs of their EHR system. Plus, in each of these cases, it seems their costs continue to balloon out of control with no end in sight. It makes me wonder if the compressed meaningful use timeline is partially to blame for a rushed implementation and poor EHR implementation and cost planning.

Second, there is still a swash of providers and organizations that haven’t yet implemented their EHR. If you can’t support the cost of EHR with government money, how does that bode for those who won’t be getting any EHR incentive money? One could make the argument that they’ll actually be in a better position since they won’t have to worry about meaningful use and can just focus on getting value out of their EHR. Hopefully that’s the case, but many of the meaningful use functions are now hardcoded into the EHR systems. Even if an organization isn’t planning on attesting to meaningful use, that doesn’t mean they won’t be forced by their EHR software to do a bunch of things they wouldn’t have done otherwise.

What are you seeing from your perspective? Is the EHR incentive money covering the costs of an EHR implementation? What are the impacts if it doesn’t?

April 21, 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.

Hospital Must Pay Back $31 Million in Meaningful Use Money

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The news just came out that Health Management Associates, Inc. (“HMA”) did not meet the meaningful use requirements necessary to receive the EHR incentive money and so they’ll have to pay back all of the money they’ve been paid by CMS. Here’s a portion of the article that details the amount they have to pay back:

The Company estimates that, between July 1, 2011 and September 30, 2013, it recognized as income HCIT incentive payments totaling approximately $31.0 million for the hospitals that did not meet the “meaningful use” criteria. Of these payments, the Company recognized as income approximately $8.3 million in 2011, approximately $17.3 million in 2012 and approximately $5.4 million in the first six months of 2013. On October 30, 2013, the Company withdrew the 11 hospitals from the HCIT programs and has repaid the majority of the funds to CMS. The Company is in the process of repaying the balance of the funds to the relevant state programs. The Company expects to re-enroll the hospitals in the HCIT programs and may be able to recoup some portion of the amounts repaid.

$31 million is a lot of meaningful use money to pay back. I’m still waiting for the details of why they failed their meaningful use attestation to come out. Although, I believe I read that the top management at HMA are gone from the company as well. So, it’s hard to say if this was a simple meaningful use mistake or if it was an intentional effort to game the EHR incentive and meaningful use system. In meaningful use stage 1 this is particularly easy to game since it was self-attestation.

I’m sad to say that I wrote about the potential of having to payback EHR incentive money previously. Plus, as I mention in that article, HMA will now be subject to the EHR penalties as well if they don’t get things corrected before those go in place. Of course, in my post I discuss organizations that make a good faith effort to attest to meaningful use. We’ll see if HMA made a good faith effort or not. Either way, this is an important warning for those organizations that aren’t doing everything they can do meet the meaningful use guidelines.

One EHR expert I spoke with about this situation said, “It’s not the last of such announcements I expect to come out in the next few months.” I’d only modify that to say “in the next few years.” If organizations had problems with meaningful use stage 1, you can be sure the problems will be multiplied with MU stage 2 and 3.

The problem is that if too many more stories like this come out it’s going to take a program that was suppose to incentivize EHR and make it into a weight around the neck of EHR implementations.

November 7, 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.

4 Things You Should Do to Make Sure You’re Compliant with Meaningful Use

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The following is a guest post by Beth Houck, Vice President of Client Services at SA Ignite.

As we near the last quarter of 2013, many providers will have earned over half of their Meaningful Use (MU) incentive dollars and will be adept at following the workflows required to meet the Stage 1 measures.  With two years (or more) of following MU under their belts, it’s really just old hat, right?  Maybe, but not so fast.

For small practices with no turnover and no upgrades to their EHR, practice managers can follow many of the same checklists that got them through the first year:  verification that all non-percentage based measures have been met (e.g., a completed security risk audit, evidence of enabled features in the EHR such as Clinical Decision Support and Formulary Checks, completion of an immunization test) and a secure copy of the report that was generated from the EHR that supports percentage-based measure compliance and CQM submission.  Practice managers may find themselves nudging providers to stay on track, but a small, stable practice has far less moving parts from year-to-year.

This is in significant contrast to large practices and Federally Qualified Health Centers (FQHCs) that experience significant turnover.  It’s September 2013 and a new provider started with your organization.  Do you know what payment year he is in?  Are you allowed to attest for him or did his previous practice lay claim on these dollars?  It’s July 2013, and a new provider brings her report from the certified EHR she was using in the first part of the year.  What do you do with this information?  How does this impact this provider’s attestation?

As larger provider organizations advance beyond the earliest stages of MU reporting, they realize that a once manageable process quickly becomes complicated, and the risk that incentive dollars will be lost drastically increases. Ensuring compliance means knowing what rules apply to these providers. Through our work monitoring more than 5,000 providers, we’ve worked to automate the attestation process. Here’s our list of four key best practices to ensure you’re on track to MU compliance.

  1. The first step is to determine the provider’s Payment Year and under which program(s) they’ve received incentive dollars. You can look this up using the same login to attest for providers.
  2. Then if they are in payment year 2 for Medicare, never having switched from Medicaid, they will need to meet MU for the entire 365 days. This means that MU data from any previous practices’ EHRs will need to be added to their current MU data. CMS has published a list of frequently asked questions on how to calculate these numbers. On a positive note, you will not be required to have your Clinical Quality Measures (CQMs) align with the previous practice’s EHR. If they don’t match, you can just use the CQMs from the system where you had more visits.
  3. The next step is to determine which of the non-percentage based measures need to be repeated for this provider. For example, if you don’t have any record of an immunization test being completed at the previous practice, one will need to be completed.
  4. Finally don’t forget that the EHR Certification ID that you used when you originally attested for your providers won’t necessarily apply to subsequently hired providers. If the new hire is bringing data from their old practice that needs to be merged with their new practice, you will need to obtain a new Certification ID from the Certified Health IT Product list. Following the sites instructions, you will need to add both the provider’s previous EHR and your EHR to the “basket” to obtain a new, unique Certification ID produced for this combination of EHRs.

It’s clear that there is so much more to MU compliance than double checking if you printed Visit Summaries for more than 50 percent of your patients.  As we move into 2014, there are multiple payment years, programs and stages to track, so you will need to be certain that you have a system in place to ensure that you can manage the cases mentioned above to maximize the EHR incentive dollars for your organization.

September 26, 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.

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.

Should We Hit the Pause Button on Meaningful Use?

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I saw this question hit my email this morning: Should We Hit the Pause Button on Meaningful Use?

It’s a controversial question without a really solid answer. A number of organizations have already called for a delay on meaningful use stage 3. They have some reasonable points to be made for why MU stage 3 should be delayed. I won’t be surprised if we see a delay in future stages of meaningful use. ONC won’t want to do it, but I think they’ll be pressured to the point that they see no other option. The government approval process just can’t work fast enough.

However, the idea of pausing meaningful use is a bit different. A delay isn’t necessarily a pause. If you delay MU stage 3, then people are still required to attest to MU stage 2. Some people (including some in congress) are asking if we should pause MU completely. The idea being that we should do an analysis of the impact of MU stage 1 and how we can make MU stage 2 and 3 more effective. The problem with this idea is that many have committed a large investment to their EHR and so pulling out promised EHR incentive money won’t likely happen.

There’s actually a growing voice to stop meaningful use completely. Certainly this will upset plenty of organizations, but I find the discussion of stopping meaningful use incredibly intriguing. Would stopping meaningful use and not paying out any more government money for EHR software have a negative impact on EHR adoption?

That’s a hard question to answer. I imagine there are a few hospitals that have started down the road of EHR adoption that would definitely step on the brakes. I don’t think the same is true in the ambulatory space. Those who’ve started down the path to EHR are already on their way and likely won’t turn back.

I’m sure stopping the meaningful use EHR incentive money would cause quite an uproar. I can’t imagine them doing it, but I think it’s unfortunate that we can’t at least have the conversation. Last I checked we’d spent about $8 billion in EHR incentive money. If the estimated $36 billion is still accurate, that leaves $28 billion of EHR incentive money left. Don’t you think we should at least consider whether we should spend that $28 billion the way we’re doing it?

August 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.

EHR Penalties after Meaningful Use Failure

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While at HIMSS I had a discussion with the consulting firm Stoltenberg Consulting. I was really intrigued by their approach to EHR consulting and will likely write more about it later. Plus, the started what in many ways became a theme of my HIMSS experience around rural healthcare EHR. You can be sure I’ll be writing about rural EHR here on this site and on Hospital EMR and EHR much more in the future.

In our casual introductory conversation we had a good discussion about how many of the smaller hospitals look at meaningful use and the EHR incentive money. Needless to say, many of these smaller institutions are faced with a huge challenge when it comes to adopting an EHR and showing meaningful use. Many of these rural hospitals barely have an IT staff and the CFO usually takes care of the IT environment. I heard one story at HIMSS where the IT person at a rural hospital started out as the janitor and his home IT skill made him the most qualified person to help.

Needless to say, rural and smaller hospitals have some real challenges facing them when it comes to EHR adoption and showing meaningful use of that EHR. Although, an even worse thought struck me in my discussions about these smaller hospitals.

Imagine many of these smaller hospitals making a good faith effort to adopt EHR and show meaningful use. It’s not that hard to see many of these hospitals falling short of the meaningful use standard. What will this mean to that organization? They’ve spent millions on an EHR. They won’t get the EHR incentive money they likely used as a justification for the EHR spending. To add insult to injury, now they’re going to get penalized for not being meaningful users of an EHR.

This scenario honestly makes me sick to even consider. Something similar could easily happen in small ambulatory practices as well. The scale of the damage will just be different. I expect in meaningful use stage 1 this won’t likely be a problem since it’s self attestation. However, this could become a much bigger issue in meaningful use stage 2.

Although, consider an organization who fails a meaningful use stage 1 audit. In most cases you can’t go back and fix whatever you failed in the audit. You’d be in a very similar situation where you have to return the EHR incentive money and would be open to the meaningful use penalties. At least that’s my understanding of how the EHR penalties will be implemented. If you know otherwise, I’d love to hear it.

While I think the above scenarios are brutal, hopefully this will also serve as a warning for those hospitals pursuing EHR and the EHR incentive money. Be sure you are able to show meaningful use or you’ll not only lose out on the incentive money, but you’ll also be open to the EHR penalties. Not to mention, are you ready for a meaningful use audit?

March 15, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 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.

EHR Benefit – Accessibility of Charts

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It’s time for the second installment in my series of posts looking at the long list of EHR benefits. In case you missed the first post, go and check out the EHR benefit of legible notes.

Accessibility of Charts
The second EHR benefit is similar to the Legibility of Notes benefit in that it is easily forgotten as a benefit to EHR and it can be hard to quantify the value of the benefit in dollar amounts. Plus, it is really easy to see how nice accessible charts are to an organization.

There are a number of ways to look at the EHR benefit of accessible charts. The most obvious one is when you think about the number of times a chart has gone missing in a clinic. In most cases, the chart isn’t really missing. It’s in the clinic somewhere, but no one can find it. Remember all those special places that a chart could hide: exam room, physician’s desk, front desk, nurse’s desk, lab sign off box, physician’s car, hospital, physician’s home, etc etc etc. Oh yes, I didn’t even mention HIM not being able to find the chart because someone (probably someone other than HIM) misfiled the paper chart.

I’m sure most HIM people who read this will have a visceral reaction. I’m sure many are likely thinking, “But we do an amazing job keeping track of all those paper charts.” I agree with them 100%. A good HIM person has done an amazing job keeping track of paper charts. It would be 100 times worse if they weren’t there. The problem is that if a dozen people are using the paper chart, the reality is that charts are going to go missing.

Now think about the concept when it comes to EHR. None of those lost chart locations exist. The nurse can’t accidentally take the chart and forget to file it. The doctor can’t forget the chart at home or in his car. No one can misfile the chart.

Think about it. An EHR solves 100% of the problem of missing paper charts.

Besides misplaced paper charts, the idea of chart accessibility is an important one when you consider the idea of accessing an EHR remotely. Even if you use a less than ideal remote desktop solution, a physician can access an EHR anywhere they have an internet connection. For web based EHR, you get exactly the same experience accessing the EHR remotely as you would in the office.

I’ve heard horror stories (at least their pretty horrible to me) of doctors getting late night patient calls which require them to get dressed, go into the office, open the medical records room to access a patient chart. With an EHR, that same workflow has the doctor booting his computer and logging into the EHR. This doesn’t apply to all doctors, but for those that do it’s a dramatic difference.

The biggest fear I’ve heard from doctors in this regard is they often equate chart accessibility with their accessibility. The argument goes that if they can access the chart 24/7, that it also means they have to work 24/7. I think this is a myth that doesn’t match most realities. Just because you had a key to your office and could go and work on paper charts 24/7 doesn’t mean you had to do it. The same is true with remote access to EHR. You choose when is appropriate and important to access and work on the EHR and when not to do so.

The key difference between EHR and paper charts is that when you do want to access a patient’s record remotely you have that option available to you. That doesn’t mean you always have to do so, but it is nice to have that option available.

When talking about EHR accessibility, I think also about the landscape of connected mobile devices (smart phones, tablets, etc). All of these devices are connected to the internet at all times and could provide a doctor access to their EHR almost anywhere in the world. Try doing that with paper.

The problem here is that most EHR don’t do well on mobile devices. Remote desktop from a smart phone or tablet works, but is a pretty terrible user experience. A native mobile app provides a much better experience for users, but we’re still in the early days of EHR mobile app development. As this matures, the accessibility of charts will become an even bigger EHR benefit.

January 10, 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.

The False Economies of EMR

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In my recent look around the EMR twittersphere on EMR & EHR, I briefly commented on the challenges of choosing the wrong EMR and EMR Switching. Dan Haley from athenaHealth asked for some deeper clarification of my comment, “I’d say the biggest driver of EMR switching is thanks to the EHR incentive money and meaningful use.”

Here was my response:

I think there are a whole list of things in the HITECH act which encourage and promote the use of outdated technologies. I’m sure this is something you agree with and know all about as well.

My core argument has been, sure we’re seeing an increase in EHR adoption. However, what if the EHR incentive money is incentivizing doctors to adopt the wrong EHR. By wrong EHR I mean one that they don’t like, that can’t adapt to changing technology, that can’t support the future Smart EMR requirements that are bound to come, that kill a physician’s workflow, that cause a doctor to not want to be a doctor, etc.

I think we may be headed this direction and the number of doctors switching EHR software is a decent example of why this is the case. I’m sure that some would argue that meaningful use is driving people to switch EHR software and that the switch we’re seeing happening is from EHR software that isn’t highly functional to EHR software that is highly functional.

While this argument is true in some cases, there are just as many cases which illustrate that the EHR switching was because their first MU EHR was such a terrible experience that they had to switch EHR. Plus, we’re just at the start of this. Many are painfully grinding through the day to day with an EHR they hate. Wait until that explodes.

Even worse is those clinics that are switching EHR for the sake of EHR incentive money and go from an EHR they enjoy to one they hate. Add in the many doctors who are stuck using an EHR that was selected by some large company who didn’t worry too much about the physician needs and we’re in for a crazy next couple years.

Hopefully this gives you a better idea where my comment was coming from. Needless to say, I’m not sure that HITECH has been a benefit to doctors. The short term numbers might look good, but it might have just created some painful underlying difficulties going forward.

With all of this said, there are some beautiful EHRs out there that make doctors lives better. I’m pro-EHR when it’s done right. I just don’t see meaningful use and EHR incentive promoting the right EHR adoption methods.

This provided some interesting background for a conversation I had recently with a doctor. He told me, “It seems like there are a number of false economies driving EMR adoption.

I think meaningful use and EHR incentive money driving EHR adoption is a false economy. This doctor described to me how many of his colleagues weren’t using the EHR that they wanted, but instead were using an EHR that they “had” to use. What are some of the forced requirements for EHR that create these false economies besides meaningful use and EHR incentive money?

Another False EMR economy is around HIE connections. Many doctors can’t select the EHR they want to use and fits their workflows best because their local HIE may or may not choose to support a connection with that EHR. So, the doctor opts for an EHR that does connect with the local HIE even though it wasn’t their EHR choice.

Hospital Connections is another false economy. Similar to an HIE, many doctors will opt for what they consider to be a less than desirable EHR because it’s the one that works with their local hospitals.

I’m not trying to pretend that doctors should be the end all be all in EHR selection. A physician can think one EHR is the best and not realize until after using it that another EHR would have been better. Sometimes you think you have a great EHR until you actually use another one and realize what you’re missing. However, the easiest recipe for disaster with EHR is for a doctor to hate using an EHR. As I mention above, it will not end well and will drive the future EMR switching that I’ve predicted.

January 2, 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.

EHR Benefit – Legibility of Notes

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I’ve hinted for a little while that I was going to start a series of posts talking about the various benefits of using an EHR. I think this is an important subject worth discussing in greater detail. I hope that this series of posts will also help us move past meaningful use of an EHR for the government EHR money and explore all the other reasons why healthcare should fully adopt an EHR.

Back when I first started blogging about EMR software (It was 2005, before the term EHR came to be), I made this list of EMR and EHR benefits over paper charts. I’ll be using that list as the starting point for this series of EHR Benefit posts. I love the first paragraph on that page (which I likely haven’t touched since 2005):

This list is just a starting point to list off all the possible benefits of having an EMR or EHR. Probably a poor one, but a start nonetheless. My plan is for this list to grow over time as I think of new benefits or as people suggest things I’ve most certainly missed. Also, I think that most people often focus too much on the financial benefits of an EMR and so hopefully this list will include financial and other benefits beyond the financial implications.

The list definitely did grow, but I guess I never got around to updating the intro paragraph. Although, I am pleased to see that even back in 2005 I was as interested in the non-financial benefits of EHR. Certainly the financial benefits of EHR are incredibly important, but far too many people don’t take into account the other non-financial benefits in their analysis of EHR benefits. It’s just too hard for many to try and compare or put a value on the non-financial benefits of EHR. We’ll try to point these benefits out just the same.

Now for the first EHR benefit on the list:

Legibility of Notes
I’m really glad to start with an EHR benefit that everyone can understand with little explanation. Poor medical handwriting has been a running challenge in healthcare for as long as we’ve been documenting patient visits. I did a quick search on Google for “write like a doctor” and it had about 321 million results. That’s quite pervasive.

I can’t think of anyone that would argue that healthcare doesn’t have a challenge reading physician’s handwriting. No doubt there are plenty of exceptions to this, but even those with beautiful handwriting still have to read other doctors’ handwriting from their own office or from other doctors’ notes that get sent to their office. It’s great to have the notes, but if you can’t read them then what’s the point.

While certainly illegible handwriting is a major problem in the office, it also extends outside the office as well. Think of all the times pharmacists have had to call a doctor to clarify the prescription a patient brought in. Even worse than that is the number of times the pharmacist misread a script because a doctor’s handwriting is illegible. This becomes a non-issue in an electronic world where the prescription is either printed or ePrescribed.

Of course, none of this is new territory. Every doctor understands these benefits better than I’ve explained here. However, far too often when we think about implementing an EHR, we forget about these simple and easy to understand benefits. How much time is saved in your clinic by being able to read the handwriting in the chart? How much time is saved in healthcare when referrals come in an easy to read, legible format? How much time and how many lives are saved by pharmacists getting the proper prescription to the patient? All of these are hard measures to quantify, but they are real, tangible benefits of an EHR.

I won’t mislead you into thinking the shift from paper charts to EHR solves all the legibility problems. Many template driven EHR software that creates a mass of mostly irrelevant data can be just as hard to decipher as the hieroglyphic handwriting of some doctors. However, I’ve seen a tidal wave of push back against these documentation approaches and I think we’re getting better. I think the shift to quality of care reimbursement versus procedure based reimbursement will help this to go away as well.

There are other things a clinic leaves behind with paper charts. I’ve heard many tell me how many times they looked at the handwriting to recognize who had documented something in a paper chart. Certainly that same info is available in an EHR, but you do lose the instant recognition of who charted what in the chart.

Despite not being able to put a nice dollar value on the Legibility of Notes, it’s certainly an EHR benefit that can’t be forgotten. It’s very easy to adopt an EHR and take this for granted.

December 12, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 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 the Commodity – Meaningful Use Monday

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I decided to take a step back this week for Meaningful Use Monday to look at where we are in the new world of health IT which includes the commonplace terms of EHR incentive money and meaningful use. Plus, I’m probably waxing a bit nostalgic today as I think about the David Brailer keynote at the Digital Health Conference today (follow my tweets on @ehrandhit for more coverage) where he spoke a bit about the origins of healthcare IT.

At this point it seems that meaningful use has become basically a commodity. There are very few EHR vendors out there now that aren’t certified EHR that can help a physician get to meaningful use (Although there are some non-certified EHR still). Basically, if you are doing EHR, then more than likely you are doing meaningful use. Or at least you’ll have that opportunity if you want. Some would argue that means that this result is a function of the meaningful use bar being set too low.

In fact, that is largely what the congressmen’s argument was in their letter to HHS about halting meaningful use. The real question is whether this is a problem. I personally don’t mind all the EHR competition. I think it would have been worse if the government incentive, meaningful use, and the RECs essentially narrowed the field of EHR vendors down to only a few.

The argument on the other side is around the “paradox of choice.” There’s little doubt that many practices are in a situation where there are so many EHR choices that they make the decision not to choose. However, I see this more as an excuse not to do EHR from people who didn’t really want to do EHR in the first place. I’m not sure these people would have been doing EHR even if there were only a few choices.

This does leave us with a challenging problem going forward. The EHR churn rate is going to go through the roof. David Brailer pointed this out today in his keynote and he’s right that it’s already happening today. Although, the majority of the EHR churn that’s happening now is from those organizations that are going after meaningful use. The major EHR churn rate of the future is going to come from EHR consolidation.

What does this all mean? Now more than ever, an organization needs to do good due diligence on the stability of the EHR software. Notice that I didn’t say EHR vendor. Just because you’re a large EHR vendor that’s financially stable doesn’t mean that the EHR software is safe (see Exhibit A and Exhibit B).

One thing is clear though, meaningful use and EHR are here to stay. There’s no escaping EHR. We’re finally back to the point where doctors are no longer asking if they should do EHR. Instead, they’re asking how, when and which EHR they should do. This is a very good industry trend.

October 15, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 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.