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Documentation by Exception is the Dredge of EHR Documentation

Posted on May 26, 2015 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

There was a very bad practice that was started thanks in large part to EHR software implementations. That practice is called documentation by exception and it’s employed by many (most?) EHR vendors. For those not familiar with documentation by exception, here’s a definition:

Charting by exception (CBE) is a shorthand method of documenting normal findings, based on clearly defined normals, standards of practice, and predetermined criteria for assessments and interventions. Significant findings or exceptions to the predefined norms are documented in detail.

In the US, we all know why this type of documentation was implemented. By documenting all of the normal finding along with the exceptions, then the doctor is able to bill the insurance company at a higher level. I totally understand why doctors want to bill at a higher level. In fact, it was the argument that most EHR vendors would make when they were selling their product to doctors. The EHR was able to help doctors bill at a higher level and get paid more.

While this is going to be hard to change for this reason, there are so many unintended consequences associated with using documentation by exception in these practices. I know so many doctors that are literally embarrassed to share their chart notes with their colleagues because their chart notes are these long, cumbersome notes that are filled with normal findings that provide no value to anyone. Many of these doctors have resorted to creating a separate “short” note that only has the relevant “exceptions” detailed when they send their chart notes to another doctor.

Every doctor knows what I’m talking about, because they’ve found these long lengthy notes that are totally unusable. Plus, in many ways it puts a doctor at some risk if they documented a long list of “normal” items when in fact they didn’t actually check to see if everything was normal or not. However, more important than this is that the doctor can’t even read their own historical notes because they’re so cluttered with all these “normal” findings that it takes real work and effort (Translation: Wasted physician time) trying to search through these awful notes.

If somehow all of these normal findings that were being documented could add some value down the road, then I might change my mind about documentation by exception. However, I can’t imagine any useful clinical benefit to documenting a bunch of normal findings that weren’t actually checked or that were only casually observed. If you didn’t document something was wrong, then we can assume that everything else was normal or at least the patient didn’t complain of anything else. Why do we need to document it clinically? The answer is we don’t and we shouldn’t (except for the getting paid comments above).

We need to find a way to abolish these documentation by exception notes from healthcare. In the US this will be hard since it’s so tied to the payment system, but I’m sure smart minds can figure out a way to fix it. Every doctors I’ve ever talked to wants this solved. It almost makes the EHR notes useless to document this way. This is one more driver in the US system towards concierge and direct primary care models. In these cases, the doctors aren’t worried about reimbursement and so I can’t imaging they’d even consider documenting a patient visit in such an awful manner.

A part of me wonders if EHR vendors will work to solve this problem as well. They could have the beautiful note and the crappy, mess of a note. They’ll use less vulgar terms like the “clinical note” and the “billing note” or something like that, but maybe that’s a small step in the right direction to satisfying the clinical needs (short, concise, relevant notes) together with meeting the billing requirements note. It’s sad that EHR vendors need to do something like this, but it would be better than the current state of EHR notes.

Healthcare IT Marketing and PR on the Mind

Posted on April 2, 2015 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Healthcare IT marketing and PR have been on my mind lately as I’ve been preparing for the Healthcare IT Marketing and PR Conference (HITMC) and for HIMSS. We’ve published the full HITMC program if you haven’t seen it yet. It’s going to be a really amazing 2 days of learning for me and everyone who attends. Hopefully many EMR and HIPAA readers can make it. There’s only 5 days left to register for the event, so do so now if you’d like to attend.

We’ve certainly seen the evolution of marketing here on EMR and HIPAA. At first people mostly wanted to buy a link to their site from us since we were on the first page of Google for the term “EMR”. (Side note: Don’t buy links. That’s a bad strategy today.) Then, we started doing banner ads and those have always performed really well for our advertisers since we have such a targeted, niche audience. Recently we’ve been expanding our email marketing, event marketing and sponsored content packages. They’ve really become fully integrated marketing packages that touch on email, social media, blogs, and display advertising. It’s exciting what we’re able to deliver sponsors of our site.

10 years later it’s amazing to think back on the 2239 posts we’ve published, the 9743 comments that readers have contributed and the 10,689,418 pageviews for EMR and HIPAA. I wonder how many emails we’ve sent out with our content over the years, but I don’t have a good way to track it. Just last year I estimate that this blog has sent out 1.25 million emails. Wow! Thanks to all of you who read and contribute.

Every 6 months or so I like to highlight the companies who support the work we do here at EMR and HIPAA. Without them, I wouldn’t be able to be a full time blogger and provide you the content I do. Take a second to look through the list and see if one of them might be able to help you solve a problem you’re working on in your job.

Vocera – Vocera is an interesting story for me, since they acquired a secure messaging company I advised (docBeat). Since that acquisition, I’ve been lucky to advise them on some marketing and they’ve also been sponsoring a number of Healthcare Scene email campaigns. They offer a pretty compelling set of secure, real-time communication solutions for healthcare. Plus, they have a good announcement coming out at HIMSS that I think will set them apart from the other secure messaging solutions out there. Although, I’m not allowed to talk about the announcement yet. You can see Vocera’s HIMSS 2015 plans if you want to meet with them in person and learn about the announcement.

Iron Mountain – It was fun working with Iron Mountain on their Healthcare Information Governance Predictions and Perspectives series. You can find all the entries in that series here and my entry here. Plus, I was able to participate in their #InfoTalk Twitter chat which was really well done as well. I hope they continue the discussion, because it’s an important one.

ClinicSpectrum – Regular readers should be familiar with ClinicSpectrum. They’ve been contributing some great content in our Cost Effective Healthcare Workflow Series. I love how they’re interested in taking the discussion beyond just EHR and meaningful use into how a practice or hospital can optimize their use of technology. Plus, they’re really passionate about the hybrid workflow which mixes technology and people to find the optimal solution. We need more of this optimization in healthcare.

The Breakaway Group (A Xerox Company) – You’ll also likely be familiar with The Breakaway Group and their Breakaway Thinking Series. I’ve always loved the researched based perspective that they provide to the challenges that face healthcare IT. Plus, they offer some unique perspectives on training and learning in healthcare. One of the biggest challenges with any healthcare IT implementation is getting the training right. The Breakaway Group is dead set on solving that problem.

Ambir – Ambir’s been supporting the work we do here since January of 2010. Amazing that they’ve been with us for 5 years. I think that was before I even quit my day job. Most people know them as a scanner company, but word on the street is that at HIMSS 2015 they’ll be announcing a new tablet based product. I’ve heard the concept and I think it’s a really creative approach to solving healthcare’s workflow challenges.

HIPAA Secure Now! – We’re seeing a big wave of healthcare organizations and business associates finally starting to do something about HIPAA. Much of this has been pushed by meaningful use’s risk assessment requirement, but it’s also been driven by all the breaches. HIPAA Secure Now! is offering our readers Free HIPAA Security Training.

Colocation America – Colocation America has been supporting us for 2 years. It’s no surprise that more and more companies are looking to outsource their hosting to a HIPAA compliant hosting solution. Healthcare companies don’t want to be in the hosting business. They want to be in the healthcare business. So, working with a company like Colocation America for their HIPAA compliant hosting needs just makes sense.

A massive thank you to all the companies that support the work we do. We look forward to seeing many from the EMR and HIPAA community at HIMSS in Chicago and then at the Health IT Marketing and PR conference in Vegas.

Healthcare IT Marketing

Posted on November 20, 2014 I Written By

John Lynn is the Founder of the 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 and 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’m excited to tell you that we’ve officially announced the 2nd Annual Health IT Marketing and PR Conference happening May 7-8, 2015 in Las Vegas. We’ll do a full post in the future describing all the details, or you can check out the HITMC conference website for many of the details as well. It’s going to be the greatest gathering of healthcare marketing and PR executives that’s ever been done. People’s response to the first event has been amazing and I believe what we have planned for the second year will be even better. We hope we’ll see you there.

Here at EMR and HIPAA, we continue to grow and reach amazing new milestones. We just passed 10 Million pageviews on just EMR and HIPAA. We’ve done 2142 blog posts and you’ve contributed 9598 comments during that same time. Plus, I’m really excited that the Healthcare Scene blog network has over 29,500 Healthcare Scene email subscribers. I appreciate every reader that trusts us to provide thought leadership on the healthcare IT industry. We’ll keep doing everything we can to provide you value every day.

As part of our regular content, we’ve been working really hard on a number of amazing sponsored blog post series. They’ve been very well received by readers. I previously highlighted the content series that have been sponsored by Medical Management Corporation of America and The Breakaway Group. I’m sure that many of you have also enjoyed the recently started Cost Effective EHR Workflow Series that’s being sponsored by ClinicSpectrum. I’m looking forward to the amazing content these sponsored series provide readers.

Since our last post recognizing companies who support the work we do, we’ve had all of these great companies renew their sponsorships:
Ambir – Advertising since 1/2010
Cerner – Advertising since 9/2011
Canon – Advertising since 10/2012
gMed – Advertising since 8/2013
Colocation America – Advertising since 10/2013
Modernizing Medicine – Advertising since 1/2014

I’m extremely proud of those advertisers who’ve supported us for such a long time. Hard for me to believe that Ambir, for example, is about to reach their 5 year mark advertising on EMR and HIPAA.

A big thanks also goes out to our new sponsors. If you enjoy the content we create, take a minute to check out these companies and see if they can help you in your business:

HIPAA Secure Now! – I’ve written regularly about the need to do a proper HIPAA Risk Assessment in order to avoid any HIPAA penalties and to meet the meaningful use requirements. While you can do the HIPAA risk assessment in house, there’s some real value in having someone outside your organization being the one doing the HIPAA Risk Assessment. Avoids a conflict of interest. If you’re looking for someone to help you with your MU risk assessment, check out what HIPAA Secure Now has to offer.

Blue Horseshoe Network – I think their ad says it all. “Just Call Justina” if you need support for your EHR Go-Live, EHR Training or EHR optimization support. I’ve had a chance to interact with Justina myself and she’s got a lot of energy and passion for the work she does. Check out what Justina and Blue Horseshoe Network can do to help you in your EHR efforts.

Canon – You’ll see that Canon was listed in our renewing advertisers, but I wanted to highlight them here as well since they just started a big email sponsorship campaign with us. Canon is doing a lot of work to bring their fully integrated scanning solutions to healthcare organizations. We appreciate their support of our site and now our email lists as well.

You can get more details on how to get your company added to this list of EMR and HIPAA supporters. Just drop us a note on our contact us page. We’re happy to talk with you and your company about our sponsored content, display ads, email marketing, and webinar options. I think you’ll be impressed by the fully integrated email, SEO, display, and social marketing campaigns we provide.

2000+ EMR and HIPAA Blog Posts and 9.5 Million Pageviews Later

Posted on May 22, 2014 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

We just passed 2000 blog posts on EMR and HIPAA (officially this is blog post #2009) and we’re right at 9.5 million pageviews since we first started this blog. Plus, to round out the numbers, we just passed 12,000 (officially 12,065) comments on the blog as well. I’m honestly not really sure how to process these numbers. Not to mention that nearly 5000 email subscribers get their “daily cup of EMR and HIPAA” in their inbox 6-7 days a week.

Over the years we’ve had a number of writers contribute amazing content to the site, but most of our regular writers contribute to another Healthcare Scene website like EMR and EHR. I’ve generally reserved EMR and HIPAA for the content that I write and so 1705 of the blog posts were written by me. Not too bad for a little over 8 years of writing. I think I’ve accomplished some good.

Every 3-6 months I like to also take a minute to thank the sponsors who support the work we do here at EMR and HIPAA. Without them, I wouldn’t have the time to do what I do and provide the value that we provide the readers of EMR and HIPAA.

Key Sponsors
At the core of supporting our website has always been our sponsors who put up their advertising on the site. Take a look at these companies who’ve sponsored the site and see if one of them can help you and your organization:

Ambir – Advertising since 1/2010 – If you’re looking for a workgroup scanner for your organization take a look at Ambir’s scanners. I have one on my desk at home and it’s worked great. Plus, Ambir is expanding what they do beyond scanners. At HIMSS I saw a demo of their new forms program for tablets that is really slick. You can basically take any paper form and make it so you can write on top of it. It’s a really slick product. I know they’re still adding a few features to the product. Once it’s out in the wild, I’ll do another post about it with more details.

Cerner – Advertising since 9/2011 – I really don’t think anyone needs an introduction to Cerner EHR. The Cerner Ambulatory EHR team has advertised with us for a very long time. One of the things that I find most exciting about the Cerner ambulatory EHR product is their mobile interface. It has some slick features and I think we’re just getting started with optimizing EHRs on tablets and other mobile devices.

Canon – Advertising since 10/2012 – Another company that really doesn’t need an introduction other than to say that this is the Canon scanners, not the Canon cameras. I have a Canon scanner on my desk at work and it’s worked wonderfully well for me. It saves me so much time to have a real workhorse of a scanner. A scanner is one of those essential EHR peripherals and that won’t likely change for a long time to come.

gMed – Advertising since 8/2013 – If you’re in gastroenterology, then you need to take a minute to check out gMed. I recently did a demo and I was particularly impressed with their Endoscopy Report Writer. I loved the way it integrated with external devices and the EHR for easy documentation. Along with being an advertiser, gMed has also invited me to be the keynote speaker at the gMed Summit 2014 (the gMed user group event). I’m really excited to share my insights into the future of EMR and healthcare IT with the gMed users. Those working in gastro should also download this gMed whitepaper: Independent Gastroenterology: A Look into the Future.

interfaceMD – Advertising since 9/2013 – Better than me trying to explain what makes the interfaceMD EHR unique, check out this video interview I did with Joel Kanick, interfaceMD’s founder. The video really shows what a unique approach they take to EHR. I’d describe their approach to EHR a little like having a private butler or concierge service at a hotel. They want to make everything as easy as possible for you and if something’s wrong they’ll take the blame for everything. I think it’s a smart approach that resonates with many doctors.

Colocation America – Advertising since 10/2013 – The demand for HIPAA compliant cloud hosting is only going up and up. Whether you’re a small practice, a large organization, a startup company or a publicly traded healthcare IT organization, you likely need a HIPAA compliant host. Colocation offers a wide variety of options for you to choose from.

Modernizing Medicine – Advertising since 1/2014 – I’ve written a number of articles that describe the Modernizing Medicine EHR much better than I do. Check out their unique EHR interface and their approach to ICD-10 (which I guess will now have to wait another year to be really valuable). I’ll be doing an interview on Thursday next week with Modernizing Medicine’s CEO, Daniel Cane and Chief Medical Officer Dr. Sherling to talk about their new integration between IBM’s Watson with their EHR. Watch the @ehrandhit Twitter account for all the details.

VM Racks – Advertising since 1/2014 – Another HIPAA compliant host you should consider for your hosting needs. One thing I love about VM Racks is that they offer a free 30 day trial of their hosting. What better way to know if they offer a quality service or not than to try it for 30 days?

Quirk Healthcare – Advertising since 3/2014 – While Quirk Healthcare is a newer advertiser, the Founder of Quirk Healthcare advertised with us at his previous EHR consulting company as well. I know they originally cut their teeth on NextGen EHR, but their website says they’ve helped 100 providers go live in 4 months and generated over $2 million in meaningful use payments. They also blog regularly and put on webinars with the latest on meaningful use. When the ICD-10 delay happened they were one of the first that wrote about it. When meaningful use stage 2 was delayed, they were on top of it. I love that about them.

You can get more details on how to get your company added to this list of EMR and HIPAA supporters. Just drop us a note on our contact us page.

Whitepaper Portal
Along with our key sponsors that support the site, a few months back we launched our Healthcare IT whitepaper portal. It’s done phenomenally well as thousands of people have downloaded relevant whitepapers that can help them do their job better. For example, you’ve probably seen me mention this whitepaper that covers the 6 Reality Checks of HIPAA Compliance.

We’re working with a bunch more companies to get some more high quality whitepapers on the portal. So, watch for those in the future. Plus, we’re looking at sharing a few Healthcare Scene specific ones as well. If you’re a company that has an amazing whitepaper, feel free to reach out to us to learn about how you can get it on our portal.

Content Series
We’ve also started doing a number of special blog post series on EMR and HIPAA that are sponsored by the Medical Management Corporation of America and The Breakaway Group. I’ve really enjoyed both of these blog post series and it really shows the depth of knowledge that both companies possess. I really love this content sponsorship model where a company with extraordinary expertise can share their knowledge and experience with the EMR and HIPAA audience while they build some recognition for their companies. Hopefully you’ve enjoyed it as much as I have.

Reader Thanks
Thanks to everyone who reads the site regularly. We couldn’t do what you do without your support as well. We have some of the best readers on the planet. They’re not afraid to share their wisdom, correct us when we’re wrong and improve healthcare as we know it. I’m looking forward to the next 2000 blog posts!

Do Security and Privacy Concerns Drive Cloud Adoption?

Posted on April 24, 2014 I Written By

John Lynn is the Founder of the 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 and 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 one of my recent conversations with Dr. Andy Litt, Chief Medical Officer at Dell, he made a really interesting but possibly counter intuitive observation. While maybe not a direct quote from him, I took away this observation from Dr. Litt:

Security and privacy drives people to the cloud.

Talk about an ironic statement. I imagine if I were to talk to a dozen CIOs, they would be more concerned about the security and privacy implications of the cloud. I don’t imagine most would look at the cloud as the solution to some of their security and privacy problems.

However, Dr. Litt is right. Many times a cloud based EHR or other software is much more secure than a server hosted in a doctors office. The reality is that many healthcare organizations large or small just can’t invest the same money in securing their data as compared with a cloud provider.

It’s not for lack of desire to make sure the data is secure and private. However, if you’re a small doctor’s office, you can only apply so many resources to the problem. Even a small EHR vendor with a few hundred doctors can invest more money in the security and privacy of their data than a solo practice. Although, this is true for even very large practices and even many hospitals.

One reason why I think many will disagree with this notion is because there’s a difference between a cloud provider who can be more secure and private and one who actually executes on that possibility. It’s a fair question that everyone should ask. Although, this can be verified. You can audit your cloud provider and see that they’re indeed putting in security and privacy capabilities that are beyond what you’d be able to do on your own.

What do you think? Is hosting in the cloud a way to address security and privacy concerns?

Will Your EHR Vendor Be Around in 5 Years?

Posted on January 10, 2014 I Written By

The following is a guest post by Angela Carter, marketing manager at ChartLogic.
Angela Carter
A major concern physicians have dealt with over the past 10–15 years has been choosing the right EHR solution for their practice. With the rise and fall of numerous electronic health record companies, that concern has evolved to whether a chosen EHR will still be in business five years from now.

According to the Centers for Medicare and Medicaid Services (CMS), there are over 900 EHR vendors currently on the market, many of whom offer more than one product. In some ways, the huge number of EHR choices has been a good thing for healthcare; it has forced vendors to be more innovative and to cater to the needs of their users. However, the market can’t possibly sustain this many similar projects for long. Eventually, small vendors will be swallowed up by larger vendors and many others will simply go out of business.

So how do you know if your EHR vendor will survive the EHR purge that has already started? Of course there is no way of knowing for sure, but below are a few questions you can ask yourself that will give you a good idea of your EHR’s future.

1. How long has the vendor been in business?

Past performance is usually a good measuring stick for the future. Hundreds of vendors were born after the HITECH Act was passed in 2009, which means that most EHR vendors are still relatively new. Newer EHR companies aren’t necessarily a bad thing—some of them are actually better than some of the legacy systems that have been around for decades—but be wary of any company that doesn’t have the years in business to back it up. A vendor that has already proven it has weathered the EHR storms for 10–15 years will be much more likely to survive current and future challenges than the new, promising EHRs.

Don’t just look at how long the vendor has been in business, though. Research the vendor’s track record as well. If your vendor has a high retention rate—90 percent or higher—then you’re in good company.

2. How usable is the EHR?

For years, doctors put up with EHRs that didn’t meld with their workflow, but that tolerance is coming to an end. Black Book Rankings called 2013 “The Year of the Great EHR Switch” because most EHR implementations happened in practices that were on their second or third EHR. The reason for this shift? Usability. Eighty-seven percent of doctors cited usability as their primary complaint about EHRs. (Source:

For some reason it took many years for usability of EHR systems to catch on, but now that it has, the difficult-to-use systems will have a difficult time holding on to customers. Point-and-click EHRs have never been popular among physicians, especially those who see 50+ patients a day. EHRs that utilize voice technology, though, are growing in popularity. It is highly unlikely that any EHR system will cater 100 percent to a physician’s needs and preferences, but voice offers much more flexibility than traditional point-and-click systems do, not to mention voice-driven systems are more likely to follow the workflow physicians already use.

3. How well does your vendor understand your specialty?

The reason the industry hasn’t settled on just a couple of vendors by now is because workflow among different specialties varies so widely. Physicians need vendors that are very good at their specialty, not those that claim to answer to the needs of all physicians. A vendor that dedicates itself to producing and improving capabilities that align with your specific needs will take much better care of you. Not only that, but they will be more able to evolve with you as technological demands change, giving the company more stability in a shaky market.

4. How’s the support?

Never underestimate the power of a good support team. Most EHRs aren’t designed to work flawlessly fresh out of the box; you need adequate training and ongoing support, too. A recent Software Advice survey revealed that about 60 percent of respondents reported “learning to use the system” as a one of the main challenges with their EHR, even more challenging than achieving meaningful use or finding costs to support the system. (source:

As a business metric, support may be even more powerful than usability, especially since federal regulations keep tightening, limiting the freedom to change certain aspects of an EHR. A vendor that communicates with its customers regularly will stand out.

5. Is the vendor ready for meaningful use stage 2? ICD-10?

Over a thousand vendors certified for meaningful use the first time around. Less than 40 of those vendors have received complete ambulatory certification required for 2014. Add ICD-10 to the mix and very few vendors will be able to keep up with these increasingly difficult technological advancements. Vendors that don’t have a plan already in place regarding how they will re-certify for meaningful use and be ICD-10 compliant will be among the first to go.

A vendor that scores well in each of the five questions above will most likely have what it takes to make it through the next five years.

Angela Carter is a marketing manager at ChartLogic, an EHR for orthopedists, ENT doctors, and other specialists. In addition to managing all of the company’s content, she writes regular blog posts for various health IT sites. She is also the associate editor for Utah Technology Magazine, a start-up magazine that aims to tell the tech story happening in Utah.

Thankful for Amazing Support

Posted on December 2, 2013 I Written By

John Lynn is the Founder of the 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 and 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’m so excited. Things are coming together for a really big announcement next Monday. I’m really excited about what we’ve put together and I think many readers will be interested in it as well. I’ve leaked the idea a little bit on Twitter, but I should be able to announce a lot more details next Monday. Watch for that next week.

Until then, it seems really appropriate at this time of Thanks to take a few seconds to recognize the many sponsors who support the work we do here at EMR and HIPAA. It’s been a really great 6 months and we’ve received a lot of amazing support. In fact, I’m really pleased by the variety of healthcare IT companies that are supporting the work we do.

I hope you’ll take a second to look over these new and renewing sponsors to see if they can help you solve some of your pressing issues.

New Sponsors
interfaceMD – This EHR company is quite unique. Rather than try and explain their unique approach to EHR and EHR implementation, take a second and watch this video interview I did with interfaceMD CEO Joel Kanick. I think many of the things he shares will resonate with small practices out there. Joel and interfaceMD have taken a really holistic approach to implementing an EHR and all the IT in between. Check them out if you want to see what I mean.

Proven Backup – One of the biggest risks of any EHR is not having a proper backup. Unfortunately, many don’t pay attention to their backup plans until it’s too late. The best way I’ve seen to solve this is to do a mock situation where your database is corrupt. What will it take you to restore from backup? Do you have a backup that works? The beauty is that there are relatively inexpensive backup offerings like the one from Proven Backup. Done correctly, your EHR backup can be much more robust and less risky than paper ever could be.

Colocation America – One of the major features of all healthcare IT is the need for some sort of hosting. Colocation America offers a wide variety of hosting options for applications and organizations of all sizes. As a past server admin and data center manager myself, I can’t ever imagine building my own data center again. The service a hosting company like Colocation America provides is impossible for small organizations to build on their own and is likely out of reach for even the largest organizations.

HealthFusion – Some might not recognize this name, but might be more familiar with HealthFusion’s MediTouch EHR software. If you want to find out what’s unique about Health Fusion, check out this interview with HealthFusion’s Co-Founder and CEO. I was really interested with HealthFusion’s efforts to incorporate the native iPad interface in their EHR very early on. I don’t know many other EHR vendors who can say that “every EHR function that can be performed on the desktop can also be performed on the iPad.”

Doc Halo – HIPAA secure texting is starting to hit healthcare in a really big way. Many in healthcare have found the value of a simple text message communication. However, every healthcare compliance department is scared about the HIPAA implications of such text messages. The answer to this is to empower the end users to have the simplicity of a text message, but done on a secure platform like Doc Halo. If you want to learn more, the Doc Halo CEO has been contributing a number of blog posts on the subject as well.

gMed – If you are a gastroenterologist, then you need to take a look at gMed’s EHR solution. I’ve always been a fan of the specialty specific EHR software. They can offer a unique experience that gets washed over by most of the EHR vendors who want to apply a one size fits all approach to EHR. If you’re interested in Gastroenterology, you’ll want to check out this excellent whitepaper on the Future of Gastroenterology.

The Breakaway Group (A Xerox Company) – Many of you may recognize this company since they’ve been doing a monthly series of blog posts called Breakaway Thinking. You can expect a lot more amazing content on EMR and HIPAA from the talented people at The Breakaway Group. They have a lot of first hand experience with EHR training and ICD-10 training. Being on the front lines provides them some really interesting insight into the industry.

Renewing Sponsors
I’m always thankful for the ongoing support of our renewing sponsors. So, a big thanks to all of the companies listed below for renewing their support of us. It’s great to look over so many of these companies who have been supporting us for so many years. Here’s to many more years working together.
Ambir – Advertising since 1/2010
Amazing Charts – Advertising since 5/2011
Cerner – Advertising since 9/2011
simplifyMD – Advertising since 9/2012
Canon – Advertising since 10/2012

Look for the really big announcement next Monday.

Great EMR and HIPAA Supporters

Posted on October 21, 2013 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

We have a number of really big announcements we’re going to make in the next month. One of them I can’t really mention, but the other is a Healthcare Marketing and PR Focused conference in Las Vegas (of course, since I live in Vegas). I’ve floated this conference idea to a couple healthcare marketers and their response has been nothing short of amazing. I think they’re really excited to go to a conference which helps them do their jobs versus going to conferences to market their company. Watch for the official announcement to come out soon. Plus, the other announcement I can’t talk about is even more exciting for the network.

With that said, Healthcare Scene (which EMR and HIPAA is a part) is doing really well. We’re well over 12 million pageviews and over 6500 blog posts since we started blogging on EMR back in 2005. I want to take a second to thank all those organizations that support what we do. Some have just started working with us and then there are many who have been supporting us for a lot of years. Either way, their support is always appreciated.

If you enjoy the content we create, I hope you’ll take a second to check out these EMR and HIPAA supporters. Their support keeps the lights on.

New Supporters
interfaceMD – One of the things I like about how interfaceMD looks at the EHR market is that each installation needs some custom work to match the unique needs of a doctors office. To use the oft quoted phrase, if you’ve seen one clinic, you’ve seen ONE clinic. I’ll be doing a G+ Hangout with the interfaceMD President and CEO, Joel Kanick where I’m sure we’ll explore this topic more.

DrChrono – A lot of EHR vendors talk about their iPad EHR application, but there are few EHR vendors that have created an iPad first EHR application. That’s the way DrChrono has approached the development of their EHR. Plus, they offer a free version where you can give their EHR a test drive before you buy. Just download the drchrono EHR on your iPad and try it out.

gMed – I’ve often written about the value of specialty doctors purchasing a specialty specific EHR. If you’re looking for a Gastroenterology EHR, then you should check out gMed. Plus, they’ve even put out this free whitepaper called Independent Gastroenterology: A Look into the Future. It’s a good example of their deep understanding of gastroenterology.

The Breakaway Group (A Xerox company) – This company takes a really unique approach to EHR and ICD-10 training. Plus, I love that they have deep roots in researching the most effective leaning techniques which they then use to refine their product. So, I’m excited to have them contributing to a monthly series of blog posts that we’re calling the Breakaway Thinking Blog Series.

GNAX Health – As healthcare IT continues to be implemented, I’m seeing more and more organizations looking at their disaster recovery plans using an external data center. GNAX has a whitepaper called Healthcare IT Disaster Recovery: 9 Steps to Help Target a Reliable DR Datacenter where they cover some of the challenges associated with finding the right disaster recovery data center. The time to prepare the disaster recovery is now and now when the hurricane is bearing down.

Renewing Supporters
These organizations have renewed their support of EMR and HIPAA. It’s always appreciated to see these companies renew year after year.
Ambir – Advertising since 1/2010
Amazing Charts – Advertising since 5/2011
simplifyMD – Advertising since 9/2012
Canon – Advertising since 10/2012
Xerox – Advertising since 2/2013

Thanks for reading!

The EMRs You Don’t Hear About

Posted on September 4, 2013 I Written By

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

The best-known EMRs got that way because they target the masses. About a third of the country’s physicians focus on primary care, with the remainder fragmented across dozens of specialties and subspecialties. It’s easy to see, then, why the major EMRs are primary-care centric.

For specialists, the solution is often to use a general EMR and tailor it, with templates and other features, for the field’s common diagnoses and treatments, as well as its workflow. The question is whether the customization is enough. After all, the practice of, say, a nephrologist, who focuses on kidney ailments, doesn’t look much like that of the average family practitioner. And that’s not even considering other health care providers, such as optometrists, who aren’t MDs but who are eligible for meaningful use incentives all the same.

Some providers, then, choose a single-specialty EMR. Sometimes it’s a specific product from a larger health IT company. In other cases, it’s software from a vendor operating in but one niche.

Here are a few specialties with very specific practice patterns and the vendors who serve them with EMRs and practice-management software.

  • Nephrology. Physicians in this specialty deal with conditions and treatments such as kidney stones, hypertension, renal biopsy and transplant. A major part of the workflow is dialysis. One vendor catering to this specialty is Denver-based Falcon, which claims that its electronic notes transfer feature can “bridge the gap between your office EMR and dialysis centers.”
  • Eye care. Care in this field is provided by ophthalmologists, optometrists and opticians. Diagnosis and treatment rely on equipment and techniques unlike those found anywhere else in medicine. If you’ve ever had your eyes dilated, you know this is true. Hillsboro, Ore.-based First Insight created MaximEyes with eye care’s peculiar workflows in mind.
  • Gastroenterology. More commonly referred to as Gastro or GI. Florida based gMed (Full Disclosure: gMed advertises on this site) focuses on GI practices with GI specific problem forms, order sets, history forms, and Endoscopy reports to name a few. Plus, they are the only EHR which reports directly to the AGA registry.
  • Podiatry. These specialists of the foot train in their own schools. Bunions, gout and diabetic complications are among the problems they treat with therapies ranging from shoe inserts to surgery. DOX Podiatry, based in Arizona, concentrates on this field, providing clinical, scheduling and billing and collections modules. Its clinical component starts with a graphic of a foot, allowing the podiatrist to specify the problem area and tissue type. DOX claims that the software can eliminate the need to type reports.
  • Addiction. Chemical dependency and behavioral health providers include a variety of specialists, including psychiatrists, psychologists and counselors. Documentation in the field must account for outpatient, inpatient and residential services and for individual and group counseling sessions. Buffalo, N.Y.-based Celerity addresses the heavily regulated industry with its CAM solution, developed by a clinical director in the field.
  • Oral Surgery. This field is a dental specialty focused on problems of the hard and soft tissues of the mouth, jaws, face and neck. As such, an oral-surgery EMR needs heavy-duty support for the anatomy in play. DSN Software, based in Centralia, Wash., sells Oral Surgery-Exec for this group of providers. You might actually have heard about this one, because I interviewed its creator, Dr. Terry Ellis, in July for a post called “Develop Your Own EMR Crazy, But This Guy Did It Anyway.” In fact, there’s nothing crazy about using an EMR custom-designed for the work you do.

EHRA’s EHR Code of Conduct – Will Anything Change?

Posted on June 11, 2013 I Written By

John Lynn is the Founder of the 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 and 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 big news that had to be covered today was the announcement by the EHR Association about the EHR Developer Code of Conduct. The core topics of the EHR Developer Code of Conduct are great:

  • General business practices
  • Patient safety
  • Interoperability and data portability
  • Clinical and billing documentation
  • Privacy and security
  • Patient engagement

Certainly there are other areas that I would have loved to see included, like EHR usability, but if we could address each of the areas listed above we’d have a big improvement over where we are today. Be sure to also check out the EHR Developer Code of Conduct and FAQs document and the EHR Developer Code of Conduct Implementation Guide for the full details on the EHR Code of Conduct.

The problem I have with this EHR Code of Conduct is that it has no teeth. There’s no enforcement mechanism or reporting mechanism to show how an EHR vendor has chosen to implement the code of conduct. They won’t even commit to having a list of EHR vendors that have adopted it. Trust me when I say that for every element of the EHR Code of Conduct, there’s A LOT of room for interpretation.

Where there’s room for interpretation, there’s room for abuse.

Obviously, when you bring together 40 EHR vendors it’s a real challenge to create something that has no interpretation. However, it seems they could have created a way to display how an EHR has chosen to meet the EHR code of conduct guidelines.

For example, the guideline says, “We will work with our customers to facilitate the export of patient data if a customer chooses to move from one EHR to another.” Then, it even sets a minimum export of a CCD/CCDA document. We could discuss how that type of document is nearly enough to switch EHR software, but even if it was enough, there’s a lot of ways you could implement this guideline. An EHR vendor could let the customer download a CCD for each patient individually and leave it to the customer to download all 5000 individual CCDs for their patients. That meets the guideline, but would be very different than an EHR vendor that gave you a one click download of CCDs for all your patients.

This qualitative data about how an EHR vendor has implemented the code of conduct should be easily available to doctors to compare across vendors. Otherwise, it has much less meaning and a lot of doctors will get bamboozled by the impression “commitment to the EHR Code of Conduct” implies. It’s similar (and even worse) than the pass/fail EHR certification. Not all certified EHR are created equal and not all EHR Code of Conduct adopters will be equal either. Why not be transparent about how they meet the code?

In the webinar they suggested that “the industry itself will kind of make it transparent who has adopted the code and who hasn’t adopted the code.” Maybe a third party will make that data available, but it’s a lot of work without a clear mechanism to pay for the work.

The other part of the code of conduct that really bothers me is the question posed in the title of this blog post: Will anything change? I loved a question that was asked on the webinar, “What pieces of the code of conduct were an EHR vendor not doing before the code?” They skirted the question saying that they couldn’t comment on it and some other tap dancing around the question. Does this mean that EHR vendors will just use the EHR Code of Conduct’s false trust to sale more product while doing little to change operationally? I’m certain this is not the intent of the committee, but could be the end result if those adopting the EHR Code of Conduct aren’t held accountable.

I got comments from two EHR vendors about the EHR Code of Conduct. Take a look to see what SRSSoft’s CEO Evan Steele said in their press release:

“SRS has always been committed to the principles identified in the Code of Conduct—designing our products with patient safety in mind, supporting physician/patient ownership of their data, safeguarding privacy and security, and communicating honestly in the marketplace,” says Evan Steele, CEO of SRS. “We are pleased to be among the first EHR companies to adopt the formal code, and hope that all vendors will follow suit.”

And John Glaser in the Siemens comment:

“The release of the EHR Developer Code of Conduct by the EHR Association is an important milestone in the maturation of the healthcare information technology industry, and we at Siemens Healthcare are proud to have supported its drafting and ratification,” said John Glaser, PhD, CEO, Siemens Healthcare, Health Services. “The Code of Conduct includes many elements that just make too much sense to be ignored and it’s my belief that Siemens and many players in this industry have already been adhering to many of these principles. Codifying these principles and providing a transparent way to show customers that companies are going to adopt them will help propel our industry’s ability to deliver safer, more effective and more interoperable solutions.”

It’s not like an EHR vendor’s going to come out and say they weren’t following the Code of Conduct principles. They’re not going to come out and say they don’t care about the EHR Code of Conduct principles either. The question is whether they state it in public or not, will EHR vendors really change? I have my doubts without a clear mechanism of accountability.

In some ways this reminds me of the doping scandal in cycling. Everyone knew that everyone else was doing it and no one wanted to say anything to rock the boat because it would mean they’d have to admit to doing it. Once a few cyclists stopped doping, they were at a disadvantage to those who continued the unhealthy practices.

I vividly remember in the post-Lance Armstrong years an interview with Levi Leipheimer where he was asked about doping. He tersely responded, “I hope all the dopers and cheaters get caught. It’s not fair that I’m having to compete with them.” (Not an exact quote, but you get the gist) Once he stopped doping he knew he was at a disadvantage. He wanted those that were still doping to be held accountable. I wonder if we’ll see something similar play out in the EHR world. Some EHR vendors follow the letter and intent of the code of conduct while other EHR vendors continue to skate around the edges since there’s still nothing holding them accountable. Just like Levi couldn’t name names in his interview, EHR vendors won’t be able to name names either.

As I said to start this post, I love the intent of the EHR Code of Conduct. I just worry that it will do little to change the EHR world as we know it.

I’d also be remiss if I didn’t also share a comment someone made on the Code of Conduct announcement webinar. Someone obviously didn’t realize their mic was on and they said, “It’s a love fest, an EHR Love Fest!” I’m not sure who it was that said it or why exactly they said it, but it gave me a good laugh. I always love a good EHR love fest myself.