As is often common at the end of the year, a lot of companies have started putting together their “Top 10″ (or some similar number) lists for 2011. In fact, some of them have posted these lists a little bit earlier than usual. This week as people are often off work or on vacation, I thought it might be fun to take one list each day and comment on the various items people have on their lists.

The first list comes from Booz Allen Hamilton and is Booz Allen’s Top 9 ways IT is Transforming healthcare. Here’s their list of 9 items with my own commentary after each item.

Reduces medical errors. I prefer to say that Health IT has the potential to reduce medical errors. I also think long term that health IT and EMR will reduce medical errors. However, in the interim it will depend on how people actually use these systems. Used improperly, it can actually cause more medical errors. There have been studies out that show both an improvement in medical errors and an increase in medical errors.

My take on this is that EMR and health IT improves certain areas and hurts other areas. However, as we improve these systems and use of these systems, then over all medical errors will go down. However, remember that even once these systems are perfect they’re still going to be run be imperfect humans that are just trying to do their best (at least most of them). Even so, long term health IT and EMR software will be something that will benefit healthcare as far as reducing medical errors.

Improves collaboration throughout the health care system. I’m a little torn as we consider whether health IT improves collaboration. The biggest argument you can make for this is that it’s really hard to be truly interoperable in really meaningful and quick ways without technology. Sure, we’ve been able to fax over medical records which no one would doubt has improved health care. However, those faxes often get their too late since they take time to process. Technology will be the solution to solving this problem.

The real conundrum here is the value that could be achieved by sending specific data. A fax is basically a mass of data which can’t be processed by a computer in any meaningful way. How much nicer would it be to have an allergy passed from one system to another. No request for information was made. No waiting for a response from a medical records department. Just a notification on the new doctor’s screen that the patient is allergic to something or is taking a drug that might have contraindications with the one the new doctor is trying to prescribe. This sort of seamless exchange of data is where we should and could be if it weren’t for data silos and economics.

Ensures better patient-care transition. This year there was a whole conference dedicated to this idea. No doubt there is merit in what’s possible. The problems here are similar to those mentioned above in the care collaboration section. Sadly, the technology is there and ready to be deployed. It’s connecting the bureaucratic and financial dots to make it a reality.

Enables faster, better emergency care. I’m not sure why, but the emergency room gets lots of interesting technology that no one else in healthcare gets. I imagine it’s because emergency rooms can easily argue that they’re a little bit “different” from the rest of the hospital and so they are able to often embark on neat technology projects without the weight of the whole hospital around their neck.

One of the technologies I love in emergency care is connecting the emergency rooms with the ambulances. There are so many cool options out there and with 3G finally coming into its own, connectivity isn’t nearly the problem that it use to be. Plus, there are even consumer apps like MyCrisisRecords that are trying to make an in road in emergency care. I’d like to see broader adoption of these apps in emergency rooms, but you can see the promise.

Empowers patients and their families to participate in care decisions. Many might argue that with Google Health Failing and Microsoft HealthVault not making much noise, that the idea of empowering patients might not be as strong. Turns out that the reality is quite the opposite.

Patients and families are participating more and more in care decisions. There just isn’t one dominant market leader that facilitates this interaction. Patients and families are using an amalgamation of technologies and the all powerful Google to participate in their care. This trend will continue to become more popular. We’ll see if any company can really capture the energy of this movement in a way that they become the dominant market leader or whether it will remain a really fluid environment.

Makes care more convenient for patients. I believe we’re starting to see the inklings of this happening. At the core of this for me is patient online scheduling and patient online visits. Maybe it could more simply be identified as: patient communication with providers.

I don’t think 2011 has been the watershed year for convenient access to doctors by patients. However, we’re starting to see inroads made which will open up the doors for the flood of patients that want to have these types of interactions.

Helps care for the warfighter. This is an area where I also don’t have a lot of experience. Although, I do remember one visit with someone from the Army at a conference. In that short chat we had, he talked about all the issues the Army had been dealing with for decades: patient record standards, patient identifiers, multiple locations (see Iraq and Afghanistan), multiple systems, etc. The problem he identified was that much of it was classified and so it couldn’t be shared. I hope health IT does help our warriors. It should!

Enhances ability to respond to public health emergencies and disasters. I’ve been to quite a few presentations where people have talked about the benefits and challenges associated with electronic medical records and natural disasters. They’ve always been really insightful since they almost always have 5-6 “I hadn’t thought of that” moments that make you realize that we’re not as secure and prepared for disasters as we think we are.

It is worth noting that moving 100,000 patient records electronically to an off site location is much easier in the electronic world than it is in paper. With paper charts we can’t even really discuss the idea of remote access to the record in the case of a natural disaster.

Possibly even more interesting is the idea of EMR and health IT supporting public health emergencies. We’re just beginning to aggregate health data from EMR software that could help us identify and mitigate the impact of a public health emergency. Certainly none of these systems are going to be perfect. Many of these systems are going to miss things we wish they’d seen. However, there’s real potential benefit in them helping is identify public health emergencies before they become catastrophes.

Enables discovery in new medical breakthroughs and provides a platform for innovation. Most of the medical breakthroughs we’ve experienced in the last 20 years would likely have been impossible without technology. Plus, I don’t think we’ve even started to tap the power that could be available from the mounds of healthcare data that we have available to us. This is why I’m so excited about the Health.Data.Gov health data sharing program that Priya wrote about on EMR and EHR. There’s so many more medical discoveries that will be facilitated by healthcare data.

There you have it. What do you think of these 9 items? Are there other things that you see happening that will impact the above items? Are there trends that we should be watching in health IT in 2012?

Be sure to read the rest of my Health IT Top 10 as they’re posted.

In a post on EMR and EHR about Pharma and Health Plans paying for EMR software, I got the following comment from Aaron Holloway:

I am partnered with a Practice Management/EMR/EHR platform and we are in negotiations now with Pharma companies who are interested in subsidizing the platform from many perspectives:
1. Integration option of a sales visit app for rep’s (details, samples, etc.)
2. De-identified data procurement (measure brand impact)
3. Ad placement (lessor priority/ROI)

I’ve previously posted about the riskiness of pharma ads in EHR, but also have commented on how pharma ads in EHR are inevitable. However, I thought Aaron’s comments provided some interesting new ways I hadn’t heard for pharma to interact with a doctor thought an EHR than I had heard before.

I’m sure some people like Bruce Friedman from Lab Soft News will still be a little concerned whenever Pharma puts their fingers into things. Bruce has a right to be concerned. However, I still believe that it’s going to happen. So, I’d rather be part of the discussion than to sit back and say it shouldn’t happen while it happens anyway.

Yesterday, I created a post on EMR & EHR called The Must Have EMR Feature – An iPad Interface. that post has driven quite a bit of discussion on Twitter and Google Plus. One comment from @2charlie hit me the most though:

2charlie – Charlie Gaddy
A decent web interface wouldn’t hurt either. RT @ehrandhit: The Must Have EMR Feature – An iPad Interface dlvr.it/tYkN7

Charlie’s twitter response highlights a number of interesting ideas. The first point that every SaaS EHR company will point out is that he said a web interface. We could go into the semantics of what is “the web”, but I have little doubt that Charlie meant a browser based interface when he said web. I’ll leave the rest of the discussion of “web” EMR interfaces for another post (plus, we’ve had that discussion many times on this site).

Instead, I want to focus on his use of the word “decent.” That adjective is interesting because no one would really argue that there aren’t plenty of web EMR interfaces out there. If you look at the EHR Scope EMR Comparison site, you’ll see a huge number of web based EMR companies listed. However, when you add the word “decent” to web EMR interface, I think we could have some really interesting discussion.

At least a couple times a week I get a doctor sending me an email or posting a comment on my website saying that “all of the EMR interfaces are terrible.” I don’t necessarily agree that “all” EMR interfaces are terrible, but a lot of them do fit the description quite well. I’m sure at this point all the EMR companies are thinking about their competitors and agreeing with me.

The iPad Opportunity for EMR Interfaces
As I thought on Charlie’s comment of a “decent web interface” as compared with an iPad EMR interface, I realized that the iPad provides a unique opportunity for EMR vendors with less than stellar web interfaces. While it would be great for EMR vendors to create stellar web interfaces or improve their current web interfaces, that’s much easier said than done. Many are working on older technologies. Others have so much company culture built into their interface that it’s hard to change. Many have large user bases that will freak out at the idea of a new web interface. Etc etc etc! The point being that the culture and history of many EMR interfaces make it hard to change.

In these cases, I see the iPad as a great opportunity to start fresh with your EMR interface. Many EHR vendors could use the iPad as a way to be able to create a new interface for their EMR with all the knowledge they’ve learned over the years baked in. Doctors expect the iPad interface to be different and unique.

I’ll be interested to see which EMR companies take this opportunity and make something of it. It’s the perfect chance for EMR companies to create a paradigm shift in their EMR software without having to admit publicly the mistakes they made in their first EMR interface. Unless you happen to be from an EHR company who built the perfect EMR interface from the start. Then, this need not apply.

Looks like Estonia is the new model for system wide EHR http://bit.ly/liYLwe

June 19, 2011 10:27 pm via TweetDeckReplyRetweetFavorite

@boltyboy

Matthew Holt

I’m always fascinated by other countries EHR implementations. So many other countries are interesting to consider since they’re missing so many of the barriers that make EHR adoption and even more specifically health information exchange between EHR software so difficult. Nice to learn more about the success that Estonia has had adopting EHR software. I’d like to learn a lot more about what’s being done with international EHR implementations.

The difference between an ambulatory and hospital EHR http://goo.gl/fb/YDWaO

June 19, 2011 7:01 am via GoogleReplyRetweetFavorite

@kevinmd

Kevin Pho, M.D.

I often have an internal battle when writing on this blog when I’m writing something that’s ambulatory EHR specific versus Hospital EMR specific. In fact, I was struck when someone recently told me that this site focuses more on hospital EMR and not ambulatory. I had to laugh since when I write, I’m mostly writing from the hospital EMR perspective.

This stuff aside, there are distinct differences between a hospital EHR software and an ambulatory EHR software. The article linked above highlights some of those differences. Coincidentally, I’m going to be working to write more about specific hospital EHR issues on the aptly named Hospital EMR and EHR blog. If you like Hospital IT, then go and sign up for the Hospital EMR and EHR email list. It will be a nice compliment to this blog and the EMR and EHR blog. I’ve got 3 other writers that will be starting to write on that blog as well. I’m excited to learn more about large hospital EHR vendors like the mythical Epic. Plus, as I learn more about hospital specific EHR issues, I think the content on this site will benefit as well.

I found a couple interesting tweets from EMR answers. Some interesting advice for those interested in EMR and EHR.

#EMR #EHR Vendors- busy w/ #MU R&D. Demo specific to #physician spec. & work flow. Watch for clicks, alert fatigue and “One size fits all”

May 15, 2011 8:16 am via webReplyRetweetFavorite

@EMRAnswers

Linda Lia Stotsky

Some good advice and scary thought that all the EMR and EHR vendors’ R&D is going to meaningful use.

#EMR #EHR 101.Vendor Customization.”Fit” system to #physician, specialty, #RN w/flow. Invest time on front end b4 losing $$ after “Go Live”

May 15, 2011 8:10 am via webReplyRetweetFavorite

@EMRAnswers

Linda Lia Stotsky

Definitely better to invest up front. Sadly, our society seems to be all about the immediate result and not the long term investment.

Today I’m happy to officially introduce readers of EMR and HIPAA to my latest project: The Healthcare Scene blog network. If you follow me on twitter (@techguy and @ehrandhit), then you’ve probably already come across one or more of the great blogs in this new healthcare IT blog network. I’m really excited with the group of bloggers that I have working on the network and the amazing content they’ve been creating and will create.

Before I introduce you to the various websites on the network, here’s a little background in why I decided to do this. As I looked at the various healthcare IT and EMR bloggers producing content, I was disappointed that many of them were creating great content that wasn’t getting nearly as much attention and traffic as the content deserved. Plus, many hadn’t benefited financially from all the great content they were creating. Combine lack of traffic with lack of financial rewards and these independent voices often disappear.

I saw this as a real opportunity to leverage many of the marketing and advertising tools that I’d created for EMR and HIPAA to the benefit of many others in the EMR and healthcare IT world. Plus, a number of my current advertisers told me that there weren’t enough online healthcare IT advertising options out there. I see this network as a real win for everyone. Independent bloggers can have their voices magnified while making money doing so. Readers and the EMR and Healthcare IT industry get more independently created content (including content by doctors). Healthcare IT advertisers will have more opportunities to advertise next to great content. I get to expand my network and work with a bunch of really smart people.

Now here’s a look at the websites that will be part of the Healthcare Scene blog network:

• Meaningful HIT News – This blog written by Neil Versel started in May 2004 and has over 500 posts. Neil is one of the only pure healthcare IT journalists out there and has been doing it for the past 15 years across more publishers than you can count, but most recently at Fierce Healthcare. I’m excited that Neil has chosen to move his blog to the HealthcareScene.com blog network. He’s a must read journalist for anyone in EMR and healthcare IT. I borrowed much of my writing style from Neil and so if you like this site, go and subscribe to Meaningful HIT News email list and you won’t be disappointed.
• EMR and Healthcare IT News – The firehose of EMR and Healthcare IT news sent out by vendors. A great way for vendors to get their word out and for industry people to see the latest developments in EMR and healthcare IT. I’m looking to partner with healthcare IT PR firms on the site, so hit my Contact Us page if you’re interested.
• Happy EMR Doctor – This blog first started out as a Doctor’s Blog guest post on EMR and EHR, but the content from Dr. West was too good. So, I rolled it off onto its own blog. Dr. West has been through a failed EHR implementation and now is using one of the Free EHR vendors. So, he has some interesting stories to tell.
• Smartphone Health Care – I recently heard that there were something like 30+ mobile health conferences or conferences with a mobile health track in the past year. That seems like far too many, but it is quite clear that Smart Phones and other mobile devices are going to play a huge role in the future of healthcare. Consider this my foray into the mHealth world.
• Wired EMR Practice – Many of you might remember that I already introduced Dr. Koriwchak’s blog on EMR and HIPAA earlier. Many of you subscribed to his blog and have seen the type of quality content he’s creating. I love doctor’s perspectives on EMR.
• nextHospital – We’ll see how this blog evolves, but it’s the Healthcare Scene’s first blog that isn’t really IT focused. Written by Katherine Rourke (mentioned above), nextHospital will focus on the business of healthcare in hospitals.
• EMR, EHR and HIPAA Wiki – Not a blog, but a pretty cool part of the network nonetheless. Be sure to add your EHR vendor if it’s not on there already.
• EMR and EHR Job Board – Not a blog either, but this job board will be syndicated across all the HealthcareScene.com websites. So, it’s a great places to post or look for a job.
• EMR and HIPAA – Hopefully it needs no intro if you’re reading this post. Let’s just say, 1000 posts, 4713 comments, and over 4 million pageviews.
• EMR and EHR – Very similar to EMR and HIPAA, but only about 2 years old. 300 posts, 1092 comments and 700,000+ pagevies. Katherine Rourke, a healthcare IT journalist with 15+ years of experience, recently started posting on EMR and EHR and is a welcome addition to the site.

I’d say that’s a pretty good start. I’m in talks with a few more bloggers that may or may not join the network. I think there’s still some interesting niches that haven’t been filled. For example, a blog tracking publicly traded healthcare IT stock movements and other healthcare IT investment opportunities could be interesting. Either way, I’m excited to see all the great content that will be created on these sites. Much like this site, each site encourages you to respectfully comment, share the content, and join the conversation. Please let your voice be heard in the comments.

Yes, right now each site looks very much like the rest, but we’re just getting started. Over time I’ll work to give each blogger it’s own brand while also building up the HealthcareScene.com domain to better represent all the activity that’s happening on the network. I see it becoming a virtual hub of the best and brightest conversations happening in and around healthcare IT and EMR.

Let me know what you think of these additions in the comments or drop me a note on my Contact Us page.

As you know on the weekend, I try to do my simple posts since most of you are enjoying the weekend like you should.

Today I thought it might be interesting to point to a few different EMR and healthcare IT blog recommendations. This is far from an inclusive list. In fact, I could probably do this every weekend and not repeat the same blog recommendations. Maybe I will! Especially since then as I read various other blogs I can remember to make note of it. So, for this post I’ll start with some popular ones that many people know about.

Fierce EMR – I really like the work that Neil Versel does and Fierce is lucky to have him working on their EMR content.

HIStalk – This is often a bit too hospital focused for my tastes. They do have HIStalk Practice which is more ambulatory focused and has gotten better as Inga’s focused on it more.

Chilmark Research – I really enjoy John’s blog. He does a good job analyzing HIE, EHR and mobile healthcare. The only complaint is that he doesn’t publish enough, but that’s ok. When he does publish it’s almost always an interesting read.

The Health Care Blog – My only complaint about The Health Care blog is that often times it has a lot of posts that aren’t related to health care IT. Although, it does have a strong group of health care IT bloggers that do some great IT and EMR related posts.

Like I said, there are dozens and dozens of other ones. These are a few of the ones that have been around for quite a while doing their thing. I’ll cover some more of the other blogs I enjoy next time. Or you could just keep reading this site and my other blogs (EMR and EHR & The Wired EMR Practice) where I try to write about a lot of the major happenings in the EMR and healthcare IT world.

Many of you have likely noticed that I like to use the terms EMR and EHR almost synonymously. In fact, it’s kind of a game for me now. I generally try to stick with one term for a certain blog post, but I even break that rule on occasion. I guess the thing is that it really doesn’t matter to me at all.

I don’t like to debate the meanings and definitions of words since it doesn’t matter how you define a term. Instead, I just try and communicate the substance of the issues. Words matter as part of that communication, but whether I call it an EMR or an EHR doesn’t change the value of what I’m trying to communicate (at least 99% of the time).

There are a few rare cases when I do differentiate. For example, I would likely never say that you need a “certifed EMR” to get the available HITECH Act stimulus money. I wouldn’t do so because the legislation specifically says “certified EHR” and so I’d respect the verbiage. Although, these cases are few and far between.

Plus, I try to be the voice of the physician. I’d bet if you asked most physicians the difference between an EMR and EHR they’d likely laugh, walk away or know what an EMR was but ask you to define the term EHR. I, like most physicians, don’t care what you call it. They (and I) care more about the substance of selecting, implementing, using, maximizing, enjoying and even sometimes enduring an EMR or EHR.

As you can imagine my inbox has been kind of blown up with all the people talking about the final meaningful use rule. It’s going to take a bit to really digest what the final rule will mean for healthcare and EMR in general. I’m still trying to digest everything that’s been said and the 864 pages of the meaningful use rule (seriously, that’s longer than most books I read). Later today I’ll be posting a list of links to the various meaningful use articles and summaries I find on EMR and EHR. I think that will become a really valuable resource since a lot of people have done a lot of digging into the rule already.

While I still have some concerns about how doctors will or will not take to the meaningful use rule and the EMR stimulus money, I have to admit that HHS did scale back some of the requirements rather significantly. I’ve always found David Blumenthal and the other people at ONC to be sincere people that were trying to make a sincere effort to make this work. I think the changes to the meaningful use rule reflect this sincerity also.

Of course, the million dollar question is what will doctors think? There going to be inundated with information. I’m pretty sure a lot of doctors aren’t going to know which way is up and will be sitting out at list the first round of fun to see how their colleagues who take the meaningful use plunge fair first.

Also, here’s the 864 pages of the meaningful use final rule for those who want to go to the source:

If you want to see the HHS dog and pony show that you missed yesterday, I’ve embedded the video of the press conference for meaningful use below:

A lot of people have been asking me lately how long I’ve been blogging about EMR. It’s kind of hard for me to believe that I’ve been blogging about EMR for about 4.5 years. What’s even more crazy is that this is my 902 blog post on my EMR and HIPAA & EMR and EHR blogs. Not too bad for what started out as a Christmas break project.

What’s disappointing about all of these blog posts is that most people that visit the site only see the most current blog posts. Certainly some of the older blog posts aren’t worth reading (ie. some of my initial stimulus money posts). However, many others are just as relevant today as they were 4 years ago (don’t ask me if this is a good or a bad thing).

So, I think every week or so I’m going to do a blog post linking back to some of my old posts that people probably haven’t read before. Plus, I’ll look at some of the previous posts and do updates to those posts to highlight any new information we have on those subjects.

However, since this is my first look back post, I thought I’d highlight some unique ways to read content on my site.

EMR Tags:
Tags are a really cool way to read and find content about a specific topic. I try my best to be good about tagging posts appropriately. For example, here’s a list of links that include posts I’ve done and tagged with a certain keyword:
Meaningful Use
Certified EHR
EMR Stimulus
EMR Selection
EMR Implementation
You’ll find more links like this at the bottom of every post I do.

EMR and HIPAA Search:
There are 3 ways to search through all my posts on the site.
EMR and HIPAA Search – This is the built in search function that comes with the site.
EMR and HIPAA Google Search – This is the embedded Google search feature that will actually search across both EMR and HIPAA & EMR and EHR.
EMR and HIPAA Archive – This is a list of all the EMR posts I’ve done along with links to the posts By Subject and By Month.