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Will an EMR’s Quality Metrics Differentiate it from Other EMRs?

Posted on April 11, 2013 I Written By

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

In the emerging consumer-centered, value-driven U.S. healthcare marketplace, the EHR vendors that survive and thrive will need to differentiate their brand by successfully competing on the value (quality/price) their product actually delivers to its end users.

Bob Coi, MD

This is a fascinating look at EMRs and future differentiation in the EHR market. There’s little doubt we could use some EMR differentiation with so many EMR companies still out there. I’m just not sure that the quality of care that an EMR provides is going to be why a doctor selects one EMR over another EMR.

Every doctor I know wants to provide great care to their patients. Every patient I know wants to go to the doctor who provides them the best care. The problem is that most doctors don’t see a direct correlation between EMR use and the quality of care given. Patients don’t either, and the other challenge is that patients have no way to measure the quality of care they’re given anyway. The closest we come to knowing if the doctor provided quality care is that as a patient I know I’m sick and then I get better. I guess if I got better, then the doctor must have provided me quality care.

With this said, I think there’s the possibility that an EMR discovers a way to clearly show that something they do improves the care of the patient. The incremental document management and simple alert notifications that we see from EMR’s today won’t show that clear improvement in care.

No, we have to think much bigger to clearly show that the care provided was better because of the EMR and that the improved care wouldn’t have been possible without the EMR. An example of this would be integrating genomic data into the care provided. What if genomic data influenced which drugs you prescribed so that the drug was perfectly tailored to the patient? This is a great example where it would literally improve the care you provide a patient and it would be impossible without the technology to do the analysis. Assuming this technology was integrated with the EMR, it would be impossible for doctors not to use the EMR.

This is just one example. I’m sure creative entrepreneurs will come up with many more. Showing that EMR improves quality of care is a really high barrier. Plus, changing physicians perceptions on EMR is going to be really hard even if an EMR system does indeed improve the quality of care. Some company will do it and then Dr. Coi will be right that an EMR’s quality metrics will differentiate it from other EMR companies.

My 2012 EMR and Health IT Wish List

Posted on January 3, 2012 I Written By

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Exposing the Jabba the Hutt EHRs and Finding the Han Solo EHRs

Posted on June 21, 2011 I Written By

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

I’ve had some interesting reactions to my post about the various characteristics of a Jabba the Hutt EHR Vendor. One of the more interesting conversations happened by email with a reader named Richard. Yes, I have lots of interesting back channel discussions.

After a lengthy email exchange, I asked Richard if I could post our discussion on the blog so you could participate as well. He agreed and even commented, “I look forward to an expansion of our discussion.” So, here you go (or at least scroll to the bottom for a short summary of my feelings).

The conversation started with this email that Richard sent me:

I understand your reluctance to name names in your article, BUT… this is exactly what is needed.

I’ve taken a few days to ruminate over what I was going to suggest and I’d like to hear your thoughts on this if you have time.

With your readership, I suspect there are plenty of users and observers of current packages and lots of opinions. Why not set up something like a Wiki-EMR site to provide a resource that will allow everyone to provide input into the details making “Jabba” and “Han Solo” EMR systems and see where it goes? Maybe it could eliminate some of the BS surrounding some of these systems and help others who are trying to sort out there own future needs. I’m sure there are plenty of people out there who want, need and are willing to provide information on the state and future of EMR and what is BS and what isn’t. I certainly would. Let me know your (or your readers) thoughts.

Richard

Here was my response:

Hi Richard,
Yes, this is something I’ve thought a lot about. The key question for me is how to publish some sort of “authenticated” information. Most systems are so easily gamed and/or abused that they basically have no worth. I haven’t figured out a scalable way to be able to provide information that is actual data and not provided with undue influence.

As I read your email, I wondered if some sort of combination of LinkedIn might be the key. At least then any review that’s done would be tied to an individual. Although, by doing so, you’d then discourage many of the most interesting reviews and feedback because their name would be explicitly tied to the review.

Along these same lines I’ve wondered how I could provide a “Meaningful EHR Certification” that wasn’t based on a pass/fail system that has no value. Instead it was a mixture of qualitative and quantitative data that would actually be of value to the reader. Scaling that up is the challenge I have with that idea. Not to mention figuring out the right financial model for it.

So, as you can see I’m with you on wanting more specific information out there, but not sure how to overcome the abuse and the scale that you need for it to be valuable.

As a side note, I do have a wiki page: http://emrandhipaa.com/wiki/Main_Page and it even has an EMR and EHR Matrix of companies. Although I closed registrations since spammers were getting into it.

Richard then provided this response:

It seems to me that user editing must be do-able if Wikipedia has found a way. Additionally, I think that unvarnished truth through comments creditable or not (but differentiateable ) would be a place for insiders or knowledgeable users and IT pros to vent. I realize that it is open to abuse, but a user moderated (or whatever Wikipedia uses) forum will turn upon such miscreants and their abuse might well backfire. I realize it is quite a project, but I’ll bet there are a handful of your readers, if not many more, that would gladly help put something this critical in place. If this can be pulled off, it might create “the world’s foremost authority” * in EMR.

I don’t know much at all about this, but I have a feeling that so much is riding on all of this and that there is a vacuum of useful, meaningful and understandable information that is needed to make this whole thing work. I know there must be something prescient sounding I could offer here, but it might be just indigestion that’s giving me this feeling. John, there must be some other smart guys around; try to round up some and see what they think.

Then I offered this response which shows I’ve been on Wikipedia far too much:

I’ve been rolling around something like this since I first started blogging about EMR. Wikipedia’s a bad comparison because it tries to formulate 1 truth instead of a series of opinions about something. Plus, Wikipedia relies on the masses of people (we don’t have enough mass) and even they get to a point where they regularly lock pages after abuse happens. Wikipedia’s a crazy community once you get into it. There are flame wars and battles on Wikipedia that rage in the background that most people don’t realize are happening.

Travel and hotel sites are a better comparison actually. Since reviews of hotels are more similar to a review of an EMR. The hotel owner wants to put the best reviews on there and can plant good reviews amongst many other ways to game the ratings and review systems. I read an interesting story about how Trip Advisor tried to deal with this. Unfortunately, it put on the image of successfully battling it, but didn’t do that well. Matters much less when you’re talking about a hotel versus an EMR.

I agree that it could become the authority on EMR software if it’s done right. Although, for me to do it, I have to find a model that’s authentic, honest, reliable, scalable and that makes sense economically. At least until I sell off a company for a few million. Then, maybe I can cut out the economical requirement.

Then Richard commented:

I didn’t realize that abuse was that rampant and that a fix was so difficult. I think I see some of the problems. You almost need a cadre of “fair witnesses” to explore the opinions and observations of users and provide incorruptible analysis. Not a promising outlook.

I’d be happy to assist this enterprise in any way I can, but don’t think I would bring anything very useful to the table. I feel you may be the right person to bring something like this to fruition, but the resources needed may be out of reach. It’s too bad there isn’t a Consumer Reports -like group out there for something like this. Maybe some group has enough vested in the outcome of shake-out to fund independent assessment and provide a forum for users.

I know very little about the technology involved in EMR, I am more aware of the medical business and needs for improvement in record and information management. Additionally, if cost containment can’t be managed and a “best practices” can’t be incorporated into every patient’s care then our society may be doomed economically (even morally). You’re doing something valuable, so keep it up, there must be a way to sort out the players and the technology so we can get on with the real need which is getting something useful and beneficial installed for quality patient care. Even getting this discussion broadened is worthwhile.

Well, there you go. If you made it through that, then you must really care about EHR and healthcare IT like I do.

In summary, I think it’s quite clear that it’s an incredible challenge for those searching for EHR software to find reliable information. The need for good EHR vendor information is extraordinary and no one has cornered that market…yet? There is no “consumer reports” for EHR software.

I haven’t yet identified a model that’s authentic, honest, reliable, scalable and that makes sense economically to deliver said “consumer reports for EHR software.” (or maybe I’m just too lazy, scared, busy, etc to try)

I do think that this site and the other members of the Healthcare Scene blog network provide a valuable independent resource for those selecting and implementing an EMR. My free EHR selection e-book was one effort to help providers in the EHR selection process in a very targeted way.

Are there other things that I (we) could do to help even more? I’m sure. If you have ideas, I’m interested to hear. You see my off the top of my head criteria above.

If nothing else, we can reach Richard’s goal of “broadening the discussion”