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Downsides of Incorporating Behavioral and Social Data Into an EHR

Posted on June 19, 2015 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 response to my post about incorporating behavioral and social data into EHR, I got the following email from one of our readers:

My worry on the collection of such behavioral and social data is that it will get used to further prescribe people with the psychiatric drugs that have such horrendous side effects to the benefit of big pharma rather than move towards diet, health education, nutrition and other non-medical remedies that can have long lasting benefits for a lifetime.

It’s a very fine point. In my previous article I didn’t spend enough time talking about the potential downsides of incorporating all that data into an EHR. The reader pointed out the potential abuse by big pharma to sell more drugs. No doubt, pharma is trying to sell more drugs. I’m sure the creative minds at pharma will try and find ways to leverage this data and sell more drugs. That’s the nature of healthcare.

However, I think pharma would try to do this whether the data was in the EHR or not. In fact, having this data in the EHR for the doctor might mean the doctor makes better choices and doesn’t always default to pharma to treat a patient. For example, if you know they’re living in a poor area, then you can ask them if they have enough food or heat in the winter in order to avoid them returning to you a few weeks later with another cold. This would actually lead to less drugs because you’re actually treating the cause of the problem as opposed to just the presenting problem.

While this example paints a pretty picture, you could also paint an awful picture where this data is used for discrimination. This could be in the office itself or by insurance companies. Some of the new ACA laws help when it comes to insurance discrimination, but many fear that the move to ACOs will cause these organization to discriminate against the unhealthy and poor. I have this fear as well. When you pay to keep people healthy, who do you want to have in your patient population? The healthy.

When you start talking about including all this new data in an EHR, there are a lot of privacy and security questions that come up as well. We’ve always known that the patient record was a treasure trove of personal information that needed to be safeguarded and protected from abuse. Social and behavioral data makes the health record even that much more desirable to nefarious groups who want to abuse the data. HIPAA along with privacy and security will become that much more important.

I’m sure I’m just touching the surface on the challenges and problems associated with all this new data. Although, the thing that scares me most is the way people could abuse the data. I don’t think these are reasons to not use this data. We need to use this data to move healthcare forward. However, it is a call to be very thoughtful about how we collect, secure, and use the data we’re collecting.

A Few Quick HIMSS15 Thoughts

Posted on April 13, 2015 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.

Today’s been a long day packed with meetings at HIMSS 2015. I need to reach out to HIMSS to get the final numbers, but word is that there are over 40,000 people at the show. In the hallways, the exhibit hall and the taxi lines it definitely seems to be the case. I’m not sure the jump in attendees, but I saw one tweet that IBM had 400 people there. Don’t quote me on it since I can’t find the tweet, but that’s just extraordinary to even consider that many people from one company.

Of course, the reason I can’t find the tweet is that the Twitter stream has been setting new records each day. The HIMSS 2015 Twitter Tips and Tricks is valuable if you want to get value out of the #HIMSS15 Twitter stream. I also have to admit that I might be going a bit overboard on the selfies. I think I’ve got the @mandibpro selfie disease. Not sure the treatment for it since my doctor doesn’t do a telemedicine visit while I’m in Chicago.

I’ve had some amazing meetings that will inform my blog posts for weeks to come. However, my biggest takeaway from the first official day of HIMSS is that change is in the air. The forces are at work to make interoperability a reality. It’s going to be a massive civil war as the various competing parties battle it out as they set the pathway forward.

You might think that this is a bit of an exaggeration, but I think it’s pretty close to what’s happening. What’s not clear to me is whose going to win and what the final outcome will look like. There are so many competing interests that are trying to get at the data and make it valuable for the doctor and health system.

Along those lines, I’m absolutely fascinated by the real time analytics capabilities that I saw being built. A number of companies I talked to are moving beyond the standard batch loaded enterprise data warehouse approach to a real time (or as one vendor said…we all have to call it near real time) stream of data. I think this is going to drive a massive change in innovation.

I’ll be talking more about the various vendors I saw and their approaches to this in future posts after HIMSS. While I’m excited by some of the many things these companies are doing, I still feel like many of them are constrained by their inability to get to the data. A number of them were working on such small data sets. This was largely because they can’t get the other data. One vendor told me that their biggest challenge is getting an organization to turn over their data for them for analysis.

While it’s important that organizations are extremely careful with how they handle and share their data. More organizations should be working with trusted partners in order to extract more value out of the data and to more importantly make new discoveries. The discoveries we’re making today are really great, but I can only imagine how much more we could accomplish with more data to inform those discoveries.

The Future Of…Healthcare Innovation

Posted on March 17, 2015 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.

This post is part of the #HIMSS15 Blog Carnival which explores “The Future of…” across 5 different healthcare IT topics.

Innovation is a fascinating concept. Historians and philosophers have been thinking and investigating the key to innovation forever. I’m not sure anyone has ever found the true secret sauce to innovation. Every innovation I’ve ever seen has been a mix of timing, luck, and hard work.

Some times the timing is not right for a product and therefore it fails. The product might have been great, but the timing wasn’t right for it to be rolled out. Innovation always requires a little luck. Maybe it was the chance meeting with an investor that helps take and idea to the next level. Maybe it’s the luck of getting the right exposure that catapults your idea into a business. Maybe it’s the luck of the right initial end users which shape the direction of the product. Every innovation has also required hard work. In fact, the key to ensuring you’re ready for luck to be heaped upon you or to test if your timing is right is to put in the work.

The great thing is that it’s a brilliant time to be working on innovations in healthcare. We’re currently at the beginning of a confluence of healthcare innovations. Each one on its own might seem like a rather small innovation, but taken together they’re going to provide amazing healthcare innovations that shape the future of healthcare as we know it.

Let me give a few examples of the wave of innovations that are happening. Health sensors are exploding. Are ability to know in real time how well our body is performing is off the charts. There are sensors out there for just about every measurable aspect of the human body. The next innovation will be to take all this sensor data and collapse it down into appropriate communication and actions.

Another example, is the innovations in genomic medicine. The cost and speed required to map your genome is collapsing faster than Moore’s law. All of that genomic data is going to be available to innovators who want to build something on top of it.

3D printing is progressing at light speed. Don’t think this applies to healthcare? Check out this 3D printed prosthetic hand or this 3D printed heart. If you really want your mind blown, check out people’s work to provide blood to 3D printed organs.

If you think we’ve gotten value out of healthcare data, you’re kidding yourself. There are so many innovations in healthcare data that are sitting there waiting in healthcare data hoards. We just need to tap into that data and start sharing those findings with a connected healthcare system.

The mobile device is an incredible innovation just waiting for healthcare. We are all essentially walking around with a computer in our pocket now. We’ve already started to see the innovations this will provide healthcare, but it’s only just the beginning. This computer in our pocket will become the brain and communication hub for our healthcare needs.

I’m sure you can think of other innovations that I haven’t mentioned including robotics, health literacy, healthcare gaming, etc. What’s most exciting to me about the future of healthcare innovation is that each of these innovations will combine into a unforeseen innovation. The most powerful innovations in healthcare will not be a single innovative idea. Instead, it will come from someone who combines multiple innovations into one beautiful package.

The most exciting part of innovation is that it’s usually unexpected and surprising. I love surprises. What do you see as the future building blocks of innovation in healthcare?

De-Identification of Data in Healthcare

Posted on January 14, 2015 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.

Today I had a chance to sit down with Khaled El Emam, PhD, CEO and Founder of Privacy Analytics, to talk about healthcare data and the de-identification of that healthcare data. Data is at the center of the future of healthcare IT and so I was interested to hear Khaled’s perspectives on how to manage the privacy and security of that data when you’re working with massive healthcare data sets.

Khaled and I started off the conversation talking about whether healthcare data could indeed be de-identified or not. My favorite Patient Privacy Rights advocate, Deborah C. Peel, MD, has often made the case for why supposedly de-identified healthcare data is not really private or secure since it can be re-identified. So, I posed that question to Khaled and he suggested that Dr. Peel is only telling part of the story when she references stories where healthcare data has been re-identified.

Khaled makes the argument that in all of the cases where healthcare data has been reidentified, it was because those organizations did a poor job of de-identifying the data. He acknowledges that many healthcare organizations don’t do a good job de-identifying healthcare data and so it is a major problem that Dr. Peel should be highlighting. However, just because one organization does a poor job de-identifying data, that doesn’t mean that proper de-identification of healthcare data should be thrown out.

This kind of reminds me of when people ask me if EHR software is secure. My answer is always that EHR software can be more secure than paper charts. However, it depends on how well the EHR vendor and the healthcare organization’s staff have done at implementing security procedures. When it’s done right, an EHR is very secure. When it’s done wrong, and EHR could be very insecure. Khaled is making a similar argument when it comes to de-identified health data.

Khaled did acknowledge that the risks are never going to be 0. However, if you de-identify healthcare data using proper techniques, the risks are small enough that they are similar to the risks we take every day with our healthcare data. I think this is an important point since the reality is that organizations are going to access and use healthcare data. That is not going to stop. I really don’t think there’s any debate on this. Therefore, our focus should be on minimizing the risks associated with this healthcare data sharing. Plus, we should hold organizations accountable for the healthcare data sharing their doing.

Khaled also suggested that one of the challenges the healthcare industry faces with de-identifying healthcare data is that there’s a shortage of skilled professionals who know how to do it properly. I’d suggest that many who are faced with de-identifying data have the right intent, but likely lack the skills needed to ensure that the healthcare data de-identification is done properly. This isn’t a problem that will be solved easily, but should be helped as data security and privacy become more important.

What do you think of de-identification in healthcare? Is the way it’s being done a problem today? I see no end to the use of data in healthcare, and so we really need to make sure we’re de-identifying healthcare data properly.

Healthcare Interoperability Series Outline

Posted on November 7, 2014 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.

Interoperability is one of the major priorities of ONC. Plus, I hear many doctors complaining that their EHR doesn’t live up to its potential because the EHR is not interoperable. I personally believe that healthcare would benefit immeasurably from interoperable healthcare records. The problem is that healthcare interoperability is a really hard nut to crack

With that in mind, I’ve decided to do a series of blog posts highlighting some of the many challenges and issues with healthcare interoperability. Hopefully this will provide a deeper dive into what’s really happening with healthcare interoperability, what’s holding us back from interoperability and some ideas for how we can finally achieve interoperable healthcare records.

As I started thinking through the subject of Healthcare Interoperability, here are some of the topics, challenges, issues, discussions, that are worth including in the series:

  • Interoperability Benefits
  • Interoperability Risks
  • Unique Identifier (Patient Identification)
  • Data Standards
  • Government vs Vendor vs Healthcare Organization Efforts and Motivations
  • When Should You Share The Data and When Not?
  • Major Complexities (Minors, Mental Health, etc)
  • Business Model

I think this is a good start, but I’m pretty sure this list is not comprehensive. I’d love to hear from readers about other issues, topics, questions, discussion points, barriers, etc to healthcare interoperability that I should include in this discussion. If you have some insights into any of these topics, I’d love to hear it as well. Hopefully we can contribute to a real understanding of healthcare interoperability.

A Little #AHIMACon14 Twitter Roundup

Posted on September 29, 2014 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’m in San Diego today at the AHIMA Annual Convention. It’s a great event that brings together some really passionate and wonderful Health Information Management professionals. There’s been some interesting Twitter activity at the event. Here’s a roundup of some of the interesting tweets:

Some really great insights. I’d love to hear your thoughts on the tweets above.

Modeling Health Data Architecture After DNS

Posted on September 12, 2014 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 was absolutely intrigued by the idea of structuring the healthcare data architecture after DNS. As a techguy, I’m quite familiar with the structure of DNS and it has a lot of advantages (Check out the Wikipedia for DNS if you’re not familiar with it).

There are a lot of really great advantages to a system like DNS. How beautiful would it be for your data to be sent to your home base versus our current system which requires the patient to go out and try and collect the data from all of their health care providers. Plus, the data they get from each provider is never in the same format (unless you consider paper a format).

One challenge with the idea of structuring the healthcare data architecture like DNS is getting everyone a DNS entry. How do you handle the use case where a patient doesn’t have a “home” on the internet for their healthcare data? Will the first provider that you see, sign you up for a home on the internet? What if you forget your previous healthcare data home and the next provider provides you a new home. I guess the solution is to have really amazing merging and transfer tools between the various healthcare data homes.

I imagine that some people involved in Direct Project might suggest that a direct address could serve as the “home” for a patient’s health data. While Direct has mostly been focused on doctors sharing patient data with other doctors and healthcare providers, patients can have a direct address as well. Could that direct address by your home on the internet?

This will certainly take some more thought and consideration, but I’m fascinated by the distributed DNS system. I think we healthcare data interoperability can learn something from how DNS works.

Value of Data, EMR Jobs, and EMR vs EHR

Posted on July 27, 2014 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 agree with Wen that the EMR and claims data needs to be cleaned up. I think it gives the wrong message to say it’s not meaningful though. Once it’s cleaned up, it has a lot of value.


How many of you have applied for a job because you saw it posted on Twitter? I’m really interested in this since I do a lot of health IT job posts on Twitter. We see quite a bit of traffic from Twitter to our healthcare IT job board, but I haven’t added a good way to track who signs up and applies for jobs. That’s next.


I love how academic Practice Fusion tries to make the discussion. I thought I made the discussion of EMR vs EHR much simpler.

IMS IPO and Health Data Privacy

Posted on January 7, 2014 I Written By

The following is a guest post by Dr. Deborah Peel, Founder of Patient Privacy Rights. There is no bigger advocate of patient privacy in the world than Dr. Peel. I’ll be interested to hear people comments and reactions to Dr. Peel’s guest post below. I look forward to an engaging conversation on the subject.

Clearly the way to understand the massive hidden flows of health data are in SEC filings.

For years, people working in the healthcare and HIT industries and government have claimed PPR was “fear-mongering”, even while they ignored/denied the evidence I presented in hundreds of talks about dozens of companies that sell health data (see slides up on our website)

But IMS SEC filings are formal, legal documents and IMS states that it buys “proprietary data sourced from over 100,000 data suppliers covering over 780,000 data feeds globally”. It buys and aggregates sensitive “prescription” records, “electronic medical records”, “claims data”, and more to create “comprehensive”, “longitudinal” health records on “400 million” patients.

* All purchases and subsequent sales of personal health records are hidden from patients. Patients are not asked for informed consent or given meaningful notice.
* IMS Health Holdings sells health data to “5,000 clients”, including the US Government.

These statements show the GREAT need for a comprehensive health data map—–and that it will include potentially a billion places that Americans’ sensitive health data flows.

In what universe is our health data “private and secure”?

Physician Focus, Data as King, and Real Time EHR Data

Posted on December 1, 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.


I’m a little torn on this tweet. While I agree that there is too much administrative overhead in healthcare that distracts from patients and lifelong learning, I also think that things like EMR could contribute to both. A well implemented EMR software can help doctors focus on patients and help the doctor learn. This is certainly not the way most doctors look at EMR. Is this an EMR image problem or EMR software that’s not living up to its potential?


Of course, you have to take this tweet with a grain of salt since it comes from our very own Big Data Geek, Mandi Bishop. However, it’s an interesting topic of discussion. How important is the EMR data in healthcare today?


This tweet is related to the healthcare data tweet above. We all know that the EHR data isn’t perfect. Although, it’s worth noting that the paper chart wasn’t perfect either. However, I was more interested in the idea of real-time EHR data. I don’t think we’re there yet, but I’m interested to see how we could get there.