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Meaningful Use Stage 2 Commentary and Resources – Meaningful Use Monday

Posted on March 5, 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.

For this week’s Meaningful Use Monday, I decided I’d go through the large list of meaningful use stage 2 commentary that’s been put out over the past week. I’ll do my best to link to some of the most interesting commentary, summaries, etc of meaningful use stage 2 and point out some resources that I’ve found useful.

John Halamka on Meaningful Use Stage 2
First up is the blog post by John Halamka about MU stage 2. I really like his recommendation to read pages 156-163 of the MU rule (PDF here). Sure, the rule is 455 pages, but many of those pages are a recap of things we already know or legalese that is required in a government document. Halamka also created a meaningful use stage 2 powerpoint that people can reuse without attribution. Worth looking at if you’re not familiar with MU stage 2 or if you have to make a presentation on it.

Health Affairs on MU Stage 2
Health Affairs has a nice blog post covering meaningful use stage 2. They offer “3 highlights that seem particularly important:”

  1. The bar for meeting use requirements for computerized provider order entry (CPOE), arguably the most difficult but potentially the most important EHR functionality, has been raised: now a majority of the orders that providers write will have to be done electronically.
  2. There is a major move to tie quality reporting to Meaningful Use. We knew this was coming, but CMS has laid out a host of quality measures that may become requirements for reporting through the EHR.
  3. Health Information Exchange moves from the “can do it” to the “did do it” phase. In Stage 1, providers had to show that they were capable of electronically exchanging clinical data. As expected, in Stage 2, providers have to demonstrate that they have done it.

Health Affairs also talks about the timeline for this rule and the feedback that CMS is likely to get on MU stage 2. I’m sure they’re going to get a lot of feedback and while they suggest that the rule will look quite similar to the proposed rule, I expect CMS will make a couple strong changes to the rule. If nothing else to show that they listened (and I think they really do listen).

Stage 2 Meaningful Use by The Advisory Board Company
The Advisory Board Company has a good blog post listing the 10 key takeaways on stage 2 of meaningful use. Below you’ll find the 10 points, but it’s worth visiting the link to read their descriptions as well.
1. Centers for Medicare & Medicaid Services (CMS) affirms a delay for 2011 attesters.
2. Stage 1 requirements will be updated come 2013.
3. Medicaid definitions are loosened; more providers are eligible.
4. While the total number of objectives does not grow, Stage 2 measure complexity increases significantly.
5. Information exchange will be key, but a health information exchange (HIE) will not be necessary.
6. Patients will need to act for providers to succeed.
7. Sharing of health data will force real-time, high-quality data capture.
8. More quality measures; CMS’ long term goals—electronic reporting and alignment with other reporting programs—remain intact.
9. The Office of the National Coordinator’s (ONC) sister rule proposes a more flexible certification process and greater utilization of standards.
10. Payment adjustments begin in 2015.

AMA MU Stage 2
The American Medical News (done by the AMA) has a blog post up which does a good job doing an overall summary of where meaningful use is at today (post MU stage 2). Meaningful Use experts will be bored, but many doctors will appreciate it.

Justin Barnes on Meaningful Use Stage 2
Justin Barnes provides his view on meaningful use stage 2 in this HealthData Magement article. It seems that Justin (and a few other of his colleagues at other EHR vendors) have made DC their second home as they’ve been intimately involved in everything meaningful use. I found his prediction that the meaningful use stage 2 “thresholds and percentages will remain largely in place come the Final Rule targeted for August, and should not be decreased via the broader public comment phase next underway like we saw with Stage 1.” Plus, he adds that the 10 percent of patients accessing their health information online will be a widely discussed topic. Many don’t feel that a physician’s EHR incentive shouldn’t be tied to patients’ actions. Add this to the electronic exchange of care summaries for more than 10 percent of patients and the healthcare data is slowly starting flow.

Meaningful Use Stage 2 and Release of Information
Steve Emery from HealthPort has a guest post on HIT Consultant that talks about how meaningful use stage 2 affects ROI. This paragraph summarizes the changes really well:

The bottom line for providers is that Stage 2 MU changes with regards to these specific criteria will drive organizations to implement a patient portal or personal health record application; and connect their EHR systems to these systems. Through these efforts it is expected that patient requests to the HIM department for medical records will decrease; as patients will be able to obtain records themselves, online and at any time.

e-Patients and Meaningful Use Stage 2
e-Patient Dave got together with Adrian Gropper MD, to put together a post on meaningful use stage 2 from an e-Patient perspective. This line sums up Adrian Gropper MD’s perspective, “My preliminary conclusion is that Stage 2 is a huge leap toward coordinated, patient-centered care and makes unprecedented efforts toward patient engagement.”

Meaningful Use Stage 2 Standards
Those standards geeks out there will love Keith Boone’s initial review and crosswalks from this rule to the Incentives rule here.

Shahid Shah on Meaningful Use Stage 2
I like Shahid Shah’s (the Healthcare IT Guy) overview and impressions as well. He’s always great at giving a high level view of what’s happening in healthcare IT.

Are there any other meaningful use stage 2 resources out there that you’ve found particularly useful or interesting?

EMR and Healthcare IT Blogging Community – Let the Sparring Begin

Posted on July 1, 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 remember when I first started blogging about EMR and health care IT about 5.5 years ago, I searched out whatever EMR and healthcare IT blogs I could find. The first three blogs that I can remember finding (and loving) were Neil Versel’s blog, Shahid’s Healthcare IT blog and Will Weider’s Candid CIO blog.

I loved reading Neil Versel’s blog because he was actually a professional journalist in the healthcare IT arena. I learned a lot by watching what he did. In fact, I think some of my writing style came from reading his blog. Along with his blog, Shahid provided HITsphere where I could see the posts from other bloggers. Plus, in the early days the traffic from HITsphere to my blog was really great. It’s hard to have a blog that no one reads. I loved the Candid CIO. Partially because the writing was so good and Will is a really smart guy. Partially because I was completely intrigued that the CIO of an organization was blogging. At that time I think I also aspired to be a CIO like Will. Funny how life changes and I prefer to be a blogger now. I’ll leave the stress of CIO to Will. I’m happy to say that all three of these bloggers are still wielding their blogging sword and I still enjoy reading their work.

Needless to say, the EMR and Healthcare IT blogging community has gotten much larger than it was 5.5 years ago when I started. Like many things, with that growth a lot of things have changed. Some for the good and some for the bad. One thing that I miss is all the interaction we use to have as bloggers. Certainly some of that interaction has moved to Twitter and other social media sites. However, I wish we had more interactions with bloggers like we use to do when there were only 5 of us out there.

I personally like to call it blog sparring. Basically, you take someone else’s post and provide the opposing perspective or at least you add to the conversation that they started. I love these types of interactions with other bloggers. Plus, I love the deep dive into a specific topic that happens when you do this type of blogging. As a reader, I think it’s fun to read the various blogger’s perspective on the topic.

So, on that note, I’m going to make the next week, Blog Sparring Week. I’m going to find interesting posts from some of the best EMR and healthcare IT bloggers out there and I’m going to write a post in response or in addition to the comments they made. This way, you’ll get to know some of the other interesting bloggers out there, but you’ll also get the chance to read some interesting in depth commentary.

Hopefully, the bloggers I write about will join in on the fun by either replying to my blog posts or blog sparring with other EMR and healthcare IT bloggers.

If you have posts you think I should consider, let me know in the comments.

Lots of Interesting Discussions at HIMSS Day 1

Posted on February 20, 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.

Today’s been a really interesting first day of HIMSS. I’d heard good things about the Health IT Venture Forum in past years and so I was really glad to be able to attend this year. Of course, if you’re following @techguy and/or @ehrandhit, then you’ve already read a number of my updates.

I also posted what might be the biggest news coming out of HIMSS 11 today that meaningful use stage 2 will include EHR usability.

I was impressed by the Mitochon systems presentation at the New Venture Forum. I had a great talk with CEO, Chris Riley after their presentation. I really like his vision for what they’re working to create. The more I talk with Free EHR vendors like Mitochon, the more I can see the potential of their business model. Shahid, the Healthcare IT Guy, told me that he knew of a couple other free EHR at HIMSS. I didn’t get those requests, so I’m interested to know the other Free EHR competitors. (Full Disclosure: Mitochon is an advertiser on this site)


As you can see from that tweet. I was really intrigued by ZyDoc. I’ve been fascinated with NLP since last HIMSS. Combine that with the increasingly popular auto coding engines that are coming out and it’s a really interesting offering.

One of the presenters at the venture forum said the following about the hospital connectivity market. I wonder what people think about it:


I’ve always been fascinated with China. Add in my interest in EHR and of course I loved the presentation on EHR in China. This company is even more interesting since they have built the EHR with the Chinese character set and it seems like they understand the Chinese healthcare culture.


I loved how the Rothman score tried to quantify a patient’s condition for early warning. To see the score change on a graph really does change your view of a patient’s progress. I just wonder what a hospital’s liability is if the score changes and they don’t follow the alert. I also wonder how many false positives it would produce. Some sort of summary like this has to be the future. I really hope that they’re successful.

The following tweet was the best quote by Aneesh Chopa, CTO of the US. I also loved his energy. I bet he’d be a fascinating person to have dinner with.

I also had a chance to meet with Shareable Ink, but I think I’m going to save my discussion of their technology for an after HIMSS post. So, watch for that. It’s really neat technology.

The increasingly famous Brantley Whittington, CEO of spoof EMR company Extormity, stopped and chatted with me. I’m still holding out on saying who’s behind Extormity, but just look for the Brantley Whittington name badge and you’ll be able to figure it out early (or check back Tuesday when I’ll post it).

I also had a good chat with Dynamic Health IT during the HIMSS opening reception. Check them out for EHR certification and meaningful use consulting. Or as they describe it, the gap analysis for hospitals interested in becoming certified and showing meaningful use. Yes, they help with the hospital EHR self-certification.

In the evening, I got the chance to meet with Dana Sellers, CEO of Encore Health Resources. I told one PR person that emailed me that I have a policy of only meeting with smart people. Dana definitely fits this category.

As most of you know, a lot of my focus is on the ambulatory EMR world and so I appreciate Dana taking some time to talk with me (and really educate me) about healthcare IT in the hospital world. One of the most incredible things they told me was that Encore Healthcare has 143 employees and they’re only 2 years old. That’s some pretty good growth for an EHR consulting company.

One thing I was impressed with was Dana’s candor with her previous company (which was sold to IBM) and now what they’re able to do with Encore Health. Dana was partially embarrassed to admit that in the previous company they worried too much about processes and not enough on getting the data back out. She did say that she thinks that Encore Health is in a much better position based on changes to technology and the environment to really get the data out of these systems so they can focus even more on the quality of healthcare that’s provided.

So much more that I could share from my talk with Dana. It probably deserves it’s on post and most certainly the things she shared with me will come up in future posts. Needless to say I was extremely impressed with Dana and so it’s no wonder why Encore Health has been so successful. I might have to stop by Tommy Bahama’s again just to hang out with more smart people.

Finally, a couple interesting tweets I saw during the show:


and
http://twitter.com/#!/biomedsociety/status/39357644800000001

Isn’t it cool that I can cover sessions that I didn’t even attend thanks to Twitter?

Much much more tomorrow. Unless I’m too tired from all the parties;-)

EMRandHIPAA.com’s HIMSS11 coverage is sponsored by Practice Fusion, provider of the free, web-based Electronic Medical Records (EMR) system used by over 70,000 healthcare providers in the US.

Speech Recognition and EMR

Posted on September 21, 2010 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.

Shahid, The Healthcare Guy, recently added a guest post from Nick van Terheyden, MD, Chief Medical Information Officer (Clinical Language Understanding) from Nuance Healthcare (Yes, they make Dragon Naturally Speaking – DNS) about making the most of speech recognition with an EMR. Here are the major points that Nick made:

  • Have the right hardware installed.
  • Intelligent application Coexistence.
  • Use good quality microphones and sound recording equipment.
  • Environmental Considerations.
  • Create a Standard and Replicate.
  • Anticipate Resistance. Expect resistance.
  • Quick Portable Guides.
  • Preparation.
  • Horses for Courses.
  • Identify champion(s).

I think that voice recognition is fascinating. Personally, I haven’t used it all that much. I certainly write a lot and so you’d think it would be perfect for me. I guess the reason I haven’t done it is first that I type pretty fast and second the extra time that it takes me to type the post helps me to formulate my ideas into a more coherent manner.

People are generally surprised to find out that I don’t proofread these blog posts (most of the time). It’s definitely a different type of publishing, but for the most part I build an idea in my head and then formulate the content for the blog as I type it. I’m not sure how well that would work with voice recognition. Although, maybe this week I’ll try it and see how it goes.

This said, I think many doctors have well trained dictation skills and so the idea of using speech recognition to capture their documentation into an EMR is a very natural thing. Hopefully the above ideas will help out those that are interested in pursuing speech recognition.

HHS Says Certified EHR Available in Fall 2010

Posted on June 21, 2010 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.

Well, it always seems to happen when I go out of town on vacation that HHS finally decides to go to work and make some announcements. The final rule for the Temporary EHR certification rule is out and will be published to the Federal Register on June 24th. It’s non-final format is available at the Federal Register’s Public Inspection Desk. Does anyone else kind of squirm when they read about this final rule for a temporary EHR certification. Final and temporary just don’t sound right together, but that’s what we have.

The Healthcare IT Guy attended an HHS ONC press conference and added a nice little summary of what was said:

*As of today if you’re interested in being a certification body you must request the HHS Certifying Body application in writing
*On July 1 ONC will start accepting applications
*By the “end of the summer” (HHS’s words) there will be one or more certifying bodies open for business (accepting products)
*By “this fall” (again, their words) there will be fully HHS certified products available

One important clarification was made by ONC — there is no grandfathering in CCHIT or previously certified products. Everybody is going to be re certified using the new NIST rules. This means that if you have even 2011 CCHIT certification now it won’t mean anything, you have to go through the process again. CCHIT is offering their “ARRA Interim Certification” but beware — the rules say that you have to follow the NIST plans, not what CCHIT developed. So, if you have the ARRA Interim Certification you may not have pay again but you still will be required to change your software to meet the HHS/NIST test plans and requirements.

Nothing that’s all that newsworthy, except it’s nice to finally have a little bit more solid timeline for when there will be some ARRA EHR certification bodies.

I think that Shahid’s analysis of the now meaningless 2011 CCHIT certification is spot on as well. Although, I’m sure we’ll still see quite a few EMR vendors using the marketing power of the CCHIT certification on unsuspecting clinics who don’t know the difference.

Yes, it does also mean that clinics will have to wait until Fall of 2010 (or later) before they’ll really know if an EHR will be a certified EHR or not. Of course, I’ll be very surprised if less than 98% of EMR vendors don’t become ARRA certified.

Regional Extension Centers (RECs) and HITRCs

Posted on March 23, 2010 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.

One area of the HITECH act that I haven’t heard discussed nearly enough is the Regional Extension Centers. Sure, I’ve heard them mentioned in passing plenty of times. However, I haven’t heard any real good information on what’s being done to make sure that these RECs are going to be successful in their goal of 100,000 providers becoming meaningful users of EHR’s by 2011.

Yes, that’s a pretty big hairy goal. Especially considering the EHR adoption rates up until today. Not to mention, these Regional Extension Centers (RECs) are going to have to find a way to effectively help doctors sort through the 300+ EHR vendors that are on the market with more coming out every day. This is not an easy task to accomplish and will require a lot of great tools to do it effectively.

Shahid, The Healthcare IT guy, created an interesting post about the Regional Extension Centers where he talks about the challenge these RECs will have to “offer unbiased advice on the systems and services best suited to enable the priority primary-care providers to become meaningful users of EHRs. Regional Centers will avoid entering into business arrangements creating an actual or apparent conflict of interest.”

Can you imagine the lobbying that will happen by the big EMR vendors towards these RECs? The reality is, who else can these RECs turn to for “unbiased” advice on EMR selection and implementation? I can’t imagine that the people behind these RECs just want to be a marketing front for EMR vendors who pay to lobby them. Seems pretty clear that you have to be really careful where you get your information.

Of course, this is just one of the many challenges that these RECs face. Personally, I hope that the RECs are incredibly successful and do a great job assisting doctors to find and implement the right EHR. However, if these RECs aren’t careful, they can actually have the opposite effect on EHR adoption.

If people have more information on these RECs, I’d love to hear more. I’m interested in doing what I can to help these RECs succeed.

HIMSS 10 Day 3

Posted on March 2, 2010 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 was a much more laid back day at HIMSS. I still had pretty much back to back meetings, but I’m learning little by little to manage the day at HIMSS. It’s still a work in progress, but I’m getting closer to managing this HUGE event.

In kind of a surprise meeting, I had a chance to sit down and talk with Shahid from The Healthcare IT Guy. We had a really good chat and I can see us working on a number of projects together. It’s been really interesting to meet people in person that you’ve only ever known online. A few times I’ve come away disappointed, but the opposite was true with Shahid. I couldn’t be more impressed with Shahid.

I had a number of really interesting interviews today and a meeting with the CMO of Verizon to talk about an interesting medical data exchange that they’re working on. It was really interesting to hear the vision of what Verizon and the group behind it are doing to make healthcare data exchangeable. I’ll be posting a lot more on this in the future, but you can see my original post about this consortium for some initial information. I have a video talking about the consortium and another video talking about the really neat technology behind MModal.

I also had a nice media lunch from HP. The food was great. The content was a little weak, but their talk of the thin clients was pretty useful for me in my day job. Little by little I’ve been getting more and more convinced that thin clients will be the future of desktop management. At least in any reasonably sized implementation.

Oh yes, and I have to mention the most incredibly tacky part of the lunch. While they were speaking, one of the media people’s phone rang. Not only did they not turn off the ringer, but he then proceeded to answer the phone in the middle of the meeting and was talking on the phone while the person was presenting. Then, after the call he got up and left. I was totally shocked that he really did that. Unbelievable!!

However, the event of the day without a doubt was the ONC town hall. It started off with David Blumenthal announcing that the details of accrediting the EHR certifying bodies (officially the NPRM on certification) were just released. You can find the details posted on the HHS website. I’ll be posting a lot more about this soon. ONC did a pretty lengthy question and answer and even a powerpoint on the new accreditation for EHR certifications. I’ll cover those details very soon.

I also met one of the people behind Fierce Health IT and talked about possibly working together on something. They really went all out to kind of make a splash at HIMSS and I must admit that they’ve come along way since they first started.

Lots of other things, but I better get to bed so I can make the Blumenthal keynote tomorrow.