Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and HIPAA for FREE!!

Things Your EMR Will Never Do

Posted on August 15, 2013 I Written By

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

EMRs can be powerful tools for building practice efficiency.

But they can’t do it all.

Ruth Sara Hart-Schneider, sales and marketing director for Cincinnati-based Salix, says health care providers are still paying too many people to move too much paper. Her firm helps them to fill the gaps left after even the most successful EMR implementation.
Ruth Sara Hart-Schneider is sales and marketing director for Salix
Salix specializes in workflow automation, business process outsourcing and litigation support. Health care makes up about 30 percent of its workload.

Hart-Schneider works with physician practices, hospitals and a variety of other health care clients, such as durable medical equipment firms and clinical research organizations. She deals with 26 EMR systems.

Note: If you catch her hanging out by your fax machine, don’t be alarmed. It’s part of her job.

Here’s what Hart-Schneider had to say:

Can you explain more about what your company does in health care IT?

We support health care companies in leveraging the electronic data they already have. We help them to avoid having redundant systems or people hand-filling forms or electronic systems generating paper systems. We work around the electronic systems in an office, like EMRs and practice management systems. Usually an office will have both, but there are all these other functions that have been left on the table.

What are some examples?

Most EMRs we deal with are not set up for prior authorization requests. And every state has its own forms for different programs — Medicaid HMOs, workers’ compensation. Particularly for practices dealing across state lines, it becomes cumbersome for the staff. EMR companies don’t want to program all these forms for all the states, and they change constantly anyway. That’s a sweet spot for us. Prescription monitoring is another one if the practice is giving many narcotics. Also, EMRs don’t interface with many of the tools the carriers have out there for eligibility, benefits and claims status. Some other areas are disability, return-to-work forms, immunization logs for pediatrics and certificates of medical necessity for things like wheelchairs and oxygen.

When practices invest in EMRs, do they realize how much they’ll still need to do on paper?

They’re trying to meet meaningful use. When they choose a system, they know what it will do. It’s not a tool to manage your office. Still, people get frustrated with how many repetitive tasks their employees have to do even after all this money has been spent. For example, a group had a pulmonary function testing machine that wouldn’t talk to the EMR. They would print the report and then walk over and scan it into the EMR. A lot of equipment is like that.

How do you identify the inefficiencies in a practice?

If you stand by the fax for 10 minutes and watch what comes through, you’ll have a pretty good idea. You can also look around at the stacks of paper. You can ask people what they’re behind on.

How do you help?

Salix will work with an organization to help them identify their biggest pain points and then customize a solution that will free up staff time and save them money. We look for the best tools for each application. We like FileBound, which has an ASP model product that meets all the HIPAA security requirements, has a very reasonable price point and allows unlimited users without user fees.

Among our services: We can help with the auto-population of forms, we can provide data-entry services for labs and test results that are faxed in and we can help provide interface solutions for equipment that’s not hooked to the EMR. For a surgery practice, as one example, we can help design and implement systems so that the manager can look at tomorrow’s schedule and ensure that all pre-certs have been completed.

How important is it to address these areas?

Most often, there are higher-level tasks that aren’t getting done because staff is bogged down in some very menial, basic and repetitive tasks. You don’t need your nurse spending time on data entry or filling out school forms.

Is it realistic for a practice to go completely paperless?

Yes, but not in the near future. You couldn’t do it yourself. Vendors and everyone else that you deal with would have to be paperless, too, and that’s not happening. Many of the nursing home and hospice operators I talk to say they’re not going electronic because they don’t have the money. I think some things will always come in on paper.

Interoperability: The High Jump and The Long Jump with ONC’s Doug Fridsma

Posted on March 5, 2013 I Written By

Mandi Bishop is a healthcare IT consultant and a hardcore data geek with a Master's in English and a passion for big data analytics, who fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

I’ll admit, I was incredibly nervous about interviewing Dr. Doug Fridsma, the Chief Science Officer for the Office of the National Coordinator and the face of both the Standards and Interoperability (S&I) Framework and the Federal Health Architecture initiative. Not only do I consider him a key luminary, but his overarching responsibility for the future of interoperability and standards-based programs is incredibly alluring. I swoon over those who have the power and desire to effect meaningful, positive change on a grand scale. I wasn’t disappointed.

Doug explained his philosophy towards fulfilling the promise of interoperability with a sports metaphor: the high jump and the long jump.

“I don’t like high jumps,” he said. “High jumps, if you knock down the bar, you’re done and you get no points. Long jumps, you get points for each increment. The high jump for interoperability is ubiquitous data liquidity. The long jump is Meaningful Use.”

The S&I Framework project is tracking progress towards standardization and standards adoption across 5 areas of Meaningful Use and interoperability:

  1. Meaning – shared vocabularies across continuum of care
  2. Structure of messages shared across continuum of care
  3. Transport of messages
  4. Security of transport and messages
  5. Services for accessing messages

All of these categories are exemplified in the flagship project for Meaningful Use and interoperability: the Automate Blue Button Initiative, affectionately known as ABBI. For those not familiar with ABBI, do an experiment: ask your primary care provider whether you can visit a patient portal and download your medical records by clicking the “Blue Button.” If your PCP can provide you the website link to request the download, you should be able to receive your entire medical record (from that provider) in a vaguely huma-readable format (Excel, Word, PDF, etc.). The medical and clinical jargon may not make a lot of sense; however, it’s certainly an incremental hop in the long jump towards interoperability and standards adoption. The standard vocabularies, structure, transport mechanism, security protocol, and web-enabled access are foundational building blocks which enable the Blue Button program’s adoption.

Doug’s goal with the ABBI program was three-fold: get it OUT there, have providers and patients start USING it, and structure it so that it can be repeatable and scalable. Patient engagement advocates across the Twittersphere applaud the sentiment that we, patients, should have ownership of our health data, and many recognize the ONC’s efforts as instrumental in turning the tide for patient access. Several notable bloggers have covered the ABBI project in detail, analyzing its value to healthcare IT development professionals, providers, and patients, including:
Keith Boone @motorcycle_guy – the ABBI Pitch, with a quick overview of the goals for the program, and humorous insight into providers’ qualms about adoption

Greg Meyer @greg_meyer – Scalable Trust and Trust Bundles, with developer-focused details on the structure and transport categories of interoperability

For the next incremental long jump beyond ABBI and Meaningful Use Stage 2, Doug Fridsma and the ONC have several new initiatives tackling the atomic-level data governance and quality of clinical information. In order to communicate between disparate EHR systems, across multiple facilities and potentially multiple payers, it isn’t just the structure of the container and transport of the message that must be consistent: it’s the individual data elements, themselves, which comprise the meat of the message that must be standardized.

The ONC recently announced the Structured Data Capture Initiative with the goal of creating a technical infrastructure to support “structurally sound” standard data elements with support for “unique semantics”, to capture EHR and supplemental clinical data for use across the continuum of care. This effort officially kicked off the week of HIMSS 2013; its progress will be instrumental in broadening the effectiveness of interoperability and Meaningful Use.

So, as I walk the Interoperability Showcase at HIMSS13, watch the use case demonstrations, and ask the participants the tough questions like, “How are you incorporating the use case development you’re exhibiting here into consideration for your next product full release,” I’ll be taking note of those organizations that seem focused on the next incremental jump towards patient-centric, data-driven healthcare systems. And I’ll be wondering what Doug Fridsma and the ONC will do to get to the next incremental jump on the way to the nirvana of ubiquitous data liquidity.

…I’ll also be kicking myself for not taking the opportunity to get a fan photo with Doug while I had the chance.

What Would ONC’s Dr. Doug Fridsma Do? (THIS Geek Girl’s Guide to HIMSS)

Posted on March 2, 2013 I Written By

Mandi Bishop is a healthcare IT consultant and a hardcore data geek with a Master's in English and a passion for big data analytics, who fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

I know you’ve all been wondering how I’m planning to spend my mad crazy week at HIMSS in New Orleans. Well, maybe not ALL of you, but perhaps at least one – who is most likely my blog boss, the master John Lynn. Given the array of exciting developments in healthcare IT across the spectrum, from mobile and telehealth to wearable vital sign monitoring devices, EMR consolidation to cloud-based analytics platforms, it’s been extraordinarily difficult to keep myself from acting like Dori in “Finding Nemo”: “Oooooh! Shiny!” I’ve had to remind myself daily that I will have an opportunity to play with everything that catches my eye, but that I am only qualified to write and speak intelligently on my particular areas of expertise. And so, I’m proud to say I’ve finally solidified my agenda for the entire week, and I cannot WAIT to go ubergeek fan girl on so many industry luminaries and fascinating up-and-comers making great strides towards interoperability, deriving the “meaning” in “Meaningful Use” from clinical data, and leveraging the power of big data analytics to improve quality of patient experience and outcomes.

On Sunday, I’m setting the stage for the rest of the week with a sit-down with ONC’s Director of Standards and Interoperability and Acting Chief Scientist, Dr. Doug Fridsma. His groundbreaking work in interoperability spans multiple initiatives, including: the Nationwide Health Information Network (NwHIN) and the CONNECT project, as well as the Federal Health Architecture. For insight into his passion for transforming the healthcare system through health IT, check out his blog: From The Desk of the Chief Science Officer.

Through the rest of the week, I aspire to see the world through Dr. Fridsma’s eyes, focusing on how each of the organizations and individuals contribute to the standards-based processes and policies that form the foundation for actionable analytics – and improved health. I’ve selected interviews with key visionaries from companies large and small, who I feel are representative of positive forward movement:

Health Care DataWorks piques my interest as an up-and-comer to watch, empowering healthcare systems to improve outcomes and reduce medical costs by providing accelerated EDW design and implementation, whether on-premise or via SaaS solution. Embedded industry analytics models supporting alternative network models, population-based payment models, and value-based purchasing allow for rapid realization of positive ROI.

Emdeon, is the single largest clinical, financial, and administrative network, connecting over 400,000 providers and executing more than seven billion health exchanges annually. And if that’s not enough to attract keen attention, they recently announced a partnership with Atigeo to provide intelligent analytics solutions with Emdeon’s PETABYTES of data.

Serving an area near and dear to my heart, Clinovations provides healthcare management consulting services to stakeholders at each link in the chain, from providers to payers and supporting trading partners – in areas from EMR implementation (and requisite clinical data standards) to market and vendor assessments, and data management activities throughout. With the dearth in qualified SME resources in the clinical data field, I look forward to learning about how Clinovations plans to manage their growth and retain key talent.

Who doesn’t love a great legacy decommissioning story? Mediquant proports adopting their DataArk product can result in an 80% reduction in legacy system costs through increased interoperability across disparate source systems and consolidated access. The “active archiving” solution allows for a centralized repository and consolidated accounting functions out of legacy data without continuing to operate (and support) the legacy system. Longitudinal clinical records? Yes, please!

Those are just a few on my must-see list, and I think Dr. Doug Fridsma would be proud of their vision, and find alignment to his ONC program goals. But will he be proud of their execution?

Can’t wait to find out, on the exhibit hall floor – and in the hallway conversations, and the client case study sessions, and the general scuttlebutt – at HIMSS!

Interoperability, Clinical Data, and The Greatest Generation

Posted on February 21, 2013 I Written By

Mandi Bishop is a healthcare IT consultant and a hardcore data geek with a Master's in English and a passion for big data analytics, who fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

As a healthcare IT zealot and wanna-be policy wonk, I find myself mired in acronyms, and surrounded (and indulged) by those who understand my rapid-fire Klingon-esque rants on BETOS and LOINC and HCPCS. The larger concepts of interoperability and meaningful use lose the forest for the trees of IHE standard definitions and specific quality measures. Have we lost sight of the vast majority of the healthcare consumers, and their level of understanding and awareness of those larger concepts? Could you explain HL7 ORUs or CCDs to your great-grandma?

I recently visited my 90 year-old grandparents, both remarkably healthy multiple cancer survivors who show no signs of slowing down, and have maintained enough mobility to continue bowling 3 times a week. After an evening of pinochle, my grandma asked me to please help her understand what it is that I DO for a living. We’ve had this conversation before.

“I’m a healthcare technology consultant, Grandma. I work with insurance companies and doctors to help them get all your information.”

Puzzled look.

“When you go to the doctor, Grandma, do they write anything down on paper, or are they using a computer when they talk to you?”

“Oh, they’re always on those computers! Tap-tap-tap. Every question I answer and they tap-tap-tap.”

She illustrates by typing on her lap, and I confirm that she’s a hunt-and-peck person. She stops only after I finish asking my next question.

“Do you have private insurance, or do you use the VA?”

“I have Blue Cross. Your grandpa uses the VA.”

“How many doctors did you have to see for your blood infection?”

“FOUR! Sometimes two in one day!”

“Did they all have to ask you for your history?”

“No – they already had it, on their computer. They even knew about my mastectomy, 30 years ago. One corrected me on the date; I’d thought it was only 20 years ago.”

“Well, Grandma, when you booked your appointment with the first doctor, their computer system automatically requested your medical records from your insurance company. And the insurance company automatically sent your records back to the computer. After the first doctor made notes on your visit, just after you walked out the door, the computer sent an updated copy of your medical records back to the insurance company, and it ordered the lab tests you needed before you went to the next doctor. Then, the lab automatically sent your results to the insurance company AND the doctor who ordered the tests.”

“But the other doctors had the test results.”

“Yes, ma’am. Each time you made an appointment with a new doctor, that doctor’s computer requested your medical records from the insurance company, and the insurance company sent out the most recently updated information. It only takes a minute!”

“Goodness. So, do you build the computer programs that make all that work?”

Eyes wide. THIS impresses her.

“No.”

Puzzled look again, so I quickly continue.

“But I make sure those computer programs can talk to each other, and that the insurance company can make sense out of what they’re saying.”

“Because if they couldn’t talk to each other, I’d have to haul a suitcase from doctor to doctor with my chart?”

“Yes, ma’am. That’s called ‘interoperability’. There are new rules for how doctors’ computers should talk to each other, and to the insurance companies. And I get to work with the insurance company to do other really cool stuff. I take a look at LOTS of people’s medical records to find patterns that might help us catch diseases before they happen.”

“And what’s that called?”

“Clinical informatics. It’s my favorite thing to do, because I get to study lots and lots and LOTS of information. That’s called ‘big data’.”

“Sweetheart, you lost me with the computer words. But I’m just so happy you’re happy!”

She hugs me and grins, and I finally feel like I’ve found the right way to talk about my passion: through use cases. Although, Grandma would call them stories.

And there you have it: the importance of interoperability and clinical data, through the eyes of The Greatest Generation. Check in next year for an update on whether my definitions stuck!

Does Healthcare IT Need Stability?

Posted on February 12, 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.

Last night during one of my favorite TV shows, Charlie Rose, he interviewed a guy about the economy. One of the discussion points that came out of this interview and that I’ve heard a lot in all the discussions about the economy is having some stability to the economy. Many argue that one of the biggest things holding our economy back is all the unknowns. When there are unknowns companies get paralyzed and hold back doing things they’d do if the economy felt stable.

I wonder if we’re experiencing the same thing in healthcare IT? Could we use some stability in healthcare IT?

Think about all the various unknowns that exist in healthcare IT. Let’s start with ICD-10. The pending ICD-10 implementation date is looming, but that date has been pushed back so many times it’s still unknown if it’s really going to happen this time. That’s the opposite of stability.

I’m sure that many also wonder if the same will be the case with EHR penalties. Will the EHR penalties go into effect? What exceptions will be made for the EHR penalties? I could easily see the EHR penalties being delayed, but then again what if they’re not?

Is it hard for anyone else to keep up with what’s happening with meaningful use? I do this every day and so I have a pretty good idea, but even I’m getting confused as it gets more complex. Imagine being a doctor who rarely looks at meaningful use. So, we’re in meaningful use stage 1, but meaningful use stage 2 is coming, unless you didn’t start meaningful use stage 1 and then meaningful use stage 2 won’t come until later. Oh, and they’re making changes to meaningful use stage 2. That’s right and they’re also coming out with meaningful use stage 3. However, don’t worry too much about meaningful use stage 3 because a lot of people are calling for it to be slowed down. So, does that mean that meaningful use will be delayed? Now how does the meaningful use stages match with the EHR certifications? Which version of my EHR software does which stage of meaningful use?

I think you get the picture.

Of course, I haven’t even mentioned things like ACO’s, HIE’s, 5010, HIPAA, RAC Audits, Medicare/Medicaid cuts, or healthcare reform (ACA) to name a few others.

It’s a messy healthcare IT environment right now. We could definitely use some stability in healthcare.

Yes, Healthcare IT Adoption Is Expensive AND Painful!

Posted on December 4, 2012 I Written By

Mandi Bishop is a healthcare IT consultant and a hardcore data geek with a Master's in English and a passion for big data analytics, who fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

<Mandi’s Rant>

Few topics infuriate me as much as the notion that national standards-based implementation and adoption of healthcare IT should be cheap and easy. Haven’t we all heard the adage, “You can only have things done two of three ways: fast, cheap, or well”? Considering that the “thing” we’re trying to do is revolutionize the healthcare industry, the effects of which may be felt in each and every one of our lives at some point, don’t you want to include “well” as the bare minimum of what is required? After all, this is YOUR electronic health record, YOUR data, YOUR treatment plan and effectiveness measurements. So, what’s the other way we want this “thing” done: fast or cheap?

We’re talking about an industry that takes an average of 17 YEARS to put significant medical discoveries into routine patient care practice. (Numerous sources confirm this: The Healthcare Singularity and the Age of Semantic Medicine Translating Research into Public Health Action, etc.)

17 years is an entire generation of doctors. Doogie Howser could have been born, graduated med school, and begun to practice medicince by the time any insights from his birth were applied to practice. Suffice it to say, “fast” is not a way that healthcare is used to doing a “thing”.

Let’s contrast that with the information technology industry’s acceptance of iterative development releases and planned obsolescence for enterprise AND consumer assets. The big boys (Oracle, IBM, etc.) generally cease support of older products between 7-10 years after their introduction. Your company’s AS/400 server hardware may be 15 years old, but the O/S is the latest release, and all the data on the legacy server is preserved with the latest in backup packages over a wire-speed network connection. How long have you had your laptop? How frequently have you updated your Facebook app this year?

If someone tried to sell you a 17 year-old 480DX PC with a 9600 baud modem, 5″ floppy disk, 64MB RAM, running Windows 3.11 using the argument that, although much newer, faster, cheaper, more effective technology is available it is not yet PROVEN, would you buy it?

So, healthcare – an industry which moves at the speed of 17 years of Doogie Howser medical student maturity, and technology – an industry reinvented with the introduction of the iPhone in June of 2007, are at a crossroads for how to accomplish this “thing”: developing, implementing, and widely adopting national standards-based healthcare IT within mandated timelines that fall well within the next 10 years.

It must be done “fast”, relative to the usual pace of healthcare change.

And it must be done “well”, because it is OUR health at stake.

Suffice it to say, it will not be “cheap”. And my momma always told me that nothing worth doing is easy.

We have to stop whining about how costly and hard it is to turn this ship, and start working with the ONC on how to make healthcare IT better, faster, and ultimately more meaningful to all stakeholders involved in its use.

</Mandi’s Rant>

Will EMR Adoption Bankrupt Medicare?

Posted on November 27, 2012 I Written By

Mandi Bishop is a healthcare IT consultant and a hardcore data geek with a Master's in English and a passion for big data analytics, who fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

Much hullaballoo is made over the 47% increase in Medicare payments from 2006-2010, which some seem eager to attribute to the adoption of EMR. The outcry is understandable; a 47% increase is a big dang deal, and taxpayers should be concerned. But haven’t we all heard that statistics lie?

“Hospitals received $1 billion more in Medicare reimbursements in 2010 than they did five years earlier, at least in part by changing the billing codes they assign to patients in emergency rooms,” cited the New York Times based on analysis of Medicare data from American Hospital Directory. Indeed, billing codes have changed from 2006-2010, in accordance with the HCPCS (Health Care Procedure Coding System) reform of CPT (Current Procedural Terminology) application and inclusion guidelines, cited here: HCPCS Reform from CMS. Healthcare industry growth and care advances drove an increase from 50 – 300 new CPT code annual applications between 1994-2004, leading to sweeping change in the review and adoption process starting in 2005 – including elimination of market data requirements for drugs.

Think about that for a second. If Pharma no longer has to submit 6 months of marketing data prior to applying for an official billing code, how many new CPT codes – and resultant billing opportunities – do you think have been generated by drugs alone since that HCPCS process change adoption in 2005? Which leads me to my next correlating fact: the most significant Medicare Part D prescription drug provisions did not start until 2006.

Let’s put two and two together: Medicare Part D prescription drug coverage (2006) + change in HCPCS billing code request process to speed drugs to market adoption (2005) = significant increase in Medicare reimbursements. To use the NYT analyst language, “in part”, administration of those drugs occurs in an emergency room. And who might be in the ER on a regular basis? I’ll give you a hint: “I’ve fallen, and I can’t get up!”

Perhaps the most profound contributor to this Medicare reimbursement increase is a recent dramatic rise in the Medicare-eligible population. Per the National Institute on Aging’s 65+ in the United States: 2005, the 65+ population is expected to double in size between 2005 and 2030 – by which point, 20% of the US will be of eligible age. The over-85 age group, as of 2005, was the fastest-growing population segment. Elderly people who are prone to chronic conditions as well as acute care events just might lead to higher Medicare reimbursements.

Of course, there are myriad contributing factors. Some industry analysts attribute the rise in Medicare claims cost to fraud, citing that the workflow efficiencies that the EMR technology provide allow for easy skimming. Activities such as “cloning”, or copying and pasting procedures from one patient to the next with minimal keystrokes within the EMR software, might contribute to false claim filing for procedures that were never performed. While the nefarious practice of Medicare fraud long predates EMR, the opportunity to scale one’s fraudulent operations to statistically relevant proportions increases significantly with automation. And as my mother always told me, it only takes one bad apple to spoil the bushel.

But how many bad apples would it take to spoil a multi-billion dollar bushel to the tune of a 47% cost increase? According to the NYT article, “The most aggressive billing — by just 1,700 of the more than 440,000 doctors in the country — cost Medicare as much as $100 million in 2010 alone,” and the increase in billing activity for each of those 1700 occurred post-EMR adoption. After all, “hospitals that received government incentives to adopt electronic records showed a 47 percent rise in Medicare payments…compared with a 32 percent rise in hospitals that have not received any government incentives.”

Wait, did that statistic just indicate a significant increase in Medicare reimbursements, across the board? So the differential between those providers who have received government incentives for EMR adoption, and those who have not, is 15%. The representative facilities and providers responded to the “aggressive billing” accusation by indicating that they had 1) more accurate billing mechanisms, 2) higher patient need for billable services. I’ll buy that. Sure, it’s likely that there is Medicare fraud happening, but that’s not new – it’s unfortunate that there will always be ways to game the system, whether manual or electronic. But is the increase in “fraud” pre and post-EMR adoption statistically relevant?

Considering the complex variables involved, I’ll chalk up the 15% increase to the combination of more specific billing practices, Medicare Part D drug provisions, an aging population and the health issues which accompany it, and not vilify the technology which facilitates further advances. Let the EMR adoption expansion continue!

Food Brings Clinical and IT Together and Other Clinical-IT Perceptions

Posted on August 8, 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.

I’ve gotten quite the response from my post about Hospital IT and Nursing Perceptions on EMR and HIPAA. Since many of you don’t read all the comments (particularly those that are sent to my by email or left on other social media), I thought I’d share a couple of them that I found worth sharing.

First up is what I think is an eternal principle: FOOD!

As an Rn who spent most of 30yrs in IT thus works well:

Advice for Nursing: Sent Pizza
Advice for IT: Bring Doughnuts

Then take the time to listen. Ya gott’a have Big Ears!!!!!!!!!

Since I’m an IT Guy by background, I can assure you that I’ve done amazing work on the back of doughnuts. Although, I think Pizza would have worked for me as well, but it’s hard to beat a great doughnut. I do like the final comment though about listening. I always love “breaking bread” with someone because then you have something special that remains with you after the fact. Plus, I have a great memory and so once I’ve shared a meal with someone I will never forget them (their name maybe, but never them).

This next opinion is a bit stronger (and possibly more cynical), but I hope will start some really good discussion.

I’ll tell you I’m a former clinical lab person who moved to IT, so I have a warped sense of nursing and their perception of their purpose in life from way back.

IT’S PERCEPTION OF IT: We’d be more than happy to double our personnel in order to halve our response time if administration would fork over the budget for it. We have done everything we can think of to speed response time—help desk carries the phone with them at all times so they can answer it regardless where in the hospital they are, we have the capacity via VNC to spy on a session so the person doesn’t have to wait for us to walk over to the nursing unit to see what is going on, and more. If the people other than help desk are not on the phone, they get the call when it is forwarded.

IT’S PERCEPTION OF NURSING: Nurses are control freaks with OCD issues. We have a computer every four feet along every wall in every nursing station, in every patient room, and on wheels so they can be taken anywhere they want. They decide which one they are going to use for the day and, if it dies, they cannot be pried away to a different device. THEIRS is broken. And they have no idea that electronics are part of patient care now, not just an add-on to their work. Too many cannot comprehend that because they don’t feel like scanning a patient armband before giving them meds, it is okay to get the computer off their back by scanning anything with the patient number on it instead—a marvelous way to circumvent patient safety aspects of computerization.

If nursing (and physicians, too, for that matter) spent as much energy deciding they were going to learn how to most efficiently use their electronics as they do complaining about them, there wouldn’t be extra time taken away from patient care. It would become a break-even proposition.

One thing is absolutely certain: it’s not an easy task to bridge the IT and clinical divide. I bet a great book could be written on the subject.

Needed iPad Feature for Healthcare IT and EHR

Posted on July 6, 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 most of you know, in my pre-blogger life I was a tech guy. In healthcare I did top to bottom IT support at a health and counseling center. I dealt with everything from servers to networking to desktop support to project management and everything in between. It was a great job since I was never bored and always had a variety of things to do. Not to go into my entire career history, but just to say that it’s with good reason that I’m @techguy on Twitter. I love tech and always will.

When I think back to my tech support days, I remember one time where we had an influx of cash as part of a big move into a new building. With that move we ordered ~100 new desktop and laptop computers. You can imagine the logistics of deploying this many devices all at once. We had to take over what use to be a conference room in order to make it happen.

One of the keys for myself and my student worker to be able to deploy all of these devices quickly and effectively was desktop imaging software. We installed one computer with all of the necessary applications and other security configurations. Then, we copied that computer to all of the other computers. It made for a wonderfully consistent experience for everyone and made support so much easier. Plus, if and when someone had issues with their desktop computer I’d just restore it back to the original install point.

None of this information will be all that exciting for those tech people reading this blog post. However, most that read this site aren’t that technical and so hopefully it gives some perspective to those readers.

The point of telling this background is that I think it’s one of the major weaknesses of the iPad. Can you reinstall the iPad after use? Can you restore it back to it’s original install point? Sure, if you’re in a solo physician practice or small group then maybe this doesn’t matter as much. However, if you’re in a hospital or large group practice these types of features can be really important to your IT people.

I’ve argued since nearly the beginning of the iPad that the big issue for the iPad in healthcare is the lack of enterprise features. The features described above are just a few simple examples of enterprise features that I’m not sure the iPad will ever support. Sure we’ll still see the iPad in healthcare. We already do see it, but we’ll never see the ubiquitous adoption of iPad in healthcare without these features.

I’m sure that some would suggest that by using a remote desktop application like Citrix you can achieve much of the enterprise features that I mention above and more. Things like security of data are much easier in Citrix. I’m just still skeptical that any remote desktop application can reach the type of iPad usability that a native iPad app can achieve.

I am interested to see how well the new Windows 8 platform will do. The idea of marrying the best of the tablet/iPad world with the best of the desktop world is an interesting idea. We’ll see if they’re able to walk that balance beam and provide that seamless experience across both sides of the aisle.

SCOTUS Decision and Healthcare IT

Posted on June 28, 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 those living in a hole that haven’t read about the SCOTUS supreme court decision that was issued today, here’s a good one paragraph summary of their decision from a post by The Atlantic:

In Plain English: The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters. Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn’t comply with the new requirements, rather than all of their funding.

There have been a lot of interesting reactions to the SCOTUS decision. Many of them revolve around the politics of the decision. We’ll obviously avoid the political side of the discussion for the most part. I did find HIMSS response to the ACA Supreme Court decision quite interesting. They are mostly grateful that some of the uncertainty is gone so we can move forward in healthcare. Plus, they remind people that health IT has had bipartisan support in Washington despite Obamacare’s obviously partisan issues.

Personally, I think that this decision (regardless of which way it went) will not have a major effect on the healthcare IT and EHR world. Most of the major happenings in healthcare IT and EHR aren’t related to Obamacare. There are a few places that impact it, but most are relatively innocuous.

My biggest concern with the SCOTUS decision is how it will impact healthcare reimbursement in general. Plus, the ACA uncertainty is still there since if the Republicans take control in Washington, then you can be sure that they’re going to repeal ACA as one of the first things they do. This uncertainty could affect the health IT decision making by many institutions.

I’d be interested to hear what other impacts people think the SCOTUS ruling will have on healthcare IT. I do agree with HIMSS that I’m glad we have a decision and can at least move forward with that knowledge.