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#HIMSS14 Day 1 – Interoperability, HIE and Social Media

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Well, this is technically my second or third day, but this is the first official day of HIMSS. It’s a mad house like you can imagine and the vendor hall is as big as you’d expect. You need about 3 weeks to go through it. I actually decided to do a walking meeting with someone and we basically walked the whole exhibit floor twice. Luckily, the conversation was good and we dove into some interesting topics. I also told them about my future mobile strategy for Healthcare Scene. She liked it. Hopefully I can roll it out in the next few months.

My day happened to start off with a lot of discussion on interoperability and HIE with MAeHC and then Orion Health. I think it’s really interesting to see the progress we’ve made when it comes to interoperability and HIE, but I also found it interesting that Micky Tripathi from MAeHC still described healthcare interoperability as being in its infancy. I largely agree with him and it’s really too bad. Although, it was also interesting to compare that to Orion Health talking about how they’ve proven that HIE can work. Plus, they also noted something I’ve written multiple times: Private HIEs are growing faster than the Public HIEs.

I’m still really torn on the business model for interoperability and HIEs. I don’t see a clear model in most situations. I even saw one tweet yesterday that talked about taxing on a per patient basis to pay for the HIE. I heard that in NY they’re actually literally working on a tax to fund it. However, I really think that calling it a per patient tax is a really bad way to describe the funding. I’ll certainly be covering more of my interoperability and HIE discussions in the future. Watch for those blog posts in the coming weeks.

I also did a lot of social media talk today. Together with Shahid Shah and Cari McLean we had a discussion about Social Media and Influence. It was great to see so many friendly faces in the audience. I feel lucky every chance I get to hear Shahid talk. He’s really good at reframing things in interesting ways. Plus, Cari has a unique perspective to offer from her perch on top of the HIMSS Social Media tower. I previously noted that social media has just become an integral part of HIMSS. What’s interesting is that most of the companies at HIMSS haven’t created it as an integral part of their company. Many are still learning, but it’s great to see them learn. I hope many will attend the Health IT Marketing and PR Conference where we dive in a lot deeper on these topics.

As I said to someone today, social media can provide value to every company, but not every company should do social media. Some companies aren’t ready to commit to doing social media the right way. Other companies aren’t ready to be that open and transparent. Social media is just one tool in the kit. Although, it’s a really powerful one if used properly. I’ve also been touched by the power of social media to help individuals. Social media has connected me to people that would have no doubt been back at their rooms or in the corner of the event wondering why they were there, but instead they’re out having a good time and connecting with other interesting people.

There you go. I talked about a number of other things today, but I’ll cover that over the weeks and months ahead. For now I’m calling my day today HIMSS HIE, Interoperability and Social Media day.

Be sure to also check out my #HIMSS14 Twitter Roundup and my post on Hospital EMR and EHR about the real cause of hospital readmissions. I think the later post will be a post I reference over and over as people continue to talk about solutions that reduce hospital readmissions.

February 24, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Health Insurance Exchange Q&A with John Kelly from Edifecs

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The following is an interview about Health Insurance Exchanges with John Kelly, Principal Business Advisor, Edifecs.
John Kelly
1. Where are we at with Health Insurance Exchanges (HIX)? What are the timelines for their implementation?

The Patient Protection and Affordable Care Act (ACA) mandates creation of a retail market for health insurance, where individuals can shop, compare and buy healthcare coverage much the same way as they would a car. The goal is to provide greater access to healthcare coverage and eventually lower costs. While the ACA initiated the health insurance exchanges (HIXs) as the first step in creating a new retail market for healthcare, it specifically did not stipulate the Federal and State exchanges as the stated goal of the legislation. The stated goal was to reform the way Americans purchased their healthcare. Before the October 1st deadline has even arrived, the HIX model is already evolving beyond the federally funded exchanges. Private exchanges are already up and running and private websites (eHealth Insurance, et al.) have begun to integrate with public infrastructure. Much of the country has focused on the open enrollment date, but the real challenges come afterward, as the industry deals with the operational realities of participating on HIXs over the long term.

The public exchanges are due to launch next week, and open enrollment runs through March 31, 2014. Starting January 1, 2014 all health plans purchased through the insurance exchanges will go into effect, meaning those who bought their health insurance on an exchange will be covered.

2. This is implemented on a state-by-state basis, right? Are all 50 states ready?

There are numerous exchanges. Each state had the option to establish its own state-operated HIX or participate in the Federally Facilitated Marketplace (FFM). Thirty-three states chose the FFM, 15 states plus the District of Columbia are running their own marketplaces, and two states are partnering with the federal government to run their exchange.

In addition to the state-run marketplaces, another major component is the Data Services Hub, which is a tool developed by The Centers for Medicare & Medicaid Services (CMS) to interact with all 51 exchanges, verify applicant information and determine eligibility for enrollment in select health plans and subsidy programs.

Some states are more prepared than others, having made investments in customer service hotlines, technology testing, and consumer education campaigns. Generally, these states made early decisions to participate, so their implementations are more mature, though I doubt any would say they are all set to go. As enrollment gets underway, all of the exchanges will engage in constant improvements (much like any large technology project) to iron out bugs and improve functionality. For the states that didn’t make those investments, it will be a more difficult process.

3. What do health insurance exchanges mean for the health plans? What’s their reaction to the health insurance exchanges?

HIXs are creating a disruptive force for insurers and purchasers, a force that will change the way they conduct business. For insurers, it will change everything from attracting consumers to their end-to-end administrative processes (member enrollment, system integration, payment transactions, etc.).

It hasn’t been easy, particularly because of the compressed timeline between the federal government releasing detailed guidelines and the go-live date of October 1, 2013. Insurers are trying to balance caution with the prospect of 30 million enrollees and $200 billion in revenue within the next decade.

Many health insurers have realized they already participate in Medicare and Medicaid, a form of retail healthcare purchasing, so why not exploit the opportunity of these new exchanges? The reward potential is compelling, especially for regional plans that can now compete with national plans for employers who may choose to migrate to “defined contribution” plans. This is likely to be the largest open enrollment period in history nationwide. While it is not an ideal situation to increase enrollment under such a tight timeline, many realize the potential opportunities and are committed to making it work.

Perhaps the biggest change for plans is that they will have to learn to compete for members and customers, rather than employer groups and brokers. The shift away from competing for members began in the early 1990’s with “sole source” health plan marketing. Plans will need to re-learn some old skills. Plans will need to compete much more consciously on value as opposed to just cost. This was the primary and clear intent of the ACA.

4. What do the health insurance exchanges mean for an employer?

Up until recently, the consensus in the industry was that most employers would stick with the conventional employer-sponsored benefits system, rather than switch to a defined contribution plan. But as this recent Wall Street Journal article explains, many employers are now moving toward providing employees a sum of money to go buy their own coverage. This trend indicates that many companies are looking at HIXs as a way to control the increase in their healthcare benefit costs, while perhaps more importantly, providing their employees with greater choice. This is a huge sea change. While employers have known they need to continue offering healthcare coverage to attract the most talented workforce, they have been struggling with the spiraling costs. Many now see HIXs as an ideal solution.

5. What do the health insurance exchanges mean for patients?

These exchanges are part of a greater trend toward patients playing a larger, more active role in their own healthcare. For selecting a healthcare plan, HIXs are shifting decision-making from employers to their employees; in essence returning healthcare to a direct-to-consumer sales model that will redefine consumer expectations, customer service and healthcare consumer marketing. The overall success of this shift will be based upon the ability of consumers to be better purchasers. There is certainly more risk and effort involved, but the upside is a significant increase in choice and a strong incentive for the plans to compete aggressively on value for dollar.

6. What broader goals do you see the health insurance exchanges bringing to healthcare?

As I mentioned above, one mandate in the ACA is to establish a retail marketplace for healthcare as a means to improving access to healthcare and inevitably lowering costs. HIXs are the current manifestation of that goal, and it’s a positive disruption in the market. As we’ve seen with other such market force change, we may be able to predict the disruption, but we can only guess at the form it will take after the first wave of innovation and market reaction.

7. What are the biggest challenges for health insurance exchanges?

There are a lot of moving pieces, and as with any large technology project, there are always going to be bugs to be fixed and improvements to be made. There is no reason to believe each state’s marketplace won’t go live on October 1 or soon after; however, many won’t be perfect. This launch is similar to the “soft launch” of a retail store opening, and it may take a few months to get everything working. It will probably take a couple of open enrollment cycles to achieve a steady state. The long-term challenge is the same as any insurance product; will the actuarial base support the financial health of the system over time? As this is a market rooted in Federal Law, similar to the experience seen in the Commonwealth of Massachusetts Connector (“Romney Care”), I suspect the system will demonstrate remarkable inertia and will roll slowly toward equilibrium.

These Exchanges have no choice but to continuously improve. By March 2014, I expect the industry will be thinking, “It could have been a lot worse, but we made it,” and they’ll be moving forward to make the next open enrollment much smoother.

September 27, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

A Biometrically Controlled Healthcare System

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I recently had a nice conversation with Brian Dubin, VP at CERTIFY, where we discussed biometrics in healthcare. Brian got me interested when he described CERTIFY as a biometrics based “big data” company. When I first started this blog, I fell completely in love with all the various biometric options. Check out one of my first posts on Facial Recognition back in April 2006. Shortly after that I even made this EMR and biometrics contribution to a healthcare IT wiki as part of a “blogposium”. [Excuse my moment of nostalgia]

While CERTIFY works with all of the major biometric fingerprints: Finger, Palm, Iris, Facial, Voice, and Signature, I was even more intrigued by a discussion we had around a healthcare system that was biometrically controlled (my word not CERTIFY’s). I realize that the word “controlled” might have negative connotations surrounding it, but I think it is fascinating to consider all of the ways that your biometric identity could be incorporated into healthcare.

Here are some examples I’m considering (some are a reality today and others will be in the future):
Arrive at the office – Imagine that when you arrive at the hospital or medical practice and a video camera grabs your image and the front desk already knows who you are and can say, “Hi John, glad to have you hear today.” Yes, this freaks out some people, but many of the front desk people remember the faces of the patients. Now they can know your name and check you in much quicker.

Positive patient identification – If you don’t like the video camera identification of a patient, you can also do positive identification of the patient using biometrics in a less big brother’s watching you way. When they sit down at the desk to check in, the patient can use a biometric device to identify themselves. Technology like the one I talk about in my post Retina Scanning vs. Iris Recongition are what can be used for this approach.

Voice recognition for a call center – Imagine when you call into a call center they used voice recognition to identify you. This could be used to access your information more quickly. Although, it could also be used to make sure that whoever the person in the call center pulled up matches the voice on the phone. This could solve them pulling up the wrong “John Smith.”

Single sign on – If your biometric identity is stored in the cloud, then that should make that identity available on any system. Plus, I’ve always been fond of single sign on with Facial recognition. The camera is always watching if you’re there or not and so if you open a new application it can immediately authenticate you since it’s constantly authenticating your biometric identity.

I’m really intrigued by the idea of using biometric identities across multiple systems. I’ve heard many hospital CIOs talk about the hundreds of IT systems they have to support. I’ve also heard doctors and nurses complain about the number of logins and passwords they have to remember. Could biometrics be the solution to this problem? Could a biometric identity be shared between systems or would each system need to do more of the traditional single sign on integration?

Unattended computer – Related to the single sign on, facial recognition can also identify when you’re no longer at a computer. If you leave the computer it can automatically lock the computer to ensure that the health data is kept private. You have to balance how quickly the device locks, but this can be great for security.

Location access – A lot of places already do this with fingerprint or palm scans to access private areas. Plus, this prevents the sharing of keys. You can’t really share your fingerprint very well.

Signatures – There’s certainly an art and identity in someone’s signature. However, why don’t we incorporate even more biometrics into someone’s signature? The combination of a signature plus some other biometric identity would be even more powerful. Plus, when I sign to pick up a prescription, if the pharmacy knew my fingerprint, they could indeed verify that I was the right patient.

HIE identification – I don’t know anyone that’s doing this, but I wonder if instead of trying to make a unique patient identifier, using social security numbers, or some other convoluted method of identity management, could we just use someone’s biometric identity? If we aren’t there today, I think we’ll get there eventually. I’m sure there could be mismatches when it comes to matching two biometric identities that were captured by two separate systems. However, we have plenty of mismatches using ssn, name, birthdate, etc. Maybe the real answer is a combination of biometrics and name, birthdate, etc.

A Biometric Healthcare Experience
Those are some general examples. Now let’s imagine a patient visit where they walk into the hospital and are immediately recognized as a patient seeing Dr. Jones for a surgery. The front desk knows who you and has you sign any forms using your biometrics and then directs you to room 315. When you arrive at room 315 you gain access to the room using your biometric identity. The nurse arrives to prep you for surgery and knows she’s working on the right patient because of your biometric identity.

The nurse signs into the EMR using facial recognition and that biometric identity is captured so the EMR knows exactly who is entering the data into the system. The lab arrives and attached your biometric identity to the blood draws and the results will automatically be sent to the EHR matching on your biometrics.

Your doctor writes a prescription for you which gets sent to the pharmacy. The pharmacy knows that he is indeed a doctor based on the biometric identity of the doctor. Once you go to pickup the prescription they verify your biometric identity to ensure you’re in fact the right patient for that prescription. You later go to your family doctor who’s received all of the information and reports from your surgery which were easily matched to you thanks to your biometric identity.

I could keep going, but I think you get the idea. I’m sure there are major holes in the above example, but I think it’s interesting to consider what a biometrically controlled healthcare experience would look like. Plus, to take a line from Google’s Founder, maybe I’m still thinking too small. It’s possible that biometrics will be able to do so much more. It’s not going to happen tomorrow or all at once, but I’m certain that biometrics will play a big part in the future of healthcare.

I’d love to hear your thoughts on this. Are we on the path to a biometric controlled healthcare system?

September 6, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Bring Your Own EHR (BYOEHR)

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Nerd Doc recently offered a new term I’d never heard called Bring Your Own EHR (BYOEHR). Here’s the explanation:

As a tech nerd doc, the best advice I can give to CIOs/CMIOs is to find a framework for ambulatory practices that embraces a BYOEHR (Bring your own EHR) in the same vein of BYOD (Bring your own device). What I mean by that is allow providor choice in purchasing and implementing their own EHR while insuring that a framework is set up for cross communication to interlink records.

This is to fend off the trend to a one size (Epic) fits all approach in which no one is happy. C-level management needs to realize that if users (providers) are not happy, the promises of savings via efficiency simply will not happen.

I think we’re starting to hear more and more examples like this. We saw evidence of this in my previous post called “CIO Reveals Secrets to HIE.” That hospital organization had created an HIE that connected with 36 different EMRs. Think about the effort that was required there. However, that CIO realized that there was a benefit to creating all of those connections. The results have paid off with a highly used HIE.

I’m sure we’ll still see hospitals acquiring practices and forcing an enterprise EHR down their throats for a while. However, don’t be surprised if the cycle goes back to doctors providing independent healthcare on whatever EHR they see fits them best. Those hospitals that have embraced a BYOEHR approach will be well positioned when this cycle occurs.

July 23, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

HIEs and Patient Engagement – Why and Why Now?

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The following is a guest post by Jeff Donnell, President of NoMoreClipboard.
Jeff Donnell - NoMoreClipboard PHR
Health information exchanges have become quite adept at moving medical data from provider to provider on behalf of patients, but making that data available to those same patients has rarely been attempted – until recently.

Not including patients at the HIE exchange table is understandable, but ironic. Understandable for reasons ranging from policy challenges to a lack of standards to technical limitations. Ironic because HIEs are ideally positioned to aggregate data from multiple providers – leveraging the interfaces already in place with provider applications – and deliver that data to consumers, overcoming several of the major barriers to patient adoption and use of tools like PHRs and patient portals.

HIEs have recently grown interested in supporting electronic patient engagement, in large part based on provider inquiries regarding meaningful use stage two requirements. Many providers are looking for affordable alternatives to the tethered patient portals being offered by their EHR vendors, and they want to provide their patients with a solution that can be used across the care continuum. Increasingly, providers recognize that a patient who visits five different clinicians is not about to create five different patient portal accounts. Savvy providers realize that the HIE is well equipped to provide portable, interoperable solutions.

For HIEs interested in long-term sustainability, patient engagement makes perfect sense. The HIE can leverage its existing interfaces and aggregated data – making existing medical information available to patients from a single pipe, in a standardized format. The HIE can act as a conduit between consumers and clinicians – adding value for all parties. Providers can transmit data to patients, and recent CMS guidance indicates that all providers who contribute data to a shared portal (like that provided by an HIE) can count patients who use that portal toward their 5% patient participation requirement. Patients avoid having to collect data from every provider they see, and can populate a PHR or HIE portal account with existing electronic data. Everybody wins.

The value is evident, but what about those challenges? In the state of Indiana, we received an ONC Challenge Grant to figure out how to get HIE data in the hands of consumers with a PHR. We are fortunate to reside in a state with five well-established HIEs and a provider community eager to innovate, and we have spent the last two years working on those challenges (giving us a real appreciation for why the ONC affixed the challenge label to this grant program). We have addressed issues ranging from patient ID/Auth/Match to minor consent to provider skepticism to amended data use agreements. We have overcome any number of obstacles to get data flowing, and we are seeing increased levels of engagement and enhanced clinical outcomes.

We have learned any number of lessons to help other HIEs, state agencies and healthcare providers avoid pitfalls and make accelerated progress. We are eager to share what we have learned. Perhaps the most important lesson is to get started now – as crafting and implementing a patient engagement strategy takes time. As nobody appears to be manufacturing more time these days, HIEs and other organizations that envision sharing data with patients even a year or two down the road would be well advised to begin working in earnest, with an eye on making incremental progress.

Jeff Donnell is president of NoMoreClipboard, a web-based, Personal Health Record (PHR) management system designed to consolidate medical information in one convenient and secure location for easy retrieval and updates. NMC enables consumers to share personal or family member medical information with medical professionals electronically, reducing the need for repetitive medical paperwork.  Jeff and the company are committed to developing PHR applications that are consumer-friendly, interactive, secure, mobile and interoperable.  For more information, follow us on Twitter @NoMoreClipboard or visit www.NoMoreClipboard.com.

June 20, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Health IT Interoperability, HIE, and mHealth — #HITsm Chat Highlights

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A couple of the Health IT regulars got together again this week to video chat during the #HITsm Chat Highlights. Here are some of their thoughts. If you want to participate, be sure to comment!


Topic One: How far off is a solution to the problem of #healthIT interoperability? Is one actually within reach?

Topic Two: Is patient consent being overshadowed by sustainability as the most significant obstacle to #HIE?

Topic 3: What is the role of #telehealth and #mHealth in #healthcare reform and patient engagement?


Topic Four: Are competing deadlines (e.g., Stage 2 Meaningful Use v. ICD-10) going to be responsible for undermining healthcare reform?

 

Topic Five: Who or what will be most influential in determining the next phase in the evolution of #healthIT?

June 8, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Integrating Telemedicine And EMRs

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Have you considered what an EMR would look and feel like if it integrated telemedicine? Rashid Bashshur, director of telemedicine at the University of Michigan Health System, has given the idea a lot of thought.

In an interview with InformationWeek Healthcare, Bashshur tells IW’s Ken Terry that it’s critical to integrate HIEs, ACOs, Meaningful Use and electronic health records.

Makes sense in theory. How would it work?

To begin with, Bashshur said, healthcare providers who have virtual encounters with patients via a telehealth set-up should create an electronic health record for that patient.  The record could then be ported over to the patient’s PHR.  The physician can also share the health record via an HIE with other providers.

When providers attempt mobile and home monitoring, it steps the complexity up a notch, as such activities generate a large flow of data. The key, in this situation, is to use the EMR to sensitively filter incoming data.

Unfortunately, few EMRs today can easily pinpoint the information providers need to process, so most organizations have nurse care managers sift through incoming monitoring data. That’s the case at University of Michigan Health System, where care managers sift data manually to determine whether patients seem to be seeing changes in their conditions.

Unfortunately, even attentive care managers can’t catch everything a properly-designed system can, Bashshur notes.  To integrate EMRs and telemedicine/remote monitoring, it will be important for EMRs to have sophisticated filters in place which can pinpoint trouble spots in a patient’s condition, using a standard protocol which is applied uniformly.

According to InformationWeek, vendor eClinicalWorks has promised a new feature which can pick out relevant data from a large data stream. But until eCW or another EMR vendor produces such a feature, it seems that remote monitoring will be labor-intensive and expensive.

May 17, 2013 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

NetPulse, HIEs, and The Importance of Reliable EMRs — Around Healthcare Scene

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Have you ever wished that all your fitness and food trackers were in one place? Well, look no further. NetPulse is trying to do just that. The new platform is working with some of the hottest apps, as well as fitness equipment makers, to make taking control of your health easier and more convenient.

A group of researchers recently published an opinion in the Journal of the American Medical Association regarding cloud-based health records versus HIEs. The verdict? They feel that the cloud-based health records might be a better way of sharing health records. What they had to say was rather interesting, so don’t miss the recap of it over at EMR and EHR.

Still looking to use HIEs, rather than Cloud-based health records? The ONC has recently released a toolkit to help different healthcare professionals use them more efficiently. This toolkit includes several guides and a spreadsheet to help determine costs and savings that are associated with implementing an EHR.

For those that missed HIMSS, check out the video that John filmed of the Metro point of care solutions. It gives you a first person perspective of what you could have seen demoed at HIMSS if you were able to attend. Plus, it’s pretty cool to see the point of care and BCMA technologies in action.

It’s important for an EMR to be usable. However, this isn’t always the case, and it can be extremely frustrating. Dr. Shirie Leng, an anesthesiologist, is someone who feels that way. In a recent piece over at KevinMD.com, Dr. Leng discusses her EMR usability wish list. Be sure to check it out, and see if you agree. What is your usability wish list?

And, how smart is your current EMR? According to John, it might just be stupid. While they may have value, most EHR software is just full of dumb data repositories. Despite the negativity of this perspective, the future of EHRs does have hope. With the help of entrepreneurs innovators, current EHRs will be turned smart.

Finally, in order for EMRs to make the changes needed, to improve usability and become more “smart,” the vendors need to get it together.  KLAS recently put several popular EMRs head-to-head, reviewing their usability and efficiency. Although names weren’t listed, they found that some EMRs were very difficult to learn, and it’s not necessarily the physician who is using its fault. Perhaps it’s time that physicians and hospitals demand higher quality products.

March 24, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

The Marvelous Land of Oz: The HIMSS Interoperability Showcase

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As I walked the floor of the HIMSS Interoperability Showcase, listening to the tour guide’s carnie-esque pitch on the wonders awaiting me with each successive use case encounter, I ALMOST wished I hadn’t worked with so many of the organizations hawking their wares. It’s a bit sad to know the man behind the curtain, to realize that The Great and Powerful Oz is simply a man with a highly mechanized presentation. But that knowledge gives me insight that others attending the Showcase may not have had – and validation that, in the end, Oz IS Great and Powerful, even though he’s just a man.

There were 20 specific interoperability use cases represented at HIMSS this year, collectively, by 101 vendors. In order to qualify to participate, each of the organizations had to successfully demonstrate proficiency with their chosen use case at the Connectathon event in Chicago. In January. In a basement the size of a football field. Packed shoulder-to-shoulder with your closest competitors at high school-cafeteria tables. Talk about a frigid atmosphere!

Perhaps to stay warm, perhaps to pass the time, perhaps in the pursuit of the patient-centric design principles the healthcare industry espouses publicly yet so seldom seems to put into practice, cross-company collaboration occurs. Competitors converge on each others’ laptops, debugging code, refining business rules and algorithms. Functional use cases emerge, success stories are shared, everyone goes home happy with a list of enhancements to incorporate before the main event at HIMSS. The frantic rush to prep for Connectathon is amplified by the urgency and importance of HIMSS. The ONC is watching! Your competitors are watching! The 40K HIMSS attendees will be watching!

Invariably, the use cases are perfected in the weeks leading up to HIMSS, each click carefully orchestrated, each transition scripted, all parties putting forth their best effort to insure success for the spectators – many of whom are clients, prospects, regulatory officials, or journalists seeking The Next Big Healthcare Thing to go viral in the blogosphere. The yellow brick road is constructed, and as one walks its length, the carefully choreographed demonstrations come to life with compelling tales: “Keeping a Newborn Safe,” “Improving Pediatric Care,” “Optimizing Cancer Care,” “Beneficiary Enrollment.” The show goes on, and it’s a good one – albeit with the occasional glimpse of the man behind the curtain.

The perfectly nice gentleman manning the Federal Health Architecture booth seemed eager to demonstrate the capability to request and retrieve a patient’s medical record from multiple HIEs and disparate EMRs. He walked me through the provider portal view, showed me how he could see that there were multiple medical records available for this patient across providers, and talked me through each click up until the print button. Print?

“Aren’t you importing the records into the requesting EMR?” I asked.

“No. Right now, they have to print each set of records.”

“So, each time this scenario presents itself, the provider has to click on each available external record, print multiple pages, compare notes across screen and paper, and later choose whether to manually update his own EMR with the other information?”

The perfectly nice gentleman suddenly seemed uncomfortable. The Great and Powerful Oz, exposed as mere mortal, Oscar Zoroaster Diggs. You’d think I’d know when to quit.

“The standards and technology exist to do CCD discrete data import, and a couple of the large EMR vendors are implementing that capability for high Medicare population IDNs. How does it make the provider more efficient, and give the patient more face-time with his doctor, if we’re still printing and no data consolidation or reconciliation is happening prior to point-of-care? Why didn’t you extend the use case to show end state?”

He assured me that they’re working on it, and we made a deal that NEXT year, I’ll come back and he’ll walk me through their progress towards discrete data import. No printing, he promised. I’m going to hold him to it.

Aside from this specific use case, across the Marvelous Land of Oz, what I’d REALLY love to see next year: the basement Connectathon advancements made to support the use cases for HIMSS actually incorporated into the products. As part of the qualifying criteria for repeat showcase exhibitors, have them demonstrate the capabilities developed in prior years actually functioning in the marketplace under general release. That would be a substantial improvement on this year’s long jump attempt for the Interoperability Showcase.

I want to fall in love with the hard-working man behind the curtain, not the showy pyrotechnics.

March 11, 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.

Does Healthcare IT Need Stability?

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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.

February 12, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.