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Importance of Defining “Meaningful Use” and “Certified EHR”

Posted on August 14, 2009 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.

John at Chilmark Research posted a note about the importance of how ONC and HHS define the terms “meaningful use” and “certified EHR.” I wanted to echo his comment so here it is:

Note: We can not emphasize enough just how important these two terms (meaningful use & certified EHRs) are to the market. These terms will literally define the HIT market for the next decade and whether you are an HIT vendor or one looking to adopt an HIT solution, having a clear understanding of what these terms mean and their implications will be critical to your success.

Basically, the $36.3 million in EHR stimulus money is dependent on “meaningful use of certified EHRs.” That’s a lot of money and influence on two terms. I hope as many people as possible will participate in today’s HIT policy committee meeting which should work to define “certified EHR.”

Pros and Cons of Thin Clients with an EMR

Posted on August 13, 2009 I Written By

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

This is the second guest post by Bill Horvath II describing the pros and cons of thin clients with an EMR.  Also, take a look at his first entry discussing the pros and cons of laptops with an EMR.

Thin Clients

Overview

An office which chooses this approach will typically have one thin client terminal in each exam room, as well as in each physician’s office, and at stations occupied by non-mobile staff who need access to computerized records.  The terminals are typically managed or ‘driven’ by a server, which provides applications, data storage, and administrative control over the whole system.  Remote access to charts is usually provided via application server software.

Pros

  • Easy To Use – Thin clients don’t have to be carried or pushed from room to room, and don’t require recharging.  Some manufacturers also use smartcards or other technologies to offer location-independent desktop sessions, whereby the desktop session virtually ‘follows’ the doctor from room to room, eliminating the hassle of logging out and logging in at each station, or of figuring out how the last person to use the computer left it.  Many thin clients can go from off to fully ready to use in 15 seconds or less, and because they have no moving parts, they are silent when operating.  And because data storage is centralized, a complete backup strategy is straightforward.
  • Inexpensive – A fully-furnished thin client (with monitor, mouse, keyboard, and cabling) can be purchased at a price starting around $650, depending on the makes and models of the components.  Spare parts are inexpensive to keep in inventory, and individual parts can be replaced in the event of failure.  Because they are highly reliable (and their capabilities are usually determined by the central server which administers the network), they can remain functional for 7 years or longer.
  • Reliable – Modern thin clients have no moving parts, making them exceptionally resistant to normal wear-and-tear.  Since they aren’t typically moved by the doctor, they’re less likely to be broken through an accidental drop or collision.
  • Trivial to Replace – Since thin clients are usually controlled and configured by am administrative server, it’s trivially easy to replace one in the unlikely event of a failure.  In such cases, replacement of the device is simply a matter of unplugging cables from the old unit and plugging them into the new one.
  • Energy Efficient – Because they have no moving parts, thin clients use very little electrical power.  Around 5-15 watts or less is common, even when operating at full capacity.
  • Highly Secure – Thin clients, by definition, have no local data storage, meaning it’s impossible to lose data by way of theft or equipment failure, and a bad actor can’t use a stolen device to extort money or expose private or embarrassing information.  Some thin client manufacturers also provide two-factor authentication built into their products, which precludes access to the system entirely without an alternate means of identification, such as a smart card.  Under these circumstances, the thin client won’t even present a password request (or other user interface) without the required token.  It is also easy to physically lock a thin client in place to prevent theft.
  • Unlimited Scalability and Upgrade Capabilities – The capabilities of some manufacturers’ thin clients are completely determined by the managing servers, which means the maximum number and processing power of the thin clients in any particular installation are limited only by the capabilities of the controlling server.  To allow for more simultaneous users or more complex applications, only the servers need to be upgraded or replaced; the thin clients can remain unchanged.
  • Automatic Firmware Updates – Many thin client manufacturers provide software in their thin client server package which automatically keeps the firmware of the thin clients up-to-date.

Cons

  • Expensive Back End - A thin client installation with an administrative server will almost always be more expensive at the point of purchase than a set of laptops, especially if the laptops are deployed without an administrative server.
  • Single Point of Failure – If the server which provides administrative control to the thin clients fails, all of the thin clients may be down until the server is brought back up.  Exposure to this risk can be mitigated by using redundant servers, which themselves feature redundant systems (power supplies, memory, processors, etc.), however it can’t be entirely eliminated.
  • Everyone is Subject to Each Others’ Usage Patterns – The performance of thin client’s desktop sessions can be adversely affected by what other users on the system are doing.  Someone watching online videos, for example, may occupy significant processing power and bandwidth, which can drag down the performance of other user’s sessions.  This problem can be alleviated by upgrading the administrative server, but doing so engenders additional costs.
  • Limited Peripheral Support – Thin clients may have limited support for attachable peripherals, such as USB storage or printers.  (This will mostly depend on the operating system of the administrative server.)
  • Geographically Grounded – Because they aren’t mobile, a thin client terminal is needed for each location in the office at which a computer is desirable.  Power and network access are needed at each such location, which may require the installation of additional wiring.
  • Limited OS Options – Most thin clients come with a Linux desktop as a default option, as this doesn’t force any additional licensing costs.  Presenting a Windows-based desktop to thin client users currently requires Windows Server, Windows Client Access Licenses, and Windows Terminal Services licenses, each of which costs extra.  Furthermore, Apple does not currently offer a suitably efficient protocol for serving an OSX desktop to a thin client.
  • Server Requires Physical Security – The administrative server must be physically secured from theft, accidental damage, and power loss.  In addition, such servers are typically noisy, meaning placement in a closet, mechanical room, or soundproof rack is usually highly desirable, but may require additional wiring or other expenses.

Bill Horvath II is the CXO of DoX Systems, a company which offers medical office productivity solutions to physicians in private practice. Their flagship product is DoxCIS, an electronic medical records system.

Pros and Cons of Laptops with an EMR

Posted on August 12, 2009 I Written By

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

In the comments of my previous post about Tablets vs. Convertibles vs. Laptop and EMR, we started an interesting discussion about “thin clients” in addition to laptops and desktops in the healthcare environment.  From that discussion I invited Bill to do a guest post about the various advantages and challenges of laptops and thin clients with an EMR.  Bill did such a detailed job I decided it was worthy of 2 posts.  The following is Bill Horvath II’s description of the pros and cons of laptops with an EMR.

Because doctors who have an EMR system need access to patient histories at the point of care, they need a computer in the exam room.  Traditional desktop computers have been used for this purpose in the past, however, more cost-effective laptops and thin clients are becoming much more common in clinical settings.  This post examines some of the pros and cons of laptops.

Laptops

Overview

An office which chooses this approach will typically have one laptop per physician, and possibly one for each of the other staff members who move between exam rooms, such as nurses.  In this scenario, traditional desktop PCs are usually used at the stations occupied by non-mobile staff, such as the receptionist.

Pros

  • Mobility – The doctor can take a laptop wherever he or she goes, including out of the office.  Remote access to charts is usually accomplished via a VPN.
  • Local Data Storage – The doctor can easily store files on the hard drive of the laptop, meaning those files are accessible wherever the laptop is, and regardless of whether it’s connected to a network or the Internet.
  • Many OS Options – Laptops are available for virtually all of the major operating systems (Windows, Apple, Linux, Unix, Solaris, BSD, Chrome).
  • Broad Peripheral Support – Laptops usually have built-in drivers for dealing with a wide variety of peripheral attachments, such as USB mass storage devices, cameras, printers, and scanners.
  • Flexible Performance – With a few minor exceptions, the performance of a laptop computer is determined solely by the capabilities of the computer itself, and how it’s used by the person sitting in front of it.

Cons

  • Require Recharging – When configured for mobile use, laptops run off battery power, which means they must be plugged in periodically to recharge, or the doctor must switch to a freshly charged battery when the available charge runs low.  Most laptops will provide two to four hours of continuous use on one battery charge.  Laptop battery capacity also typically declines approximately 20% per year, which adversely affects performance over time.
  • Expensive – Good quality, business-class laptops start at around $1000, and can range into $3000+ for more advanced units.  Necessary accessories (docking station, supplemental monitor, extra batteries, carrying case, etc.) can add significantly to the cost.  Support contracts for the laptop can be pricey as well, as the components are tightly integrated and difficult to replace.
  • Fragile – Most laptops have moving parts (typically fans, optical drives, and hard drives; also mechanisms such as the connection between the lid and the monitor) which will wear down, and which don’t respond well to being dropped.
  • Difficult to Repair – It is often not possible for the doctor or her staff to repair or replace the components of a laptop (such as the screen or keyboard) if they fail. Laptops often need to be shipped to the manufacturer to be fixed.
  • Hard to Replace on Short Notice – Even if a ‘hot spare’ laptop is kept in the office for emergencies, synchronizing applications, settings, and files between a (possibly broken) machine and the spare may not be trivial, nor is updating the operating system.  This effect is amplified when each doctor has their own particular configuration, and if there is no centralized management server (e.g., Apple Workgroup Manager, Windows Server Domain) in place.
  • Complicated to Secure – Because they are mobile, laptops are subject to theft.  This problem can be mitigated by encrypting the hard drive, but doing so creates challenges around encryption key management, especially in multi-laptop environments, and as laptops and hard drives are replaced over time.  In addition, laptops accidentally left in exam rooms with patients are particularly subject to a variety of security risks, such as accidental damage, malicious hacking, etc., especially if the laptop lacks a two-factor authentication system.
  • Limited Upgrade Potential – Most laptops are limited in how they can be upgraded over time (Typically RAM and the hard drive are the only user-upgradable components.)  This can become an issue in keeping current with software and operating systems, as new programs often have more stringent system requirements.
  • Noisy – The fans, hard drive, or optical drive on a laptop can spin up at inopportune times, creating a distraction, and making soft sounds harder to detect.
  • More Complicated Backups – Because a laptop’s data is stored locally on the hard drive, the laptop must be backed up on a regular basis to protect against data losses due to breakage or theft.  This typically requires action on the doctor’s part (connecting a cable, triggering the backup function, taking the backup medium off-site), though some systems come with an automated backup system which can function wirelessly.   However, changes to the laptop’s files which occur between backups may be irretrievably lost if the machine is compromised.
  • Require Individual Updates – Laptops which aren’t managed by an administrative server require individual patching to stay current with operating system and application updates.  Furthermore, since laptops aren’t typically on for automatic updating late at night, the update process which takes place during the day may interrupt the doctor’s workflow by forcing reboots at inconvenient times.  Laptop firmware also usually requires manual updating, a process which may not be especially ‘user friendly.’

Bill Horvath II is the CXO of DoX Systems, a company which offers medical office productivity solutions to physicians in private practice.  Their flagship product is DoxCIS, an electronic medical records system.

Top 5 Wireless Challenges for Healthcare IT

Posted on June 5, 2009 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 came across this article that identified the top 5 wirless challenges in healthcare. They go into more detail of the challenges, but here’s their list:

  1. Physical connectivity (especially in old hospitals)
  2. Technology connectivity issues
  3. Meeting user demand
  4. Security considerations (high risk of stolen laptops)
  5. Network management issues

So these challenges are really mostly focused on hospital situations or at least larger group practices. The exception is the security considerations. However, I think most people are far past the idea of wireless being any less secure than a wired connection. In fact, one could argue that wireless is actually more secure than the wired connection if it’s set up properly.

The biggest issue on this list that I see with wireless is the first one. Some of these old buildings just kill a wireless signal. Add in asbestos and the difficulty to run wire for a wireless access point and you have a real challenge getting a good wireless signal in these old buildings.

One thing I think this list and article are missing is that I think we’re going to see an ever growing trend of people using wireless broadband cards instead of the traditional wireless. Sure, in a small fixed setting, they’ll still use the traditional wireless. However, the mobile doctors doing visits to the hospitals or other locations are going to be using the wireless broadband cards more and more.

A Failed Hard Drive on Your EMR Server

Posted on May 19, 2009 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.

Note: This post starts a bit technical, but even those less technical should benefit from the second half of the post.

Today I had the very exciting event of a hard drive dieing on one of my servers. Luckily, I had the drives mirrored and nobody noticed. The server just kept running off of the good drive. I’ve had this happen a couple times and it always makes me happy to say that we lost a hard drive and nobody noticed the difference. Nice to know that things work the way they should be working.

However, the thought of losing the other hard drive before I could restore the second drive is always a little bit tense. Luckily for me, I was able to just connect to the raid controller (yes I just lost half my readers) and rebuild the failed hard drive and we’re back in business (at least for now).

I admit that when this happened I went straight to my backups to make sure that they were working correctly and I immediately made a backup of all the databases on that server. Of course, the thought being that if I lose both hard drives I’d at least have my backups (which I’d saved to another machine).

Enough technical already. My point of this post was that this event really made me think about what a doctor’s office would do if they lost a hard drive. They better hope they have good IT staff to be able to fix it. It’s far from rocket science, but you do have to be careful in these situations. The other important lesson is who do you have monitoring that the drive failed? Most servers have the ability to notify you when a drive fails. However, how many doctors or IT people that support doctors have set up these notifications?

I wish I could say this was an isolated incident that’s rare. Over the past 4+ years in my current job, I’ve had 3 or 4 hard drives fail. Not a huge number, but also enough to require a good plan for when this happens. I’ve often heard that the first thing to die on a server is the hard drive. Why? Because the hard drive is a moving part (the disk spins) and moving parts break. So, you just have to expect for these things to happen and plan for it.

At the end of the day, nothing was lost and there was no down time for our EMR server. That’s the good news about a well designed EMR server. The problem comes when no one’s watching for these events or when the EMR server isn’t installed in order to plan for these types of events.

I’m pretty sure my SaaS EMR friends are going to love this post. There’s no doubt this is a huge plus for SaaS (hosted) EMR companies, but there are other challenges associated with SaaS that should be considered as well. I’ll let the SaaS enjoy this benefit for now and leave those comments for another post.

HHS HIT Website

Posted on April 27, 2009 I Written By

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

Today I came across what someone called a new Health and Human Services (HHS) health information technology (HIT) website. Unfortunately, they didn’t get the same graphic designer and web developer that have been doing such a fine job with the various websites that Obama has been putting up.

I find the first page interesting since it has HHS asserting the following:
Health information technology (Health IT) allows comprehensive management of medical information and its secure exchange between health care consumers and providers. Broad use of health IT will:

  • Improve health care quality
  • Prevent medical errors
  • Reduce health care costs
  • Increase administrative efficiencies
  • Decrease paperwork
  • Expand access to affordable care

Interoperable health IT will improve individual patient care. It will also bring many public health benefits including:

  • Early detection of infectious disease outbreaks around the country
  • Improved tracking of chronic disease management
  • Evaluation of health care based on value enabled by the collection of de-identified price and quality information that can be compared.

I wish that each of these bullet points had links to all of the research that shows these are indeed the outcomes of HIT. This should include the research that argues against HIT being able to solve these problems. That would turn the list into an invaluable resource on the benefits and challenges of HIT.

I’m going to need to take some time to look at the rest of the site. However, the link that said “Standards and Certifications” certainly caught my eye and is guaranteed to be a future blog post.

Fake HIT and EMR Twitter Accounts

Posted on April 23, 2009 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.

Many people know that I’m quite fascinated by Twitter. I love it and I love connecting with people on Twitter. However, today I came across a clearly fake twitter account. At least to me it was easy to see it was fake. It was a twitter account supposedly for Dr. David Blumenthal. Yes, the name might be familiar to many people here. How did I know it was fake? It linked to some awful news site. Plus, the tweets were just odd and so you could tell it wasn’t really Blumenthal at all.

What scares me is that many people in IT and healthcare won’t know that it’s not him. In fact, that’s why I’m not going to add a link to the fake account. I guess there’s no harm in someone following a fake account. Some of the fake accounts on twitter are really funny. In this case it was someone just promoting their waste of a website. That’s not something I like.

I’ve posted my personal twitter account on here before, but I recently just started a general EMR, EHR and HIT twitter account. It’s currently aggregating some of my favorite HIT and EMR bloggers. We’ll see how it evolves over time. I know I’ve used it to keep track of a bunch of great content that’s being created.

Also, thanks for those who have signed up for the EMR and HIPAA email subscription. It’s been growing like crazy. Nice to think that people enjoy the content I’ve created.

EHR Interoperability and the Transcontinental Railroad

Posted on April 7, 2009 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 recently read a nice article comparing EHR interoperability to the Transcontinental Railroad. They hit the key point when they said, “Just as standardizing the railroad gauge created a uniform distance between tracks so that track the came from the East and West would fit together, health care IT standards will create a seamless and interoperable IT infrastructure that will benefit the entire nation.”

I find the comparison incredibly intriguing and thought provoking.

The only problem I have with the comparison is that the transcontinental railroad was merging essentially 2 standards (east and west) and standardizing the gauge was the only standard needed. In health care IT we have far more stakeholders in the game and far more standards that need to be established (allergies, labs, RX, diagnosis, just to start).

This doesn’t diminish the value of the comparison since it’s often valuable to see a complicated challenge in a simplified way. I’m just saying that creating a standard in HIT is going to be much more difficult.

Comparison With British National Health System EMR Implementation

Posted on March 13, 2009 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 been really amazed at the number of people I’ve heard talking about the HITECH Act bringing in a “new age of EHR” and other similar phrases. Then, I usually consider who’s been saying it and I realize that their pocketbooks are going to be lined with money from the HITECH Act and EHR adoption. So, I take it with a grain of salt.

Instead, I like to look at examples to help me better understand what might happen with the $18 billion Obama’s planning to spend on EHR adoption. The best example I know of comes from the British National Health System. It’s certainly not a perfect match, but should open our eyes on government funded EHR systems.

The Examiner (San Francisco) provided an interesting editorial on Britain’s National Health Service’s HIT systems implementation:

Britain’s NHS, who have been trying to get their HIT system to work properly for the past 5 years. The cost of NHS’ HIT has escalated to 6 times the original estimate — the U.S. equivalent of $18.4 billion — to serve just 30,000 physicians in 300 state-run hospitals, a fraction of the health care providers in the USA.

HIT is such a mess that Leigh recommended funding alternative systems if matters don’t improve within the next 6 months.

A large 2003-04 study of 1.8 billion ambulatory patients discovered that the use of electronic health records provided no difference in 14 of 17 quality-care indicators, produced significantly better care in just two and worse care in one.

And, a summary of 33 studies done in Europe between 1985 and 2009 found that HIT actually causes a significant number of medical errors.

Definitely cause for concern since Britain has spent $18.4 billion on a MUCH smaller health care system. Looks like Obama should have applied his “down payment” principle to HITECH Act’s $18 billion towards EHR too.

HITECH’s Fundamental Assumptions and Plans

Posted on February 27, 2009 I Written By

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

I was browsing through a document on the House Ways and Means website and I was really interested in what I found listed for what I believe is the basic assumptions and plans Congress and the House used to pass the HITECH act through congress.

Health Information Technology for Economic and Clinical Health Act
or
HITECH Act

Health information technology helps save lives and lower costs. This bill accomplishes four major goals that advance the use of health information technology (Health IT), such as electronic health records by:

  • Requiring the government to take a leadership role to develop standards by 2010 that allow for the
  • nationwide electronic exchange and use of health information to improve quality and coordination of care.
  • Investing $20 billion in health information technology infrastructure and Medicare and Medicaid
  • incentives to encourage doctors and hospitals to use HIT to electronically exchange patients’ health
  • information.
  • Saving the government $10 billion, and generating additional savings throughout the health sector,
  • through improvements in quality of care and care coordination, and reductions in medical errors and duplicative care.
  • Strengthening Federal privacy and security law to protect identifiable health information from misuse as the health care sector increases use of Health IT.

As a result of this legislation, the Congressional Budget Office estimates that approximately 90 percent of doctors and 70 percent of hospitals will be using comprehensive electronic health records within the next decade.

The opening line underscores what I believe is their basic assumption “Health information technology helps save lives and lower costs.” The main problem with this assumption is that it’s not complete. A more complete assumption would be “Well implemented and designed health information technology helps save lives and lower costs.” Unfortunately, you can take a look through this long list of cases to see that poorly implemented EHR can do just the opposite. My strongest hope is that doctors will understand this and choose an EHR wisely instead of focusing on the potential stimulus money.

We could discuss many of the other points in more detail, but the one that stood out to me was the purported $10 billion in government savings from the HITECH Act. At least all of the other bullet points had a section in the document which at least at a high level described how it would be done. Somehow the description of how the HITECH Act would achieve $10 billion of government savings was missing from the document.

Can we seriously believe that the $10 billion in government savings from the HITECH act is anything but conjecture? I can’t remember the last time I looked at my savings and it ended on a nice round number like this. Maybe this calculation was done in the math class I never took in college.

I’m not saying that HIT can’t save the government money. I’m a huge proponent of leveraging technology to save money and improve quality. I just wish the HITECH act would tell me how they think this is going to happen.