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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.

The EMR and EHR Pool Party

Posted on November 16, 2011 I Written By

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

I was chatting with the VP of Marketing from GE at MGMA recently and he made a good analogy. He said that the current EHR environment feels like being at a pool party. Everyone’s in their swimsuits, but they’re waiting for someone else to jump in first.

I think we’ve all been at a pool party (same thing happens on the dance floor too) where we’re waiting for someone to start, but once someone does everyone else joins in. I agree that for many the market kind of feels that way. There’s very little doubt that the HITECH Act has increased interest in EMR and EHR software. The number of people looking at and considering EMR and EHR software has got to be at an all time high. However, so far we haven’t had enough people jump in (buy and implement an EHR) so that everyone else will follow.

I’m sure we could think up a lot of reasons why this is the case. I guess many of those standing on the sides are waiting to hear from others if “the water is too cold.” This analogy goes well with my belief that the early meaningful use and EHR users are going to have a strong effect for good or bad on the next wave of EHR adoption. If those that have jumped into the proverbial EHR waters enjoy the experience and find that it’s not “too cold,” then I’m sure that many others will jump in as well. If the first to jump in jump right out or look like they’re having a miserable time, then we can expect many of the others to stay on the sidelines.

I think it’s still a little bit too early to tell how the first meaningful use EHR adopters are doing and what their message to their colleagues will be. So far most of the meaningful EHR users were those who adopted EHR long before the HITECH Act. I’m waiting to hear from those who started adopting post-HITECH Act. Then, we’ll have a better idea of how EHR adoption will progress going forward.

EMR Marriage, EMR Divorce, EMR Pregnancy and Now Marrying an EMR for Money

Posted on May 28, 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.

Yes, I’ve compared EMR to Marriage and it talks about it being a huge deal to “divorce” your EMR.

Yes, I’ve compared EMR Implementation to Pregnancy.

Now I bring you what may be my most important comparison of all: Don’t marry an EMR because of money!

Sure, the allure of $18 billion of EMR stimulus money is attractive, but don’t choose an EMR because you can get that money. You shouldn’t choose someone to marry because of money and you shouldn’t choose an EMR for the EMR stimulus money as well.

Certainly you want to make sure your mate EMR company is financially sound, can provide for your needs, and is going to be around even if times get tough. However, more important than all of that is you want your EMR company to be willing to make you (the user) the center of their attention. If they do that, then you’ll have a happy “marriage” that will last for a long time to come. If you get WOW’d by the EMR stimulus money, you might just regret it later.

I could keep going about the prenup (EMR guarantees) and other similarities, but I think you get the point. Don’t buy an EMR based solely on EMR stimulus money!

Plans for EMR Stimulus Money Poll

Posted on May 22, 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 posted an EHR stimulus poll a week ago and I thought it would be interesting to post some preliminary results. I really wish a few more people would have participated in the poll. It’s only 2 clicks to add your opinion. I expect over time I’ll get some more responses.

Take a look at the current results for the question: How will your clinic be approaching the EMR Stimulus money made available in the HITECH Act (ARRA)?
EMR Stimulus Money Poll Results

What’s surprising to me from the results so far is that such a large percentage of people are either waiting to hear about the EHR stimulus money or are planning on the EHR stimulus money. This poll is a little bit biased since so many of the people visiting EMR and HIPAA these days are coming here to learn about the EHR stimulus money.

Like I’ve said before, there’s no doubt that the $18 billion investment by Obama into electronic health records has increased the interest in EHR software. We’ll have to just wait and see how much of this increased interest in EHR turns into actual EHR purchases.

ARRA’s Effect on EMR Reporting Versus Functionality

Posted on May 21, 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 just reading through Jamie’s post on EMR and EHR talking about showing EMR “meaningful use” and EMR reporting. She provides some really interesting examples about the challenges of reporting out of an EMR that wasn’t designed to report those various data elements.

This discussion caused me to think about the impact that having to report on meaningful use will have on an EMR implementation. An EMR implementation is hard enough as it is now. Now, not only will an EMR user have to focus on learning all the new EMR functionality and translating their various clinical workflows into an EMR workflow, but they’ll also have to take into consideration the reporting requirements that will be necessary to get access to the EMR stimulus money and show meaningful use.

Certainly some of this planning could be a good thing and probably should have been done regardless of whether a doctor wanted EMR stimulus money or not. However, anyone that’s had to deal with reporting knows that it takes a lot of work and planning to get it right.

It will be interesting to see how much of an impact these reporting requirements will have on the already abysmal successful EMR implementation success rates. Granted, most doctors implementing an EMR won’t properly address these requirements during implementation and will just suffer the consequences of not showing meaningful use when that time comes.

Potential Doctor Misgivings About EMR Stimulus Money

Posted on May 15, 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 have a feeling there’s going to be a lot of doctors looking at the pile of $18 billion and have a strong internal debate about implementing an EMR or not. They’ll feel like they should implement an EMR by utilizing the EMR stimulus money from the HITECH Act (ARRA). However, deep down in the pit of their stomachs, they’ll have huge misgivings about it all. Many will end up regretting it later.

That’s why I keep hammering home the idea that you should implement an EMR on its own merits and not worry so much about EMR stimulus money. There is a huge list of potential EMR benefits that don’t include government money.

Kind of reminds me of the feeling you get when you hear someone peddling some get rich quick scheme. You kind of have that feeling that if you pass up this $18 billion carrot that you’re going to be a fool and wish you took advantage of it. However, deep in the pit of your stomach there’s a feeling that everything doesn’t feel quite right.

I really think that the only way to avoid this feeling is to focus on implementing an EMR that will provide a number of benefits to your clinic regardless of ARRA stimulus money.

EMR Stimulus Money Poll

Posted on May 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.

I decided to try out a few polls on EMR and HIPAA. I have a feeling they’ll be pretty popular and could provide some interesting insight into the world of EMR and EHR. If you have a poll, you’d like me to run, let me know in the comments and I’ll consider adding it. I don’t want to overrun this place with polls, but hopefully my readers will find them interesting as will I.

Here’s the first poll about people’s interesting in the ARRA/HITECH act EMR stimulus money:

I’m sure this poll could be improved, and it’s far from scientific. Nonetheless, I think the results could be really interesting.

EHR Discussions Website by e-MDs

Posted on May 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.

Someone pointed me to a new website created by e-MDs called EHR discussions. The site says “Welcome to EHR Discussions, a moderated discussion forum that will feature discussions on health information technology.”

When someone suggested that it was a discussion forum about EHR that was hosted by an EMR company I was really interested. Unfortunately, I was sorely disappointed by what I found. There was almost no discussion on the website and it was really hard to even figure out how someone could comment. Basically, it’s just a real simple blog implementation. They do allow comments, but they require you to register before you comment. If you’re trying to create discussions about EMR, then that’s the very worst thing you could do.

At the end of the day, it all goes back to expectations. I was hoping for a killer forum for people to really discuss important EMR topics. That’s what I was told it was and it says it’s going to be at the top of the website. When that expectation wasn’t met I was disappointed.

If e-MDs would have just said they started a blog about important EHR topics, I think I wouldn’t have been nearly as disappointed. They actually have created a good post about the HITECH act for example. Certainly it shows a lot of vendor bias perspective and doesn’t do any real hard core analysis, but for information purposes it’s interesting.

Just don’t expect this information intensive type of website to engender a lot of conversation around EMR. Do expect it to be a nice marketing tool for e-MDs. I’m a strong advocate for blogging by EMR companies that want to increase their presence online.

Meaningful Use in Hospitals vs Meaningful User (Physicians)

Posted on May 6, 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 a concept I’ve been thinking about for a while (or at least since I wrote about the definition of meaningful use). It seems like we can often get confused when we talk about how a hospital system might use an EMR and how a solo or small doctors office might use an EMR.

I hadn’t seen anyone articulate that until I saw this news on the HIMSS website about HIMSS publishing it’s definitions of “Meaningful Use.” The broke it down into two definitions which they called “meaningful use of technology in hospitals” and “meaningful users of EHR technology.”

I should mention I don’t agree with all of HIMSS recommendations, but I think that this differentiation is important and I’m really glad that HIMSS made the distinction. I’m surprised that I haven’t seen the distinction made more apparent in other places. Should be interesting to see if ONCHIT, HHS or whoever else is deciding the definition of “meaningful use” will make the distinction.

Definition of Meaningful Use

Posted on May 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.

We’re all still sitting here waiting for the government to finally decide two key terms in regards to gaining access to the $18 billion in stimulus money in the HITECH act (ARRA). I’ve been interested in the subject myself since before it was even settled that we’d call it meaningful use as opposed to meaningful EMR user. From the looks of that post back in February, there was still a lot of confusion about “meaningful use” and “certified EHR.”

Turns out that a few months later, we still have very little clarification about what these two terms mean. Certified EHR discussion has really revolved around CCHIT certification or some other alternative. We’ll try to leave that discussion for other posts. What has been interesting is in just the past week or two there has been a literal flood of people offering their perspective on meaningful use. Sometimes I like to be on the cutting edge of these definitions (like I was in the link above) and other times I like to sit back and let them play out. This time I’ve been letting it play out and it’s really interesting to see the multitude of perspectives.

I’m not planning on writing my own plan for how they should do meaningful use. I may do that at a later time if so inclined. For now, I’ll just focus on highlighting points from what other people have suggested and provide commentary that will hopefully enhance people’s understanding of this complicated mandate (yes, that means this post will be quite long).

I think it’s reasonable to first point you to the NCVHS hearing on “Meaningful Use” of Health Information Technology. This matters, because at the end of the days hearings like these are where most of the information are going to come. Then, with the information from these hearing decisions will be made. The other sources like blogs won’t carry nearly as much weight (although it’s unfortunate that more politicians aren’t listening).

John Chilmark on Meaningful Use
Next, I’ll go to one of my newly found favorite bloggers named John Chilmark (any coincidence we’re both named John). John from Chilmark Research commented that HHS is bringing together the “usual suspects” to discuss “meaningful use. Chilmark also states that the following criteria are what’s required for meaningful use:

  1. Electronic Prescribing
  2. Quality Metrics Reporting
  3. Care Coordination

I’m not sure where he got this list, but this list feels kind of weak if you ask me. In fact, John suggests that these requirements will be simple and straightforward and first and then ratcheted-up in future years. Interesting idea to consider. I hope that they do draft the requirements for meaningful use in a way that it can be changed in the future if it turns out to not be producing the results it should be producing.

John Halamka on Meaningful Use
Next up, the famous John (another John) Halamka, Chief of every Health IT thing (at least in Boston), calls defining “meaningful use” “the most critical decision points of the new administration’s healthcare IT efforts.” He’s dead on here. In fact, it might not be the most critical decision for healthcare IT, but for healthcare in general as well. Here’s John Halamka’s prediction for how “meaningful use” will be defined:

My prediction of meaningful use is that it will focus on quality and efficiency. It will require electronic exchange of quality measures including process and outcome metrics. It will require coordination of care through the transmission of clinical summaries. It will require decision support driven medication management with comprehensive eRx implementation (eligibility, formulary, history, drug/drug interaction, routing, refills).

Basically, he’s predicting inter operable EMR software and ePrescribing with a little decision support sprinkled on top. I won’t be surprised if this is close to the final definition. The only thing missing is the reporting that will be required to the government. The government needs this data to fix Medicare and Medicaid (more on that in another post).

Blumenthal Comment to Government Health IT
Government Health IT has a nice quote from David Blumenthal that says: “The forthcoming definition of the “meaningful use” of health information technology will set the direction of the Obama administration’s strategy for health IT adoption, said David Blumenthal, the new national coordinator for health IT.”

I think there’s little doubt that David Blumenthal has a good idea of the importance of the decisions ahead. What should be interesting is to see how involved Obama is in these very important decisions. I’m guessing Obama won’t do much more than sign a paper to make it happen. I just hope I’m wrong.

HIMSS Definition of Meaningful Use
Here’s a short summary of the HIMSS definition of “meaningful use”

According to HIMSS officials, EHR technology is “meaningful” when it has capabilities including e-prescribing, exchanging electronic health information to improve the quality of care, having the capacity to provide clinical decision support to support practitioner order entry and submitting clinical quality measures – and other measures – as selected by the Secretary of Health and Human Services.

Basically, e-prescribing, interoperability and clinical decision support. Turns out a BNET Healthcare article suggested the same conclusion “The consensus of physician and industry representatives was that meaningful use should include interoperability, the ability to report standard quality measures, and advanced clinical decision-making.”

I think we’re starting to see a bit of a pattern here. I should say that these are all very good things, but the challenge I see is that any requirement needs to be easily and consistently measured. Interoperability and clinical decision support are both very difficult to measure. Just wait until they see the variety of software that tries to do those two things. It’s very difficult to measure it consistently across so many EHR software.

Wow!! I barely even got started on this subject. Instead of belaboring the point, let me just point you to some other interesting readings about the HITECH Act, ARRA, and “meaningful use.”

Please let me know if there are other good sources for perspectives on defining “meaningful use.” This really is a landmark decision for healthcare IT.