About a month ago I read an interesting post by Will Weider, CIO of Ministry Health Care and Affinity Health System, where Will is the first to announce delays in the HITECH Act (ARRA) EHR stimulus money. To make his case he gives two reasons for his belief:

1. In my experience, government mandates delays are the rule
2. This EHR deadlines are completely unreasonable

HHS finally has Kathleen Sebelius in as secretary and so that should help move things along. However, I have to agree with Will that the EHR stimulus money will be delayed.

I’m not really blaming HHS or ONC or any other government organization for this. The HITECH Act (ARRA) guidelines are so vague that they should take their time and make sure the $18 billion is spent wisely. Luckily, I feel like David Blumenthal seems to understand the importance of the decisions they make as far as what’s defined as a “certified EHR” and meaningful use. That’s a good thing and it’s better to do things slowly than to do things poorly.

This will be bad news for all those EHR vendors who aren’t selling products. More delays on the definitions of these two things could put a number of EHR vendors in trouble (as I’ve spoken about a few times before).

I think we’re in for a really interesting year for those interested in selecting an EHR and the EHR space. I wonder if the first person to get a stimulus check from the government will take a picture and post it on Twitter or some blog. That will be a momentous occasion indeed.

Marc Probst, CIO at Intermountain Healthcare and member of the new Health Information Technology Policy Committee, gave a really interesting interview to Healthcare Informatics. I really don’t know Marc Probst other than what I read in this interview, but I do know something about Intermountain Healthcare (or IHC as it’s known in Utah). When I was in high school I actually worked for IHC spending one hour a day cleaning a local doctors office. I’m glad those days are over and I don’t think I did a very good job at it either.

However, from that experience and also my high school friend’s dad being the CEO of IHC I got to know the company pretty well. I was really impressed with how the company was run. From the above interview I think that Marc Probst probably has quite a bit to do with that. Let me give a few examples of things he said that I liked:

AG: I completely agree about John (Glaser’s positive influence on defining “meaningful use”) and I’ve written as much. You may not know the answer to this, but there is also a Standards Committee that has yet to be formed. And there have been a lot of questions about what the differentiation might be between the Standards Committee and HITSP, John Halamka’s group. Do you have any information about the Standards Committee makeup, how it’s going to interact with the Policy Committee and the relationship of the Standards Committee to HITSP?

MP: I don’t know any of that, no.

AG: But they’re good questions.

MP: They are really good questions. Blumenthal has just gotten in and HHS still needs to finish their appointments, I think it’s just all very preliminary. Congress basically set down the dates for GAO to have to have the first 13 in place. But I don’t know if there are those same triggers out there for the other committee or the other seven on the Policy Committee. I think GAO has just met the timeline that they had to meet.

AG: We’re all just working our way through this, right?

MP: The best thing about standards is that there are so many of them, right? I hope the Standards Committee can become a brokering point to say, ‘Whether or not they’re the perfect standards, these are what we’re going to follow.’ Where does HITSP fit in this? Where does HL7 fit in this? I don’t know. We may only be 85 percent right in terms of agreement, but boy, it would be nice to have a target to go after.

Call me crazy, but I like I guy that’s not afraid to say that he doesn’t know. Makes me trust someone a lot more when they don’t try to fake something.

AG: Let’s not forget CCHIT.

MP: Do we have to talk about CCHIT?

AG: We can never leave any acronyms out as far as I’m concerned.

MP: CCHIT in my book is really good; I’m just concerned about a blanket rule that every system has to be CCHIT-certified, boy, that’s got a lot of challenges in that statement, and I’d be careful.

My understanding is that IHC built most of their EHR systems in house. This may be why Probst is not so happy with the blanket statement of CCHIT, but he realizes he has to be politically correct enough to not bash it (something I haven’t learned).

Let’s just say that I’m quite happy to see Marc Probst on the Health Information Technology Policy Committee. I’m adding him to my list of really smart and thoughtful people in healthcare.

I’ve had on my list to do a nice post talking about all the people suggesting how meaningful use should be defined. Unfortunately, I’ve been sidetracked by a number of projects in my life. Not the least of which is a website about EMR and EHR that I’ll announce officially on this website shortly. Hopefully I’ll have the time to do a full fledge post on defining meaningful use very soon. I’ve been collecting a lot of perspectives on meaningful use and so it just takes a lot of energy to sort through them all.

The other thing that has really taken my time was this presentation about EMR that I did today at a local medical school. You may remember that I asked for some help in preparing a quality EMR presentation and so I wanted to thank all those who contributed to my presentation. It’s really amazing how much better the readers of this website can make me look in a presentation or article that I’m doing. I must admit that I really enjoy doing presentations and I love talking about EMR. So, it was a lot of fun. I think next on my wish list is to be invited to present at some EMR related conference or even better would be to take part in a panel at some conference.

What I did find really interesting with the medical students was what it was like to explain the HITECH Act and $18 billion of EHR stimulus money to a bunch of students. They were all just laughing at the way the HITECH act is set up and trying to promote EHR usage. I was laughing myself thinking about how silly it sounds when you talk about why a doctor might not want to worry about the possible EHR stimulus money. I don’t think they were fooled by the pile of EHR stimulus money.

What’s really amazing is that I just checked and this will be my 400th post on EMR and HIPAA. I don’t usually sit there and look at how many posts I’ve done. I just try to create some good content that people will find useful. Then, I look back and think about what 400 posts involves and I must admit that I’m pretty proud of what I’ve created here.

I also find it funny that while this will be my 400th post to this blog, I still have 168 drafts of ideas that I just have never had the time to post about. I really should go back and see what’s in there. I rarely ever look past the last 10-20 draft posts. I’m sure there’s some real gems that I just never found the time to write about. So, if you start seeing some references to older items, then you’ll know I’m just doing some spring cleaning on the blog.

I’ve got a lot of other things I’d like to do with this blog including creating some really pointed e-books on EMR implementation, EMR selection, EMR features, EMR consultants, etc. I also hope to have some more time to flesh out the EMR, EHR and HIPAA wiki. It definitely needs some more love if you want to participate. I know I’ve used the information a couple of times and it’s starting to grow more and more useful as people add information to the wiki.

Ok, that’s enough rambling for now. Thanks for being a reader and here’s to the next 400 EMR and HIPAA posts.

I’m sure that most of you in healthcare saw that Kathleen Sebelius was finally sworn in as the new HHS secretary. You can read the reuters report on the confirmation and swearing in of Kathleen Sebelius.

From the report, there’s no doubt that a lot of Kathleen Sebelius’s first job will be to work on this swine flu. No doubt a very important thing for her to keep an eye on and do what she can to protect us from having a major outbreak.

However, I must admit that I get the feeling that were going to hear very little from this new HHS secretary about EMR and EHR. I could be wrong, but I just don’t see her getting really involved in all the discussions of EHR implementation and the $18 billion of EHR stimulus money as part of the HITECH Act (ARRA).

Certainly she’ll be around for major announcements, but I get the strong impression that it’s actually David Blumenthal that’s going to be in the trenches doing the work of defining “certified EHR” and “meaningful use.”

Anyone know more about the situation that can help clarify what might happen, who will be responsible and whether Kathleen Sebelius will do much for EMR as HHS secretary?

There are a bunch of myths being perpetuated right now around ARRA and the HITECH act. I’ve been on a number of conference calls and read a number of people perpetuating these myths. Some might call it poor communication and others might call it downright unethical talk. I’ll leave any judgment to someone else, but I believe these myths could lead to major problems in HIT.

Here’s the first myth I’d like to debunk here and now:
Myth: The EHR Stimulus bill (often referred to as ARRA or the HITECH Act) REQUIRES doctors to use EHR and be interoperable.

Reality: The government has no ability to actually require the use on an EHR. ARRA and the HITECH act do require you to use a certified EHR and show “meaningful use” IF (that’s a big IF) you want to receive the potential $44k in stimulus money avoid the 1-5% medicare/medicaid penalties that will go in force a few years down the road.

That means that if you’re not interested in the government stimulus money then you’ll need an EHR. However, I have a feeling that a large number of people are going to sit back and take the penalties and forget about the stimulus money. In fact, don’t be surprised if many just stop taking medicare/medicaid in response. The point being that it’s a requirement to get money, but not a legal requirement that a doctor use an EHR. I have a feeling those not using an EHR will still have lots of company for the forseeable future.

The interoperability falls under the same story. However, you may not even have to have an interoperable EHR at all if interoperability isn’t part of the EHR certification and “meaningful use” requirements. That part we’ll just have to wait and see.

Moral of the Story: Select an EHR because it makes sense for you and your practice. Don’t focus on the stimulus money and you’ll be much happier in the end.

I recently got the following message from a colleague who was attending HIMSS:

I overheard a couple of sales managers discussing how they have seldom had longer lists of promising prospects and shorter lists of contracts they expect to close this month.

This all goes back to my previous assertion that the HITECH Act and ARRA are actually slowing the number of EHR implementations. I expect this trend to continue throughout the rest of this year.

I’d say my nice bump in traffic also shows a similar trend. The HITECH Act and ARRA so far doesn’t seem to have increased adoption, but it certainly has increased interest in EHR. We’ll see if the increased interest in EHR ends up eventually increasing EHR adoption. Interest and education on the subject is the first step and a very good thing for the EHR industry.

I’m sad to say I’m back again with another rant on terminology. You may remember my previous EMR versus EHR rant. Yes, I’m sorry to say that once again we have two terms which in practice mean the same thing.

Take a look at the following 2 terms:
HITECH – Health Information Technology for Economic and Clinical Health
ARRA – American Recovery and Reinvestment Act

Since the HITECH Act was passed, everyone I interacted with called the $18 billion in EHR stimulus money the HITECH Act. Now, it seems like most of the people at HIMSS are calling it the ARRA. In the end, they both mean the same thing. Just sad that we still can’t standardize the most trivial of things. I’ll continue to use HITECH act since it sounds better than ARRA (how do you even say that?). Although, I’ll be certain to add in a few ARRA so Google sends me some ARRA traffic as well.

Since I’m ranting for a moment. Turns out I also screwed up CCHIT. No, I didn’t screw up the certification. Someone else did that. I always called it C-C-H-I-T (basically spelled out), but it seems like the more common pronunciation is C-Chit. Luckily I mostly read and write about it as opposed to saying it since I try to avoid 4 letter words with “hit” in them. It’s funny how two people reading the same thing can change how it’s said.

Now back to our regularly scheduled program of EHR, EMR, HIT, HIPAA, HIE, RHIO, HL7, CCR, PHR, HITECH, ARRA, CCHIT, ONC, HHS, and of course the women love when we talk about PMS. Not to mention I still have quite a bit to write about HIMSS. Oh brother.

One of my loyal readers and colleagues in the EHR field recently sent me a link (pdf) to the list of members that were announced on the Health Information Technology (HIT) Committee. Take a look at the list of members on the HIT Policy Committee:

• Christine Bechtel, vice president, National Partnership for Woman and Families
• Arthur Davidson, director, Public Health Informatics, Denver Public Health Department; director, Denver Center for Public Health Preparedness; medical epidemiologist; director, HIV/AIDS Surveillance, City and County of Denver
• Adam Clark, research and policy director, Lance Armstrong Foundation
• Marc Probst, chief information officer, Intermountain Healthcare
• Paul Tang, vice president and chief medical information officer, Palo Alto Medical Foundation
• Scott White, assistant director, technology project director, 1199 SEIU Training and Employment Fund
• LaTanya Sweeney, director, Data Privacy Lab, Carnegie Mellon University
• Neil Calman, president and chief executive officer, Institute for Family Health
• Connie Delaney, dean, University of Minnesota School of Nursing
• Charles Kennedy, vice president, Health Information Technology, Wellpoint
• Judith Faulkner, founder, CEO, president and chairman of board, Epic Systems
• David Lansky, president and CEO, Pacific Business Group on Health
• David Bates, medical director for clinical and quality analysis, Partners HealthCare/Brigham and Women’s Hospital

I think the person that sent it to me was surprised that someone from Epic, a private vendor, was on the committee. What was more interesting to me was that there wasn’t one representative on the HIT policy committee from a small doctor’s office. There was plenty of hospital representation and public health but no one to speak for the small doctors offices. Sad part is that small doctors offices make up the major part of the US healthcare system and should be the ones who really need to access the HITECH Act EHR stimulus money.

Looks like my list of HITECH Act EHR stimulus winners is becoming more true every day. My list didn’t include small doctors’ offices and neither did their committee.

Today I was talking with someone about the way the HITECH act works and I thought about an interesting scenario.

Let’s say that a clinic decides to implement one of the “certified EHR” in their practice. Everything goes well and they implement without any problems. The clinic spent a large sum of money to implement an overpriced certified EHR, but felt good because it would be offset by the $44k (approximately) that they’d receive from the HITECH act.

Let’s say it comes time for the practice to prove “meaningful use” in order to receive their reimbursement. Unfortunately, something about the way they are documenting in the EHR excludes them from being able to show “meaningful use” (hard to give a specific example until we know what that means) and therefore excludes them from getting any of the hoped for $44k of reimbursement money.

Would be a horrible situation, no? I’m not sure about this next part (so correct me if I’m wrong), but think about this. Now the clinic has spent a large sum of money on an EHR, isn’t eligible for the hoped for $44k, and now are going to incur a 1-5% penalty for not having an EHR that shows “meaningful use.” Maybe I’m wrong, but I don’t remember hearing about an exception to the penalty if you tried to show “meaningful use” and failed. Talk about adding insult to injury.

Imagine if one of the “certified EHR” ends up learning that no one who selected that certified EHR will be eligible for the reimbursement, because the way the certified EHR was designed doesn’t meet the “meaningful use” criteria.

I hope that none of these happens, but I know if I was a doctor of practice manager looking at the HITECH act money I’d be worried that something will go wrong and I’ll have spent a lot of money and be stuck with no reimbursement.

John over at Chilmark Research has a really good find on his blog. He quotes the new head of ONC, David Blumenthal, from an article in the New England Journal of Medicine (NEJM) where Blumenthal talks about the certified EHR requirement in the HITECH act. Here’s the quote:

ONCHIT currently contracts with a private organization, the Certification Commission for Health Information Technology, to certify EHRs as having the basic capabilities the federal government believes they need. But many certified EHRs are neither user-friendly nor designed to meet HITECH’s ambitious goal of improving quality and efficiency in the health care system. Tightening the certification process is a critical early challenge for ONCHIT.

I find it really interesting how two people can take the same quote different directions. Chilmark Research gives a nice little rant about how you can’t certify usability, quality and efficiency in an EHR. I agree with him on most points and I definitely agree that the market is much better at these three items than some government certification body.

However, I don’t feel like this was what Blumenthal meant in the above quote. I don’t think Blumenthal was trying to say that the certification would need to certify user-friendly, quality and efficient EHR software. Instead, I see the above quote meaning that the current CCHIT certification isn’t good enough, because it has certified a bunch of unusable EHR (a topic we’ve talked about many times before). Sounds to me that Blumenthal is making a case for why the government shouldn’t use the CCHIT certification. At least not in its current form. Essentially Blumenthal is saying that CCHIT isn’t good enough to meet the goals of HITECH.

This seems like a ray of hope for myself and others who think that selecting CCHIT certification as the certified EHR requirement of the HITECH act is the worst decision the government could make. Albeit still just a ray.

What Blumenthal means about “tightening the certification process” is up for debate. He could mean something like what John from Chilmark research describes. Basically some convoluted method of measuring usability, quality and efficiency of an EHR system. Or it could mean that the certification process will need to be tightened so that unneeded requirements are removed and it gets cut down to what will help an EHR achieve the ambitious goals of the HITECH act.

Of course, in the end the certified EHR criteria will probably land somewhere in between. However, this quote did give me some hope that Blumenthal realizes the impact that it will have on EHR adoption if many of the currently unusable certified EHR gain wide adoption thanks to the $18 billion in EHR stimulus money.

I do think John from Chilmark Research does make a nice conclusion to his post:

Suggesting that we tighten the certification process is heading in the wrong direction. Instead, we need to actually relax the certification process to encourage innovation in the HIT market allowing developers to create solutions that will truly provide value to their users while concurrently meeting the broader objectives of delivering better care and better outcomes. Creating light certification criteria and focusing more on what outcomes we wish to see occur as a result of broad HIT adoption is where Blumenthal and his staff need to focus their energies.