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Realizing the Value of Health IT

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I’ve been focused on the value of healthcare IT for a long time. Obviously, I’ve been particularly focused on the value of EHR including a whole series of posts on the benefits of EHR (which I need to finish). I’m a huge fan of the value of EHR and healthcare IT, but I also am a realist. I realize that we aren’t getting all of the value out of healthcare IT that we could be getting. I also realize that poor health IT implementations can actually decrease value as opposed to increasing the value of health IT. Plus, I also see a huge disconnect between the value government sees in healthcare IT and what doctors find valuable.

If you don’t believe healthcare is missing out on the value healthcare IT could provide we don’t need to look any further than the fax machine. A recent Covisint-Porter Research study found that “76% of respondents stated that they are handling their inflow of information via Fax.” Mr H from HISTalk aptly described this: “Healthcare: the retirement home for 1980s technology.”

I’ve also seen illustrated dozens of times the way a poor implementation can actually cause more problems than it solves. The Sutter EHR implementation is one example to consider. No doubt there is a lot of internal politics involved in the challenges that Sutter is facing with their EHR, but soon I’ll be publishing on Hospital EMR and EHR some first hand experiences with that EHR implementation. It’s a sad thing to see when an EMR implementation is done the wrong way. However, the opposite is also true. I’ve seen hundreds of organizations that love their EHR and can’t imagine how they practiced medicine before EMR.

One thing I’ve never heard a practicing doctor say is that they want to show meaningful use to be able to realize the value of health IT. I’ve certainly heard doctors say they have to show meaningful use to get the government money. I’ve certainly heard doctors say they want to show meaningful use to avoid the EHR penalties. I haven’t heard any doctor say they want to show meaningful use because it provides value to their clinic.

To me this illustrates the wide divide between the value government wants to see from healthcare IT and the value healthcare IT can provide a healthcare organization. Currently the government is riding on the back of incentive money and penalties to motivate healthcare organizations. No doubt this has caused many healthcare organizations to adopt an EHR. However, the incentive money and penalties won’t last forever. Then what?

What’s sad for me is that EHR adoption was starting to gain some momentum pre-HITECH act. There was a definite shift towards EHR adoption as organizations realized they needed to head that direction. Then, once the HITECH act hit it threw every EHR organizations plans out the door and created an irrational hysteria around EHR. This has led to irrational selection of EHR vendors, rushed EHR implementations, and cemented in many Jabba the Hutt EHR vendors that the relatively free EHR market wouldn’t have adopted pre-HITECH. To be honest, I’m ready for a return to a more rational EHR market based on value created. That’s when we’ll truly start realizing the value of health IT.

Beyond EHR, we need more brave leaders in healthcare IT that aren’t afraid to move beyond the fax machine. Leaders who don’t need a business model to realize that we can do better than the fax machine and other 80′s technology. It shouldn’t take five committees, two research studies, a certification, and outside money for an organization to do what’s right for patients. In fact, doing so is the very best business model in the world.

What scares me is that we’re going to miss out on the value of healthcare IT because our healthcare leaders are too busy fighting the proverbial meaningful use, ICD-10, and ACO fires.

September 16, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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.

Does Spending More on EHR Mean You Get More?

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There is a really ugly myth out there that I’d like to dispel. The myth is: if you spend more money on an EHR, you’re getting more EHR. From years of experience in the EHR world (Will be 8 years in April), this statement is just not true. In fact, in many cases you can actually get more EHR from a more moderately priced EHR than you can from a really expensive EHR.

A few months back I wrote about how a clinic’s Second EHR Purchase was their Most Expensive EHR purchase. I think this is largely the case because of the myth mentioned above. Once a clinic has a failed EHR experience, the budget goes out the window and the clinic is happy to spare no expense to ensure that the next EHR they purchase is better than their first EHR purchase. Luckily, there are other factors involved in a second EHR purchase which make it more likely to succeed, but I don’t think that cost is one of them.

To be honest, I’m not sure how some EHR vendors get away with the EHR pricing that they do. With more than 300 EHR vendors out there, you can find pretty much every pricing plan under the sun. From Free EHR to High Priced EHR and every price in between. The reality I’ve seen is that there are good and bad EHR across the entire spectrum of EHR price ranges. You can find Jabba the Hutt EHR (see more about Jabba the Hutt EHR’s in this post or this one) at every EHR price point.

EHR price is always a part of every EHR selection process, but don’t let price be the main factor in how you select an EHR for your clinic.

February 7, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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.

Exposing the Jabba the Hutt EHRs and Finding the Han Solo EHRs

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I’ve had some interesting reactions to my post about the various characteristics of a Jabba the Hutt EHR Vendor. One of the more interesting conversations happened by email with a reader named Richard. Yes, I have lots of interesting back channel discussions.

After a lengthy email exchange, I asked Richard if I could post our discussion on the blog so you could participate as well. He agreed and even commented, “I look forward to an expansion of our discussion.” So, here you go (or at least scroll to the bottom for a short summary of my feelings).

The conversation started with this email that Richard sent me:

I understand your reluctance to name names in your article, BUT… this is exactly what is needed.

I’ve taken a few days to ruminate over what I was going to suggest and I’d like to hear your thoughts on this if you have time.

With your readership, I suspect there are plenty of users and observers of current packages and lots of opinions. Why not set up something like a Wiki-EMR site to provide a resource that will allow everyone to provide input into the details making “Jabba” and “Han Solo” EMR systems and see where it goes? Maybe it could eliminate some of the BS surrounding some of these systems and help others who are trying to sort out there own future needs. I’m sure there are plenty of people out there who want, need and are willing to provide information on the state and future of EMR and what is BS and what isn’t. I certainly would. Let me know your (or your readers) thoughts.

Richard

Here was my response:

Hi Richard,
Yes, this is something I’ve thought a lot about. The key question for me is how to publish some sort of “authenticated” information. Most systems are so easily gamed and/or abused that they basically have no worth. I haven’t figured out a scalable way to be able to provide information that is actual data and not provided with undue influence.

As I read your email, I wondered if some sort of combination of LinkedIn might be the key. At least then any review that’s done would be tied to an individual. Although, by doing so, you’d then discourage many of the most interesting reviews and feedback because their name would be explicitly tied to the review.

Along these same lines I’ve wondered how I could provide a “Meaningful EHR Certification” that wasn’t based on a pass/fail system that has no value. Instead it was a mixture of qualitative and quantitative data that would actually be of value to the reader. Scaling that up is the challenge I have with that idea. Not to mention figuring out the right financial model for it.

So, as you can see I’m with you on wanting more specific information out there, but not sure how to overcome the abuse and the scale that you need for it to be valuable.

As a side note, I do have a wiki page: http://emrandhipaa.com/wiki/Main_Page and it even has an EMR and EHR Matrix of companies. Although I closed registrations since spammers were getting into it.

Richard then provided this response:

It seems to me that user editing must be do-able if Wikipedia has found a way. Additionally, I think that unvarnished truth through comments creditable or not (but differentiateable ) would be a place for insiders or knowledgeable users and IT pros to vent. I realize that it is open to abuse, but a user moderated (or whatever Wikipedia uses) forum will turn upon such miscreants and their abuse might well backfire. I realize it is quite a project, but I’ll bet there are a handful of your readers, if not many more, that would gladly help put something this critical in place. If this can be pulled off, it might create “the world’s foremost authority” * in EMR.

I don’t know much at all about this, but I have a feeling that so much is riding on all of this and that there is a vacuum of useful, meaningful and understandable information that is needed to make this whole thing work. I know there must be something prescient sounding I could offer here, but it might be just indigestion that’s giving me this feeling. John, there must be some other smart guys around; try to round up some and see what they think.

Then I offered this response which shows I’ve been on Wikipedia far too much:

I’ve been rolling around something like this since I first started blogging about EMR. Wikipedia’s a bad comparison because it tries to formulate 1 truth instead of a series of opinions about something. Plus, Wikipedia relies on the masses of people (we don’t have enough mass) and even they get to a point where they regularly lock pages after abuse happens. Wikipedia’s a crazy community once you get into it. There are flame wars and battles on Wikipedia that rage in the background that most people don’t realize are happening.

Travel and hotel sites are a better comparison actually. Since reviews of hotels are more similar to a review of an EMR. The hotel owner wants to put the best reviews on there and can plant good reviews amongst many other ways to game the ratings and review systems. I read an interesting story about how Trip Advisor tried to deal with this. Unfortunately, it put on the image of successfully battling it, but didn’t do that well. Matters much less when you’re talking about a hotel versus an EMR.

I agree that it could become the authority on EMR software if it’s done right. Although, for me to do it, I have to find a model that’s authentic, honest, reliable, scalable and that makes sense economically. At least until I sell off a company for a few million. Then, maybe I can cut out the economical requirement.

Then Richard commented:

I didn’t realize that abuse was that rampant and that a fix was so difficult. I think I see some of the problems. You almost need a cadre of “fair witnesses” to explore the opinions and observations of users and provide incorruptible analysis. Not a promising outlook.

I’d be happy to assist this enterprise in any way I can, but don’t think I would bring anything very useful to the table. I feel you may be the right person to bring something like this to fruition, but the resources needed may be out of reach. It’s too bad there isn’t a Consumer Reports -like group out there for something like this. Maybe some group has enough vested in the outcome of shake-out to fund independent assessment and provide a forum for users.

I know very little about the technology involved in EMR, I am more aware of the medical business and needs for improvement in record and information management. Additionally, if cost containment can’t be managed and a “best practices” can’t be incorporated into every patient’s care then our society may be doomed economically (even morally). You’re doing something valuable, so keep it up, there must be a way to sort out the players and the technology so we can get on with the real need which is getting something useful and beneficial installed for quality patient care. Even getting this discussion broadened is worthwhile.

Well, there you go. If you made it through that, then you must really care about EHR and healthcare IT like I do.

In summary, I think it’s quite clear that it’s an incredible challenge for those searching for EHR software to find reliable information. The need for good EHR vendor information is extraordinary and no one has cornered that market…yet? There is no “consumer reports” for EHR software.

I haven’t yet identified a model that’s authentic, honest, reliable, scalable and that makes sense economically to deliver said “consumer reports for EHR software.” (or maybe I’m just too lazy, scared, busy, etc to try)

I do think that this site and the other members of the Healthcare Scene blog network provide a valuable independent resource for those selecting and implementing an EMR. My free EHR selection e-book was one effort to help providers in the EHR selection process in a very targeted way.

Are there other things that I (we) could do to help even more? I’m sure. If you have ideas, I’m interested to hear. You see my off the top of my head criteria above.

If nothing else, we can reach Richard’s goal of “broadening the discussion”

June 21, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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.

You might be a Jabba the Hutt EMR if….

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Many long time readers of EMR and HIPAA will know I like to call big, bulky, old EMR software systems, Jabba the Hutt EMR. I think comparing these old legacy EMR software to Jabba the Hutt is a great comparison. For those that don’t know Star Wars that well (and I’m no expert), Jabba the Hutt was a very powerful figure. Although, over time he’d grown so big that he wasn’t very nimble (to say the least). So, despite his power and prestige, there was little to admire about him.

Does that sound a bit like some legacy EMR software? They’re big and powerful figures in the industry. However, their software has grown to the point that it’s clunky and not very nimble. Getting something changed on it is difficult and it’s built on a platform that makes it hard to add new features. Thus, they are Jabba the Hutt EMR.

Without naming names, here’s a list of things that will help you identify the Jabba the Hutt EMR software.

You might be a Jabba the Hutt EMR if…
your interface looks like it’s from the 80′s.

You might be a Jabba the Hutt EMR if…
you use a non SQL database.

You might be a Jabba the Hutt EMR if…
you’re better at marketing than programming.

You might be a Jabba the Hutt EMR if…
you cludged together your PMS that you bought from someone else.

You might be a Jabba the Hutt EMR if…
your interface looks more like DOS than Windows.

You might be a Jabba the Hutt EMR if…
your diagnosis description is restricted to 50 characters.

You might be a Jabba the Hutt EMR if…
your EMR salespeople don’t know your EMR developers who don’t know your EMR customer service people.

You might be a Jabba the Hutt EMR if…
iPad interface….what’s that?

I think it’s worth noting that having one or two of these things doesn’t absolutely mean an EMR vendor is a Jabba the Hutt EMR vendor. Although, the more of the above characteristics an EMR vendor has, the more you should look into it.

I hope others will add to this list in the comments.

June 7, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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.

Jabba the Hutt EMR Vendor Perspective on ARRA

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I just love reading what the “Jabba the Hutt EMR Vendors” (Definition of Jabba the Hutt EMR Vendors: Good in their day, but have gotten so big and bulky that they’re barely functional) offer as a perspective on what the ARRA EMR stimulus money will do. Check out a few quotes from this article which highlight what I believe is most Jabb the Hutt EMR vendors take on the ARRA stimulus money:

“We anticipate ARRA to result in widespread adoption and use of comprehensive EHRs that support interoperability, decision support, quality reporting and clinical research,” said Justin Barnes, EHR Association Chairman and Vice President of Greenway Medical Technologies. “If we continue to work together in public and private collaboration, and build on the successes of CCHIT, HITSP and NQF, along with prudence and fiscal responsibility, we will achieve our goals of healthcare transformation and the estimated $100-$200 billion of annual savings that will come with a fully-integrated and interoperable healthcare system.”

Or Justin Barnes could have easily said that adoption would make his company millions of dollars if doctors started adopting EHR. That wouldn’t be a conflict of interest with the statement he’s making would it? Ok, I’m not saying that EHR software can’t help the healthcare industry. I think it can do some great things. However, I think the above statement lives in a far rosier world than we currently enjoy when it comes to EHR and healthcare.

Here’s another nice quote from Mark Segal, Ph.D., member of the EHR Association Government Relations Workgroup and Director of Government and Industry Relations for GE Healthcare IT (biased opinion?).

“HITECH will transform our industry and the health care system,” said Segal, “We expect a substantial increase in hospital and professional adoption of comprehensive EHRs, with most of the impact occurring over the next five years. We also expect changes in the structure of our industry and in how its products are developed, priced, and deployed.”

“As businesses, and as an Association, we are laser focused on helping our customers qualify as meaningful users,” Segal went on to say. “Even before ARRA, the Association published its interoperability roadmap and supported the development of practical, meaningful CCHIT certification criteria. We understand the dedication required to implement EHRs and want to make sure that ‘meaningful use’ criteria are achievable while moving healthcare forward, especially in such critical areas as interoperability and health information exchange.”

I do agree with Mark that how EHR products are developed priced and deployed has got to change. If it doesn’t doctors will continue to not adopt them. Let’s just not be surprised if we don’t see the “substantial increase” in EHR adoption that Mark Segal suggests. Plus, it seems like their laser focus on “meaningful use” and “CCHIT certification” misplaces what we really want to accomplish with EHR. First, “meaningful use” hasn’t been defined and second shouldn’t you have been laser focused on this goal before now?

June 7, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John 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.