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Surviving 2014: The Toughest Year in Healthcare

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The following is a guest blog post by Ben Quirk, CEO of Quirk Healthcare Solutions.
Ben Quirk
How bad is 2014 for the healthcare industry? We’ve all read about ICD-10, EHR incentives, Medicare cuts, and the Affordable Care Act. But the most telling moment for me occurred during this year’s HIMSS conference in Orlando. There was quite a bit of B2B enthusiasm, but among the civilians it was mostly a lot of stunned looks and talk about how to get through the year. Here are some of my observations:

ICD-10. CMS has made it abundantly clear there will be no further delays to the October 1 deadline for ICD-10 implementation. This is possibly the most significant change to the healthcare industry in 35 years, affecting claims payment/billing systems, clearinghouses, and private and public software applications. Anyone who provides or receives healthcare in the US will be touched by this in some way.

In a recent poll of healthcare providers conducted by KPMG, less than half of the respondents said they had performed basic testing on ICD-10, and only a third had completed comprehensive tests. Moreover, about 3 out of 4 said they did not plan to conduct tests of any kind with entities outside their organizations.

Incorrect claims denial will be the most likely result. CMS will not process ICD-9 Medicare/Medicaid claims after October 1, and there is a high potential for faulty ICD-10 coding or bad mapping to ICD-9 codes. Error rates of 6 to 10 percent are anticipated, compared to an average of 3 percent under ICD-9. ICD-10 will result in a 100 to 200 percent increase in denial rates, with a related increase in receivable days of 20 to 40 percent. Cash flow problems could extend up to two years following implementation. This will be a costly issue for providers, and a very visible issue for patients.

We advise our clients to be proactive in their financial planning. This should include preparation for delayed claims adjudication and payments, adjustments to cash reserves, or even arranging for a new/increased line of credit. Having sufficient cash on hand to cover overhead during the final quarter of 2014 could be very important, as could future reserves to cover up to six months of payment delays. Companies not in a position to set aside reserves should consider working with lenders now before any issues arise.

Meaningful Use. As with ICD-10, CMS has stated there will be no delays to MU deadlines in 2014. That means providers who have never attested must do so by September 30, or else be subject to penalties in the form of Medicare payment adjustments starting in 2015. Providers who have attested in the past will have a bit longer (until December 31), but the penalties are the same.

There is much dissatisfaction with the government’s “all or nothing” approach to MU, where even the slightest misstep can invalidate an otherwise accurate attestation. While the ONC has proposed a more lenient model for EHR certification in coming years, everything will be measured against a hard deadline in 2014.  CMS is offering some mitigation through hardship exemptions, based on rules that are somewhat broad at this point. Providers should consider applying for an exemption if no other options are available.

We advise against taking shortcuts or rushing to beat the clock on MU. Up to ten percent of eligible professionals and hospitals will be subject to audit, and large hospitals may have millions of dollars at stake. Being prepared for an audit means more than just making sure an attestation is iron-clad; internal workflow and communication are also important. A mishandled audit notification can result in a late response and automatic failure.  Data security should also not be overlooked. Medical groups have failed audits due to lapsed security risk assessments as required under HIPAA.

Medicare Payment Cuts. Medicare Sustainable Growth Rate (SGR) cuts continue to hover over Medicare providers. Enacted by Congress in 1997, the SGR was intended to control costs by cutting reimbursements to providers based on prior year expenditures. But every year costs continue to rise, as do ever-worse SGR cuts (almost 24% in 2015). And every year Congress prevents the cuts via so-called “doc fix” legislation.

In early 2014 there was surprising bi-partisan agreement on a permanent doc fix, whereby Medicare reimbursements would be based on quality measures rather than overall expenditures. However, the legislation was derailed by linking it to a delay of the ACA’s individual mandate. As of mid-March there is still no permanent or temporary solution. Congress will almost certainly intervene to prevent SGR cuts, but by how much is uncertain.

The ACA. As the cost of insurance has increased over the past decade, high-deductible plans have become more and more common. Due to the Affordable Care Act, this trend has become the norm. Media outlets focus on the impact to consumers, and argue about whether more “skin in the game” leads to better choices or less care. What we’re hearing from the front lines is much more concrete: high deductibles are having a negative impact on revenues.

Very few people understand their liabilities under a typical health insurance plan. Last year George Loewenstein, a health-care economist with Carnegie Mellon University, published a survey showing that only 14 percent of respondents understood the basics of traditional insurance policies. At the same time, hospitals report that about 25 percent of bad debt originates from patients who are currently insured. With millions of new enrollees in high-deductible plans and an ongoing economic slump, the situation can only get worse.

The ACA had a further impact by reducing the amount of Disproportionate Share Hospital (DSH) charity funds available, based on a projected increase in insurance coverage.  But with some states not participating in Medicaid expansion, combined with an increase in patients lacking the knowledge or resources to manage large medical expenditures, the reduction in funds comes at exactly the wrong time.

Providers can cope by adjusting revenue cycle processes. For example, new programs should focus on estimating patient liabilities pre-arrival, educating the patient at check-in, and instituting proactive billing/collection at the point of service. In general, providers must pay more attention to the self-pay process, focusing on patient education and offering transparent, easy-to-use billing and payment methods.

Value Modifier. This program has not been a worry for most providers thus far. Not because it won’t have an impact on revenue, but because they don’t know about it. A little-known provision of the ACA, the Value-Based Payment Modifier mandates adjustments to Medicare reimbursement based on quality and cost measures. The program is being phased in, and so far has applied only to group practices of 100 or more Eligible Professionals (EPs). In 2014, smaller groups of 10 or more EPs will be subject to the legislation. These groups must apply and report to the program by October 1. Otherwise, they will be subject to a 2 percent cut in Medicare reimbursements starting in 2016.

One of the most important aspects of the program is its definition of “eligible professional” when defining the size of a group practice. For the purposes of Value Modifier, eligible professionals include not only physicians but also practitioners and therapists. That means that a practice with 8 physicians, a nurse practitioner, and a physical therapist would qualify as a practice with 10 EPs.

Value Modifier is part of the growing trend toward quality-based reimbursement. Even commercial payers are considering some version of the program. The scoring calculations are complex and poorly understood, so we advise clients to get up-to-speed as soon as possible. Groups with high quality and low cost will receive incentives rather than cuts, with additional upward adjustment for services to high-risk beneficiaries. Groups that are not paying attention may be surprised by an additional hit to revenue in 2016. In addition, quality scores will eventually be published to the general public on the Physician Compare website.  Sub-par or missing scores could have a negative financial impact on a practice.


These are only the most high-profile impacts to the healthcare industry during the current year. Much else flows from them: changes to workflow, to computer systems, to financial expectations. Tremendous pressures are coming to bear within a limited timeframe.  We’re seeing an industry in the midst of tectonic change, with 2014 as the fault line. It’s unclear whether these disruptions will be for better or worse. But there certainly will be winners and losers, and those who plan ahead are most likely to survive.


Ben Quirk is CEO of Quirk Healthcare Solutions, a consulting firm specializing in EHR strategic management, workflow optimization, systems development, and training. The company’s clients have enjoyed remarkable success, including award of the Medicare Advantage 5-star rating. Quirk Healthcare presents a weekly webinar series, Insights, to inform clients and the general public about government programs and industry trends. Mr. Quirk is also Executive Director of the Quirk Healthcare Foundation, a learning institution which fosters innovation in the healthcare industry.

March 26, 2014 I Written By

Usable EMR, Post EMR World, and Impact of Meaningful Use

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This is an important nuance. Although, I’d argue that the biggest challenge to EMR usability is onerous billing requirements and prescriptive meaningful use requirements.

I’m really interested in the description of a post EMR world. It makes me ask myself the question, “What can we do with 100% EMR implementation?”

MU has spurred EHR adoption. No arguments there. Hard to argue against MU killing much of the EHR innovation and usability. We’ll see which exceptions emerge from the dust.

February 23, 2014 I Written By

John Lynn is the Founder of the blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: and, 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.

Eyes Wide Shut – Teaching to the Meaningful Use Stage 2 Test

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According to Twitter analytics, one of my more engaging tweets recently stated that Meaningful Use is stifling innovation by requiring that health IT vendors and healthcare providers employ very specific tactics to capture and report on clinical data capture and interoperability standards compliance – ostensibly to engage and empower the patient, and improve coordination of care between providers. Of course, I said it much more succinctly than that. In effect, conforming to the Meaningful Use Stage 2 attestation measures is akin to “teaching to the test”:

Here’s a real-world example of what it means to “teach to the test” of Meaningful Use. In order to qualify for CMS incentive dollars, Meaningful Use Stage 2 Year 1 patient engagement measures must be met, with auditable data captured, in a 90-day contiguous period in 2014. An eligible provider (EP) must demonstrate that 50% of all patients with encounters during that time period have online access to their clinical summary within 4 days of the data becoming available to the provider. 5% of those patients must access the clinical information within the 90 days, and 5% of those patients must leverage secure messaging to communicate relevant health information with the provider. Finally, the MU-certified EMR must proffer patient-specific education materials for 10% of the patients seen during that time.

What I believe the ONC had in mind when they crafted these measures: engaged patients who will log in to their portal after each encounter, review the findings and lab results to assess their own progress and outcomes, read or listen to the condition-specific educational materials provided that resonate with them, and ask more meaningful questions of their providers as a result of this new-found, data-enabled empowerment. That is why they categorize these measures as “patient engagement”, right?

Wrong. This is what “patient engagement” looks like, from the EMR implementation, Meaningful Use-consultant, EP business process standpoint.

First, establish the bare minimum thresholds for meeting the measures. If the EP saw 1000 patients during the same 3-month period the previous year, your denominator is 1000; calculate the numerator for each measure based on that. So, we need 500 patients to have access to their clinical data online; 50 patients must access their information; 50 patients must communicate with their provider via secure messaging; 100 patient encounters must prompt specific educational opportunities.

To meet the 500 patients with online access to their clinical data, patient portal software is preloaded with patient demographic accounts, based on the registration data already available in the EMR. An enrollment request is emailed to the patient or authorized representative (assuming an email address is available in their demographic information). The EMR captures the event of sending this email, which contains the information about how to enroll and access the patient’s medical records via the portal. This measure is met, without the patient acknowledging the portal’s existing, and without any direct communication between provider and patient.

The medical records view and secure messaging measures can be met simultaneously, in a matter of days, by planning to add a few extra minutes to each encounter for 50 patients’ worth of appointments. The EMR has already triggered an email with portal enrollment information to each of the patients in the waiting room on a given day. As the medical assistant (MA) is taking vital stats, she asks whether the patient has enrolled in the portal. It’s likely the patient has not; the MA hands the patient a tablet and has him log in to his email, and walks him through the portal enrollment and initial login process. Once logged in, the MA directs the patient to click the link to view his medical record. That click is recorded, and the “view” measure is met; whether a CCD or C-CCD is actually displayed is irrelevant to the attestation data capture.

Having demonstrated how a patient can view his record, the MA then asks the patient to go into the portal’s message center, to send a test communication to the provider. The patient completes the required fields, and the MA prompts him with a generic health-related question to type into the body of the message. Once the patient hits “Send”, the event is recorded, and the “secure messaging” measure is met.

For all patients, whether portal-users or not, a new process begins when the MA finishes, the provider enters the room and begins her evaluation of each of the 100 patients required to meet the education measure. As the patient talks, the provider is clicking through EMR workflow screens, recording the encounter data. The EMR occasionally prompts with a dialogue box indicating educational materials are available for patients with this diagnosis code, or this lab result. Each dialogue box prompt is recorded by the EMR; the “patient-specific education” measure is met, whether the provider acts on the prompt and discusses or distributes the educational information or not.

To put it simply: the patient never has to log in to a portal to meet the 50% online availability requirement, they don’t have to actually view their records to meet the 5% view requirement, they don’t have to have an actual message exchange with their provider to meet the 5% communication requirement, and they don’t have to receive any tailored materials to meet the 10% education requirement. Once those clicks have been recorded, the actions never have to be repeated; meaningful and ongoing patient engagement is not needed to meet the attestation requirements and receive the incentive dollars.

In a previous post, I introduced my interpretation of the difference between the spirit and letter of the Meaningful Use “law”. By teaching to the test, we’re addressing the letter of the law, only, in its narrowest interpretation. When will we incent vendors and providers to go above and beyond and find ways to truly engage patients in meaningful ways, empowering them with accurate, timely data access and tools to analyze it?

September 30, 2013 I Written By

Mandi Bishop is a healthcare IT consultant and a hardcore data geek with a Master's in English and a passion for big data analytics, who fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

A Patient’s View of Meaningful Use Questions

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The creativity of humans will never cease to amaze me. If you’re someone who works in the EMR world, you’ll love this video. I honestly don’t know whether to cry or cry laughing. I’m sure many doctors and nurses reading this will have had some first hand experiences like this. Enjoy a nice patient view of meaningful use thanks to Ashley Fuller.

July 22, 2013 I Written By

John Lynn is the Founder of the blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: and, 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.

Patient Education, Cloudalization of Healthcare, and EHR Vendors – #HITsm Chat Highlights

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Topic One: How valuable do you see the use of gaming as a vehicle for patient education and engagement? #mHealth

Topic Three: Is healthcare departing from the client/server architecture toward the cloud? AKA, “The cloudalization of healthcare.”

Topic Three: Is HITECH to blame for introducing false demand for #EHRs? What will happen after all the money is flushed out of the system?

Topic Four: If an #EHR vendor fails, how will their customers migrate to another product if their data is locked in a proprietary system?


March 23, 2013 I Written By

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

An Interview with Mitochon About Their Recently Launched EMO (Electronic Medical Office)

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The following is an interview with Mitochon about their newly launched EMO (Electronic medical Office) and a discussion of some of the various trends happening in healthcare IT like: ACOs, Meaningful Use, and HIEs.

Q: Tell us about your recently launched EMO (Electronic Medical Office) product.

A: Our Electronic Medical Office product is a complete end-to-end solution for the modern day medical practice. Allowing the practice to accomplish all their daily task in one solution. One application, one vendor, one solution….. EMO.

Q: When did you start thinking about a suite of applications beyond just EHR?

A: We have seen for years the issues the practice has had to endure when dealing with multiple vendors, products and interfaces. The finger pointing and passing the buck when many different vendors are involved. Its the old right hand left hand issue. Just over two years ago as a team we knew we had to step forward and develop an end-to-end solution and give the practice the continuity and consistency of dealing with one vendor and one solution to take care of all the practice needs from the Patient accessing their medical records and financial data from their own PC to the tracking of insurance claims and collections.

Q: Will EMO (Electronic Medical Office) be free like your past Free EHR offering?

A: Yes EMO will be a FREE offering. In addition to our FREE EMO we are offering a plus package, with EMO+ you get all the features of EMO and back office Revenue Cycle Management. With EMO plus the practice pays only 2.85% of their monthly collections and we handle all the billing and collections from a back office perspective.

Q: In this world of EHR consolidation, EHR’s closing down, etc, why should a doctor feel comfortable choosing Mitochon?

A: We started Mitochon with the belief that Health IT services are too expensive and too complex! We wanted to take away the cost barrier that many independent physicians couldn’t previously overcome, enabling them to provide better patient care while qualifying for Meaningful Use incentives. Our advertising business model is proven, sustainable and successful and is a similar model that works for TV, radio, newspaper and the web. We’re here to stay!

The Mitochon application is used in other markets on a paid basis. We are saddened by the fact that companies still pay to use systems that were closed down such as Kareo and Epocrates recent announcement, they are late and trying to resurrect a system that was closed down. We understand other free vendors have over spent on promotion and the day of reckoning is coming closer, we gain 30% of our new users from other free systems that offer poor support, when the investors get sick of running a business with scant regard to profits they will go the way of MySpace, remember them?

Q: Do you think that most of the doctors using your EHR will becoming “meaningful users”?

A: The question should really be if the physicians believe the meaningful useage criteria, as defined, really add to their patient care or do they see it more of a hassle or prying eyes of payers. The vast majority of our users have achieved Meaningful Use. We are a conservative company owned by physicians, we build a real base of users, no hype. We believe we likely have the highest percentage of users achieve MU versus any other EHR.

Q: The claims clearinghouse is a new Mitochon feature. Tell us more about that part of the product.

A: EMO would not be an end-to-end solution if we did not include medical claims clearing. There are no gimmicks or gotchya’s with our clearinghouse. The sending of medical claims as well as status updates of those claims is FREE as well! We are redefining the end the end solution

Q: What other applications aren’t part of EMO (Electronic Medical Office) that you’ll look at incorporating in the future?

A: We have appointment reminders, Statement printing, fully integrated credit card processing that is linked to a users account. We have the in built HIE that allows Physician to Physician referral as well as the soon to be launched Patient Health Record. As the market demands we will continue to add features and functionality. In office dispensing solutions can bring Physicians significant revenue, up to $7,000 per month profit depending on sub-speciality. We are also working to bring an integrated sample closet so physicians can add further value to their patient interaction. Also remember we also have free mobile access to our EHR.

Q: How do you think what you’re doing fits in with other trends like ACOs (Accountable Care Organizations)?

A: In an ACO the goal is population management, better outcomes with lower cost. As such you have to manage the 30% of chronically ill patients who are utilizing 60-70% of the health care dollars. To do so, every provider needs to be engaged, integrated and connected. So our free solution has a role to complement the other solutions so that an ACO can gather information from all their providers. The risk is very high for an ACO that has a leaky infrastructure because the management of risk will be exposed and the cost curve will not be bending, hence no savings will be generated. Our EMO solution is created for instant collaboration and coordination because of the built in HIE function. In our network physicians who care for the same patients instantly are connected and can share medication list, problem list, labs, radiology and progress notes without the additional cost of integrating. We have contracts with 3 ACO’s.

Q: What’s your take on mobile adoption by doctors, particularly when it comes to products like EHR?

A: Mobile phones are ubiquitous in the medical community. We see Physicians and Nurse Practitioners adopting our mobile solution. It is unlikely they will undertake a full clinical interaction on an iPhone but they do use our native iPad App. The key here is it is a tool for the Doc on the run. The office based PC will always be the tool of choice in the foreseeable future, many have just purchased them recently!

Q: What’s something that doctors aren’t paying enough attention to right now?

A: Connectivity. They have just paid for a stand alone EHR, now they need to coordinate care with other providers/hospitals/labs etc. These other entities are cherry picking and paying certain providers who have enough volume or contribution to the hospital or system. It is a cost that may be just as expensive as the EHR in the long term for the physician. This is a crucial part of the solution and why we have an inbuilt HIE functionality allowing physicians to immediately refer patients across our system. This is particularly attractive to the ACO market.

Also, the meaningful use subsidy will end in a few years, if a provider is using an expensive system, how will that affect the ability for the provider to sell their practice to a new physician who is already in debt from med school. We have many fat cat EHR vendors just milking the Physician who they see as an equal opportunity victim. How many EHR’s are showing 60% revenue growth since 2009? This will come to a end soon and the physician will be leveraged again unless they are using a system with an alternate revenue model. Thats where our Mitochon Patent comes in, introducing contextual clinical content into the workflow and subsidize the Physician’s cost.

Full Disclosure: Mitochon is an advertiser on EMR and HIPAA.

February 27, 2013 I Written By

John Lynn is the Founder of the blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: and, 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.

EHR Benefit – Legibility of Notes

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I’ve hinted for a little while that I was going to start a series of posts talking about the various benefits of using an EHR. I think this is an important subject worth discussing in greater detail. I hope that this series of posts will also help us move past meaningful use of an EHR for the government EHR money and explore all the other reasons why healthcare should fully adopt an EHR.

Back when I first started blogging about EMR software (It was 2005, before the term EHR came to be), I made this list of EMR and EHR benefits over paper charts. I’ll be using that list as the starting point for this series of EHR Benefit posts. I love the first paragraph on that page (which I likely haven’t touched since 2005):

This list is just a starting point to list off all the possible benefits of having an EMR or EHR. Probably a poor one, but a start nonetheless. My plan is for this list to grow over time as I think of new benefits or as people suggest things I’ve most certainly missed. Also, I think that most people often focus too much on the financial benefits of an EMR and so hopefully this list will include financial and other benefits beyond the financial implications.

The list definitely did grow, but I guess I never got around to updating the intro paragraph. Although, I am pleased to see that even back in 2005 I was as interested in the non-financial benefits of EHR. Certainly the financial benefits of EHR are incredibly important, but far too many people don’t take into account the other non-financial benefits in their analysis of EHR benefits. It’s just too hard for many to try and compare or put a value on the non-financial benefits of EHR. We’ll try to point these benefits out just the same.

Now for the first EHR benefit on the list:

Legibility of Notes
I’m really glad to start with an EHR benefit that everyone can understand with little explanation. Poor medical handwriting has been a running challenge in healthcare for as long as we’ve been documenting patient visits. I did a quick search on Google for “write like a doctor” and it had about 321 million results. That’s quite pervasive.

I can’t think of anyone that would argue that healthcare doesn’t have a challenge reading physician’s handwriting. No doubt there are plenty of exceptions to this, but even those with beautiful handwriting still have to read other doctors’ handwriting from their own office or from other doctors’ notes that get sent to their office. It’s great to have the notes, but if you can’t read them then what’s the point.

While certainly illegible handwriting is a major problem in the office, it also extends outside the office as well. Think of all the times pharmacists have had to call a doctor to clarify the prescription a patient brought in. Even worse than that is the number of times the pharmacist misread a script because a doctor’s handwriting is illegible. This becomes a non-issue in an electronic world where the prescription is either printed or ePrescribed.

Of course, none of this is new territory. Every doctor understands these benefits better than I’ve explained here. However, far too often when we think about implementing an EHR, we forget about these simple and easy to understand benefits. How much time is saved in your clinic by being able to read the handwriting in the chart? How much time is saved in healthcare when referrals come in an easy to read, legible format? How much time and how many lives are saved by pharmacists getting the proper prescription to the patient? All of these are hard measures to quantify, but they are real, tangible benefits of an EHR.

I won’t mislead you into thinking the shift from paper charts to EHR solves all the legibility problems. Many template driven EHR software that creates a mass of mostly irrelevant data can be just as hard to decipher as the hieroglyphic handwriting of some doctors. However, I’ve seen a tidal wave of push back against these documentation approaches and I think we’re getting better. I think the shift to quality of care reimbursement versus procedure based reimbursement will help this to go away as well.

There are other things a clinic leaves behind with paper charts. I’ve heard many tell me how many times they looked at the handwriting to recognize who had documented something in a paper chart. Certainly that same info is available in an EHR, but you do lose the instant recognition of who charted what in the chart.

Despite not being able to put a nice dollar value on the Legibility of Notes, it’s certainly an EHR benefit that can’t be forgotten. It’s very easy to adopt an EHR and take this for granted.

December 12, 2012 I Written By

John Lynn is the Founder of the blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: and, 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.

Meaningful Use for Radiologists – Meaningful Use Monday RSNA12 Edition

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This week is the enormous RSNA conference in Chicago. I almost made the trip to the event, but wasn’t able to figure out the logistics. Plus, with a wife and kids the less travel the better. One day I’ll make it to RSNA. Until then, I thought I’d dedicate this edition of Meaningful Use Monday to the radiologists out there.

In short, meaningful use stage 1 was not good for radiologists. Most radiologists saw it as a non-starter for them. In fact, I think it’s safe to say that smaller radiologists couldn’t tell you much of anything about meaningful use stage 1. Meaningful Use stage 2 has made some progress for radiologists, but is unlikely to really get them off the bench and showing meaningful use.

Healthcare IT News has a good article on radiologists and MU where they point out some image centric updates to meaningful use per RSNA:

compliance exemptions for many hospital-based providers who are not involved in their facility’s information technology decisions, a discretionary menu set objective targeted toward diagnostic image accessibility in EHRs, recommendations for radiology-relevant clinical quality measures, more flexible definitions of what constitutes justified EHR, and a consolidation of the eligible hospital and eligible professional technology certification criteria.

Although, the article also points out two other very important points. First, radiology practices will likely forgo participation in the meaningful use program and avoid the EHR financial penalties by way of an exemption. If that exemption ever runs out, then radiologists might change their tune. Although, my guess is that the meaningful use penalties will never be enforced or that there will always be exemptions that radiologists can fall back on.

The second point is even more interesting. Lineage Consulting’s Nakhle suggests that all of the other ordering physicians that are adopting EHR and showing meaningful use might be the real driver for radiologists to get on board meaningful use. I agree that ordering physicians being meaningful users of an EHR is going to change imaging facility requirements. Certainly imaging facilities are going to have to work on new tech workflows, but that doesn’t mean they have to go so far as meet meaningful use. Plus, most imaging facilities are working on these workflows already, so I don’t expect meaningful use will cause much change.

I’m sure this will be a huge topic of discussion at RSNA. If you’re there, we’d love to hear what’s being said on the show floor.

November 26, 2012 I Written By

John Lynn is the Founder of the blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: and, 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.

Meaningful Use Stage 3 Timeline – Meaningful Use Monday

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The big meaningful use news this week was the release of the meaningful use stage 3 recommendations (PDF) that the meaningful use workgroup released to the public. Some on Twitter thought that this was the meaningful use stage 3 rule that could be commented on. This is not open for public comment yet, but should be soon.

In fact, Healthcare IT News listed the following timeline for meaningful use stage 3:

  • Dec. 21, 2012 – RFC deadline
  • January 2013 – ONC to synthesize the RFC comments for HIT Policy committee workgroups to review
  • February 2013 – The workgroups will reconcile RFC comments
  • March 2013 – The workgroups will present a revised draft of Stage 3 requirements to ONC
  • April 2013 – ONC is expected to approve final Stage 3 recommendations
  • May 2013 – ONC will transmit final Stage 3 recommendations to HHS

That’s a pretty aggressive timeline to have meaningful use stage 3 published by May 2013. If my dates are right, meaningful use stage 3 won’t be effective until 2016. I like that ONC wants to get the MU stage 3 out soon so that no one can use not having the meaningful use details as an excuse for not complying. However, I also don’t think ONC should rush the process either. We have to live with meaningful use, good and bad, for a long time to come.

I’d love to hear what you notice in the meaningful use stage 3 proposal (PDF). We’ll be sure to cover it a lot more in the future.

November 19, 2012 I Written By

John Lynn is the Founder of the blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: and, 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.

EMR Tea Party, EMR Scribes, Older MDs, and MU+

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This tweet is a little self serving since it links to my post on EMR and EHR about what I call the EMR Tea Party. Although, Charles Webster, MD’s response was too funny not to share. I haven’t seen any pitchforks or torches yet, and someone commented that Tea Party is a tainted term that shouldn’t be used, but I think there are some parallels.

EMR Scribes seem to be growing slowly in popularity. $10/hour does seem low for someone who needs to have some clinical understanding and more important clinical vocabulary. However, I imagine if the cost goes too high, then no doctor would ever get a scribe.

I think there’s definitely a gulf between those doctors that can type and those that can’t. Age is definitely correlated to typing speed. Although, I’m not sure I agree that tabets are the answer to this problem. One thing that is certain is that EMRs in their current form aren’t using an optimized UI for tablets. We’ll see if any EMR can bridge the tablet UI and make the case for touchscreen documentation by doctors. I’m skeptical that a nice tablet UI can replace type/text for most doctors.

This is a very interesting tweet from John Sharp. He’s right in many regards. There are plenty of elements of HITECH that don’t get enough exposure, but I’m not sure how many of those other HITECH elements really move the needle.

November 11, 2012 I Written By

John Lynn is the Founder of the blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: and, 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.