I always love when people talk about the paperless medical office. It’s as if they believe that after implementing an EMR they will no longer have to have paper in the office. Turns out, EMR software can print out a lot of paper if you’re not careful.

While ePrescribing is on the horizon in many places, the harsh reality is that many still have to print out prescriptions. Add in the requirements around prescribing controlled substances and in almost every state doctors using an EMR are still having to print out prescriptions.

In my clinic, it always felt wrong to print out an entire sheet of paper for one prescription. Eventually we got our vendor to support printing out multiple prescriptions on one sheet of paper. That helped, but many patients only need one prescription so that’s a lot of wasted paper. Beyond the green movement, wasted paper = wasted money.

With this background, that’s why I was intrigued by the DYMO Prescription Printer that I saw at MGMA. I’d worked with DYMO label printers before since the lab I worked with printed off lab labels directly from our EMR software. It makes sense that they could use a little bit larger printer and do the same thing with prescriptions.

It’s pretty obvious to see the paper saving benefits of using a DYMO printer like this, but I think the other advantage to this printer is its size. The printer has such a small footprint that you could easily put it a lot of places that a standard printer just won’t fit.

I admit that I haven’t done a full analysis of the savings using this printer compared with a standard printer. However, the nice thing about the DYMO printers is that they’re thermal printers which means that you’ll never have to spend money on ink or toner to print prescriptions. That’s pretty nice.

I’d love to have some of my readers try out the DYMO Prescription Printer to let me know what they think and whether they think I should add it to my list of EMR related technology products. Maybe I should see if DYMO will give one away to one of my readers to try out and report back.

I always love when small adjustments to current technology can make a huge difference. Or in other words, did I just write a post about a label printer? Sometimes the best innovations are subtle changes.

UPDATE: I just got word that DYMO will be happy to provide a product for review. So, drop me a line on my Contact Us page if you’re interested in trying it in your clinic.

Many of you have probably read about the problems that GE Centricity EHR software had with a few of the meaningful use guidelines. If you haven’t read about it, go and check out that link to read Priya Ramachandran’s post about what happened. Plus, you can read a GE representative’s additional comments and clarifications. I actually had the chance to talk with GE in person at MGMA about these issues. While there’s no doubt that GE is taking heat for these problems (and they should), I personally believe it just highlights a bunch of possible problems with meaningful use attestation and raises a lot of unanswered questions.

My first premise is this, “If a large EHR vendor that’s intimately involved in the meaningful use rule creation process can mess up some of the meaningful use guidelines, how many other EHR vendors are going to do the same?”

This is a serious issue. Imagine you’re using an EHR software that runs into this problem. How quickly will that EHR vendor respond? Will they even know that they have an issue with meaningful use attestation before it’s too late? At least GE caught it early and can now address the issue for all of their doctors that are affected and get their EHR stimulus money. Even if they don’t get it resolved this year (which wouldn’t be a good outcome), then they do have next year which pays the same amount of money.

I’m not sure the same outcome will occur for some doctor who instead of proactively realizing a meaningful use attestation mistake gets “caught” with some mistake in some sort of meaningful use attestation audit. I guess we’ll see how those play out, but I imagine it won’t be as pleasant for MU attestation issues to be caught in an audit.

Plus, I think there’s very little doubt that there are other EHR companies which haven’t implemented the meaningful use attestation requirements quite right. I’m sure it’s just a matter of time before we hear of more issues. In fact, I have a feeling that EHR vendors that are reading this post are ready to forward it to their meaningful use expert/development staff to evaluate if they’re at risk for such a problem. The answer is that many EHR vendors likely are at risk. I imagine part of the risk is due to laziness in implementing the meaningful use guidelines (I guess they haven’t been reading our Meaningful Use Monday series), but the other part is that it’s not like meaningful use is that simple. It’s not quite the tax code, but it’s not always that straightforward.

This incident does bring up a whole new set of questions for CMS to answer. For example, what happens if a doctor attests to meaningful use and then realizes that for some reason (their fault, their EHR vendor’s fault or some other situation) they actually didn’t meet the meaningful use guidelines as required? Do they need to show another 90 days of meaningful use? Do they need to return their EHR stimulus check? Will CMS take the money back out of future payments? Can a physician go back and fix any mistakes that were made (this will likely depend on what went wrong)?

I’ll be keeping an eye on this discussion and we’ll do our best to post what GE and others learn from CMS when it comes to mistakes in meaningful use attestation. I have a feeling this could get a little messy. Based on my own experience with CMS in the past, I have a feeling they’re going to be as lenient as they possibly can be. However, they’re still going to have to follow whatever legal guidelines they’ve been given.

One other question that still makes me wonder is why didn’t the CCHIT EHR certification catch this mistake too? This would obviously require a pretty good dive into the EHR certification guidelines and the implementation of these guidelines. To me it highlights how little value the EHR certification process adds to the EHR market.

I have a feeling that this post has people like Dr. West enjoying their Meaningful Use Freedom even more.

Today at MGMA, Fujitsu together with Osmosyz announced a new scanner that supports the relatively new CDA “Unstructured Document” HL7 standard at MGMA 2011. I must admit that the press release is a little intense. However, I find what they’re doing with a hardware product to support HIE is quite interesting.

I don’t want the title of this post to be misleading. While certainly HIE has generally become synonymous with some large health information exchange entity, in this case I’m describing a hardware device (a smart scanner if you will) that acts as a small health information exchange. Basically, it’s more along the lines of Direct Project as opposed to NHIN. Although, I imagine that it could send the documents to some larger health information exchange if someone wanted to do so.

The larger application I see of this technology is as a replacement for the fax machine. In some ways, it’s like a second generation fax machine. The major differentiation I see between a document sent using the CDA “Unstructured Document” HL7 standard and a fax is all the meta data that comes with the CDA document.

The fax or scanning workflow for most EHR software consists of receiving faxed documents or scanning documents into what amounts to basically a bucket of all the scanned documents. Then, it’s up to the user to go in and sort through all the various faxes that have been received or documents that have been scanned. At this point, the user can assign the document to a patient in the EHR. You can imagine the challenges that this can pose. I wonder how many documents scanned or faxed into an EHR have been assigned to the wrong patient accidentally.

That’s what makes this new Fujitsu scanner quite interesting. If it’s receiving the document from an outside source, it will come with the meta information for the document as part of the CDA standard. That can then be leveraged to more quickly assign that document to the patient. Not to mention, then all of that CDA information is available for other uses within the EHR.

For inside documents that are scanned in through the Fujitsu device you can actually assign the document to a patient on the scanner itself. That’s right, you can identify which patient a scanned document belongs to while you’re holding the document in your hand. A much better way to ensure that the document you scanned gets attached to the right patient in your EHR.

I’m just touching on a few of the features of what’s possible with this new Smart Scanner from Fujitsu and smart documents. You can do other things on the scanner like dividing document scans between multiple patients.

Meaningful Use Monday Angle
Of course, as most of you know, on Monday we usually do our regular Meaningful Use Monday series. Turns out that the CDA Clinical Document standard that I discuss above is being adopted by ONC as part of meaningful use. I’ll be interested to see how this plays out over time, but don’t be surprised if EHR software has to support this standard in the future.

What I find more intriguing is that the above scanner could be used by someone who doesn’t have an EHR, but wants to exchange patient information. I still think that the long term solution to interoperability of patient information has got to come from connections with EHR software. However, this does illustrate that technology solutions can and will be created to exchange health information. In fact, some combination of these solutions could be a way to meet some of the meaningful use requirements around exchange of health information. You still can’t get the EHR stimulus money without an EHR, but technologies like this could help you achieve meaningful use.

I’ll keep an eye on how this technology progresses. I wonder how many EHR vendors will integrate with this type of technology. Whether we like it or not, documents are going to be a major part of healthcare for the foreseeable future. We’ll see if smart documents and smart scanners are an intermediate step to the health information exchange nirvana (whatever that might be).

Following on the extremely successful New Media Meetups we’ve held at HIMSS, we decided to do a similar New Media Meetup at MGMA 2011. This time I decided to join up with the great people at HITECH Answers to put the meetup together. Plus, Free EHR vendor, Mitochon Systems, has graciously offered to sponsor the event along with providing the food and drinks.

In case, you’ve missed the previous New Media Meetups we’ve done, this is an event for anyone that participates in new media, is interested in new media, reads new media or just likes hanging out with a bunch of cool people. Yes, that pretty much means that everyone is welcome. Just don’t be surprised if you see people taking pictures and tweeting while at the event.

There’s no specific agenda for the event. Just great networking with interesting people. So, come enjoy some food, drinks and connect with interesting colleagues.

Here are the details for the event:
When: Tuesday, Oct. 25 from 5 – 7 pm
Where: Suite 2169 at Hilton Hotel (right next to Conv Ctr)
RSVP:
Fill out the form embedded below so we know how many to expect:

Or Complete this form to RSVP

About Mitochon Systems
Mitochon’s mEMR system is the first, free, fully certified EHR system. Mitochon uses a free, ad-supported model. Ads are displayed within the workflow of the application. The Mitochon mEMR system, designed by physicians for physicians, is intuitive and easy to install. Most customers are up and running in one day. Mitochon Systems was founded in 2006 by André Vovan, MD, MBA, FCCM, the director of a critical care department at a large California hospital. Information: 877-817-0902 or http://mitochonsystems.com/.

Event hosted by HITECH Answers and HealthcareScene.com

Time for my roundup of interesting topics seen throughout the interwebs and related to EHR and healthcare IT.

@Allscripts
Astounding growth in use of EHRs – 5x in 2.5 yrs – Dr. Mostashari at #ACE2011 (via Skype) – does your doc use an EHR?

I’d like to see where Dr. Mostashari got those numbers. I think there’s little doubt that EHR use is up. If we say that 2.5 years ago it was at about 15%, then that would mean that using his growth number we’re now at 75%. That seems way too high for me.

@shelleypetersen – Michelle Petersen
US are starting to standardise vendor requirements for #healthit and language used in #EHR regions, important move

Is this a misread of what’s being done with meaningful use and EHR certification? I haven’t seen standards really emerge for most of this. I guess it does say “starting.”

Hospital EMR User Tracking Bill
Don’t ask me why, but this post about a CA Bill Requiring Hospital EMR Software to Track Users came across my tweet stream as well even though it was posted back in June. I guess that’s one thing I love about Twitter. It can bring back interesting content that you wouldn’t have seen otherwise.

After reading the post, I wondered if the CA bill passed or not. I’m guessing not. Although, I’m still shocked by the article’s comments that even an expensive Epic install at Kaiser can’t meet the requirements of reporting on what data for a patient in an EHR has been deleted and who’s accessed that patient data.

MGMA Conference in Las Vegas
I’ll admit that I’ve wanted to go to the MGMA conference for a couple years now. This year I’m lucky that it’s hosted in the beautiful Las Vegas. So, I’ll definitely be there enjoying the event. I’ve been thinking about doing a New Media Meetup at MGMA like I do at HIMSS. Are any readers interested if I put it together? If there’s only a few of you, we could just do a dinner or something. Let me know in the comments or on my contact us page.

I’m pretty sure that many readers of this site haven’t found my new EMR related website called EMR and EHR Thoughts and so you might have missed the post I did about Greenway Medical filing to go public. This is obviously big news for Greenway, but I also think it’s a sign of things to come. I believe that Greenway is likely the first of many EHR companies that we’ll see go public over the next year or so.

I’m sure that many of you haven’t followed the trends of tech company IPO’s and I’m far from an expert on this. However, the IPO window which was generally closed for tech companies now seems to be open after a number of successful public offerings from tech companies. I’m not sure why it took me so long to realize this, but I believe that we’re going to see a number of IPO’s from the larger privately held EHR companies during this period as well (Don’t be surprised if even Epic can’t resist).

Many people in silicon valley are suggesting that we’re in a startup internet bubble that in some ways is similar to the initial dot com (or bomb if you prefer) bubble. When you look at startup company valuations, I believe this is definitely the case. In some similar ways, we are also in an EHR bubble. However, I don’t believe this EHR bubble is going to pop for a couple years.

The obvious reason we’re in an EHR bubble is the EHR stimulus money. That’s going to continue to hold the EHR bubble up for at least another 2-3 years. Then, the real fun (or sadness depending on your position) is going to start to set in. However, until then HIMSS, MGMA and other EHR related conferences are going to have some really great parties.

We’ll see what the post EHR bubble looks like, but I can see a number of EHR companies enjoying the benefits of an IPO during the current bubble.

This week I finally got my flight and hotel all lined up for my trip to HIMSS. Thanks to Practice Fusion for sponsoring that part of my trip to HIMSS. It’s greatly appreciated. I think Orlando is going to be a great destination for HIMSS and the energy and excitement is going to be something else thanks to the EMR stimulus money. It should be a pretty exciting event with far too many people, sessions and vendors to take in.

I’m still considering throwing together a New Media Meetup at HIMSS like I did last year. It was a lot of fun and worked out well since we just partnered with MEDecision to pull it off. If you’re interested in helping put something like that together or attending an event like that, let me know and I’ll be sure to let you know the details. I personally really like these sorts of intimate meetings with interesting people who understand New Media like blogs, twitter, Facebook, etc.

What other conferences do people attend? I’ve been to a number of different EMR events this last year. The Mobile Health Expo was a fun event and should get better as it grows. I really enjoyed mixing it up with all the doctors at AAFP (even if I did get kicked out of a session since I wasn’t a doctor).

I’d wanted to go to MGMA this year, but couldn’t quite swing it. The good thing is that the 2011 MGMA Annual Conference is in Las Vegas (my backyard) and so I can easily attend while still enjoying my own bed. HIMSS 2012 is also going to be in Las Vegas which is very convenient for me. Obviously, you can see I have a bit of a bias to EMR or healthcare IT related conferences in Las Vegas. It’s just so much nicer and luckily a fair amount of them come to Las Vegas.

I heard there’s going to be a healthcare portion of SXSW in Austin. That’s a conference I’ve always wanted to go to. Health 2.0 could also be interesting, but I find it much more consumer health app focused than EMR and doctor focused.

Are there any other EMR related conferences that I should keep my eye on?

Mobile Healthcare Expo
I recently signed up to be a media partner for the Mobile Health Expo in Las Vegas. It’s happening October 19,20, and 21st and it looks to be a really interesting conference with some really power players in the mobile healthcare market.

I’ll be “moderating” a couple sessions on Wednesday, but that’s just misuse of a term. I’m going to be introducing the speakers and opening it up for question and answers as needed. I of course will be doing the HITECH and mHealth session by Vince Kuraitis and then I also was asked to do the session titled “The Role of Mobile in Professional Marketing Programs” by Robert Kadar.

I must admit that I’ve gone pretty light on the mobile healthcare and mHealth coverage on this site. Hopefully this conference will open my eyes to some new elements of mobile healthcare that I hadn’t considered before.

Of course, if that doesn’t work, it looks like they have some pretty good parties. It is Las Vegas after all.

If you’re planning to attend, I’d love to meet up with you.

MGMA Annual Conference
I was hoping to go to the MGMA annual conference in New Orleans October 24-27, but it doesn’t look like it’s going to happen. I thought I had a vendor who was going to sponsor my flight and hotel in return for sponsorship of my posts from MGMA, but that fell through. There’s always next year. I hear that registrations numbers for MGMA are way up. If you’re planning to go, I’ll be interested to hear how it goes.

The MGMA sent a letter to David Blumenthal warning that if done poorly the ARRA’s EMR stimulus money could result in “the needless squandering of resources and significant disruption to the nation’s healthcare system.”

The bNet Healthcare blog gives a summary of MGMA’s recommendations to avoid this situation:

• The meaningful use criteria should be easily adoptable in a wide range of practice settings, including small practices and rural practices.
• Between the date of the final rule and the 2011 start date of the incentive program, the government should conduct a pilot to ensure that “the process of demonstrating meaningful use is achievable and practical.”
• Instead of using a “pass/fail” structure, the government should inform physicians of whether they meet the criteria and give them an opportunity to modify their systems and submit corrected data.
• There should be a simplified process for physician attestation of their use of EHRs, to be verified through random audits.
• If vendors cannot provide “appropriate and cost-efficient products” that enable physicians to show meaningful use, the government should use its statutory authority to provide a low-cost EHR that meets those criteria.
• Doctors should be able to use a range of methods of reporting quality data, including claims-based information, and they should be able to test their reporting systems before the incentive start date.
• The government should create a website and toll-free telephone numbers so that physicians can report problems with vendors.

I especially like the pilot program idea since one of my biggest complaints about previous government healthcare IT incentives was that many people planned and hoped for the government money and some catch left them empty handed.

Neil Versel posted a list of upcoming Healthcare IT conferences (a few aren’t just IT, but IT will be a large part of it) in the sidebar of his blog. Check out his list:

Medical Device Connectivity (Sept., Boston)
Medicine 2.0 (Sept. 17-18, Toronto)
AHIMA (Oct. 3-8, D-FW)
Health 2.0 (Oct. 6-7, SF)
MGMA (Oct. 11-14, Denver)
Connected Health Symposium (Oct., Boston)
CHIME09 (Oct., Indian Wells, Calif.)
E-Patient Connections (Oct., Phila.)
NIH mHealth Summit (Oct. 29-30, DC)
Inst. for Health Tech Transformation (Nov., LA)
AMIA (Nov. 14-18, SF)

That’s a lot of conferences. Were there any that we missed? That just goes through the end of the year. How do people stay up with all these conferences? I still haven’t made it to HIMSS, but am planning to go to Atlanta in March.

I’ve always wanted to put together my own EMR conference. Basically, just bring in a lot of really smart people to have insightful discussion about topics related to EMR. You could even bring in some EMR vendors and run them through the ringer. Maybe none of them would want to come and be held accountable for their software. However, if they did that would really say something. We could always do it on some test installs or something. Maybe the conference could put 10 EMR vendors through their paces and publish a report evaluating those 10 EMR companies. Then, that report could pay for the expenses of the conference. Who knows, I’m just thinking out loud on my blog. That’s what I love about blogs.

I’m not even sure it has to be a conference. Now that I think about it, it might be even more interesting to just bring a nice group of really smart people together to meet and discuss EMR and HIT for a day. Could produce some pretty interesting content. Plus, with a small group, you could pretty easily find a place to host the event I would think. Not to mention, I live in Las Vegas and everyone loves to come visit Las Vegas.

Back to the list above, which of the above conferences will you be attending? Are there any types of conferences that you wish were available related to EMR and HIT?