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EMR Voice Recognition, EMR As Medical Devices, ACOs and HIEs, Top 100 Hospitals, and MU Stage 1 Money

Posted on April 29, 2012 I Written By

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

I’m traveling in what I consider the heart of healthcare IT: Boston. Everywhere you turn and look there’s healthcare all around. I’ve seen multiple vans with Partners on them. I even had a mobile health story in the Delta magazine I checked out on my flight out. Although, I’m not actually in Boston for work. I’m just here on vacation with my wife. So far I’ve done a pretty good job enjoying the vacation and not working. We’ll see how the last couple days go.

Don’t worry Boston, I’ll be back in two weeks for Health 2.0 Boston and we’ll get all the #HITsm crew together for some healthcare IT fun. Yes, bad planning on my part, but I do have an affinity for visiting Boston.

Ok, enough of the sidebar. Now to the usual round up of Healthcare IT tweets:


Is there an EMR where you can’t use voice recognition? I wrote a post on that a long time ago where the answer was no. They can all use voice recognition. Although, as I’ve written about the deep embedding of voice in some EMRs, it’s also true that not all EMR voice recognition is created equal. So, check it out if you like voice.


My answer is that they’re not medical devices. I think we have more than enough regulation in EMRs and I haven’t seen that regulation actually improve EMR software. So, I’m against more EMR regulation.


It’s true that many EHR vendors hold the blame for not exchanging data even if they put on nice demos at the Interoperability exchange at HIMSS. How about next year the interoperability showcase at HIMSS can only show actual implementations of real exchanges? I wonder how different it would be.


This top lists are always fun to click and rarely have much value. Although, to me it probably mostly shows a correlation by the money made and the IT implemented. The more money they have the more likely they are to implement healthcare IT.


Stage 4? You have to have completed every EMR stage (ie. Full implementation).

They Do Listen: Stage 2 Proposal Includes Some Changes to Stage 1 – Meaningful Use Monday

Posted on April 9, 2012 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

Included in the Proposed Rule for Meaningful Use Stage 2 are several modifications to the requirements for Meaningful Use Stage 1—likely in response to a barrage of comments from providers. 

The MU Stage 1 measure requiring a test of the ability to exchange clinical data would be removed effective 2013. Apparently, the concept of a test created a great deal of confusion. This change, however, should not be interpreted as reduced interest in interoperability. In fact, Stage 2 is all about the sharing of data. The measure would be replaced in Stage 2 by numerous other measures that require the sharing of clinical information—both between providers and with patients. 

The “all 3 vital signs dilemma”, (described in a previous Meaningful Use Monday post), would be resolved by a change to the vital signs measure. Separating height and weight from blood pressure, the revised measure would allow a provider to meet the threshold for recording height and weight, while claiming an exclusion for blood pressure, (or vice-versa). This is good news for specialists like orthopaedists who may routinely document height and weight but who rarely document blood pressure unless it is relevant to a specific patient’s problem. This change would be available as an option in 2013, and formalized in 2014. (The vital signs measure would also increase the minimum age requiring blood pressure documentation from 2-year olds to 3-year olds.) 

Many providers reported a problem in meeting the CPOE measure because of the way the calculation was defined—particularly those providers whose treatment does not frequently include prescribing medication. Now, providers would be able to define the denominator as the number of medications ordered, rather than the “number of unique patients with at least one medication in the patient’s medication list”, (since that list often includes medications downloaded from Surescripts and prescribed by other providers.) There is already a CMS FAQ (#10369) that allows providers to use this alternate definition even in 2012.

The government is listening, so make your voice heard. Use your experience in Meaningful Use Stage 1 to influence Meaningful Use Stage 2. Submit your comments on the Proposed Rule for Stage 2.

Meaningful Use Interview with HVCA Administrator Barbara Watkins, R.N.

Posted on May 4, 2011 I Written By

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

My last meaningful use interview went over so well, that I decided that I should do some more. When I saw the news that a GE Centricity customer met meaningful use, I decided that would be a good opportunity for my next meaningful use interview.

I’m certainly interested in doing more interviews from a variety of EMR vendors, specialties, and regions. I’d be happy to interview someone who’s deciding to wait or to forgo meaningful use completely. If you are a doctor or practice manager interested in being interviewed, just drop me a note on the EMR and HIPAA contact us page. Now some background on Barbara Watkins and HVCA.

Heart & Vascular Center of Arizona (HVCA) Administrator Barbara Watkins, R.N., helped lead the practice’s six cardiologists through the process of preparing for attestation to meet Stage 1 of Meaningful Use. The practice serves more than 15,000 patients and the providers started preparing for attestation actively in fall 2010.

An interview with Heart & Vascular Center of Arizona (HVCA) Administrator Barbara Watkins, R.N.

How long have you been using an EMR? Which EMR do you use?

We’ve been using GE Healthcare’s Centricity Practice Solution since June 2008.

Did you have to upgrade your EMR to meet the certified EHR and meaningful use requirements? How much did it cost for you to do that if you had to?

Yes, we upgraded to Centricity 9.5. We spent around $60,000 to upgrade our servers and laptops.

How long did it take you to select and implement your EHR? What criteria did you find most important in your selection of an EHR?

We went on the Practice Management software in September 2007, and then implemented the EMR in June 2008. It’s interesting that many of the components I purchased we did not fully implement until we went live on the EMR. The patient portal was one of those products, as well as the Indexing Client that facilitates the movement of scanned documents into the charts. Centricity has a wide spectrum of products that fully integrate and compliment the PM/EMR software.

How many hours of extra effort do you estimate it took for you and your staff to meet meaningful use criteria?

We began to actively prepare for attestation in the fall of 2010 when the CMS issued their final rule. Towards December, we were honing in on our workflows and consulting with our physicians to ensure that they were capturing all the necessary data within the EMR. In total, we estimate that 60 extra hours were spent on this project.

What were some of the changes you had to make to your practice style or documentation methods to meet meaningful use?

Ensuring that we were careful and precise with our documentation was certainly critical, since the Centers for Medicare and Medicaid Services (CMS) require specific tracking of criteria. For example, medication reconciliation is done in our practice at every office visit because we’re specialists. However, CMS views medication reconciliation only in the context of “transition of care,” so that’s how we have to document it – even when we are seeing the patient in a post-op visit. Our providers had to be trained to use a specific code to identify a post-op visit as a “transition of care” event in order to satisfy the medication reconciliation criteria.

Overall, the most important factor for us in meeting meaningful use requirements was understanding how certain data was being captured and recorded. We also made sure to match the new reporting requirements with our workflows, which naturally takes a little time.

Were there any surprises in the meaningful use attestation process?

I was very excited when we ran the first reports – our physicians were actually doing most of the processes that were required and at very high percentages. But the biggest surprise was that we would need to modify our workflows to prove some of the measures.

Who helped you through the process (your vendor, a consultant, your REC, etc.)?

We’re thrilled that we have a strong vendor partnership with GE Healthcare – they were extraordinarily supportive throughout the process of helping us prepare for attestation and run the necessary meaningful use reports.

I believe dependable vendor support is especially important for physician practices who do not have IT departments at their disposal to help troubleshoot the EMR and ensure that all the meaningful use reporting requirements are met.

Were there any unique challenges for cardiologists in showing meaningful use?

Actually, I feel cardiology is one specialty that easily meets meaningful use, barring the immunization requirements. We easily met the core measures and many of the quality measures as well. We have been participating in PQRI (now PQRS) and e-Prescribing with GE’s MQIC product. MQIC’s reporting tools keep us on track with many quality measures and protocols that we have instituted in our practice on our own.

Meaningful use Stage 1 has a relatively low bar. Are you concerned that stages 2 and 3 might be a much harder challenge?

I’m optimistic about meeting the requirements for stage 2, although I do have concerns about exchanging data between disparate providers. Given my knowledge of the Phoenix market, I don’t believe that level of data exchange has gained real traction yet in our region. We will have to work hard to encourage data exchange with our referring doctors.

What do you say to your fellow doctors who are concerned about implementing an EHR in their practice?

EHR is a necessity in today’s time. We have found a real scale of efficiency in using the Centricity product. It has improved communication within our practice. With the patient portal, we have improved communication with our patients as well. Our physicians love the ability to login to the system from anywhere and access patient data to facilitate communication with hospitals and other physicians in an instant!

Interview with Meaningful Use Physician #23

Posted on April 19, 2011 I Written By

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

Yesterday morning, River Falls Medical Clinic (RFMC) of River Falls, Wisconsin, attested for Meaningful Use at 7:30 a.m. CT. The clinic was one of the very first – in fact, #23 to attest to meaningful use under the Medicare program. The following is an email interview I did with Dr. Tashjian about RFMC’s experience in the meaningful use attestation process.

Christopher H. Tashjian, MD is the president of River Falls, Ellsworth & Spring Valley Medical Clinics in Wisconsin. The three clinics provide primary care services as well as specialty consults.

How long have you been using EMR? Which EMR do you use?
River Falls Medical Clinic, RFMC, implemented Cerner’s Ambulatory EHR in March of 2010 after several years of working with Cerner’s PWPM solution.

Did you have to upgrade your EMR to meet the certified EHR and meaningful use requirements?
From day one of EHR implementation, our staff has made it a priority to utilize our EHR solution to its full extent to benefit the care we deliver to our patients and to enhance our workflow. From the time Meaningful Use was announced, our staff was quick to realize that the proposed criteria would help us to better utilize our EHR and to enhance the care and delivery of that care our patients. We made it a goal to not simply attest for Meaningful Use for the monetary benefits that the stimulus dollars provided, but to more importantly enhance patient care. Therefore, we did not upgrade our EHR to solely meet the certified EHR/Meaningful Use requirements. We did add several pieces into our daily routines including Cerner’s departure summary and patient education –even though this piece isn’t required this year, we know that it will be in stage 2 and beyond. We also continued to improve our eprescribing procedure. We will also be upgrading to include Cerner’s IQHealth® solution to provide a patient portal that enables patients to review their own information and interact with us within a secure platform.

How much did it cost for you to do that?
There is a cost to move to an electronic record from paper – RFMC’s physicians feel it is vital to recruit today’s top medical students/residents. We felt if we did not have an EHR, we were at a serious disadvantage. More than 70% of the physicians in our area have gone electronic– we had to stay up-to-date. Patients in our area want to see a physician who has embraced technology and made the commitment to enhance patient care and safety; they want a physician who is moving forward with technology, not one who is still using paper when a better option is available. There is a cost associated with being a provider of choice and RFMC, like any other physician office, wants to attract new residents (physicians) and new patients. Providing better care is one way to do this. There is no way we could stay competitive in the marketing place if we did not choose to go electronic. The cost of not doing so was too high.

Why was it important to you/your office to be one of the first physicians in the nation to attest?
We wanted to make sure we were doing it right – we looked at the Meaningful Use requirements and said, “These things all appear to provide measurably better care.” Our physician’s felt that meeting Meaningful Use requirements would point our focus in the right direction. Most importantly, we wanted to follow the steps to enhance care. There is value in being one of the first physicians to attest and in being able to tell our community that RFMC is up and running at the first opportunity. This is of significant value to us. Additionally, our physicians literally put their own dollars into the HER; we made a personal investment in this. Many private groups owned by physicians have followed the same suit. This is not a situation where we just said, “Okay, we can rearrange some dollars.” If we don’t succeed – we don’t take our money home. It’s very personal to us as individuals and meaningful because we practice medicine to help our patients. Additionally, we wanted to be able to assist our fellow physicians in the process. By being one of the first physicians in the nation to attest, I can provide feedback and suggestions to assist others in the field.

How many hours of extra effort do you estimate it took for you and your staff to meet the meaningful use criteria?
We were committed to meeting Meaningful Use requirements already, so it’s difficult to say exactly how many hours we put into this initiative specifically. There were many hours spent making sure we met the requirements. We felt the requirements were so valuable and worthwhile that we began working on them day one because we felt they would enable us to deliver better care for our patients. Instituting an EHR required significant effort to change the way we document and the way we take care of our patients, but we saw this as part of the natural cost of doing business and we chose to do it in real time rather than seeing fewer patients. Our staff simply worked more hours – longer hours –so we did not interrupt the care to our patients. Within 6 weeks we were back up and running at full speed – this really is a fairly rapid adoption.

What were some of the changes you had to make to your practice style or documentation methods to meet meaningful use?
We aim to have all notes completed the same day. For us, this was a huge transition from the dictation world. Our team had to learn to document electronically and have things done by the time the patient left the room. This is vital for our patients incase they find themselves visiting the ER that night or seeing another physician that day. In these cases – the information on their visit with our physicians is complete and available. We also completely transitioned from writing prescriptions and went all eprescribe.

There were several changes in the way we practice. For example, now, every visit ends with the patient summary, which I never did before. Now, I sit down with the patient and whoever is with them to discuss, “Here is what we did, here are the tests we conducted today, the labs we completed and prescriptions written.” I provide a full, comprehensive overview of their visit. Incorporating the patient summary into the exam has enhanced my relationship w/my patients and they feel more confident walking out the door. Before, visits ended with a physician writing a prescription and saying goodbye.

We’ve also decided to put printers in every room to provide the after visit summary to our patients. We want everyone to receive their after visit summary and to get the appropriate patient education. We’ve gone to two-sided printing for all documents, so we aren’t printing anymore than what is absolutely essential for each situation. This is helpful for our elderly patients who are on multiple medications, which can get confusing. It’s easier to keep track of everything if it’s written down. We’ve also received feedback that this is valuable for their caregivers who may not have been in the exam room with them. On the other end of the spectrum, this is incredibly beneficial to parents of children, particularly newborns. Parents want to track progress and they want to be able to easily recall information. As we adopt Cerner’s IQHealth®, we anticipate moving the majority of this information into the patient portal for easy accessibility and storage in one central location. We also regularly utilize the immunization registry, which we did not engage with previously.

What steps did you take to ensure you were ready to attest?
To ensure we were ready to attest, we used the reporting capabilities within Cerner’s solution to extract the appropriate data. We used weekly reports to note where each physician was in regards to meeting the requirements for attestation. We also enlisted the support of WHITEC, The Wisconsin Health Information Technology Extension Center, to make sure we covered every base.

Were there any surprises in the meaningful use attestation process?
I was overall impressed that the process was put together so meticulously. There were multiple forms that needed to be filled out as we went through the process, and our staff truly did their due diligence prior to “pushing the button” to ensure we were ready. Thanks to the staff’s preparation, we were prepared when the numbers were requested. It was very easy for us.

Who helped you through the process (your vendor, a consultant, your REC, etc)?
Cerner played a large part in our success. Early on, we began working with Karen Berg, a Cerner Ambulatory director, who came to our clinic to meet with our quality physicians and walk us through the process of getting signed up for Meaningful Use. Berg worked through our questions to help physicians get ready to attest. She highlighted the need for us to prepare for Meaningful Use and beyond and laid out foundational steps for us to focus on patient care beyond Meaningful Use. We have been pleasantly surprised by the wealth of resources available through uCern, a collaborative website for Cerner clients, and we use them regularly. Additionally, our office manager receives regular emails from a group of people at Cerner who are dedicated to help their clients attest and prepare for certification. On our behalf, Cerner also works hand-in-hand with WHITEC, a health information technology extension group that our peer review organization put us in touch with. WHITEC has been very helpful for directing us through the Centers for Medicare and Medicaid Services website and doing research around questions that arise.

What benefits are your patients seeing from you showing meaningful use of an EHR?
Overall, our patients are receiving better quality of care as a result. They’re receiving patient education as well as after visit summaries and their information is tracked for accuracy. Their immunizations, which are one of the most complicated things for parents of minors to track, are recorded in the immunization registry and interfaced with the Wisconsin Immunization Registry. We’ve eliminated errors through eprescribing, there are simply no more errors due to handwriting legibility. They don’t have to worry about losing a prescription, because we send it directly to their pharmacy electronically. Eprescribing also conducts side effect checking and keeps record of the time and date a script is written and sent. Interoperability is a huge benefit for our patients – there is now no need to transfer things to other physicians in our 5 sites, which saves the physician and patient time.

What efforts are you taking to progress towards meeting meaningful use stage 2 and beyond?
RFMC is excited to move forward towards Stage 2 and beyond. We’re already working on next year’s goals; that is, giving diagnosis related patient education to my patients.” We have implemented Patient Education within our practice. We’re moving ahead to continue to deliver the best to our patients.

What do you say to your fellow doctors who are concerned about implementing an EHR in their practice?
I have never met a physician (who has moved to electronic records) say they would like to go back to paper. True, it requires a concerted effort to move to the EHR but the gains in patient care are worth it.

What do you know now about attesting for meaningful use that you wish you knew prior to attesting?
Be organized, choose the right vendor and all will go smoothly. If you actively work to do what is in the best interest of the patient, meaningful use will naturally follow.

What can you share with other physicians who are getting ready to attest in the next weeks and months?
There is very little way to prepare other than to prepare your attitude. Meaningful Use is the way the industry is going and we’re on board with a focus on our abilities to better our care – it’s a job standard to move in this direction. So, jump on board.