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Where is the Value in Health IT?

Posted on August 10, 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.

What a powerful question that I think hasn’t got enough attention. Everyone seems to be so enamored with EHR thanks to the $36 billion in EHR incentive money. I seem to not be an exception to that rule as well. Although, at least I was in love with EHR well before the government started spending money on it.

While so many are distracted by the government money I think it’s worth asking the question of where the value is in healthcare IT.

Practice Management software has a ton of billing benefits. Is there a practice out there that doesn’t use some sort of practice management software? I don’t know of any.

Health Information Exchange (HIE) has a ton of value for reducing duplicate tests. Certainly we have challenges actually implementing an HIE, but the value in reducing healthcare costs and improving patient care seems quite clear. Having the best information about someone clearly leads to better healthcare.

Data Warehouse and Revenue Cycle Management (RCM) has tremendous value. RCM is not really sexy, but after attending a conference like ANI you can see how much money is on the table if you deal with revenue integrity. I add data warehouse in this category since they’re often very closely tied together.

Since this is an EHR site, where then does EHR fit into all this? What are the really transparent benefit of using an EHR. I know there are a whole list of EHR benefits. However, I think it is a challenge for many doctors to see how all of those benefits add up. EHR adoption would be much higher if there was one big hair benefit to EHR adoption. Unfortunately, I don’t yet think there’s one EHR benefit that’s yet reached that level of impact. I hope one day it will. Not that it matters right now anyway. Most practices wouldn’t see the benefit between the EHR incentive weeds.

Real-Time Analytics and Dashboards for Streamlining Revenue Cycle Automation

Posted on January 25, 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.

Last month CareCloud announced a new real-time analytics dashboard to help doctor streamline revenue cycle automation. The core of their product is what they call CareCloud Analytics. As I think about the announcement, I wondered if it was really a big deal or not and why we hadn’t seen more of this in the various practice management systems and EHR software on the market today.

Is Data Analytics important in Healthcare?
I think this type of information is a big deal. Information is power and this is never more true than in healthcare. The press release does a great job of describing how real-time analytics and dashboards provide information which provides transparency and accountability to a practice. One quote from the article says, “The practice can now manage the productivity of the office staff, monitor in real time the productivity of billers, and gain transparency into the business side of operations to help form better decisions through data, instead of intuition.”

I’m a huge fan of analytics in my business. I call myself a stats addict. I have 2-3 stats programs running on my websites at all times. I get stats from my ad server, from Google’s ad server, and from every other stats engine I can find that has reliable data. Much of my success with my websites is because of my passion for knowing what’s happening with my websites. To me, Data is power! The same can be said for a practice. Data is the power to make important decisions that are needed for the success of your practice.

Why don’t more EHR and PMS vendors provide these analytics?
I’m sure there are a number of reasons why we don’t see real time analytics happening very often in the small practices. Hospitals are a bit different. There are whole companies devoted to just providing these types of services to hospitals that can pay for a full scale data warehouse environment to provide this type of data. A hospital that doesn’t do this type of data mining is missing out as well, but they have a number of options. Although, I don’t think many hospital HIS vendors offer this info by default.

The key reason I think real-time analytics and customizable dashboards are missing in the small practice environment has to do with doctors demand (or lack thereof) for such a feature. This will surprise some, but most will agree that the majority of doctors don’t care much for the business side of the practice. Sure, they care that the business side of the practice effects how much money they take home at the end of the day, but a large portion of doctors would love their lives a lot more if they didn’t have anything to do with the business of a practice. Yes, I know there are exceptions to this, but most doctors want to practice medicine not business.

With this as background, if you ask most doctors what they want from their EHR and Practice Management software, they’ll start to list off all of the clinical and workflow needs that they have. Very few of them will even venture into the business requests like real time analytics. Plus, even if they did venture into the business side of things, would they know how to request such a feature?

EHR and Practice Management Vendors have to show them why it matters to have these real time analytics. It reminds me of the famous quote attributed to Henry Ford. “If I had asked people what they wanted, they would have said faster horses.” This can often be taken too far, but I think it applies well when it comes to things like real-time analytics of a practice.

One other reason that a number of companies are missing the analytics and its relationship with revenue cycle management is that they’re too focused on EHR. Many just consider the PMS a standard thing that everyone has already and that there’s no room to innovate. Last I checked meaningful use didn’t have any practice management elements and that’s taken up at least one development cycle for most companies. Too many doctors later dismay, the EHR selection process often puts the practice management side of the puzzle on the backseat. This is a mistake that many practices are paying for today.

As one PR rep for a major EHR company said to me, “Revenue Cycle Management isn’t sexy.” Although, she said this directly after telling me how beneficial it was to their bottom line.

Around Healthcare Scene: The mHealth Summit, DentiMax PM Software, and Getting Physicians Onboard with mHealth

Posted on January 15, 2012 I Written By

Here is a quick look at some of the other articles recently posted on some of the other HealthcareScene.com websites:

EHR and EMR Videos

David Collins of HIMSS Discusses the Course of Global Health at the 2011 mHealth Summit– David Collins, Senior Director of Professional Development at HIMSS, speaks at the 2011 mHealth Summit about HIMSS’ involvement in this year’s Summit, and about how HIT X.0 is affecting the course of Global Health.

Cerner Smart Room Technology Overview Video– An updated view of Cerner’s Smart Room technology. The Cerner Smart Room incorporates technology and workflow software to improve consumer care and clinician efficiency. The Smart Room is powered by CareAwareTM device connectivity architecture.

EHR and EMR Screenshots

These three posts provide numerous screenshots from the DentiMax Dental Practice Management Software.  Are there special considerations for a dental practice as opposed to a regular medical practice when it comes to EHR/EMR/PM?

Screenshots from the DentiMax Dental Practice Management Software
More Screenshots from the DentiMax Dental Practice Management Software
Appointment Book Pro Screenshots from the DentiMax Dental Practice Management Software

Smart Phone Health Care

How to Get Physicians Onboard with mHealth- No matter how great an app or device may be, it will be difficult for any developer to be successful if they don’t get some level of buy in from physicians in general.  People will always resort back to their physician when it comes to the quality of medical products.

Axial’s Care Transition Suite Wins “Ensuring Safe Transitions from Hospital to Home” Mobile App Challenge– In a recent online discussion I had concerning an article I recently wrote, the point was raised that for an app or device to be successful it must fulfill a need.  While I don’t think that it is absolutely essential to success, it certainly makes the path to success much more realistic.

Away From Blogging Sick

Posted on July 27, 2010 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.

The latest flu bug that’s been going around has hit me pretty hard. I’ll be back tomorrow (assuming all goes well) with more posts.

Until then, some interesting news items for you to consider:
SOAPware Announces Release of PMS – They’ve been working on this for a while. Plus, it’s interesting to see the pure EMR companies getting a PMS. Check out this interview I did previously with the SOAPware president.

SRS and Ingenix Collaborate to Deliver PMS and EHR – Another case of an EMR partnering with a PMS system. Plus, now SRSsoft can get to meaningful use. As expected, EVERY EMR vendor is likely going to need to be able to say, “Our EMR can show meaningful use.”

EMR Install Base – According to Vendors

Posted on March 17, 2009 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 was recently reading a post on EMRUpdate (great EMR Forum) by a man I highly respect who goes by CEOMike. In his long post, he made the following short analysis that I thought was really interesting:

I thought by now you would have figured out EMR vendors are LIARS, making some of the bankers look like choir boys. I have done other posts on the install base claims of vendors. Figure it out 4% (studies show) of approx 400,000 primary care docs is only about 16,000 EMRs in use. Divide that by the approximately 400 EMRs [see my list of over 400 EMR companies] that have been listed in the last three years = 40 users per EMR Or go at the other way – take all claims by EMR vendors and add them up (I did this exercise a few years back) and you get something like over a million doctors using EMRs???

The million EMR installs seems a little high, but the point is well made. How do we really get accurate data about install base? The answer is that you really can’t from most vendors.

When we first implemented our EMR, we were told that they had close to 100 college health centers. Little did they ask (I wasn’t there when they selected this particular EMR) how many of the 100 health centers actually used EMR versus just their practice management system. Let’s just say I was quite surprised by the reality.

That didn’t deter me. In fact, if anything it motivated me to make it happen. Still today I think our clinic is the most cutting edge in our category for use of EMR. I enjoy that feeling and I enjoy when other clinics want to come and take a look at what we’re doing. Yes, I am sure they want to see our EMR and not just have a trip to Las Vegas.

Reasons Why CCHIT Certification is an Inappropriate Standard for EHR Stimulus

Posted on March 15, 2009 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.

An EMR and HIPAA reader, recently pointed me to a post on a Google Group called “Response to HIMSS ‘Call to Action’: Interoperability First.” The response starts with a short discussion of the need for government to promote and support some sort of interoperability standards. I’ve said a number of times before that interoperability should be a focus of government, because interoperability is more of a public health benefit than it is a benefit to doctors.

After discussing interoperability, the response discusses reasons why CCHIT certification is an inappropriate standard for the HITECH act to use to determine “certified EHR.” Take a look at the reasoning:

As it currently exists, CCHIT certification is an inappropriate standard for federal funding, authorization or endorsement of HIT systems:
*CCHIT 2009 certification has over 450 separate requirements, the collective effect of which tremendously increases the cost and complexity of IT solutions. Many of these requirements are “functional specifications” that should be determined by customer needs and priorities, rather than by committee. These requirements foster (if not mandate) the development of rigid, monolithic systems.

*The monolithic approach to certification taken by CCHIT does not reflect the current advances in information technology being leveraged by other industries where integrated solutions are used to support the complete “end-to-end” business process. Integration and interoperability are essential to leverage the potential of “cloud computing” and other service orientated delivery mechanisms.

*CCHIT works to the benefit of a small number of large EMR vendors that can command a high price from the relatively small segment of the market able to currently afford their products. It is essentially anti-competitive, and establishes a major barrier to entry by new vendors and open source projects (where the majority of innovation will take place).

*A quick count from the CCHIT website gives the following results for the number of systems certified for ambulatory EMR (including conditional certifications and multiple certified products from a single vendor):
i) 2006 = 93
ii) 2007 = 55
iii) 2008 = 14

*At this rate of attrition, the number of certified products will dwindle to the single digits.

*The shrinking number of vendors that are capable of meeting CCHIT certification exposes a fundamental flaw in its current organizational structure – CCHIT is funded by the very vendors it certifies. In order for it to maintain revenue, it needs to provide a reason for vendors to continue to either:
i) re-certify on a regular basis
ii) apply for new certifications

*The problem with this model is that, in order to justify ongoing re-certification, CCHIT must continue to add new certification requirements year-to-year. The driver for more requirements is not necessarily the needs of customers or the best interest of the healthcare system, but the need to have new requirements against which to certify vendors. This is illustrated by the fact that CCHIT has recently reduced the length of the certification from three to two years, and is adding numerous supplemental certifications in areas like child health, cardiovascular, etc. There is no end to the number of requirements to which this could lead, but there is no evidence it will serve anyone well in the long run, other than the few large vendors with the resources to keep up with this process, and CCHIT itself.

*Although in theory vendors can apply jointly for CCHIT certification, in practice the monolithic certification process will limit the ability for vendors to provide component solutions from which customers can choose to create best-of-breed, low cost solutions that best fit their needs. For instance, in the ambulatory arena, this might typically be a combination of Practice Management, EMR and e-Prescribing solutions.

*Certification of Practice Management systems in other markets (e.g., UK) has arguably reduced innovation and investment, increased the total cost of ownership and consolidated the market to such a point that there is limited choice and the barrier to entry for new entrants into the marketplace is unaffordable.

I think this is just the start of what could be said, but it raises some really important points about certification.

EMR’s Affect on Medical Billing Costs

Posted on September 29, 2008 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 received an email not too long ago from a medical billing company who talks about the crazy costs associated with medical billing. In their email they offered the following statistics on the costs of medical billing.

The statistics below represent industry averages taken from the MGMA.

Claims Rejected on 1st Submission – 30 %
Underpayed Claims – 20%
Gross Collection Rate – < 60% Preventable Denials - 90% Denials that are Recoverable - 67% Average days in A/R - 52.32 Cost per claim - $5-$7 Cost per FTE physician - $30,000-$60,000 Cost of billing operations - 18-22% Cost of Billing Personnel - 58-62% Cost of Technology/ Practice Management Solution - 18-22%

Source: Avisena whitepaper

I must admit that billing is far from my expertise, but it’s a well described necessary evil for almost any practice. Plus, the better you do it, the more money your clinical practice can make.

Of course, my question is how did implementing an EMR in your clinic either help or hurt these various costs? Were you better able to process claims, because the charting was done electronically and the coding done at the time of visit? Were you able to process claims at a higher rate because your documentation was more complete using an EMR? Could you more quickly process denied claims because it was electronic? Did you need more or less employees to do your billing after implementing an EMR?

I guess it would also be important to know if you decided to go with an integrated Electronic Medical Record and Practice Management System or if you tried an interface between your legacy system and a new EMR system.