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Hospitals Like Modular EHR, Ambulatory Likes Complete EHR

Posted on July 20, 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.

For those reading this site that don’t know Dr. Robert Rowley, you should. He’s the original Chief Medical Officer (CMO) at Practice Fusion that recently parted ways with Practice Fusion to work on some other projects along with still practicing medicine. Along with this background, he’s a really smart guy that has a lot of knowledge about the EMR and EHR industry. Plus, he’s a downright nice guy.

The good thing is that he got addicted to blogging while working at Practice Fusion and now he’s carried over that love to his own blog (linked above). I’m sure I’ll be referencing Dr. Rowley and his blog many more times in the future. The title of this post came from a blog post he wrote about Mass Consolidation of EHR software. Here’s a quote from that post:

If one carries out a detailed analysis of 2011 Meaningful Use data, some patterns emerge. Firstly, ambulatory clinicians nearly always choose Complete EHRs – 95% of ambulatory Meaningful Use attestations were done using Complete EHRs. Hospitals, on the other hand, represent a different pattern – only 48% of hospitals attested for Meaningful Use using a Complete EHR, whereas 52% used Modular EHR components.

I found this to be a really interesting observation. It’s not all that surprising when you think about it, but it’s very interesting.

I know there’s a strong group of people that participate in the Collaborative Health Consortium that have been proponents of using modular EHR components. It looks like this is definitely happening in the hospital environment. I think that’s a very good thing.

EMR and HIPAA Interviews on XM Radio Station ReachMD

Posted on November 29, 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.

When I attended the Practice Fusion Connect conference in San Francisco, I had the opportunity to do a couple interviews for a segment on the XM radio station ReachMD. They’ve posted the segment I did on EMR and meaningful use on their website (Free registration required). In the radio segment I interviewed:
-Camille Williams, practice manager from ENT Associates of South Atlanta in Marietta, Georgia
-Ken Harrington, practice manager from Washington Endocrine Clinic in Washington, DC
-Robert Rowley, MD, chief medical officer of Practice Fusion

It was a fun experience recording something for radio. I learned a bit about radio production and enjoyed interviewing people. If you’re pretty familiar with EMR, meaningful use and healthcare IT, then the segment probably won’t be that interesting to you. However, if you’re just starting to get into EMR, then I think you’ll find some interesting information in the interviews.

Let me know what you think if you listen. Should ReachMD create a healthcare IT and EMR show?

Challenges with EMR and EHR Data Sharing

Posted on January 7, 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.

In the last blog post, Dr. Rowley discussed an interesting example where data sharing would be useful and various methods of sharing that data.

I think we can all agree with Dr. Rowley that in the ideal world #6 (sharing patient data within the same EHR system) is the best way to facilitate sharing of clinical information between doctors. Having a unified database of all patient records would of course make sharing information easier. However, there are a number of challenges with this scenario. Let’s discuss a few of these.

The first problem is that the dream of one system is just a dream. There are just too many disparate systems already in place and so we have to be practical and plan for scenarios that aren’t ideal (ie. multiple EHR systems). It’s hard enough to get consensus around one EHR vendor amongst a small set of doctors in a group practice. Try selling the same EHR to doctors from multiple specialties across a geographic region to choose the same EHR. At the end of the day, even if you had the best EHR it is likely that one doctor will just want to be different for different’s sake. Thus killing the idea of a unified system across all providers.

Just for fun, let’s say every doctor in the area does implement the same hosted EHR system. Even then it’s not very likely at all that the hospital is going to use the same EHR. Software that works well in a hospital setting doesn’t usually work well in an ambulatory setting. So, you still don’t have the patients hospital information because they’re using a different system.

I don’t want to be a complete naysayer about the idea. I have seen this implemented rather effectively in a Hospital system which had 116 multi-specialty clinics. From what I heard, they had a huge majority of the health care in their regional market. At the time they’d only implemented 25% of those clinics, but they’d implemented an EHR across specialties of almost every kind. They have a unified database where patient information was available regardless of where it was done. They even had an interface with the hospital system (the hospital system owned the clinics so this made sense). I also think it’s important to mention the interface they had with their various labs. Essentially, they had the dream that Dr. Rowley espouses. Interesting that this was all done with a client server based EHR.

While I describe the above scenario as a wonderful example, they aren’t without their challenges. They faced head on some of the challenges I described in my previous post. For example, an update to the EHR software affected every clinic using the EHR whether they liked the update or not. Anyone that’s gone through an update to an EHR is familiar with some “new feature” causing untold heartache because the EHR company didn’t realize how that “new feature” would affect the doctors using the EHR. Often the “new feature” isn’t listed in the release notes and so there was no notification to prepare for the change. Even more difficult is that with 116 clinics of varying specialties it’s nearly impossible to know how changes to the EHR software will affect each of the doctors. I’ve seen both of these problems happen even with a small 2 clinic implementation. Multiply this times 58 and you can imagine the challenge.

One other problem this implementation faced and certainly PracticeFusion or other one database web 2.0 type implementations will face is scalability. Obviously, it’s possible to scale the application if done right. Google’s done a pretty good job proving it’s possible. However, that’s much easier said than done. Many a Web 2.0 company has gone under due to their inability to scale properly. A doctor relying on a web 2.0 EHR will not likely support any significant down time. Once an EHR is implemented, most doctors become nearly paralyzed and unable to function when they can’t connect to it. While not impossible to scale a web EHR, amazing attention must be paid to the reliability of the web application. Any significant down time by a web EHR will ensure that it won’t need to worry about scaling their application for long since no doctors will want a web EHR that isn’t reliable.

My point is that in order to reach the Nirvana state of a unified web 2.0 EHR where data sharing is possible, you’ll need to be able to scale the application with near 100% reliability. Users of an EHR won’t be nearly as forgiving as social networking users when downtime occurs.

I also think it’s worth mentioning that sharing becomes much more complicated when it’s done in a unified database. Let me explain. Sharing with a fax machine (or the likes) requires a request for information to be made and a reply made. With a unified database you open up a new world of sharing which can be very powerful, but also difficult to manage. For example, if I sign a release of information which is in effect for 90 days, then why not allow me to turn on sharing of the information for the entire 90 days? Then again, one clinic might have a policy that they want to share prescriptions with another clinic for 90 days. Another clinic might want to share all clinical notes except those marked confidential with another clinic for 30 days. Once again, this can all be coded into an EHR, but it adds one more layer of complexity for the EHR to program and support and for the end users to have to learn.

At the end of the day, my biggest question is not whether there’s value in sharing data between clinics. It’s not whether the technology can support sharing of data in any number of ways. My question is increasingly whether the barriers to sharing patient data are so large that the cost is not worth the benefit. The jury’s still out on this one….and may not be back for a while.

EHR Data Sharing Example

Posted on January 6, 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.

In my recent post about hosted EHR versus client server EHR Dr. Rowley commented on the various scenarios that could occur for sharing a patient record. The comment was so worthwhile that I wanted to make it it’s own blog post and add a few comments of my own. Here’s Dr. Rowley’s comments on data sharing scenarios with various EHR:

Whether you are an enthusiast of free, hosted, web-based EMRs, or an enthusiast of local client/server installations (or a wait-and-see skeptic), the question of data sharing is one that is important to us all.

Maybe the discussion can be best moved forward by considering a real-life scenario and examining how data sharing can occur in different situations. Let’s say that I am the Family Practitioner taking care of Mr. Chest-Hurts, who just was released from the hospital after a heart attack, and you are the cardiologist who saw him there. Mr. Chest-Hurts is in my office for post-hospital follow up, wants a referral to see you as an outpatient, had numerous tests done (which I don’t have in my records when I see him), states that you changed several of his medications on discharge and is confused as to which ones to take (and did not bring them with him for his visit). I just did some lab test and found his cholesterol to be not-quite-at-target. Let us assume that the referral is a simple administrative matter that happens anyway. What is important for patient care here is for us to share our records with each other – we need to reconcile his meds lists, you need the labs I just got, I need the cath report from the hospitalization, etc. Now let’s explore how we share data, given different scenarios:

1. Neither of us have EMRs; we both use paper charts. In this case (the traditional one in medicine), we copy and fax information to each other from our charts. We take each other’s faxes and make them permanent parts of our own separate charts.
2. I have a client/server EMR and you use paper charts. I generate a fax to you from my EMR, which you place in your paper record. You fax records to me, which I scan and import into my EMR.
3. I have Practice Fusion, and you use paper charts. Several options exist here: (a) I can generate a fax to you, like scenario #2 above; or (b) you sign in to Practice Fusion (after all, it’s free, and with “Live in Five” provisioning, you will be able to have access almost immediately). You can then print out what you might need, for inclusion into your own paper chart.
4. We each have client/server EMRs (maybe the same one, or maybe different). Like with paper, we each have separate chart records, and there is no unified patient identifier. A few options exist here: (a) we each have our systems fax out the desired records to each other, and import the data as scanned documents into our separate charts; (b) we each output a Continuity of Care Record (CCR), and somehow push it to each other. There are some efforts (like Relay Health, for example) who are trying to build an infrastructure to be an intermediary for CCRs – I push out a CCR and post it to Relay Health, and you look there and import the CCR directly into your EMR. This need to build a connection between local installs is a challenge (weakness, in my view) of local client/server systems, and will take effort and money to build. There is a lot of activity here.
5. I have Practice Fusion and you have a local client/server EMR. Several options can take place: (a) we each fax our information to each other; (b) we exchange CCRs (like #4 above); (c) I give you access to Mr. Chest-Hurts’ chart (like #3 above), so that you can see the record, and copy-and-paste between the systems if desired.
6. We each have Practice Fusion. We can share the same record on the same patient, and with the right permissions, can see each other’s notes, shared lab values, meds lists, etc. No uploading or downloading of CCRs required. No faxing needed. This is the most compelling scenario.

Pardon my long-windedness here, but my belief is that the discussion of data sharing is very important, and vital to unlocking the true potential of e-tools in improving health care in this country.

I’ll be posting my comments on these scenarios in my next entry.