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300 Automatic E&M Coders in EMRs

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Automated coding has been a popular topic ever since I first started blogging about EMR software 7.5 years ago. In fact, back then the discussion was usually around how great automated E&M coding was going to be for a doctor. Everything from increased coding levels to firing your billing person were talked about. However, I think the reality is that we’ve seen something much different happen.

Many people hate the automatic E&M coding in EMR because it is wrong so often. If they can’t trust it to do the right coding, then what savings are they really getting from the automation? To put it in the words above, they still need their billing person. Plus, the idea of coding higher is great because it can mean more revenue. However, it also can be seen as upcoding and give you plenty of grief as well. “My EMR told me to do it” isn’t a great defense for over coding a visit.

As I think about these automatic E&M coding engines, it makes me wonder why we don’t have someone who’s created a really great coding engine like we have with drug databases. Since there isn’t that means that every one of the 300+ EMR vendors has their own coding engine. That means we have 300 different E&M coding engines all with different ways to approach coding.

I imagine many would argue the reason the E&M coding engine needs to be part of the EMR is because it needs deep integration with the EMR data. This is true, but the same is going to be true as we enter the world of smart EMR software with deep CDS applications. EMRs aren’t going to build all of these pieces. They’re going to have to enable entrepreneurs to build some really cool stuff on top of their EMR. Why not do the same with E&M coding?

Although, it’s also worth consider, is medical billing one area where human touch is better than automated coding?

May 30, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, 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.

Smart EMR & CDS

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For those who don’t know, I’ve started a series of EMR, EHR and Healthcare IT video interviews with some of the leaders of our industry. You can attend the video interviews live and can ask questions on Twitter. If you want to receive email notifications of upcoming interviews, just subscribe on this page. Tomorrow I’ll be doing another video hangout on Hospital EHR and Healthcare Analytics with Dana Sellers and James Kouba.

The following video embed is from an interview I did with Sean Benson and Andre L’Heureux from Wolters Kluwer Health. We had a great discussion about the gap or white space between EMR software and what clinicians want them to do. We also talked about the challenge of integrating EMR with CDS systems. Plus, I asked them what EMR vendors could do to make the Smart EMR of the future possible. Their answer was quite interesting. We also discussed the challenge hospitals face of clinical knowledge management in their organization. Then, we wrapped up the conversation with a look at the WKH Innovation Lab’s sepsis project.

I think there’s a lot to be excited for when it comes to creating smart EHR and getting the most from clinical decision support systems. Enjoy the Smart EMR and CDS video interview embedded below.

May 21, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, 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 Add-On’s that Provide Physician Benefit

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One of the companies I met in New York City at the Digital Health Conference was MedCPU. I had a great time talking with the effervescent Founder and President, Sonia Ben-Yehuda and the Founder and CEO, Eyal Ephrat, MD. MedCPU is part of the inaugural New York Digital Health Accelerator class. Plus, they’ve created a pretty interesting concept and way to simplify their message down to a single button that analyzes both free text notes and structured data to check for compliance to best practice guidelines or for deviations from expected care.

The idea of a single button that does all the work is a decent one. Sure, real time analysis is good as well, but EHR software isn’t there yet and won’t be for a while to come. Very few EHR seem to be offering real time meaningful use compliance checking. Forget about real time clinical compliance checking.

What I found even more interesting was something that MedCPU told me when they were describing their product. Dr. Ephrat told me that one hospital was using the services MedCPU provides as the benefit that doctors will receive for using EHR. I find this concept quite interesting. I won’t belabor the point that EHR is the database of healthcare, but it’s amazing to consider that a third party application could provide enough benefit to be the reason why doctors want an EHR.

Many EHR vendors realize this is true. That’s why many are trying to offer API (application interfaces) which will allow third party vendors to interact and integrate with their EHR. I wonder what apps can be created by third parties that would really take EHR software to the next level. A thriving third party eco-system of developers can be much more powerful than trying to do all the innovation in house.

Do you know of other EHR add-ons that provide the real benefits physicians want out of an EHR? I’d love to hear of ones you think fit that test.

November 21, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, 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.

Personalized Medicine – Processing Millions of Health Data Points

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“When you go to the doctor’s office and they do a blood test, they typically measure no more than 20 things. With the technology out there now, we feel you should be able to measure thousands if not tens of thousands if not ultimately millions of things. That would be a much clearer picture of what’s going on.”

This quote comes from a fascinating article by Jon Cohen called, “Examining his own Body, Stanford Geneticist Stops Diabetes in Its Tracks.” The idea is simple, but extremely powerful. I think it also paints a clear future for healthcare.

Michael Snyder is right that we need to have tens of thousands and ultimate millions of data points to be able to really effectively treat the human body. When I start to think about this, it actually makes me proud that the medical profession can treat a patient as well as it does with such limited information. Yet, it also gives me great optimism that the best advances in healthcare are still ahead of us.

As I’ve mentioned multiple times before, I believe that the body of medical knowledge will become too complex for the human mind to process on its own. In fact, we might already be there today. When you add in thousands and eventually millions of additional data points, then no one could even start to question this idea.

How then will we be able to process all these data points? Despite the human minds amazing characteristics, it will have to be assisted by technology. The human mind won’t likely be taken out of the equation, but computing power will assist the human mind to make much better decisions.

One problem with this idea is that the EHR software of today aren’t designed to handle this type of processing. EHR software is the database of healthcare and some might say that’s even a stretch. Does that mean that we’re going to have to deploy a new wave of software and technology to support this type of smart healthcare data processing?

July 19, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, 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 Is the Database of Healthcare

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I’ve been regularly writing and thinking for the past few months about something I’ve branded as the “Smart EMR.” Basically, the EMR of the future won’t be a repository of documents and information like before. Instead, doctors will have an expectation that the EMR is smart and can do something valuable with all the health information that’s stored in the EMR. I love this subject. I should put together a presentation on it and start touring it around the country, but I digress.

While at HIMSS I had the pleasure of talking with Sean Benson, VP of Innovation at Wolters Kluwer Health. In our discussion, he said something that hit me like a ton of bricks. He suggested that EHR software is the database of healthcare. The implication being that EHR software is good at collecting healthcare data and storing that data. What they’re not good at doing is actually providing the smart layer that goes on top of that data.

I’m sure that many who know about Wolters Kluwer Health’s (WKH) software offerings might see Sean’s view as bias since WKH, as best I can tell, wants to be the smart layer that goes on top of EHR software. In fact, they showed me some really interesting technology they have for processing all the medical information out there into a really digestible format, but that’s a post for another day. Their interests and clinical decision support software aside, the idea of the EHR software being the database of healthcare seemed to resonate with me.

I’ve often described EHR software to date as a big billing engine. Some EHR are trying to break that mold, but that’s a hard mold to break since a big billing engine is what the market has asked them to create (for the most part). With that in mind, it’s certainly hard for an EHR software to develop a true Smart EHR platform.

I can see in my mind’s eye a product development team going into the EHR vendor executives office and pitching some amazingly smart and effective EHR software for improving patient care. The cynical me then sees the EHR vendor executive saying, “We can’t monetize that.” or a related “That won’t sell more EHR.” The sad thing is that the executive is probably right…at least today. The market hasn’t started demanding a Smart EHR and improved patient care. I’m hopeful that the new ACO model will help to shift that focus, but it’s still too early to tell if that will provide the impetus for change.

Another part of me hopes that a true entrepreneur will come along and build an EHR that provides such a stark contrast in how it provides patient care that doctors won’t be able to resist using it. Something impactful like the stethoscope, that if a doctor isn’t using it patients won’t go to that doctor. However, this line of thinking seems to push the concept of EHRs being the database of healthcare and not the All in One Smart EHR.

If I’m an entrepreneur with the vision of transforming patient care through smart use of EHR data, why would I want to build an EHR from the ground up when there are a number of very large EHR vendors that have APIs that allow me to build upon their data? If the data’s already been collected, then I’m likely to focus all of my energy creating innovative solutions with that data, not creating the mechanism to collect the data.

What’s a database? Tools to collect data, store data and then retrieve data. What’s an EHR today? Mechanisms to collect health data, store the data and then retrieve the data.

Ok, that’s a bit of an over simplification, but the analogy is there. You can see why so many EHR vendors are trying to become “the platform” of healthcare. Turns out that being the repository of data that everyone else builds cool stuff on top of is very valuable. However, building that platform requires a very different culture and focus than building Smart EHR solutions.

This is why I’m sure many EHR vendors will try to develop some Smart EHR solutions, but in the end EHR will be the Database of Healthcare that other Smart EHR applications connect into. I don’t think that’s a bad thing at all.

March 1, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, 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.

AI (Artificial Intelligence) in EMR Software

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Today I had an interesting conversation with MEDENT. It’s an EHR company that’s in only 8 states. I could actually write a whole post on just their approach to EMR software and the EMR market in general. They take a pretty unique approach to the market. They’ve exercised some restraint in their approach that I haven’t seen from many other EHR vendors. I’ll be interested to see how that plays out for them.

Their market approach aside, I was really intrigued by their approach to dealing with ICD-10. They actually described their approach to ICD-10 similar to how Google handled search. There’s all this information out there (or you could say all these new codes) and so they wanted to build a simple interface that would be able to easily and naturally filter the information (or codes in this case). A unique way of looking at the challenge of so many new ICD-10 codes.

However, that was just the base use case, but didn’t include what I consider applying AI (Artificial Intelligence) to really improve a user interface. The simple example they gave had to do with collecting data from their users about which things they typed and which codes they actually selected. This real time feedback is then added to the algorithm to improve how quickly you can get to the code you’re actually trying to find.

One interesting thing about incorporating this feedback from actual user experiences is that you could even create a customized personal experience in the EMR. In fact, that’s basically what Google has done with search with their search personalization (ie. when you’re logged in it knows your search history and details so it can personalize the search results for you). Although, when you start personalizing, you still have to make sure that the out of box experience is good. Plus, in healthcare you could do some great personalization around specialties as well that could be really beneficial.

I’d heard something similar from NextGen at the user group meeting applied to coding. The idea of tracking user behavior and incorporating those behaviors into the intelligence of the EMR is a fascinating subject to me. I just wonder how many other places in an EMR these same principles can apply.

I see these types of movements as part of the larger move to “Smart EMR Software.”

December 2, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, 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.

The “Smart EMR” Differentiator

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As I’ve been able to talk to more and more EMR companies I’ve been trying to figure out a way to differentiate the various EHR software. In fact, when I meet with EHR software companies I suggest that instead of them showing me a full demo of their EHR software, I ask them to show me the feature(s) that set their EHR apart from the other 300+ EHR companies out there. I must admit that it’s always interesting to see what they show me. Sometimes because what they show me isn’t that interesting or different. Many of my EMR company specific posts come from these experiences.

Today at MGMA as I went from one EHR company to another I started to get an idea for what might be the future differentiation between EHR companies. I’m calling it: “Smart EMR.”

You can be sure that I’ll be writing about my thoughts on Smart EMR software many more times in the future. However, the basic idea is that far too many EHR software are just basic translations from paper to electronic. Sure, some of them do a pretty good job of capturing the data in granular data elements (something not possible on paper), but that’s far from my idea of what a future Smart EMR software will need to accomplish.

I’m sure that many of those that are reading this post immediately started to think about the idea of clinical decision support. Certainly clinical decision support will be one important element of a Smart EMR, but I think that’s barely even the beginning of how a Smart EMR will need to work in the future. However, clinical decision support as it’s been described to date focuses far too much on how a clinician’s discretely entered data elements can support the care they provide. That’s far too narrow of a view of how an EMR will improve the patient-doctor interaction.

Without going into all the detail, EHR software is going to have to learn to accept and process a number of interesting and external data sources. One example could be all the data that a patient has in the PHR. Another could be patient data that was collected using personal various medical devices like a blood pressure cuff, an EKG, and blood glucose meters. Not to mention more consumer centric data devices and apps such as RunKeeper, Fitbit, sleep tracking, mood tracking, etc etc etc.

Another example of an external source could be access to some community health data repository. Why shouldn’t community trends in healthcare be part of the patient care process? None of this is far reaching since we’re collecting this data today and it will become more and more mainstream over time. Something we can’t do today, but likely will in the future is things like genomics. Imagine how personalized healthcare will change when an EHR will need to know and be able to process your genome in order to provide proper care.

I don’t claim to know all the sources, but I think that gives you a flavor of what a Smart EMR will have to process in the future. I’ll be interested to see which EHR software companies see this change and are able to execute on it. Many of the current innovations in EHR have been pretty academic. The Smart EMR I describe above will be much more complicated and require some specific skills and resources to do it right.

October 25, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, 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.