I’m sure many of you are recovering from the Super Bowl right now. I got exactly what I wanted from the Super Bowl: a great game. I didn’t care too much either way, but I am glad that I predicted the Giants to be the winners. Too bad I’m not a betting man. Although, I guess that’s the trick with betting….but I digress.

Time for my regular weekend round up of interesting things happening in the healthcare IT and EMR twittersphere. We’ve got some really interesting tweets this week. Here we go.

@NateOsit We also have a webinar of @eCollab12 for those that wont’ be able to make it to #HIMSS12.ecollab12.eventbrite.com #hitsm

— Leonard Kish (@leonardkish) February 3, 2012

When I created and posted my list of HIMSS 12 sessions, they hadn’t created the agenda for the eCollaboration Forum at HIMSS and so I couldn’t add any sessions. However, the eCollaboration Forum at HIMSS 12 agenda is up now, so check it out. I know there are a number of sessions I’m going to add from the forum. I also love that they have the online option linked in this tweet for those not attending HIMSS 2012.

Yes, stage 2 #meaningfuluse NPRM will be out before #HIMSS12. meaningfulhitnews.com/2012/01/30/yes… #healthIT #ONC #CMS #hitpol #EHR #EMR

— Neil Versel (@nversel) January 31, 2012

This is really important news. I think a lot of us are REALLY interested to see the final meaningful use stage 2 details. Good find by Neil Versel.

Speaking doctor-to-doctor(s) using healthcare social media bit.ly/wiqbyu #hcsm #hcsmeu

— H2Online (@H2Ohu) January 30, 2012

I’m sure we’re going to continue seeing the trend of more and more doctors gleaning value from engaging in social media. At a minimum doctors are going to start finding more and more new patients using social media including things like physician blogging. A well done practice website and social media effort is going to be really valuable for the doctor of the future.

3 reasons why you should start a blog for your hospital bit.ly/ypCE78 #hcsm #blogging

— Mark Ragan (@MarkRaganCEO) January 30, 2012

Yes, blogging will also help hospitals in a number of ways too. Social media can benefit hospitals, doctors, practices, etc.

@DonRosenthal Tablets are for content consumption. PCs are for content creation. Much more intellectual flexibility w/ PCs. #HITsm

— Erica V. Olenski (@TheGr8Chalupa) February 3, 2012

I was fascinated by this tweet. First because I wonder what changes will make tablets more than just great for content consumption. Second, the idea of PCs being more intellectually flexible.

RT @patientslikeme: “my healthcare data is not nearly as portable/accessible as my financial data.” @jeff_cole #hcsm

— Jacqueline Thong (@jacthong) January 30, 2012

I know there are reasons why financial data is more portable and accessible than healthcare data, but it still irks me that we haven’t overcome those reasons…yet!

I’m a huge fan of social media and the power that it has for people to connect with other people. What I haven’t quite figured out is how doctors should best use social media for their practice. Although, this article about the ROI of Social Media for Doctors has me thinking. Here’s some relevant quotes they posted about the subject:
“As many as a third of my patients are coming from social media,” Jerath said. (Source: 9News)

“[Dr. Zaid] estimates that his “digital footprint” — his online presence — adds $125,000 to his annual practice revenue.”(Source: Physicians Practice)
“The percent of new patients reporting that they “found” [Dr. Faust] online now varies between 30 percent and 50 percent.” (Source: Physicans Practice)

“I average 1 new patient family per week who came because of our social media presence (equals $140k added income per year)” – Dr. Burgert (Source: KevinMD.com)

“Investing time in relevant and complete posts actually saves me time in the long run.” -Dr. Burgert (Source: KevinMD.com)

One thing I’m certain of: There is a potential ROI available for physicians using social media. The above quotes remind me of this possibility.

The problem is that there are at least two major challenges to use of social media: The Social Media Black Hole and Privacy-Security.

The Social Media Black Hole
While there’s great potential in using social media to drive patients to your practice, there’s also great potential that you’ll pump a bunch of time and/or money into social media and get nothing in return. The social media black hole will open up and take whatever time and money you are willing to put into it and may or may not yield results.

One challenge I see is that most doctors are willing to spend money, but not time on social media. While this can work if done correctly, most social media is best done by having an authentic voice. Paying someone to be an authentic voice for you is quite a challenge. So, for a clinical practice to do well in social media, I argue that you need to have you and your staff carve out time to engage with it. Once you’re engaging with it, then there are some paid social media opportunities that can benefit you.

How then do you avoid spending a bunch of time on social media which ends up in the social media black hole with no results?

My biggest suggestion is to start off with smaller, more reasonable expectations. Instead of diving into social media with the expectation of finding more patients, choose a lesser goal which will lead you to the larger goal. For example, just start by interacting with other people from your area on Twitter. That’s right, just start by being social with people that you find interesting in the space that you care about. If you want more patients down the road, then talk with people about the local sports team or local news. If you want to learn more, find doctors from the specialty you serve and interact with them. If your Twitter account is @VegasDoc or @VegasChiropractor, then you have a built in advertisement every time you tweet regardless of what you tweet. Add in a short description of what you do in your profile and you have another ad.

I’m sure many of you are wondering how you find people in your local area or that tweet about topics you care about. That’s simple. Twitter has this great Advanced Search feature (although many don’t know how to get to it) where you can search and find people. Search by location and/or search term and start engaging people. Don’t start with the sales pitch. Start with adding value to the person you find that’s interesting on Twitter. Answer their question. Give them a compliment for something good they offer. Ask them a question. Just be authentic in your interactions. Relationship first! Sale second!

I, nor any other social media person, can really tell you what serendipitous occurrences will happen that will bring patients to your office. However, the same could be said for how half of your patients found your office. By starting off with just interacting with people that you find interesting, whether you get patients from it or not doesn’t matter since you’re just having a good time online. Although, over time, don’t be surprised by the unexpected benefits you receive from those interactions.

Healthcare Social Media Privacy and Security
Yes, I’m already bracing for the privacy and security people to come knocking on this post. That’s fine with me. I appreciate people who make us aware of possible privacy and security issues. No doubt there are serious potential HIPAA risks related to the use of social media in healthcare. My best advice is: Be Careful and Don’t Be Stupd (This is an example of Healthcare Social Media Stupid in case you missed it).

However, if you read my suggestions above, you’ll notice that I didn’t suggest really talking about healthcare on social media. If you find someone from your local area talking about the local sports team and you talk about your local sports team with them, where’s the privacy and security risk? If they ask you medical questions, then they’re the ones that put that information on there and consented for it to be on there. Just create a pat answer, “I don’t discuss healthcare issues on social media, but I’d be happy to talk with you about them in my office. Call for an appt: 555-5555″ You could even include something like it in your profile description if you wanted.

My point is that there are a lot of ways to use social media without violating privacy. Be careful and thoughtful about what you do.

Social Media Discovery
Of course, these are just a couple suggestions off the top of my head. What’s so great about social media is that as you use it and interact with people regularly, you’ll discover untold ways to benefit from social media. Plus, you’ll find new ways to accomplish things you never would have thought possible. That’s part of why you have to dive in and start interacting. Until you do, you won’t learn which parts are most valuable.

Social Media Not For Everyone
I’m not going to sit here and argue that everyone should be part of social media. Everyone isn’t social in their daily life, so there are certainly many that won’t want to be social online either. Although, I bet in every office there’s someone who would enjoy being the social face for your office.

Certainly there were plenty of practices that did just fine without advertising on TV, the newspaper, the yellow pages, etc. Many practices will do just fine without social media. However, you can be sure that many practices of the future will find tremendous benefit and advantages from their use of social media.

I can speak from this personally. Once you’ve built a social media following. It’s amazing the number of unique ways you can use it for good. My only regret has been that I sometimes wished I’d used it more and earlier.

For that don’t know, there’s a really strong chat happening on Twitter each Friday morning around the hashtag #HITsm. The number of people showing up is growing and growing and quite frankly it’s almost impossible to be able to keep up with all the tweets that are flying around along with the back channel conversations with those participating in the chat as well. It’s an hour long Twitter chat where you’re flooded with interesting bits of health IT information.

Of course, some of you might be overwhelmed by the thought of a Twitter chat. The key is to realize that you don’t have to know anything about Twitter to participate. To get started, just visited this #HITsm twitter page and hit the reload as it tells you there are more tweets. This is like turning on the TV and watching what’s on. Nothing wrong with being a lurker of the #HITsm Twitter chats if that’s what you prefer.

Now for those like me who can’t keep their mouth tweet shut, you’re going to want to participate as well. It’s easy and free to sign up. I’m sure many of you are like my Health IT friend Stacey who is fantastic at Health IT, but was a little nervous on how to start down the Twitter path. I told her to just go for it and now you can find her @HealthITgirl.

I introduced her to 3-4 people on Twitter and she already has 19 people following her on Twitter. Those followers will get her started off right and then as she adds more people and interacts with more people she’ll start to find the real value of Twitter.

Let me repeat my most common comment about Twitter: Twitter is about connecting people.

Certainly Twitter can be used for other things, but Twitter’s most powerful function in my opinion is to connect people. The other thing to realize is that you can’t break it, you can’t break the rules, and there’s no right or wrong way to use Twitter. So, just start using it and testing what ways it can be valuable to you.

If you’re on Twitter or sign up for Twitter let me know @techguy and/or @ehrandhit. I’ll be happy to introduce you to some smart people on Twitter too.

As most of you probably know, I’m a huge fan of technology and it’s also fair to say that I’m a pretty early adopter of social media. In fact, I’m sure that some of you think that I live on social media. I prefer to just say that I’m active in social media. Despite my love and participation in social media, I must admit that I’ve never really been able to get into the love of Foursquare.

For those that don’t know much about Foursquare, it’s an app on your phone where you can check in to specific locations and you can see which locations your friends, family and colleagues have checked into as well. As you check in, you get rewards for checking in and virtual awards such as badges. Plus, if you check in to a certain location enough times, then you become Mayor of that location. Foursquare is far from the only one in this space, but it is definitely the leader and the originator of the space. Although, don’t be surprised if Facebook Places doesn’t give them a good run for their money.

My personal problems with Foursquare is that at least on my cell phone it’s clunky to use, hard to understand and the data gets outdated so quickly that I don’t find it that useful. I’m sure that part of my problem with Foursquare is that I don’t have enough real friends and colleagues on there to really get the benefit of knowing what everyone’s doing and where they’re at. Yes, the idea of sharing and other people knowing this information is scary, but it turns out to be a really cool thing if done right. I know since I often learn where someone is at during a conference by seeing tweets from them.

Considering my lack of adoption of Foursquare, I was of course intrigued by this article talking about why medical practices should be on Foursquare. Here are the main reasons they offer:
1. It’s easy to use.
2. It’s big, and getting bigger.
3. It’s a search engine and a way of being found when people are looking for a doctor.
4. If you don’t claim your place, someone else is likely to do it for you.
5. It says your medical practice is social and tech savvy.

Obviously I disagree with the first one, but that might be my bias. Maybe it’s so easy to use that it’s useless to me. My bias aside, I actually agree with this article that a medical practice should take the 5 minutes it takes to get their practice listed on Foursquare. I’m not suggesting that a doctor or medical practice should become really active on Foursquare. Instead, I’m just saying they should sign up and claim their spot on Foursquare. Then, you get to control your listing as opposed to one of your patients which adds your office for you.

A comment in the above article makes a really good point too. If you want to be active in social media and reach the typical visitors to doctors offices that tend to skew female and older, you probably should be on Twitter and Facebook, not Foursquare. Yelp is another good recommendation for many cities. Lots more could be said about those three services. If people are interested, then we’ll cover those in future posts.

A couple quick tweets to welcome your new week. Both tweets stand on their own and link to some good reads for those interested in the topics. The second one is particularly good since it’s John Halamka’s 2011 wrap up across all the various parts of John Halamka’s life. Let me know what you think of both reads.

Very good guidance on accounting and reporting for #EHR incentive payments bit.ly/xuX9Un

— Brian Ahier (@ahier) January 7, 2012

Healthcare CIO on 2011: #EHRs…added features for certification resulting in…lack of #usability & #workflow integration ehr.bz/lv

— Charles Webster, MD (@c_wb) January 2, 2012

Today my inbox was flooded with people congratulating @techguy and @ehrandhit for being part of the Top #HITsm Contributors of 2011. It’s very kind of them to recognize both of my active Health IT Twitter accounts. Officially @techguy was in the Top Individual #HITsm Contributors and @ehrandhit was in the Top #HITsm Organizations. I think @ehrandhit could have gone in organizations or publications, but either way I appreciate the recognition.

I think the comment at the top of the list describes the awards quite well:

By no means is the following lists all-inclusive. It does, however, represent some fantastic #HITsm voices on Twitter who regularly participate in weekly #HITsm TweetChats and share valuable Health IT information.

I always have a bit of a challenge with “Awards.” However, I think that #HITsm made a really great choice when they decided that instead of saying that this list is the “Best” or some other sort of magnanimous statement about the authority of their list, they instead said that these are some quality and valuable voices in #HITsm. No doubt there are a lot of others out there.

For example, I’d have loved to see @nversel and @john_chilmark on the list as well. They don’t use the tag #HITsm that often, but they definitely discuss those topics often on their various social media outlets. There are quite a few others that I could include in this category as well.

One thing I loved about the Top #HITsm Contributor list was how many familiar faces made it on the list. The great part is that there are so many smart minds on the list and social media makes them completely open and available to you. Without social media I’d likely know very few of those people and would have missed out on the tremendous interactions I’ve had with them at many a conference.

Maybe next year I should work with HL7 Standards and make the announcement of the awards part of the New Media Meetup at HIMSS. Might be kind of cool to get to meet all the great people in person. Yes, social media isn’t just about online connections, but taking those connections offline as well. As I often say:

Social Media (and Twitter in particular) is about connecting people!

In true social media fashion, the list of winners is also available as an embed, so you’ll find the list of Top #HITsm Contributor Awards embedded below as well. Here’s to another great year of Social Media in Healthcare.

Some really interested EMR related tweets in tonight’s round up from around the EMR twittersphere. I’m testing out the new Twitter embed function. We’ll see how it does. It’s a convenient thing, but might need some tweaking.

As always, feel free to follow me on Twitter @techguy and/or @ehrandhit. If you’re on Twitter, let me know so I can make sure I’m following you as well.

The #ROI on #EHR, #EMR, #Lab systems isn’t found in KLAS. It’s in the correct alignment to unique practice needs, process,workflow #HITsm

— Linda Lia (@EMRAnswers) December 10, 2011

Well said! EMR ROI can’t be certified, but it can be measured and planned for.

what if #stevejobs developed #emr software?

— HIT Consultant (@hitconsultant) December 12, 2011

I wrote a bit about Steve Jobs and EMR before. The icon of Steve Jobs and creating something the way Steve Jobs did is going to be around for a very long time to come.

Good progress! 10,566 #Medicare Providers & #Hospitals receive almost $1 billion in #EHR #MeaningfulUse adoption incentives. #HealthIT #EMR

— Justin Barnes (@HITAdvisor) December8, 2011

Over 10k eligible providers and $1 billion in stimulus money. I wonder how many of those 10k providers already had an EMR and how many implemented an EMR to get the stimulus money.

Wow, that high? Impressive RT @amednews: Only 24% of doctors rank data security as a top priority in EMR systems bit.ly/vTUz0F

— johnmoehrke (@johnmoehrke) December7, 2011

Definitely much higher than I’d have thought as well. Sure, every doctor wants their systems to be secure, but very few make it any sort of priority beyond expecting it to be secure.

Today I opened up a web browser and eventually made it to Twitter to see what was going on. I was greeted by the not so friendly Twitter site redesign. If you’re on the Twitter page at all, you won’t miss it. To be honest, it felt like going to a foreign land. I use a number of tools for Twitter, but my favorite is just going to the Twitter website to consume and send my @techguy tweets. Although, maybe I should say it WAS my favorite place.

Yes, change is always hard, but isn’t that kind of the point? Was there any announcement about the change before it happened? Nope! Did they give users a chance to try the new interface before they made a wholesale swap to the new interface? Nope. Google’s actually done this really well recently with things like Gmail. They’ve made the new interface available, but you can always click back to the old interface if you don’t like. That way they can solicit feedback and improve the new interface while still not alienating those that love the old interface.

In my example on Twitter, I quickly was able to identify the thing that annoys me most. When I click on someone’s Twitter name it gives me a pop up box for that person. Before it use to have that appear on the side. It’s a small subtle change, but makes a huge difference since on the side I can continue consuming tweets, but in a pop up box I have to remove it before I continue on.

I could go on about the new Twitter, but the point is that software vendors have to be careful when they change the user interface. Maybe this new Twitter interface will even grow on me. I didn’t like the last time they changed the Twitter interface either, but once I found some of the secret features I came around for the most part. Maybe I’ll come around on this too, but it would have been nice if I knew it was coming.

What does this have to do with EMR?

The connection seems quite clear to me. EMR and EHR companies have to be really careful and considerate when they change their EHR interface. Give users options to be able to try it and to adapt to it over time. With a sort of limited opt in release of a new EMR interface to an active user base, you’ll likely get a lot of pointed feedback for the new EMR interface. Certainly you’ll get the useless “I hate the new look” emails without any value. However, you’ll also get the pointed emails that provide constructive ideas on things you probably didn’t realize were important in the old EMR interface.

Most SaaS EHR companies are constantly considering this since they’re rolling out changes to their software all the time. Client server based EHR software also takes it into account, but this can be shown and taught as each client is upgraded.

The main point is to be thoughtful of and upgrade to your EHR user interface. Get feedback and whenever possible let them opt in and out of the new interface so you don’t alienate your users.

While I may not be totally enamored by the new Twitter interface, I do always love new features in software. For example, as part of the new Twitter interface there’s a feature that lets you embed tweets. Here’s a few EMR related tweets to see how it works.

Need marketplace to reward good design & doc reimbursement for social@jacthong @AtlasMD How to close gap between EMR & consumer tech? #hcsm

— borborygmi (@nickgenes) December5, 2011

And then some big news from GE and Microsoft that just came out:

G.E.-Microsoft Venture to Create ‘Windows’ for Health Care. #ehr #emrnyti.ms/u8ttTu

— Andrew Herman Heller (@andrewhheller) December8, 2011

Hmmm…still looks like they have some work to complete on their embedded tweets (UPDATE: The preview looked different from when it’s posted. It’s not too bad in the actual post). Sounds like many doctors talking about EHR features that get rolled out.

Jeremy Bikman from KATALUS Advisors wrote this interesting comment on a LinkedIn discussion I was participating in:

Perhaps there is a place for MUMPS but only if healthcare continues to thumb its nose at the prevailing technology trends. It’s hard for me to envision healthcare to continue to embrace a technology that doesn’t like to play nicely with other non-MUMPS systems. If there were real advantages to it you would see a fair number of high tech firms utilizing it (Facebook, salesforce.com, Twitter, Spotify, etc).

If your goal is to have an enterprise system with a database that has some scale to it and certainly has good speed, and you don’t really care about interoperability with other systems, then MUMPS is certainly a good viable option. But IMO, the days of healthcare IT being insular, and moving out of phase with the rest of the tech world, are numbered.

I found this comment incredibly interesting. Mostly because I’ve never personally believed that the fact that many of the larger healthcare IT and EMR systems are built on MUMPS was any part of the reason why healthcare entities aren’t interoperable. I’m a tech guy by background, but I’ve never worked on a MUMPS software system myself so I don’t have first hand knowledge of MUMPS in particular. However, it seems wrong to “blame” MUMPS on the lack of healthcare data interoperability.

I guess the way I look at it is that no matter which database back end you have, you’re always going to need some front end interface to take care of the transport of the healthcare data to another system. Is this any harder with MUMPS than another SQL or even NOSQL database? From my experience it shouldn’t matter. I’d love to hear if there are reasons why it is harder.

I also don’t want to give the impression that Jeremy is trying to say that MUMPS is the only reason that healthcare IT has been so insular and closed. I’m pretty sure he agrees with me that a lot of other factors that have stopped healthcare from sharing data. I just don’t believe that MUMPS is one of those reasons.

Of course, the question of whether MUMPS should continue in healthcare is a different question. In fact, I wrote about MUMPS in healthcare IT and EMR here.

What are your thoughts? Is MUMPS the problem with healthcare interoperability? What are the other reasons stopping healthcare interoperability?

Update: Jeremy Bikman provided the following clarifying comment in the comments of this post:
Good points John. I really should have clarified. MUMPS is not really the issue (although I still stand by my assertion that if it was such a superior technology you’d see it all over Silicon Valley, RTP, etc). The main issue is really with the walled garden (w/ razor wire and machine guns along the top) approach of the major EMR/HIS vendors that have it as their foundation.

The more control you exert over your clients and the harder you make it to connect with other systems, the more money you can make…at least in the short-term.

John’s thought: I still look forward to the discussion around MUMPS and interoperability and healthcare interoperability in general.

Yesterday, I created a post on EMR & EHR called The Must Have EMR Feature – An iPad Interface. that post has driven quite a bit of discussion on Twitter and Google Plus. One comment from @2charlie hit me the most though:

2charlie – Charlie Gaddy
A decent web interface wouldn’t hurt either. RT @ehrandhit: The Must Have EMR Feature – An iPad Interface dlvr.it/tYkN7

Charlie’s twitter response highlights a number of interesting ideas. The first point that every SaaS EHR company will point out is that he said a web interface. We could go into the semantics of what is “the web”, but I have little doubt that Charlie meant a browser based interface when he said web. I’ll leave the rest of the discussion of “web” EMR interfaces for another post (plus, we’ve had that discussion many times on this site).

Instead, I want to focus on his use of the word “decent.” That adjective is interesting because no one would really argue that there aren’t plenty of web EMR interfaces out there. If you look at the EHR Scope EMR Comparison site, you’ll see a huge number of web based EMR companies listed. However, when you add the word “decent” to web EMR interface, I think we could have some really interesting discussion.

At least a couple times a week I get a doctor sending me an email or posting a comment on my website saying that “all of the EMR interfaces are terrible.” I don’t necessarily agree that “all” EMR interfaces are terrible, but a lot of them do fit the description quite well. I’m sure at this point all the EMR companies are thinking about their competitors and agreeing with me.

The iPad Opportunity for EMR Interfaces
As I thought on Charlie’s comment of a “decent web interface” as compared with an iPad EMR interface, I realized that the iPad provides a unique opportunity for EMR vendors with less than stellar web interfaces. While it would be great for EMR vendors to create stellar web interfaces or improve their current web interfaces, that’s much easier said than done. Many are working on older technologies. Others have so much company culture built into their interface that it’s hard to change. Many have large user bases that will freak out at the idea of a new web interface. Etc etc etc! The point being that the culture and history of many EMR interfaces make it hard to change.

In these cases, I see the iPad as a great opportunity to start fresh with your EMR interface. Many EHR vendors could use the iPad as a way to be able to create a new interface for their EMR with all the knowledge they’ve learned over the years baked in. Doctors expect the iPad interface to be different and unique.

I’ll be interested to see which EMR companies take this opportunity and make something of it. It’s the perfect chance for EMR companies to create a paradigm shift in their EMR software without having to admit publicly the mistakes they made in their first EMR interface. Unless you happen to be from an EHR company who built the perfect EMR interface from the start. Then, this need not apply.