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.

Time to go through some interesting Tweets from the world of EMR and EHR.

@glevin1 – gary levin
Commodization of EMR | HealthWorks Collective

There was a link on this tweet too, but it looked like a link to a page that stole the content from the original article. I’ve been intrigued by the question of whether EMR is a commodity software or not for a while now. I still haven’t come to a firm conclusion. This article uses the idea that you can buy Allscripts MyWay at Costco as a way to say that EMR is a commodity. You can also buy eCW at Sam’s Club I believe. Although, as best I can tell, that was basically a PR move on the various EHR vendors part.

Also, the article says that Allscripts MyWay product came from the purchase of Misys. Actually, I think MyWay was originally Aprima. I believe the Misys EHR software is set to be sunset.

What do you think? Is EMR a commodity?

@BrianSMcGowan – Brian S. McGowan PhD
Percent of US PCPs using EMR = 17% in ’00′ – 28% in ’06′ – 46% in ’09′ (vs 99% in Netherlands) #socialQI #progress??

The link on this one was to a terribly long PDF file. So, I cut it out. I just wish I knew where Brian got his numbers. I call BS on the US having 46% EHR adoption in 2009. I still put us at about 25% EHR adoption now. Maybe a little higher if I’m being generous. Of course, a lot of people define EHR a lot of different ways. So, that might be part of the issue.

@DRZORBA – Zorba Paster
Back to the clinic. Everyone brings their records with them. No EMR here. If they lose their record then they’re @*%&M.

Hmm…imagine a world where the doctor didn’t keep any record. The patient was just responsible for the record. That idea is fraught with trouble and issues, but I bet many doctors would love to not have to worry about the records part of their job.

@medreccom – Medical Records
“Paper is dangerous and inefficient, it doesn’t belong in health care any longer.” Future of #EMR: on.mash.to/uhVkHn

I was interested in this tweet since it linked to an article on Mashable (a mainstream tech site). So, if I get this right, this article and series was sponsored (ie. paid for) by Lenovo and profiles Practice Fusion. In other words, Lenovo paid to advertise Practice Fusion on Mashable. Good for Practice Fusion. Although, I’m not sure how many doctors read Mashable. Maybe the article wasn’t about finding doctors, but was a way to find more tech people to come work at Practice Fusion. The article itself is pretty basic for someone that reads this site. Not a bad play if that was the intent. Full Disclosure: Practice Fusion advertises on this site. Although, they certainly didn’t pay me to write about this and link to it.

We’re back once again with our weekend roundup of a few interesting EMR and healthcare IT related tweets. Seems like the #hcsm chat was enjoying tweeting about some of the challenges of EMR and EHR:

@RyanMadanickMD
Ryan Madanick, MD
EMR=elec versn of chart RT @MrPug94: T1 #hcsm There really isn’t a true provider-patient collaboration platform. #EMR is simply a database

I agree with the assertion. Although, the reason an EMR is just a database and not a true provider-patient collaboration platform is because there’s no exchange of data. That’s what’s missing most from today’s EMR software.

Then, I also saw this related tweet about EHR:

@JackWestMD
H. Jack West, MD
Also, w/#EMR, it has never been easier to produce so much boilerplated documentation that says so little. #hcsm

I know where this comment comes from, but as I said in previous posts. I think we’re ready to see a revolution in clinical documentation that kicks against the boiler plate documentation that’s been so dominate in legacy EHR software.

Plus, is anyone else still kind of annoyed that we’re still debating whether to use EMR or EHR?

@EHRgeek
Helen Phung
@ehrwatch @nestorarellano @WittRZ Used interchangeably. #EHR refers more often to a physician/patient facing record while #EMR is for docs.

Personally, I have one thing to say about the EMR or EHR debate: Who cares? Once you can use them interchangeably to communicate the same thing, it really doesn’t matter. I tell you now that it really doesn’t matter.

I saw this tweet and decided I couldn’t pass up posting it. When I read it, all I could think was, Yeah……right!! (yes, that last part is in the sarcasm font)

@NewIQ – David Whitaker
The next five years will be pivotal for EHR solutions. The cloud presents a real opportunity for the creation of a truly dynamic system.
Followed by…
I would not be surprised if the folks at Google or Facebook werent already working on a strategy. #EHR #cloud

I think the last thing Facebook is thinking about is anything to do with EHR. They might be interested in healthcare apps for “consumers” managing their health, but they couldn’t give a rip about EHR. They might even consider helping doctors connect with patients on Facebook (although, even that I think is unlikely), but not an EHR.

Google has probably thought of EHR back when Google Health launched. Obviously they chose to go with PHR and we see how that turned out. I don’t think Google could make a worse mistake than to try and create an EHR.

Yeah, Facebook or Google doing EHR…that would be surprising.

I’ve been really intrigued lately by the changing media landscape. Things like Blogs and Twitter are providing opportunities for basically anyone to be able to share a message with the world. Certainly, many of the blogs don’t get read and a tweet on Twitter falls off people’s radar very quickly. However, some of the better or more interesting ones rise to the top and provide an interesting and sometimes dissenting voice to the conversation. Personally, I think this type of open discussion around topics is valuable and beneficial as long as people maintain a certain level of respect and decency.

My question to you then, is what would you say to a Healthcare IT audience?

As I considered on this difficult question myself, I decided the message that I would want to deliver: You can resist all you want, but the future of healthcare will require IT.

Pretty much every day, someone comes on this site to talk about the benefits and challenges associated with EMR and EHR in their office. As I’ve listened to the various challenges that people have posted, I’m sympathetic to them. However, almost all of those I’ve heard boil down to poor EMR selection or poor EMR implementation.

To me, the EMR selection is the absolute most important part of the EMR implementation process. Far too many doctors and clinics don’t take the time and effort that’s required to really go through a proper EMR selection process. I’m very sympathetic to them for a lot of reasons (ie. It’s not their job or interest, there are 300 EHR vendors, there aren’t great resources for differentiating EHR, there are a lot of perverse incentives, etc). However, it’s worth the cost to do it right. Otherwise, you should wait until you can do it right.

However, I believe that EMR is still only one small part of how healthcare IT is going to impact healthcare. Just last night I was at a local event and someone who use to work in the casino industry has been working for the past year or so on an app that helps improve doctor to doctor communication. Fascinating stuff.

Personally, I see us just at the very begging of a revolution in healthcare IT. IT is going to start invading every part of healthcare and will pretty much be impossible to avoid.

Certainly there will be some (possibly many) who continue to resist the adoption of technology in their clinic. However, I’m seeing more of a shift by patients and doctors that are interested in finding more ways to integrate technology into their healthcare. Most of the doctors aren’t sure what to do next, but they’re looking.

I can certainly understand and appreciate those that say that the current EMR and healthcare IT offerings aren’t up to snuff. The fact is that many of them aren’t. However, that doesn’t change my belief that IT is still going to change how healthcare is provided. It just may mean that healthcare will be changed by an IT offering that most of us don’t know about today.

My greatest wish would be that we could close the case on whether healthcare IT is important and/or it can change healthcare. Instead, let’s put our energy into finding the ways that it can change healthcare IT for good. All of us focused on using healthcare IT and EMR for good in healthcare would produce some amazing results.

I don’t know about the rest of you, but a big part of me is getting anxious for the start of college football (for my team it starts tomorrow) and the NFL starting on Thursday. It’s one of my favorite times of the year and probably my wife’s least favorite times, but I digress.

During the #HITsm chat today I saw a great quote that talked about HIPAA from Peyton Manning:
@bwilsonIntel – Ben Wilson
RT @jonmertz: HIPAA qte of the week from Peyton Manning: “I dont know what HIPAA stands for, but I believe in it and I practice it.” #HITsm

In case you don’t follow football, Peyton Manning is recovering from neck surgery and the above comment was a nice way for Peyton to say he didn’t want to talk about his medical information.

How long until someone from Peyton’s doctor’s office or hospital gets canned for looking at his records?

Since we’re talking football, healthcare and HIPAA, I’d be remiss to not mention Arian Foster’s recent tweet. This is what he said:
@ArianFoster – Arian Foster
This is an MRI of my hamstring, The white stuff surrounding the muscle is known in the medical world as anti-awesomeness http://moby.to/zta9xp

That’s right. Arian Foster tweeted a picture of the MRI of his hamstring. Of course, he’s welcome to do this. He’s suffering the consequences of his choice (his team said it’s a violation of their team policies). When I heard about the tweet, all I could think was, It’s amazing what some people will do to make a joke. I know this first hand.

Also, I haven’t dug into Arian’s MRI, but it seems like there might be some info in the corners of his MRI that he might not want people to know, no?

Tonight I happened to eavesdrop (the beauty of Twitter) on a Twitter conversation between Bobby Ghaheri, MD (@DrGhaheri) and Chad Peterson (@hosewater2). Dr. Ghaheri is an ENT/Facial Plastic Surgeon and Dr. Peterson is a hockey loving urologist. I loved their twitter exchange about email and Twitter follow up with patients, so I’m posting it here for others to comment on.

UPDATE: Since there’s a problem with pulling in the tweets automatically from Twitter, here’s what was said:
DrGhaheri Bobby Ghaheri, MD
I use email and Twitter to follow-up on my patients. #hcsm

hosewater2 Chad Peterson
@DrGhaheri I don’t use email or twitter with patients. Just encourages unnecessary undocumented interactions. Is twitter HIPaa certified?

DrGhaheri Bobby Ghaheri, MD
@hosewater2 I document the conversation in EMR.

@hosewater2 Chad Peterson
@DrGhaheri wow, so double the time investment then. Interesting

DrGhaheri Bobby Ghaheri, MD
@hosewater2 yup. But not having to answer a phone note saves on the back and forth, which is what I’d prefer

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I’m not sure how many of you have followed the announcement of the Google 1+ button. If you haven’t seen them yet, you’ll start seeing them sprinkled all over the internet soon. I just added them to a couple of my sites including EMR and HIPAA. You can see it next to the Facebook button on the right side of each post. Feel free to click it if you’re reading a post that you like. It’s a simple action which can tell me a lot about whether people like the post or not.

Of course, I’ve been using social media indicators like this for a while. For example, I’ve known the number of people who tweeted out my various posts on Twitter. I often can see how many times an article gets published on Facebook. I always love to get feedback like this that tells me that someone liked the article I created. However, often tweeting a link or sharing a link on Facebook is more than someone wants to do. The Google 1+ is an even simpler and more anonymous way of telling a blogger or other website that you like what they’ve created. I’m interested to see how many people are willing to take the simple step of clicking the Google plus 1 button when they like a post.

However, beyond the benefit to a blogger of knowing which content its readers like, Google is no doubt going to use this information as well to create more targeted search results (and likely ads as well). Some people bristle at the idea that Google would have this information. However, I don’t have any problem with it. In fact, I like that Google will be able to provide me a better service. For example, if I search for EMR on Google, they should know I want to know about electronic medical record sites and not the EMR paintball one. I think data like the plus 1 could help Google to improve that experience for me. That’s a good thing.

I’ve been really interested in these social media indicators and the influence that someone can have online. For example, just because someone has a lot of followers, does that make them an authority? What if you find some health information online? How do you know the quality of that information? What if you’re searching for EMR software? How do you evaluate the quality of the information that’s being provided? What about any biases that information might have? Can social indicators help you to improve your understanding of the quality of the information?

I’m not sure the answers to many of these questions, but I do think there’s power in a crowd of people expressing their opinions on a subject. Even something as simple as clicking on a Google plus one benefit. Will it cure Cancer? No. However, it can still have a profound impact on the way we discover information and how we help others understand the quality of that information.

It’s that time again for a quick roundup of some interesting tweets happening out their in the wonderful twittersphere.

(awkward moments on Twitter) RT @techguy: Is that a change? ;-) RT @Doctor_V I’m gonna turn 33 charts into a link-baiting content farm

April 29, 2011 4:49 pm via TweetDeckReplyRetweetFavorite

@Doctor_V

Bryan Vartabedian

This series of responses made me laugh. Mostly because my response was totally facetious (and just like me in real life). I wouldn’t have said it if it were true. 33 Charts is an amazing blog. Especially if you love social media and healthcare.

Agree! RT @RichmondDoc: T2 Even if not used 2 practice medicine, SocMed can allow providers 2 support & provide resources 2 each other #hcsm

May 1, 2011 6:33 pm via TweetDeckReplyRetweetFavorite

@Colin_Hung

Colin Hung

Since we’re talking social media and healthcare, this tweet seemed appropriate. I love when people say that they don’t like Twitter because they don’t care what someone ate today. My do people that say such things not understand the real power of social media. I sum it up by saying that Twitter is amazing at connecting people.

Must read and must bookmark! RT @ahier: In case you missed it ~ a #DirectProject must read: http://bit.ly/k0A2bw

May 1, 2011 8:30 am via TweetDeckReplyRetweetFavorite

@janicemccallum

Janice McCallum

Fine, if @ahier and @janicemccallum say I must read it I will. Although, I’ll actually book mark and and post about it later.

Where health care dollars go http://j.mp/m1MnQ5

April 30, 2011 1:54 pm via ReederReplyRetweetFavorite

@erikpupo

Erik Pupo

I’m a sucker for charts. These are quite interesting. At least if you care about the costs of healthcare and where the money is spent.

Can the use of Digital Pen and Paper Technology Shorten the Path to Meaningful Use? http://su.pr/6SmKWv

April 30, 2011 12:44 pm via Su.prReplyRetweetFavorite

@EMRDailyNews

EMR Daily News

I’m not sure if I’m ready to usher in the digital pen and paper technology as the path to meaningful use. Although, many of you will likely remember how much I enjoyed Shareable Ink when I first saw it.

RT @kevinmd: Our health is worsening at time when medicine has never been better http://is.gd/4Yi7SD|comments help balance biased post. #hcr

April 30, 2011 5:35 am via Seesmic for AndroidReplyRetweetFavorite

@janicemccallum

Janice McCallum

I’m not sure about the article, but I love the commentary on blogging. I love the comments on the blog. They definitely do a great job of balancing out and mistakes in my posts. Not that I’ve ever created a “biased post.” Not me;-)