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Random Thoughts: EMR Projects Decentralized; Problems Persist Despite ‘Solutions’

Posted on August 4, 2011 I Written By

Once in a while, I run out of Big Ideas to share and resort to a rundown of short items. This is one of those times. Often, though, that approach turns out to be more interesting than a well-thought-out commentary. (Thus, the popularity of Twitter, right?)

Speaking of Big Ideas, I’m thinking that the age of the massive EMR project may be coming to an end. You may have seen my piece in InformationWeek today about the reported end of the national EMR in England. London’s The Independent reported earlier this week that the Cameron government will announce next month that it will scrap the national strategy in favor of allowing local hospitals and trusts to make independent EMR purchasing and implementation decisions.

This news comes on the heels of a decision by the government of Ontario to give up on hopes for a single EMR for all of Canada’s most populous province.

On the other hand, here in the States, we’ve seen a lot of consolidation among healthcare providers, but I’m guessing that has more to do with administrative Accountable Care Organizations and the prospect of bundled payments than any desire to build a more unified EMR. Though, consolidation does make health information exchange somewhat easier, and that’s going to be key to earning “meaningful use” dollars beyond 2013.

On a somewhat similar note, doesn’t a headline like, “Positive Outlook for Small Practice EHR Adoption” sound like a no-brainer? I mean, isn’t that the segment of healthcare providers that historically has had the slowest adoption rates? More than anyone else, small practices—particularly small, primary care practices—are the intended target of the federal EHR incentive program. And most of the news from health IT vendors of late has been about how they are going after this long-neglected market, right? The innovation seems to be happening in ambulatory EMRs, as evidenced by DrChrono’s newly certified iPad EHR app, aimed squarely at independent physicians.

That said, vendors and publicists, please do not start inundating me with news about other EHRs getting certified. There are hundreds of certified products out there now, and I cannot and will not write about, oh, about 95 percent of them.

While you’re at it, please stop using the word “solution” as a synonym for “product” or “service.” Tech journalists hate this trite, lazy and, frankly, inaccurate term so much that I’ve been instructed by the editors of InformationWeek not to use it, except in direct quotes. In fact, I get reminded not to use it pretty much every time I’m forwarded a press release laden with news about someone’s “solution.” Solution to what? I’ve been seeing that term since I started covering health IT more than a decade ago, and I still don’t see much getting solved in healthcare. With all the “solutions” out there, you’d think that healthcare had been fixed by now.

I could get a whole lot more curmudgeonly on you, but I think I’ll stop now and await your comments.

 

What UK ICD-10 Use Can Teach the US ICD-10 Implementations

Posted on August 11, 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.

I guess kind of like they just had Shark Week on TV, this week on EMR and HIPAA has been ICD-10 week. So far I’ve covered EMR vendors ICD-10 planning, moving to ICD-10 and bridging from ICD-9 to ICD-10.

In response to my previous ICD-10 posts, Gordon Fenton provided this interesting insight about the UK’s experience with ICD-10.

Over in the UK we already use the ICD10 along side the OPCS code to generate our HRG’s which is the currenvy that commissioners and providers use in the billing process.

While I am based on the commissioner side I know that our providers employ coders whose specific job is to translate Doctors notes into ICD and OPCS codes.

The main challenge will be in varifying and validating the codes being applied by providers, the IT is just a small issue. It will be very easy for providers to inadvertantly apply the wrong code simply by the fact that there are so many.

You could do a lot worse than look at the UK model for guidance on how we deal with it

I’m always interested to learn from what other countries are doing with technology and EMR. I’d love to learn more about UK provider’s experience with ICD-10 and how we can improve the eventual ICD-10 implementations in the US.

UK EHR Landscape

Posted on July 1, 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.

I hadn’t posted much about the UK, and so I thought I’d post (with permission) this email I got from a regular commenter DKBerry about the UK EMR world. I find it fascinating that one EHR vendor owns 50% of the private EHR market in the UK. Polar opposite of our world, no? Now to his email:

Have you ever presented any information on the United Kingdom’s efforts?  Everyone thinks that the entirety of the UK healthcare system is run by NHS.  NHS operates the secondary care facilities … but the primary care practitioners are private … and are contracted by NHS.  Unlike the U.S. where there are 300+ EHR vendors in the U.K. there are only a handful.  Literally.  Egton Medical Information Systems (EMIS) has over 50% of the private GP market in the U.K.

Thought you might appreciate this … Don

From this article

“EMIS and INPS software users in the UK represent around 75% of GP practices and together hold approximately 46 million electronic patient health records.

The formation of Healthcare Gateway Limited allows real-time interoperability with GP systems and other healthcare professionals within the NHS. This has the potential to significantly increase efficiency in the NHS in addition to improving patient care.”

From the EMIS Wikipedia entry:

“EMIS chose not to be one of the major current GP computer providers initially included in the proposed National Programme for IT(NPfIT) due to issues surrounding the lack of system choice for GPs.[1]

The disenfranchisement of General Practitioners and the resultant political change which affected the NPFIT led to the creation of the GPSOC (General Practitioners System of Choice) programme which allowed individual GPs to choose their own system for storing electronic patient notes. As a result EMIS are now involved in the GPSOC programme.

As of 2009, of the 5000 practices using EMIS, 40% are now able to transfer notes electronically with the GP2GP electronic record transfer software to other GP practices using either EMIS or INPS Vision.[3] In 2009 EMIS is also to release its next generation system, EMIS Web, which (with other interoperability initiatives pioneered by EMIS) is intended – subject to patient consent – to allow patient data to move freely and safely not just between GPs but also elsewhere within the NHS (Accident & Emergency, Out of Hours, Hospitals, Community Nursing, etc.).”