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Meaningful Use Feedback for ONC and CMS – Meaningful Use Monday

Posted on November 7, 2011 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today I thought I’d cover some feedback and comments that have recently been posted on some of my previous posts. Some are feedback for ONC on meaningful use. Another suggests that more of us get involved in the meaningful use rule making process. These comments and others that I’ve ready have me wondering if I and others of my readers should be playing a more active role in helping form the meaningful use criteria.

As is evidenced by the 60 Minutes interview with Jack Abramoff last night, there’s so much messed up about Washington and the legislative process. I guess I partially see that with meaningful use and the HITECH Act and I’m sure there’s plenty more happening in Washington DC that I don’t know about.

The problem I see is that the ones interested in being actively engaged in the rule making process are those that have the most financial benefit to gain. Certainly all of us have some reason to care how our government spends money and particularly the health of our healthcare system. Unfortunately, financial benefit seems to be a much stronger motivating force to participate than the greater good.

Look at it this way. If I’m an EHR vendor that’s going to have to comply with meaningful use and use it and EMR certification to sale my product, then I have a reason to pay for someone to fly to Washington DC and be involved in the process. I could even make some reasonable argument for me as an EHR and healthcare IT blogger to make the journey to Capitol Hill to talk about what’s happening. In fact, I’m going to be in DC in December, but I’m not going there to help improve meaningful use. The idea of getting ONC and CMS or other members in Washington DC to talk with me about meaningful use and the HITECH act sounds daunting and I’m not sure it’s worth the effort for a one time event.

Does that basically mean that ONC and CMS are listening mostly to those who have a vested financial interest in meaningful use and certified EHRs?

I like many others would likely be happy to share our voice in the meaningful use stage 2 creation process. It just feels so hard to participate and with little confidence that our voice will be heard above those who are paying a lot more to have their voice played over a proverbial loud speaker. I’m sure most doctors feel this same way. Although, Dr. Koriwchak over at Wired EMR Practice was in Washington DC this last week. I’ll be interested to hear more details on his visit, but I think his visit came as part of a larger health organization. Evan Steele of SRSsoft has a good post requesting other medical organizations become more involved in the meaningful use process. Could they be an independent voice for the physicians they represent?

Enough ranting about the challenge of working with the government to shape policy. Although, a comment from Anthony Subbiah was what prompted my reaction above. The following are Anthony’s comments from my Small EHR Vendor and Specialty EHR post suggesting that EHR vendors get more involved in the process:

As a vendor who works with ONC, and having gotten to know them better, they do have the greater good in mind; and some of these hurdles are un-intended and un-foreseen. The Phase II of the meaningful use requirements are in pilot and this is a good time for the EHR vendors to work with ONC and point out the flaws which ONC will graciously accept and review. It has been interesting working with ONC and understanding their thought process goes a long way in positioning and requesting exemptions. Key here is for the EHR vendors to spend the time and effort and work with ONC helping to meet their objectives.
On another note, while reducing the expenses is the goal, its more about the reduction of wastefull expenses which is being targeted to get the healthcare costs under control.

ONC maintains an extensive directory and blog of what they do at WIKI and any company interested can join. In order to realize value, the companies interested should be able to dedicate one or two senior resources towards this; there are many pilots that go on related to MU Phase II; the EMR companies can participate in the Pilots, provide their inputs and the ONC group is more than willing to listen. Actually, this is a great group of people to work with and they take the input and integrate that within the initiatives framework. We do not participate in all the Pilots – we are participating in two of them currently.
I believe its better to participate and shape the outcome as opposed to sitting on the sidelines and later on finding fault in such initiatives…………..

Here’s a link to the Wiki that Anthony mentions.

The other comment that prompted this post was a comment made by Julie Lundberg about the meaningful use smoking status requirement:

In an attempt to improve ‘Usability” we are trying to build a smoking status that will satisfy both the Core Measure (which requires CDC smoking status categories) and CQMs (which require SnoMed codes). There is no 1-1 relationship between the 2 lists. In fact, the CDC list makes no distinction between a “Light” cigarette smoker (1-9 cigs/day) and a “Very Heavy” cigarette smoker (40+ cigs/day). Both would be considered a “Current every day smoker”. We can obviously gain this granularity with SnoMed codes but this makes the task more onerous for the provider to capture (selecting from 2 lists of “descriptions”). Let’s give the Providers 1 smoking status to fit all requirements.

It’s an interesting question for which I don’t have the answer to which feels odd since I feel that I’m reasonably well versed with meaningful use and the creation of the meaningful use creation process. The only way to know the answer to this is to have been intimately involved in the creation process in Washington. Something no doctor that sees patients daily can really do.

I love that Julie was willing to offer her suggestion on my EMR blog. Plus, I know that a number of people from ONC read this site, so I’m hopeful that now that I’ve posted Julie’s comment it will get more traction from the people in Washington. However, I still feel there needs to be an easier way for those who can’t spend their days following the latest meaningful use happenings in Washington DC to have their voice heard in the process. Then, they wouldn’t have to resort to blogs like mine to provide comments.

I’m open to other suggestions on how regular people can get involved in the process. Maybe my personal fear of involvement is that I want to actually effect change on something I’m involved in. It seems like casual involvement in the process isn’t enough to be heard. I guess that’s the problem when you want what you said to be meaningful (ie. actually heard and used).

Great EMR and Healthcare IT Content

Posted on March 3, 2011 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today I’m happy to officially introduce readers of EMR and HIPAA to my latest project: The Healthcare Scene blog network. If you follow me on twitter (@techguy and @ehrandhit), then you’ve probably already come across one or more of the great blogs in this new healthcare IT blog network. I’m really excited with the group of bloggers that I have working on the network and the amazing content they’ve been creating and will create.

Before I introduce you to the various websites on the network, here’s a little background in why I decided to do this. As I looked at the various healthcare IT and EMR bloggers producing content, I was disappointed that many of them were creating great content that wasn’t getting nearly as much attention and traffic as the content deserved. Plus, many hadn’t benefited financially from all the great content they were creating. Combine lack of traffic with lack of financial rewards and these independent voices often disappear.

I saw this as a real opportunity to leverage many of the marketing and advertising tools that I’d created for EMR and HIPAA to the benefit of many others in the EMR and healthcare IT world. Plus, a number of my current advertisers told me that there weren’t enough online healthcare IT advertising options out there. I see this network as a real win for everyone. Independent bloggers can have their voices magnified while making money doing so. Readers and the EMR and Healthcare IT industry get more independently created content (including content by doctors). Healthcare IT advertisers will have more opportunities to advertise next to great content. I get to expand my network and work with a bunch of really smart people.

Now here’s a look at the websites that will be part of the Healthcare Scene blog network:

  • Meaningful HIT News – This blog written by Neil Versel started in May 2004 and has over 500 posts. Neil is one of the only pure healthcare IT journalists out there and has been doing it for the past 15 years across more publishers than you can count, but most recently at Fierce Healthcare. I’m excited that Neil has chosen to move his blog to the blog network. He’s a must read journalist for anyone in EMR and healthcare IT. I borrowed much of my writing style from Neil and so if you like this site, go and subscribe to Meaningful HIT News email list and you won’t be disappointed.
  • EMR and Healthcare IT News – The firehose of EMR and Healthcare IT news sent out by vendors. A great way for vendors to get their word out and for industry people to see the latest developments in EMR and healthcare IT. I’m looking to partner with healthcare IT PR firms on the site, so hit my Contact Us page if you’re interested.
  • Happy EMR Doctor – This blog first started out as a Doctor’s Blog guest post on EMR and EHR, but the content from Dr. West was too good. So, I rolled it off onto its own blog. Dr. West has been through a failed EHR implementation and now is using one of the Free EHR vendors. So, he has some interesting stories to tell.
  • Smartphone Health Care – I recently heard that there were something like 30+ mobile health conferences or conferences with a mobile health track in the past year. That seems like far too many, but it is quite clear that Smart Phones and other mobile devices are going to play a huge role in the future of healthcare. Consider this my foray into the mHealth world.
  • Wired EMR Practice – Many of you might remember that I already introduced Dr. Koriwchak’s blog on EMR and HIPAA earlier. Many of you subscribed to his blog and have seen the type of quality content he’s creating. I love doctor’s perspectives on EMR.
  • nextHospital – We’ll see how this blog evolves, but it’s the Healthcare Scene’s first blog that isn’t really IT focused. Written by Katherine Rourke (mentioned above), nextHospital will focus on the business of healthcare in hospitals.
  • EMR, EHR and HIPAA Wiki – Not a blog, but a pretty cool part of the network nonetheless. Be sure to add your EHR vendor if it’s not on there already.
  • EMR and EHR Job Board – Not a blog either, but this job board will be syndicated across all the websites. So, it’s a great places to post or look for a job.
  • EMR and HIPAA – Hopefully it needs no intro if you’re reading this post. Let’s just say, 1000 posts, 4713 comments, and over 4 million pageviews.
  • EMR and EHR – Very similar to EMR and HIPAA, but only about 2 years old. 300 posts, 1092 comments and 700,000+ pagevies. Katherine Rourke, a healthcare IT journalist with 15+ years of experience, recently started posting on EMR and EHR and is a welcome addition to the site.

I’d say that’s a pretty good start. I’m in talks with a few more bloggers that may or may not join the network. I think there’s still some interesting niches that haven’t been filled. For example, a blog tracking publicly traded healthcare IT stock movements and other healthcare IT investment opportunities could be interesting. Either way, I’m excited to see all the great content that will be created on these sites. Much like this site, each site encourages you to respectfully comment, share the content, and join the conversation. Please let your voice be heard in the comments.

Yes, right now each site looks very much like the rest, but we’re just getting started. Over time I’ll work to give each blogger it’s own brand while also building up the domain to better represent all the activity that’s happening on the network. I see it becoming a virtual hub of the best and brightest conversations happening in and around healthcare IT and EMR.

Let me know what you think of these additions in the comments or drop me a note on my Contact Us page.

EMR and Older Doctors

Posted on December 9, 2010 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Dr. Michael Koriwchak recently did a great post about implementing an EMR in a practice with an older physician. He does a great job analyzing the challenge that a group practice faces when one of the older physicians (I prefer mature physicians, but he said older) is the “lone hold-out.” Here’s his suggestion which is really valuable:

So the older doc who claims to be ready to retire may not retire as soon as he thinks. So do you let him opt out of EMR or not?

I would be happy to let him opt out of EMR…provided he commits in writing to a retirement date and allows the practice to begin making plans to recruit a replacement physician. The date would be fairly soon, no more than 18 months in the future. If he fails to retire by that date he would begin incurring costs related to EMR, both in take-home pay and retirement buy out.

This approach avoids the nearly impossible task of trying to calculate the return on investment “break-even point” for an EMR purchase, as many authors try to do.

This is definitely an interesting challenge. In response to Dr. Koriwchak’s post I wrote the following about the mature physician population and EMR:
No doubt there are a lot of interesting dynamics like this in a group practice. I’m glad you’re bringing them to light.

What I’ve found interesting in my experience is many of the really close to retirement age doctors that I know are actually quite happy to adapt to an EMR. They have some learning curve, but they aren’t generally the problems (although there are exceptions).

I’m not sure exactly why, but I think it might have to do with demeanor and their easy going personality and love of what they’re doing. If they didn’t have these qualities they would have retired from the medical profession already.

The hardest ones are the middle to upper age doctors that have 5-10 years before retirement. When they don’t want an EMR it’s an ugly situation.

Tell me about your experiences with mature doctors and EMR. Any secrets to be shared?