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ICD 10 And Meaningful Use Lack Incentives for Doctors

Posted on March 31, 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.

One of the really interesting conversations I had recently was with Tori Sullivan from Capgemini. Tori is knee deep in the fun that is ICD 10 and the transition to ICD 10. However, one thing that she said really struck a major chord with me during our discussion. She said…

“ICD 10 and Meaningful Use Don’t Focus Enough Incentives for Doctors.”

Basically, what’s the benefits for doctors to implement these regulations and changes? If you’ve ready me for any length of time, you probably have realized that I’m a doctor’s advocate. I strongly believe that some of the major reasons that EMR software hasn’t been adopted more widely is because far too many of the EMR software don’t put enough focus on the doctor.

Like it or not, Doctors are VERY powerful in their offices and can derail a project or make it succeed very easily.

This is why I agree completely that if you really want to affect change in the healthcare industry using EMR (or any other system), focus on benefiting the doctors and you’ll see amazing changes for good start to happen.

EMR Stimulus Q&A: Government Incentives for EMR Adoption Outside of Medicare and Medicaid

Posted on March 30, 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.

Time again for everyone’s favorite topic (or so it seems), EHR stimulus questions and answers. Today’s EMR stimulus question comes from Jamie who asked the following question on a previous post:

Does anyone know whether or not the government is implementing some kind of incentive benefit for non-Medicare/Medicaid users? Or are these practices totally out of luck?

The short answer (at least for now) is not really. The ARRA EHR stimulus money is provided through Medicare and Medicaid programs as “bonuses” for those who show “meaningful use” of a “certified EHR.”

With that said, there are some grants available for special situations. For example, they have a beacon communities program which are given to organizations that will supposedly take EHR software to the next level and be examples for their communities of what can be done with IT and EMR software.

I’ve heard there’s other grants that people can apply for also, but I’m not sure all of the details. I also hear that there might be some EMR stimulus money available in the latest healthcare reform bill. For example, I read somewhere recently that the healthcare reform bill includes some stimulus money for long term care which has basically been left out of stimulus money as well.

Clinics interested in EMR software should also be able to get some help from the RECs and HITRCs. At least their stated mission is to assist doctors to adopt and meaningfully use EMR software. I think the jury’s still out on how helpful these RECs will actually be. It’s a nice idea, but could go horribly wrong if not done right.

I won’t go into all the details here, but not qualifying for the EMR stimulus money might just be the best thing that’s happened to your practice. That means you won’t be distracted and you don’t need to wait. You can hone in on the other EMR benefits and start reaping those benefits without all the bureaucracy.

Athena Health EHR Stimulus Guarantee Program

Posted on March 29, 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’m always amazed at the ability of businesses to innovate and find new ways to build their business. One of the impressive ones I’ve seen lately is Athena Health‘s EHR stimulus guarantee program. Yes, you might remember that I’ve written about the EMR stimulus guarantees before. Seems like most EMR vendors are providing some sort of guarantee or promise about the EMR stimulus money.

Of course, the Athena Health EHR stimulus guarantee is probably the strongest guarantee I’ve seen. Most other EHR stimulus guarantees still require that the end user fulfill their part of the bargain or else there is no guarantee. Makes sense right? How can an EMR vendor guarantee that you’re going to actually meaningfully use their EHR software? You are the one that’s going to have to show the meaningful use. The EHR vendor can only provide you the software to hopefully make that process easier (although, some probably don’t help this either).

However, Athena Health (from what I can tell) is actually guaranteeing that you’ll be able to get stimulus regardless of if it’s your fault or theres. I imagine they’ll still require that you go through the process, but there guarantee is the broadest of any I’ve seen covering even something that might be the doctors fault. How nice of them right?

Ok, let’s not get too far ahead of ourselves here. From what I can tell, Athena Health makes more of its money from the collections piece than they do from selling software. So, it makes sense why they’re willing to basically give you the software for free if you can’t get the EMR stimulus money. They probably don’t care (that much) about the revenue from selling software. They realize that the real cash cow in their business is the percentage they take from collections. Jonathan Bush never ceases to amaze me. I just wish I could have had a chance to interview him at HIMSS. Maybe next year.

EMR Platform

Posted on March 26, 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.

After I wrote my post about 50 EMR markets instead of 1 EMR market, I started to wonder what an EMR might look like that was just an EMR platform.

The basic idea would be that some vendor would create a platform where other vendors could build on top of their platform. They’d offer the core elements and foundation needed for an EMR and then companies could build applications on top of those core elements that focus on the 50 different EMR markets (or whatever the number actually is).

The easy part is seeing someone who builds some specialty specific applications like growth charts for pediatrics or a drawing application for dermatology. The hard part is to decide which elements of the EMR are “core elements” that can act as a foundation for every type of specialty, practice, location, etc.

I guess the question of core elements really comes down to whether we can define any part of the EMR to be something that EVERY doctor could use. I think of the iPhone as the example of a platform that people have taken and expanded with applications. The core elements are the phone, the GPS, the accelerometer, etc. Then, various companies have created applications using that platform that can cover a wide range of markets. Making the comparison of EMR features with iPhone features is not an easy one.

I honestly don’t think any EMR vendor has done something like this yet. Sure, some of them have some API’s where some customizations can be done. However, I’m not sure I’ve seen the full embrace of creating an EMR platform. The closest I’ve probably seen is some to the open source EMR software that’s out there. It seems like some of them have done a good job modularizing the software so that many different people can iterate on the software.

What do you think? Is an EMR platform possible and what would it look like?

Super Technical Solution for Practices

Posted on March 25, 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.

In a recent session I attended about EMR ROI, the guy gave a really technical solution for practices that is highly effective:
Use Walkie Talkies

Ok, I think he said 2 way radios or something, but I think it sounds better walkie talkies. Kind of takes me back to being a kid again and always wanting one of those.

No doubt some people won’t feel comfortable walking around their clinic with a 2 way radio attached to them. However, this doctor swore by them. Basically, solves the challenge of opening the door and looking down the hall and hoping to find someone. I think he had a policy that only the providers were allowed to initiate a call on the radios or something.

So, I didn’t point this out because I thought that walkie talkies were such a fantastic solution. I actually think that IM can solve a lot of the same communication issues and it’s silent. However, what I found most interesting about this solution was that sometimes we over think the solutions to problems.

Sometimes 1 sheet of paper or an excel spreadsheet is better than trying to force something into your EMR.

NIST Posts First Details on EHR Testing Methods

Posted on March 24, 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.

One of EMR and HIPAA’s regular readers, DKBerry, sent me an interesting link to the NIST Health IT Standards and Testing website. I don’t have much time to look over the details of this website since I’m about to leave town, but it looks like this is NIST’s first attempt to define the standards for EHR testing. Here’s some of the major categories they have listed:
Health IT Testing Infrastructure
Meaningful Use Test Methods
What is Conformance Testing?
Health IT Testing and Support

I welcome your comments on what’s found on the website. In fact, if someone has a little more time than I do right now, I’d certainly welcome a guest blog post summarizing what’s been made available.

Regional Extension Centers (RECs) and HITRCs

Posted on March 23, 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.

One area of the HITECH act that I haven’t heard discussed nearly enough is the Regional Extension Centers. Sure, I’ve heard them mentioned in passing plenty of times. However, I haven’t heard any real good information on what’s being done to make sure that these RECs are going to be successful in their goal of 100,000 providers becoming meaningful users of EHR’s by 2011.

Yes, that’s a pretty big hairy goal. Especially considering the EHR adoption rates up until today. Not to mention, these Regional Extension Centers (RECs) are going to have to find a way to effectively help doctors sort through the 300+ EHR vendors that are on the market with more coming out every day. This is not an easy task to accomplish and will require a lot of great tools to do it effectively.

Shahid, The Healthcare IT guy, created an interesting post about the Regional Extension Centers where he talks about the challenge these RECs will have to “offer unbiased advice on the systems and services best suited to enable the priority primary-care providers to become meaningful users of EHRs. Regional Centers will avoid entering into business arrangements creating an actual or apparent conflict of interest.”

Can you imagine the lobbying that will happen by the big EMR vendors towards these RECs? The reality is, who else can these RECs turn to for “unbiased” advice on EMR selection and implementation? I can’t imagine that the people behind these RECs just want to be a marketing front for EMR vendors who pay to lobby them. Seems pretty clear that you have to be really careful where you get your information.

Of course, this is just one of the many challenges that these RECs face. Personally, I hope that the RECs are incredibly successful and do a great job assisting doctors to find and implement the right EHR. However, if these RECs aren’t careful, they can actually have the opposite effect on EHR adoption.

If people have more information on these RECs, I’d love to hear more. I’m interested in doing what I can to help these RECs succeed.

50 EMR Markets Instead of 1 EMR Market

Posted on March 22, 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.

John Moore at Chilmark Research said, “So Many EHRs, So Little Time: Simply amazing that this market can support so many EMR/EHR companies. How they all survive or will survive is a mystery to me and rationalization will occur. ”

It really is pretty stunning that 300+ EMR vendors are still trying to carve their niche in the EMR market. That’s a lot of friendly (or not so much) competition.

However, I can’t help but sit back and wonder if we’re looking at this the wrong way. Maybe there’s not actually 1 EMR market out there. Maybe there are actually 50 EMR markets.

The case for 50 EMR markets is simple. There is an EMR market for every specialty. Add in regional differences, countries, and I think you could get close to 50 markets. However, the number of markets doesn’t really matter. What matters is that there’s more than 1 EMR market.

Almost every EMR vendor I’ve seen has had the challenge of deciding how they want to market their EMR software. It’s not an easy choice, but more and more we’re seeing EMR vendors focus on specific markets. I think that they’ve found that they can’t be all things to all doctors. Doctors in different specialties are unique and that by focusing on a certain specialty they can provide a real value added service to the doctors in that specialty.

Assuming there’s 50 EMR markets, that means that there’s only 6 EMR vendors per market. That’s a much more reasonable number to consider.

Now there’s no doubt that EMR vendors are working in more than one EMR market. Some of the larger EMR vendors are doing a great job focusing on a number of specialties. So, maybe it’s 10-20 real players in each specialty market. Still too many, but we’ll definitely see a lot of consolidation in this regard.

In fact, I’m a little surprised that we haven’t seen more EMR vendors purchasing up these specialty specific EMR vendors and having them work as kind of subsidiaries of the other company. Then, the large company can provide a variety of very targeted EHR products. The key for that company would be to build amazing interfaces between the various EHR products you own. Show true EHR interoperability between these products and you can sell them as a great package to even the larger hospital owned ambulatory practices. Could be a really interesting play for an EMR vendor I think.

Now, I’m sure that someone will say in the comments that one EMR vendor can serve all 50 markets. They can just build “modules” (or some other similar term) that customizes the EMR to meet the needs of that specialty. The problem is that the “modules” are always limited and lacking. Focusing a “module” of an EMR on a specialty and focusing an EMR on a specialty ends up with very different results.

HIMSS 2010 Attendance Numbers

Posted on March 21, 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 always find the attendance numbers for a conference interesting. Ok, I pretty much find any statistics interesting. Just ask me about the statistics for my various websites and I can tell you them up and down. I’m a stats addict.

So, it seems fitting that I share the HIMSS attendance stats:
Registration: 27,855, compared to 27,627 at HIMSS09, healthcare industry experts learning about the latest solutions for improving healthcare through IT.

  • Professional registration outpaced 2009 by 8.5% with 13,846, compared to 12,766 in 2009, registrants in this category
  • Nearly 30% of those registering come from healthcare provider settings
  • 11% of registrants are CIO and CTOs; nearly 10% are CEOs
  • Almost 8% are from countries outside of the United States

Here’s a nice graph of the numbers comparing HIMSS 2009 and HIMSS 2010:

HIMSS10 HIMSS 10 HIMSS 09
Total registration 27,855 27,627
Professional registration 13,846 12,766
Exhibiting companies 934 907
Number of new exhibitors 289 256
Square feet for exhibits 391,560 375,840
HIMSS10 Interoperability Showcase HIMSS10 HIMSS09
Total Participants 84 72
Number of unique systems 96 60

It really is quite amazing that the attendance at this conference was up despite this current economic recessions we’re experiencing. I guess government money will bring people out of the wood works.

I wish that they would have shared percentage of clinical staff that attended. Yes, I’m talking about doctors, nurses, practice managers, etc. I actually saw quite a few in the sessions that were targeted at them. However, those sessions were generally poorly attended compared to many of the other sessions about policy or stimulus money.

Also, if you look at the CEO, CIO and CTO’s that attended the percentages break out to about 6000 people. I wish I knew how many CEO, CIO and CTO’s there are in the healthcare space so I knew if 6000 was a large percentage or small. I also wish they would have broken out the CEO, CIO and CTO’s and told us how many hospital ones were at the show. I could have easily put down CEO of EMR and HIPAA, but that’s not the same as the CEO of a hospital. I think I know which one is better.

EMR Backups

Posted on March 19, 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.

My favorite part of HIMSS is meeting all sorts of interesting people. One of those people I met was Lyndsey Coates from Nuesoft. I have a soft spot in my heart for Nuesoft since they were the company that trained me on my first EMR. I still remember the 3 day intense training in their office. Lyndsey and I had interacted a few times before the conference and so it was nice to meet her in person. It was just too bad that we didn’t get to spend more time together.

What does this have to do with EMR backups?

Well, Lyndsey and I didn’t have much time together at the conference, but she sent me a nice bloggers “love note” in the form of a blog post about offsite EMR backup systems after meeting me at the conference. She even sent me a friendly tweet to let me know about the post.

I was a little busy with HIMSS and all, but I’m always happy to share in a little blog sparring. So, Lyndsey, here we go.

I’m really glad to hear you respect my opinion, but I’m a little surprised that you didn’t like my post about offsite EMR backup services. I guess I could have imagined that a SaaS EMR vendor might have a different view. In fact, you make a nice case in your blog post about the challenges of backup with the client server model. Definitely a number of good points for doctors to consider when selecting their EMR.

However, somehow your post left out some of the problems related to backups with a SaaS EMR. No worries though, I’ll be happy to share;-)

First and foremost, I can’t believe you think that doctors will trust an EMR vendor to back up their EMR appropriately. I mean seriously, we’re talking about my whole clinical practice stored on your servers and trusting that your IT staff are doing my backups? I don’t think so. I barely trust my own staff to do backups, so why would I trust my EMR vendor’s staff to do something as important as the backups of my EMR?

No, I’m definitely not trusting you and your IT staff to backup my EMR. Maybe there are a lot of doctors that don’t do backups properly, but there are a lot of large vendors that don’t do backups properly either. Yes, even the all powerful Google lost some data because they didn’t have the right backups.

Plus, if you’re doing my backups that means that you establish the policy and time frame that the backups are done. If I do them in house, I get to schedule the backups, verify the backups and see the reports and logs about when backups are done. I get to choose when and how often those backups are done. With you, I just have to hope that you’re doing them.

Plus, there’s just something that doesn’t feel right about you having the backup of all my data. Maybe you don’t remember that the data stored in the EMR is my life. Not my literal life, but the life of my practice. Maybe you feel comfortable with my life being stored in your redundant data centers across redundant servers who mirror the data and all sorts of other cool backup processes. Personally, I feel comfortable knowing I have a backup of my life in my office with me. I can see it, touch it, pet it and know that it’s safe in my loving arms.

Finally, let’s not call out my previous post about Offsite Backup Service for EMR for “missing the mark a bit.” While SaaS EMR are doing very well, there’s still a VERY large number of people who will select a client server EMR. Better to help them get their client server backup services right than to just tell them that they should have bought a SaaS EMR.

Plus, maybe Nuesoft and other SaaS based EHR should consider partnering with one of these offsite backup solutions. I imagine a lot of doctors would love to have their SaaS EHR backed up to an offsite backup provider like the ones I mentioned in that post. Basically, a location that the doctor can access and control. Could be an interesting service to offer your clients.

Your turn Lyndsey!

P.S. I personally don’t care either way. I think that the client server or SaaS model are legitimate EMR solutions. Long term SaaS EMR are likely to win the day, but that’s still a long ways away. I do enjoy playing devil’s advocate though.