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First ONC-ATCB Certified EHR – Drummond Group Wins

Posted on September 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.

Drummond Group just posted the news of the first 3 EHR vendors which have been officially certified EHR for the ARRA EHR stimulus money. Looks like Drummond Group won the race to be the first to certify an EHR.

The interesting thing for me is the list of 3 EHR vendors that became the first certified EHR:
PARADIGM (QRS Inc.)
ifa EMR (ifa united i-tech Inc.)
ChartLogic EMR (ChartLogic, Inc.)

I consider myself pretty well informed about EMR vendors, but I only realy knew 1 of the 3 and I’d maybe heard of one other, but just by name. As all the ONC-ATCB certified vendors start completing their EHR certification, I think we’re going to learn about a WHOLE lot of EMR vendors that very few people knew about previously.

I also find it interesting that all 3 EHR vendors have already updated their website in some way to represent the new ONC-ATCB EHR certification.

Note: We need a new way to identify the certified EHR. ONC-ATCB just doesn’t have the right ring to it. I might work on this problem.

“I use EMR and so I am MY OWN transcriptionist.” – Doc at AAFP

Posted on 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 currently in Denver attending the AAFP conference. So far I’m really glad that I’ve come to the conference. It’s really fantastic to be surrounded by providers. It’s a stark contrast to HIMSS where you’re mostly surrounded by industry insiders and not that many providers. The practical questions the doctors ask are fascinating.

Of course, the comments they make are also fascinating. The title of this post is a comment one lady made in the David Kibbe session on Meaningful Use:
“I use EMR and so I am MY OWN transcriptionist.”

The problem with this comment is that it just doesn’t have to be true. It could be true depending on which EMR software you selected and how you implemented the EMR. However, that’s a choice you make when you choose and implement an EMR without any transcription.

I’ve actually seen a number of EMR vendors that have some really nice and deep integration between their software and transcription companies. There are even transcription companies that are building their own EMR software which obviously leverages the power of transcription.

Plus, many doctors happily use voice recognition like Dragon Naturally Speaking to still do what essentially amounts to transcription with their EMR.

Add in developments around natural language processing and the idea of preserving the narrative that is so valuable and interesting while capturing the granular data elements is a really interesting area of EMR development.

Of course, one of the problems with this idea is that many people like to use the savings on transcription costs as a way to justify the cost of purchasing and implementing an EMR. Obviously, you’ll need to look for other EMR benefits if you choose to continue transcription.

Just to round out the conversation, there are a wide variety of EMR vendors which each have their own unique style of documentation. Part of the problem is that many people don’t look much past the big “Jabba the Hutt” EMR vendors which are these ugly click interfaces that spit out a huge chunk of text that nobody wants to see. There’s plenty of EMR vendor options out there. Keep looking if you don’t like an EMR vendor’s documentation method.

NYC Hospital Puts 6800 Health Records Online

Posted on September 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.

A New York City hospital has apologized for a security lapse that allowed personal information belonging to as many as 6,800 former patients to be published on the Internet.

New York Presbyterian Hospital/Columbia University Medical Center says the information included names, clinical data and a few social security numbers.

The hospital said in a statement that the data had been inadvertently placed on a server, which was accessible online. The information has now been taken down. –Source

This is a pretty sad indiscretion although it is lacking some important details. I hate that it only says personal information for 6800 former patients. Ok, putting ANY health information on an insecure web server is just dumb, but not all health information is created equal. Plus, wouldn’t it be nice to know what happened to cause this issue so that others could learn from their mistakes?

Plus, was the health information placed on the web server in an accessible location or was it just on the web server? That would be very different things.

Still something’s wrong if they’re putting patient information on an unsecured server. Makes me wonder what the rest of the story really is though.

More CCHIT Details

Posted on September 28, 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.

The good people over at >HITECH Answers must have more time on their hands than I do. They got on the CCHIT conference call where they talked about their newest ONC ATCB certified EHR program. Here’s a portion of the HITECH Answers summary which includes some CCHIT pricing details:

The ONC-ATCB Certified 2011/2012 Toolkit will help prepare health IT companies and EHR developers for testing. You can purchase the toolkit for $1000. Pricing will be in tier levels and range from $8K to $34,300K. They want to do the testing in a single day. There can be an accumulative approach where modules can be certified and added to the current certification without having to retest previously certified criteria.

It still feels wrong that they charge you $1000 for the toolkit you’ll need to use in order to pay them $34k more dollars to become certified. Uhh…yeah.

The fact that you can use a cumulative approach to certification is a difference between CCHIT and Drummond Group. Drummond Group has said that you would have to recertify everything if you wanted to do more modules.

HITECH Answers also mentioned that CCHIT has a program called EACH (EHR Alternative Certification for Hospitals) that will certify EHR technology in place for legacy and custom programs. They’d been calling this the EHR site certification before.

They also did a quick poll on the CCHIT call with the following results:
“Using the interactive polling option of the meeting, CCHIT asked attending vendors what their plans on certification were. In a quick response from about 250 vendors, 24% said they were intending to certify immediately, 45% said in the next few months, and 8% where not sure.”

Don’t ask me what the other 23% of responses were. However, these results do point to my belief that most EHR vendors will certify.

EMR Stimulus Poll

Posted on September 27, 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 previously posted an EMR Stimulus poll asking about people’s plans for the EMR stimulus. Well, that was more than a year ago and before we really knew what the words meaningful use and certified EHR meant. Now that we know more about those two important terms and the EMR stimulus in general, let’s do the poll again and see how things might have changed.

Physicians Don’t Know About EMR Stimulus Penalties and Don’t Care

Posted on September 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.

The Physicians’ Reciprocal Insurers (PRI) recently posted the results of a survey they did of 500 physicians regarding Electronic Medical Records (EMR) software and the EMR stimulus money and penalties. Here’s one of their most interesting findings about EMR implementation:

One significant finding was awareness of financial incentives and penalties for implementing EMR systems. While 85 percent of physicians were aware of the financial incentives for implementing the systems, more than 35 percent did not know that they face government-assessed financial penalties for not complying. The penalties are equal to a one percent reduction of the physician’s annual Medicare payments per year up to five percent. However, those penalties do not seem to be having the intended effect, as more than 65 percent of physicians who were unaware of the financial penalties said this would not cause them to implement EMR.

So, most physicians are aware of the financial incentives of implementing an EMR. This was a bit of a surprise for me, but I guess not a HUGE surprise. The more interesting part is the 35% of physicians that didn’t know about the Medicare penalties and that the majority of those people didn’t think that penalties would cause them to implement an EMR.

Does this mean that doctors won’t be implementing EMR? No, I think that we’re going to see a big uptake in EMR adoption over the next two years. One thing the HITECH act and EMR stimulus money has done is increased the awareness of the good and bad of EMR. This increased awareness will be a great thing and will spur EMR adoption.

What this poll shows is that the EMR stimulus is out of touch with what physicians and medical practices think is important. The real driver for EMR adoption won’t be a government handout. The real driver for EMR adoption will be hundreds of doctors implementing EMR software which makes their life easier, increases their reimbursement and solves the physician pain points. EMR vendors that provide these benefits to their users are going to be in a great position going forward since that’s what doctors consider meaningful use.

Healthcare Data Breaches

Posted on September 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.

I was recently sent an Information Week article on the “Steady Bleed: State of HealthCare Data Breaches.” The article basically tries to list out all of the data breaches that are happening in healthcare and how healthcare companies aren’t doing what they need to do to protect patient data.

Now, I’ll be the first to acknowledge that more can always be done. I even agree that more can and needs to be done to protect patient information. However, I don’t agree with the article’s assertion that the use of an electronic health record (EHR) is the reason why health care providers are so poorly securing patient information.

Many of you might remember my post on EMR and EHR about HIPAA Breaches related to EMR. In that post, I discuss how it’s unfair for someone to automatically assume that if there was a breach, then it was the electronic medical record software’s fault. In the analysis I did in the above post, I found that most of the HHS list had nothing to do with EMR software. In fact, many of the HIPAA breaches were lost devices which contained lists of insurance information. EHR had nothing to do with that.

I’m not saying that breaches don’t happen with an EMR. They do. However, most of the examples given in the Information Week article could have happened just as easily in the paper world. It didn’t take an electronic health record for people to start looking up famous sports stars health information.

Maybe the real difference with an EHR is that now we can know and track who accesses each patient record. That just means that now we actually know about all the violations whereas with paper charts they’d just happen and we’d likely never know about it or have a way to prove that it happened. So, yes, the number of reported HIPAA breaches should be going up. We have more information to report on.

The good thing long term is that with an EHR we now have tracking mechanisms that allow us to hold someone accountable for their breaches of HIPAA. If this accountability is taken seriously, the number of breaches will go down. That’s a much better long term solution than the naive ignorance of not knowing about breaches in the paper chart world.

Sure not all EHR software is secure. They need to fix that and improve that. However, the numbers and reports I’ve seen don’t seem to indicate that breaching an EHR software’s security is the real problem. There are far easier ways to take patient data than trying to breach an EHR’s security system. Let’s focus on those other ways that people take patient data and punish it appropriately. That’s far more productive than saying that we’re rushing too quickly into an unsecured EHR world.

SaaS EMR vs. Client Server EMR and AAFP in Denver

Posted on September 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.

I knew that my previous post about the cost to update an EMR would bring out the people who like to back the SaaS EMR model versus those who like to back the Client Server EMR. As I’ve said before, it’s one of the most heated debates you can have in the EMR space.

I realized in the comments of that post why it’s such a heated topic. It’s because once an EMR software chooses to go down one path or the other, it’s nearly impossible to be able to switch paths. Why? Cause if you do choose to switch you basically have to just code a new application all over. Basically, the switching costs are enormous. So, only a few software companies (let alone EMR software companies) ever change from one to the other.

Considering the high switching costs, that basically means that an EMR vendor that is SaaS based has a strong vested interest in the benefits and upside of the SaaS model of software development. The same is true for Client Server EMR software and client server EMR companies looking at the benefits and upside of the client server model of software development.

This entrenching around a software development methodology (for which they can’t change) is what makes discussing each model so interesting. Each party dutifully makes the most of whichever software development methodology they’ve been given.

Of course, from the clinical perspective it’s sometimes hard to cut through all this discussion and get good information on the real pros and cons of each model.

In that vein, I’m looking for a couple EMR and HIPAA readers that would be interested in making the case for one or the other. All you’d need to do is create a guest blog post on the pros and cons of your preferred method. If needed, you’d also be welcome to do a response post to the other method’s post as well.

If this interests you, leave a comment or let me know on my Contact Us page. I think this could be really interesting.

On a different note, it looks like I’m going to be attending the AAFP conference in Denver next week. Is anyone else planning to be there? Anything I should know about the conference to get the most out of it?

Speech Recognition and EMR

Posted on September 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.

Shahid, The Healthcare Guy, recently added a guest post from Nick van Terheyden, MD, Chief Medical Information Officer (Clinical Language Understanding) from Nuance Healthcare (Yes, they make Dragon Naturally Speaking – DNS) about making the most of speech recognition with an EMR. Here are the major points that Nick made:

  • Have the right hardware installed.
  • Intelligent application Coexistence.
  • Use good quality microphones and sound recording equipment.
  • Environmental Considerations.
  • Create a Standard and Replicate.
  • Anticipate Resistance. Expect resistance.
  • Quick Portable Guides.
  • Preparation.
  • Horses for Courses.
  • Identify champion(s).

I think that voice recognition is fascinating. Personally, I haven’t used it all that much. I certainly write a lot and so you’d think it would be perfect for me. I guess the reason I haven’t done it is first that I type pretty fast and second the extra time that it takes me to type the post helps me to formulate my ideas into a more coherent manner.

People are generally surprised to find out that I don’t proofread these blog posts (most of the time). It’s definitely a different type of publishing, but for the most part I build an idea in my head and then formulate the content for the blog as I type it. I’m not sure how well that would work with voice recognition. Although, maybe this week I’ll try it and see how it goes.

This said, I think many doctors have well trained dictation skills and so the idea of using speech recognition to capture their documentation into an EMR is a very natural thing. Hopefully the above ideas will help out those that are interested in pursuing speech recognition.

Cost to Update to Meaningful Use Certified EHR Software

Posted on September 20, 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 my previous post about the EHR certification costs, a reader emailed me that I’d missed an important downstream cost. It’s not as much a cost for the EHR company as it is for the current user of an EHR system. It’s the cost for a current EHR user to upgrade their software to the latest and greatest version of the EHR software. You know, the one that is certified and allows you to show meaningful use of that EHR.

All EHR Will Need to Update
Lest you don’t think this is going to happen, I can pretty much guarantee that EVERY EHR company will need to upgrade their software to become a certified EHR and meet all the meaningful use requirements. The good thing is that most EHR users have a contract that provides them with all the upgrades free. Although, there might be some users that will incur a cost to upgrade.

Less Visible Update Costs
Beyond the potential cost to get the upgraded software, there’s also the cost to physically update your EHR software. There’s the very apparent cost of having to run a software install on all the computers in your clinic. This is pretty negligible for a small clinic with only a couple computers. However, in one clinic I supported we had 100+ computers and so the update process did take time.

However, more important than the actual software update is the process of preparing for the update. Certainly you could just update the software and go forward with it. Although, this is far from recommended and can be really problematic. I should cover this topic in a future blog post, but suffice it to say that the upgrade process goes much better when you 1. Look over the new features/changes to the EHR softare 2. Test the changes to see how they work 3. Train your staff on the new changes and how it will affect their workflow. These are all pretty academic steps, but they do take time.

SaaS EHR Vendors
Of course, the SaaS-hosted EHR vendors will all really enjoy this part of the process. They can easily update their EHR software to meet the guidelines with little interaction or work from the customer end. They still could cause the headache of an update to their EHR software affecting a clinic’s workflow. However, most SaaS EHR software companies are doing many regularly scheduled smaller updates as opposed to the large traditional client server EHR updates. These smaller changes generally cause fewer issues or at least spreads those issues out over time.

Even More Hidden Update Costs
I recently was aghast to learn of the EHR update requirements for a certain very popular EHR vendor. They’d told a clinic (or at least given them the impression) that in order to update their clinic to the latest EHR software that met the meaningful use and certified EHR guidelines (which is kind of silly since there still aren’t any officially recognized Certified EHR, but I digress) that the clinic would need to have computers that ran the Windows 7 Operating System. The sad news for this clinic was their current Windows XP machines weren’t powerful enough to run the Windows 7 operating system.

Let me translate what this means for the less tech savvy readership. The clinic would need to buy all new computers and the Windows 7 operating system (which should come on the new computers) in order to upgrade their EHR software to the latest meaningful use-certified EHR software. One could certainly argue that the clinic might need to upgrade these older computers anyway, but something doesn’t feel right about this being “forced” on a clinic. I personally still use Windows XP and don’t see much benefit to pay for a new computer with Windows 7. I will at some point, but there’s no compelling reason for me to move now. Why should clinics be forced into this expense by an EHR vendor?

Certainly Windows 7 and Windows XP are not ALL that different, but be sure that the change will cause some heartache in a clinic. Some mundane task that a user use to do easily in Windows XP will require a change to make it work in Windows 7. It’s easy to quantify the cost of new computers with Windows 7. It’s much harder to quantify the cost of this heartache.

Ongoing Update Costs
Many of these costs aren’t generally meaningful use specific. These costs or some variation are going to be part of the EMR update costs going forward. Unless your EMR vendor stops updating. Although, if your EMR vendor stops putting out updates, then you have a much different problem to deal with.