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Meaningful Use – Doctors Have No Choice

Posted on November 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.

In a recent article at Physicians Practice, James O/’Connor, MD describes well the current EHR climate:

Physicians’ responses are all over the map. A surprising number of our colleagues still don’t know about meaningful use. Some doctors plan to ignore it altogether. (It appears that the fewer the number of years to retirement, the greater the apathy towards meaningful use.) Some practices are optimistically and enthusiastically making plans. Others are revealing their ambivalence, wrestling with the question “should we or shouldn’t we?”

I whole-heartedly support the adoption of electronic health records. I was an early adopter in my own practice and have spent a good deal of time in the industry. I am aware that the majority of my colleagues remain resistant to EHRs.

Nonetheless, the pros and cons of meaningful use are not really the problem. The problem is that, once again, we physicians are subject to a mandate over which we have little control and no choice whether to comply. Is this surprising to you?

He then goes on to make the case for why doctors really don’t have much choice but to comply with meaningful use of an EMR system. His reasons are essentially:
1. HITECH EHR penalties
2. Major Insurer adoption of meaningful use
3. ABMS Maintenance of Certification program adoption of meaningful use
4. Board Certification meaningful use requirement

We’ve talked about pretty much all of these reasons in the past on EMR and HIPAA.

1. The EMR Stimulus Medicare penalties don’t amount to a whole lot.
2. I think major insurance companies are in wait and see mode for commercial insurance adoption of meaningful use. They definitely want more data, but I think they’re not sure meaningful use is going to give them that data.
3. I don’t know much about ABMS and how that works for cash only doctors. Maybe someone can tell me why this matters in the comments. I guess you need this certification to practice medicine on a cash basis?
4. I thought I wrote about this before, but I can’t find the article. I guess it’s possible. Isn’t board certification done on a state by state level? I must admit that it just seems weird that to practice medicine you somehow would have to show meaningful use of an EHR. What about recent grads? I don’t know, this just doesn’t make much sense to me.

Dr. O’Connor describes the choice as follows:

OK, so technically, we do have a choice. We could stop taking Medicare and Medicaid patients, accept cash only, give up our board certification (and thus usually hospital privileges), and move to a state (or country) that doesn’t impose EHR requirements. But is that really a choice? No.

He does then encourage active participation in the discussions of meaningful use so that you can affect it for good. I agree this is a good thing and an important act. I believe Meaningful Use stage 2 will be greatly impacted by 1. public comment and 2. experience in meaningful use stage 1. It’s important that doctors are part of this conversation or I think they’re going to be unhappy with MU stage 2.

EMR and HIPAA Interviews on XM Radio Station ReachMD

Posted on November 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.

When I attended the Practice Fusion Connect conference in San Francisco, I had the opportunity to do a couple interviews for a segment on the XM radio station ReachMD. They’ve posted the segment I did on EMR and meaningful use on their website (Free registration required). In the radio segment I interviewed:
-Camille Williams, practice manager from ENT Associates of South Atlanta in Marietta, Georgia
-Ken Harrington, practice manager from Washington Endocrine Clinic in Washington, DC
-Robert Rowley, MD, chief medical officer of Practice Fusion

It was a fun experience recording something for radio. I learned a bit about radio production and enjoyed interviewing people. If you’re pretty familiar with EMR, meaningful use and healthcare IT, then the segment probably won’t be that interesting to you. However, if you’re just starting to get into EMR, then I think you’ll find some interesting information in the interviews.

Let me know what you think if you listen. Should ReachMD create a healthcare IT and EMR show?

A Healthcare IT Twitter Roundup

Posted on November 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.

It’s the weekend and I have this cool new Twitter plugin, so I decided it would be fun to do a twitter roundup. I’ll post some of the tweets I find and add some short commentary. I’ll admit that I haven’t necessarily read all of the links, but the concepts I found interesting. As a side note, you can find me on @ehrandhit and @techguy (although this one has all sorts of tweets).


I’ve discussed the changing legal landscape in the EHR world. My personal feeling is that it’s a legal wash. There are likely more liabilities with EHR, but it also resolves some of the liabilities of a paper chart world. What do you think?


Mobile in healthcare is going to be a common theme going forward. I also love VoIP in many situations, but I’m still waiting to see the real breakthrough that makes VoIP the only solution. We’ll see.


I wonder how many responses he’s gotten. I think he’s in very good company as far as starting EMR projects. I’m just not sure how many are on Twitter and know of him. I figured I’d let others find him:-)


I know nothing about this glaucoma calculator or this person on Twitter. However, I think this is an example of the hundreds and even thousands of very specific niche applications that are going to hit the healthcare IT market.


Another EMR vendor to add to the 300+ EMR vendors. I wonder how often a new tweet is sent for a new EMR vendor. Anyone know anything about ElationEMR?

Speaking of new EMR vendors…


I’ve seen some financial statements for the EMR business model. There’s certainly a great investment opportunity available to those who are able to get a reasonable amount of EMR sales.

A Lot to Be Thankful For at EMR and HIPAA

Posted on November 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.

Today has been a pretty wonderful day for me. I played some Turkey bowl this morning, had a wonderful meal with my wife and kids and then watched The Grinch in the afternoon. A nice relaxing day with the people that I love the most.

As I think about my life, I have so many things to be thankful for. In fact, I think I take them for granted far too often. Right after I married my wife I took her on a trip back to Guatemala where she had lived for a year and a half. During our visit we visited one of her favorite friends. Turns out this lady lived in one of the poorest parts of Guatemala in what amounted to a river bed with some metal sheet roofs held up by old washing machines and stove tops stacked up.

Even amidst these amazing conditions, the wife gave some money to a child to run and buy some soda (since I’m sure they never usually had this) so that she could offer her guests (us) something wonderful. It was an amazing gesture and a great lesson. Although, what was also amazing was how this wonderful family was incredibly happy even in such difficult conditions.

As I think about wonderful people like this that I’ve met throughout my life, it makes me even more grateful for what I’ve been given.

This year I’ve also been reflecting on my decision to quit my day job and become a full time blogger and entrepreneur. While I can’t say that it’s not been without its challenges, I’m incredibly satisfied with my decision. In fact, it’s hard for me to imagine ever going back to work for someone again. I guess there’s probably some situation where it would be fun, but right now I’m incredibly happy with a wonderful job that most the time barely feels like work.

Of course, none of what I’m doing would be possible if it weren’t for great readers and great advertisers. I think this site has some of the best and smartest healthcare IT people that exist. There’s so many things that I don’t know, but I believe there’s few things that readers of this blog don’t know. My only hope is that I offer as much to my readers as they offer to me. The advertisers that support EMR and HIPAA are fantastic. Thanks to each one of you who support my efforts. Many of you have been advertising on here for years. I very much appreciate it!

I hope everyone had a great Thanksgiving. We indeed have so much to be grateful for.

Complaints of EMR Documentation Aren’t Completely the EMR Vendors’ Fault

Posted on November 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 the biggest complaints surrounding the implementation of an EMR is the way the EMR software handles the documentation method. Beyond just the learning curve, there are plenty of EMR software that have a terrible user experience.

While I don’t want to totally let EMR vendors off the hook, I do think it’s worth noting that EMR vendors aren’t completely to blame for the unwieldy interfaces. I believe one of the biggest reasons that the EMR documentation interfaces are so terrible is thanks to the crazy insurance billing and documentation requirements.

Seriously, it’s a total mess. Everyone that’s involved with insurance billing in healthcare knows what I’m talking about. Trying to code an application that’s easy to use, works well for the doctors and still handles all the insurance billing and documentation requirements is a serious challenge and so it’s not surprising why so many EMR software fails to deliver a great user experience.

That’s not to say that all EMR software have terrible user experiences. Although, let’s be honest that they’re taking on a nearly impossible task. I guess I compare the insurance documentation and billing requirements to cleaning a toilet. Nobody really likes to do either. Yet, they’re absolutely necessary jobs. Certainly there are some tools that can make cleaning a toilet easier (gloves, wands, cleaning solutions, etc). However, it’s still a task that isn’t fun to do no matter how you slice it (unless you pay someone else to do it, but the pain of the expense is still there). The billing and documentation parts of an EMR software are trying to do the same thing: make a task that no one likes easier. Unfortunately, using an EMR isn’t going to change a task that no one likes into something fun.

I hope that EMR vendors don’t use this as an excuse to not focus on creating usable software. It’s NOT! However, I think it’s important to consider the true impact of the EMR. Is it really the EMR software that is so bad or did you hate these parts of practicing medicine before having an EMR as well?

If you find that it’s the EMR software that’s so bad, then hopefully you were smart in the contract you signed with your EMR vendor (see the EMR contract section of my Free EMR Selection e-Book). You won’t be the first or the last practice to switch EMR vendors.

Of course, if the complicated insurance billing and documentation is the problem. Maybe Obamacare’s single payer insurance plan will help to solve that issue. At least there would only be one organization to deal with.

Meaningful Use Assistance Poll

Posted on November 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 almost forgot to post today. What can I say? I’ve had a crazy busy today. Lots of interest in advertising on EMR and HIPAA lately. So, we’ll keep it short and sweet. Here’s a poll that I posted on EMR and EHR also and originally took from HIStalk Practice about the resources people plan to use to achieve meaningful use. The early voting seems to indicate that EMR vendors better be prepared to help. We’ll see after EMR and HIPAA readers vote how that changes:

Is cut and paste in EHR software really such a bad thing?

Posted on November 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.

The following is a guest blog post by Dr. Michael West. I recently met Dr. West and was really impressed with his approach to EHR. After reading a few of his comments on the site, I asked if he was interested in doing some guest blog posts. This is the first of what I hope will be many more blog posts by Dr. West.

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.

When, I was in residency at a large health system in Pennsylvania, several of the residents and interns got into the habit of templating hospital notes on their home computers the night before they would go in to see patients who were chronic players with multiple medical problems who would often stay for long times in the hospital. I’ll openly admit that I was one of the many who bought into the perceived need to make things more efficient in order to get out of the hospital sooner and have a better home life. The concept was simple: design a pre-templated note for each chronic patient, detailing the plans (which would rarely, if ever, change), and then save it and mass produce at will. Of course, this did not go over well with our purist administration who were in charge of ensuring the highest quality, authentic notes for each patient on each day. In their correctness, they noted that sometimes these notes would be put into patient charts without those small changes that would, in fact, take place from day to day, thus resulting in erroneous documentation.

Now, years later, in the world of EHRs, there seems to be a push-back against the “cut and paste” concept. I know this is out there for two reasons: one, because I have read a blog or two citing it, and two, because I have enjoyed doing it myself. In the cut-and-paste world of computerized documentation, it’s addictively efficient. Gutenberg, the inventor of the printing press which allowed mass production of books and changed the world, would be proud. The responsibility for using such powerful efficiency does fall to the individual health provider to carefully review, edit, add and subtract documentation to ensure current accuracy. However, if done correctly, it allows careful preservation of a summary of what came before.

For this, I have some personal recommendations. First, actually DO the editing, don’t just cut, paste, and sign. Second, go back and refine the previous note for word choice and economy. Otherwise, you will create endless run-on documentation that is unprofessional in appearance and a burden for your colleagues to wade through later. From a billing perspective, it facilitates and supports that you have actually reviewed the patient’s previous history rather than just asking them what’s going on today. I find that cutting and pasting the old plan prompts me to consider everything I was trying to accomplish after the last visit and promotes holding the patient accountable for getting all of their previous orders accomplished. If something was not followed up on by the patient despite my recommendation, then this definitely gets documented in the current note. And then, of course, I ask them to “try, try again.”

I find nothing inherently wrong in this process and my patients get the benefits of an accurate portrayal and review of their conditions with appropriate follow up evaluation and managent. So cut, paste, edit, and save your evenings for yourself, rather than dictating entirely new notes that regurgitate the same old information. Work smart, while still working hard.

A Few EMR and Healthcare IT Blog Recommendations

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.

As you know on the weekend, I try to do my simple posts since most of you are enjoying the weekend like you should.

Today I thought it might be interesting to point to a few different EMR and healthcare IT blog recommendations. This is far from an inclusive list. In fact, I could probably do this every weekend and not repeat the same blog recommendations. Maybe I will! Especially since then as I read various other blogs I can remember to make note of it. So, for this post I’ll start with some popular ones that many people know about.

Fierce EMR – I really like the work that Neil Versel does and Fierce is lucky to have him working on their EMR content.

HIStalk – This is often a bit too hospital focused for my tastes. They do have HIStalk Practice which is more ambulatory focused and has gotten better as Inga’s focused on it more.

Chilmark Research – I really enjoy John’s blog. He does a good job analyzing HIE, EHR and mobile healthcare. The only complaint is that he doesn’t publish enough, but that’s ok. When he does publish it’s almost always an interesting read.

The Health Care Blog – My only complaint about The Health Care blog is that often times it has a lot of posts that aren’t related to health care IT. Although, it does have a strong group of health care IT bloggers that do some great IT and EMR related posts.

Like I said, there are dozens and dozens of other ones. These are a few of the ones that have been around for quite a while doing their thing. I’ll cover some more of the other blogs I enjoy next time. Or you could just keep reading this site and my other blogs (EMR and EHR & The Wired EMR Practice) where I try to write about a lot of the major happenings in the EMR and healthcare IT world.

Thought Provoking EMR Comment – Simple EMR but “Apped” Silly

Posted on November 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.

This weekend’s thought provoking EMR comment comes from Dr. Gregg Alexander, a grunt in the trenches pediatrician, in a post he did on HIStalk Practice (which seems to be a duplicate from his blog):

“I want a beautiful [EMR] system that works as easily as my iPad and as intelligently as WebOS, one that I can start using as simply as I need and which can then be “apped” silly at my discretion”

I must admit that I LOVED the description of a simple EMR system that could be “apped” silly at his discretion. Makes you think!

Meaningful Use Exceptions for Specialists

Posted on November 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.

Neil Versel at Fierce EMR recently did a post talking about the meaningful use exceptions that are available for specialists. In it he quotes David Blumenthal, national health IT coordinator, and Dr. Derek Robinson, medical director for HHS Region V. They provide an example of an exception to the meaningful use criteria that a specialist might be able to use:

For example, three of the “core” measures of meaningful use that all providers must be able report on are blood pressure levels, whether patients over 13 use tobacco products and adult weight screening. “You may say that one of these or all three of these may not be part of your scope of practice,” Robinson said, amednews reports. It is possible to report zero as both the denominator and numerator for the quality measure if that specific item is outside a physician’s scope of practice.

This is what I was talking about in my last post about the EHR Stimulus money for dentists. No doubt there are a whole lot of specialties that will want to be granted these types of exceptions. It will be interesting to see what the exact process is for being granted the exception. I also won’t be surprised if we see some EMR vendors (specialty specific EMR vendors in particular) helping their doctors apply for these exceptions.

The only problem with the exception is for those specialists where the denominator is not 0, but it’s a very small number. I seem to remember a pediatric orthopedic surgeon saying that he only wrote prescriptions a few times a week. Learning and implementing an ePrescribing system for a couple scripts a week isn’t going to be very fun.