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Physician Reaction to Meaningful Use

Posted on March 30, 2012 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.

An EHR vendor recently got some bad news about a doctor who chose not to implement EHR. In the response, the doctor gave them this message:

“Meaningful use is the destructive component that all of medicine should be fighting as it clearly prevents the EMR from achieving it’s potential.”

My gut reaction to this comment is: He’s right.

I’ve often talked about how meaningful use and certified EHR have hijacked an entire EHR development cycle. That means that all 300+ EHR companies had the same development list for that time period instead of focusing on creating a broad variety of innovative solutions for doctors and patients.

I imagine some would argue that EHR vendors had a lot of years to create innovations and they fell short of doctors’ expectations and so meaningful use will get them to implement features they should have implemented long ago. In some cases, this is accurate. I actually love meaningful use stage 2’s focus on interoperability. A feature that should have been developed long ago and should have been. Although, on the whole I think we are missing out on a lot of potential benefits that EMR could provide an office because the EMR developers aren’t being allowed to innovate.

I’d also argue that our billing system has had that same effect on EHR. Instead of developing EMR software that will improve patient care, it was built to maximize reimbursement.

Going back to the doctor mentioned above. While I can agree that meaningful use diminishes the value of what an EHR could potentially provide a clinic, that doesn’t mean that the EHR doesn’t still provide value. That’s like saying that a $10 bill isn’t worth as much since with an extra 0 it would be a $100 bill, so I’ll throw out the $10 bill because it’s not providing all the value that it could provide if they’d done something a bit different.

At this point, I always refer back to my list of EMR benefits. There are benefits to EHR adoption beyond government handouts. Although, for some reason we get all crazy when the government starts handing out money and forget about other outside reasons to do something.

PHR Options for Meeting Meaningful Use Stage 2

Posted on March 29, 2012 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.

An EHR vendor recently asked me for some suggestions of PHR or portal options that they could use with their EHR software. Turns out that this is going to be particularly important given the changes in meaningful use stage 2 that require you to not only share medical information with the patient, but the patients have to actually access that information as well (unless that gets taken out in the MU stage 2 rule making process). Regardless, the question of which PHR and/or patient portal solutions was an interesting question. Here’s my answer to him (with a little bit added):

I only know of a few and you’ve probably heard of the ones I know about. I’m also not sure of the price of the various options really [He wanted to know of an inexpensive option]. Here’s what I know:

I like what NoMoreClipboard has done and that they’ve been doing it a really long time. They have a good understanding of how to work with many different vendors and also sizes of practices or healthcare institutions. Plus, you can be sure they’re going to be on top of all the meaningful use stage 2 requirements you’ll need to meet.

I also know that Medical Web Experts was working hard on a patient portal. I’m not sure how far it’s come since I first talked to them though. It might be one worth checking out. Just be sure that they can meet the meaningful use stage 2 requirements.

Then, of course you have Microsoft HealthVault. Everyone seems to know about them. I’ve heard that they’re a bit of a challenge to integrate with. Hopefully they also don’t have the same fate as Google Health. Although, Microsoft has a much better position in healthcare than Google ever did.

Coincidentally, I also was just emailed about a brand new book just released by O’Reilly Media about HealthVault and how to integrate with it. It’s called Enabling Programmable Self with HealthVault: An Accessible Personal Health Record. I’ve heard it’s a pretty technical book that would be quite useful if you decided to go with Healthvault for your PHR.

What other PHR and/or patient portal options are out there? I’m sure there are more that I’m missing and have probably just forgotten about them.

I’ll be interested to see if meaningful use stage 2 will drive the return of the PHR.

Full Disclosure: NoMoreClipboard is an advertiser on this site.

RockHealth Startup Elements: Accounting

Posted on March 28, 2012 I Written By

Richard Croghan and David Sage of accounting firm Moss Adams share everything startups need to know to keep their books in order, deal with taxes and stay out of trouble with the IRS.

 

 

Watch the video here.

EMR Design Errors That Cause Patient Harm per NIST

Posted on I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

As long as there have been EMRs, there’s been endless debate over what system designs are most appropriate. Unfortunately, no matter how heated a threaded discussion gets, it’s unlikely to solve big problems.

Now, however, we may have a chance to build a consensus on what NOT to do in building out EMRs. A new report from NIST has painstakingly analyzed which EMR design factors have an impact on usability (PDF), including one subset which seems likely to cause patient harm.

The section on design problems which may cause patient harm is (unfortunately) rather long, so I’ll only provide some of the highlights, but you can download the whole PDF by clicking on the link above. (The “potential for harm” section begins on page 66.)

One major area NIST addresses is patient identification errors.  For example, if EMR displays don’t have headers with two patient identifiers, lock out or control multiple accesses to records, or fail to provide full patient identification with integrated apps like imaging, the wrong actions could be performed on the wrong patient.

Another major concern NIST identifies is data accuracy errors. There’s lots of ways EMR design foster data errors, the report notes, including when information is truncated on the display, when accurate information isn’t displayed unless users refresh the data, when discontinued meds aren’t eliminated and when changes in status aren’t displayed accurately.

NIST also identifies data availability errors as a big issue. Among other concerns, clinicians can easily make mistakes if they can’t easily see all the information they need to understand doses without additional navigation; if complex doses aren’t easily understandable without extra navigation; and if information accurately updated in one place shows up accurately and efficiently within other areas or integrated software.

As you can imagine, NIST has a lot more to say here. The report also includes analyses of how mode errors, interpretation errors, errors when physicians are forced to remember data, lack of system feedback when clinicians make inappropriate actions for the context and other tricky designs cause errors that can harm patients.

While I’m not a clinician, so bear this in mind, my feeling is that everyone here ought to read this report. Lots o’ valuable insights here!

Resistance to Change Will Fuel EHR Adoption

Posted on March 27, 2012 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.

Resistance to change is the number one reason doctors aren’t adopting EHR software. Sure, doctors will often give a lot of other reasons why they’re not adopting EHR software, but in most cases those are just shields for the real reason they don’t ant to adopt EHR software: Change.

Doctors are certainly not unique in this arena. None of us like to change. I’m a creature of habit as much as the rest of us. In fact, I just tweeted yesterday that I need to change my method for writing posts. I know it’s the right thing to do and would make me more productive and probably increase the quality of my posts, but I’m resistant to changing the approach that I’m comfortable doing. Doctors are no different and let’s be clear that documenting in an EHR is different than a paper chart. An EHR implementation requires change.

While resistance to change is the current barrier to EHR adoption, I would also assert that resistance to change is going to be the reason why EHR adoption will become the norm.

I’m sure this will make some of you feel a little uneasy. What we have to realize is that most new doctors coming into the medical profession love technology and can’t imagine having to go find a paper chart. They can type faster than they can write and so they idea of writing in a paper chart would be a big change for them. These doctors are use to only reading typed material. They don’t care to learn how to read physician hieroglyphics. These new doctors don’t see carrying around a device as a burden, but as a normal part of life. Taking that device away is a change for them. They won’t want to change their digital ways in order to live in a paper chart world.

In a story I’ve often related, I saw this first hand when my medical student friend told me he hated his current rotation because they used paper charts. He then went on to say, “I hate paper charts because I can type faster than I can write. And…” The glazed over eyes was when I could see that for him he couldn’t see any justification for using a paper chart. He wasn’t quite sure how to articulate why he didn’t like paper charts, but he just inherently knew that he didn’t.

Time is the great healer. With enough time, the resistance to change will be against those who want a doctor to use a paper chart.

Tattoos that Vibrate Could Have Numerous Applications

Posted on I Written By

Tattoos are a pretty polarizing subject.  Most people either think they are awesome, or think they are disgusting and/or desecrate the body.  Personally, I have always thought small simple ones can be very cool but have never gotten one because of the whole permanent nature of the process.

Scientists are now working on a way to make tattoos that can vibrate much like your cellphone.  In fact, that is one of the applications that they are hoping to make work.  According to an article in the Toronto Star, you wouldn’t have to be right next to your phone if you were waiting for an important call.  You could be out swimming or otherwise exercising and when you felt the tattoo vibrate you could retrieve your phone and not miss the call.

There is a whole slew of ideas for applying tattoos in healthcare, many of which have been covered by MedGadget, and like many other ideas this one may still be years away from becoming a reality, but it does get you thinking about the things that have seemed impossible becoming a reality in the not so distant future.

What kind of technology would you like to see become a reality?

MU Attestation: Save Your Documentation – Meaningful Use Monday

Posted on I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

The end of March will likely bring a host of meaningful use attestations as the first 90-day period in 2012 draws to a close. Before you sit back and wait for your check, make sure that you assemble all the documentation that supports the information you provide to CMS. There will be provider audits, and EPs who cannot back up their attestation could forfeit their incentive payments. Documentation can be in paper or electronic format, and should be retained for 6 years. 

CMS does not specify all the necessary documentation, so the following are some suggestions:

  • Your EHR’s Automated Measure Calculation report – showing the numerators and denominators for each of the meaningful use measures that are numerically based
  • Clinical quality measures report – clinical quality measures must be reported “exactly as generated as output from the certified EHR technology.”
  • Clinical decision support rule – perhaps a dated screen shot to show that a CDS rule was implemented for the reporting period
  • Evidence of your data exchange test – whether the test was successful or not
  • Documentation of the security risk analysis you conducted – what you did, deficiencies you identified, corrective actions you took
  • Your test of the ability to submit immunization data and/or syndromic surveillance data – either proof that you conducted the test or documentation that the registry/public health agency cannot electronically accept the data (if you claim that exclusion)
  • The actual Patient List you generated (if you selected this menu measure)

 For more information, see the CMS website.

The Disappearing EMR, Patient Built EMR, EMR Competes with Paper, and Healthcare and Data

Posted on March 25, 2012 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.

You should know the drill by now. Each weekend, I go through and list some of the interesting, insightful, entertaining, news-worthy or otherwise notable tweets that I find covering my favorite topics of EMR, EHR and healthcare IT.

I have a feeling a few of these tweets will drive some interesting discussion around EHR. I hope they do since I do enjoy a nice discussion.

First up is a tweet that’s pretty profound to consider when we think about EMR:


I think the EMR has disappeared for a number of clinicians, but not enough. Maybe this supports my comment in a previous post that we hear a lot of stories of failed EMR implementations, but we don’t hear the stories of as many successful EMR implementations. Is that because those EMR that are so successful basically disappear. Reminds me of life where you start to take for granted something that at first was such a game changer.


My first gut reaction to this tweet was the need to link my really old post, “Develop Your Own EMR, Are You Crazy?” Although, this seems like a little bit different situation. I do wonder how many people developing EHR software end up seeing doctors who use that same software. I wonder if they’d have different priorities and/or if they’d take different approaches if their healthcare was the only motivator behind the EHR software they developed.


This one’s a little self congratulatory I admit, but I always love to see people tweeting my posts. Plus, I love to see how they frame what I’ve written. I prefer to look at that post as a look at ways that EHR can still improve, not as an ode to paper or even worse an excuse for doctors to still use paper. If you liked that post, look forward to another post this week in the “Healthcare Spoiled” series.


This is very true. We’re not ready to handle all the healthcare data that’s being produced today, let alone the tsunami of healthcare data that will come. I’m not too concerned though. It means there’s a tremendous opportunity on the horizon for an entrepreneur to do something amazing.