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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.

EMR Design Errors That Cause Patient Harm per NIST

Posted on March 28, 2012 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.

MU Attestation: Save Your Documentation – Meaningful Use Monday

Posted on March 26, 2012 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.

What Information an HIE Should Pass?

Posted on March 23, 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.

I had a post by Dirk Stanley, MD recently pointed out to me where Dirk discusses the challenge of deciding which information an HIE should pass. Dirk is the CMIO at a hospital and also a genuinely nice guy. He frames the answer to the HIE data passing question really well:

And after a rousing discussion, the answer I heard was this :Everyone has a different opinion.

I guess it’s entirely understandable… ICU docs, PCPs, surgeons, specialists, hospitalists, and everyone else has a common goal – making the patient healthier – but they have different training and thus they all have different needs. This is why when I hear docs say “I just need the important information!“, I smile because ultimately, all of the information in a chart is important – It just depends on your context and clinical needs.

So I’m left with the ultimate Informatics challenge – How can we get the right information to the right person in the right place in the right time in the right way? Especially when everyone has a different opinion on what the right information is?

He then offers this zinger which describes the real core of the problem: “Looking at the current buffet table of documentation, it’s no wonder that every doctor has a differrent opinion of what they need. There aren’t really any hard standards for clinical documentation.”

Dirk then goes on to describe his solution to the problem which essentially revolves around the idea of a new type of note that can be transferred. You can read all the details in his post.

Reading through Dirk’s thoughts on the subject I’m reminded of the conversations that surrounded the creation of CCR back in the day. They seem to have taken a very similar approach to what Dirk describes. I wonder what Dirk thinks of the CCR (now basically merged with CCD) standards that are already out there. Do they not cover what he has in mind? Are their gaps in the CCD standard that don’t cover his “new note?” Could we just improve the CCD standard to cover those gaps? I’ll ping Dirk and hopefully he’ll join the conversation.

The real challenge when looking at what data should an HIE pass is that computers aren’t very good at understanding context. I’d be interested to hear people’s thoughts about this and how we’ll solve this problem going forward. My gut feeling is that we need to start with something that will solve a lot of problems for a lot of people. We don’t need something that will solve all things for everyone from day one. We can incrementally improve the exchange of data as we go forward.

Pilot Tests Use of Tablets To Get Medical Record-Sharing Consent

Posted on March 22, 2012 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.

A Western New York based program has begun testing whether patients can “meaningfully consent” to exchange of their medical data after going over a tablet-based application.

The pilot, which begins in September, will measure whether patients truly understand how their information will be shared. It’s being tested at a hospital and three clinics which already participate in the HEALTHeLINK HIE.  If the project, (which uses technology from APP Design) turns out well, the app will be made available as open-source software.

How does it work?  Well, in essence, patients are handed a tablet in the waiting room, work through an app allowing them to consent to as little or much sharing as they wish through the HIE, and along the way, learn enough to find out whether they’re well advised to do such sharing.

Patients will have the chance to do everything from share everything all the time, forbid all data exchanges, prevent certain organizations from seeing the data and allowing exchange only in emergencies.

By the way, the pilot tickles ONCHIT, which likes the idea of patients getting a better grip on what they’re consenting to when they agree to data exchange between providers.

I think it will take many more form factors and approaches before we’ve got this concept just right, but I’m with the ONC that this is a good issue to take on.  After all, if we’re honest, many of us would have to admit that we’re just waiting for the first lawsuit in which a patient is upset cause data went to that doc in addition to this hospital.

Regardless, it’s more than time that someone take on this issue. The issue of multi-layered patient data sharing over HIEs is a ticking time bomb otherwise.

Guest Post: HIPAA Responsibility – Whether You Want It or Not

Posted on March 21, 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.


Guest Blogger: Jan McDavid is General Counsel and Compliance Officer at HealthPort, a Release of Information and Audit Management Technology company. You can read more of Jan’s posts on the HealthPort blog.

John Lynn’s post “Covered Entity is Only One with Egg on Their Face” is good warning to healthcare providers: as HIPAA enforcement gains teeth, you are responsible for breaches caused by your business associates. The increase in HIPAA enforcement, penalties and current ONC audits make it clear that ignorance of adherence to HIPAA by your business associates (BA) is not a valid strategy.

In fact, the Poneman Institute Study cites 46 percent of breaches as caused by BAs, yet the covered entity (CE) is responsible for 100 percent of them from a legal prospective.

The time for inaction regarding your BAs is over. Now is the time to confront the issue head-on. The good news is that it costs less in the long run to prevent breaches than it does to pay for breaches committed by your BAs. Here’s how to get started.

It’s Time to Act

The same policies and procedures that you have implemented for yourself are applicable to your BAs. Of course, since the BAs do not report through your organization, the best way to assume compliance is through your contracting process.

It is not enough to just put it in the contract. In the old “trust but verify” school of management, your contract must also contain avenues of verification. That can include surveys, reports, audits, policy and procedure manuals, etc. This due diligence at contracting time pays off in many ways when ONC auditors knock on your door.

The due diligence must be a continual process, not just “once and done”. The laws are changing and Health and Human Services (HHS)’s Office of Civil Rights (OCR) is implementing new risk audits in 2012 to test your readiness. New breach notification and accounting of disclosure rules are imminent and will further tighten the laws. Also, many institutions focus on the Privacy Rules, while paying less attention to the Security Rules. The privacy rules focus on the “what,” while the security rules focus on the “how” of compliance.

To protect yourself, you should be doing self assessments using both internal and external auditors. Anything you do for yourself should be considered for your business associates.

Simple Encryption Goes a Long Way

Most accidental large-scale breaches are caused by lost or stolen electronic devices. The small one or two patient breaches are much less of a publicity problem but still require a risk assessment. The small breaches are going to happen; it is inevitable. The large breaches carry a higher degree of severity.

To prevent large breaches, it is essential that BAs which use electronics have the same tight policies and procedures in place that you do (or should). They can go beyond the HIPAA-mandated policies. One practice that should be implemented is encryption.

Remember, a lost electronic device that contains encrypted data is not considered a reportable breach. Encryption is a logical first step that, while not yet HIPAA mandated, will save considerable pain and expense over time. Notice it is only a first step. There are other security technologies available that will call a central location to pinpoint a device’s location. Further, they can wipe themselves clean if not accessed properly or in a given timeframe.

Paper Breaches Also a Concern

And providers shouldn’t lose sight of paper medical records and how BAs are using them. In fact, many breaches to date have involved paper. Understand how your BAs use paper records and patient information. Is it going off site? If so, there should be established policies and procedures.

Any access to paper records and appropriate destruction of those records must be HIPAA compliant. Locked bins for disposal and state-of-the-art shredders are a must at the provider’s site and the BA’s office. Do not let paper records lay around on desks and make sure all personnel are trained in the handling of paper records.

Training and Education for All

Training and educating are the foundation of any compliance program. BAs should have an in-depth training and education program that is as robust as that of the covered entity. Best practices make training an ongoing, living process with regular updates and mandatory attendance at classes.

Making the effort to fend off unauthorized disclosures will go a long way toward mitigating risk. Staying in front of the threat curve is difficult but not impossible. Remember to apply lessons learned to your BAs so you aren’t the only one with egg on your face!

Drivers of Healthcare Interoperability – Meaningful Use and ACOs

Posted on March 20, 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.

Seems like this week must be interoperability week on EMR and HIPAA after my post yesterday about HIE transport in meaningful use stage 2 and my post today on drivers of healthcare data interoperability.

I was looking through some past notes from a meeting at AHIMA that I had with Health Language Inc. It was a fascinating conversation with Brian F. McDonald, Executive VP and CFO and Marc A. Horowitz, Senior VP. I remember that these guys eat, drink and sleep medical terminology. One of the really interesting observations I took from talking with them was:

Meaningful use and ACOs are the drivers of interoperability in healthcare.

Months after first hearing this idea, it rings even more true. In meaningful use stage 2, ONC and CMS have made it very clear that they plan to use meaningful use as a motivating force behind the sharing of healthcare data. This includes sharing of healthcare data doctor to doctor and also doctor to patient. I expect meaningful use stage 3 will find these concepts at their core as well.

As we try and evaluate what an ACO would look like, some form of healthcare data exchange has got to be part of the solution. I don’t believe anyone will find a way to really improve health the way an ACO will need to improve care without an exchange of data between EHR systems. Considering the pay for performance days are short at hand, this will be an encouraging factor for EHR systems to start exchanging data.

I’ve often said the big problem with interoperability of data in healthcare is the financial aspects and the governance (ie. when to share data) aspects. I see ACOs and meaningful use pushing healthcare providers to figure out both problems.

If not these drivers, what else will get healthcare to start sharing data?