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10 Ways to Meaningful EHR Use for Doctors

Posted on August 31, 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.

Rob Lamberts, MD offered 10 ways to make an EHR meaningful for doctors on the KevinMD blog. It’s a really interesting list that’s worth sharing:

1. Require all visits to have a simple summary.

2. Allow coding gibberish to be hidden.

3. Require all ancillary reports to be available to the patient.

4. Require integration with a comprehensive and unified patient calendar.

5. Put most of the chart in the hands of the patient.

6. Pay for e-visits and make them simple for all involved.

7. Allow e-prescription of all controlled drugs.

8. Require patients’ records to be easily searchable.

9. Standardize database nomenclature and decentralize it.

10. Outlaw faxing.

That’s a pretty compelling list. What do you think of his list? Are there things you’d add to it?

Vital Signs Collected by a Camera

Posted on August 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.

Last year at the Connected Health Symposium I saw a glimpse into the future of continuous medical monitoring. A lady got on stage and showed the results of research into how with a simple cell phone camera, you could collect various vital signs. A recent article from MITnews talks more about this type of continuous medical monitoring. Here’s a portion of that article:

So far, graduate student Ming-Zher Poh has demonstrated that the system can indeed extract accurate pulse measurements from ordinary low-resolution webcam imagery. Now he’s working on extending the capabilities so it can measure respiration and blood-oxygen levels. He hopes eventually to be able to monitor blood pressure as well. Initial results of his work, carried out with the help of Media Lab student

In the article, they talk about this technology being used to monitor people in situations where attaching sensors to the body would be difficult or uncomfortable like burn victims and newborns. While this would be a good use of the technology, I’m much more interested in this technology for the average person.

The problem with so many of the medical devices use for monitoring is that they are so obtrusive. The Fitbit like technologies that you wear on your belt aren’t terrible, but they are one more thing you have to put on and not knock off in the arch of your day. Other monitoring goes as far as requiring a pin prick every time it takes a reading. I’m not sure we’ll ever get away from the need for blood for certain monitoring, but the above technology gives me hope that we might.

Katie on Smart Phone HC recently posted about a non-invasive Cholesterol test using a digital camera. This is amazing technology, and I believe we’re just at the beginning of what will be possible.

One challenge doctors will face as these technologies develop is what to do with all the data. Imagine the web cam that’s sitting on top of my computer right now was continuously monitoring me and my vital signs. It could collect a lot of data. Will the EHR software be able to receive all that data? Will EHR or other software process all that data? IT will have to be involved in the processing of the data. I’m just not sure yet which software will do the work. My best guess is that EHR will provide the platform for other companies to create innovative solutions with the data.

Are we ready for all of this health data? The answer is no, but it’s coming just the same.

A Smart Approach To Medicine And Social Media

Posted on August 29, 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.

It’s always a pleasure to touch base with the thoughtful blog  (33 Charts) written by pediatric gastroenterologist Dr. Bryan Vartabedian. This time, I caught a piece on how Dr. Vartabedian handles social media communication with patients, and I thought it was well worth a share.

While your mileage may vary, here’s some key ways Dr. Vartabedian handles medical contact online with consumers:

* He never answers patient-specific questions from strangers

As he notes, people generally ask two kinds of questions, patient-specific and non-patient specific. While he’s glad to answer general questions, he never answers patient-specific ones from strangers, as it could be construed that he’s created a professional relationship with the person asking the question.

* He guides patients he’s treating offline

If an existing patient messages Dr. Vartabedian, he messages back that he’d be happy to do a phone call. He then addresses their concern via phone, while explaining to patients how both he and they could face serious privacy issues if too much comes out online. Oh, and most importantly, he documents the phone encounter, noting that the patient who reached out in  public.

* He flatly turns down requests for info from people he loosely knows

The only exception he makes is for family and very close friends.  In those cases he arranges evening phone time and spends 45 minutes getting facts so he can offer high-quality direction.

I really like the way Dr. Vartabedian has outlined his options here — it’s clear, simple, and virtually impossible to misunderstand.  It’s hard to imagine anyone being offended by these policies, or more importantly, having their privacy violated.  Good to see!

If you’re a doctor how do you handle your social media interactions with patients?

ACOs (Accountable Care Organizations)

Posted on August 28, 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.

ACO’s Built Around Primary Care Not Payers
It’s always quite interesting when a non-healthcare journalist covers healthcare. The above title comes from this article on NJBiz.com. In the article they offer the following interesting ACO stats (as of Sep 2011):

-51% of all ACOs are buist as joint ventures between doctors and hospitals
-20% of ACOs are physician led
-18% of ACOs are hospital led
-75% of hospitals surveyed were not planning on participating in ACOs
-13% of hospitals are already participating in ACOs


Then, the article offers this insight into the ACO battle between payers, physicians and hospitals:

The report also noted that hospital- and physician-led ACOs tend to focus more on primary care than acute care, but Horizon Blue Cross Blue Shield’s partnership with Optimus is set up to promote primary care based on patient-centered medical home models, according to spokesman Tom Vincz.

“Horizon ACO arrangements include incentive payments to support improved patient care coordination and fund other activities to further transform offices into patient-centered practices,” said Horizon in a statement from Vincz. “Entities that Horizon collaborates with are given other valuable resources, such as timely, population-based data, to help them deliver more effective and efficient care to their patients.”

Since I consider myself a physician advocate, it seems appropriate for me to add in a quote from a blog post Kerry A. Willis, MD did on KevinMD:

During the PHO debacle a few years ago, I reminded our physicians that the letters should represent the ownership and direction that these organizations should take as they developed. I frequently offered that they were really pHO’s with Big hospitals and Big organizations with little physician control over the direction and quality that was important to us.

I fear that the same is true with ACOs. If we are not vigilant in their formation and direction, then they will become AcOs with physicians being a small part of their governance but very accountable to their owners. They will be dependent on the revenue streams that spring from them. I see scenarios where physicians will profit but then be caught in a spider’s web of their own design where they will be told how to practice and what kind and amount of care they can provide. I guess you could claim that I don’t trust insurance companies and you would be wrong. I do trust them. I trust them to do what is best for the corporate profits and the nonprofit executives’ with bonus clauses at the end of a successful year.

I fear that when it comes to ACOs many physicians are sitting on the sideline. We saw what happened with EHR incentive money and meaningful use when more doctors weren’t involved in the process. There were requirements that didn’t make any clinical sense. I can see the same thing happening with ACOs if doctors don’t get involved.

It’s a rapidly changing ACO environment, and my hope is that many smart physicians will add their voice to the mix. Otherwise, the shift to hospital owned practices will continue and doctors won’t have much of a choice but to be beholden to a big company.

Meaningful Use Stage 2 Final Rule: What You Need to Know—At Least For Now – Meaningful Use Monday

Posted on August 27, 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.

Without delving into all the specifics detailed in the 672-page Final Rule for Stage 2, what is important to comprehend—for now—is how Stage 2 raises the bar set by Stage 1 and how it intensifies the focus on health information exchange and patient engagement.

The following are some highlights of Stage 2:

  • The Final Rule not only confirms 2014 as the earliest effective date for Stage 2 (as expected), but it provides additional leeway for providers and for vendors by limiting the Stage 2 reporting period to 90 days in 2014, instead of a full year.
  • EPs must meet or exclude all 17 core measures and must meet—not “meet or exclude”—3 of the 6 menu measures. (Unlike Stage 1, exclusions of menu measures do not count unless the EP cannot find 3 relevant menu measures.)
  • All Stage 1 menu measures except syndromic surveillance become core measures.
  • 5 new menu measures have been added: access to imaging results, family history, progress notes, reporting to cancer registries, and reporting to specialized registries.
  • Stage 2 increases most Stage 1 thresholds.
  • CPOE is expanded to include lab and radiology orders, in addition to prescriptions.
  • Patient portals play an important role as a means of providing patients with access to their medical records. Physicians will have to ensure that at least 5% of the patients they see actually view, download or transmit their health information and that over 5% of the patients seen send them a secure e-mail message containing clinical information, (i.e., not just a request for an appointment.)
  • Clinical summaries of office visits must be available to patients within 1 day, instead of the 3-day timeframe in Stage 1.
  • The Stage 1 measure requiring a test of the ability to exchange clinical data with another provider has been dropped effective 2013, in favor of a more robust 2014 Stage 2 requirement for ongoing exchange of a significantly more extensive data set.
  • EPs will report on 9 of 64 clinical quality measures, and after the provider’s first incentive year, the CQM data must be submitted electronically, rather than by attestation.
  • In an effort to streamline the reporting process, Stage 2 offers opportunities for batch reporting by group practices and for consolidated CQM reporting for PQRS and meaningful use.
  • Penalties and hardship exemptions are defined, establishing October 1, 2014 as the latest date by which an EP can attest for the first time and avoid a 1% payment adjustment in 2015.

More information about Stage 2 will follow in future Meaningful Use Monday posts.

MU Stage 2, ICD-10 Delay, Epic-Related Safety Errors, and Mobile EMRs – Around HealthCare Scene

Posted on August 26, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

EMR Thoughts

Meaningful Use Stage 2 Final Rule Published

The long awaited MU Stage 2 final rule was published last week by CMS. No one will be required to follow the requirements until 2014, when the program is set to begin. The Stage 2 final rule is 672 pages long. The press release concerning MU Stage 2 mentions interesting facts, such as 3,300 hospitals have participated thus far.

ICD-10 Delay Finalized with New Unique Plan Identifier

In an announcement that was kind of lost in the midst of the meaningful use stage 2 final rule, the ICD-10 delay is official. As someone said on Twitter, you now have two years to get ready for ICD-10. You better get started now. The announcement of a Health Plan Identifier (HPID) is also very big news.

EMR and EHR

Nurses Raise Alarm Over Epic-Related Safety Errors

With any EMR, there is an adjustment period. However, there was an error recently at a prison clinic in California that could have been deadly that was related to the implementing of an Epic installation. Nurses have raised many concerns about the system, and have likely not been adequately trained. Is the issue with Epic because of the system, or because of inadequate training?

We Know What’s Right, but It’s Hard
Being healthy and overcoming illnesses takes works. And obviously, most of us know that if we don’t put in that effort, there will be negative consequences. Unfortunately, many people don’t put in that effort. Luckily, with the advent of being able to monitor health from home with smart phone apps and other gadgets, it is easier to do what we know is right. Is mHealth applications the answer to the question of how do we motivate ourselves to do what we know we should?

Happy EMR Doctor

Can We Talk? Challenges of SaaS Type EMR User Interfaces

SaaS EMR User Interfaces have a variety of challenges. The latest issue is ensuring that all the individual software work together in a way that doesn’t interrupt a practice’s workflow. This week, Dr. Michael West talks about how, when one component gets updated, it often causes others to work less efficiently. His office recently experienced this, and described the frustrating experience.

Smart Phone Health Care

Detecting Parkinson’s with a Phone Call

About 5 percent of adults over the age of 80 has Parkinson’s Disease. A new technology is being developed that supposedly can detect Parkinson’s Disease. And not only can it detect it, but with 98.6 percent overall accuracy. This raises the question, what can a smart phone not do? This is just the beginning of disease detection and treatment with smart phones. What’s next?

Five Health Communities Every Patient Should Use

It’s easier than ever to have a health problem. Okay, not really, but it’s easier to find support. There are many great communities online dedicated to helping patient’s find information about just about every health topic out there. Some offer free advice from medical professionals, and others implement social media. Here are five of the best communities everyone should join.

Hospital EMR and EHR

Survey: Virtually All Docs Want Mobile EMRs

9 out of 10 doctors want to be able to access their EMR on a mobile device, according to a recent study. It makes sense, since so many doctors are using iPads and smart phones nowadays. Luckily for these doctors, companies like Vitera and eClinicalWorks are working on mobile solutions for this. Hopefully these solutions will include things like reviewing and updating patient charts, and ordering prescriptions, which ranked among the top functions doctors are hoping a mobile EMR would include.

Patient Engagement Platforms, iPhones Replace Doctors, and a Wireless Health Research Center – #HITsm Chat Highlights

Posted on August 25, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Every week, HL7 Standards, hosts a #HITsm Tweet Chat and poses four questions “on current topics that are influencing healthcare technology, health IT, and the use of social media in healthcare.” It’s always a great discussion and also a great chance to meet a wide variety of people that are passionate about healthcare IT.

In case you missed it, or are curious about what went on this week, we’ve put together the list of topics with some of the best responses for each topic. There were some interesting topics this week, as well as some great responses. If you have any opinions on any of these topics, feel free to continue the discussion in the comments. This chats take place every Friday at 11AM CST. You’ll find members of Healthcare Scene regularly participating in the chat under some of the following Twitter accounts: @techguy@ehrandhit@hospitalEHR, and @smyrnagirl.

Topic One: Payers are adopting more member/patient engagement platforms. How would you design these systems?

Topic Two: Group Health discussed their “learning health system.” What strategic decisions must a health system make to learn?

Topic Three: There’s a new noninvasive total cholesterol test using a digital camera. Could an iPhone replace your doctor some day?

Topic Four: NYU Medical Center opened a wireless health research center. What should their first research project be?

Grab Bag

6 Rules for Ethical Data Handling in a Health Organization

Posted on August 24, 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.

The following is a guest post by Danny Lieberman. Danny Lieberman, founder of Pathcare, the private social network for doctors and patients, talks about how to develop clinical care teams that will become world-class at patient data-handling.

Patient data loss is a peculiar problem. 

Unlike malware and attacker intrusions that is caused by “attackers” who are “other people”, data loss happens inside your healthcare provider organization and is perpetrated by your people, your contractors and your business partners who have access to your patients data and your systems.

Patient privacy data loss is best mitigated by management leadership reinforced by real time data loss monitoring that is part of a continous process of improving data governance.

Management needs to lead from the front, providing a personal example for how to handle data and behave ethically in the workplace.

Real-time monitoring of data loss events on a healthcare provider network can be performed using DLP (data loss prevention) technologies from companies like Websense, Fidelis Security Systems (recently acquired by General Dynamics) and Verdasys.

While I do not subscribe to vendor rhetoric regarding data loss prevention,  experience tells me that data loss detection provides information security and privacy officers with firm examples of what data is actually exiting the network.

The combination of management commitment to ethical behavior with a real time monitoring facility can create a powerful feedback loop that improves behavior and drives improved data governance.

The practical question is then  “How do I go from Point A to Point B”:

How do I take an organization where HIPAA compliance is the auditors’ responsibility and make the responsibility of care team leaders and members?

Let’s start with management.

In a follow-on article, we’ll discuss how to best deploy DLP technologies and integrate them with security and privacy leadership.

Just because everyone does it doesn’t make it right

Data leakage is as old as mankind. Think about Jericho and Rahav. People have always bartered or “sold” things of value to one another.  This doesn’t make it acceptable on your watch.

Getting it right is why they pay you the big bucks

Managing a care team is complex, especially since your care team is not you. They have their own economic background, religious beliefs, and cultural upbringing.  Your team will look at you for both formal and informal cues as to your data handling ethics and then they will follow that direction intuitively.

If you close an eye to infringements of data handling procedures (like exchanging plain text files with external users over Gmail since the internal email system won’t let you attach files with PHI, then you are sending a subliminal message to the team that is acceptable to bend rules.

Patient data breaches are bad for business

Aside from this being an inappropriate security policy, it is also bad for business. If your team doesn’t care about the little stuff like HIPAA physical and administrative safeguards then maybe they won’t wash their hands as often as they should.  Patients (who are also customers) may feel that an organization where patient data leaks like a sieve, is an organization that cares less about healthcare and take their business elsewhere.

Since your clinical care team looks at your data handling as a role model for their expected behavior, setting an ethical standard for data handling is as much your job as it is the individual responsibility of nurse, resident or surgeon on your team.

The 2 elements of ethical standards for healthcare privacy are shared by manager and team members:

1)      healthcare provider standards for patient privacy (nominally at least HIPAA compliance since a hospital or HMO are covered entities and must comply) and

2)      individual responsibility.

6 rules for ethical data handling in a health organization

  1. Ethical data handling must be verbalized and demonstrated. You must communicate to your healthcare  team your expectations of what you expect and what you consider unacceptable. Set the standard for all to be measured by. Once a quarter, discuss ethics, privacy and data governance at a team meeting.
  2. Develop a detailed set of data/privacy breach use cases in your practice area, and have your teams to sign off on them.
  3. Management must use a top-down ethical approach and demonstrate the standards they expect their team(s) to follow. This includes not accepting unauthorized gifts from vendors, or allowing nursing and administrative staff to bend the rules of disclosing patient files to non-family members.
  4. When hiring employees, include a clause on ethics in their job description. (Check with your company lawyer on this.)
  5. Communicate to your care team on a monthly basis what is expected of them with regard to maintaining security and enforcing privacy.
  6. Don’t always assume that a a team member is unethical just because a patient complains.

Does Changing EMRs Make Security Vulnerabilities Worse?

Posted on August 23, 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.

I don’t have good statistics on hand, but changing EMRs isn’t unusual, and changing them a few times isn’t as rare as it should be.  Readers here know that this is a painful proposition for many reasons, including cost and the need to re-tool workflow over at minimum several months.

But I’ve noticed that few if any IT pundits talk about the security risks that must come from making such a shift. A few common sense issues come to mind:

*  Retraining staff:  Your overall security policy might not change, but the security workings of the new software may be somewhat different.  As staff reacclimates, there’s plenty of room for mistakes.

* Transferring patient information:  Whether you’re currently a Web-based EMR or one installed on site, you’ll have to transfer a lot of information to the new system.  What happens if the isn’t encrypted and locked down during or after the transfer?

*  Back door vulnerabilities:  If your existing installed software has any back-door vulnerabilities in it, they may remain or even become even more deeply buried when the new software is put in place.

* Re-establishing device security:  Whatever you’ve done to secure mobile devices may have been sufficient for your last system, but what about your new one?   Even cloud systems with strong back-end data protections aren’t going to make sure smartphones and iPads and laptops are secure against security breaches, and you may need to re-do protections for them.

In proposing these ideas, I’ve mostly envisioned what small- to medium-sized medical practices face. If the EMR change is from Cerner to Epic rather than a small-practice system to another, the problem is vastly more complicated.  Either way though, it isn’t a pretty picture.

So readers, if you were responsible for such a shift, what would your next steps be?  Do you have a transition security checklist you can share?

What Will Take Down the Epocrates Monopoly?

Posted on August 22, 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.

The most popular mobile health app for medical professionals is far and away Epocrates. I haven’t seen the latest numbers on Epocrates physician install base, but they have what I consider a pretty solid monopoly when it comes to drug information on a mobile device. Almost every doctors has Epocrates, uses it, and can’t imagine life without the information Epocrates provides.

Consider Epocrates dominance in this area, it made me start to wonder what changes could occur that could cause Epocrates to fall from its pedestal. Here are just a few thoughts on what could diminish Epocrates powerful market presence.

Drug Information Integrated with the EHR – If I were Epocrates, this would be my biggest concern. If I’m a doctor seeing a patient, I’m certain to have my EHR close by. If I can find the information Epocrates right in my EHR, then why would I open up another device to find the same information which is just a click away? The answer is that you wouldn’t. The good news for Epocrates is that it will take a while for EHR vendors to integrate this info. EHR companies are a bit distracted by something called meaningful use right now.

No iPad App – Yes, you can use the regular iPhone optimized Epocrates app on the iPad, but how is it possible that Epocrates has missed out on not creating an iPad optimized version? Considering physicians deep love of the iPad this is crazy to consider. Imagine the possibilities with so much more screen real estate as well. What a missed opportunity for Epocrates.

Lack of Epocrates Focus – The best example of Epocrates lack of focus was the Epocrates EHR. They first announced the Epocrates EHR at HIMSS 2010. Almost 2 years later and right after the official launch of their EHR, they shutdown the Epocrates EHR. Distractions like creating an EHR is an example of how Epocrates lack of focus could lead to issues in their core business.

Public Company – Yes, Epocrates is now a public company (EPOC:NASDAQ). Will being a public company cause issues with Epocrates? The founder is already gone and working at Doximity. We’ll see how Epocrates does with the challenges of being a publicly traded company.

Don’t misunderstand me. Epocrates is still well positioned in the medical space. However, I think there are opportunities for entrepreneurial companies to cut into Epocrates current monopoly.

One thing I do wonder is why Epocrates hasn’t come out with some killer APIs for their drug information. Epocrates has all of the info, and EHR companies would love to have that info integrates into their EHR. Seems like the perfect marriage. I expect the answer is that Epocrates doesn’t have the expertise to execute on the API front.