Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and HIPAA for FREE!!

mHealth Summit Next Week

Posted on November 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.

We’re really excited to be participating in the mHealth Summit in Washington, DC next week. We attended the event last year and are excited to see the various technologies that will be there again this year.

I was told that they’re expecting about 4000 attendees at the conference and about 300 vendors. I’m excited to see how the conference goes post-HIMSS acquisition. So far I’ve seen nothing but good things come from the acquisition by HIMSS.

My schedule is chalk full of meetings with various mHealth companies. So, I’ll try to get as much information for you from the event as possible.

You can follow all of the happenings at the mHealth Summit on Twitter using the hashtag #mhs12. If you plan to be at the conference, I’d love to connect with you in person.

Is Healthcare Big Data Biased?

Posted on I Written By

Mandi Bishop is a hardcore health data geek with a Master's in English and a passion for big data analytics, which she brings to her role as Dell Health’s Analytics Solutions Lead. She fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

Have you ever wondered whether YOUR healthcare data is included in the “big data” everyone’s talking about? After all, healthcare big data analytics are going to change the world; shouldn’t those changes be representative of the population they will impact?

To answer that question, we have to identify the sources of the healthcare big data being used to effect change, and consider the likelihood that your data may have been captured and consumed by one of the reporting organizations. So let’s start with the “capture” part of that equation.

Have you received some type of healthcare service this year? That includes, but is not limited to: hospital visit, physical therapy, doctor visit, chiropractor visit, urgent care visit, e-visit or phone consultation, health risk assessment or health fair.

Have you purchased or requested any regulated healthcare product this year, such as prescription drugs?

Do you have private health insurance?

Are you enrolled in Medicare or Medicaid?

If yes to any of the above, and the last question, in particular, YES, your data is included in the “big data” analytics currently shaping policy. It is likely that each billable product and service is attached to your Electronic Health Record, available for review and reporting by each involved party from your PCP (Primary Care Provider) to your friendly insurance call center agent. Your individual collection of data points are aggregated into a larger population, and sliced and diced to provide insights into groundbreaking research efforts. Congratulations! But does that inclusion mean that the conclusions driven by healthcare big data are representative?

By nature, the relevance of data-driven insights increases in proportion to the size of the population – and data points – included. But what if the outliers for the general population are the norm for your data set? Are your conclusions skewed?

What if you represent a population segment that is recognized as underserved? Consider the following, from the first Health Disparities and Inequalities Report, prepared in 2011 by the CDC (Centers for Disease Control): “Increasingly, the research, policy, and public health practice literature report substantial disparities in life expectancy, morbidity, risk factors, and quality of life, as well as persistence of these disparities among segments of the population…defined by race/ethnicity, sex, education, income, geographic location, and disability status.”

If your access to healthcare is limited by any of the factors indicated above, your data may not be captured unless/until there is an acute episode which requires medical intervention. In the report, the CDC acknowledges the challenge of capturing national data to support health initiatives for these populations; it is widely accepted as a barrier to healthcare equality that must be overcome.

What if you’re healthy? I’ll use myself as an example. I don’t go to the doctor unless it’s urgent, and I haven’t visited my PCP in over a year. I’ve injured my shoulder and my back over the past year, both of which required MRI and CAT scans to diagnose severity; however, I do not follow any medically supervised treatment plan for rehabilitation. I don’t take any routine prescription medication. I’m an exercise enthusiast who works out intensely 5-6 days/week, and I sleep 8-9 hours a night. Yes, I do sleep that much. And no, me putting all this information into a blog does not constitute the data being captured for use in healthcare big data analytics. Because I haven’t needed to go to my PCP lately, don’t take routine prescription medication, and am not of age for Medicare or income level for Medicaid, the only current healthcare data available for analysis for me is orthopedic in nature and revolves around imaging data, not traditional clinical measures. Someone like me who had NOT experienced an acute care episode would have no current data available for consumption and reporting as part of a larger population.

Could it be that much, if not most, healthcare big data cited for research purposes is comprised primarily of a triangle of outlier population segments: 1) oldest, 2) poorest, and 3) sickest?

Perhaps. So, when reading on the advances in healthcare big data analytics, ask yourself whether that “big data” means “YOUR data”.

PS – For those of you curious about defining “big data” in healthcare, read Dr. Graham Hughes blog post for SAS, “How Big Is Big Data In Healthcare?”, detailing the nuances of the term as it relates to data size, complexity, and usage. Also, I’d like to thank the good folks at Vanderbilt University for compiling a fairly comprehensive list of healthcare data resources; it has been highly educational. Finally, if you’d like to read the complete CDC report, you can find it here.

What’s Behind the Pri-Med Acquisition of Amazing Charts EHR?

Posted on November 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.

For those of you who missed the news, Pri-Med acquired Amazing Charts EHR for a currently undisclosed amount. This was a really interesting move in the EHR industry. Anne Zieger suggested that this and other indicators was a sign of EMR consolidation. Turns out there’s a lot more behind the Pri-Med acquisition of Amazing Charts than most people would see on the surface.

In a call I had with Amazing Charts founder and president Dr. Jonathan Bertman, as well as John Mooney, founder and CEO of Pri-Med, I learned a lot about why this acquisition makes sense and how they’re planning to capitalize on the investment.

CME Chart Level Review
One of the most interesting things I learned was that chart level review was the best way to see the gaps and needs that can be satisfied by CMEs. Considering Pri-Med is a major player in the CME space, you can see the value that having relationships with a bunch of doctors using an EHR can be for them. I didn’t dive into how Pri-Med plans to leverage the Amazing Charts EHR charts, but you can see the possibilities. Although, Amazing Charts is a mostly client-server based EHR, so Pri-Med won’t have any access to do chart level reviews without permission from the doctors using the EHR.

Protecting EHR Data
In fact, in my discussion I learned that Dr. Bertman and John Mooney both had no interest in using a physician’s EHR data to make money. That philosophy actually seemed to bring Pri-Med and Amazing Charts together to make this acquisition happen. Both believe that their company should make money providing the software and services a doctor needs as opposed to making money off the data in an EHR. This is nothing new since I’ve heard Dr. Bertman espouse this belief many times before, but does contrast with other EHR vendors in the market.

EHR Acquisition Options
I was also fascinated to hear about Dr. Bertman’s thoughts on Amazing Charts approach to acquisition. He said that he didn’t want Amazing Charts users to experience what other EHR users had experienced when their EHR was acquired by another EHR company. He didn’t want Amazing Charts to be one of many EHR software in a company’s portfolio. Inevitably, EHR software will get sunset to streamline the company and Dr. Bertman didn’t want that for his users.

What does the Acquisition Mean for Users?
Ont thing users of Amazing Charts can expect is efforts to create clinical training and information at the point of care. John Mooney mentioned their “5 Minute Clinical Consults” as a model of short education that could be integrated into the clinical documentation process. I’ll be interested to see how this evolves. Even 5 minutes seems too long for most doctors to stop their patient workflow. However, it is interesting to bring Pri-Med’s education knowledge, experience and library to the point of care in the Amazing Charts EHR.

I also was fascinated by John Mooney’s suggestion of Amazing Charts possibly integrating a Provider Self Assessment tool into Amazing Charts. Definitely makes sense to have the doctors self assess to get the best CME. While not a perfect match inside an EHR software, it doesn’t seem completely out of place in the EHR if it’s done right.

Amazing Charts User Groups at Pri-Med Events
I also learned that they’ll be working to hold Amazing Charts user group meetings at the various Pri-Med events. This could be a great boon for Amazing Charts users. I know a lot of doctors and their staff won’t or can’t attend the national user group meetings that most EHR vendors hold. I’m not sure where the 6500 Amazing Charts users are found throughout the country, but if planned well it would be great to leverage the existing Pri-Med events for this and engage more of their EHR users close to home.

Post-Acquisition Logistics
They told me that Amazing Charts would maintain a separate entity in Rhode Island to continue developing and supporting the EHR software. Their marketing and sales would come out of Boston where Pri-Med is located. For Amazing Charts users, this sounds like it will be mostly business as usual from their perspective. In fact, it could mean Amazing Charts has more resources available to build our their EHR software. All in all, this seems like a smart move for Amazing Charts and their users.

Full Disclosure: Amazing Charts is an advertiser on this site, but you can be sure I’d cover every EHR acquisition I can find.

Smart Phone Enabled Thermometer Approved By FDA

Posted on November 28, 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.

Well, this is pretty neat.

The FDA has recently approved a body thermometer that works with the iPhone. It is said to be suitable for people ages two and up, so along with the at-home remotoscope and the smart phone brain scanner, people can basically start having an at-home doctor’s office! Okay, not really, but it’s starting to seem this way.

The “Raiing” is a small device that is placed under the armpit. Not only does it give the temperature of an individual, but it has the ability to continually track for a period of time, all the while having the information sent via bluetooth to an iPhone, iPad, or iPod touch. A “pre-set temperature” can be selected, and if it is reached or surpassed, an alert is sent to the mobile app. For anyone worried about their own temperature (or a child’s) throughout the night, this could really bring some piece of mind and perhaps a few less sleepless nights.

72 hours can be recorded before the information has to be synchronized with the mobile device, and a record can be kept as well — either on the phone, or on the cloud service provided by Raiing.

This image below is from the website, and shows a little bit how it works, and what the interface of the app looks like.


And here is an actual screenshot of the app:

 

This looks like it’s the first smart phone thermometer available, and it looks like it has been well-thought out. I didn’t see anything about pricing on the website, or the ability to purchase it, but the accompanying app can be downloaded here from iTunes (and is free).

I’d love to see this available for Android devices sometime in the future. Hopefully if it is successful on iOS devices, then it will be offered to Android as well. This is definitely something I would be willing to invest a little bit of money into getting.

EHR & Super Storm Sandy

Posted on I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was recently contacted by Waiting Room Solutions, an EHR company located in New York City about their experience during Super Storm Sandy. Sandra Levy talked to a number of Waiting Room Solutions EHR doctors to learn about their experience with EHR during Super Storm Sandy. She tells their stories in the embedded PDF below (try the full screen button for easy reading).


Five Helpful Mobile Apps for Radiologists

Posted on November 27, 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.

After seeing the popularity of my post about great mobile apps for medical students, I thought I would do a few more posts like that, focusing on different types of medical professions. Today, radiologists.

There are TONS of mobile resources for radiologists. Granted, the best ones are rather expensive, but from what I gather, well-worth the cost. However, there are also some pretty handy free (or really inexpensive) ones as well. After doing some research, here are a few of the apps I think could be helpful for those in radiology. Unfortunately, they are all for iOS devices, though some may be available for Android in the future.

1) Diagnostic Radiology App

iMedicalapps.com made the claim that this app is “possibly the best radiology app for iOS.” This is actually more like an interactive textbook. There is a very comprehensive, searchable database with over 30 different cases. The results from each case can be hidden in order to help the user think up their own solutions. There are excellent image sets included in each case as well. The app is meant for the iPad, but apparently, works rather smoothly on the smaller iPod and iPhone screens. This specific app is geared toward abdominal radiology, though other emphases are in the works. The app does cost quite a bit at $44.99, however, there is a free version which apparently is still very good. One reviewer claimed that “this app is amazing. I . . . expected a freebie with perhaps a bit of useful content. How wrong I was.”

This app is amazing. I downloaded it yesterday and expected a freebie with perhaps a bit of useful content. How wrong I was.

Download the full version here, and the free version here.

2) RSNA Radiology

This app is for Radiology, a top-rated, peer-reviewed journal. It contains tons of great articles that can be easily searched, as well as sent to colleagues. The font size is also adjustable, which accomodates the young and old radiologist. There are also included podcasts which can be listened to through the app. As I mentioned, the articles can be searched, which is definitely useful if someone is looking for a specific part of a certain article. New research with commentary and critiques from different experts in the radiology world is one of the highlights of RSNA Radiology. This app is totally free, which is awesome, considering all the great resources that it includes. It isn’t currently available for Android devices, though it can be accessed from Android phones and tablets at m.radiology.rsna.org.

Download for iOS devices here.

3) Radiology Toolbox

According to the description on iTunes, Radiology Toolbox is “the radiologist’s ectopic brain.” This app was created to anyone involved in radioloy, from the student just starting their studies, to the seasoned radiologist. There are two versions, the lite and the pro, and each include useful tools such as a GFR calculator, gastric emptying times, and a radiographic contrast premedication. The pro version has a lot more tools like a adrenal adenoma calculator and charts of AFI, pediatric spleen, and kidney size. The apps are still in their beginning stages, so expect updates to come regularly, but this is definitely an app that anyone in the radiology field should have.

Download the pro version for 4.99 here, and the free version here. This app is only available for iOS devices at this time.

4) SeeMyRadiology Mobile

This app allows users to view medical images and reports, right on their mobile device! Not only that, but photos can be taken directly with the mobile device and saved directly to the app or shared with others. It is HIPAA compliant, a secure cloud-computing platform, and approved by Accelarad for medical image review. Images can be searched for very easily, using either a patient’s name, time-frame, or medical record number. There’s a bunch of other neat features, and the app creators have gone to great lengths to ensure the security of the app (such as requiring a pin after a period of inactivity, and making sure no PHI is stored on the device upon closure of a case.) The app goes hand-in-hand with SeeMyRadiology.com. Best of all, it’s free.

Download for iOS here.

5) Radiology 2.0: One Night in the ED

For those that can’t afford Diagnostic Radiology, or simply would like another reference guide, this is another great option with tons of features. It has different cases that can be viewed, and the user is able to act as if they are actually reading and interpreting the CT scan from a PACS workstation. There are over 7,000 images included in the app and hundreds of pages of information, all of which can be viewed offline. It’s an excellent way to improve one’s ability to interpret images. Important information is highlighted and explained, and images are shown in a very realistic way.

Download for iOS here (the complete version, for free!)

Although I only highlighted five apps here, there are many more worthy to be on this list. Feel free to let me know what your favorite radiology app is!

Is there a specific field of medicine you’d like me to find good apps for? Leave a comment, and I’ll put in on my list! 

Will EMR Adoption Bankrupt Medicare?

Posted on I Written By

Mandi Bishop is a hardcore health data geek with a Master's in English and a passion for big data analytics, which she brings to her role as Dell Health’s Analytics Solutions Lead. She fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

Much hullaballoo is made over the 47% increase in Medicare payments from 2006-2010, which some seem eager to attribute to the adoption of EMR. The outcry is understandable; a 47% increase is a big dang deal, and taxpayers should be concerned. But haven’t we all heard that statistics lie?

“Hospitals received $1 billion more in Medicare reimbursements in 2010 than they did five years earlier, at least in part by changing the billing codes they assign to patients in emergency rooms,” cited the New York Times based on analysis of Medicare data from American Hospital Directory. Indeed, billing codes have changed from 2006-2010, in accordance with the HCPCS (Health Care Procedure Coding System) reform of CPT (Current Procedural Terminology) application and inclusion guidelines, cited here: HCPCS Reform from CMS. Healthcare industry growth and care advances drove an increase from 50 – 300 new CPT code annual applications between 1994-2004, leading to sweeping change in the review and adoption process starting in 2005 – including elimination of market data requirements for drugs.

Think about that for a second. If Pharma no longer has to submit 6 months of marketing data prior to applying for an official billing code, how many new CPT codes – and resultant billing opportunities – do you think have been generated by drugs alone since that HCPCS process change adoption in 2005? Which leads me to my next correlating fact: the most significant Medicare Part D prescription drug provisions did not start until 2006.

Let’s put two and two together: Medicare Part D prescription drug coverage (2006) + change in HCPCS billing code request process to speed drugs to market adoption (2005) = significant increase in Medicare reimbursements. To use the NYT analyst language, “in part”, administration of those drugs occurs in an emergency room. And who might be in the ER on a regular basis? I’ll give you a hint: “I’ve fallen, and I can’t get up!”

Perhaps the most profound contributor to this Medicare reimbursement increase is a recent dramatic rise in the Medicare-eligible population. Per the National Institute on Aging’s 65+ in the United States: 2005, the 65+ population is expected to double in size between 2005 and 2030 – by which point, 20% of the US will be of eligible age. The over-85 age group, as of 2005, was the fastest-growing population segment. Elderly people who are prone to chronic conditions as well as acute care events just might lead to higher Medicare reimbursements.

Of course, there are myriad contributing factors. Some industry analysts attribute the rise in Medicare claims cost to fraud, citing that the workflow efficiencies that the EMR technology provide allow for easy skimming. Activities such as “cloning”, or copying and pasting procedures from one patient to the next with minimal keystrokes within the EMR software, might contribute to false claim filing for procedures that were never performed. While the nefarious practice of Medicare fraud long predates EMR, the opportunity to scale one’s fraudulent operations to statistically relevant proportions increases significantly with automation. And as my mother always told me, it only takes one bad apple to spoil the bushel.

But how many bad apples would it take to spoil a multi-billion dollar bushel to the tune of a 47% cost increase? According to the NYT article, “The most aggressive billing — by just 1,700 of the more than 440,000 doctors in the country — cost Medicare as much as $100 million in 2010 alone,” and the increase in billing activity for each of those 1700 occurred post-EMR adoption. After all, “hospitals that received government incentives to adopt electronic records showed a 47 percent rise in Medicare payments…compared with a 32 percent rise in hospitals that have not received any government incentives.”

Wait, did that statistic just indicate a significant increase in Medicare reimbursements, across the board? So the differential between those providers who have received government incentives for EMR adoption, and those who have not, is 15%. The representative facilities and providers responded to the “aggressive billing” accusation by indicating that they had 1) more accurate billing mechanisms, 2) higher patient need for billable services. I’ll buy that. Sure, it’s likely that there is Medicare fraud happening, but that’s not new – it’s unfortunate that there will always be ways to game the system, whether manual or electronic. But is the increase in “fraud” pre and post-EMR adoption statistically relevant?

Considering the complex variables involved, I’ll chalk up the 15% increase to the combination of more specific billing practices, Medicare Part D drug provisions, an aging population and the health issues which accompany it, and not vilify the technology which facilitates further advances. Let the EMR adoption expansion continue!

New Withings Wireless Internet Scale Hits the Market

Posted on November 26, 2012 I Written By

Scales sure have come a long way from the old spring-driven models that I grew up with.  I remember thinking how cool it was when I saw my first digital readout scale.  Compared to what is available now, those old digital scales are about as modern as a stone tablet.

The new Withings Wireless Internet scale offers a lot more than just a person’s weight.  It also instantaneously provides a person’s BMI and provides tracking capability with all kinds of different functions.

The scale can be synced to numerous existing mobile apps to accent fitness tracking, weight management, or even just to keep friends, family, or your doctor informed.  It also has its own app that allows the user to set goals, receive coaching, or generate historical reports.

While this is all very cool the price tag seems a little steep to me.  The Withings WS-30scale is available now from Amazonfor $129.95.  But, for someone who is serious about monitoring their weight, this could be a very useful tool.

Meaningful Use for Radiologists – Meaningful Use Monday RSNA12 Edition

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.

This week is the enormous RSNA conference in Chicago. I almost made the trip to the event, but wasn’t able to figure out the logistics. Plus, with a wife and kids the less travel the better. One day I’ll make it to RSNA. Until then, I thought I’d dedicate this edition of Meaningful Use Monday to the radiologists out there.

In short, meaningful use stage 1 was not good for radiologists. Most radiologists saw it as a non-starter for them. In fact, I think it’s safe to say that smaller radiologists couldn’t tell you much of anything about meaningful use stage 1. Meaningful Use stage 2 has made some progress for radiologists, but is unlikely to really get them off the bench and showing meaningful use.

Healthcare IT News has a good article on radiologists and MU where they point out some image centric updates to meaningful use per RSNA:

compliance exemptions for many hospital-based providers who are not involved in their facility’s information technology decisions, a discretionary menu set objective targeted toward diagnostic image accessibility in EHRs, recommendations for radiology-relevant clinical quality measures, more flexible definitions of what constitutes justified EHR, and a consolidation of the eligible hospital and eligible professional technology certification criteria.

Although, the article also points out two other very important points. First, radiology practices will likely forgo participation in the meaningful use program and avoid the EHR financial penalties by way of an exemption. If that exemption ever runs out, then radiologists might change their tune. Although, my guess is that the meaningful use penalties will never be enforced or that there will always be exemptions that radiologists can fall back on.

The second point is even more interesting. Lineage Consulting’s Nakhle suggests that all of the other ordering physicians that are adopting EHR and showing meaningful use might be the real driver for radiologists to get on board meaningful use. I agree that ordering physicians being meaningful users of an EHR is going to change imaging facility requirements. Certainly imaging facilities are going to have to work on new tech workflows, but that doesn’t mean they have to go so far as meet meaningful use. Plus, most imaging facilities are working on these workflows already, so I don’t expect meaningful use will cause much change.

I’m sure this will be a huge topic of discussion at RSNA. If you’re there, we’d love to hear what’s being said on the show floor.

Interview with John Lynn, HealthcareScene.com and Jonathon Dreyer, Nuance Communications

Posted on I Written By

We recently caught up with John Lynn, blogger and founder of HealthcareScene.com while he was in town for Health 2.0 Boston. In part one of this three part interview series, John Lynn and Jonathon Dreyer discuss their take on the today’s top health IT trends.

 

 

Watch the video.