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What Happened with EMR and Health IT in 2013?

Posted on December 31, 2013 I Written By

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

As we wrap up 2013, I thought I’d take a look back at some of the major things that happened in 2013. They will be topics you’re very familiar with, but hopefully this will tie a nice bow on the top of 2013 as we look towards 2014.

ICD-10 Got Real – There are still many organizations that aren’t focusing on ICD-10 or that are underestimating it, but for the most part I’m seeing a lot of concern around ICD-10. I’ve started a whole series on ICD-10 and as I’ve been preparing posts the impact of ICD-10 is going to be huge. I think people are just starting to realize it and 7-8 months from now there’s going to be a lot of organizations that are going to go into panic mode. Some of the panic they could solve if they started working on ICD-10 today. Some of the panic will likely come from outside vendors who end up not delivering ICD-10 the way they should.

ACO’s Are Still a Mystery – Some of the ACO work from the government is coming into some focus, but that barely feels like an ACO to me. Of course, it’s all how you define an ACO. I mostly see defensive efforts by organizations trying to group and align themselves with other organizations for whatever reimbursement changes come down the pipe. However, I don’t think any of them really know what’s coming (and I don’t claim to know either).

Meaningful Use Stage 2 Hit Us – We got a meaningful use stage 2 extension and a meaningful use stage 3 delay, but we didn’t get what many were hoping would be a meaningful use stage 2 delay. That means organizations have little choice but to proceed with meaningful use stage 2. As I’ve seen more and more organizations get into MU stage 2, I’ve seen two main actions: workarounds and complaints.

I believe the inverse relationship between incentives and requirements is starting to become an issue. It will certainly blow up when the even more challenging meaningful use stage 3 requirements hit and the EHR incentives are gone.

Consolidation (Hospital and Physician Practice) – Everyone tells me private practice acquisition is cyclical and at some point we’ll see a return to independent doctors. However, I haven’t seen that cycle happen yet. All I see our hospitals acquiring practices like crazy. Not to mention hospitals joining together as well. I wonder if the prediction I heard of only 5-10 major health systems will play out.

HIPAA Omnibus Landed (and is mostly forgotten) – HIPAA Omnibus is in place whether a practice likes it or not. Most never realized it went into affect or have forgotten it already. Watch for 2014 to be the year that it starts biting organizations in the backside. Give us 4-5 stories about HIPAA Omnibus making a physician’s life miserable and then we’ll see more people getting HIPAA training, fixing their business associate agreements, and maybe even implementing encryption on their devices. Maybe I should have added this to my 2014 wish list I’ll post tomorrow.

Did I miss anything? Probably. So, let’s hear what I missed in the comments. Also, I made some similar comments with a hospital focus over on Hospital EMR and EHR.

Bridging the Fitness Apps and Device Trackers with the Medical Community

Posted on December 30, 2013 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.

Next week I’m going to the International CES (Consumer Electronics Show) in Las Vegas. Obviously, being a consumer show, the health applications are very much consumer focused. They have a whole section of the show dedicated to digital health and it’s been growing each year (up 60% this year I’m told).

I’m on the press list and I’ve been really interested in the wave of fitness devices that have passed through my inbox. They come in all shapes and sizes and record everything from steps to heart rate to blood pressure to every in between. Basically, I see a whole plethora of applications and devices that are measuring various aspects of our health. The wave is here. Who’s going to win this race isn’t all that clear to me, but the fact that we’re going to have devices measuring our health is clear.

What’s also not clear is how these measurements are going to bridge over to the medical community. Sure, there are targeted pilot programs where some of these devices are used by doctors or hospitals. However, most of these consumer monitoring and device companies aren’t thinking about the medical implications. In fact, many of them are staying far away from it as they avoid any sort of FDA oversight.

While I understand the desire to not have to make the bridge to the medical community, I don’t think most of these devices and apps will make it without making the bridge. If I’ve already recorded all of my blood pressure data on my iPad using a blood pressure cuff at home, I’m going to want an easy way that I can provide that data to my doctor.

Maybe this is an opportunity for an innovative company to provide that bridge. I’m sure most of these mobile health developers would be happy to tap into a public “utility” that would connect their data to the medical community. The problem is that it’s not sexy to be a utility.

EHR Vendor Says Good Bye to Meaningful Use

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.

ComChart Medical Software, LLC president, Hayward K. Zwerling, MD, earlier this month posted a letter on The Health Care Blog saying that the ComChart EMR would no longer be meaningful use certified. Here’s a portion of the letter that describes the reasoning:

ComChart EMR will continued to be certified as a Complete EMR for Stage I Meaningful Use. Unfortunately, we will not be able to meet the Stage 2 (or greater) Meaningful Use certification requirements as these requirements are technically extremely difficult to implement.

In addition to the Meaningful Use mandates, there continues to be a never ending stream of new mandates such as ICD-10, PQRI, Meaningful Use 2, Meaningful Use 3, SNOMED, ePrescribing, LOINC, Direct Project, health information exchanges etc. As a result of the mountain of mandates, ComChart EMR and the other small EMR companies will have to choose to implement the mandates or use their resources to add “innovative” features to their EMR. Unfortunately, the small EMR companies do not have the resources to do both.

(I suspect this is also true, to some extent, for all EMR companies.)

While the individual people involved in promulgating these EMR mandates (mostly) have the best of intentions, they clearly do not understand what transpires in the exam room, as many of the mandated features confer little or no benefit to either the patient or the healthcare provider.

In addition to a lack of understanding of what is important during the process of providing healthcare, it has also become apparent to me that the Federal and State health information technology agenda is now largely driven by the strongest HIT companies and health institutions; the individual physician is only an afterthought in the entire process.

This choice basically means that anyone interested in meaningful use and EHR incentive money won’t be doing so with ComChart EMR. The regulations say that even someone attesting to meaningful use stage 1 in 2014 has to use a 2014 certified EHR. ComChart won’t be able to meet that requirement.

I knew that this was going to happen with a number of EMR vendors, but ComChart really missed a huge opportunity with this announcement. The most damning part of the letter is when Dr. Zwerling says “we will not be able to meet the Stage 2 (or greater) Meaningful Use certification requirements as these requirements are technically extremely difficult to implement.” I was aghast by this statement. So much so that I had a brief email exchange with Dr. Zwerling to see if he really meant what he said. Was it that they weren’t able to meet the requirements or that they chose not to meet them?

He responded, “Anything can be done, it is just a question of how much resources are going to be thrown at the problem and what is not going to get done return.”

It seems that Dr. Zwerling didn’t consult a PR or marketing person on how to make the most of this decision. Any of them would have told him that this decision could be a huge opportunity to differentiate the ComChart EHR from all the hundreds of certified carrot chasing EHR companies out there.

If Dr. Zwerling had asked me, I’d have told him that he should have said, “ComChart EHR has talked with our hundreds of physician end users about meaningful use and EHR certification and we’ve found that they don’t value any of the meaningful use criteria. Because of doctors desire to not be bogged down by meaningful use requirements, we’ve chosen to listen to our doctors and focus on what makes doctors lives easier. We’ll continue innovating our product to the needs of doctors, but we’ll be letting doctors drive that innovation versus some committee in Washington.”

I could keep going, but you get the idea. ComChart could have told every doctor out there that they were the ULTIMATE PHYSICIAN EHR that cares so much about the physicians who use their EHR that they’re shunning meaningful use because it’s detrimental to the way physicians should be practicing medicine. Making this case would not be hard and the message would resonate with the majority of physicians.

I’m not sure if this strategy would work or not. Government money that’s perceived as “free” is a hard opponent. However, government bureaucracy and headaches are an easy target that everyone understands and hates. In ComChart’s case, saying that they essentially aren’t capable of the complex meaningful use requirements is sending the wrong message. All doctors hear when they read this is that your EMR development team isn’t sophisticated or strong enough to keep up. What a missed opportunity and likely the nail in ComChart’s coffin!

Hopefully this is a warning message to any other EHR vendors who choose to go the route of shunning meaningful use and EHR certification. I’m not sure that shunning MU is a winning strategy for an EHR vendor, but being the physician advocate at least gives them a fighting chance.

Healthcare Productivity Roller Coaster

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 thought this video by TrustHCS was a nice look at the productivity roller coaster that healthcare’s been on and where it’s heading in the future. The video focuses a lot on coding productivity with ICD-10 coming. It also suggests that the meaningful use and EHR productivity dip is almost over. I’m not sure I agree with this, but I do agree with them that ICD-10 will cause some major productivity issues for a number of organizations. Enjoy the video.

Open EMR’s Death, Collaborative Health Record, and Improving EMR

Posted on December 29, 2013 I Written By

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


It seems a little ironic that an EMR vendor would write about wanting an open source EMR to die. Although, I couldn’t help but read the irony that this person chose not to be involved in the open EMR community because people weren’t getting involved in the community. A good old chicken and egg problem. Instead of contributing to the community so that it would be more vibrant, they chose to go out and develop EVERYTHING. The reality is that this person just wanted to build an EMR business. They didn’t want a real open source EMR community. There’s nothing wrong with wanting to build an EMR business, but it’s very different than contributing to a great open source EMR community and build a business.

As the author mentions, the Open EMR community isn’t going anywhere. In the hospital space, the Vista community isn’t going anywhere either. I will be interested to see how Open EMR handles MU. They did stage 1, but future stages are still a question mark from what I’ve seen. Of course, they could go radical and not worry about meaningful use. It will be interesting to see.


I’ve always loved the idea of the collaborative care record. Unfortunately, I don’t see much movement by the healthcare industry to make it a reality.


A lot of people are going to start asking this question. I believe it will be a couple years before this discussion really goes mainstream in hospitals (possibly post-MU), but it will be an important discussion. Of course, this isn’t a new discussion. It’s always a question of whether it’s best to improve the software you have or rip and replace. In the ambulatory side I predict we’re going to start seeing a lot of ripping and replacing of EHR software.

Healthcare Data Center Rap

Posted on December 27, 2013 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.

Nothing like the holidays to take a few minutes to let loose while still sharing a healthcare IT message. In case you need a little humor in your health IT, then check out the playlist I’ve been creating of Funny, Entertaining, and Unique Health IT videos. Many of the videos will be familiar to you, but are worth a second watch.

The following video is the latest addition to the list. It’s a Healthcare Data Center Rap by Susan Biddle. As it says in the YouTube description:

Last month my employer, Juniper Networks, launched the Data Center Rap Battle marketing campaign: http://www.datacenterrapbattle.com — In the spirit of supporting the effort, it was time to put the Healthcare Biz in a rap…

Enjoy the video embedded below.

Who wouldn’t love Susan working at your company? Great stuff! Plus, she has the YouTube recipe down. Kids. Check. A beautiful woman. Check. Music. Check. Nice message. Check.

Nicely done!

Google Glass in Public

Posted on December 26, 2013 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 recently acquired a pair of Google Glass. It’s been quite an interesting experience wearing them around. I haven’t worn them many places. In fact, I took them to the mHealth Summit in DC and barely took them out. As I considered it, I found it really pretentious to have on a pair of Google Glass. Even when I did wear them, I’d usually flip them up on my head so people knew I wasn’t using them.

I imagine over time this will change as more and more people wear some sort of eyeware that contains computing power like Google Glass. However, of all places, you’d think that wearing them at mHealth Summit people would generally know what they were and not be so phased when you had them on. It was interesting to see the looks people gave you.

I will say that wearing Google Glass is a good attention getter. Random people will come up to you and ask to wear them or try them. This can be a great thing at a conference where breaking the ice can be hard. However, you just have to be sure to bridge the conversation to something more than Google Glass. For some reason, women seemed particularly interested in them.

I have CES (Consumer Electronics Show) coming up in a few weeks. I think I’ll wear Google Glass around some just to see what people do. At a show like CES I’m afraid I’ll end up meeting a lot of people that I don’t necessarily want to meet (do I really care to hear about your iPhone case company?).

I’m still torn on Google Glass. I think the technology is a really amazing experience. It’s just hard for me to see it as an every day type of accessory like your phone. Maybe I’ll hop on eBay and sell mine off.

A Look Back on My 2012 Christmas Wish List

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.

Last year, I posted a healthcare IT Christmas Wish list. A year later, I thought it would be fun if I got what I wanted for Christmas last year or not (yes, it takes healthcare at least a year to grant wishes).

Here’s the list and my thoughts on how far we’ve come on each wish:

1. Open EHR Systems – We’re certainly not there yet, but I think there has been a sea change when it comes to opening up EHR software. I’m sure some could appropriately argue that we still have a long way to go, but let me give you some examples from Epic that give me cause for hope. First, this Epic Interoperability chart that Judy shared. Second, Kaiser joined the Epic network. Third, the Epic API.

It’s fun to use Epic as a proxy for openness because they’ve been so closed for so long. Judy Faulkner was after all the one that suggested that open EHR was an issue for patients. I’d love to see EHR more open, but I’m excited by the possibilities of open EHR. I believe this will have to happen and vendors who fight against it will be left behind.

2. Remove Healthcare’s Perverse Incentives – Sadly, I’ve seen almost no change to this yet. One area where I think this could be starting to change is around price transparency. There’s been a strong push to make healthcare pricing more transparent. As more and more patients have high deductible plans (like me), we start to shop around a lot more and be more interested in price. When we’re footing the bill, that price translates to our cost. This will cause companies to change how they do business.

3. Beautiful EHR User Interfaces – I’ve seen very little change in this regard. Sure, a few have rolled out an iPad interface, but I think they’ve missed out on the iPad Opportunity. Although, I recently saw the Modernizing Medicine iPad interface again in person. It’s so fundamentally different than every other EHR interface I’ve seen. While it demonstrates well the opportunity, it’s so fundamentally different that I’m not sure any existing EHR vendors can replicate it. I ask myself if we’ve spent billions of dollars on EHR user interfaces that can’t be what they should become.

4. More Empowered and Trusted Patients – I’m sure we’ll be battling this one for a long time to come. Although, the empowered patient is happening. Health information is available to everyone at the click of the mouse or a swipe of the finger. This shift is going to happen. There is nothing anyone can do to stop it. It’s more a question of whether people will embrace it or “kick against the pricks.”

Overall I’d say that we’re generally trending towards my wish list, but as is usually the case there is plenty more to do. I’d love to hear your thoughts on the above items.

Merry Christmas!

Posted on December 25, 2013 I Written By

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

In case you missed it, you can read my post on Holiday Greetings and Merry Christmas. With that in mind, I thought I’d share a few pictures from my Christmas. If you don’t care for family pictures, then you’re welcome to delete this email, close your browser, etc and we’ll be back to our regularly scheduled EMR and HIPAA programming tomorrow.

I thought this captured our Christmas the best. It’s kind of become a tradition for us on Christmas Eve to take a crazy picture. The best part is that we didn’t event coordinate it. We just said go crazy and this was what came out. Love it!
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We also went to ride the Polar Express train in Williams, AZ, about an hour from the Grand Canyon. It was my first time going to the Grand Canyon. How spectacular! The polar express was awesome too. The highlight for me was dancing to Jingle Bell Rock on the train with my daughter.
IMG_2769

Then, here’s our official Christmas picture. Yeah, now I’m just showing off my cute kids and wife. Sorry. I couldn’t help myself.

Back to the grind tomorrow. Lots to think about as we end this year. More on that to come.

‘Twas the Night Before ICD-10

Posted on December 24, 2013 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.

HIStalk posted a great little twist on a Christmas favorite entitled ‘Twas the Night Before ICD-10 by Luke O’Cyte.

Here’s the first part:

‘Twas the night before ICD-10, when all through the payer
Not a claims engine was stirring, not even a benefits layer;
The mappings were hung in the systems with care,
In hopes that St. Remediolas soon would be there.

Merry Christmas to those who celebrate. My wife outdid herself tonight and I’m going to bed grateful for so many things. Plus, I love the excitement of my children’s anticipation of Santa.