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EMR Scribes, EMR Big Brother, Right Tool for Right Job, and MU’s Affect on EMR Adoption

Posted on September 8, 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’ve heard more and more people proclaiming the value of scribes with their EMR. Certainly many are leery of the costs associated with scribes, but I don’t know anyone who has tried a scribe and been disappointed with the choice.


Far too often when we’re in technology we think that we have to always look for a tech solution to the problem. It is often the case that technology will take part in some part of a solution, but far too often we try and over architect a technology solution. Instead of implementing more technology we need to implement the right technology. Often that means choosing simpler technology.


I think this is an important question. I’m sure cutting MU would cause a lot of shock waves in the industry, but I don’t know many people who would stop their EHR use because MU was gone. I don’t know many that are implementing an EHR that would stop if MU was gone. I don’t think MU will be stopped, but I still think a delay is likely.

More Meaningful Use Stage 1 Numbers from 2011

Posted on February 3, 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.

In a previous Meaningful Use Monday we wrote about a bunch of the Meaningful Use 2011 statistics that were put out by ONC and CMS. I know that my readers love statistics and information about Meaningful Use. Carl Bergman sent me a PDF file that contained some really interesting data on Meaningful Use stage 1 in 2011. The first pages we basically covered in the previous post, but starting on about page 10 or so there are some more detailed numbers.

Take a look at let us know which numbers you find interesting and/or unique.


Meaningful Use Numbers from 2011 and Looking Towards 2012 – Meaningful Use Monday

Posted on January 16, 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.

HITECH Answers recently posted a great post that gives a run down of the EHR Incentive program’s progress in 2011. Here’s their list with my own analysis and commentary of each point.

123,921 Eligible Professionals have registered for EHR Incentives, 15,255 have successfully attested to meaningful use in the Medicare program.
This seems like such a HUGE difference in numbers. That’s just over 12% of Eligible Professionals that registered attested to meaningful use. Does this mean that we’re going to see a tidal wave of meaningful use attestation in 2012? Possibly.

I believe that we’ll see more eligible professionals attesting to meaningful use in 2012. However, the question is how many of those other 108,666 will attest to meaningful use in 2012 and how many are like the Happy EMR Doctor who just registered to see the MU process. I wonder how many first hand meaningful use experiences by doctors will scare doctors away from MU attestation.

3.077 Eligible Hospitals have registered EHR Incentives and 604 of those have successfully attested to meaningful use.
This is almost 20% of hospitals that have registered that have attested to meaningful use. It’s not surprising that this number is a lot higher than eligible professionals. I still believe that the wave of meaningful use attestation will come from these other 2473 hospitals and probably many more that still haven’t registered. I haven’t seen a good number of how many hospitals are in the US. Does anyone know that number? The EHR incentive money that goes to hospitals will dwarf those of eligible professionals.

$2,533,689,145 has been paid out in Medicare and Medicaid Incentives.
$2.5 billion sent out in 2011. I just went back to the first time I tagged meaningful use on this site on April 3, 2009 (coincidentally I have 19 pages of 10 posts each tagged with Meaningful Use). Amazing to think that it’s taken basically 3 years to spend $2.5 billion on EHR.

277 hospitals have received payments under both Medicare and Medicaid and of those 12 were CAHs.
That’s about half of the hospitals that have attested to meaningful use under Medicare are also getting the Medicaid EHR incentive money as well.

22% of eligible professionals that have been paid EHR incentives are Family Practitioners and 20% are Internal Medicine.
I must admit that I would have thought that the percentage of family doctors that got paid EHR incentive money would have been a lot higher. I guess when you have so many other specialty areas I shouldn’t be that surprised. I also wonder why the internal medicine number is so high. These numbers actually make me believe that a lot of family practice doctors are sitting out when it comes to meaningful use.

41 States Medicaid programs were open for registration. Two additional States launched in January of 2012.
I wonder what’s holding back the other 7 states. From what I’ve seen all the states will eventually get there.

More than 1500 EHR products have been certified by ONC-ATCBs.
That’s a lot of EHR software. I still put the EHR company list at about 300 EHR vendors. 1500 includes multiple versions of the same software, partial EHR certification for products like data warehouses, ePrescribing, etc. The best thing that’s come from the ONC-ATCB program is that it has made EHR certification basically irrelevant in the EHR selection process. Every EHR vendor is certified now. This is much better than the false assurances that EHR certification provided before. I still dislike what EHR certification has done to the industry, but at least it’s not misleading doctors the same way it was before.

Tips for Successful MU Attestation – Meaningful Use Monday

Posted on January 9, 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.

Having just experienced the attestation process firsthand as I watched an SRS client successfully attest to meaningful use, I am happy to report that this part of demonstrating meaningful use is relatively easy—a bit tedious if you are attesting for multiple providers, but not at all difficult. CMS has created a user-friendly, web-based attestation system. Assuming that your EHR provides the information you need in a useful format, you have successfully met all the required measures, and you come prepared, there should be no reason to have an unsuccessful attestation.

Here are some tips that will ensure your success:

  • Register in advance: Even though you can register as late as at the time of attestation, the combined task would be overwhelming—particularly if you are attesting “on behalf of” a provider. Registering in advance ensures that everything is up-to-date in NPPES and PECOS and that you have all the necessary information.
  • Make sure that all measures have been met: If your EHR does not show the percentages for measures that have thresholds, do the math yourself to verify your success on each one. CMS offers a worksheet that you might find helpful for this purpose. Verify that you have also met all other (non-numerical) measures. If you fail to satisfy even one measure, do not attest now—go back and try another reporting period.
  • Have documentation for each provider:
    – Registration confirmation page with registration ID#

    – Password

    – EHR certification number

    – Reporting period dates (make sure it covers at least 90 days)

    – Printout of all meaningful use measures: numerators and denominators, exclusions and reasons

      (when there is more than one possible reason)

    – Clinical Quality Measure report: numerators, denominators, exclusions

  • Do not hit “Submit” until you have reviewed the “Attestation Summary” page: Double check your data. Make sure that you have said “yes” to all yes/no measures and that your numbers are entered accurately. The summary page does not display percentages, so you have to do the math yourself to be sure that you meet the thresholds.
  • Submit attestation and print the “Submission Receipt” as confirmation: If you have done everything correctly it will state that “all measures are accepted and meet MU minimum standards.”

While not necessary, I highly recommend having a second person help you attest. A second set of eyes will shorten the time the process takes and will reduce the potential for errors in posting your data.

Two Stage Process for Meaningful Use Stage 2?

Posted on October 5, 2011 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 interesting piece of news (some might say rumor) is coming out of AHIMA as posted by Joseph Goedert on Health Data Management. Here’s an excerpt of what was said:

An idea floating around Washington could result in Stage 2 of the electronic health records meaningful use program being different in each of its two years.

That’s what Dan Rode, vice president of advocacy and policy at the American Health Information Management Association, told an audience during the AHIMA 2011 Convention & Exhibit in Salt Lake City.

So the scenario could be that Stage 2 starts in January 2013 with minor changes from Stage 1, such as raising meaningful use quality measures a bit. But any major changes or new requirements, such as requiring the use of SNOMED CT in certain parts of the medical record, would wait until 2014, Rode said.

I’m sure this would be welcomed by almost everyone in the healthcare IT and EMR industry. Doctors and EHR vendors in general want to do as little as possible to get the government EHR incentive money. Even if some will publicly say that they want to use meaningful use to raise the standard of care.

I purposefully created the title to highlight the irony of meaningful use stage 2 having 2 stages. I’m not sure if we’ll call it meaningful use stage 2.0 and meaningful use stage 2.5 for the second step of stage 2. Of course, they could just make meaningful use stage 2 a simpler model and then add a meaningful use stage 4 (assuming the legislation allows it). However, then we’d really confuse doctors more than they already are when it comes to EHR incentive money, meaningful use requirements and their various stages.

This to me is still just a rumor, but it will be interesting to see how they make it happen if in fact they do try and do it. I know many people who will welcome any watering down of meaningful use. Even if you won’t hear them saying it in public.

Dr. Lynn Ho – Ultra-Solo Doc: Meaningful EHR User With Amazing Charts

Posted on August 2, 2011 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.

1.  Please tell us about your background and training and when you became a sole practitioner?

I graduated from NYU School of Medicine and finished a family practice residency at the University of Rochester in 1989. Before opening my micropractice, I had worked in a variety of different settings, including an HMO, community health centers, a university health center and a typical private office practice. I opened my no-staff micropractice in 2004 after reading Gordon Moore’s groundbreaking articles on solo-practice and seeing a local colleague succeed with a similar type of practice in Rhode Island.

2.  I understand your practice is defined as a “micro practice”. Can you explain what you mean by that and how it differs from a traditional practice?

In my particular case, ‘micropractice’ refers to a small, low overhead, no staff, high tech – high touch practice.
– a small practice (850 patients vs. the usual patient size panel of 1500-3000 patients)
– that because of low overhead (25-30% of gross collections vs. usual 60%, attributable to not paying staff salaries and leveraging computers to run an efficient and effective practice)
– is able to spend adequate amounts of time with the patient during each patient encounter (30-60 minutes vs. the national primary care average of about 7.5 minutes)
– which leads one to be able to better provide the cardinal primary care functions of supplying “access, continuity over time, coordination and comprehensiveness” in a patient centric manner.

3.  What led you to make the change from traditional to micro practice?

The current financing model of delivering primary care – cranking on volume of visits to meet overhead and salary – is bankrupt and broken. I wanted to move to a model that would be better for patients and lead to more professional satisfaction for myself. I wanted more control over the way I practiced medicine.

4.  When did you start using Amazing Charts (AC) and why did you choose them over other EHR vendors?

One of the key underpinnings of running a micropractice is achieving and maintaining low overhead, (around 30% of gross earnings). I did know that I did NOT want to work just to have to pay for my EHR.

When I first started my practice my AC license cost me just $500. Back in 2004, AC did not have a lot of bells and whistles but as a startup I was nowhere near using the program to its fullest capacity. Starting out is tough! I had the naive idea that with a laptop, an all-in-one, an internet connection and an EHR as the centerpiece of my technology stable, I was set for life. I was blissfully unaware of what my burgeoning technology configuration (see list below) was going to evolve to include, and how many other pieces of technology were going to have to ‘play nice’ with my EHR. Luckily for me, and because AC is very responsive to requests from users, all of the software pieces that I use integrate well with my EMR, both via formal interfaces and in my informal workflow.

To reiterate, low cost, ease of set up, maintenance and use, and ability to easily integrate with other workflow processes are the EMR qualities that I’ve found to be essential in my micropractice, and I find that AC meets and often delightfully exceeds these criteria.

Instant Medical History – automated patient entered histories
Updox – document management and patient portal
Paperport – document management
Appointment Quest – online patient entered appointments
EZ Claim – practice management
Zyantus (clearing house) – electronic billing
Shortkeys – macro for documentation
HowsYourHeath – web based patient entered practice quality tool
Brinkster – website hosting

5.  Did you have any prior experience using EMRs?

No – actually I had never really used a computer (except for email, and that was a Mac!) before opening my practice in 2004.

6.  I understand you are in the process of attesting to Meaningful Use. Was it necessary to upgrade your current EHR in order to meet requirements for MU?

I had to upgrade to the latest version – version 6 to use the wizards that would count up my data.

7.  How long have you been working towards MU?

I’ve been counting data for about 2 months, and am on track to “pass” by month 3.

8.  How much additional time is it taking to meet the criteria for attestation?

It takes about 2-5 more minutes per encounter to include the documentation for Meaningful Use.

9.  Can you give us an overview of what the process has been like thus far?

Generally speaking, I find it exceptionally vexing to have to spend extra time documenting what I already do for bean counters. I could be using this extra time to actually improve patient care instead of just filling in boxes. Luckily, on a visit by visit level, the MU wizard in my EMR makes it mindless, simple and not too painful to collect the required data and document the required work processes.

10.  What changes have you had to make in your practice as a result of meaningful use?

I have not materially had to change office processes, though I have had to change documentation procedures so that items are compiled correctly for MU.

For example: I used to send patient summaries via email to most patients.
5 clicks: copy content – return to demographics screen – open email to patient – paste – send, about 30 seconds.
Now, in order to document that I am sending these summaries for MU, I have to click on the MU box, print that to a secure email, click( 2x )and type (2x ) within the secure email program to attach label and send, wait for the CCD to print and then click to return to the note. 8 steps and some are slightly more than just a click. It all takes about 90 seconds.

Another example – Smoking documentation requires a formal reassessment of the data as MU needs it, but it’s usually not the way I’ve previously free texted it.

It’s just a little more cumbersome, might take about 2-5 minutes more per patient encounter.

11.  Word is that you’re a “paperless office.” How do you handle things like the patient intake paperwork to avoid having lots of paper lying around?

Patients send me their clinical histories before every visit electronically using Instant Medical History from my website or from an office kiosk, so I don’t use paper for those forms at all.

I do have new patients sign a laminated “HIPAA-consent to bill-consent to email form” – one signature gets it all. Then I scan in the page along with a copy of the insurance card to a file. I rinse off the marker from the laminated sheet under the tap and am ready for the next new patient.

I use EDI interfaces for most labs and some x Rays and consults, and most consultants fax me their information electronically.

Other non interfacing labs and radiology reports come in via paperless fax to a folder on my computer.

If there is a particular consultant or facility that mails me information more than twice, I will call them and ask them, going forward, to fax their information to me.

There are a number of tricks to minimizing use of paper in the office. Having paper embedded into your office routine requires extra labor (opening mail, scanning, shredding, filing, retrieving files) and the expense of storage space and materials.

12.  Who has been helping you through the meaningful use process (consultant, your EHR vendor, your REC, etc.)?

Mostly the EHR folks- attended a webinar and then had some back and forth with the developers, as I was an early beta tester for the MU process.

The REC folks came by, but since the processes were in place they just encouraged me to actually decide to apply for MU by dangling the financial rewards in front of me.

13.  What would you offer as guidance to your fellow doctors regarding EHR’s and obtaining MU status?

If the processes that MU is supposed to document are already in place – if you are already leveraging your EMR to help you in your practice in a meaningful way, then depending on your Medicare/Medicaid revenues/patient mix, it may be worth it to apply. The question there is, are the monies received – or the penalty that you would incur, worth the time it will take you to: 1) learn about the MU program, 2) learn how to use the MU features of the EMR, and, 3) actually do the documentation?

Payout is also dependent on your payer mix and volume of the practice. For example, because my straight Medicare income was about $10K last year, I stand to get, over 4 years, about $22K so, coupling the payment with the curiosity factor of seeing what our cutting edge HIT people are up to, I decided it was almost ‘worth it’ for me.

If the processes are not in place – items such as, ‘you don’t use the EMR to collect demographic data’ to ‘your EMR does not support E-prescribing’, then there’s the additional work of adopting these processes into your workflow. Again you’d have to weigh the payment against the work of adopting new workflows AND becoming schooled and practiced in MU deployment. This work is not an insignificant burden and many small primary care practices that run with very tight margins and lack breathing room will not be able to succeed.

Of course, if you work for Kaiser or another large group, I would imagine that they would deploy both IT and clinical staff to do this work for you.

Would Any Current EMR Users Be Able to Show Meaningful Use?

Posted on July 9, 2010 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 think this might be the million dollar question. Or I guess you might say it’s the $18 million question (depending on the EMR stimulus projections you like most). Think about it…

Would Any Current EMR Users Be Able to Show Meaningful Use?

Ok, think about the 25 meaningful use objectives (here’s a page with links to all the various meaningful use matrix out there). How many of the 15% or so of doctors who are currently using an EMR would meet the meaningful use guidelines?

I would say that the number likely approaches 0. If not, it’s extremely low I believe.

If this is the case, then why aren’t they meaningful users of an EMR. Is it because the meaningful use guidelines are off base? Or is it because these current EMR users need to step up their game and start using their EMR software the right way (or at least the meaningful use way).

This will give you something to think about this weekend.

Will Meaningful Use be Relaxed?

Posted on June 28, 2010 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.

After my post on EMR and EHR about Relaxing of the Meaningful Use rule, I thought it would be interesting to do a quick poll on what people think will happen with the Meaningful Use rule. Should be an interesting result: