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What’s the Future of Health Information “Disposal”?

Posted on July 30, 2015 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.

While at the HIM Summit, Deborah Green from AHIMA talked about the information lifecycle in healthcare. She showed a number of representations and flow charts of how information is collected and used in healthcare. Although, the part of the chart that intrigued me the most was the “disposal” element at the end. In fact, it prompted me to tweet the following:


As you look back at history disposal of paper charts was pretty straightforward. Most of the charts were organized by year and so you could have a 6 year retention policy. You’d collect all the charts that were older than 6 years and then either shred the old charts or move them to a more long term storage facility.

This concept gets much murkier in the world of EHR and digital charts. In fact, I talked with Deborah after her talk and asked if they’ve ever seen an EHR vendor which had a feature that would allow them to digitally “dispose” of an electronic chart. I’ve talked to hundreds of EHR vendors and I’ve never seen such a feature.

As a tech guy, I’ll admit that I wouldn’t want to be the programmer responsible for writing the code that “disposes” of an electronic chart. EHR software has been coded to never delete anything. At a maximum it might mark a record as inactive or essentially hide a record, but very few things in an EHR are ever really deleted. The concept of deletion is scary and has lots of consequences. Plus, what happens if your algorithm to delete old charts goes wrong and deletes the wrong information? You can fix that with some great backups, but I can imagine a lot of scenarios where even the backup could fail.

Technical challenges of an EHR delete feature aside, what does the future of digital chart “disposal” look like? What should digital chart disposal look like? Do we “shred” digital charts? Do we “shred” part of them? Do we keep them forever?

The reality is that the decision of what to do with the electronic chart is also dependent on the culture of the hospital. Research organizations want to keep all of the data forever and never ever delete anything. That old data might be a benefit to their research. Rural organizations often want to keep their data as long as possible as well. The idea of deleting their friends and neighbors data is foreign to them. In a larger urban area many organizations want to dispose of the chart as soon as the retention requirements are met. Having the old chart is a liability to them. Not having the chart helps remove that liability from their organization. Those are a few, but EHR vendors are going to have to deal with the wide variety of requirements.

If you think of the bigger picture, what’s the consequence if we shred something that could benefit the patient later? Will we need all of the historical patient information in order to provide a patient the best care possible?

These are challenging issues and I don’t think EHR vendors have really tackled them. This is largely because most organizations haven’t had an EHR long enough that they’re ready to start purging digital charts. However, that day is fast approaching. It will be interesting to see the wide variety of requests that organizations make when it comes to disposing of digital charts. It will also be interesting to see how EHR vendors implement these requests.

Would Cerner DoD Loss Seal Its Fate As An Also-Ran?

Posted on July 29, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Update: Cerner has been announced as the winner of the DoD EHR Contract.

As everyone knows, Epic has attained a near-unbeatable place in the race for U.S. hospital market share. By one important criterion, Meaningful Use attestations, Epic has the lead hands down, with about 186,000 attestations as of March 2015 compared with 120,331 attestations on Cerner systems.

That being said, Cerner is hardly an insignificant force in the hospital EMR marketplace. It’s a multibillion-dollar powerhouse which still holds a strong #2 position and, if a casual survey of Web and social media commentary is to be believed, has done far less to alienate its customers with high-handed tactics. And while Cerner systems are far from cheap, you don’t regularly see headlines citing a Cerner investment as pivotal in a hospital’s credit rating taking a pratfall. Also, Cerner has the most contracts with MU-eligible hospitals, holding contracts with about 20% of them.

Nonetheless, there’s an event looming which could tip the scales substantially further in Epic’s direction. As many readers know, Epic is part of a team competing for the Department of Defense’s $11B Healthcare Management Systems Modernization contract (Word on the street is that we could hear the winner of the DoD EHR bid this week). I’d argue that if Epic wins this deal, it might have the leverage to push Cerner’s head under water once and for all.  Cerner, too, is fighting for the deal, but if it wins that probably won’t be enough to close the gap with Epic, as it’s harder to play catch up than to zoom ahead in a space you already control.

Now my colleague John argues that winning the DoD contract might actually be bad for Epic. As he sees it, losing the DoD deal wouldn’t do much damage to its reputation, as most hospital leaders would understand that military healthcare bears little resemblance to commercial healthcare delivery. In fact, he contends that if Epic wins the contract, it could be bad for its customers, as the Verona, Wisc.-based giant may be forced to divert significant resources away from hospital projects. His reasoning makes sense.

But losing the DoD contract would almost certainly have a negative impact on Cerner. While Epic might not suffer much of an image loss if it loses the contest, Cerner might. After all, it doesn’t have quite the marquee list of customers that Epic does (such as the Cleveland Clinic, Massachusetts General Hospital, Mayo Clinic and the Johns Hopkins Hospital). And if Cerner’s rep suffers, look out. As a surgeon writing for investor site Seeking Alpha notes, the comparatively low cost of switching TO Cerner can just as easily be used as a reason to switch AWAY FROM Cerner.

What’s more, while Cerner’s acquisition of Siemens’ health IT business — adding the Soarian product to its stable — is likely to help the company differentiate itself further going forward, but that’s going to take a while.  If Cerner loses the DoD bid, the financial and PR hit could dampen the impact of the acquisition.

Net-net, I doubt that Cerner is going to lie down and play dead under any circumstances, nor should it. Epic may have a substantial advantage but there’s certainly room for Cerner to keep trucking. Still, if Cerner loses the DoD bid it could have a big impact on its business. Now is the time for Cerner to reassure current and potential customers that it’s not planning to scale back if Epic wins.

Why Not “Meaningful Interoperability” For EMR Vendors?

Posted on July 28, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

At this point, arguably, Meaningful Use has done virtually all of the work that it was designed to do. But as we all know, vendors are behind the curve. If they aren’t forced to guarantee interoperability — or at least meet a standard that satisfies most interconnectivity demands — they’re simply not going to bother.

While there’s obviously a certification process in place for EMR vendors which requires them to meet certain standards, interoperability seemingly didn’t make the cut. And while there’s many ways vendors could have shown they’re on board, none have done anything that really unifies the industry.

PR-driven efforts like the CommonWell Alliance don’t impress me much, as I’m skeptical that they’ll get anywhere. And the only example I can think of where a vendor  is doing something to improve interoperability, Epic’s Care Everywhere, is intended only to connect between Epic implementations. It’s not exactly an efficient solution.

A case in point: One of own my Epic-based providers logged on to Care Everywhere a couple of weeks ago to request my chart from another institution, but as of yet, no chart has arrived. That’s not exactly an effective way to coordinate care! (Of course, Epic in particular only recently dropped its fees for clinical data sharing, which weren’t exactly care coordination-friendly either.)

Increasingly, I’ve begun to think that the next stage of EMR maturation will come from some kind of “Meaningful Interoperability” incentive paid to vendors who really go the extra mile. Yes, this is iffy financially, but I believe it has to be done. As time and experience have shown, EMR vendors have approximately zero compelling reasons to foster universal interoperability, and perhaps a zillion to keep their systems closed.

Of course, the problem with rewarding interoperability is to decide which standards would be the accepted ones. Mandating interoperability would also force regulators to decide whether variations from the core standard were acceptable, and how to define what “acceptable” interoperability was. None of this is trivial.

The feds would also have to decide how to phase in vendor interoperability requirements, a process which would have to run on its own tracks, as provider Meaningful Use concerns itself with entirely different issues. And while ONC might be the first choice that comes to mind in supervising this process, it’s possible a separate entity would be better given the differences in what needs to be accomplished here.

I realize that some readers might believe that I’m dreaming if I believe this will ever happen. After all, given the many billions spent coaxing (or hammering) providers to comply with Meaningful Use, the Congress may prefer to lean on the stick rather than the carrot. Also, vendors aren’t dependent on CMS, whose involvement made it important for providers to get on board. And it may seem more sensible to rejigger certification programs — but if that worked they’d have done it already.

But regardless of how it goes down, the federal government is likely to take action at some point on this issue. The ongoing lack of interoperability between EMRs has become a sore spot with at least some members of Congress, for good reasons. After all, the lack of free and easy sharing of clinical data has arguably limited the return on the $30B spent on Meaningful Use. But throwing the book at vendors isn’t going to cut it, in my view. As reluctant as Congressional leaders may be to throw more money at the problem, it may be the only way to convince recalcitrant EMR vendors to invest significant development resources in creating interoperable systems.

Hospital to Turn Off EHR Access for Doctors Who Haven’t Finished ICD-10 Training

Posted on July 27, 2015 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 article is pretty shocking. I can imagine how well this would go over at most hospitals. I hope we get to hear how well this strategy works and who will win what appears like a game of chicken between the doctors and hospital. Does the hospital need the doctors more or do the doctors need the hospital more?

Here’s an excerpt from the article linked above that describes what they’re doing:

“There is a ‘go live’ date for these changes that is Oct. 1 for everyone across the country, including us, so we felt it was very important that all medical providers be trained,” Groves said. “We set a date of July 27, which is Monday — if they have not done the training by then, their access to Soarian will be cut off.”

If they don’t have access to the EHR, that’s basically saying that a doctor can’t practice at that hospital, no? It’s interesting that access to the EHR is being used as essentially revoking privileges to be a doctor at a hospital. I can hear many doctors initial reaction being that they didn’t want to access the EHR anyway. Although, it’s a lot more complex than that response would describe. Can you practice medicine at a hospital that has an EHR without having access to the EHR? I believe the answer is no unless the hospital makes some extraordinary concessions to a doctor (not likely to happen in the hospital mentioned above).

What do you think about using EHR access as a way to motivate doctors to do something? Is that a good strategy? Will we see it happen more?

ICD-10 – Is Your Hospital Ready?

Posted on July 22, 2015 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.

There’s been some interesting ICD-10 news coming out lately. It make sense since we’re just over 2 months from the October 1st implementation date. I recently made the case that there will be no more ICD-10 implementation delay now that AMA and CMS have joined together. I think that’s the best assurance we can get that ICD-10 will go forward with no more delay. Although, I’m sure that many hospitals will still play Russian roulette and hope for another delay. I think that’s a dangerous strategy.

For those people that still think ICD-10 is a joke (and there are plenty of funny codes), Jennifer Della’Zanna did a good job looking at the “funny ICD-10 codes” and providing some perspective. My biggest takeaway from her analysis is that there have been funny ICD-9 codes and we didn’t make a big deal out of it. Why are we making a big deal out of the rarely used “funny” codes in ICD-10?

Leave it to Brad Justus to put the funny ICD-10 codes in perspective with a little humor:

What are you doing to get prepared? Have you checked with your software vendors? Do you know that they’re really ready or just gotten lip service? Not all ICD-10 implementations are created equal. Will your payers be ready? Do you have an ICD-10 claim monitoring service so you can know which payers aren’t ready on go live date? How’s your ICD-10 training going for your doctors, billers, etc?

I believe that ICD-10 is on its way. Is your hospital ready? Sadly, I think many hospitals won’t wake up to ICD-10 until October 1st. It’s not going to be pretty at those organizations.

New Merit Based Incentive Payment System (MIPS) Whitepaper

Posted on July 20, 2015 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’m not sure why MIPS (Merit-based Incentive Payment System) doesn’t seem to have gotten more attention, but for those not familiar with MIPS, it’s the law that was put in place as apart of the replacement to SGR. What does that mean? MIPS is going to be the framework that’s used to switch from a fee for service based reimbursement environment to a value based care model. Short Story: MIPS is going to be very important to the future of healthcare!

Jim Tate just put out a whitepaper he recently created that covers the details of the MIPS program. If you’re not familiar with what was signed into law, Jim’s whitepaper will be a good place for you to start. Here’s a small section of the whitepaper which will give you a feel for the MIPS program:

Under MIPS, high-performing providers will be rewarded and low-performing providers will be penalized. It is designed to strengthen, incorporate, as well as consolidate the financial impacts of the MU of CEHRT, PQRS, and VBM programs. The current incentive programs will be combined and a composite threshold performance score (scale 0-100) will be established aimed at informing providers of the levels of reimbursement based on four key performance measures: resource use, MU, quality, and clinical practice improvement activities.

There are four performance categories for deriving a provider’s potential annual score (0-100 points) for MIPS: 25 points for the MU of CHERT, 15 points for clinical practice improvement, up to 30 points for VBM-measured quality and 30 points for the VBM-measured resource use. The details for the MIPS program will be determined by CMS. 2017 will be the first MIPS performance year and those scores will lead to potential payment adjustments in 2019.

Check out Jim’s whitepaper for a lot more details. You can be sure we’ll be talking a lot more about MIPS in the future. Understanding MIPS is going to be extremely important for every healthcare organization. Get ready to put together whole teams of people to make sure you understand MIPS and are able to comply.

Key Big Data Challenges Providers Must Face

Posted on July 17, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Everybody likes to talk about the promise of big data, but managing it is another story. Taming big data will take new strategies and new IT skills, neither of which are a no-brainer, according to new research by the BPI Network.

While BPI Network has identified seven big data pain points, I’d argue that they boil down to just a few key issues:

* Data storage and management:  While providers may prefer to host their massive data stores in-house, this approach is beginning to wear out, at least as the only strategy in town. Over time, hospitals have begun moving to cloud-based solutions, at least in hybrid models offloading some of their data. As they cautiously explore outsourcing some of their data management and storage, meanwhile, they have to make sure that they have security locked down well enough to comply with HIPAA and repel hackers.

Staffing:  Health IT leaders may need to look for a new breed of IT hire, as the skills associated with running datacenters have shifted to the application level rather than data transmission and security levels. And this has changed hiring patterns in many IT shops. When BPI queried IT leaders, 41% said they’d be looking for application development pros, compared with 24% seeking security skills. Ultimately, health IT departments will need staffers with a different mindset than those who maintained datasets over the long term, as these days providers need IT teams that solve emerging problems.

Data and application availability: Health IT execs may finally be comfortable moving at least some of their data into the cloud, probably because they’ve come to believe that their cloud vendor offers good enough security to meet regulatory requirements. But that’s only a part of what they need to consider. Whether their data is based in the cloud or in a data center, health IT departments need to be sure they can offer high data availability, even if a datacenter is destroyed. What’s more, they also need to offer very high availability to EMRs and other clinical data-wrangling apps, something that gets even more complicated if the app is hosted in the cloud.

Now, the reality is that these problems aren’t big issues for every provider just yet. In fact, according to an analysis by KPMG, only 10% of providers are currently using big data to its fullest potential. The 271 healthcare professionals surveyed by KPMG said that there were several major barriers to leveraging big data in their organization, including having unstandardized data in silos (37%), lacking the right technology infrastructure (17%) and failing to have data and analytics experts on board (15%).  Perhaps due to these roadblocks, a full 21% of healthcare respondents had no data analytics initiatives in place yet, though they were at the planning stages.

Still, it’s good to look at the obstacles health IT departments will face when they do take on more advanced data management and analytics efforts. After all, while ensuring high data and app availability, stocking the IT department with the right skillsets and implementing a wise data management strategy aren’t trivial, they’re doable for CIOs that plan ahead. And it’s not as if health leaders have a choice. Going from maintaining an enterprise data warehouse to leveraging health data analytics may be challenging, but it’s critical to make it happen.

Are 3 Square Meals the Key to Avoiding Hospitalizations?

Posted on July 16, 2015 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin is a true believer in #HealthIT, social media and empowered patients. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He currently leads the marketing efforts for @PatientPrompt, a Stericycle product. Colin’s Twitter handle is: @Colin_Hung

We’d like to welcome a new guest blogger to our ranks. If you’re on social media, you probably know Colin Hung (@Colin_Hung), Co-Host of #hcldr. Colin is also head of Marketing for @PatientPrompt, a product offered by Stericycle Communication Solutions. We look forward to many posts from Colin in the future.

On our weekly #hcldr (healthcare leadership) tweetchat, we had two special guests who have done pioneering healthcare work – Leonard Kish (@LeonardKish) and Dave Chase (@chasedave). Together Kish and Chase authored the #95Theses, a wonderful call-to-action for those of us in healthcare that’s written in same style as the seminal Cluertain Manifesto.

The first topic of last night’s #hcldr chat was “What are some creative/effective ways patients can use to avoid hospitalizations?”. There were many interesting and insightful answers, but one tweet from Chase really caught my eye:

The first statement was fascinating – Meals on Wheels as a way to reduce hospital admissions.

This concept is at the heart of the discussion around Social Determinants of Health (#sdoh) – a topic that has gotten a lot of buzz over the past couple of years. There is a really great definition of SDOH on the WHO website. I’d also recommend this blog post from John Lynn on a similar topic from earlier this year.

As we move towards a system that is based on wellness rather than sickness, I wonder if healthcare providers and organizations will look to preventative measures such as providing meals or teaching basic nutrition as a way to keep their communities healthy? Will the day come when this type of service will become necessary for a provider to remain relevant?

I doubt that most providers and healthcare organizations will reach this point by their own volition. However, I do believe that some innovative organization and entrepreneurial companies will emerge that will make this a reality in specific communities.

I would love to see a future where we will have community wellness centers where we used to have hospitals – places where local people can gather to learn about how to stay healthy and get social as well as emotional support from their peers. These centers would be helped by a network of technologies that combine an individual’s personally tracked data with insights gleaned from “Big Data” analytics resulting in a personalized wellness plan. A plan that includes recommendations for 3 square meals each day that would optimize a person’s health and has the facilities to then create those meals and a mechanism to deliver them (especially to elder adults who lack mobility).

I am excited and intrigued by the possibility that something as simple as a meal can be the key ingredient in reducing healthcare costs while improving health.

Know anyone who is doing this already?

Why Should You Invest in Health Information Governance?

Posted on July 14, 2015 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.

Hospitals are becoming large data centers of health information. In some ways, they’ve always been the storage facility of health information, but how we store, transfer, access, and share health information is dramatically changing in our new digital world. Plus, the volume of information we collect and store is expanding dramatically. This is why health information governance is becoming an extremely important topic in every hospital.

In order to better understand what’s happening with health Information Governance, I sat down with Rita Bowen, Senior Vice President of HIM and Privacy Officer at HealthPort, to talk about the topic. We shot these videos as one long video, but then chopped them up into shorter versions so you could more easily watch the ones that interest you most. You can find 2 of the videos below and 3 more over on EMR and HIPAA.

Who Should Manage Information Governance at Healthcare Organizations?

Why Invest in Health Information Governance?

Finding New People on Healthcare Social Media and The Power of Showing Gratitude

Posted on July 13, 2015 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 know that many in healthcare aren’t sure how to get started with social media. The reality is that Twitter is not very fun until you’re following 50-100 smart people that share interesting content, tweets, images, and videos. Once you do that, your entire Twitter experience changes because it’s a great font of learning and connection.

In case you don’t read one of my other blogs, EMR and HIPAA (and if you don’t why don’t you?), we recently announced the #HIT99. For those that don’t want to click into the post, you can basically include the hashtag #HIT99 in a tweet along with someone you want to nominate for the #HIT99 and why you’re nominating them. You can see that a lot of #HIT99 nominations have occurred.

For those of you new to social media, following people nominated to the #HIT99 is a great way for you to discover smart, interesting people in healthcare IT. Follow 50-100 people nominated and you’ll start to love Twitter and all you learn on it. The #HIT99 is a smorgasborg of social media discovery and connection. Finding new, interesting people to follow is always a treat. The #HIT99 provides the perfect opportunity to find and connect with new people you’d have never “met” otherwise.

Of course, if you’re already on social media, there’s a lot more to the #HIT99 if you participate. The #HIT99 asks that you mention why you’re nominating someone. These displays of gratitude are powerful for you and the person receiving it. Even if you don’t want to participate in the #HIT99, think about doing something similar using whatever medium you prefer. It’s a powerful idea that will reap major rewards for everyone involved.

I look forward to many in the Hospital EMR and EHR community participating in the #HIT99. In case you need an example, here’s a nomination that I sent (and is a great person to follow):

Let’s let the social media connection and gratitude flow! We can use more of that in this world.