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Hospital EMR and EHR Tops 400,000 Pageviews

I was flipping through my stats today and I was amazed to find that Hospital EMR and EHR just blew past 400,000 pageviews. We’re about 1 month away from the third anniversary for this site. I’d say that’s pretty amazing growth over that time period. Thanks everyone who’s been reading.

For those who love stats, we’ve published 583 posts in that time with 1844 comments. That means that a lot of you have been commenting on the site. Thanks so much!

I checked out the posts with the most comments and it was a tie between the following two posts:
Why Is It So Hard to Become a Certified Epic consultant?
Could Epic End Up The Victim Of Its Own EMR Success?

A couple of my other favorite posts are in the top 10 for comments:
Judy Calls Epic “Most Open System I Know”
“Old Boys Club” of Healthcare IT
Why Don’t We Groom the Next Generation of Health IT Leaders?

All of those posts are still really interesting today. I took a look at the stats for the most viewed posts and the above posts were all in there as well. That seems like statistics at work.

I wanted to recognize a key sponsor of Hospital EMR and EHR as well. Canon has been a sponsor of the site for a number of years now. If you need a scanner in your hospital (and sooner or later we all do), then take a look at the Canon products. I have a great Canon scanner in my office and I love that it just works. As much as I try to purge paper from my life, there are always many situations where I just need to scan something. I know in many hospitals they have dedicated scanning teams. Finding the right scanner for these people is really important. I appreciate Canon supporting the work we do on this site.

If any of you reading focus on the hospital healthcare IT market, we’d love to talk with you about our advertising options as well. Just drop us a note on our Contact Us page.

Thanks everyone for reading and supporting the site. We’ll keep providing the best quality information we can find.

April 18, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Hospital EMR and EHR Recruiting

Late last year, I acquired the healthcare IT career website Healthcare IT Central. Since bringing Healthcare IT Central into the Healthcare Scene family, I’ve dove head first into the healthcare IT Recruiting and career space. It’s been quite an adventure with a lot of great learning for me along the way.

What I’ve learned most is that there are some really amazing people working in healthcare IT and some really amazing companies that are trying their best to make healthcare better. There are a lot of screwed up things in healthcare, but the people are generally good people and a real pleasure to work with.

Health IT Job Seekers
If you’re in the job market and looking for a healthcare IT job, take a few minutes to register as a job seeker where you can upload your resume and apply for jobs at some of the top healthcare IT companies. Also, be sure to check out some of these popular job searches:

Of course, you can always do your own health IT job search using the criteria that matter for you. All of this is all free for the job seeker.

Health IT Employers
If you’re a health IT company or a hospital organization looking to hire qualified healthcare IT professionals, you can register and post your jobs as well. We just passed over 20,000 registered job seekers and are getting close to 11,000 active health IT focused resumes.

We also have other options available to employers like eNewsletter sponsorships (almost 16,000 email subscribers), webinars, and resume database access where you can search for specific candidates.

We’re working really hard to be an amazing health IT career resource for both job seekers and employers. If you have any feedback on the site and what we’re doing, we’d love to hear it on our contact us page.

April 17, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

A Meaningful EHR Certification

In many ways this post could be considered a continuation of my previous post on data liberation. I’ve really loved the idea of a creating a meaningful EHR Certification and that could include data liberation. Let’s be honest for a minute. Do any of you find value in the current EHR certification?

You know that a certification is screwed up when it requires certain interoperability standards and then when you go to actually implement the sharing of data between two systems you find out that the two systems are working on two different standards. They are close standards, but close doesn’t count with standards. Many have asked the question, “What did the EHR certification do if it couldn’t test the standard?” I have no answer to that question.

Now imagine we created an EHR certification that actually did require a standard for interoperability. Not a flavor of a standard, or something that closely resembles a standard. I’m talking about a standard. Would hospitals find this useful? I think so.

Another example of a meaningful EHR certification could be certifying that an EHR vendor will not hold your EHR data hostage. Think about how beneficial that would be to the industry. Instead of EHR vendors trying to trap your data in their system, they could focus on providing the end user what they need so the end user never wants to leave that EHR. What a beautiful shift that would be for our industry.

There could be many more things that could be meaningfully certified. However, this would be a simple and good place to start. I have no doubt that some would be resistant to this certification. That’s why those who do become meaningfully certified need to get the proper boost in PR that a meaningful certification should deserve. No EHR vendor wants to be caste as the EHR vendor who can’t figure out the standard and that holds its customers hostage. Yet, that’s what they’re able to get away with today.

What do you think of this idea?

April 16, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Data Liberation Is The First Step Towards True Collaboration

I generally agree with this idea. It’s really hard to collaborate with someone if you’re not sharing the data about a patient. So, data liberation can be a true enabler for collaboration.

While I think most hospital CIOs will agree with this, I wonder how many act like data liberation is an important strategy for them. Is data liberation really a core value of their hospital organization? My guess is that for most of them it is not.

One major place they can start to make this part of the culture is in the procurement and contracting process. Software vendors are going to happily keep the data as closed as possible unless you require it of them in the contract stage. Once hospital systems make data liberation part of the IT systems procurement process, then we’ll finally be able to see the benefits of data liberation.

The problem we have today is that data liberation and sharing wasn’t part of the previous procurement and contracting process. My guess is that most assumed that being able to share data would be allowed, but few people looked at the fine print and realized what it would mean to them when it came to data sharing. Thus, we’re in a situation where many organizations have contractual issues which make data sharing expensive.

It will take a cycle of new contracts for this to be fixed, but even then it won’t be fixed if you’re organization doesn’t add this to their agenda. Software vendors happily provide the customer what they demand. We need more hospital organizations demanding data liberation.

April 15, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

HIPAA Breach at Kaiser

Healthcare IT News reported that Kaiser had it’s Fourth HIPAA breach. Here’s a part of their description of the breach:

Some 5,100 patients treated at Kaiser Permanente were sent HIPAA breach notification letters Friday after a KP research computer was found to have been infected with malicious software. Officials say the computer was infected with the malware for more than two and a half years before being discovered Feb. 12.

We have confirmed that the infection was limited to this one compromised server, and that all other DOR servers were and are appropriately protected with anti-virus security measures,” said Tracy Lieu, MD, director of the division of research at Kaiser Permanente, in an emailed statement to Healthcare IT News. “It is important to note that the compromised server is used specifically for research purposes at the DOR and is not connected to Kaiser Permanente’s electronic health records system.

It’s quite interesting that in one part they say that the computer was infected with malware and that caused the breach. Then, they note that the antivirus software wasn’t being updated properly because of a “human error related to configuration of the software.”

This is a little disturbing to a tech person like me, because the person doesn’t know the difference between anti-virus software which works to stop and prevent viruses from infecting your computer and malware which usually isn’t covered by anti-virus software. They do have malware software to prevent malware, but it’s only so so in my opinion. It’s fighting a losing battle, but an important battle nonetheless.

I bet if we went into any hospital today, we’d find dozens of their computers infected with malware. Would be an interesting study for someone to do. I know many hospitals lock their computers down and block them from surfing many internet sites to try and deal with this problem. That can be pretty effective, but you do make many of your users angry in the process. The IT security people don’t mind that at all. Luckily, with phones people can still get their Facebook IV drip without having to infect the hospital computer. That is until the personal mobile phone gets compromised and infects the hospital network. That’s coming down the road as well.

April 14, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

HHS Secretary Sebelius Resigns

The big news coming out of Washington yesterday was that Kathleen Sebelius is resigning as secretary of HHS. This is the end of a stormy 5 year tenure filled with Obamacare and the famed roll out of Healthcare.gov. I can’t imagine the temporary SGR fix and the ICD-10 delay didn’t help keep her around longer either. For those of us who live and breathe the HITECH Act and EHR incentive money, my guess is that the $36 billion is barely a blip on Sebelius’ radar.

Word is that she chose to leave and wasn’t forced out by the administration. To be honest, would any of you have wanted to be in her position? What a tough job she’s had. Many called for her resignation after the botched Healthcare.gov roll out, but she stayed. At least she stayed long enough for that to mostly roll through.

In fact, I find the headlines of her departure pretty interesting. For example, the New York Times says, “Sebelius Resigns After Troubles Over Health Site.” Farzad pointed to an article by Vox that says, “Kathleen Sebelius is resigning because Obamacare has won.” Seems like the headline people choose/tweet is in line with their politics.

Word is that Sylvia Matthews Burwell will be nominated as Sebelius’ replacement. You can read more about Burwell here. I saw a doctor tweet the question of whether this is the best we can do, someone with work history at foundations. I imagine many doctors feel the same way. Although, we all understand that the HHS secretary is very much part of the political discussion.

All in all, I don’t think Sebelius being gone will mean much change for those of us in the trenches.

April 11, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Outsourcing Your Disaster Recovery Team

I imagine most hospital CIOs are overwhelmed by the total number of systems and applications that they have to support. Hospital systems can have hundreds of applications that they’re required to support. Along with having to support the day to day operations of these systems, you also have to plan for business continuity and disaster recovery as well.

Every 6 months to a year, it seems we get a stark reminder of the need for good disaster recovery thanks to some devastating hurricane, earthquake, or other natural disaster. Plus, the stories of Hurricane Katrina and Super Storm Sandy and their impact at hospitals still ring in my ears and likely many other hospital CIOs.

Considering this background, I was intrigued by this Florida Hospital Case Study on Disaster Recovery. Obviously, Florida sits out there in a position that’s just waiting to be hit by a hurricane. So, good disaster recovery is a necessity for them.

What was most intriguing to me was that this hospital chose to use a managed recovery program from SunGard to make this a reality. While I don’t suggest outsourcing all of your disaster recovery (you need in house expertise deeply involved), I think it’s a great idea to work with a third party provider for your disaster recovery.

First, there are so many systems that it’s great to have a third party hold you accountable for all of your systems. Second, a third party can ensure that you do proper and regular disaster recovery testing of your systems. Third, they can provide an outside perspective that can improve your internal approach to disaster recovery.

Many of the above items can be done in house as well, but we all know that there’s a certain level of accountability that comes from having paid someone to hold you accountable. Otherwise, it’s really easy for one of your staff who’s being pulled in a hundred different directions to let your disaster recovery program slip through the cracks.

April 10, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

What About Data Beyond the EMR?

I saw this tweet from the famous @HealthcareWen which asks a really good question:

While I enjoy the humor of the tweet as much as the next person (everyone who knows me knows I’m all about the humor), this conversation reminds me a lot of what was done with ICD-10. The “funny ICD-10 codes” got all the attention and made ICD-10 a joke in the minds of so many people. This was highlighted by this guest post on EMR and HIPAA called “Why Do People Find ICD-10 So Amusing?” Those who support the shift to ICD-10 did a poor job explaining why ICD-10 was valuable to the quality of care a patient gets. Talking about all the funny ICD-10 codes (and they are funny) goes against the goals of those who see value in the move to ICD-10.

I bring this up because the same thing could easily happen with big data in healthcare. While it’s funny to think about how a doctor might treat us if they know we had a donut for breakfast, there are really meaningful data sources beyond the EMR. If we focus too much on the periphery of the data, then we’re going to miss out on a lot of the value that comes from the not so funny parts of big data.

Right now our EMR systems can’t support most of the data that could come from outside the EMR. However, that shift is going to happen and it’s going to happen quickly. My gut tells me that it will start with the wave of consumer centric medical sensors. Then, I see genomic and social data getting integrated next (both really large projects). These three areas will set the baseline for how outside data is integrated with the EMR data.

Let me offer the key points to consider in these data integrations:
-Automated: The data must pass seamlessly without the need for user interaction
-Smart Data: The user of the system needs the system to be smart. The user should only be notified with what’s actionable, but with the ability to drill into the data as needed.
-Bi Directional: The data needs to be seen and updated by both provider and patient. The system will need to have a great way to track who updated which data. However, we need both the patient and providers eyes on the data with the ability to update incorrect data.

These points should illustrate why integrating outside data is going to be such a challenge. However, it’s also why it holds such promise.

April 4, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Weird News Wednesday – Man Arrives at Hospital with a Chainsaw Stuck in His Neck

I saw this picture and I knew that I just had to share it even though we usually don’t cover this sort of topic. It’s a picture from a hospital where the guy showed up with a chainsaw in his neck:

This isn’t really a health IT story like we usually do, but I will offer one health IT twist. You just really never know what’s going to come through the doors of the ED. You can plan for a lot in healthcare, but not everything. Maybe some of those funny ICD-10 codes are more common than we think.

April 2, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

The Forgotten Argument For ICD-10

The following is a guest post by Eric Hodge, Service Line Executive for Revenue Cycle and ICD-10 at Encore Health Resources.

Yesterday evening, the United States Senate joined the House of Representatives in Washington D.C., voting to delay ICD-10 adoption until October 2015.  That’s no surprise.  Truth be told, the vast majority of discussion related to ICD-10 has been all about how difficult it will make our lives.

Providers are asking, “Why is HHS forcing this down our throats when it obviously won’t help me do my job any better?” The AMA is throwing out headlines like, “ICD-10 Compliance Costs Are Triple What Was Expected,” while reminding us that they warned us all along. Now, many commentators are declaring the whole shmeer a disaster before it even goes live.

This attitude has skewed the thinking on ICD-10. Few providers are asking how they will benefit from the new information; the vast majority are simply asking how they will survive getting ready to meet the requirement. And that’s too bad, because what we as providers, as an industry, and even as an economy will find that ICD-10 is a key step toward gigantic improvement in how healthcare works in the U.S.

I am not going to argue that the transition is coming without cost or discomfort. But I am saying that this is how large-scale improvement of a system (a broken system, don’t forget) works, and that the benefits are clear and significant, at least for those who get past our first reaction (“Change frightens me!”) and take the time to understand what kind of system this whole healthcare reform effort is trying to build.

Benefits that I have seen with my own two eyes include:

  • Dramatic improvement in the assignment of costs to procedures performed. Most industry observers agree that we ought to move toward rewarding activities that keep a population healthy instead of getting paid for how many times we can treat a patient. Most would also agree that identifying the costs associated with certain disease states or treatments is the key to figuring out economical ways to promote healthy populations. ICD-10 will allow us to develop meaningful estimates about what a disease state or a procedure costs us, while ICD-9 is limited in what it can do in this regard.

    For example, I was working with a well-regarded regional hospital in the Mid-Atlantic on an effort to improve their charge capture. They knew they were losing money in their obstetrics operating room, but they were having a hard time figuring out exactly what was going on. Using ICD-9 information, all we could tell was that there were wildly variable times that a patient would spend in the OR for a cesarean procedure, but we could not gather any more detail. ICD-9 diagnosis codes do not have very specific information about the severity of the condition or comorbidities. Fortunately, this hospital was dual-coding at the time, and we were able to take advantage of the severity information included in the ICD-10 codes to identify the fact that they had a relatively high percentage of moderate and severe diagnoses — complications that were likely to lead to longer OR times and higher resource consumption (costs) to the hospital.

    This information allowed them to build a business case for establish pricing tiers for their OB OR services and gave them the information they needed to turn obstetrics surgery into both a profitable activity center and one that could revise treatment protocols for high-resource-consumption patients (costs).

    Could this have been done without ICD-10 data? Probably. But it would have taken many hours of chart review and qualitative analysis instead of the several dozen key strokes of a database query.

  • Identify opportunities to avoid cost and improve lives. The additional information inherent in an ICD-10 diagnosis code includes severity and specific comorbidity, as illustrated in the OB OR example, but it can also include information about demographics and some of the underlying reasons for the diagnosis. All of this information can easily be combined to make decisions that will save lives while cutting costs for a provider.

    I was working with a multi-facility provider in New England on vendor selection for revenue cycle technology, and I visited the cancer clinic. In talking with the nurses there about the kind of data that would help them care for their patients, they let me know that they would like to be able to flag patients with a high chance of readmission. One of the nurses told me that after 22 years of experience, she knew that a patient who was over 80 with moderate or severe lung cancer and a history of mental illness was going to be readmitted within three weeks. “And wouldn’t it be nice,” she said, “if my new system could flag those patients when they came in for an appointment?”

    Well, only ICD-10 codes include severity of illness, age, and the latitude to include reasons for a diagnosis. In this case, included in the diagnosis code was the fact that the patient was non-compliant in taking his/her medication. We were able to model this scenario for ICD-10 and identify these patients with a simple data query – in minutes. This allowed the clinic to first confirm the nurse’s intuition about those high-risk patients, and second to identify those patients who could use a case manager’s involvement to ensure that they are compliant with their regimen, saving the costly readmission and improving the quality of the patient’s remaining life.

    Again, this sort of effort is possible with ICD-9, but it would take chart reviews, extensive manual analysis, and aggregation of data from several sources to model this type of patient for predictive purposes. This organization did not have the extra resources or the budget to undertake such an effort.

  • Share higher-quality data with other providers and partners. When I meet with providers who are trying to figure out whether to start or join an Accountable Care Organization (ACO), the first question is generally, “What is this big pile of aggregated data going to do for us?” Actually, that’s the second question after, “What incentive dollars am I going to get for doing this whole ACO thing?” But it should be the first question.

    As the data sets grow larger, the ability to parse information into meaningful subsets will become more important. ICD-10 increases the amount of specific information in every diagnosis code and actually makes these large, aggregated pools of data from many providers useful. For example, ICD-9 has a code for laceration of an artery. ICD-10 lets you know if that artery was in someone’s finger or in their heart. If I want to be able to pull meaningful information out of my ACO data sets, I need to have the information that is included in ICD-10.

    I have helped organizations use aggregated diagnosis data like this to decide whether pursuing certain services in certain markets will pay off for them. We helped a provider in Washington State decide to extend its diabetes education services into rural Oregon and Idaho by demonstrating that there were enough diagnosed patients to support that business. This type of analysis becomes much faster and easier with ICD-10 data.

There are dozens of other tangible benefits to ICD-10 analytics, but this is a blog entry, not a thesis. Briefly, some of the biggies:

  • Being able to aggregate our diagnosis and procedure information with the rest of the industrialized world, which has already demonstrated that the benefits of ICD-10 will significantly advance healthcare service in the US. There are lots of sick people outside America, too, so being able to combine our coding data with theirs for analysis would be most helpful.  For example, the US has benefited from the increased data collected about the Avian Flu and how to best treat the disease based on ICD-10-collected information.
  • Reimbursements will better align with activity and cost. Payers will reimburse severe and complex cases better and simple cases at lower rates – because now they will be able to identify them as simple or complex from the codes. Those providers whose costs are higher will get paid more. Those whose resource costs are lower based on actual services rendered will get paid less. This principle is how the rest of the free market works; it should also work well in healthcare.
  • Outcome analytics will become more accurate and more efficient. I can quickly determine what happened to my severe CHF cases without having to go back through every single one of their charts or pull in data from multiple sources to figure out which CHF patients were only moderate or mild.
  • Population-based projections will become much more possible. If you want to look at the incidence of advanced diabetes in the aged population in southeast Missouri so you know how to negotiate your value-based reimbursement contracts, you can use ICD-10 data or you can go do a lot of legwork.

The point here is that ICD-10 makes coding information detailed enough so that American providers and payers can make healthcare work in ways that it doesn’t work now: like a free market, with costing and pricing that accurately reflects the effort and the expense. Like a continuously improving system where better courses of treatment are developed for more specific populations. And like a system where we try to prevent high cost and lousy outcomes before they happen.

Looks like we’re going to have to wait until 2015 before we see many of these benefits.

April 1, 2014 I Written By