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Epic Wants to Be Known for Interoperability – Are They Interoperable?

Posted on September 19, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

Epic has been fighting the stigma of being a closed system for a while now. It seems that Epic isn’t happy about this characterization and they’re coming out guns blazing to try and show how Epic is interoperable. They’re so interested in changing this perception that Epic recently hired a lobbyist to change how they’re viewed by the people in DC.

A recent tweet highlighted a slide from the Epic user conference (Epic UGM) that shows how many Epic patient records they’re exchanging per month. Here’s the tweet and graph below:

Farzad Mostashari asks a very good question, “Does that graph help?” I find Farzad’s tweet also interesting because just over a year ago Farzad tweeted another Epic interoperability chart when he was still National Coordinator at ONC. I’ll embed the previous chart below so you can easily compare the two graphs side by side:
Epic Data Sharing Chart

I think Farzad is right to be skeptical about Epic’s claims to interoperability. First, it seems Epic is finally making some progress with Epic to Epic interoperability, but Epic to Non-Epic systems is still far behind. Second, Epic loves to claim how they have charts for some huge percentage of the US population (currently about 314 million people). I bet if we looked at the percentage of total Epic charts that have been exchanged, it would be an extremely small number. I also wonder if the charts above count a full patient chart or something simple like a lab result or prescription.

I don’t want to harp on this too much, because this is a step forward for Epic. Even if they’re not as interoperable as they could be and as we’d like them to be, I’m excited that they’re now at least open to the idea of interoperability.

With that said, I wish that Epic would spend more time and effort on actually being interoperable and not just trying to say that they’re interoperable. This includes committing the resources required to support connections outside of Epic. I’ve heard over and over from health IT vendor after health IT vendor about how hard it is to get Epic to work with them in any form or fashion. There’s a way that Epic could scale their effort to hundreds of other health IT vendors, but they haven’t made the commitment to do so.

Think about the opportunity that Epic has available to them. They have enough scale, reach and clout that they could by force of size establish a standard for interoperability. Many health IT vendors would bend over backwards to meet whatever standard Epic chose. That’s a powerful position to be in if they would just embrace it. I imagine the reason they haven’t done so yet is because the market’s never demanded it. Sometimes companies like Epic need to embrace something even if it doesn’t drive short term sales. I think this is one of those choices Epic should make.

I’m sure that lobbyists can be an effective solution to change perceptions in Washington. However, a far more effective strategy would be to actually fully embrace interoperability at every level. If they did so, you can be sure that every news outlet would be more than excited to write about the change.

Healthcare IT Leadership Infographic – A 25 Year History

Posted on September 17, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

Always a fan of an infographic, I thought many of my readers here would be interested in this Healthcare IT Leadership infographic that HIMSS and HIMSS analytics just put out for National Health IT Week. Pretty interesting data that HIMSS has been collecting in their annual leadership survey for the past 25 years.
Health IT Leadership Infographic - A 25 Year History

Hospitals and Wearables

Posted on September 12, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

I’ve been pretty closely following the various wearable options that have been entering the tech marketplace as part of my mobile health coverage. The most recent coverage is of the Apple Watch that was just announced. It’s a fascinating market and one that’s just barely getting started. It includes everything from smartwatches to eyeware (led by Google Glass) to contact lenses to fitness trackers to even your smartphone and more.

As I think about the wearable marketplace, I was thinking about how these wearables will apply in the hospital setting. I’d divide wearables impact on hospitals into two main categories: enterprise wearables and consumer (patient) wearables.

Enterprise Wearables
In the enterprise wearables space, I think we’ve seen the most traction with Google Glass. There are a whole plethora of eyeware computing companies that are using Google Glass in enterprise applications in hospitals. I’d say that most of the solutions revolve around telemedicine like applications, but we also see a few that are starting to integrate with other outside data and displaying that to the doctor. We’ve also seen a few applications where Google Glass has been used to document something for the patient. I’m interested to see how these technologies evolve over time. The tests of all of these things are so early that it’s hard to say if they are must have features for every hospital organization.

I have yet to see an enterprise smartwatch implementation. I expect that the first implementation will likely be in the healthcare communication space. One challenge in hospitals is definitely around hospital communication. Access to various messages on your watch could make accessing them easier. I’m not so bullish on this idea because it’s not that much easier than just pulling out your smart phone.

In the enterprise wearables world, what does seem clear to me is that these applications will have to integrate with the legacy systems. There are a few implementations (ie. Telemedicine applications) where this isn’t completely necessary, but the applications will have limited benefit to a hospital without a great integration with the other hospital systems.

Patient Wearables
I’m much more bullish on the various patient wearables. Many of these wearables were designed for consumers, so it makes sense that they would work well for consumers. Take for example, a smart watch. What a perfect way to track a diabetic and remind them of appropriate treatment. I’ve seen this done with smartphones and that’s pretty smooth, but a watch is even easier. Done right, it can be made so easy, even my mother could do it (no offense to my mother, but she’s not very technical). I love that type of monitoring and tracking that could be done with patients and hopefully reduce hospital readmissions and ensure care plans are followed. I haven’t seen anyone doing it yet, so maybe that’s an opportunity waiting for you.

I’m less excited about eyeware computing with patients. There might be some edge cases, but I haven’t seen or heard of any great patient focused applications with Google Glass. If you know of some, I’d love to hear of any.

Those are a few of my thoughts on wearables in the hospital. I’m sure there are plenty of implementations and technologies I’m missing. It’s a rapidly changing area. I’d love to hear your thoughts on what’s happening with wearables in hospitals or things you think could or should happen with them.

Thinking About 9/11

Posted on September 11, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

Today we’re going to see a rash of tributes for September 11th. I think that’s beautiful and wonderful. My football team, BYU, is playing Houston tonight and they even have 9/11 tributes on their helmet with the American Flag incorporated into the logos. I love it. I hope we never forget the tragedy of that day.

Although, I can easily see why tragedies are too quickly forgotten. I’ll certainly never forget what happened that day because I saw it. However, my children weren’t alive and so they have no memory of that day. They just have the stories we tell them. In some ways, that’s a good thing. Our lives need to continue forward and we shouldn’t let a tragedy ruin our lives. However, just because we continue forward with our lives, it’s important to remember the lessons of that day. I’m sure those that experienced the tragedy of Pearl Harbor feel the same way. If it weren’t for a little help from Hollywood, I probably would still be pretty naive about what happened at Pearl Harbor.

As I think back on 9/11, what I remember most wasn’t the tragedy of lost lives and the terrible things that occurred (and they were indeed terrible). Instead, I remember most the way the country came together in ways I’d never seen before. There was a unity in the country that likely only occurs after tragedy. It’s unfortunate that unity dwindles away even faster than grief. The lesson I take from it is that service for a noble cause with friends and colleagues is a powerful way to unify people.

Excuse the personal side note, but I wanted to take a few minutes to remember. My thoughts are with all those who lost someone they love that horrible day.

The Various Approaches to Mobility in Healthcare

Posted on September 9, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

I’m about to head down to the CTIA Super Mobility Week conference. I try to attend a few conferences each year that aren’t directly related to healthcare and health IT in order to get a broader perspective on what’s happening in the rest of the world. I think this will be one such case (although, they do have some mHealth sessions and exhibitors as well).

As I started to think about mobility and where it’s headed, the industry is all about the smart phone and smart mobile devices. I think it’s an incredibly powerful concept and one that will only become more important. However, I think that many people are taking it too far. While I love my smartphone and its capabilities, I still love the productivity that’s possible with a great desktop setup with dual monitors, a mouse and a keyboard. I’m not sure we’ll replicate that in a mobile world and I’m not sure we should.

In fact, it’s one of the trends I hate most about many of the website designs that are coming out lately. They are going all in on mobile and in the process they’re killing the productivity of the desktop experience. It’s a travesty and continues to annoy me with many of the applications I use on a daily basis.

We can apply this same principle to healthcare IT. Often we need to step back and ask ourselves if something really needs to be mobile or not. Plus, if we decide to make something mobile, we need to ensure that those who still use the same application in a non-mobile environment have their workflow optimized as well.

At the end of the day, we need to create a much more sophisticated approach to mobile computing. There are many times when a doctor or nurse really need whatever they’re working on to be mobile. There are extreme benefits to having a point of care device which allows the nurse or doctor to document at the point of care. However, there are just as many times when mobility is actually a hindrance to the required workflow.

What are you doing in your organization to leverage the amazing mobile technologies that are out there while still maintaining the optimized workflow?

The Importance of Defining a Legal Health Record with Mary Beth Haugen, RHIA, MS

Posted on September 8, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

In this interview, we sat down with Mary Beth Haugen, founder and CEO of Haugen Consulting Group, about the intricacies and challenges of the legal health record and how it’s been impacted by EHR and other healthcare technology. Plus, we give HIM leaders some firepower on how to convince hospital leadership that defining the legal health record is important for every healthcare organization. Enjoy the video below.

Where Do You Want to Go?

Posted on September 5, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

Our hospital’s a lot like Alice in Lewis Carroll’s classic Alice’s Adventures in Wonderland? You may remember that Alice comes to a crossroads with two paths before her, each stretching onward but in opposite directions. She is confronted by the Cheshire cat, of whom Alice asks, “Which path shall I follow?”

The cat answers: “That depends where you want to go. If you do not know where you want to go, it doesn’t matter which path you take.

I’m afraid that many hospital IT organizations are very much like Alice. They’re so distracted by the operational challenges they face that they don’t really have a good understanding of where they’re going. This is a tremendous problem because it starts to compound itself.

An organization without a steep sense of direction will waffle and go any direction. This will lead to your best employees leaving for greener pastures. No direction and loss of your best people is a recipe for disaster for any organization.

I recently heard that Marc Andreessen’s (created first widely used web browser) personal mantra is “Often wrong but never in doubt.” I’m still chewing on whether I agree with this approach to leadership, but at least there’s no doubt about where a leader like Marc wants to go. There’s power in all team members rowing in the same direction. Even if you have to change course along the way, you’re still getting somewhere. Everyone rowing in different directions just makes you go in circles.

Does your hospital IT organization have a good vision of where they want to go?

Why Don’t We Hear More from Epic, Cerner, or MEDITECH?

Posted on September 4, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

Epic is notorious for being “closed.” In fact, people talk about Epic being closed in so many ways, it’s hard to keep up. However, I think they are mostly seen as closed because of Judy’s decision to almost never talk to the media. In fact, it’s pretty rare that any one from Epic talks to the media. I remember when it was groundbreaking news when someone at Forbes did an interview with Judy.

Obviously, opening yourself to the media isn’t essential to making an enterprise sale. Judy and Epic have done quite well without opening themselves up to the media. In fact, their closed approach has in some cases gotten them more media coverage (see this blog post). Regardless of what you think of Epic, they are largely perceived as a black box that we don’t know nearly enough about. They have been more open with who they are and what they do in the past couple years than they ever were before, but that’s really not saying much.

While many love to talk about Epic’s closed nature, are any of the other hospital EHR vendors like Cerner or MEDITECH much more open? Last I checked, I have’t seen any of the CEOs of these companies blogging about their company and sharing their company’s culture and approach to the future publicly like we see in so many other tech companies. I haven’t seen many of the top leadership at any of these companies active on Twitter or other social media. Do any of these companies really show us any of their humanity? I can’t think of any that do.

The same isn’t true in the ambulatory world. We know all about athenahealth from Jonathan Bush who’s never afraid to bear his soul. SRSSoft and SOAPware have had really active CEOs who’ve openly shared their view of the EHR industry. Those are just a few of the examples. Why don’t we see the same from hospital EHR vendors?

I think the reason why is that it’s never been part of the culture of these companies. Changing that is a really hard thing to do. I don’t see it happening anytime soon. The closest we came to it was when the CEOs of many of these companies joined in the ALS Ice Bucket Challenge. Watching those videos made those companies a little more human. I think that’s a great thing for these companies.

While these companies have proven that you don’t need to engage their community in public to be successful, I’d suggest that the company that does start to do this will be at a distinct advantage. If the existing companies don’t decide to do it, then don’t be surprised if a new company disrupts the market with a more open and human approach. The incumbent EHR vendors won’t know what hit them and likely won’t be able to change the culture fast enough to fight them off.

Assuming you’re working on and doing amazing things for your customers, transparency can be an amazing marketing tool. If you’re not, then it’s better to hide in the shadows.

The Unsustainable Financial Realities of Hospitals

Posted on September 3, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

There’s a great blog post up on the Medsphere blog which talks about the challenging financial realities that hospitals are facing today. I especially like this summary list of the unsustainable healthcare business based on a Moody’s analysis of hospitals:

  1. Private insurers did not increase payments to hospitals.
  2. Medicare reduced payments due to federal budget cuts.
  3. Demand for inpatient services declined as outpatient care options rose.
  4. Retail outpatient options now compete with hospital clinics.
  5. Patients with higher copays and deductibles chose not to seek care.
  6. Hospitals are buying up physician practices.
  7. The costs of electronic medical record systems are impacting the bottom line.

As we talk about why healthcare in the US costs so much money, we always talk about programs that will lower the costs of the healthcare we provide. I often point out that while we love to talk about lowering the costs of healthcare, from a hospital perspective that translates to lowering the revenue they generate while keeping their costs the same. This is the real challenge we face in trying to lower the costs of healthcare. There are really large organizations that stand to lose if we lower the cost of healthcare.

The shift to Accountable Care Organizations and Value Based Reimbusement is a step towards dealing with the issue. If done right, these programs allow a hospital organization to get paid a similar amount while lowering the number of patients they see. The concept is good, but when you get into the details it’s much more complicated with a lot of odd incentives. Plus, I think it’s likely not nearly enough to save many of these hospitals that are already struggling. These programs are new and often just lead to the rich hospitals getting richer.

Unfortunately, as the list above shows, the EHR has been a cost pressure as opposed to a cost saver. Long term, the EHR has the potential to really lower costs, but in the interim many hospitals are suffering under the costs associated with EHR.

It’s not a pretty financial picture for most hospitals. What do you see on the horizon that could change this outlook?