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Andy Slavitt Talks Healthcare Interoperability and Data Blocking

Posted on February 8, 2016 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 all the reporting around meaningful use being replaced (or as many mis-reported meaningful use ending), Andy Slavitt also made a number of other points in his talk at JP Morgan’s Healthcare conference. Much like he did with meaningful use, he live tweeted his talk. Here were a couple of his non-meaningful use tweets that stood out to me.

Has there ever been any doubt that HHS was serious about wanting organizations to be interoperable and for data blocking not to exist? There hasn’t for me. It’s been one of their main goals. The problem is two fold. First, CMS is fighting an uphill battle against the economic realities that not sharing data has been very profitable for healthcare organizations. Second, CMS only has so much power available to them to make interoperability a requirement.

Despite these challenges, CMS is doing everything in their power to encourage and promote interoperability. Put another way, they’re trying everything they can to make it so that interoperability is a wise business decision for healthcare organizations. Although, much of what they’re trying to do also harkens back to a statement I heard from Jonathan Bush, CEO of athenahealth that, “Interoperability should not be used as a point of competition.”

The problem is that today interoperability is used as a point of competition. We’re seeing that change, but it’s slow and there are still many who haven’t made the change. Plus, all of the interoperability solutions that have been offered (yes, I’m looking at the popular FHIR standard) are still quite limited in scope. They’re really just evolutions on existing interoperability and not a revolution to what interoperability should and could become.

Plus, I fear that many of these new interoperability options are really just creating a new market for vendors to charge providers. When you think about it, what’s the easiest way to block the sharing of information? Just charge too much for it. More on this in a future article.

Ironically, I think my perspective on Andy Slavitt’s comments on interoperability and information blocking are not all that different from my view on meaningful use. Andy and the people at CMS are saying the right things. They’re seeing the right dynamics at play in the market place. The problem is that they’re hands are tied in many ways and the bureaucratic process could lead to something even worse if they’re not careful. No doubt they’re dealing with really challenging, complex issues. It’s good to know that their hearts are in the right place. I just hope that regulation and legislation matches it.

EHR, What’s Next?

Posted on February 1, 2016 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.

EHR Whats Next with Dana Sellers

With the announcement that meaningful use is going to be replaced (Not to be confused with meaningful use is dead like many claimed.) along with a maturing of the EHR market, I thought it might be time to ask the question, EHR, what’s next? This discussion should include how to better leverage your current EHR investment, but also look at what other investments organizations should be making to get the most out of everything that’s happening in healthcare IT. On Thursday, February 4, 2016 at 11:30 AM ET (8:30 AM PT), I’ll be sitting down with Dana Sellers, CEO of Encore, A Quintiles Company to talk over what’s next for EHR and healthcare IT.

You can join my live conversation with Dana Sellers and even add your own comments to the discussion or ask Dana questions. All you need to do to watch live is visit this blog post on Thursday, February 4, 2016 at 11:30 AM ET (8:30 AM PT) and watch the video embed at the bottom of the post or you can subscribe to the blab directly. We’ll be doing a more formal interview for the first 30 minutes and then open up the Blab to others who want to add to the conversation or ask us questions. The conversation will be recorded as well and available on this post after the interview.

With an amazing depth of experience, Dana’s been through a wide variety of healthcare IT cycles. I can’t wait to hear Dana’s thoughts on what’s going to happen with meaningful use, how can healthcare organizations better leverage their EHR investment, where are we really seeing analytics and other buzzword worthy terms breaking through, and what other technologies are on the horizon that will improve healthcare? Please join us Thursday and share your experience as well.

If you’d like to see the archives of Healthcare Scene’s past interviews, you can find and subscribe to all of Healthcare Scene’s interviews on YouTube.

Patient Identification and Patient Matching – A Million Dollar Challenge

Posted on January 22, 2016 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.

UPDATE: For those who missed the live discussion, you can watch the recording of our patient identification and patient matching interview in the YouTube video below:

Patient Identification and Patient Matching - A Million Dollar Challenge-blog

Given the recent announcement by CHIME about the $1 Million Patient Matching and Identification competition, I thought it would be the perfect time to explore the challenges of patient identification and matching in healthcare. On Monday January 25, 2016 at 10:30 AM ET (7:30 AM PT), I’ll be sitting down with 2 great experts on patient identification and matching:

The great part is that you can join our conversation live and even add your own comments to the discussion. All you need to do to watch live is visit this blog post on Monday January 25, 2016 at 10:30 AM ET (7:30 AM PT) and watch the video embed at the bottom of the post. You can also subscribe to the blab directly. We’ll be doing a more formal interview for the first 30 minutes and then open up the Blab to others who want to add to the conversation or ask us questions. The conversation will be recorded as well and available on this post after the interview.

I’m excited to talk with Beth and Michael about the impact of poor patient matching on healthcare, the current solutions to the problem, and their thoughts and views on CHIME’s $1 million National Patient ID Challenge. We hope you’ll join us on Monday and share your expertise and questions!

If you’d like to see the archives of Healthcare Scene’s past interviews, you can find and subscribe to all of Healthcare Scene’s interviews on YouTube.

How Rampant is Double Documentation in EHRs?

Posted on January 18, 2016 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 tweet inspired me to talk about the problem of double documentation in an EHR. This is a massive problem for many organizations. Unfortunately, when you look at Many EHR workflows they do require double documentation. Sometimes this is thanks to regulations like meaningful use. Other times it’s medical billing requirements that necessitate double documentation. In other cases patient safety and quality of care requires something to be documented twice.

Of course, when I say that these things “necessitate” and “require” double documentation that might not be completely accurate. Medical billing, patient safety, and quality of care don’t require double documentation (with a few well known exceptions like verifying allergies). Instead, it’s the EHR workflow that requires something be documented twice in order for you to bill at the highest levels or in order for the EHR to later make the right information available to you at a later time as part of a patient safety or quality of care effort.

The reality is that many EHR workflows are constrained in a way that doctors and other medical staff our doing double work. If you’ve ever been in the doctors or nurses shoes, you know how irritating double entry can be in a work environment. On the other hand, purging the double work can be a great way to improve your employee’s work life.

Turns out that patients have the same problem. I don’t know how many thousands of people over the years have complained about having to fill out the same health forms over and over. Turns out that patients don’t like the double entry and more than the doctors and nurses.

This post also reminds me of my doctor friend who taught me about how the EMR perpetuates misinformation. When you start double entering something, that makes that issue twice as complex to track and update.

Personally, I’ve found two types of double documentation. The first is when poorly implemented processes require double documentation. If multiple departments within the same organization were communicating more effectively, then this wouldn’t happen. The fix to this problem is not easy, but can be solved if the right leader brings together the various departments to help everyone really understand and address the problem.

The second situation is where the EHR interface doesn’t allow a specific workflow and so the only way to satisfy your internal requirements is to double document. This is a much more challenging siuation to solve. The only solution I’ve found is to become deep partners with your EHR vendor so that you can effectively communicate the problem and convince them to add your requirement to their long list of EHR product enhancements. This can be even more effective if you’re connected to other customers of your EHR vendor and you can leverage them as a second voice for why the problem needs to be solved. No doubt there is power in numbers when influencing changes in an EHR.

If you’re dealing with the challenge of double documentation, what are you doing to combat it? What solutions are available to help make this less of an issue?

What at CES Requires Immediate Action from Hospitals?

Posted on January 11, 2016 I Written By

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

As I process my week at CES (Formerly known as the consumer electronic show), I was blown away by all the amazing technology. This was true across a wide variety of spaces including drones, virtual reality (VR), 3D printing, smart homes, robotics, and yes digital health. 170,000 people at CES and over 20,000 products launched the week of CES means I missed a lot. However, I did get a chance to see a lot of the digital health solutions on display at CES. In fact, see most of my Digital Health coverage of CES on EMR and HIPAA.

While the event was enormous, the observation I’ve made most about digital health is that there was very little that was revolutionary when it comes to health care itself. Pretty much everything I saw was part of the evolution of digital health that we already understood. There was really no game changing technology, app, software, hardware or other solution that would dramatically change the course of healthcare.

In fact, if I were a hospital executive coming out of CES, I wouldn’t have any immediate action items on my list. Sure, there are a lot of fun technologies, but there really aren’t that many clinically relevant innovations at CES.

While I do think that’s the case today, I believe that’s going to change. If I were to compare digital health to the internet, we’re still working on compuserve or prodigy (Yes, those were the “internet” before their were web browsers). We don’t even have a great web browser developed and mobile computing wasn’t really even much of a thought. However, I see a lot of organizations starting to build something that innovative in healthcare. Plus, the building blocks are now in place that a unique entrepreneur will put together all these innovations in devices and data and create something that transforms healthcare.

Most hospitals aren’t entrepeneurs. So, the opportunities presented by digital health at CES aren’t that interesting. However, CES is a digital health entrepreneur’s playground. The opportunities to leverage technology to improve health are endless. The groundwork that’s been laid is amazing. It will just take a number of years for it to reach hospitals in a package that works for them.

Why Are We Still Talking About Cloud in Healthcare?

Posted on January 8, 2016 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.

Today’s post come from some tweets:


And here’s a great response from CIO David Chou:


I find it really interesting that he added mobile. Most hospitals realize that cloud has to be part of their IT strategy. Every hospital has some sort of cloud solution that they support. However, in the hospital EHR world, is there a viable cloud EHR option for hospitals?

On the other hand, mobile EHR is really lacking. Certainly there is a lot of mobile use in healthcare, but not for most of the enterprise applications.

I really hope that the tweet at the top is wrong. Healthcare needs to be doing a lot more than just cloud and mobile. Those should just be features and not trends. Here’s the unfortunate reality though:

Merry Christmas – A Time to Give

Posted on December 25, 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.

Merry Christmas to all of you! What better way to celebrate this holiday season than a deep quote about giving? I’ve seen this first hand in my work here at Hospital EMR and EHR and the entire Healthcare Scene network. I try to give as much as possible to my readers. What’s amazing is how much more I’ve gotten in return.
Christmas Giving

Hospital Readmission Penalties Reward Patient Populations, Not Quality Care

Posted on December 24, 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’ve been really interested in the shift to value based care, accountable care organizations and related initiatives like reducing hospital readmissions. While their goals are noble and their intent good, I’ve always been afraid that these programs could lead to issues related to discrimination against the most vulnerable populations and those who serve them.

Turns out this article from Harvard Medical School highlights this problem when it comes to hospital readmissions:

To encourage hospitals to improve quality of care, Medicare penalizes those with higher than expected rates of readmission within 30 days of discharge.

The logic behind the penalties is that if patients receive high quality care, including proper discharge planning, they should be less likely to end up back in the hospital.

This seems straightforward, but it turns out that the social and clinical characteristics of a hospital’s patient population that are not included in Medicare’s calculation explain nearly half of the difference in readmission rates between the best — and the worst — performing hospitals, according to the results of a study published in JAMA Internal Medicine.

The article later goes on to highlight how hospital readmission penalties are impacting organizations based on their patient population as opposed to the quality of care they provide:

“The readmissions reduction program is designed to penalize hospitals for poor quality of care, but our findings suggest that hospitals are penalized to a large extent based on the patients that they serve,” said J. Michael McWilliams, HMS associate professor of health care policy and medicine, a practicing internist at Brigham and Women’s Hospital and senior author of the study.

No doubt this is a complex issue, but it’s only going to get more complex as reimbursement models get more complex. The article suggests that one simple solution would be to compare an organization against its baseline instead of comparing it against national averages. Of course, this has the problem of penalizing those organizations who are already doing a good job of reducing hospital readmissions. Maybe we need a mix of a baseline and a national average?

As we continue to develop new reimbursement models that incentivize quality care and penalize poor quality of care, we need to be careful to ensure it reaches the goal and doesn’t just cost healthcare organizations that are serving the most vulnerable and difficult patient populations.

A Look At Precision Medicine Solutions Available Today

Posted on December 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.

Personalized and Precision Medicine are all the buzz since President Obama announced the Precision Medicine Initiative. However, after the government tragedy known as meaningful use, many are reasonably skeptical of government initiatives to improve healthcare. Plus, the rhetoric around what’s possible with precision medicine and the realities that most hospitals and doctors face every day feels like a massive disconnect.

The reality is that there’s good reason to be skeptical of precision medicine. Think about the scope of the problem. The world of health data that we live in today is 10-20 times bigger that it was even a decade ago. That’s a massive increase in the amount of data available. Plus, much of that data is unstructured data. Combine the volume of data with the accessibility (or lack therof) of that data and it’s easy to see why some are skeptical of really implementing precision medicine in their hospital today.

When you look at current EHR systems, none of them are built to enable precision medicine. First, they were built as massive billing engines and not as engines designed to improve care. Second, meaningful use has hijacked their development roadmap for years and will likely continue to hijack their development teams for years to come. Finally, there’s been so much money doing what they’re doing, what motivation do the entrenched EHR companies have to go out and do more?

The unfortunate reality of EHR systems is that they’re not built for real time availability of data analytics that provides improved care and precision, personalized medicine. Some may get there eventually, but we’re unlikely to see them get there anytime soon. I’ve heard precision medicine defined as a puzzle with 3 billion pieces. We have to start looking outside of traditional EHR companies to start solving such a complex puzzle.

The good news is that even though EHR vendors are not providing precision medicine solutions, we’re starting to see other vendors providing precision medicine solutions today. You no longer need to wait for an EHR vendor to participate.

One example of precision medicine happening today is the recently announced SAP Foundation for Health (we’ll forgive them on the somewhat confusing name). At the core of the SAP Foundation for Health is the SAP Hana engine. Unlike many EHR systems, SAP Hana was designed for real time data analysis of massive amounts of data and that includes both granular and free form data. You can see this capability first hand in the work SAP is doing with ASCO (American Society of Clinical Oncology) and their CancerLinQ project.

Dr. Clifford Hudis from CancerLinQ (Created by ASCO) described how personalized medicine to his grandfather was going around and visiting each patient. Over time that practice stopped and we started seeing patients in clinics where we generally only had one data set available to us: the clinical data that we captured ourselves on a paper chart. Unfortunately, as we moved electronic, we just recreated our paper chart world in electronic form. It’s too bad we didn’t do more during our shift to going electronic. However, that still means we have the opportunity to aggregate and analyze health data for the benefit of our patients. In some ways, we’re starting to democratize access to health data in order to enable precision medicine.

As Dr. Hudis pointed out, healthcare currently really only learns from patients who take part in clinical research trials. In other words, that only amounts to about 3% of adult patients who contribute to our learning. This limits our view since most clinical research trials have a biased sample which aren’t representative of the general population. How can we create personalized medicine if we only have data on 3% of the patient population? This is the problem CancerLinQ and SAP Foundation for Health are working to solve. Can they create a platform that learns from every patient?

ASCO together with SAP’s Foundation for Health is working to aggregate and analyze data across cancer patients regardless of whether they’re part of a clinical research study or not. In the past, Dr. Hudis pointed out that cancer tracking use to track cancer populations with simple groups like “small cell cancer” versus “non-small cell cancer.” That was a start, but had limited precision when trying to treat a patient. With this relatively new world of genomics, ASCO can now identify, track, and compare a patient’s cancer by specific genomic alterations. This is a fantastic development since tumors generally contain changed DNA. We can now use these DNA abnormalities to classify and track cancer patients in a much more precise way than we’ve done in the past.

This platform enables oncologists the opportunity to see real time information about their patient that’s personalized to the patients own genetic abnormalities. Instead of calling around to their network of oncologist friends, Cancer LinQ provides real time access to other patient populations with similar genetic abnormalities and could give them insight into what treatments are working for similar patients. This can also provide benchmarking for oncologists to see how they compare against their colleagues. Plus, it can show real time data to an oncologist so they can know how thorough and consistent they are with their patient population. Instead of working in a bubble, the oncologist can leverage the network of data to provide true precision medicine for their patients.

Another great example of precision medicine happening today is seen in the work of Carlos Bustamante, Professor of Genetics and Stanford University School of Medicine. Carlos is using SAP Foundation for Health to quickly identify genetic abnormalities in high performing athletes. Rather than recount the stories of Carlos’ work here, I’ll just link to this video where Carlos talks about the amazing insights they’ve found from studying the genomic abnormalties of high performing athletes. I love that his precision medicine work with high performing athletes has significant potential benefits for every patient.

Carlos is spot on in the video linked above when he says that the drop in genomic sequencing costs would be like taking a $400,000 Ferrari and now selling it for 10 cents. What originally took $13 billion and years of effort to sequence the first genome now takes $1500 and a few days. Access to every patient’s genome is going to change the types of drugs we develop, the treatment options we provide patients, our choice of drugs to treat a patient, and much much more. You can see that first hand in the work that ASCO and Stanford University School of Medicine are doing. Is there any more personalized medicine than the human genome?

Of course, the genome is just one of the many factors we’re seeing in the precision medicine revolution. We can’t forget about other variables that impact a patient’s health like environmental, behavioral, patient preference, and much more. We really are looking at a multi-billion piece puzzle and we’re just getting started. Remember that healthcare is not linear, but we’ve been treating it like it is for years. Healthcare is a complex matrices of challenges and we need our technology solutions to reflect that fact.

I see a beautiful future for precision medicine that’s already begun and builds into the future. We’re developing and targeting new drugs, devices and services that work for populations and individuals. We’re seeing new open, secure platforms that provide real-time flexible R&D analysis, genomics and other “omics” disciplines, patient cohort building and analysis, patient trial matching, and extended care collaboration solutions.

Data by itself is not valuable. However, the right engine on top of the right data is changing how we look at healthcare. We’re getting a much more precise view of each individual patient. Where have you seen precision medicine starting to take hold? What precision medicine solutions are you using in your organization?

Also, check out this infographic which looks at SAP’s view of precision medicine:
Personalized Medicine You Can Do Today

SAP is uniquely positioned to help advance personalized medicine. The SAP Foundation for Health is built on the SAP Hana platform which provides scalable cloud analytics solutions across the spectrum of healthcare. SAP is a sponsor of Influential Networks of which Healthcare Scene is a member.

Healthcare CIO Priorities

Posted on December 11, 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.

Here’s some really interesting data in response to the question “What are the top optimization priorities for your organization over the next year?”

Top Healthcare CIO Priorities

Do your priorities align with what’s above?

One challenge with a survey like this is that it’s one thing to say you’re going to do something and another to actually make it a priority, commit resources and do it. “Improve the quality of care” is a great example. It would be leadership malpractice to say that you’re focusing on anything else. It’s a much harder thing to actually do it.