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Software Design – Dilbert Cartoon

Posted on August 31, 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 afraid I’ve seen this approach in far too many healthcare organizations. This is particularly true in health data analytics. Let me know if you can relate to this cyclical discussion. I do think it’s getting better though as more people have experience in the process. It’s just been a very long road.

Population Health Survey

Posted on August 28, 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.

One of the themes we’ve been writing a lot about recently is incorporating more social and behavioral health data into the EHR and healthcare. I think we’re at the start of a trend around using data in healthcare that is not going to stop. While we currently have more access to data than ever, it feels more like getting beat down by a wave on the beach than it does surfing a wave that provides an amazing thrill and speed. I guess I’m saying that we haven’t learned to harness the power of the wave data yet.

Much of the work we’re doing with healthcare data is around population health. I was intrigued by the findings of a population health survey done by Xerox. Here are some of the insights they shared with me:

What is population health? Definition components were ranked in the following order:

  1. Facilitates care across the health continuum
  2. Supports providing the highest quality of care at the lowest cost
  3. Uses actionable insight for patient care based on a variety of data
  4. Targets a specific population of individuals
  5. Enables patient engagement

Is population health management necessary?

100 percent of polled providers agree that population health management is necessary as the U.S. shifts to value-based care. 81 percent indicated they “strongly agree” with the statement, while the remaining 19 percent indicated they “somewhat agree” with the statement.

What is driving population health? Driving factors were ranked in the following order:

  1. Improved health outcomes
  2. Improved patient relationships and experiences
  3. Cost containment
  4. Increased revenue opportunity
  5. Brand and competition with others in market

What challenges exist in population health management? Challenges were ranked in the following order:

  1. Data management and integration capabilities
  2. Lack of financial incentives, too much risk
  3. Poor care coordination across care providers
  4. Creating actionable intelligence from available data
  5. Lack of provider expertise or knowledge
  6. Low patient engagement

When will population health management be a reality?

81 percent of polled providers believe their organizations will deliver fully scaled population health management programs within 5 years, which includes 16 percent who indicated they already are.

What this survey tells me is that we’re still trying to figure out population health. Plus, people have a really broad definition of what’s considered population health. Does that mean the word no longer has much meaning?

The final stat might be the most telling. Almost everyone believed that their organization would be able to deliver a fully scaled population health management program. Maybe there’s some arrogance bias in who participated in the survey, but I’m quite sure that we’ll have a lot more stragglers in the population health world than 18%. It’s taken us how many years to get 60% EHR adoption? I won’t be surprised if population health takes us even longer.

All of that said, the best organizations are going to leverage healthcare data to improve population health. That’s a powerful concept which isn’t going away ever.

Integrating Social Media Data Into Healthcare Graphic

Posted on August 21, 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.

Today, during the #HITsm chat, Charles Webster (The workflow addict), shared this interesting graphic on how social media gets integrated into the healthcare workflow. I’d never seen it before today, so I was glad he shared it:

I’m not sure I understand all the lines and abbreviations on the graphic, but the things that resonated to me was the size of the social media funnel and how we need to take that mass of data (much of which is useless) and funnel it down into usable data which then gets funneled down into actionable tasks.

This is actually a lesson for all data in healthcare. The process is the same. Social media is just another form of data. I’ve only seen a few cases where organizations have done this process already, but over the next 5 years we’re going to see thousands of ways this is done to improve healthcare. It’s very exciting for me to consider.

Reddit Users Comment on Epic Losing the DoD EHR Contract to Cerner

Posted on August 17, 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.

The reactions to Epic losing the DoD EHR contract to Cerner have been all over the place. Most of them create some simplified view of why Epic beat out Cerner. I personally think that Leidos vs IBM had a lot more to do with the DoD’s decision than Epic vs Cerner. Either way, HIStalk reported that the protest period for the DoD EHR bid has expired and so Cerner is the big EHR winner. Mr. H said that rumors have been that Cerner’s bid was $1 billion less than Epic and Allscripts and so that’s why there was no protest.

Personally, I’ve been most fascinated by the reactions to Cerner beating out Epic in this reddit thread that includes a number of current and former Epic employees. The person who started the thread conveyed many people’s reaction to the selection of Cerner over Epic:

RIP my contracting plans for the next 2+ years :(

No doubt, Cerner consultants are celebrating in the opposite direction along with the 30+ other partners that won the bid with Leidos, Cerner, and Accenture. I previously wrote about how many people will be required in the $4 billion DoD EHR contract.

Here are some of the other interesting reactions in the reddit thread linked above:

I don’t think this is that bad for Epic.
* The government contract likely would have significantly shifted the focus of R&D efforts for the next few years towards features that may not be in the best interest of other Epic customers.
* When the project invariably runs into issues: overbudget, overtime, stability, training, response time, upgrades, etc. Cerner will be on the hook and take the hits in the media. Much of this implementation will be handled by outside consultants so coordination will be a huge challenge for any company.

Reminds me of the post I wrote about a year ago suggesting that losing the DoD bid might be the best thing for Epic.

Some source claim the contract would have been worth $9 billion overall. Just to put that in perspective… For an Epic employee making $200k a year, $9bn would pay your salary for 45 THOUSAND years. For 5,000 employees each making $200k a year, $9bn would pay their salaries for nine years.

(Yes, I know its not that simple… just trying to put $9 billion dollars in some kind of perspective).

Point is, yes, gaining or loosing a contract for that kind of money is a very big deal for ANY company, and impacts the future of that company in a significant way.

I don’t think most of us can comprehend a billion dollars. I know I can’t. However, I agree with the point that losing the DoD EHR contract is a big deal for any company. Even with this other clarification about how much money the EHR vendor will get from the contract:

I saw estimates that the contract would be worth $9 billion over 18 years, and that Cerner was likely to get only 10-20% of it (with most of the money going to Leidos). That means Cerner is getting $50-$100 million per year. This is obviously substantial, but it’s not as impressive as the $9 billion sounds.

I’ll be interested to see if those estimates are accurate. Plus, we’ll see how much the project cost balloons over time.

This Epic employee offered an interesting concern over Epic losing the DoD contract:

As a current Epic employee, I’m more than a little concerned about how much of the current building projects and massive hiring was made under the hope/assumption that we would be awarded this contract. I think this represents a much bigger deal for Epic than what you try to wave off.

Another user offered this comment on why Epic might have lost the deal:

What everyone needs to consider is that Epic is currently working on the build for United States Coast Guard (USCG). 1.The USCG falls under the DoD in terms of rules of engagement to include use of CHCS and PGUI (USCG didn’t transition to ALHTA). 2. The Epic build is consider by most involved on this project as an Epic failure! 3. DoD know about this Epic failure and of course the decision to to choose Epic is based upon this build failure. 4. After five years of this USCG contract Epic is still trying to understand military processes.

However, I think this was the feeling for many and why many are still in shock that Cerner won the contract over Epic:

Wow, I thought Epic had that contract locked up.

Just like I’ve done with ICD-10, I chose not to try and predict what the government will do. So, I wasn’t personally surprised by the DoD picking Cerner over Epic. However, now that Cerner is chosen, I’m interested to see how this affects both companies. The last comment about Epic’s USCG implementation illustrates how challenging working with the government can be. Cerner will definitely be spending time developing some unique software and technology to meet the DoD’s unique needs.

25% of EHR Budget Goes to EHR Training…At Least for the DoD EHR

Posted on August 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.

In all of the news surrounding Leidos and Cerner winning the DoD EHR bid, I was really struck by this one piece from Healthcare IT News:

Training. As is often the case in massive software implementations, training eats up a lot of the costs and, in the DoD’s case, “over 25 percent of the contract goes to training users and clinicians,” Miller said.

Think about how much training you can get for $1+ billion. I get that training is not cheap. I also get that the DoD EHR implementation is a massive project, but that’s a lot of money for training. Do you think that most EHR implementations spend 1/4 of their budget on training?

Hopefully people will chime in with their answer to that question in the comments. My experience is that hospitals probably should budget 1/4 of their budget for training, but most don’t get anywhere near that amount. Plus, the EHR training budget often starts much larger and then when the budget overruns start to happen, EHR training is one of the first places they go to cut the budget.

How much EHR training is enough in your experience? Should it be 25% of the budget? I’m not sure how much is needed, but I do know that most organizations don’t purchase enough. Sounds like the DoD might be the exception.

The Power of Medical Device Data Infographic

Posted on August 6, 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.

One of the advantages of devices is that they’re really good at collecting vast amounts of data. One of the problems we have in healthcare is that our medical devices collect a lot more healthcare data than we actually use. It’s too bad since no doubt there is a lot more benefit we could receive from all the medical device data we’re collecting.

This point was really driven home when I saw the infographic below from Capsule which looked at The Power of Medical Device Data. Take a look and see what I mean and then ask yourself, how could we better use medical device data?
THE POWER OF MEDICAL DEVICE DATA to Healthcare

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.

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.