Free Hospital EMR and EHR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to Hospital EMR and EHR for FREE!

An Acronym Look at MACRA QPP

Posted on April 28, 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.

The proposed rule for the MACRA program has been announced. Here’s an acronym laden summary of what MACRA did (Worth noting that CHIP is the C in MACRA for those keeping track of acronyms at home).

MACRA creates a QPP.

MACRA ends SGR

MACRA creates two paths: MIPS and APMs.

MIPS and APMs timeline from 2015 through 2021.

MIPS combines PQRS, VM (or VBPM if you prefer), and Medicare EHR (MU and Certified EHR) into 1 program.

APMs include ACOs, PCMH, and bundled payments.

MU is now ACI.

If you’re not sure about some of the acronyms above, you can find their longer names here. Good thing they simplified and streamlined the various programs!

We’ll be becoming friends with the acronyms MIPS and APMs. Here’s a good summary PDF of MACRA as well. More details to come.

UPDATE: In a bit or irony, Andy Slavitt posted this acronym free video about MACRA:

Health IT Software Must Be Meaningful and Pleasurable

Posted on April 27, 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.

One of the most dynamic healthcare CIO’s is Shafiq Rab, MD, MPH, Vice President and CIO at Hackensack UMC. Healthcare Scene was lucky enough to talk with him at the DataMotion Health booth during HIMSS 2016. Dr. Rab talked with us about Hackensack UMC’s approach to healthcare IT innovation. He offered some great insights into how to approach any healthcare IT project, about Hackensack University Medical Center’s “selfie” app, and their efforts to use Direct and FHIR to empower the patient.

I love that Dr. Rab leads off the discussion with the idea that healthcare IT software that they implement must be meaningful and pleasurable. Far too many health IT software miss these important goals. They aren’t very meaningful and they’re definitely not pleasurable.

Dr. Rab’s focus on the patient is also worth highlighting. Health IT would be in a much better place if there was a great focus on the patient along with making health IT software meaningful and pleasurable. Thanks Dr. Rab and DataMotion Health for doing this interview with us.

The “Feature List” Disconnect from Healthcare Problems

Posted on April 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.

One of the big takeaways coming out of the Healthcare IT Marketing and PR Conference is that most health IT companies are still spouting out the features they offer and very few actually talk about the problems they solve. This is a huge mistake for a health IT company, but it’s also a big reason why most hospital executives don’t want to hear from you.

As a healthcare executive you’re inundated with marketing and sales pitches and after a while they all start to look the same. Plus, many (some might say most) of those pitches require the hospital executive to try and translate a long list of features into the problems that executive is trying to solve. It’s no wonder that most hospital executives barely look at these pitches and often aren’t aware of the opportunities for innovation that exist for the problems they’re trying to solve.

Think about how many healthcare IT companies could list the following set of features in their sales and marketing:

  • Data Analytics
  • FHIR Enabled
  • HIPAA Compliant
  • EHR Integration
  • Machine Learning
  • Mobile Optimized
  • Real Time Processing
  • etc

I could keep going on, but you get the point. I’m reminded of something Shahid Shah said at our session at HIMSS. No one in healthcare has an interoperability problem. His point isn’t that interoperability isn’t important or valuable. His point was that no one is trying to solve interoperability. They have other problems they are trying to solve and data sharing (ie. interoperability) might be the solution. However, when they think about their problems and challenges interoperability is not on that list.

Hospital systems definitely have plenty of problems they’re trying to solve. Here’s just a few examples to give you a flavor of problems hospital executives are working to solve:

  • Improving HCAPHS Scores
  • Reducing Hospital Readmissions
  • Improving Provider Efficiency
  • Ensuring Accurate Patient Identification
  • Lowering Sepsis Numbers
  • etc

This list never ends. These are problems that hospital executives are working to solve and understanding which problems are vexing a hospital executive is key to getting them interested in the solutions. I think this small change would make it so hospital executives dread the wave of marketing and sales pitches a little less. The reality is that most of these executives are looking for great solutions. It’s just often hard for them to know what problems your company can really solve.

Of course, the next challenge is showing proof of your ability to solve the problem. However, at least that gets a hospital executive one step closer to finding solutions to their problems and challenges.

The Misconceptions of Social Media in Healthcare

Posted on April 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.

Today I came across this blog post on the Cisco blog about an employee’s entry into the world of Twitter and social media. She offers a number of great points that are worthy of highlighting:

  • It’s Not Stupid
  • You Don’t Have to Be All-In
  • Twitter is a Great Equalizer
  • You Be You

This is all some great advice. Except I would argue that some parts of Twitter are stupid. However, that’s true of most things of value. There’s a lot of email in this world that is terribly stupid. That doesn’t diminish the value of email.

Although, as I read through the list, I recognized the real problem with social media is that people have the wrong perception of what social media is and how it can benefit them. Sure, social media can be a marketing tool for your company. Social media can be a way for you to broadcast what you eat and when you sleep and when you see a beautiful pink flower. It literally can be anything you want it to be. However, if you don’t want it to be those things, then it won’t be those things.

Twitter is literally what you make of it. If you want it to be about food, then you can follow the kind of people that post about food. If you want to enjoy pictures of flowers, then you can find someone who posts pictures of flowers. However, if those topics don’t interest you, then don’t follow those types of accounts. On just my @techguy account I’m somewhere around 22,696 tweets in and I can only remember 3-4 pictures that included food ever. There might be a flower picture in there somewhere, but it’s likely in the background.

Of course, if you don’t care about healthcare IT, then you probably don’t want to follow me either. I’ve sent a lot of tweets about healthcare IT and had a lot of conversations with people about EHR. The point is that if there’s a topic you enjoy or a topic that’s needed for your work, you’ll find it on social media and on Twitter. Sure, there’s plenty of other junk, but you really won’t see it if you’re following the right people. Plus, if you get the random food picture, I can promise you that it won’t hurt you. In fact, some randomness is part of the fun of Twitter.

So far I’ve really only talked about social media consumption. That’s the beauty of social media as well. There’s no requirement that you ever actually broadcast anything yourself. More and more people are just using social media for content curation and education. They never send a tweet. They don’t know what a retweet or favorite is. They don’t DM. They don’t use hashtags. They just consume the social media others create.

While I think there’s some missed value if all you’re doing is consuming content and not interacting on social media, that doesn’t mean there’s not a lot of value available on social media even if all you’re doing is consuming. It can be incredibly valuable. You can learn a lot to help your career. You can learn a lot about people. You can learn a lot about a company or your competitor. There’s so much value that can be obtained through simply consuming information shared on social media.

With that said, the blogger linked at the top of this post is right. Social media is the great equalizer. This is especially true if you’re a nobody at a small company. How many times do you get an audience with the CEO of your company. Probably not very much. However, on social media you have the open opportunity for them to see what you’re doing and you to engage them on topics that matter to you. Much of this can happen naturally. Just be yourself and you’ll be surprised how effective that can be.

Of course, like I’ve always said. Not everyone should do social media, but everyone could benefit from using social media. However, don’t let the misconceptions of what social media “is” deter you from trying it out and seeing where and how it can provide value. You can make it work for you.

Looking Into the Future of Hospital EHR

Posted on April 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.

I’ve been thinking a lot lately about where the world of hospital EHR software is going to head. At the top of the market we have Cerner and Epic taking most of the share. As we go down the market we see a lot of other large players, but we still only have 20 or so EHR vendors playing in the hospital EHR world.

In the last year we’ve seen aggressive moves by athenahealth and eCW to enter the hospital EHR space as well after previously only providing ambulatory EHR software. I’ve heard predictions that entrants like these are going to charge significantly less for their EHR software and that’s going to really shake up the market. You can imagine how the discussions in most hospitals will go if there’s an EHR alternative that’s 1/10th the price of their current EHR.

What’s interesting is that I haven’t seen any major moves by the large competitors to really accelerate the services, features, and functions they provide a hospital in order to justify the large premium. If I were Epic or Cerner, I’d be thinking about something really special that we could create that would be cost prohibitive for these new entrants to create. No doubt the Innovator’s Dilemma is at play here. Hard to fight against so much proven history around business dynamics.

Something that’s shocking to me is that these new entrants into the hospital EHR space aren’t really leveraging new technology either. They’re not building new features or functionality that doesn’t exist today (for the most part). They’re using things like cloud and mobile that are now relatively old technologies, but haven’t been applied to healthcare.

Said another way, will doctors love this new breed of hospital EHR any more than the current breed? I believe the answer to that question is no. Doctors will hate this new breed of EHR just as much. With this insight, I could imagine some other companies coming along and creating true innovation with new technologies that today we can’t even imagine. Although, it won’t likely be just technology innovation, but in healthcare it will likely include business model innovation as well.

EHR Ratings – GomerBlog Style

Posted on April 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.

I first saw this tweet without the image and wondered what the GomerBlog had done for April Fool’s day. I also wondered how I’d missed it on that day. Turns out that the above image and the corresponding blog post on the GomberBlog was definitely not on April Fool’s day, but on March 26th. Although, some might say that the GomerBlog celebrates April Fool’s all year round. For those not familiar with it, they’re basically the Onion of healthcare.

I had to laugh at the ratings they posted. The should have added another column to the chart “Vendor’s Take” and had them all say “Fantastic!” as well.

Dean Sittig is right in his tweet though that this chart isn’t far from the truth. Things that are close to the truth make for the best humor. However, if you’re a doctor or nurse using an EHR, it’s likely getting less and less funny.

Also, for those searching for EHR ratings, good luck. There are so many reasons that EHR ratings are a challenge to do. I’d be careful trusting any rating system out there.

Accessing Near Real Time Patient Data In & Out of the Hospital with Alan Portela

Posted on April 4, 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.

Healthcare Scene recently sad down with Alan Portela, CEO of AirStrip to talk about the shifting world of real time access to healthcare data in and out of the hospital. We cover a lot of ground including AirStrip’s experience being on stage at the announcement of the Apple Watch, the challenge of EHR data interoperability, and the amazing work that AirStrip is doing to make near real time health data available on devices across healthcare. Enjoy the recorded video interview with Alan Portela below:

In the “after party” discussion, we continue the discussion and are joined by Jimmie Legan, MD and Charles Webster, MD.

Value Based Care Hurting Most Vulnerable Hospitals

Posted on March 25, 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 an article by the Washington Examiner, they highlight an interesting impact of the shift to value based reimbursement on hospitals:

Safety-net hospitals are getting hit by Obamacare’s push to penalize poor quality, the latest evidence of problems with the law’s effort to improve quality of care.

A new study from Harvard Medical School found that safety-net hospitals that treat many low-income or uninsured individuals are being penalized more for hospital readmission rates than other hospitals.

If a hospital readmits too many patients 30 days after they are discharged after being treated for a certain condition, that hospital gets penalized. A hospital could receive up to a 3 percent reduction in its Medicare annual patient payments.

The policy, which started in 2011, a year after Obamacare was passed, is intended to address a quality issue at hospitals. It is part of a larger shift in Obamacare to transition Medicare payments away from traditional fees for service toward a new model that rewards quality care.

We saw something similar to this happen during meaningful use as well. The most vulnerable hospitals couldn’t get the EHR incentive money because the incentive money wasn’t enough to cover the entire costs of the EHR. So, they just went without. In fact, an argument could be made that a large portion of the meaningful use EHR incentive money was paid to hospitals that were already on the path to EHR, but that’s a topic for another day.

When it comes to value based reimbursement it takes the right investment in technology and processes to be successful. I know a lot of hospitals that are just trying to keep their doors open. Where does that leave them time to think about these new complex government regulations? No doubt this shift to value based reimbursement is going to cause a lot of them to close their doors or be merged into the larger hospital systems. In fact, the later has been happening for a while and will continue to accelerate.

The article above does suggest a possible solution:

One alternative would have a hospital be measured by how its readmission rate improves rather than whether it meets a national average.

“Hospitals could be rewarded based on improvements off what their prior performance has been,” Barnett said.

Another alternative is for a hospital to become an accountable care organization. The concept gives a hospital a spending growth target that it has to meet for its Medicare patients.

I like the idea of benchmarking, but that can get really messy really quickly. The more I learn about value based reimbursement the more I worry that we’re just making things more complex without actually solving healthcare’s core problems.

Quick Hitting Thoughts on CDS (Clinical Decision Support)

Posted on March 21, 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.

I’m finally starting to go through all my notes from HIMSS. Part of that is because I’ve been busy after HIMSS. Part of it is because I like to recover from what I call the #HIMSSHaze. Part of it is that I like to see what still resonates a few weeks after HIMSS.

With that in mind, I was struck by a number of quick hitting comments that I noted from my interview with Dr. Peter Edelstein, CMO at Elsevier. Dr. Edelstein is a fascinating guy that I’ll have to have on a future Healthcare Scene interview. In the meantime, here are some of the quick hitting thoughts he shared about CDS (Clinical Decision Support).

One key point he made is that it seemed like many organizations didn’t have a strategy for CDS. He also aptly pointed out that the same seemed to apply to big data. I agree with him wholeheartedly. If we were to go to a healthcare organization and ask them their CDS strategy I don’t think most of them would have an answer. I think if we dug in, we’d probably find that most of them have essentially deferred their CDS strategy to their EHR vendor. Does anyone else feel like this is a problem?

When I asked Dr. Edelstein what would be his suggested strategy on adopting CDS, he suggested that he’d want to make sure that the CDS solution worked across all provider types. Next he compared the pull CDS solutions (Reference resources, etc) to wearing seat belts in a car and the push CDS solutions (Order sets, care plans, etc) to an airbag in a car. While we certainly need both sets of solutions, he suggested that we should make more of an effort to get the push CDS solutions implemented in healthcare.

I thought the analogy was a great way to look at the various types of CDS solutions. Plus, I agree that we need more push solutions in healthcare. The pull solutions are necessary for some of the most challenging problems, but we all know that when a doctor is busily going about their day they often choose not to check with the pull solutions when they should. The push solutions can be integrated into their workflow so that providers can more easily address any potential issues from within the flow of their day.

Dr. Eldestein also pointed out that Wikipedia is still the most commonly used reference resource despite many studies which have illustrated the medical errors that exist on it. Why do they use it? It’s because it’s simple to use and easily accessible. This is a great illustration of why we need the right CDS information to be more easily available to the doctor at the point of care at the moment they need it.

Definitely some great insights into CDS. What’s great about CDS is that at this point pretty much everyone is using some form of CDS. We’re also seeing CDS integrated more deeply into EHR software. I expect this trend will continue and will become much more sophisticated.

It does beg the question, what’s your healthcare organization’s CDS strategy?

Healthcare Analytics Biggest Competitor – Excel

Posted on March 16, 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 highlighted an interesting observation I had after experiencing so many healthcare analytics pitches going into and at HIMSS. I’ll set aside the email comment for now (email is still very powerful if done right) and instead focus on Excel. Here’s what I discovered about healthcare analytics:

Excel is a healthcare analytics company’s biggest competitor.

It’s crazy to think about, but it’s true. When a healthcare organization is evaluating healthcare analytics platform the “legacy system” that they’re usually trying to replace is Excel. I can’t tell you how many times I heard analytics vendors say that “Hospital A was doing all of this previously on a bunch of Excel spreadsheets.” If you work at a hospital, you know that you have your own garden of Excel spreadsheets that are used to run your healthcare organization as well.

When you think about the features of Excel, it’s no wonder why it’s so popular in healthcare and why it’s a challenging competitor for most healthcare organizations. First, it’s free. Ok, it’s not technically free, but every healthcare organization has to buy it for a lot of reasons so that cost is already in their standard budget. Second, every computer in the organization has a copy of Excel on it. Third, the majority of people in healthcare are familiar with how to use Excel. Since we love to talk about healthcare IT usability, Excel is extremely usable. Fourth, Excel is surprisingly powerful. I know many healthcare analytics organizations could argue its limitations, but Excel is more powerful than most people realize.

That’s not to say that Excel doesn’t have its weaknesses. I’m sure that most organizations have experienced time wasted trying to figure out which Excel file has the accurate data or is the most up to date. No doubt you’ve experienced the multiple copy problem where 2 people are editing the same file and now you have 2 versions of the same file that need to be merged. Document management software has helped with this situation in many regards as it locks the file when someone starts to edit it and things like that. However, it’s still often a problem.

Another problem with Excel as compared with a true analytics platform is when you want to go in and slice and dice the data. What’s possible with a true analytics platform is so much more powerful when you want to really dive in and chop up the data in unique ways.

While possible in Excel, most uses of Excel are backwards facing data analysis and tracking. You can do some near real-time data analysis in Excel, but newer analytics platforms do a much better job of real time analytics using the latest data.

Of course, the biggest problem long term with Excel is that it can’t scale. Once you reach a certain amount of data points or a certain amount of complexity in the data, Excel falls on its face. However, most healthcare organizations are still working on small data, so Excel’s worked fine.

I’m sure there are many more issues. Hopefully some analytics vendors will chime in with more examples in the comments or on their own blogs. However, it’s worth acknowledging that for many organizations it’s really hard for them to find a healthcare analytics solutions that’s so much better than Excel. Plus, many of these expensive analytics solutions fail when it comes to some of the things that makes Excel great (ie. Free, Usable, Ubiquitous).