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Scribe Criticism is Unwarranted

Posted on January 26, 2015 I Written By

The following is a guest blog post by Michael Murphy, MD CEO of ScribeAmerica.
Michael Murphy
It is clear there is a major amount of tension around the cumbersome technology associated with most electronic health records (EHRs). Unfortunately, some are blaming the technology’s limitations on the ever-popular Medical Scribe. Many have gone as far as to insinuate the use of medical scribes is the reason why technology is not developing quickly to resolve EHR problems – this is like saying that citizens paying their taxes are to blame for the government not seeking to balance the budget and exercise appropriate fiscal control. Can you honestly believe that the small minority of providers who find EHR acceptable due to scribes are what is preventing EHR companies from making improvements? No, it is a result of system and technology limitations.

A more comprehensive understanding of the scribe industry is needed instead of blaming them for the problems facing EHRs. Importantly, the scribe industry has developed over the years to improve patient care, protect the sacred provider/patient relationship and help to prevent physician burn out. Statements that The Joint Commission (TJC) cannot regulate or monitor scribes, are analogous to saying the local police department has no control over a city. There will always be “bad actors” willing to act outside of accepted industry norms, however, that does not mean that the TJC does not have control over the Scribe industry.

A few recent, ill-informed articles have recently circulated about Medical Scribes and it is only a matter of time before other writers rely on the incomplete information and slanted view of the article when gathering information on the topic. This will result in a continuous cycle of blaming scribes for a variety of shortcomings in the medical field beyond the original intended topic of the need for advancement in EHR technology.

Articles that improperly suggest a scribe would document services that were not performed to increase patient billing only serve to take focus away from any medical providers that may engage in fraudulent billing practices. Scribes do not share in revenues received from the physician’s practice and would have no reason to falsify services to increase revenues. Any concern over billing patient’s for services that were not provided should be directed at the medical provider who engages in such practice. Instead, the use of scribes will hopefully deter such unethical practices by physicians in the future as they will no longer be entering the information into a medical record with no one around to see what they are doing or question them on their actions. A scribe will act as a check and balance in the system by documenting only the services that are provided.

What about the providers who work sans scribe and document a full H&P and never took their stethoscope out of their pocket and only conversed with the patient once all the labs and CT results are back? Again, these providers are a minority in the grand scheme of things but to infer that adding a scribe into the equation increases the risk of chart copying or excessive over documentation is completely unfounded. If anything, the scribe adds an extra layer of accountability for the provider who might otherwise be tempted to ride the line of integrity due to the downward pressure by administration to see more patients faster and with greater quality.

The use of EHRs may have increased the demand of medical scribes recently, but there are many other factors that have contributed to the increase. Physicians went to medical school for four years and completed their residency programs to treat patients, not to become secretaries. Physicians truly want to engage their patients, take care of them and not be hamstrung with meaningful use, ICD­10, PQRS, or Core measures.

In the future scribes can assist with population health management data collection, which will free physicians to provide much needed patient education and will be vital to the solvency of Accountable Care Organizations. Additional pressure on physicians comes from falling reimbursements, which are forcing everyone to do more with less, an impending physician shortage and smaller health insurance networks. This all adds up to physician burnout, which is the primary driver of increased medical scribe utilization, not EHRs. Burnout has been reported nationally and will continue to increase if physicians do not seek assistance. Patients seek treatment with physicians based on their medical knowledge and skills, not based upon their data entry skills or knowledge of technology. Patients want to be treated with respect, which includes being seen promptly and being able to converse face to face with their physician while discussing their health concerns instead of being ignored while the physician is focusing on the data entry instead of the symptoms. The use of a scribe will allow the physician to focus on the patient and will most likely be in a better mood than the physician who is frustrated that his time is spent on data entry and not practicing medicine.

I applaud anyone in their desire to see EHR technology advance and improve, but suggest that more research be done on the topic instead of misplacing blame on the scribe industry just to publish an article on the topic. Collectively, we can and need to address the shortcomings of current EHR solutions and the resulting physician burnout.

Michael Murphy, MD CEO of ScribeAmerica
ScribeAmerica is a provider of medical scribes to hospitals and medical practices. Co-founders Michael Murphy and Luis Moreno met in 2002 and founded ScribeAmerica the following year in Lancaster, California. ScribeAmerica is the largest independent scribe company and they are committed to helping improve patient care by doing what we do best, continue to save doctors – one. click. at. a. time.

EHR APIs Are Hard

Posted on January 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.

I’ve been thinking a lot about healthcare interoperability lately. I’ve long argued that it’s one way we can really lower the costs of healthcare. Plus, I’m a true believer in the value of doctors having all the information possible in the right place at the right time. I’ve also advocated strongly for EHR vendors to create APIs that allow other entrepreneurs to build really amazing functionality on top of the EHR.

This last point is the one I want to address now. I still think an EHR API is going to be essential to the future success of an EHR vendor. The reality is that the EHR isn’t going to do everything for everyone. My favorite example is genomic analysis. EHR vendors are not going to do this. Some other company is going to take care of the genomic analysis and then they’re going to need to want to have to integrate with the EHR for their to be a beautiful workflow for everyone involved. This integration is going to best be done by an API. Plus, genomics is just one example of hundreds of integrations that might be needed.

To me the case is clear why there’s a benefit to having an open EHR API. Why then, don’t we see more of them in the EHR world? The simple answer seems to be that APIs are hard!

I found a great description of the challenge of creating a quality API on the WordPress developer blog:

Developing APIs is hard.
You pour your blood, sweat, and tears into this interface that bares the soul of your company and of your product to the world. The machinery under the hood, though, is often a lot less polished than the fancy paint job would lead the rest of the world to believe. You have to be careful, then, not to inflict your own rough edges on the people you expect to be consuming your API because…

Using APIs is hard.
As an app developer you’re trying to take someone else’s product and somehow integrate it into whatever vision you have in your head. Whether it’s simply getting a list of things from another service (such as embedding a reading list) or wrapping your entire product around another product (using Amazon S3 as your primary binary storage mechanism, for example), you have a lot of things to reconcile.

You have your own programming language (or languages) that you’re using. There’s the use case you have in mind, and the ones the remote devs had in mind for the API. There’s the programming language they used to create the API (and that they used to test it). Finally, don’t forget the encoding or representation of the data — and its limitations. Reconciling all of the slight (or major) differences between these elements is a real challenge sometimes. Despite years of attempts at best practices and industry standards, things just don’t always fit together like we pretend that they will.

He also offers 3 recommendations when you choose to provide an API:
#1 You want people to use your API.
#2 You have no control over what tools others are using.
#3 Your API is a promise.

Let’s also be clear that a WordPress API is much simpler than what a quality EHR API would require. The principles still apply, but the complexity makes it even harder. I think this is a major reason why many EHR vendors haven’t yet done an API to their EHR. An EHR API is not a one time job where you set it and forget it. It’s an ongoing project that has to be updated and improved with every release. Plus, you have to make those changes and additions without breaking things for your partners who use the API. That’s not a simple job.

Despite being hard, I still believe that EHR APIs are going to be the future of EHR. Plus, an EHR vendor should be glad that EHR APIs are hard. That means that if they put in the effort to do one the right way, they’ll have an advantage over the others who don’t. There are hundreds of healthcare startup companies that would love to tap into a quality EHR API. If you build it, they will come.

Getting More Out of the EHR Than What You Put In

Posted on January 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.

When I first met with Stoltenberg Consulting a few years back at CHIME, they said something really interesting that I’m still thinking about today. In fact, I might be thinking about this more today than I was doing before.

Per my notes (so I won’t make it a direct quote), they commented that doctors were putting a lot into the EHR, but they don’t feel like they’re getting a lot out of the EHR.

It’s a powerful idea that is really important for any hospital executive to understand.

I recently wrote about the choice between the Best-of-Breed EHR and the All-In-One EHR approaches on EMR and HIPAA. Here’s the money section:

The real decision these organizations are making is whether they want to put the burden on the IT staff (ie. supporting multiple EHRs) or whether they want to put the burden on the doctors (ie. using an EHR that doesn’t meet their needs). In large organizations, it seems that they’re making the decision to put the burden on the doctors as opposed to the IT staff. Although, I don’t think many organizations realize that this is the choice they’re making.

Choice of EHR is only one of the main reasons why doctors likely feel that they’re getting less out of the EHR than they’re putting into it. Certainly reimbursement requirements and meaningful use should still take a lot of the blame as well. Regardless of how we got here, it’s a very precarious position when the doctors feel like they’re getting less out of the EHR than they are putting into it.

There is a solution to this problem. First, you must work to maximize the physician workflow. Sometimes this means involving the nursing staff more. Sometimes this involves a scribe. Other times it requires a change to your EHR. Other times it means building out high quality templates that make the doctor more efficient.

Second, we must all focus on more ways doctors can get more value out of their EHR. The buzzword analytics has potential, but has been a little too much buzz word and not enough practical improvement for the doctor and patient. We need more advanced tools that leverage all the data a doctor’s putting in the EHR. Clinical Decision Support, Drug to Drug and Drug to Allergy checking are just the first steps. We can do so much more, but unfortunately we’ve been too distracted by government regulation to deal with them. Plus, let’s not kid around. These aren’t easy problems to solve. They take time and effort. Plus, we need a better way for doctors and hospitals to be able to diffuse their discoveries across the entire healthcare community. Sharing these discoveries is just too hard and too slow right now.
EHR Scale
At the end of the day, it’s a simple scale. On the one side you have the time and effort a doctor puts into the EHR. On the other side is the value the doctor gets from the EHR. You can solve this by making the doctor’s EHR work more efficient or by finding more ways the EHR can provide value to the doctor. Much easier said than done. However, if this stays out of balance too long, you can count on a big EHR backlash from doctors.

CIOs Want More Responsibility — And It’s About Time They Get It

Posted on January 19, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

The life of a healthcare CIO is a tough one. More than ever before, healthcare CIOs walk a fine line between producing great technical results and thinking strategically about how technology serves clinicians. As with their more junior peers, many healthcare CIOs only get noticed when something breaks or goes offline. Worse, healthcare CIOs may get the blame dumped on them when a big project — especially a mission-critical one like an EMR implementation — fails due to problems beyond their control.

But despite the political battles they must fight, and the punishing demands they must meet, healthcare CIOs are largely satisfied with their career paths — as long as they have a shot at getting more responsibility that can help them move their organization’s strategy forward. This, at least, is the conclusion of a new survey by SSi-SEARCH.

SSi-SEARCH surveyed 169 CIOs to learn how they felt about key aspects of their job, according to iHealthBeat.  All told, the researchers found that CIOs are most satisfied with the trajectory of their career, compensation and strategic involvement. (This is a significant change from a couple of years ago, when CIOs told SSi-SEARCH that their pay wasn’t keeping up with the growth in their responsibilities.)

On the other hand, healthcare CIOs were markedly dissatisfied with the resources available to them, and almost half (48%) said that there will need to be changes within the next year. That’s certainly no surprise. As we’ve noted in this space before, not only do healthcare CIOs need to implement or further augment EMRs and handle the switch from ICD-9 to ICD-10, many need to make costly upgrades to or replace their revenue cycle management systems.

Even if their institution can’t increase their budget, healtlhcare CIOs would be somewhat mollified if they got some respect for some of the softer skills they bring to the table.

Forty-five percent of those surveyed said they wanted recognition for improving patient safety, 44 percent said they wanted to be recognized for innovation, and 37 percent wanted CEOs to appreciate their skill at “bringing departments together,”  SSi-SEARCH found.

Not surprisingly, they want to be appreciated for their overall contributions to their institutions as well. While 69 percent of CIOs felt that their work was “critically important” to the strategic mission of their organization, and 29 percent felt they had been “very important,” some of their employers don’t seem to see it. In fact, 23 percent of those CIOs surveyed felt that they hadn’t been recognized at all.

Sadly, though the healthcare CIO’s job has evolved far from bits and bytes to projects and strategies that directly impact outcomes, not every institution is ready to give them credit. But if they have CIOs pigeonholed as tech wizards, they’d better change their tune.

Giving CIOs the latitude, responsibility and budget they need to do a great job is enormously important. If healthcare organizations don’t, they’ll never meet the demands they currently face, much less emerging problems like population health management, big data and mobile health. This is a make-or-break moment in the dance between healthcare organizations and IT, and it’s not a good time for a misstep.

Google Joins PwC and Open Source Vista EHR Team in DoD EHR Bid

Posted on January 16, 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.

Chris Paton posted an interesting bit of news about Google joining forces with PwC, DSS, Inc, Medsphere, Medicasoft, and General Dynamics Information Technology. Here’s an excerpt from what Chris posted:

PwC and Google recently announced a joint business relationship where the two organizations will team together to help companies accelerate their journey to and build trust in the cloud. The combined advantage of PwC and Google teaming together on the DORHS proposal – along with commercial EHR vendors DSS, Inc. and Medsphere Systems Corporation, MedicaSoft, and systems integrator General Dynamics Information Technology — offers the DoD a distinctive, reliable and secure open source EHR solution with innovative, user-friendly operations. In addition, DORHS’ flexibility will help prevent the federal government from being locked into a single technology, avoiding “vendor lock” and “innovation lag” which can occur with proprietary EHR and technology companies.

With $11+ billion at stake in the DoD EHR project, it’s not surprising that companies are trying everything they can to make their bid the most attractive out there. Although, I’m not sure how much Google really brings to the table as far as technical expertise with Vista. Seems more like a PR move than a decision to bring on specific expertise.

I’m also interested to see if open source EHR vendors based on Vista really have much of a chance against Epic, Cerner and Allscripts (and their government contractor partners). I try not to predict government decisions, but it would be quite the coup for a Vista based EHR bid to win.

3D Printing Saves Wife’s Sight

Posted on January 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.

This is a great article which illustrates the importance of being an active patient advocate in your care, but also illustrates some of the future of technology in healthcare. Here’s a brief excerpt from the article.

Balzer downloaded a free software program called InVesalius, developed by a research center in Brazil to convert MRI and CT scan data to 3D images. He used it to create a 3D volume rendering from Scott’s DICOM images, which allowed him to look at the tumor from any angle. Then he uploaded the files to Sketchfab and shared them with neurosurgeons around the country in the hope of finding one who was willing to try a new type of procedure. Perhaps unsurprisingly, he found the doctor he was looking for at UPMC, where Scott had her thyroid removed. A neurosurgeon there agreed to consider a minimally invasive operation in which he would access the tumor through Scott’s left eyelid and remove it using a micro drill. Balzer had adapted the volume renderings for 3D printing and produced a few full-size models of the front section of Scott’s skull on his MakerBot. To help the surgeon vet his micro drilling idea and plan the procedure, Balzer packed up one of the models and shipped it off to Pittsburgh.

Pretty amazing use of 3D printing technology and it’s great to see that he could pretty easily convert the MRI and CT scan data into a 3D image that could be printed on a 3D printer. No wonder the 3D printing area was next to the digital health section at CES.

Healthcare Analytics is Everything and Nothing

Posted on January 13, 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.

Healthcare Analytics has been the buzzed word ever since last year’s HIMSS. It’s been included in pretty much every healthcare IT company imaginable. I was talking to an EHR consulting company today and I asked if they were moving into some sort of analytics offering. As we discussed the idea further, we realized that they’re not really going into healthcare analytics specifically, but that many of the projects they see as the future of healthcare IT involve analytics.

As I think over this discussion, it’s easy for me to see how healthcare analytics is involved in everything, but that the term itself means nothing.

If I dive a little deeper into this subject it reminds me of a video interview I watched last night with a popular venture capitalist. At one point in the conversation he casually said, “Once again it goes back to the data. I guess it all goes back to the data, because we think data is at the core of the future of everything we’re investing in.”

While this comment didn’t necessarily apply to healthcare, it very could have been about healthcare. The future of healthcare is about the data. It’s about how an organization leverages data to improve the care they provide a patient. EHR was just the first step in making much of the healthcare data digital. However, this new wave of wearables and health sensors is bringing another form of data to healthcare. Genomics is bringing another wave of data to healthcare. Watson is reading through all the medical studies and making that data useful and actionable for a doctor.

It’s easy for me to say that the future of healthcare is going to be dependent on data. It’s at the core of everything that we will do. Going full circle, healthcare analytics is one way of describing how you take the data and make it useful. So, it makes sense that however you look at the future of healthcare IT, you probably have some sort of healthcare analytics involved in what you’re doing. It’s all about how you slice the data.

IBM and Epic Prep for Multi Billion Dollar DoD EHR Contract

Posted on January 12, 2015 I Written By

In this recent Nextgov article, they talk about what Team IBM/Epic are doing to prepare for the massive bid:

On Wednesday, IBM and Epic raised the bar in their bidding strategy, announcing the formation of an advisory group of leading experts in large, successful EHR integrations to advise the companies on how to manage the overhaul — if they should win the contract, of course.

The advisory group’s creation was included as part of IBM and Epic’s bid package, according to Andy Maner, managing partner for IBM’s federal practice.

In a press briefing at IBM’s Washington, D.C., offices, Maner emphasized the importance of soliciting advice and insight from the group. Members of the advisory board include health care organizations, such as the American Medical Informatics Association, Duke University Health System and School of Medicine, Mercy Health, Sentara Healthcare and the Yale-New Haven Hospital.

Add this new advisory group to the report that Epic and IBM set up a DoD hardened Epic implementation environment and you can see how seriously they’re taking their bid. Here’s a short quote from that report:

Epic President Carl Dvorak explained the early move will also help test the performance of an Epic system on a data center and network that meets Defense Information Systems Agency guidelines for security. An IBM spokesperson told FCW that testing on the Epic system has been ongoing since November 2014.

As we noted in our last article, 2015’s going to be an exciting year for EHR as this $11+ billion EHR contract gets handed out. What do you think of Team IBM/Epic’s chances?

Muli-Billion Dollar DoD EHR Contract Promises Exciting Times in 2015

Posted on January 9, 2015 I Written By

This summer the DOD is set to award the multi billion dollar electronic health records contract. Each group that bid on it contains at least one company the provides product and one with heavy weight Gov’t/DOD presence.

Who is going to win? Who is in real trouble if they don’t? As far as the winner is concerned, my new, Christmas gift , Crystal Ball doesn’t have this level of experience yet. What I do know is that who the actual winner is will affect the entire Healthcare IT marketplace.

Of the bidders, there are a few companies “betting the farm” on winning this. More later on who, but they could be in serious trouble if they are not the winners.

The contract is scheduled to be awarded in early July. I’m sure there will be protests and pressure from the losers, so the contract’s full impact might be delayed briefly.

When all this is sorted out the need for qualified people to work on the project is going to be huge and securing a position there will be considered a prize for many because the contract itself is going to last for at least 8 years.

Basically this means that if you are looking for a position, there are going to be a huge amount of health IT job opportunities available. As professionals move to the DOD contract, most will need previous experience. Where are they going to come from? These experienced professional departures will create job opportunities when they leave.

For employers, you might want to look into your employee retention efforts. Some companies out there are going to have a major problem with retention. You may be putting out fires all summer long as the experienced health IT marketplace shifts.

FHIR Adoption Needs Time to Mature

Posted on January 7, 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 John Halamka’s look at Health IT in 2014 he offered some really great insight into how regulators should look at standards and adoption of standards.

Here’s one section which talks about the lesson learned from meaningful use stage 2:

“Stage 2 was aspirational and a few of the provisions – Direct-based summary exchange and patient view/download/transmit required an ecosystem that does not yet exist. The goals were good but the standards were not yet mature based on the framework created by the Standards Committee.”

Then, he offers this money line about FHIR and how we should handle it:

“We need to be careful not to incorporate FHIR into any regulatory program until it has achieved an objective level of maturity/adoption”

There’s no doubt that FHIR is on Fire right now, but we need to be careful that it doesn’t just go down in flames. Throwing it into a regulatory program before it’s ready will just smother it and kill the progress that’s being made.