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Living on the Cutting Edge, Security, and Engineer User Interfaces

Posted on October 1, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

I thought it would be fun today to mix it up a little bit and highlight a few of the interesting tweets that I’d seen recently. Plus, I’ll add a few comments after each tweet.


This is a great quote. Of course, we should add that being misunderstood might mean you’re insane. So, I’d suggest, “There’s a fine line between being misunderstood and being crazy.”


Very interesting. I think we’re starting to see this approach in healthcare, but it certainly hasn’t been the norm.


This isn’t a health IT user interface, but I’ve seen EHR software that’s just as complex.

Fall 2014 Health IT Conference Schedule

Posted on September 29, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

Going to my third conference in a week must mean that we’re in the heart of Fall health IT conference season. This week I’m at AHIMA. I love attending AHIMA. I think that the AHIMA conference is a bit like HIM staff in general. There this hidden gem that many people don’t recognize even though they have tremendous value. I feel the same at this conference. The HIM staff at AHIMA have some really great perspectives on what’s happening with healthcare IT in their organization. I don’t think it’s a must attend event for everyone, but it’s great for a blogger like me to get a variety of perspectives on the healthcare IT industry.

This is really just the start of the conference season for me. I always get asked by people which conferences they should attend. In fact, my breakfast meeting this morning with a new to healthcare vendor this morning had a lot of discussion about which health IT conferences they should attend. For those interested in this same question, I’ve created a page which lists the Health IT Conferences I’m attending and also a look at some of the major health IT conferences that happen every year.

As I’ve talked to people, I’ve realized there are a few other events that I need to add to the list. I like to joke with people that if I wanted to I could attend a different health IT event every day of the week. Although, that’s not really much of a joke since it’s basically true.

What events do you attend? Which ones do you find most valuable?

From a hospital IT perspective, the CHIME Fall Forum is the tops for me. The Digital Health Conference is good and hospital CFO’s should hit the Craneware Summit. Then, of course, HIMSS is a great place for hospital IT people, but that’s not until April 2015.

I’m looking forward to all these conferences. They provide me a lot of perspective which I use in all of my blog posts. If you’re going to be at any of the events, let me know. I always love to meet readers in person.

ACOs Stuck In Limbo In Trying To Build HIT Infrastructure

Posted on September 26, 2014 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.

Though they try to present themselves differently, ACOs are paper tigers. While they may be bound together by the toughest contracts an army of lawyers can devise, they really aren’t integrated in a meaningful way.

After all, the hospitals and medical groups that make up the ACO still have their own leadership, they don’t generally hold assets in common other than funds to support the ACO’s operations, and they’re definitely not in a great position to integrate technically.

So it comes as no surprise that a recent study has found that ACOs are having a hard time with interoperability and rolling out advanced health IT functions.

The study, a joint effort by Premier and the eHealth Initative, surveyed 62 ACOs. It found that 86% had an EMR, 74% had a disease registry, 58% had a clinical decision support system, and 28% had the ability to build a master patient index.

Adding advanced IT functions is prohibitively difficult for many, researchers said. Of the group, 100% said accessing external data was difficult, 95% said it was too costly, 95% cite the lack of interoperability, 90% cite the lack of funding or return on investment and 88% said integration between various EMRs and other sources of data was a barrier to interoperability.

So what you’ve got here is groups of providers who are expected to deliver efficient, coordinated care or risk financial penalties, but don’t have the ability to track patients moving from provider to provider effectively. This is a recipe for disaster for ACOs, which are having trouble controlling risk even without the added problem of out of synch health IT systems.

By the way, if ACOs hope to make things easier by merging with some of the partners, that may not work either. The FTC — the government’s antitrust watchdog — has begun to take a hard look at many hospital and physician mergers. While hospitals say that they are acquiring their peers to meet care coordination goals, the FTC isn’t buying it, arguing that doctors and hospitals can generally achieve the benefits of coordinated care without a full merger.

This leaves ACOs in a very difficult position. If they risk the FTC’s ire by merging with other providers, but can’t achieve interoperability as separate entities, how are they going to meet the goals they are required to meet by health insurers? (I think there’s little doubt, at this point, that truly successful ACOs will have to find a way to integrate health IT systems smoothly.)  It’s an ugly situation that’s only likely to get uglier.

EMR Change Cuts Cardiac Telemetry Use Substantially

Posted on September 25, 2014 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.

Changing styles of medical practice can be really tough, even if major trade organization sticks its oar in to encourage new behavior from docs.

Such is the situation with cardiac telemetry, which is listed by the American Board of Internal Medicine Foundation as either unnecessary or overused in most cases. But a recent piece of research demonstrated that configuring an EMR to help doctors comply with the guideline can help hospitals lower needless cardiac monitoring substantially.

Often, it takes a very long time to get doctors to embrace new guidelines like these, despite pressure from payers, employers and even peers. (Physicians may turn on a dime and try out a new drug when the right pharmaceutical rep shows up, but that’s another story.) Doctors say they stick to their habits because of patient, institutional or personal preferences, as well as fear of lawsuits.

But according to a recent study appearing in JAMA Internal Medicine, reprogramming its Centricity EMR did the trick for Wilmington, Del.-based Christiana Care Health System.

To curb the use of cardiac telemetry that was unnecessary, Christiana Care removed the standard option for doctors to order cardiac monitoring outside of AHA guidelines, and required them to take an extra step to order this type of test.

Meanwhile, when the cardiac monitoring order did fall within AHA guidelines, Christiana Care added an AHA-recommended time frame for the monitoring. After that time passed, the EMR notified nurses to stop the monitoring or ask physicians if they believed it would be unsafe to stop.

The results were striking. After implementing the changes in the EMR, the health systems average daily not intensive care unit patients with cardiac monitoring fell by 70%. What’s more, Christiana Care’s average daily cost of administering  non-ICU cardiac monitoring held by 70%, from $18,971 to $5,772.

Christiana Care’s health IT presence is already well ahead of many hospitals — it’s reached Stage 6 of the HIMSS EMRAM scale — so it’s not surprising to see it leading the way in shaping physician behavior.

The question now is how the system builds on what it’s learned. Having survived a politically-sensitive transition without creating a revolution in its ranks, I’d argue the time is now to jump in and work on compliance with other clinical guidelines. With pressure mounting to deliver efficient care, it’d be smart to keep the ball rolling.

Is No Flex-IT the Best thing for EHR and Healthcare?

Posted on September 24, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

Strategically placed during National Health IT Week, 17 healthcare organizations sent a letter to HHS requesting that the meaningful use reporting period for 2015 be adjusted from 365 days to 90 days. Along with that, the Flex-IT act was introduced to congress in order to legislate this change. It’s always hard to predict what congress will do, but many believe that the Flex-IT act will get tagged on to something else and get passed. We’ll see if that indeed happens.

What everyone I talk to agrees is that the 365 day meaningful use stage 2 reporting period is going to be impossible for hospitals to meet. Sure, a few hospitals might make some herculean effort and meet it, but they’ll be so few and far between that they’ll be a rounding error.

What would it mean to healthcare and meaningful use if almost every hospital opts out of the meaningful use program? This isn’t too hard to imagine. A large portion of the meaningful use money has already been spent and the penalties don’t look that bad when you consider the costs and risks associated with the all or nothing meaningful use program.

If the MU reporting period doesn’t change, I think it spells the death of meaningful use. Sure, the program will subsist for those who have attested, but it will be a defunct program with so few participants that the program will have little impact. Plus, we’ll see a wave of efforts to make sure that those penalties for not being meaningful users of an EHR are removed much like has been done with the SGR fix year after year.

The Flex-IT act would at least keep meaningful use on life support. MU 2 is much harder, but with a change to a 90 day reporting period many will do it to avoid the penalties and get the last bit of EHR incentive money. If we want meaningful use to survive, then the Flex-IT act (or something that does something similar) is going to be essential to its future.

I’m just personally not sure that the Flex-IT act is such a great thing for EHR or the industry. Is it better to keep meaningful use on life support or bite the bullet now and have meaningful use die on the vine.

One might argue that meaningful use has accomplished it’s main goal: adoption of EHR software. It’s dramatically accelerated the adoption of EHR software. Would it be such a bad thing for meaningful use to disappear now? With MU gone, we could return to a more rationale EHR market. I guess this is where I’m torn on whether getting the Flex-IT act passed is a good or a bad idea.

What do you think? Is the Flex-IT act a good idea or should we just fall on the sword now as opposed to prolonging the regulation?

Where Do We See the Latest Startup Methodology in Healthcare IT?

Posted on September 23, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

I’ve been spending the day at the Intelligent Insite Build conference in beautiful Fargo, ND. I’ll be on stage later to talk about what’s happening with Healthcare IT. However, the past day at the conference I’ve been really intrigued by the company culture that exists at Intelligent Insites.

While I do almost all of my work in Healthcare IT, I also have a foot in the vegas tech startup world as well. As part of that and my love of tech, I’m always interested in startup culture and the latest trends in startup company creation. What I didn’t expect was to find these startup culture concepts in full bloom in Fargo, ND. I guess I should have known that the Internet and social media were spreading these ideas everywhere. Even in Fargo and even in Healthcare.

Just to share a few examples. It was great to see the whole Intelligent InSites team training on lean startup methodology. The extreme customer service focus is another example. I also loved the way the company has integrated itself into the local startup company ecosystem. I’m sure this is just touching the surface, but is a clear sign of the startup culture they’ve created.

What’s a little surprising to me is that I don’t know of other hospital IT companies that exhibit a similar culture. I’d love to hear if you know of others.

My guess is that we don’t hear about them more in hospital IT because hospitals have a general fear of the “startup” idea. The hospital culture is a no risk culture and the startup culture is seen as one of risks.

What hospitals don’t understand is that a startup is about some business risk, but not patient risk. The former can be a challenge for some organizations, but that’s a risk with organizations of all sizes. A large organization could just as easily cut that department. Plus, a well capitalized startup company is just as stable or more stable than a large company. The patient risk shouldn’t be a concern with a well run startup company.

We need to embrace more of the creativity that startups can bring to an industry. Healthcare can use a bit more creativity.

Are EHR Complex Because Now We Can Make Them Complex?

Posted on September 22, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

I recently had a chance to do some late night research for this blog at a QuickCare center near my house (4 sutures later and I should be fine).  While I was there I dropped the fact that I was an EHR blogger so I could get them to talk about their experiences with EHR. As expected, they had strong feelings about EHR and we’re happy to share. In fact, the next week they were switching EHR software in a big bang style switchover with 4 hours of training before the switch. God bless them on their conversion.

Although, one of the comments that struck me most was from the nurse who said, “I use to use MEDITECH and it was so simple to use.”  They then went on to talk about the old DOS-like user interface that MEDITECH employed and how easy it was to use.

I’ve been thinking a lot about this response and it made me wonder, Are we making EHR more complex because now we can?  Think about it for a second. In the DOS based world, you couldn’t make an application complex because the interface couldn’t support it.

I’m not suggesting we go back to a DOS based interface. However, maybe there’s some lessons to be learned from that simpler time.

For example, could a number of keyboard commands be integrated into the EHR to make it more effecient. You might remember that the DOS-based environment was all keyboard based which was part of its efficiency. It made for a bit more learning curve, but once you mastered it, it was incredibly fast.

One thing that is missing from EHR today is simplicity. Maybe looking back might help us remember a simpler day.

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

Posted on September 19, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

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

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

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

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

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

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

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

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

Meaningful Use Delay (Again): What We Need to Learn from Critical Access Hospitals Before it’s Too Late – Breakaway Thinking

Posted on September 18, 2014 I Written By

The following is a guest blog post by Todd Stansfield from The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Todd Stansfield - Breakaway Group
Take a breather, implies the government’s latest rule for meeting meaningful use requirements of the EHR Incentive Program.  Perhaps that’s not the best plan of action.

On the brink of Labor Day weekend, the Centers for Medicare and Medicaid Services (CMS) finalized the rule for Stage 2 and Stage 3 Meaningful Use, a move designed to make it possible for more healthcare providers to attest this year and beyond. The rule pushes Stage 3 to 2017 and allows providers to meet Stage 2 requirements this year using 2011 certified electronic health record technology, among other things.

While the rule alleviates the challenges of attesting to meaningful use in 2014, it doesn’t solve the more significant problems of the 2015 reporting year, which begins Oct. 1, 2014. That date marks the beginning of the 365-day period over which providers will have to attest to Stage 2 requirements using 2014 certified technology—four times as long as the 90-day span the CMS just relaxed for the 2014 reporting year. Among critics of the ruling is the College of Health Information Management Executives, as the added burden of a full reporting year means “‘industry struggles will continue well beyond 2014,’” according to a Forbes article.

Recent news has sparked hope amid the panic for many healthcare providers. Two weeks after CMS finalized its ruling, Congresswoman Renee Ellmers (R-NC) and Congressman Jim Matheson (D-UT) introduced the Flexibility in Health IT (Flex-IT) Reporting Act, which aims to shorten the Stage 2 reporting window for 2015 from 365 to just 90 days—the same timeframe CMS granted in 2014 after providers struggled to attest. While the move would certainly ease the burden on providers, the Flex-IT Act still awaits Congressional approval before being passed into law.

So far this year, only 5.8 percent of eligible providers attested to Stage 2, according to a Health Affairs article. It’s a markedly low percentage, suggesting that if Congress turned down the Flex-IT Act few providers would be ready and able to attest in 2015.

Providers who are working toward attestation this year and planning for 2015 could learn from those who have been through the process such as Cottage Hospital and Odessa Hospital. Engaged leadership was key to these two critical access hospitals’ (CAHs’) ability to cement proper focus and commitment across their organizations to attest to Stage 2, according to EHRIntelligence and Healthcare Informatics. Both CAHs prove that attesting, however difficult, is certainly possible, and their unique strategies offer a clear path for the approximately 3000 providers eligible to attest.

At Cottage, “full support from the top for Meaningful Use” and “an all-hands-on-deck-effort” reportedly consisted of weekly meetings held by project managers and key personnel focused on discussing progress and barriers to success.

In addition to leadership support, both hospitals also reportedly transferred ownership of the initiative from the IT department to staff involved in care delivery. At Cottage, the IT team set up the infrastructure to support the EHR and then handed it over to clinical informaticists who understood the workflow of clinical staff. Clinical informaticists identified areas where the application could not support established workflows. Any discoveries were then reported to the vendor, who adapted the application to how care was being delivered, reversing the usual and inefficient route of providers adapting their processes to EHR functionality.  At Odessa, ownership transferred from a software vendor acting as Odessa’s IT department to their clinical team. While both Cottage and Odessa are fortunate to have vendors capable of meeting the 2014 certification criteria—a rarity among the 58.9 percent of eligible healthcare providers still yet to attest—both organizations are partly responsible for that success. They worked with their vendors to bring the EHR systems up to par with the requirements. This type of collaboration is crucial to establish certification-capable systems and will likely become a trend as more is asked of providers.

Both CAHs were also able to meet some of the most stringent requirements of Stage 2—which includes having 5 percent of patients view, download, and transmit their health information electronically. Cottage and Odessa found this particular requirement especially difficult, yet both were able to overcome it by educating patients, according to a Healthcare IT News article. Cottage reportedly “took down their [patients’] email addresses as they prepared for discharge and . . . [walked] them through the process of logging on and viewing their data.” This highlights that for a requirement solely within patients’ control, providers must take a more proactive approach to get their participation.

For providers to attest in 2015 no matter the reporting requirements, they will have to leverage strong leadership, clinical involvement, vendor collaboration, and strategies that focus on integrating patients in the overall care process. Cottage and Odessa prove these strategies are critical to meeting Stage 2 requirements. Their success has been validated by our research at The Breakaway Group, A Xerox Company, which shows that organizations with strong change leadership, effective education, ways to measure performance, and a means to sustain the effort are the best equipped to optimize their EHR use, and in the case of Stage 2, attest to the new requirements.

Stage 2 represents more than quantifiable criteria, but the start of using EHR systems in ways that can improve care and patient health. For our healthcare industry to ever realize buzz words like “interoperability” and “care continuum,” and for healthcare providers to breathe easier, this is a move we have to make.

Xerox is a sponsor of the Breakaway Thinking series of blog posts.

Healthcare IT Leadership Infographic – A 25 Year History

Posted on September 17, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

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