Hospital EMR and EHR

What If EMR Interoperability Was Mandatory?

For decades, industries have haggled and coded and bargained their way into shared data standards. Each agreement has made great technical advances possible and grown markets into forms which could hardly have been imagined before.

Traditionally, the idea has been agreeing on interoperable standards is a form of enlightened self-interest. The equasion “interoperability=larger markets=more pie for everyone” has nearly always managed to take root even in industries as brutally competitive as networking. Consider where we’d be without 802.11 for WiFi, for example. If WiFi manufacturers had staged a prolonged battle over standards, and the reach of WiFi didn’t blossom everywhere, the Internet as we know it might not exist.

Well, here in EMR vendor land, we’ve somehow passed the exit marked “coopetition” and wandered off into interoperability nowhere land. Sure, tell me about the CommonWell Alliance, which looks, on the surface, something like industry cooperation, and I’ll retort, “too little, too late.” And do I even have to say that the idea that Epic supports everybody is something of a laughing matter?

Maybe, after seeing how miserably the EMR vendor industry has failed to come together to share data, it’s time to force the matter. I read that ONC honcho Farzad Mostashari has occasionally threatened to do just that, but hasn’t followed through with any proposed regs on the subject.

What if the FCC, the FDA and the ONC (which are now taking comments on a regulatory framework for health IT) decide to look at standards, pick a winner and shove it down the ever-living throat of every uncooperative vendor hoping to create dependency on their way of doing things? That would include Epic, of course, which today, hears countless hospital CIOs say they had to buy their product because everybody else did.

Don’t get me wrong, this is a very, very serious matter; any regs that attempted to force interoperability would impose untold billions in costs on vendors, not to mention their customers. But if interoperability is the real prize we’re ultimately hoping to gain — the big EMR enchilada — is it possible that it’s time to take the risk anyway? I don’t know, but I certainly wonder. How about you, readers?

ONC, FCC, FDA Seek Comment On Pending Health IT Regulations

This is big stuff, folks. The FCC, FDA and the ONC are asking the public for comments they can use in developing a regulatory framework for health IT, according to iHealthBeat. While the agency alphabet soup doesn’t sound very exciting on the surface, I’d argue that this is a turning point for health IT as a whole, as such a framework is likely to change the way the HIT market does business.

So why go ahead with such a request now? iHealthBeat reports that the request for comments cites “a growing need for the federal government to develop a coordinated approach to its oversight of health IT that promotes innovation, protects patient safety and avoids regulatory duplication.”

The report is being executed by a 32-member workgroup, housed under the ONC’s Health IT Policy Committee. It’s being tasked under the authority of the 2012 FDA Safety and Innovation Act, which requires the group to submit a report by January 2014. One portion of the report will be dedicated to mobile health applications.

According to iHealthBeat, the request for comments covers three key areas:

Taxonomy, including what types of health IT the agencies should address in the report;
Risk and innovation, including what types of risks health IT poses to patient safety; and
Regulation, including what regulatory areas are overseen by more than one of the agencies and what can be done to minimize such overlap.

Commenters are encouraged to offer their in put no later than June 30, but the comment period will remain officially open until August 31.

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June 4, 2013 I Written By Anne Zieger

Filed Under: Hospital Electronic Health Record Hospital Electronic Medical Record Hospital EMR Hospital Healthcare IT Hospital IT Systems

Tags:FCC FDA Health IT Regulation ONC

Government Regulations Overwhelming Hospital CIOs

I was recently talking with a hospital CIO about the challenges that he faces as a hospital CIO today. This hospital CIO has been doing it for a long time and so I was quite interested to hear his perspective on the changes in his job.

His response was telling. He recounted how he kept a powerpoint slide which covers all of the areas and projects he’s responsible for as a hospital CIO. Over time that slide had grown into a lengthy list of responsibilities, but he’d also modified the slide into two different lists. The new list he created was all the government regulations he was required to deal with as a hospital CIO. He then told me that the list of government regulations was as long as the rest of the list.

This is not surprising for those of us in the healthcare space. Without even effort I can list the alphabet soup of government health IT regulations: MU, ACO, ICD-10, EHR, 5010, etc. Plus, that doesn’t even include all of the various healthcare regulations that tangentially impact healthcare IT.

No doubt all of these government regulations can be overwhelming to any healthcare IT organization and its leaders. Although, I’m also concerned at the impact this will have to innovation in these hospital IT organizations.

We’ve seen how meaningful use has nearly stopped innovation in EHRs. It seems that wave after wave of government healthcare regulations are doing the same. When does a hospital CIO have time to do innovative things when they can barely keep their head above water dealing with government regulations?

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June 3, 2013 I Written By John

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Filed Under: Healthcare CIO Hospital CIO Hospital EHR Hospital Electronic Health Record Hospital Electronic Medical Record Hospital EMR Hospital Healthcare IT

Tags:Healthcare Government Regulations Healthcare IT Leadership Hospital CIO Leadership Meaningful Use

Paper to EMR is Much Easier to Justify Than EMR to EMR

When I was last in DC at the Healthcare Forum, I heard hospital CIO Bill Rieger “Step Out” and talk about some of the challenges he faces as a hospital CIO. One of the things he said in his talk really rang true to me and is going to become an increasingly important topic in healthcare.

His comment: The ROI from Paper to EMR is Much Easier to Justify than EMR to EMR

This is a powerful and challenging thing to consider. I’m sure those at Epic, Cerner, Meditech, etc are licking their chops knowing that it will take a hospital CIO with special leadership skills to overcome this challenge. Yes, from their perspective they have some incredible customer lock in. However, Bill went on to describe that it’s not impossible to lead such an effort. In fact, his hospital was switching EMR software shortly after I heard him speak.

The biggest challenge with this idea isn’t that there’s no ROI to switch from one EMR to another EMR. There can be a significant ROI, but most hospital CIOs are afraid to make such a call. They’re afraid to really dig in deeply to find out what a new EMR might mean for their hospitals. Sometimes this is because they were the one who implemented the first EMR. Other times it’s they’re too risk averse to take on such a challenging project. It’s often easier to sweep thing under the rug than it is to pull up the rug and really see what’s going on under the covers.

I’m of course not suggesting that switching EMR software is always the right decision either. One of the first lessons I learned out of college was that change doesn’t always mean better. In fact, a change can make things worse.

I do believe that continuous improvement leads to beautiful results. Too many in healthcare IT are satisfied with status quo. If we’re going to continuously improve, one area we can start is to dig deeply into the ROI of going from electronic to electronic.

Do We Need To Allow Hospitals To Donate EMRs?

Today I was looking through my Twitter inbox and found this complaint, by @lee_ritz:

EMR systems are putting private physician groups out of business–we can’t afford to compete with the big hospital groups.

Certainly, it’s hard to argue that some EMRs can put a big strain ( as much as $50K+ per doctor) on medical practices . And for those in low-margin specialties like primary care, perhaps that could be the death-blow financially. But are we at a point where we need to somehow pay for EMRs for small practices above and beyond Meaningful Use incentives?

One way to address this problem comes straight from the loving arms of the American Hospital Association.

Right now, the HHS Office of the Inspector General has proposed a rule which would extend the EMR safe harbor – allowing hospitals to donate EMRs and health IT to practices and not face a kickback investigation – from the end of this year until December 31, 2106. Looked at one way, that’s a pretty good offer, as it and gives both hospitals and medical practices the change to get those donated EMRs in place and situated while both sides iron out Meaningful Use issues.

The AHA is arguing that safe harbor protections should be made permanent. Its executives argue that the safe harbor is a valuable tool for getting health IT into the hands of rural physicians; that with the donations, hospitals can provide the tech support, training and maintenance medical practices need to use EMRs properly; and that hospitals can donate EMRs to physicians across entire areas, ensuring interoperability.

The AHA also notes that not all providers are eligible for Meaningful Use incentives, and that new physicians, presumably needing hospital help to get their EMRs rolling, will begin to practice after the deadline has passed. And on top of all of this, the AHA letter to the OIG states, changes in interoperable technologies will require new donations going forward if doctors and hospitals are to stay connected.

Is this the solution to the problem of making sure cash-strapped smaller practices can afford to have powerful EMR technologies that connect with hospitals and peers? It’s hard to say, but I do think there’s some merit to at least extending the protections further and keeping a close eye on what happens.

In this day and age, when getting EMRs into medical practices is such a key federal objective, it does seem to me that the hospitals deserve a generous turn at bat. After all, the money has to some from somewhere.

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May 28, 2013 I Written By Anne Zieger

Filed Under: Community Hospitals EMR Financing Health Information Exchange HIE Hospital EHR Hospital Electronic Health Record Hospital Electronic Medical Record Hospital EMR Hospital Healthcare IT Hospital IT Systems Meaningful Use

Tags:AHA American Hospital Association EHR Donation HHS Office Of The Inspector General

Do Hospitals Care About Healthcare IT Accelerator Companies?

I’ve been thinking quite a bit about all the various Healthcare IT accelerators out there. There’s a lot of interest in investment in healthcare right now. Just today I posted about a new online healthcare investment portal called VentureHealth. Add in the Rock Health, Startup Health, NYeC Accelerator, Blueprint Health, and Healthbox (I’m sure I’m missing a few others) and we’re seeing a really tremendous interest in trying to create innovative solutions for healthcare.

Despite all this movement and investment, I’m afraid to ask, “Do hospitals care about Healthcare IT accelerator companies?”

In all the conversations I’ve had with hospital executives, I can’t remember once hearing them say that they can’t wait to see what innovations come out of a healthcare accelerator. Sure, some of the accelerators are more focused on consumer health, but there seems like a major disconnect between healthcare accelerators and actual hospitals and doctors.

I noted the one exception to this seemed to be the NYeC accelerator which seems to have good connections to a number of NY based hospitals. Now that their first class is complete, I’ll be interested to talk to those companies that participated to see how well those connections really played out.

To be honest, I’m not sure why there’s the disconnect. Are hospital CIO’s just overwhelmed with all the daily minutiae and government regulations that they don’t have time to look at innovations? Are the healthcare accelerator companies not producing something worthy of hospital CIO interest?

Regardless of why, I see a wide chasm between the innovations that are being worked on in healthcare accelerators and the actual healthcare decision makers.

Boston Children’s Creates Special Adolescent PHR

Creating PHRs for adolescents is trickier than preparing them for adults. While childrens’ and adolescents’ PHRs are usually controlled by parents, there are some areas in which teens have a right to privacy, including any discussions about sexually transmitted diseases, reproductive health, substance abuse and mental health information.

At Boston Children’s Hospital, they’re grappling with the problem of a creating a PHR which protects the adolescent’s right to privacy and confidentiality of such information without sealing parents out of areas which are public. This is a difficult problem, given that confidential information is generally seeded throughout EMRs, writes the hospital’s Fabienne Bourgeois.

To address the complex problem of giving adolescents appropriate access to their PHRs, BCH has developed a custom-built portal to meet both hospital and adolescent patient needs, Bourgeios says.

Adolescent patients and parents access the portal separately, through linked accounts. Parents have sole access until the child turns 13, at which point both get access. At 18 years, the patient becomes the sole owner of the portal account, and unless other constraints exist, the parent link is deactivated, she notes.

Within the portal, sensitive content has been identified and tagged, such as pregnancy-related labs, genetic results, confidential appointments, and possibly sensitive problems and medication. Right now this data is filtered from both parent and adolescent accounts, but in the future it will flow only to the adolescent account. “This solution does take a lot of time and effort, but best replicates current clinical practice,” Bourgeious notes.

This is quite an interesting project. It’s good to see researchers taking on unique privacy challenges involved in treating adolescents. Any efforts which engage a population in their own health and make them confident their privacy will be protected are to be commended.

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May 22, 2013 I Written By Anne Zieger

Filed Under: Hospital EHR Hospital Electronic Health Record Hospital Electronic Medical Record Hospital EMR Hospital Healthcare IT Hospital IT Systems PHR

Tags:Adolescent PHR Boston Children's Hospitall

Should EMRs Help Patients Retrieve Medical Records?

As often as not, patients who need to retrieve paper medical records from hospitals go through a painful process, one which is not much easier than it was before EMRs were introduced in hospitals.

I found this out myself recently when I attempted to retrieve a medical record for one of my children from a large hospital in my metro area. I started by reaching out to the health information management department — where it took three separate calls before I connected with a staff member. Then I was informed that the despite the paper-free hospital environment, I would have to wait two weeks before I could lay hands on the medical record, as the staff was swamped.

This would have struck me as comical if it wasn’t such an unfortunate situation. Without HIEs in place universally across the hospital world, wouldn’t it make sense if the EMR helped produce the paper copies of records needed everywhere in a universal fashion?

Yes, I realize that EMRs are optimized for care during the hospital visit, and such is necessary to get the job done. That being said, I could easily see using some of the technology hospitals already have in place to make EMR records retrievable by caregivers and patients.

After all, at least some hospitals already have kiosks in place that allow patients to pay bills. Couldn’t a modification of such kiosk allow patients to pay for their records fees, order the records for a given patient, sign electronically to give permission for such a printout and get the records into the mail on the back end — if not straight into their hands?

Sure, I know HIPAA issues arise when you’re trying to automate the dispensing of private health information, but at least until HIEs are everywhere, it’s a problem that needs to be handled. After all, the reality is that patients need to carry print records all over the place to get decent care. What’s the point of urging patients to engage with their medical records data if simply retrieving hard copies of them is such an awkward chore?

I know there was some debate about this in meaningful use. Hopefully once the future stages of meaningful use are in place, getting your records from the EHR will be a much faster process than it is today.

Health IT Haiku

Now for something completely different, folks. Here’s some haiku verses (5-7-5 syllable scheme) on EMR and HIT issues. I’m hoping y’all jump in and give it a try next.

EMR cutover
Could it be that all our work
Comes down to this day?

Everyone freaks out
EMR has gone off line
Painful nine seconds

Meaningful Use is
Years of pain and suffering
For a bite-sized check

Can’t write haiku on
interoperabili-
ty, or can you now?

Elegant, simple
EMR interface is
Rarer than diamonds

Fifty million spent
Putting in their EMR
Which they then threw out

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May 20, 2013 I Written By Anne Zieger

Filed Under: Community Hospitals Hospital EHR Hospital Electronic Health Record Hospital Electronic Medical Record Hospital EMR Hospital Healthcare IT Meaningful Use

Tags:EHR Haiku Health IT Haiku Healthcare Interoperability Hospital Haiku

Hospital EHR Subsidies

In response to Anne’s post on Senator’s questioning the meaningful use EHR incentive money, Gary Colvin emailed me the following comment:

I would argue for the case where the only reason some providers are in the M.U. game is due to their Hospital subsidies. Instead of paying approx $1,200/ month to lease out their Epic E.M.R., they are enjoying its benefits for under $300 per month. What happens when the subsidy goes away for good? I think you would be hard pressed to see a four doc family practice paying $4,800 / month to enjoy that system — so, when the subsidy goes away (maybe it will be extended to 2016?) it will surely have an impact on who stays in the game.

I did question Gary on his algebra of the cost of Epic per doctor and he said that he got numbers from his hospital which is a public hospital where the pricing has to be transparent. It actually makes me wonder what other EHR pricing data could be uncovered from various publicly available sources. I wonder if data geek Fred Trotter has ever worked on this.

Regardless, I think the EHR subsidies is an important topic. I’ve known many doctors that are afraid of the hospital EHR subsidy because of the lock in it creates with the hospital. However, in many areas the lock in is already there so it doesn’t matter.

I wonder if hospitals are worried what it will mean for them once the EHR subsidies are no longer available.

What If EMR Interoperability Was Mandatory?

ONC, FCC, FDA Seek Comment On Pending Health IT Regulations

Government Regulations Overwhelming Hospital CIOs

Paper to EMR is Much Easier to Justify Than EMR to EMR

Do We Need To Allow Hospitals To Donate EMRs?

Do Hospitals Care About Healthcare IT Accelerator Companies?

Boston Children’s Creates Special Adolescent PHR

Should EMRs Help Patients Retrieve Medical Records?

Health IT Haiku

Hospital EHR Subsidies

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