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Bringing Meaning to Disparate Clinical Data

Posted on April 3, 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.

For a while, I’ve been extremely intrigued by vendor neutral archives. While they’re usually applied to the PACS and imaging world, I’ve always thought that the concept will eventually spread across all healthcare data. With that in mind, I found this whitepaper, Bringing Meaning to Disparate Clinical Data, provided an interesting view into the world of vendor neutral archives (VNA) and it was very clear to me that the problems we’re working to solve in the medical imaging world are very much applicable to the problems we need to solve with other healthcare data (ie. EHR data).

Here’s how the whitepaper suggests you evaluate VNA solutions:

  • Interoperability
  • Image accessibility
  • Disaster recovery
  • Upgradability
  • Data security
  • Ease of use

It’s quite easy to see how this same list could just as easily apply to any healthcare IT system that a hospital adopts. The image accessibility may not apply, but accessibility of data (which is what the image represents) is extremely important. I think that many organizations would be much happier with their EHR today if they’d used the above list in their EHR selection process.

The whitepaper also lists events that affect the timing and direction around enterprise image management planning:

  • Replacing a PACS
  • Joining an integrated care community
  • Accommodating new sources of images
  • Impending mergers, acquisitions, and associations
  • Storage convergence
  • Centralized management

Looking through the list, it’s very clear to me that many of the above items are going to be drivers of EHR switching as well. In fact, it’s going to make up the majority of future EHR purchases. Plus, we’re seeing a lot of changes when it comes to joining care communities and mergers, acquisitions, etc.

At the conclusion of the whitepaper, it suggests that the single most important key to choosing an enterprise solution for image management is flexibility:

  • Flexibility of connecting all kinds of devices and systems.
  • Flexibility of accessing information anywhere, anytime
  • Flexibility to scale effectively with facilities’ growing needs
  • Flexibility to meet departmental needs

We didn’t use this framework for selecting EHR vendors, but will we use it the next time around. Has our current EHR experience helped us to realize the value of flexibility with our healthcare IT software vendors? I think these will become part of the future EHR purchase process.

I don’t think the markets are that much different. The future of EHR in healthcare organizations will likely follow the path that imaging vendors have already trod. It’s just too bad we couldn’t learn from imaging’s experiences and apply them to EHR already. Since we haven’t, I think learning about the history of image management systems in healthcare will help us better understand where EHR is headed.

Epic Does April Fool’s Day – Calls Out Cloud and CommonWell

Posted on April 1, 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.

You can always count on Epic for a great April Fool’s day joke. For as long as I can remember, they’ve swapped out the Epic home page and turned it into a great joke. Plus, this year, they took it to another level as they called out the cloud and CommonWell. Their cloud article titled “The Industry’s First True Cloud-Based Solution” is pretty great. Here’s an excerpt:

When dark clouds gather over the healthcare IT horizon, GOODyEHR, Epic’s new cloud-based hosting solution, will help our customers soar over them – literally. Cruising at 30,000 feet, Epic’s zeppelin-based GOODyEHR data center takes “cloud-based” to dizzying new heights. Other vendors have made similar claims in the past, but they have all been full of hot air. Epic’s solution, by contrast, is full of hydrogen.

Obviously, Epic is mocking Jonathan Bush, CEO of athenahealth who’s been harping on the advantages of cloud for years. I’ll be interested to see if Jonathan Bush brings this up on stage at HIStalkapalooza. I can’t imagine he won’t.

Although, even more likely is for Jonathan Bush to rant about CommonWell and Epic’s decision to not take part. Of course, Epic’s April Fool’s Day addresses it (kind of):

Neal Pasturesson, CEO of Churner Corp. swissmissed the initiative. “Until the Supreme Quart rules in favor of our CowmonWell healthcare infarmation exchange, all these efforts will corntinue to be a Tower of Baybel.” Alfalfahealth CEO Jugnathan Bush commented “That’s their idea? I can’t believe it’s not better.”

Good stuff. Thanks Epic for a good laugh. I’m sure Cerner and athenahealth will take this all in good fun.

I captured a screenshot of the homepage for posterity since many of you will read this tomorrow when it’s no longer up on their website (click on the image to see it full size):
Epic - April Fool's Day

Why Can’t Release of Records Be Automated Through A Patient Portal?

Posted on March 31, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was in a recent discussion with one of the leading providers of release of information services, HealthPort about EHR’s impact on the release of health records. In our discussion, I asked why the release of health records can’t be completely automated through a patient portal. In my mind, meaningful use is requiring that healthcare organizations put a patient’s record up on a patient portal, so shouldn’t that mean that the release and disclosure of patient records would become obsolete?

Of course, I was applying a limited view to what’s required when a disclosure happens and who is making the records request. In most cases, it’s not the patient requesting the record and these third parties don’t have access to the patient’s portal. Plus, the release and disclosure of patient records often requires accessing multiple systems along with assessing which information is appropriately included in the disclosure. The former is a challenge that can be solved, but the later is a complex beast that’s full of nuance.

In order to clarify some of these challenges and explain why a patient portal won’t replace all records requests, here’s a short interview with Jan McDavid, Esq., General Counsel at HealthPort.

Q: What are HIPAA requirements around “charging” for copies of records, and what are considered “reasonable” costs?

A: HIPAA is very clear that its pricing applies only to copies provided to “individuals,, which HIPAA defines as the person who receives treatment—the patient. HIPAA guidance pertains only to patient requests for medical records, approximately seven percent of all requests received by healthcare providers.

The majority of records are requested by physicians for continuing care, governments for entitlement benefits, insurers, and inquiries from attorneys, according to internal data from HealthPort’s 2014 record release activity nationwide.

Within the realm of patient requests, providers can charge patients no more than their labor costs to produce the record, plus supplies and shipping. No upfront fee to search or retrieve records may be charged to patients.

Q: Why shouldn’t records just be free now that they are electronic?

While many believe the cost to produce records should be negated once information is digital, there are misperceptions and logistics that must be understood. The process of disclosure management (release of information) involves many steps that still require human intelligence and intervention—especially on the front end of the process (receiving, validating and approving the request). Here are three examples:

  • The authorization must be adhered to strictly, which often requires contacting the requester and explaining that some of the records they requested may not be available, or may require very specific patient authorization.
  • Information is commonly pulled together from multiple sources and systems (paper and electronic) to fulfill a request. While providers are working toward completely electronic environments, almost all still have a combination of paper and electronic. Depending on who makes the request, every single page of a record may require review.
  • Staff releasing records must be trained on HIPAA, HITECH, the Omnibus Rule, state and federal subpoena requirements, and specific state and federal laws for drug, alcohol, HIV/AIDS, mental health, cancer, genetics, minors, pregnancy, etc.

Q: If the EHR is in the portal, what other records aren’t in the EHR that HIM staff has been aggregating in a records request?

A: Not all patient information is automatically included within the patient portal view, nor should it be. Each provider organization determines what EHR information is posted to the portal and what patients can do within the portal (e.g. requesting refills, scheduling appointments, viewing lab results, etc.). HIM experts are key in these decisions.

The Overdose – When EHRs Go Wrong

Posted on March 30, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

We’re getting more and more stories coming out about the impact for bad that an EHR can have in medicine. Most of them have been anecdotal stories like The Old Man and the Doctor Fable and Please Choose One. However, today I came across one that talked about an overdose due to an error in the use of EHR. Here’s a summary of the discovery:

Levitt’s supervising nurse was stumped, too, so they summoned the chief resident in pediatrics, who was on call that night. When the physician arrived in the room, he spoke to and examined the patient, who was anxious, mildly confused, and still complaining of being “numb all over.”

At first, he was perplexed. But then he noticed something that stopped him cold. Six hours earlier, Levitt had given the patient not one Septra pill—a tried-and-true antibiotic used principally for urinary and skin infections — but 38½ of them.

Levitt recalls that moment as the worst of her life. “Wait, look at this Septra dose,” the resident said to her. “This is a huge dose. Oh my God, did you give this dose?”

“Oh my God,” she said. “I did.”

If you read the whole article linked above, you’ll discover that the issue happened when entering the dosage for a drug into the Epic EHR system at UCSF. I’m not here to point fingers since every case is unique and you could argue forever about whether it’s the software’s responsibility to do something or whether the person using the software is responsible for understanding how the software works. I think that’s a discussion that goes nowhere since the right answer is that both can do better.

These types of stories are heartbreaking. They even cause some to question whether we should be going electronic at all. I’m reminded of a time I was considering working at a company that did expert witness testimony for cars. One of their hypothesis was that the computers that are now found in cars will usually save people’s lives. However, in a few cases they’re going to do something wrong and someone is going to lose their life. I think that’s where we’re at with EHR software. It’s not perfect and maybe never will be, but does it save more lives than it kills?

That’s a tough question that some people don’t want to face, but we’re going to face it whether we acknowledge the question or not. Personally, I think the answer to that question is that we do save more lives with an EHR than we damage. In the case above, there were still a lot of humans involved that could have verified and corrected the mistake with the EHR. They didn’t, but they could have done so and likely do with hundreds of other mistakes that occur every day. This human touch is a great counterbalance to the world of technology.

If we expanded the discussion beyond lost lives, it would be a much more challenging and complex discussion to know if EHR makes an organization more or less productive. I believe in the short term, that discussion is up for debate. However, in the long term I’m long on the benefits of EHR when it comes to productivity.

None of this should excuse us from the opportunity to learn important lessons from the story above. We need to be careful about over reliance on data in the EHR (similar to over reliance on a paper chart). We need to make our EHR smarter so that they can warn us of potential problems like the ones above. We need EHR vendors to not let known EHR problems remain unfixed. We need a solid testing plan to avoid as many of these situations as possible from ever happening in the first place.

There’s a lot of work to do still to improve EHR. This story is a tragic one which should remind us all of the important work we’re doing and why we need to work really hard to improve it now.

Meaningful Use Stage 3 Apathy

Posted on March 27, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ll admit that I was out of town when the meaningful use stage 3 rule was released. (Side Note: Why do they always release the rule on a Friday right before the weekend?) So, unlike many people I wasn’t deep in the regulatory details of meaningful use stage 3.

Since I missed the initial release of MU stage 3, I like to read the commentary coming from other people to sort of triangulate some of the most common issues and challenges people have with the new rule. However, what’s been fascinating for me in almost all of these writeups is that people are tired of meaningful use.

Over and over I’ve read of people who haven’t read the rules, people who are putting off reading the rules, and people who’ve shunned meaningful use all together. In fact, I’ve been shocked by the number of people who are just “over” meaningful use. They’re ready to move on from it and move on to something new.

Many people might misinterpret this apathy with meaningful use as a dislike for technology in general. In most of the cases I’ve mentioned that couldn’t be further from the truth. Most of the people who are tired with meaningful use are all about implementing technology in healthcare. They’re just tired of the government regulating that they do it.

What’s not clear to me is whether this apathy is deep enough that hospitals will not actually go after the meaningful use dollars or not. The EHR incentive money is very real for many hospitals and the penalties are a big deal as well. A decision to not do meaningful use is a really big one and the financial incentives and penalties might still win out. However, you can be sure that whoever’s working on the MU stage 3 project won’t do it with as much gusto as they did MU stage 1.

5 Reasons Your Hospital Is Ready for Data-Driven Medication Reconciliation

Posted on March 25, 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.

Medication reconcilliation is one of those no brainer items that every hospital implements. In fact, it’s a mandate that they do it. However, there’s a wide gap in how hospitals are approaching medication reconcilliation. This is a time when a mix of technology and human verification is at its best.

Dr First recently put out a whitepaper called “Top 5 Reasons Your Hospital is Ready to Graduate to Data-Driven Medication Reconciliation” which covers some of the reasons hospitals should look at automating more of the medication reconcilliation process. Here are their five reasons:

  1. Your providers lack confidence in your patient’s verbal med list or your current medication history feed
  2. You want to lower your readmissions rate
  3. You want to verify patient medication history in 10 minutes or less
  4. You want better visibility into patient compliance
  5. You want a better way to combat doctor shopping.

You can read the full whitepaper where they dive into each of these reasons and explain them in more detail.

We all know that medication reconcilliation is important and valuable. Getting the right balance of technology and human interaction is hard, but it’s where we need to go. The great part is that our sources for medication data are going to continue to improve as that data is more easily shared in real time.

Mark Cuban’s Comments on Healthcare IT at SXSW

Posted on March 24, 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.

Neil Versel has a great little writeup on Mark Cuban on Forbes talking about hospitals inability to innovate at SXSW. Here’s a quote from Neil’s article:

“Hospitals and healthcare, right now they react and respond to regulations and insurance. That’s understandable, but I think technology is coming on so quickly that there’s a lot of opportunity for disruption,” Cuban said.

“The challenge is the length of the sales cycle and how to introduce disruption, because [health systems] are going to fight it. That’s the catch-22 right now,” Cuban said.

I understand that a lot of people don’t like the way Mark Cuban approaches things, but the guy is really smart. One thing I’ve found about super successful people like him is that they’re almost always really good at taking something and narrowing it down to it’s core component. I think that’s what he did with the challenge of healthcare innovation.

Mark’s right that the sales cycle for getting a new piece of technology implemented into hospitals is ugly, brutal and slow. Some people argue that this is a good thing because we’re “protecting the lives of our patients.” While we should be thoughtful on how we implement new innovations in healthcare because lives are literally at risk, what about the lives that could be saved by these innovations? Shouldn’t we worry about those lives as well?

The real challenge isn’t that we’re afraid of some risky innovation harming patients. It’s a mixture of fear of change, fear of the unknown, no process for implementing new items, no bandwidth to implement new innovations, lack of ambition (at least by some), lack of budget for innovation, and then regulations and concerns over patient risk.

Do you agree or disagree? Will healthcare be blind-sided by something that will provide new avenues of innovation?

The Future of…Healthcare IT

Posted on March 23, 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.

As part of HIMSS 2015, they’re holding a blog carnival where people throughout the healthcare IT community can contribute blog posts covering 5 different topics. Each topic looks at “The Future of…” and then “Connected System, Big Data, Security, Innovation, and Patient Engagement.” I thought the topics were quite interesting, so I created a post for each of the 5 topics. Here’s links to each of them:

I’d love to have you chime in on each of the topics that interest you. Let me know if you agree or disagree with my commentary and prognostication. Even better, feel free to write your own blog post on any or all of these topics. They are important topics that will make up much of what happens in healthcare IT.

Are there any other “Future of…” topics you wish would have been discussed?

Two Hidden Gems at the HIMSS15 Annual Conference

Posted on March 20, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’m deep in my preparations for the HIMSS Annual Conference in Chicago. It’s amazing how quickly the schedule fills up. It has me really excited to meet with so many amazing people. To all the PR people who have sent me pitches, I’ll be getting back to you shortly. Yes, I do respond to each and every one of you. No, sending another request won’t get a response faster. In fact, it will make the response slower.

My own schedule aside, I was thinking today that there are two gems at HIMSS that many people don’t know about. So, I thought I’d share them with you.

The CIO Forum
This event is put together by CHIME and is a shorter version of the CHIME Fall CIO Forum. You can check out the schedule of events here. CHIME always does a great job bringing together some great speakers from the industry and also some to address topics like leadership.

While the content is great, the best part of the event is being surrounded by CIOs. Everywhere you turn is another hospital CIO. It makes for a tremendous opportunity to connect and learn from hospital CIOs. The event does cost extra, so make sure you get the right pass if you want to attend. If you’re there, come say hi.

New Media Meetup
I’m a little bias on this event since it’s the one I host, but it’s always my favorite part of HIMSS. There’s a special energy at the event that comes from all of the amazing people in New Media that are at HIMSS. Everywhere you turn at the event you run into someone else that you’ve likely interacted with on Twitter or some other social media.

The event has evolved over time. Originally it brought together bloggers, but quickly expanded to anyone involved in social media. You can find all the details for the event here. I hope that some readers can make it. If you do, be sure to come take a selfie with me or something.

Those are a few of my favorite events at HIMSS that many people don’t know about. What are your favorite parts of HIMSS?

Another Day…Another Healthcare Breach

Posted on March 19, 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.

We all know about the Anthem Healthcare breach of millions of patient records. That’s been followed by an announcement by Premera Blue Cross that they’ve had 11 million records breached as well. Plus, I’m sure we’re just at the start of healthcare data breaches that are going to occur.

What’s astonishing to me is that many seem to be playing this up as a new thing. I remember about 15 years ago when I was in college and a guy I knew told stories about hacking through an entire hospital system. In fact, he casually made the comment, “You don’t want to hack the government cause they’ll come after you, but hospitals and universities you can easily hack and nothing will happen.”

This story illustrates two points. First, breaches of healthcare organizations have been happening for a long time. This isn’t something new. Second, we’re just now starting to put in place the technology that will detect breaches. That’s a good thing. In fact, in some ways we should applaud the fact that we actually know these breaches are happening now. I’m certain that many of these breaches happened before and we just never knew about it because you don’t have to report a breach you don’t know about.

Now that we know about these breaches, will that spur action? I think it will in some organizations. It certainly won’t be a bad thing for security and privacy. Unless we’ve become so callous to the breaches (like the title of this post suggests) that we stop caring about breaches because “they’re bound to happen.”

I hope that this post doesn’t encourage apathy on the part of healthcare organizations security and privacy. I assure you that no hospital wants to go through a breach of healthcare data. While impossible to guarantee it won’t happen, a sincere effort to create a culture of compliance in your hospital can go a long way to preventing many breaches.

As my college hacker friend told me many years ago, “You can never make something 100% secure, but you can make it hard enough for someone to hack that it’s not worth their time.” If it’s not worth their time, they’ll usually move on to someone easier.