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What Can We Expect with Meaningful Use Stage 3?

Posted on October 6, 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.

The incomparable John Halamka, CIO of Beth Israel Deaconess Medical Center and Co-Chair of the HIT Standards Committee, has a good post up on his blog talking about the future of standards, certification and meaningful use stage 3. Here’s one excerpt about MU stage 3 and EHR certificaiton:

Meaningful Use Stage 3 regulations are currently in draft and will be released as NPRM before the end of the year. My hope for these regulations is that they will be less prescriptive than previous stages, reducing the burden of implementation for providers and vendors.

It’s purely my opinion, but I’m optimistic that simplification will happen, given that the 2015 Certification Rule is likely to decouple Meaningful Use and certification. Certification is likely to be incremental year to year without the tidal wave of requirements we’ve seen in the past. Certification of health IT (not just EHRs) will be with us for a long time and may be leveraged by more programs than just the EHR incentive programs. Imagine that modules for patient generated data (such as wearables), health information exchange (HISPs), and analytics services (such as those used for care management by ACOs) could be certified and used in any combination to achieve outcomes.

I’m really hopeful that Halamka is right and that MU stage 3 will be dramatically simpler. However, in government work, I’m rarely confident that something will be simple. In fact, his comments about ongoing certification are sad too. Anyone who’s had to work with supposedly certified CCD documents from multiple EHR vendors that should be “standard” knows what I mean. Because of examples like this, I’m not a fan of government certification setting the standard, but Halamka might be right that they may use EHR certification to try.

What will be interesting to me is what motivation organizations will have to continue on with meaningful use stage 3. The EHR incentive money will be gone. Certainly the EHR penalties are a pretty sizable motivation for many organizations. Although, probably not as sizable as many think when you compare it against even the MU 2 burden (another reason why MU 3 needs to be simpler). Also, I still wouldn’t be surprised if we had an ICD-10 Delay-esque move by the AMA or some other healthcare organization to remove the EHR penalties. It will be a little harder since the penalties are hard revenue that has to be accounted for, but don’t put it past a good lobbyist.

What’s Happening with All the Departures at ONC?

Posted on October 3, 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.

In many ways, it’s expected that there will be a fair amount of change in the leadership of an organization when the leader leaves. The new leader often wants to bring in their people with whom they’ve worked with before and trust. Plus, I’ve previously noted that the Golden Age of EHR is over and so it’s not surprising that many people would leave ONC as the MU money is running out and the future of ONC is uncertain.

You’ll see the letter below that Karen DeSalvo just sent out about the latest ONC departure: Judy Murphy, Chief Nursing Officer (CNO) at ONC. This is the fourth high level leader that’s left ONC in the past few months. For those keeping track at home, Doug Fridsma MD, ONC’s Chief Science Officer, Joy Pritts, the first Chief Privacy Officer at ONC, and Lygeia Ricciardi, Director of the Office of Consumer eHealth, are the other 3 that have left ONC.

When Karen DeSalvo announced the ONC reorganization, here’s the leadership team she outlined:
Office of Care Transformation: Kelly Cronin
Office of the Chief Privacy Officer: Joy Pritts
Office of the Chief Operating Officer: Lisa Lewis
Office of the Chief Scientist: Doug Fridsma, MD, PhD
Office of Clinical Quality and Safety: Judy Murphy, RN
Office of Planning, Evaluation, and Analysis: Seth Pazinski
Office of Policy: Jodi Daniel
Office of Programs: Kim Lynch
Office of Public Affairs and Communications: Nora Super
Office of Standards and Technology: Steve Posnack

Three of the people on this list have already left ONC. That’s a pretty big hit to an organization that will likely have to do some hard work to ensure they’re included in future budgets in a post-MU era. It’s hard to fault any of these people who have an opportunity to make a lot more money working in industry. It will be fun to see who steps in to replace all these departures (including Dr. Jon White and Dr. Andy Gettinger who DeSalvo talks about in her letter below).

Must be an interesting time in the hallways of ONC.

Letter from Karen DeSalvo to ONC team about the departure of Judy Murphy, CNO of ONC:

ONC Team:

I am writing to let you know that Judy Murphy, our Chief Nursing Officer (CNO) and Director of the Office of Clinical Quality and Safety (OCQS), will be leaving ONC to take on an exciting new position as Chief Nursing Officer with IBM Healthcare Global Business Services. Her last day will be October 17.

Judy came to ONC in December 2011 and continued her established tradition of giving passionately and tirelessly to the entire health IT community. As Deputy National Coordinator for Programs and Policy, she led the HITECH funded program offices to achieve key milestones, such as the RECs providing assistance to 150,000 providers and helping 100,000 of them meet the meaningful use incentive requirements (exceeding the goal by 150%). She ensured that dedicated resources were available to help 1,300 critical access and rural hospitals exceed the same goals by 200%. She helped grow the MUVer (Meaningful Use Vanguard) Program to 1,000 providers and the Health IT Fellows Program to 45, giving us real boots on the ground to help providers adopt and use EHRs.

Her long-standing reputation of patient advocacy and maintaining a “patient-centric” point of view helped in ONC’s creation of the Office of Consumer eHealth, as well as identify annual strategic goals to promote consumer engagement. With the office, she helped launch the now very successful “Blue Button: Download your Health Data” campaign initiative.

Most recently, as CNO, she championed a Nursing Engagement Strategy for ONC and initiated the joint ONC and American Nurses Association Health IT for Nurses Summit which was attended by 200 RNs and NPs. In addition, her astute organizational and project management skills were put to use strengthening portfolio management and project performance management at ONC.

In her time here, she received several awards spotlighting her work, including the HIMSS Federal Health IT Leadership Award, the AMIA President’s Leadership Award, and the Distinguished Alumni Achievement Award from her alma mater, Alverno College, in Wisconsin.

We are planning a smooth transition of Judy’s current duties. Judy’s CNO responsibilities will be entrusted to the other nurses at ONC until a replacement CNO can be named.

Dr. Jon White will be on a part-time detail to ONC from the Agency for Healthcare Research and Quality (AHRQ) to serve as interim lead of OCQS and serve as ONC’s Acting Chief Medical Officer, reporting to Deputy National Coordinator Jacob Reider, while ONC searches for permanent staff to fill these positions. Dr. White directs AHRQ’s Health IT portfolio and will continue in that role part-time.

Dr. Andy Gettinger, from Dartmouth Hitchcock Medical Center, has agreed to lead the OCQS Safety team and the patient safety work. Dr. Gettinger comes to us with vast experience in many areas of health IT and we are excited to welcome him to the team. Judy is working closely with Jon, Andy, the extraordinary OCQS team, and me to ensure a seamless transition of her responsibilities.

Please join me in wishing Judy all the best in her new role, thanking her for her public service to our nation, and welcoming Andy and Jon to our team.

kd

How Many Hospitals Follow Events Like TedMed and Exponential Medicine?

Posted on October 2, 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 was watching some of the Health Innovations Media video interviews at TedMed. It made me wonder how many hospital executives and hospital IT people pay attention to events like TedMed and Exponential Medicine. I went to TedMed last year and enjoyed it, but not sure it was worth the list cost for the event. How many readers have been to events like this?

You might also check out this interview with Daniel Kraft, MD, organizer of Exponential Medicine at the TedMed event. He points out some interesting reasons to attend such events and some thoughts about where it’s all headed.

If you don’t go to these big picture, cross collaboration events, what do you do to make sure you’re broadening your perspective on what’s happening?

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.