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A Meaningful EHR Certification

In many ways this post could be considered a continuation of my previous post on data liberation. I’ve really loved the idea of a creating a meaningful EHR Certification and that could include data liberation. Let’s be honest for a minute. Do any of you find value in the current EHR certification?

You know that a certification is screwed up when it requires certain interoperability standards and then when you go to actually implement the sharing of data between two systems you find out that the two systems are working on two different standards. They are close standards, but close doesn’t count with standards. Many have asked the question, “What did the EHR certification do if it couldn’t test the standard?” I have no answer to that question.

Now imagine we created an EHR certification that actually did require a standard for interoperability. Not a flavor of a standard, or something that closely resembles a standard. I’m talking about a standard. Would hospitals find this useful? I think so.

Another example of a meaningful EHR certification could be certifying that an EHR vendor will not hold your EHR data hostage. Think about how beneficial that would be to the industry. Instead of EHR vendors trying to trap your data in their system, they could focus on providing the end user what they need so the end user never wants to leave that EHR. What a beautiful shift that would be for our industry.

There could be many more things that could be meaningfully certified. However, this would be a simple and good place to start. I have no doubt that some would be resistant to this certification. That’s why those who do become meaningfully certified need to get the proper boost in PR that a meaningful certification should deserve. No EHR vendor wants to be caste as the EHR vendor who can’t figure out the standard and that holds its customers hostage. Yet, that’s what they’re able to get away with today.

What do you think of this idea?

April 16, 2014 I Written By

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.

eFax in Hospitals

Over the years, I’ve had the chance to interact with basically all of the major eFax services out there. I’ve even had a number of them as advertisers. This largely makes sense since healthcare it still the haven for fax. I won’t go into all the reasons why fax is still so popular in healthcare, but it’s still the most trusted form of interoperability in healthcare. As an eFax vendor pointed out to me, fax is great because it produces an unalterable document. Sure, it’s not impossible to alter, but it’s pretty difficult.

I am hopeful that fax will one day be replaced by true interoperability in healthcare. Although, I’m more hopeful that Direct Project will get us there even sooner. Fore those not familiar with Direct Project, it’s like fax, but with meta data attached to it and securely sent over the internet. Both true interoperability of data and Direct Project still have a long ways to go though. So, don’t hold your breathe on those taking out fax….yet.

A trend I have seen happening is organization replacing their current fax solution with some sort of eFax option. In many cases this shift has been driven by issues with fax when you’re in a VoIP environment. Yes, I know that many of the VoIP environments can support fax, but it takes work. In fact, it takes just as much work getting it to function as it is to just implement some sort of eFax solution.

The other real benefit I’ve seen many consider when looking at eFax is the cost structure of eFax. Instead of having to invest in faxing hardware all up front, many organizations like that the eFax can be bought on a pay as you go or usage based plan. If indeed faxing is starting to go away in favor of some other electronic transfer of data, then your organization can save money on faxing as your fax load is reduced.

There are a few trends I’ve seen with eFax in healthcare. What trends have you been seeing in your organization?

January 23, 2014 I Written By

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.

2013 Hospital EHR and Health IT Trends

There are a number of amazing milestones and trends happening with EHR and Healthcare IT. I think as we look back on 2013, we’ll remember it for a number of important changes that impact us for many years to come. Here are a few of the top trends and milestones that I’ll remember in 2013.

Epic and Cerner Separate Themselves – This has certainly been happening for a couple of years, but 2013 is the year I’ll remember that everyone agreed that for big hospitals it’s a two horse race between Cerner and Epic. There’s still an amazing battle brewing for the small hospital with no clear winner yet. However, in the large hospital race the battle between Cerner and Epic is on. Epic had been winning most of the deals, but Cerner just gave them a big left hook when Intermountain chose Cerner.

I expect we’re living in an Epic and Cerner world until at least a few years post meaningful use. The job listings on Healthcare IT Central illustrate Cerner and Epic dominance as well.

Near Universal EHR Adoption in Hospitals – I can’t find the latest EHR adoption (meaningful use) numbers from ONC, but the last ones I saw were in the high 80′s. That basically leaves a number of small rural hospitals that likely don’t have much tech infrastructure at all, let alone an EHR. Every major hospital institution now has an EHR. I guess we can now stop talking about hospital EHR adoption and start talking about hospital EHR use?

The Cracks in the Healthcare Interoperability Damn Appear – Interoperability has always been a hard nut to crack in healthcare. Everyone knew it was the right thing to do, but there were some real systemic reasons organizations didn’t go that direction. Not to mention, there was little financial motivation to do it (and often financial disincentive to do it).

With that background, I think in 2013 we’ve started to see the cracks in the damn that was holding up interoperability. They are still just cracks, but once water starts seeping through the crack the whole structure of the damn will break and the water will start flowing freely. Watch for the same with interoperability. Some of this year’s cracks were started with the announcement of CommonWell. I think in response to being left out of CommonWell, Epic has chosen to start being more interoperable as well.

Skinny Data Happens – I was first introduced to the concept of skinny data vs big data at HIMSS 2013 by Encore Health Resources. While I’m not sure if the skinny data branding will stick, the concept of doing a data project with a slice of data that has meaningful (excuse the use of the word) outcomes is the trend in data analytics and it’s going to dominate the conversations going forward.

As I posted on EMR and EHR, Big Data is Like Teenage Sex, but skinny data is very different. Skinny data is about doing something valuable with the data. Sadly, not enough people are doing skinny data, but they all will in 2014.

Hospitals Ignore Consumer Health Devices – Consumer health devices are popping up everywhere in healthcare. We’re quickly reaching the point that consumers can monitor all of their vital information at near hospital grade quality using their smartphone and sometimes an external device. This is a real revolution in medical devices. Many are still making their way through FDA approval, but some have passed and are starting to work on traction.

With all of this innovation, hospitals seemed to have mostly ignored what’s happening. Sure, the larger ones have a few pilot projects going. However, most hospitals have no idea what’s about to hit them upside the head. Gone will be the days of patients going to the hospital to be “monitored.” I don’t think most hospitals are ready for this shift.

December 31, 2013 I Written By

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.

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

May 20, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Only Incentives Will Make EHR Interoperability Happen

Today we had a really interesting #HITsm chat about interoperability, data hoarding, and sharing healthcare data. Tomorrow we’ll have a post on EMR and EHR that summarizes some of the key tweets from the chat. Although, there was one theme that really struck home to me during the chat.

The biggest barrier to EHR interoperability and data sharing is incentives.

During the chat multiple people including myself made the observation that the reason EHR vendors don’t share data is that there’s no incentive to share data. I can’t say I’ve ever seen a hospital choose to not go with an EHR because it couldn’t interoperate with another EHR vendor. The incentive isn’t there for the hospital and therefore the EHR vendor.

Think about the EHR interoeprability announcement of CommonWell. While the CEO’s of the five EHR vendors can sit there and say that they’re doing it because it’s the right thing to do for healthcare, these public company CEOs also have a legal responsibility to do what’s best for the shareholders of their company.

The reality is that CommonWell would have never happened if there wasn’t an incentive for these companies to put CommonWell together. Rather than beat around the bush, these EHR companies came together to stick it to Epic and to give them a strategic advantage over other companies that can’t or won’t share data. You can certainly make an argument for why doing this is good for healthcare as well, but if there was no outside business incentive to CommonWell then the healthcare benefit wouldn’t have been enough.

As one person tweeted during the Twitter chat, If there were money paid for sharing data, all the fear and issues would suddenly disappear and solutions provided.

When thinking about incentivizing EHR interoperability, Farzad Mostashari’s words at The Breakaway Group event at TEDMED come ringing into my ears, “Incentives and money aren’t always the same.” Cash or otherwise, EHR interoperability needs some incentive.

April 26, 2013 I Written By

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.

We Have an HIE – The Internet

Jon Fox, MD and Founder of HealthApp Connect sent me a great message:

We already have a great free HIE and it’s called the internet

He makes an interesting point. Reinforces why I called for hospital CIO’s to start making interoperability a reality as opposed to just talking about it. The technology and connectivity is there. Every hospital is connected to the internet and therefore already connected to every hospital out there. That simplifies the issues, but enough people are overcomplicating what needs to happen. Maybe we need some more people in healthcare willing to look at interoperability more simply.

February 11, 2013 I Written By

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.

Senators Join Initiative To Scrutinize Meaningful Use

A couple of weeks ago, four House GOP leaders wrote a letter to HHS head Katherine Sebelius demanding that she account for perceived failures in the Meaningful Use program.

The four congressmen had written a letter to HHS head Kathleen Sebelius to recommend that until MU Stage 2 rules require “comprehensive interoperability,” and hospitals can prove they’re capable of exchanging data, the agency shouldn’t hand out incentive payments.

Politics being what it is, the other shoe had to drop, and now a group of senators have offered their own objections.

Sens. John Thune and Dr. Tom Coburn of the Finance Committee, and Richard Burr and Pat Roberts of the Health, Education, Labor and Pensions Committee have formally requested that CMS and ONC staffers meet with the latter committee regarding the final rule for Stage 2 of Meaningul Use.

In a letter to HHS, the senators raise several questions:

* Do EMRs sometimes increase utilization of diagnostic tests, and if so, how should the government respond?

* Have some providers gotten subsidies for EMR systems they had in place prior to the kickoff of  Meaningful Use? If so, what is HHS doing to claw back such payments and prevent future outlays of this kind?

* Has the use of EMRs boosted providers’ billing of Medicare, and thereby raised the cost of the program?

* What is HHS’s strategy for “meaningful interoperability”?

Interestingly, the senators’ letter stops short of demanding a halt on MU payments, which the congressmen did in no uncertain terms.  But they’re clearly antsy about the future of the Meaningful Use program, which has paid out $6.6+ billion in incentives to date.

And you know what?  It’s about time that Congress got interested in the future of EMRs and Meaningful Use specifically.  Better to have them breathing down HHS’ neck now than further down the line when there’s far less opportunity to turn the MU battleship.

October 23, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Should Every Health IT System Support Interoperability?

In response to my post on EMR and HIPAA called “Interoperability versus Usability in Best of Breed or All-in-One HIS Systems” I got the following message:

It’s unfortunate in today’s environment that we still have a “versus” in the equation. There are some systems that fall under “best of breed” and/or “integrated” and do a pretty good job at supporting interoperability. But, there remains some that rely on proprietary data models and archaic interfaces as part of their revenue stream. Hopefully as more and more emphasis is associated with clinic value derived from data exchange/sharing the “dinosaurs” will be eventually phased out :-)

This comment prompted me to ask the question: Should we get past closed gardens and just start sharing all our data?

The simple answer that I think we all know is the right answer is: Yes, we should get past the closed gardens and start sharing our data.

All of us in our heart of hearts know this is the right thing to do. Sure, we all also know that we need to put in proper controls so that we’re sharing it appropriately, but that can be done. Why then aren’t we doing this if we all know it’s the best thing we can do for healthcare?

My simple response is that there are still financial benefits not to do it. We need someone to lead us to a point where the financial benefits of not exchanging data are so valuable that those who want closed gardens start to suffer.

This will happen. It may take some time, but the clinical value derived from data exchange/sharing will make it so the “dinosaurs” have to hop on board or become extinct.

May 2, 2012 I Written By

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.

Software to Software Interoperability and Software to Device Interoperability

We’ve been having the discussion for a long time about interoperability of healthcare data. Although, maybe I should say the discussion has been around lack of interoperability of healthcare data. However, I think we sometimes get confused in the discussion because there are a lot of different ways to share healthcare data. From the hospital point of view this becomes even more complex. Here’s a look at some of the various ways that we could and in many cases should share data.

Software to Software – When someone is talking about healthcare interoperability, they are usually talking about software to software data sharing. Some of the most common examples in healthcare include EHR to HIE, EHR to EHR, or even within modules of the same EHR or HIS system. You can also expand this to include Lab to EHR, Radiology to EHR, ED to EHR, Pharmacy to EHR, etc. In all of these cases, it’s one piece of software sharing data with another piece of software.

One of the biggest challenges with this sharing of data is that even when these software systems are the same software it can be hard to share the information in a ways that’s useful for the receiving system. Sure, we could just transfer some PDF files which are easily viewable and can be easily digested by the receiving system. The sending system and receiving system both understand the PDF format and can easily create, send and receive the file in a way that both know.

Unfortunately, a PDF file listing your drug history isn’t nearly as useful as an XML or other data driven file that contains each of the elements of your drug history including things like drug name, strength, date prescribed, data filled, etc etc etc. The challenge is not creating a file like this. That’s quite academic. The pain point is communicating to the new system the format of the file that you created so that the receiving system can ingest that file into that software in a proper manner.

There are plenty of more points on why software to software exchange is a challenge. However, we’re going to see more and more software to software exchange in healthcare going forward. We’re literally just at the beginning of this revolution.

Device to Software – Another common place for healthcare data exchange is from a medical device to software. Some of the most common examples are the blood pressure cuff and thermometers that are connected directly to an EHR software. Things like EKG’s are also becoming more and more common. In the hospital there are an amazing number of high end clinical devices that also integrate their data with software.

From my experience, these device to software integrations are pretty straightforward. The device manufacturers set the standard and there are relatively few medical device manufacturers out there. Usually it’s a one (device) to many (EHR and HIS software) which makes things easier. Although, we’ll see how this changes as more and more medical devices are built on top of various smart phones and tablets like the iPhone and iPad.

Software to Device – The exchange of data from software to a device is less common. Yes, I am excluding devices like a smart phone which to me are just an extension of the software. A better example is something like Cisco’s unified messaging system where you can have data from your EHR or HIS system sent to your Cisco VoIP phone. It’s pretty amazing technology and I hope we get to see more and more Software to Device integrations in healthcare.

Device to Device – I actually can’t think of any device to device connections that I know of today. I imagine there are some out there, but I can’t think of any that are really popular. With that said, I can see the day where devices are talking to devices. A simple example could be a medical device talking with your Smart TV. Your device could know it’s time to take another reading and so it could display that to you on your Smart TV. You could have the option to respond on the TV and the TV could talk to the device.

In some implementations, we already have a device talking to your smart phone. This will become even more common once we have things like near field communication (NFC) in all smart phones. Depending on how this is implemented, it could be considered a device to software connection, but could also land in the device to device.

Theses examples might not be a good description of what type of device to device integration we could see going forward in healthcare. I’m confident that creative minds will come up with some really fantastic device to device integrations in the future.

March 26, 2012 I Written By

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.