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EHR, What’s Next?

Posted on February 1, 2016 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.

EHR Whats Next with Dana Sellers

With the announcement that meaningful use is going to be replaced (Not to be confused with meaningful use is dead like many claimed.) along with a maturing of the EHR market, I thought it might be time to ask the question, EHR, what’s next? This discussion should include how to better leverage your current EHR investment, but also look at what other investments organizations should be making to get the most out of everything that’s happening in healthcare IT. On Thursday, February 4, 2016 at 11:30 AM ET (8:30 AM PT), I’ll be sitting down with Dana Sellers, CEO of Encore, A Quintiles Company to talk over what’s next for EHR and healthcare IT.

You can join my live conversation with Dana Sellers and even add your own comments to the discussion or ask Dana questions. All you need to do to watch live is visit this blog post on Thursday, February 4, 2016 at 11:30 AM ET (8:30 AM PT) and watch the video embed at the bottom of the post or you can subscribe to the blab directly. We’ll be doing a more formal interview for the first 30 minutes and then open up the Blab to others who want to add to the conversation or ask us questions. The conversation will be recorded as well and available on this post after the interview.

With an amazing depth of experience, Dana’s been through a wide variety of healthcare IT cycles. I can’t wait to hear Dana’s thoughts on what’s going to happen with meaningful use, how can healthcare organizations better leverage their EHR investment, where are we really seeing analytics and other buzzword worthy terms breaking through, and what other technologies are on the horizon that will improve healthcare? Please join us Thursday and share your experience as well.

If you’d like to see the archives of Healthcare Scene’s past interviews, you can find and subscribe to all of Healthcare Scene’s interviews on YouTube.

Genealogy Studies and Personal Health Records

Posted on December 2, 2015 I Written By

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin's latest HIM Scene posts here.

If you ask around, you will hear that many people are interested in their genealogy studies and family history. I have even begun to dabble in it as well and it truly is fascinating. There are many apps and kits available to help people with this trend of building an online family tree with pictures and records. These studies have even expanded into DNA testing to show your true heritage and makeup.

Online personal health records (PHR) are also an important tool to keep track of your history but more in the sense of chronic conditions, surgical history, and medication records to be shared with your next provider. So if it’s so interesting to maintain a detailed history of who you are and how you came to be using genealogy, shouldn’t there also be more interest in maintaining online PHRs? After all, your family history does play a pretty significant part in your personal health.

Your family history is part of your medical record because sometimes looking to your family’s past can help healthcare providers better understand your diagnosis and predisposition. When studying your genealogy, you can find out the genetic conditions that may have led to an early death in some of your family members.  How your parents or siblings died can be very important when looking at hereditary issues.

It seems we in HIM have struggled for many years to promote PHR adoption but not for lack of trying on the part of healthcare providers. There have been several big initiatives pushing for healthcare consumers to keep an organized PHR with the latest push coming from Meaningful Use. We now have the technology and capabilities to collect and store healthcare data electronically which can easily be shared through electronic patient portals and HIE.

Patient portals allow patients to monitor their health conditions, lab results, and upcoming appointments. By educating patients on how to care for certain conditions or maintain a healthy lifestyle, patients are empowered to drive their own care. Patients should be at the center of all healthcare provided the same way someone is the main branch that begins a family tree. Perhaps we should follow along with the popularity of genealogy tools and applications and make PHR tracking easy and useful by using technology that links people together to share information. This may be more difficult with sensitive health information but proper authorization should allow owners of the information to share it as they please.

If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.

Learning About Interoperability from Other Industries

Posted on September 21, 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.

In my recent post about DeSavlso suggesting we needed a common interoperability standard, Karl Walter Keirstead offered the following comment:

Finally, someone in government agrees that MU has not had a focus on the right things.

It’s amazing to me, coming from the industrial process control domain where interconnectivity across multiple systems and applications has been routine for 70 years, to see healthcare fussing over interconnectivity.

Their is no need to standardize.

Each set of trading partners the publisher needs to format data for easy posting to a generic data exchanger and the subscriber needs to be able to read data at the data exchanger for easy import to the subscriber environment.

The design criteria are that each partner be allowed to read/write using their own native data element naming conventions (i.e. I post “abc”, you want to be able to read it as “def”, a 2nd subsriber may want to read “abc” as “ghi”.

Of course, a long name is required per publisher data element so that subscribers are able to figure out what they are subscribing to and the other requirement is that a publisher be able to share on a need-to-know basis.

And, yes, since the usual setup will be “pull” instead of “push” each subscriber needs to be able to retain a cursor position at the exchange so they know the last line item they read.

I always learning from other industries and I think the way Karl frames it is really valuable. There are a few challenges that are unique to healthcare. First, we’re talking about 300 different EHR vendors. I guess you could argue that there are even more suppliers in industry for say something like a car or a computer, so they understand integrating with a lot of vendors. However, I think it’s slightly different since all 300 EHR vendors are trying to do more or less the same thing. Still doable, but it does add some different dynamics.

Second, I think that healthcare data is an order of magnitude more complex than much of the data that’s being shared in other industries. I still feel like that’s an excuse as opposed to a real reason for it not to happen. I know this because for years we’ve seen this data being shared at the HIMSS interoperability showcase. It’s more about will than it is about the complexity.

This all reminds me of the time I asked Judy Faulkner, CEO of Epic, if she knew the opportunity she was sitting on. She gave me a blank stare and asked what I meant. I then proceeded to tell her that if she opened up Epic to other people she’d effectively create a standard that everyone would adopt. That’s essentially what I think Karl is saying when he says:

Each set of trading partners the publisher needs to format data for easy posting to a generic data exchanger and the subscriber needs to be able to read data at the data exchanger for easy import to the subscriber environment.

Yep. Epic, Meditech, and Cerner could create a standard for EHR interoperability and everyone would start to use it. Good standard. Bad Standard. It wouldn’t matter, their “trading partners” would adapt to whatever they set as the standard.

The Value of Goals in Hospital IT

Posted on December 17, 2014 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.

When someone sends me a press release that says that a hospital has attested to meaningful use or has achieved HIMSS stage 7, I kind of roll my eyes and move on. As a blogger, it really doesn’t tell me much about that organization. It’s one small data point in what I try to look at in the broader health IT ecosystem. Now, if I don’t see these things happening, I’ll start to wonder what’s going on. However, one individual announcement to me isn’t that interesting.

That’s not to say that healthcare organizations shouldn’t participate in programs like meaningful use and the various HIMSS stages. Sure, the incentive money is great and the adoration of your colleagues at HIMSS when you achieve HIMSS stage 7 is great as well, but that’s not why you should do either of these (ok, maybe the money in MU is worth doing it for).

The best reason your organization should look at going after something like HIMSS stage 7 is because there’s a lot of value in an organization working towards a goal. Of course you should look at the goals you’re trying to achieve to make sure your pointed in the right direction, but nothing unifies an organization like trying to achieve a special recognition. It’s hard to underestimate the value that’s created working towards a common goal.

Having an ambitious goal for your organization helps everyone in your organization to perform better and takes your organization to a higher level than you could have ever dreamed. We could argue over the value or lack thereof of meaningful use. What can’t be argued is the way organizations have come together to be meaningful use compliant.

Also, don’t underestimate the power of celebrating these achievements. While it’s one thing to celebrate your achievements internally (and you should), it’s also really valuable for those in your organization to receive accolades and recognition from their peers in other organizations.

Next time you look at some of these recognition, definitely consider if they espouse the values your organization wants to achieve. However, also take into account the powerful force a high goal and recognition for achieving that goal can provide your organization.

EHR’s Influence on Practice of Medicine

Posted on November 13, 2014 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 recently met with Ensocare to talk about healthcare and healthcare IT and what they saw happening in the industry. We had a far ranging talk about what was happening. However, one thing they said has really stuck with me and caused me to ponder a lot on where we’re at with EHR, where we’ve come from, and where we’re going. Here’s what they said (per my notes):

EHRs were never designed to influence the practice of Medicine.

Thinking about the history of EHR, I concur with this statement. EHRs were designed to better bill for the care you provide. That was their initial purpose. Many were designed to replace the paper chart. Others were built to meet the government meaningful use guidelines. How many were designed to really influence the practice of medicine? Very few if any.

Before we give EHR vendors a hard time, let’s be really honest about the EHR industry. We as the users wanted the EHR to improve our billing or to help us get meaningful use incentive money. We didn’t hold the EHR to the standard of really influencing the practice of medicine. The EHR market gave us exactly what we asked for. We can’t blame EHR vendors for meeting our market demand.

Why then are we surprised that EHRs don’t improve care, when they were never designed to do so?

With this baseline history, I’m not sure this is going to be enough going forward. Now that EHR software is implemented, many have the hope that the EHR will influence the practice of medicine. I’m interested to know how many EHR vendors will be able to create features, functions, workflows, etc that influence medicine versus something from outside the EHR vendor doing it. My guess is that the majority of EHR innovations will come from outside the EHR software itself. Many will work with the EHR data to achieve the result, but it will be someone from outside the EHR vendor that creates the result.

To me, this is the potential of EHR which has yet to be realized. What do you think? Will EHR be able to influence the practice of medicine? Will organizations, companies and individuals be able to build on the top of the existing EHR to influence medicine? Or will we need a new crop of EHR systems that are designed to influence the practice of Medicine? I look forward to hearing your thoughts in the comments.

Has Epic Fostered Any Real Healthcare Innovation?

Posted on August 13, 2014 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 saw the following tweet and was really struck by the question.

I think we could broaden the question even more and ask if any EHR vendor has really fostered healthcare innovation. I’m sorry to say that I can’t think of any real major innovation from any of the top hospital EHR companies. They all seem very incremental in their process and focused on replicating previous processes in the digital world.

Considering the balance sheets of these companies, that seems to have been a really smart business decision. However, I think it’s missing out on the real opportunity of what technology can do to help healthcare.

I’ve said before that I think that the current EHR crop was possibly the baseline that would be needed to really innovate healthcare. I hope that’s right. Although, I’m scared that these closed EHR systems are going to try and lock in the status quo as opposed to enabling the future healthcare innovation.

Of course, I’ll also round out this conversation with a mention of meaningful use. The past 3-5 years meaningful use has defined the development roadmap for EHR companies. Show me the last press release from an EHR company about some innovation they achieved. Unfortunately, I haven’t found any and that’s because all of the press releases have been about EHR certification and meaningful use. Meaningful use has sucked the innovation opportunity out of EHR software. We’ll see if that changes in a post-meaningful use era.

Meaningful Use Drove the Data Gathering

Posted on February 5, 2014 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 recently heard an interesting comment that “meaningful use drove the data gathering.” As you look at meaningful use, it has been the driver of data gathering in healthcare. I’m not sure any other technology has gathered more healthcare data than EHR software (I guess the health plans might have a case here, but it’s different healthcare data). Much of the EHR adoption is attributed to meaningful use.

While it’s great that we’re gathering all of this healthcare data, it’s worth asking the question of what’s being done with this data. Are we meaningfully using the data we’ve gathered? Is the data in a format that we can use the data?

The past 3-5 years of EHR has been defined by EHR systems that converted the paper chart world into an electronic chart world. I believe this is a great step forward, but it’s only a step. The next 5 years we’re going to start using the data that’s been gathered into EHR software and that will change healthcare.

One challenge we face is that many EHR vendors are locking in the data. They’ve gathered the data, but they haven’t set it free so it can be used for good. I believe locking in the data is bad for healthcare, but I also believe that it’s a bad business decision by EHR vendors.

In the future, EHR vendors will be differentiated more on the marketplace of third party applications they support than on their own in house developed apps.

I think we can barely imagine what benefits will come from the proper use of the data we’ve collected in EHR software. EHR data is a treasure trove of opportunity. We just need EHR vendors to start acting like the database of healthcare and stop trying to be the end all be all solution. Then, we’ll see innovation that we haven’t even imagined come into view.

Healthcare CIOs Braced For Regulatory, Infrastructure Challenges

Posted on September 17, 2013 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.

As we all know, CIOs of US healthcare systems are facing a convergence of challenges more difficult than many faced by their predecessors, including Meaningful Use, Affordable Care Act pilot programs, adapting to mobile health trends, and hiring enough IT pros to make all this happen.

To get a sense of how CIOs are managing these difficult problems, the Deloitte Center for Health Solutions conducted interviews with 12 CIOs, representing four academic medical centers, seven regional not-for-profit health and hospital systems, and a Catholic hospital system.

To cope with the onslaught, they learned, CIOs are focusing on complying with regulations, building out their IT infrastructure to meet coming demands, and preparing for an accountable care–centered business environment, Deloitte found.

When it comes to regulatory preparation, the CIOs interviewed by Deloitte seem to have their act together. In fact, 11 of 12 CIOs interviewed rated their organization’s preparedness for meeting Meaningful Use requirements is “very prepared” or “prepared.”

However, this preparedness is coming at a high price. CIOs are investing major amounts of time and energy in complete updates to their current systems, including EMRs, practice management systems, billing systems and more. This work is made more difficult by the need for hospitals and health systems to implement ICD–10.

Other key activities cited by the CIOs including using new systems effectively and efficiently, updating and enhancing management capabilities, and strengthening oversight and governance. The CIOs are also upgrading the protections against fraud and abuse and securing PHI more aggressively, Deloitte reports.

Yet another challenging initiative undertaken by the CIOs – one which should eat up perhaps the most money and time long-term – is preparing for an accountable care environment which will require providers to demonstrate the quality and value of the care their institutions provide.

To meet these needs, CIOs are acquiring applications which can support clinical integration, population health management, disease management and care coordination across all of the institutions’ services, Deloitte notes.

Government Regulations Overwhelming Hospital CIOs

Posted on June 3, 2013 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 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?

Hospital EHR Subsidies

Posted on May 17, 2013 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.

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.