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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 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 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 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 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 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 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 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 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 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 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.

Healthcare Big Data vs Skinny Data

Posted on April 2, 2013 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 have heard a number of people talk about healthcare big data was all the buzz in the healthcare IT world. There’s little doubt that there’s a lot of conversation happening around big data and analytics in healthcare. While I think there’s tremendous value to be found in healthcare big data, I’ve been more intrigued by what Encore Health Resources calls skinny data.

You can read more about the Encore Health Resources CoreANALYTICS announcement, but the approach is what I find really interesting. Instead of trying to create a huge enterprise data warehouse that can be all healthcare data for everything, they instead decided to focus on created a smaller solution that just focused on one major problem: meaningful use.

Encore Health Resources was open about the reason why they chose to go with a skinny data model as opposed to a full enterprise data warehouse model, time and budget constraints. They basically were asked to produce a result with a limited budget and so there wasn’t time or money to do anything but achieve the desired results. One of the architects of the system said, “If you can give me the extra data for free, then give it to me. If it costs [time or money] more to get that data, then don’t do it. Although, if you don’t give me these other data elements, then I’m going to have issues.”

It seems like a pretty simple concept to me that makes me wonder why I haven’t seen more of it in healthcare. Encore has taken these concepts and started to expand beyond meaningful use and into other areas like at-risk populations, clinical analytics for care coordination, and financial analytics.

I asked them if CoreANALYTICS would eventually grow into what essentially becomes an enterprise data warehouse. They suggested that it wouldn’t likely ever get that large, but I can see a path to that type of result.

What I do love about skinny data is that it’s user the information a hospital has available and creating actual results. It’s one thing to have the data, but it’s what you do with that data that really matters.

Patients Question Clinical Decision Support Use

Posted on January 30, 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.

Using clinical decision support technology (CDS) is such a standard and helpful health IT approach – not to mention a central Meaningful Use feature — that we almost take its existence for granted. Apparently, however, patients aren’t as tolerant of computer-assisted decision making as clinicians and IT experts are, according to a new study published in Medical Decision Making.

The study suggests that patients actually distrust physicians who use CDS, labeling them as “less professional, less thorough, and having less diagnostic ability,” according to a report by EHR Intelligence.

The study, done by University of Missouri researchers, showed participants vignettes depicting an exam for an illness or injury. These participants were then asked to rate their reactions to the physicians showed in the vignettes.

The results suggest strongly that potential patients are unnerved by the notion of physicians making use of CDS.  Researchers found that the study subjects were less likely to trust computer-driven diagnoses, and moreover, less likely to be happy with a positive outcome if that outcome involved CDS use.

Perhaps the only social benefit to physicians using CDS was that subjects were less likely to blame a doctor for a negative outcome if the doctor relied on CDS to make a decision.  If a doctor used CDS, ignored its conclusions then had a negative outcome, patients felt strongly that he or she was deserving of punishment.

It’s not exactly good news for healthcare providers that patients are likely to be squeamish about their using CDS. That being said, my guess is that doctors can do a lot to make patients comfortable simply by explaining what they’re doing and making patients feel confident about the process. In the end, after all, patients care most about their relationship with the provider, computer-aided or not.

What HIMSS Told Congress

Posted on November 16, 2012 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.

This week, a House subcommittee held a hearing entitled “Is ‘Meaningful Use’ Delivering Meaningful Results?: An Examination of Health  Information Technology Standards and Interoperability.”  The hearing follows a recent furor over Meaningful Use’s benefits, in which HHS head Kathleen Sebelius was written a stinging letter by a quartet of Congressman arguing that the program might not be pulling its weight.

Lots of interesting discussion took place at the hearing — see a report from the indefatigable HIT blogger and expert Brian Ahier for more background — but for the purposes of this item, I’m focusing on what HIMSS had to say.

HIMSS, which obviously has a massive stake in the topic discussed, is a big Meaningful Use fan. The trade group argues that “Meaningful Use and the Stage 2 regulations allow the healthcare community to continue the necessary steps to ensure health information technology will support the transformation of healthcare delivery in the United States.”

Not surprisingly, HIMSS showed up in full color at the hearing, ready to defend MU and the progress of health IT generally. HIMSS offered Congress seven recommendations as to how to keep the MU train moving, Ahier reports. Here’s my favorites:

  1. Direct the administration to initiate an appropriate study of a nationwide patient data matching strategy with a report back to Congress.
  2. Support harmonization of federal and state privacy laws and regulations to encourage the exchange of health information across health systems, payers, and vendor systems.
  3. Continue to support and sponsor pilot programs addressing the collection, analysis and management of clinical data for quality reporting purposes to assist providers and provider organizations make informed decisions for public health, patient care and business purposes.
  4. Preclude any additional delay in the nationwide implementation of ICD-10, International Classification of Diseases beyond the current October 1, 2014 deadline.

Other than the ICD-10 recommendation, which will probably be battled down to the last millisecond by some groups, I’m betting most readers would consider these to be reasonable steps. But I could be wrong. And I don’t see a lot here on the nitty-gritty of interoperability, which was the focus of the Congressmen’s ire in the first  place.  Folks, what would you add to/subtract from this list?

HHS OIG Begins Digging Into EMR Overbilling Allegations

Posted on November 5, 2012 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.

Well, it had to happen: The furor over the possible EMR-related Medicare overbilling has moved to its next stage.  After enduring harangues by members of Congress and a widely-read New York Times article alleging that EMRs were upcoding machines, HHS has begun to look into the matter directly.

Fraud investigators within the HHS’s Office of the Inspector General have sent a 54-question survey to hospitals who got Meaningful Use incentive payments between January 1, 2011 to March 31, 2012. The survey looks into assertions that hospitals and physicians using EMRs have been inflating Medicare claims.

The logical next step for the OIG’s office is to issue a report to Congress spelling out whether it has reason to believe EMRs are linked to Medicare overbilling. The OIG will doubtless do some chart pulling and analysis to see whether it finds suspicious-looking patterns.

As I’ve said before — and will continue to say, doubtless — this whole effort concerns me. I’m not suggesting that HHS should ignore any evidence it has that hospitals or doctors are using EMRs to engineer a billing joyride. On the other hand, “overbilling” can be in the eye of the beholder, and conducting an inquisition into EMR user behavior seems premature to me.

I find myself wondering whether the feds have seriously considered hospitals’ response to these charges — that EMRs aren’t generating overbilling schemes, but instead are merely capturing and documenting services which weren’t always captured in the days of paper records.  It’s a credible argument and deserves a closer look.

So, let’s  hope HHS takes a breath and looks at the benign possibilities providers have outlined before it accuses hospitals and practices of wrongdoing. Otherwise, we’ll have a agency simultaneously pushing for EMR adoption and hanging the sword of Damocles over the heads of doctors and hospitals.