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Should Healthcare Orgs Be Required to Do Zero Cost Accounting?

Posted on August 31, 2018 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.

During today’s #HITsm chat, Jeremy Coleman made a strong statement about what he believed every healthcare organization should have to do:

What do you think of Jeremy’s idea? Should every healthcare organization be required to do zero cost accounting? Should every hospital know what their trust costs is for someone to spend a night in their inpatient bed?

These are complicated questions, so let’s start the discussion and see if we can share and learn from each other. At the core of these questions to me is a larger question of whether the price of the services we receive in healthcare should be related to their costs. We all know this isn’t the case when we think about the obscene $20 aspirin you get in the hospital. They charge that price for services they offer because they can. Ok, that’s oversimplifying it, but not too much.

Given that costs aren’t associated with the price healthcare organizations charge for things, I wonder how valuable it is to know how much something costs a healthcare organization. Would knowing this information really change how a healthcare organization operates?

What I think we might find if we do this analysis is that the way things are priced in healthcare really makes no sense at all. However, I think it will also illustrate that there’s no easy path to change the way things are priced in healthcare either. It’s going to take a series of incremental changes that in aggregate will equal a dramatic change. I’m just not sure who in healthcare is patient enough to make these types of incremental changes. Plus, many vested interests will fight against these changes.

I wish I remembered who said this, but I recently read someone who said that insurance companies have hidden behind complexity for years. It’s in their best interest to have things so complex that they don’t make sense so that they don’t have to justify the costs. It’s not just insurance companies that have hidden behind complexity in healthcare either.

As Dan Munro, author of Casino Healthcare, often says, “No one group is to blame for the US Healthcare cost crisis because each segment of the industry is complicit.” Said another way, no one wants to mention that the Emperor has No Clothes. I’m afraid this is why we don’t want to do zero cost accounting and really know how much something costs us in healthcare.

Underwhelming Epic Patient Engagement Features from #UGM2018

Posted on August 30, 2018 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.

John Moore has been live-tweeting the Epic User Group meeting happening this week in Wisconsin. John has shared a lot of interesting perspectives, but I was quite intrigued by this picture he shared of the “Really Cool Software In the Works.” Presumably, these are the big new patient experiences features that will be coming to an Epic EHR software near you.

*Yes, that is Judy at the bottom of the big screen presenting these changes and yes she is dressed up like a park ranger. This year’s Epic User Group theme was The Great Outdoors.

It’s nice to see Epic focusing efforts on the patient experience, but am I the only one that was totally underwhelmed by this graphic?

Let’s start with MyChart Bedside on smartphones. You can see a preview of this here. It’s interesting that Epic chose to create a product like this rather than partnering with companies like Oneview or TVR Communications who already have similar products that would work even better with a nice Epic integration. This is why Epic should embrace an open ecosystem for partners.

The announcements around “Get Rid of Clipboards” and “Skip the Waiting Room” are underwhelming as well. I’ve known companies that have had this solution for a decade or so. Epic is just getting them now?

I have a hard time judging the “Catch a Ride” and “Patient-Entered Social Determinants” features. I’m still not convinced how an Epic connection to Lyft and Uber is going to help patients. How many hospitals will really adopt this and will hospitals really start paying for patients rides with this? If they will, why didn’t hospitals just buy cab rides for patients in the past? Will an integration with Epic change that?

As far as patient-entered SDoH (Social Determinants of Health for those following along at home), are patients really going to do this? Once they do, what will the doctor do with this information? Nothing? On the less pessimistic side, as a fact-finding approach, this could be interesting. Assuming patients are willing to share this information (which may be possible in this world of over sharing) this could be a way to discover what SDoH are most prevalent in an area so that hospitals can then find ways to alleviate these challenges.

Finally, the “Talk to MyChart” feature. We’ve long heard that voice was coming to EHR software. Yes, I’m talking beyond the voice recognition that every EHR software has had forever. First, let me share that I’m a huge proponent of voice. It’s amazing the way Alexa has changed my and my family’s lives. I could be wrong, but the feature mentioned above feels like they’ve just voice enabled MyChart. Is it really that much easier to use voice in MyChart? Even if I enjoy the “pleasant voice”? Color me skeptical that this will really change any behavior. If Epic wanted a big voice empowered announcement it should have been being able to access MyChart through Alexa or Google Home (I’m pretty sure Epic would blame HIPAA on this one). That would be a really cool software.

Of course, here I’m just analyzing one slide in Judy’s presentation. I think John Moore commented that the analytics looked promising, but then he hedged the comment by saying that it was better than their competitors.

What can I say? Epic has made billions. I guess I just expect more from them.

Should EHR Vendors Employ Clinician “Bug” Finders?

Posted on August 29, 2018 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.

Reading through Anne Zieger’s article today about EHR usability and the tie to common safety threats highlighted to me how poorly many EHR vendors do at ensuring their EHR software won’t lead to patient safety issues. As I thought about it more, it reminded me of the work software companies do to ensure there are no software bugs as they roll out new releases of their software. Should we do something similar with patient safety threats?

For those not familiar with the software bug finding process, it can get really intense. No doubt some companies do this better than others, but every EHR software vendor has some sort of software bug finding process. If they don’t, well that’s a whole other issue altogether.

When I was in college I worked at a software company. Along with coding their website, they asked me to take part in their software testing process as well. The goal was to ensure that new releases of the software didn’t introduce new bugs that would cause errors or bad experiences for their users. This was a sometimes fun and sometimes tedious task. Tedious when you couldn’t find any issues and fun when you found something that didn’t work quite right.

I’m sure that software companies have come a long way in their testing scripts, but at the time we used a mix of testing very specific use cases and workflows along with some freestyle testing where we did abnormal workflows to try and get the software to break. Then, we’d report any errors, flaws, bugs, etc we found during our testing. Sometimes these would be new issues introduced by the new code and other times it was flaws that had been in the system for a long time. I won’t go into software programming bug theory here, but the simple description is that all software has flaws. It’s just how many and how impactful are they.

No doubt all healthcare IT software has some sort of software quality testing process. Large EHR vendors likely have full teams of people whose job is to test the latest releases for flaws. As I thought about this, I wondered if any healthcare IT software companies had doctors and nurses on staff whose job was to test for patient safety issues. I haven’t heard or seen anyone do this, but maybe they should.

The idea is simple. Have a doctor, nurse, front desk staff, etc test the latest releases of your software and evaluate patient safety issues with the software. Some of this could be due to a bug in the software and some of it could be due to other factors. However, identifying these issues could inform the programmers on how to better prevent these safety issues from happening.

No doubt, this is opening a bit of a Pandora’s Box. Similar to how all software has bugs, all medical software has potential safety issues as well. The key is to identify those issues, evaluate the impact and likelihood of these issues, and then work on ways to mitigate the risk. I’ll be interested to see how many health systems take on this testing as part of their upgrade cycles as well. No doubt some progressive organizations won’t rely on their EHR vendor to do all the testing.

As I think about the medical malpractice risk associated with EHR software that’s coming down the pipe, I can see an EHRs ability to avoid patient safety issues becoming a powerful feature. Plus, it’s just the right thing to do for the patient.

Changing Leadership’s Mentality to Be More Agile

Posted on August 28, 2018 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.

It’s become increasingly clear that most healthcare CIOs have become leaders and vendor managers. The CIO of today needs to have an understanding of technology, but the majority of their job is managing people and vendors. Hospital CIOs aren’t managing technology.

Much of what a CIO can accomplish is based on the mentality and behaviors they inspire in their people. One of the latest trends in technology thinking is around agile. Many in healthcare have pushed against the concept of agile in healthcare supposing that agile equals reckless. However, it’s been proven that just because you choose to change quickly and efficiently doesn’t mean that you’re changing recklessly in ways that will harm patients.

The move to agile has been hard for many hospital CIOs. This was highlighted recently by hospital CIO, David Chou when he shared this image and tweet:

Culture change in an organization is not really something you can buy. Plus, as the quote specifies, the change to an agile culture is really hard because it is often not the behaviors that put leaders in senior positions in the first place.

The biggest fear with any change is failure. Ironically, an agile approach embraces failure as part of the learning process and incorporates a quick recovery when something goes wrong. This is a massive change in mindset for many senior healthcare executives. It goes counter to the group decision making driven by large committees that occurs in most of healthcare. That’s why it’s scary and why most CIOs don’t do it. However, it’s exactly what’s needed to be prepared for the future.

Medical Device Vulnerability List Topped By User Authentication Problems

Posted on August 27, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

The Industrial Control Systems Cyber Emergency Response Team (ICS-CERT), a government organization which addresses threats to US infrastructure, helps numerous industries share data on cybersecurity threats. This includes building a repository of cybersecurity advisories which medical device manufacturers can use to communicate with customers.

According to a new analysis by security vendor MedCrypt, the number of cybersecurity threats reported to ICS-CERT has been growing over time. ICS-CERT released 47 advisories related to medical devices between 2013 and August 1, 2018, which included a total of 122 cybersecurity vulnerabilities.  While 12 advisories were released between October 2013 and late December 2016, it issued 35 advisories between late December 2016 to August 1 of this year. Also, while six companies were identified as having faced cybersecurity issues during the first interval, 18 were noted during the second.

The number of vulnerabilities noted has climbed as well, from 37 during the first time period to 85 during the second. According to the MedCrypt analysis, 66% of the reported advisories were related to code defects and user authentication issues. The most common cause was user authentication, which climbed from 16 to 36 instances between the two time periods, followed by code defects, which increased from 5 to 24 instances. Other areas of vulnerability included encryption issues, third-party libraries, system configuration and operating system problems.

It’s hard to determine what all of this means by scanning these statistics, interesting though they may be, but MedCrypt had some additional observations to share about the ICS-CERT data as a whole:

  • The complexity of the vulnerabilities discovered is likely to increase. Some of the more deeply technical kinds of vulnerabilities found in other ICS-CERT participating industries haven’t turned up in medical device disclosure data, including less than 10% of those found in subcategories, but they will. “Most [advisories] have focused on ‘low hanging fruit,’ like user authentication,” the report observes.
  • So far, ICS-CERT participants have reported finding few vulnerabilities related to cryptography issues, such as vulnerability reports citing the commonly-used OpenSSL open-source encryption library.
  • User authentication problems are becoming more common, accounting for 42.3% of vulnerabilities included in advisories after January 1, 2017. The report suggests the future advisories will address concerns emerging from deeper in the technology stack as medical device cybersecurity matures.

As connected medical devices become standard in healthcare organizations, medical device makers will spend more resources on securing them, and eventually, they will bake cybersecurity protections into their engineering, R&D and quality processes, MedCrypt predicts.

Health IT Consulting Demand To Explode This Year

Posted on August 24, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

As payment models shift from fee-for-service to value-based care, hospitals are having to adopt new technologies and tweak existing ones. The thing is, it takes a mighty team of IT pros to make all this happen. In some cases, a provider has enough resources to handle this kind of big transition, but most need some help, especially when they’re handling major infrastructure improvements or even switching out technologies.

This seems to be at least part of what’s driving a dramatic increase in spending on health IT consulting, according to a new study from Black Book Research. The study drew on input from 1,586 professionals with knowledge of the US health IT industry.

Black Book concluded that health IT management consulting spending has grown from $20 billion in 2016 to $45 billion last year. Not only that, the firm expects to see this number climb to nearly $53 billion for 2018. That’s a massive increase, particularly given that providers were already spending heavily on consultants as they beat their enterprise EHRs into shape.

According to the analyst firm, 64% of last year’s spending paid for implementation of software, information systems, systems integration and optimization and support for mergers and acquisitions. This summary covers a lot of ground, but it’s hardly surprising given the drastic changes underway.

Going forward, respondents expect three key forces to drive healthcare consulting spend, including a lack of highly-skilled IT professionals (cited by 81% of respondents), adoption of cloud technology in healthcare (74%) and growing industry digitalization (71%). (I’d also expect to see investment in new organizational infrastructures — for, let’s say, ACOs)  — will continue to increase in importance as well.)

Providers responding to the study said that they expect to hire health IT consultants for EHR and RCM system optimization (61%) and to offer expertise in software training and implementation (46%) next year. Other areas providers hope to address include value-based care (39%), cloud infrastructure (36%), compliance issues (33%) and a grab bag of big data, decision support and analytics projects (31%).

The vast majority of respondents (84%) said they expect to enter into a wide range of consulting agreements to include work with single-shop consultants, single freelancers, group purchasing organizations, HIT vendors, networks of freelancers, boutique advisory firms and traditional major consultancies, Black Book reported. In other words, it’s all hands on deck!

Facebook Partners With Hospital On AI-based MRI Project

Posted on August 23, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

I’ve got to say I’m intrigued by the latest from Facebook, a company which has recently been outed as making questionable choices about data privacy. Despite the kerfuffle, or perhaps because of it, Facebook is investing in some face-saving data projects.

Most recently, Facebook has announced that it will collaborate with the NYU School of Medicine to see if it’s possible to speed up MRI scans.  The partners hope to make MRI scans 10 times faster using AI technology.

The NYU professors, who are part of the Center for Advanced Imaging Innovation and Research, will be working with the Facebook Artificial Intelligence Research group. Facebook won’t be bringing any of its data to the table, but NYU will share its imaging dataset, which consists of 10,000 clinical cases and roughly 3 million images of the knee, brain and liver. All of the imaging data will be anonymized.

In taking up this effort, the researchers are addressing a tough problem. As things stand, MRI scanners work by gathering raw numerical data and turning that data into cross-sectional images of internal body structures. As with any other computing platform, crunching those numbers takes time, and the larger the dataset to be gathered, the longer the scan takes.

Unfortunately, long scan times can have clinical consequences. While some patients can cope with being in the scanner for extended periods, children, those with claustrophobia and others for whom lying down is painful might have trouble finishing the scanning session.

But if MRI scanning times can be minimized, more patients might be candidates for such scans. Not only that, physicians may be able to use MRI scans in place of X-ray and CT scans, both of which generate potentially harmful ionizing radiation.

Researchers hope to speed up the scanning process by modifying it using AI. They believe it may be possible to capture less data, speeding up the process substantially, while preserving or even enhancing the rich content gathered by an MRI machine. To do this, they will train artificial neural networks to recognize the underlying structure of the images and fill in visual information left out of the faster scanning process.

The NYU research team admits that meeting its goal will be very difficult. These neural networks would have to generate absolutely accurate images, and it’s not clear how possible this is as of yet. However, if the researchers can reconstruct high-value images in a new way, their work could have an impact on medicine as a whole.

What Happened to Care Pricing and Provider Quality Transparency?

Posted on August 21, 2018 I Written By

Healthcare as a Human Right. Physician Suicide Loss Survivor. Janae writes about Artificial Intelligence, Virtual Reality, Data Analytics, Engagement and Investing in Healthcare. twitter: @coherencemed

I’m on the Utah HIMSS board and we’re hosting an event called “Full Disclosure- Price Transparency & Provider Ratings in Healthcare.”

At the event on August 29, 2018, we’ll be talking about pricing transparency and physician outcomes. The Pricing Transparency question has multiple goals and remains a complex problem in healthcare IT and other areas. Leaders in Utah Health IT will come together to discuss resources and experiences from Utah.

Pricing in healthcare remains the number one concern for many different stakeholders. Informatics departments are still concerned with denials and claims administration. Patients are unsure of price of care. Physicians’ practices are not clearly aligned with billing codes and claims can account for up to 30% of healthcare spending waste. In April of this year, Seema Verma announced that requirements for hospitals to post standard pricing would be the start of a broad initiative to increase transparency about healthcare prices.

Can price transparency & provider ratings help manage the costs of healthcare?

Price transparency might have the single biggest effect in informing the public about healthcare costs and could support a more efficient health care delivery system in the United States. Utah HIMSS members and others are invited to submit questions for panelists.  

Please register for the event and follow the Utah HIMSS pages Linkedin and Twitter.

Here’s a look at the panel members that will be involved:

Moderator: Holly Rimmasch- Health Catalyst

Holly Rimmasch is an Executive VP/Chief Clinical Officer of Health Catalyst.  She currently leads population health, patient safety and improvement services.  Ms. Rimmasch has over 30 years of experience in clinical and operational healthcare management. She has spent the last 20 years dedicated to improving clinical care and better understanding how to sustain and achieve better value.

Holly has extensive healthcare and operational experience.  Prior to joining Health Catalyst, she was an Assistant VP at Intermountain Healthcare responsible for Clinical Services.  While at Intermountain, she also served as the system Clinical Operations Director for Cardiovascular and Intensive Medicine.  Holly co-founded and was a Principal in HMS, Inc, a healthcare consulting firm focusing on population health.

Ms. Rimmasch holds a Master of Science in Adult Physiology from the University of Utah and a Bachelor of Science in Nursing from Brigham Young University.

Price Transparency

A key question that Holly has focused on is “Are we making a difference in both quality and costs?”  “Does it translate into cost savings for those that are paying?” Part of her work involves bringing data sources together (clinical, financial, claims, etc.) to create transparency to services and care being provided and at what cost.  Over the last 6 years, Holly has been involved in developing a more accurate activity-based costing system. Accurate costing leads to more accurate pricing and more accurate pricing leads improved price transparency.

Panelist: Rep. Norm Thurston- Utah State Legislature

Personal & Professional

Dr. Thurston has a Masters and Ph.D. in economics from Princeton University, and an undergraduate degree in Spanish and Agribusiness Management from Brigham Young University.  His areas of specialty include insurance markets, health care provider markets, labor markets, and public finance/economics. 

Dr. Thurston has been a policy analyst and health economist for the Utah Department of Health since 2003. Currently, he is the Director of the Office of Health Care Statistics which is responsible for the collection, analysis, and dissemination of data related to health care cost and quality for the State of Utah.  In previous roles he has served as policy adviser and executive staff for health system reform efforts in the State of Utah. 

Before joining the state, Dr. Thurston worked for eight years as an assistant professor of economics at Brigham Young University.  He has published several articles on health care markets in nationally recognized economics journals.  He is a life-long resident of Utah, growing up in Morgan County.  He has native-level fluency in Spanish and was a Fulbright Scholar teaching economics in Argentina in 2001. He and his wife Maria have three children and two grandchildren.

Legislative

Rep. Thurston was elected to the Utah House of Representatives in 2014 from District 64 (Provo, Springville).  Currently, he is a member of the Government Operations Committee, the Economic Development and Workforce Services Committee, and the Social Services Appropriations Subcommittee.

Price Transparency:

“Norm Thurston is the director of the Office of Health Care Statistics (OHCS). The office collects, analyzes and disseminates data on health care utilization and costs for the State of Utah. Their two main data efforts include collecting information about patient encounters at hospitals and emergency rooms into the Healthcare Facilities Database and information about claims paid by health plans for all types of services into the All Payer Claims Database.

These data are used by a variety of entities, including healthcare facilities, plans, researchers, and public health programs.”

Panelist: Bob White- Intermountain Healthcare

Bob White, Vice President and Chief Operating Officer

Bob has over 27 years of experience in the Information Technology industry. He has been with SelectHealth for 20 years and currently leads member services, business systems support, program management, process improvement, business continuity, and information technology.

Previously, Bob was employed by the IBM Consulting Group. He attended Brigham Young University and holds a bachelor’s degree from DeVry University. He currently serves on the board of Trizetto Customer Group

Panelist: Katie Harwood- University of Utah Hospitals and Clinics

Patient and Financial Services Manager at the University of Utah Hospitals and Clinics

Katie Harwood is a Revenue Cycle Manager with University of Utah Health. She has been with the organization since 1995, most recently responsible for the admissions and financial counseling  teams. She is currently serving as the president of the American Association of Healthcare Administrative Management Utah Mountainwest chapter (AAHAM). She also participates with the National Association of Healthcare Access Management on the Certification Commission and is  a Certified Healthcare Access Manager. Outside of work she enjoys her two sons, dog, and Zumba.

Katie had the opportunity to participate in the development of the pricing transparency tool University of Utah Health. The goal was to create a tool that would have full care pricing available for consumers. She is excited to share what our experience in pricing transparency has been and how the consumer benefits from the use of it .

Apparently, Hospital EHR Use Still Has A Long Way To Go

Posted on August 20, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

It’s fairly easy to look back at the progress hospitals have made with EHR use and be impressed. In less than 10 years, most hospitals have gone from largely paper-based processes to relying on EHRs to support a wide range of clinical processes. Even given that hospitals got meaningful use incentives for EHR adoption it’s still a big deal.

That being said, we’ve still got a long way to go before hospitals exploit EHRs fully, according to a new research study. The study, which appears in the Journal of Medical Internet Research, concludes that it will take until 2035 for the majority of hospitals to put a fully mature EHR infrastructure in place.

To conduct the study, researchers relied on the HIMSS Electronic Medical Record Adoption Model (EMRAM) dataset, which ranks a hospital’s adoption of varied EHR functions considered important to hospital care quality and efficiency. The researchers sifted through EMRAM data for 2006 to 2014 and then leveraged them to predict future adoption levels through the year 2035.

After analyzing the data, the research team found that the majority of US hospitals were in EMRAM Stages 0, 1 and 2 in 2006 and that by 2014, most hospitals had achieved Stages 3, 4 and 5. Having analyzed this data, researchers predicted that Stage 5 use should peak by 2019 and Stage 6 levels of use by 2026.

Where things really start to get interesting is the path from Stages 5, 6 or 7 EMRAM. The study concluded that while most hospitals would reach these stages by 2020, a “considerable” share of hospitals won’t achieve Stage 7 by 2035.

It’s no surprise to read that as the level of sophistication needed grows, the number of hospitals that have achieved it tails off, with just a few likely to hit the prized Stage 7 in the near future. Developing a mature infrastructure calls for an infusion of time, talent and funding, and even resource-rich health systems might not have all three at the same time.

Also, given that one of the key requirements of Stage 7 is having interoperability functionalities in place, it’s easy to see why many hospitals won’t get there anytime soon. Heck, there’s good reason to wonder whether the bulk of hospitals will ever achieve interoperability, at least as it’s currently defined.

But do we need to measure everything by EMRAM standards? I don’t know, but it does seem that the question worth asking after defaulting to these measures for many years.

Don’t get me wrong – I’m not an EMRAM critic. It certainly seems to have done a good job of tracking hospital EHR progress for quite some time and it can be used by leaders to create a common goal for a healthcare organization. On the other hand, if it predicts that it will take more than a decade for hospitals to develop a mature EHR ecosystem, despite their pouring endless resources into the game, maybe it’s worth reevaluating this model. Just a thought.

Is It Worth The Trouble To Drop Fax Use?

Posted on August 17, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Not long ago, ONC held its 2nd Interoperability Forum in Washington, DC. One of the big ideas being kicked around at the event was killing the use of fax machines to share health data.

During her keynote address, CMS leader Seema Verma went so far as to say that she’d like to see all provider organizations go fax-free by 2020. Apparently, Verma wants providers to switch to other means of digital information sharing.

Sounds good, right?  Well, maybe not. Despite its flaws, faxing does have the advantage of being easy to use, available in virtually every provider office and fairly reliable. I’m not sure we can say that about most other forms of digital health data exchange. In fact, dropping faxing may leave doctors with bigger problems than they had before.

After all, before we stop faxing, we’ll have to find a digital document format that plays nicely with other systems and makes patient information easy to access. That, not surprisingly, may be tougher than it sounds.

I particularly like the way Jay Anders, MD, broke these issues down in a recent email message. Anders, chief medical officer of Medicomp Systems, makes the following observations:

  • E-paper may not be interoperable: In fact, it may create new barriers to data sharing, he suggests: “Electronic paper is not effective. It [can] create a data tsunami in healthcare – a flood of clinical data that physicians cannot access at the right time with the right patient.”
  • Free text is a burden: While e-documents may be easy to pass back and forth, making use of the data within can be really tough, he says. “When the EHRs receive these PDFs with mountains of free text, how do they interpret that data? How do they present that data to physicians? How do they make that data into actionable information?

His bottom line here is that while providers can use e-documents to share data, there’s no point in trying unless they can offer useful information at the point of care.

After taking in Anders’ questions, I have another one of my own. If providers will still need to go through contortions to extract data from e-documents, how is that better than using faxes? After all, if you run faxed documents through a sophisticated OCR process, you can capture and even format health data information.

In other words, given the issues inherent in using digital documents, putting faxing to bed may not be worth the trouble. I have to agree with Anders’ conclusion: “So, how does sending electronic communication of scanned PDFs rather than faxes enable interoperability? The answer is that it doesn’t.”

For another view on Seema’s comments and the fax machine in healthcare, check out John Lynn’s post on the real problem when it comes to replacing fax machines in healthcare.