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Who is the Real EHR Customer?

Posted on August 2, 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.

What a fascinating question from Clay Forsberg. In my experience writing about the EHR space, the EHR customer is the healthcare provider and not the patient. In fact, I think the impact on patients played a very small role in most EHR implementations. I don’t remember ever seeing an EHR RFP that had much of any focus on the patient. The closest you might come is that the EHR would need to have a patient portal or something along those lines. Have you seen patient focused sections of EHR RFPs? If so, I’d love to see them. If not, I’d love to see it too.

When EHR software was first being purchased (technically it was EMR at the time), the decision was largely around how they could better handle things like E/M coding and being able to use the automation in the EHR to be able to bill for higher levels of care (ie. more money). This is what’s led us to EHR note bloat.

Following this EHR era was what I call the golden age of EHR adoption fueled by $36 billion of meaningful use money. I was shocked at how irrational the market became as doctors chased EHR software that would get them access to the meaningful use dollars and avoid any penalties. There was no time for doctors that purchased EHR software in this era to really think about patients. They were too focused on the government handouts.

Long story short, the patient has generally been far from the thoughts of those purchasing EHR software. Don’t get me wrong. I don’t think most people purchasing EHR wanted to recklessly damage the patient. In fact, EHR benefits the patients in a lot of ways (access to the records is one example). However, it’s not any stretch to say that those selecting and implementing EHR software weren’t trying to improve the patient experience. If it was, they would have made different choices.

The question is will this change in the future. Or maybe even more importantly is will EHR vendors be able to evolve in a way that patients will benefit. I think we will see some evolution in this regard, but I don’t expect to see a sea change when it comes to EHR software’s focus on the patient. I think instead we’ll see 3rd party software that will change the patient experience. Some of them will integrate with EHR software which is why EHR APIs are so important, but I’m not looking for the EHR to make the patient their customer. Maybe they should, but I don’t see it happening.

The Place of EHR in the Hospital IT Ecosystem

Posted on August 20, 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’ve been thinking a lot about EHR software and the part it plays in the hospital IT ecosystem. The $36 billion of EHR stimulus money has shined a big light on EHR software. No doubt the EHR incentive money has increased EHR adoption, but at what cost. I wonder if the EHR incentive money has caused many hospital IT teams to place undue emphasis on the EHR software.

The reality of a hospital IT ecosystem is that they usually have hundreds of healthcare IT systems in their organization. The EHR is just one of those systems. In fact, it might not even be the largest system. Their ERP system (usually Peoplesoft or SAP in large hospitals) could be larger. However, try being system #90 at a hospital. Do you think the IT people at a large hospital system are paying much attention to what’s happening to that system? Not only are they distracted chasing the EHR incentive money, but even without that incentive there are 89 other systems in front of it.

I’m reminded of this Healthcare CIO Mindmap that I posted previously. It’s a great image of the amazing complexity that a healthcare CIO is facing. Each of the branches on that mindmap represent one or more IT systems that have to be managed by an organization. That’s a complex and challenging task.

I guess my message here is that while the EHR is extremely important to an organization, don’t lose track of all the other healthcare IT systems you support. They won’t likely be noticed in the short term, but transgressing these smaller health IT systems will create organizational debt that will be hard to overcome in the future.

To Purge or Not To Purge EHR Data

Posted on January 24, 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.

In every healthcare organization I’ve seen there’s been a real push and pull when it comes to EHR data retention. In fact, this doesn’t just happen in healthcare, but in a lot of organizations outside of healthcare as well (usually around email). The question is how long should we hold on to the data. In healthcare, many states have laws about record retention and so that often lays the groundwork for the discussion. However, once it gets past what the laws required there’s usually a good debate between the two extremes of keeping the data forever and purging the data as soon as is legally allowable.

If you ask the risk management professionals at a hospital, they’ll likely want the data purged as soon as is legally possible. They see the old EHR data as a liability and a risk for the hospital. If the data’s gone, then the liability is gone (or at least harder to prove). Certainly the data could set you free in some cases, but I think it’s safe to say that old data is more likely to hurt you than help you in a legal situation.

On the other side of the fence are the researchers (which in many cases are the doctors at the hospitals). As a researcher you want to have as much data as possible. It’s almost like committing a crime to purge any data that could be used to support your research efforts today or in the future. They would love to keep any and all EHR data forever.

I’ll be interested to see how this debate evolves going forward. Will the “Watson” empowered EHR software need to have all the data from the beginning to really be able to understand a patient and provide appropriate treatment recommendations? Will EHR vendors finally get on board and provide the capability of purging old EHR data? As it stands today, they really don’t offer this feature. It’s almost sacro saint to delete anything from an EHR. Nothing is ever deleted from an EHR, but is only hidden or made inactive. Otherwise, you lose the credibility of the record if something can be deleted.

This battle will likely never end. We’ll always have people wanting to purge the records to avoid liability and those who want to keep the records forever. Although, I think over time we’re more likely to move to a world where no data is ever purged. At best it will be moved off to a vendor neutral EHR archive and they’ll address the liability issues through other laws.

Meaningful Use Provides Hospital EHR Vendor Lock In

Posted on April 10, 2012 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.

One of the unintended consequences of meaningful use is that it provides a real hospital EHR vendor lock in. Certainly hospital EHR vendors have a pretty significant lock in even without meaningful use. Saying that switching hospital EHR software is a large project is a supreme understatement. However, if that wasn’t lock in enough, meaningful use makes it so that I can’t imagine a single hospital switching EHR software during the 5 year meaningful use cycle.

In a Meaningful Use Monday post on EMR and HIPAA, Lynn Scheps covered the details of Switching EHR software in the middle of meaningful use. So, yes it is technically possible and CMS has covered those that do end up switching EHR software. As the meaningful use stages progress I could even see this happening relatively frequently in the ambulatory EHR arena. I don’t see this happening at all in the hospital EHR arena.

You might ask why? I can’t imagine a hospital going to the effort of reconciling the details of meaningful use between two systems. Not to mention the implementation time for a hospital EHR system is so long that you’d likely lose out on a year of meaningful use money anyway. I don’t see any hospital CIO making this choice.

I made the argument in a previous post that much like ERP software, there will be an opportunity for some EHR software to displace the current vendor. I suggested this is most likely during the renewal or upgrade period. I still think this is sound reasoning and would be the time a hospital CIO could make the case for change. Although, I’m sure that meaningful use and the EHR incentive money will likely mean that many hospital CIOs take the upgrade cost on the chin instead of switching software.

Makes me wonder if EHR vendors will use this to their advantage when it’s time to deal with renewals and upgrades. I’d hope this wouldn’t be the case, but I won’t be surprised if it happens.