EMR and HIPAA 2009

I knew that this year had been a really great year on EMR and HIPAA. However, I didn’t really realize how much we’d exploded until I started looking at the stats for the site. Thanks to the EMR stimulus (among other things), EMR and HIPAA saw an 800% increase in traffic in 2009 as compared to 2008. That amounts to the following stats for the year:
1.57+ million pageviews
900,00+ visits to EMR and HIPAA
Average Time on Site: 3 minutes and 17 seconds
Biggest Single Day: 8,679 pageviews

I’m most proud of how long people stay on the site to read what’s been written. However, I can’t really get my head around 1.5 million pageviews either. Isn’t technology amazing?

In 2009, I wrote 386 Articles on EMR and HIPAA. That’s a little over 1 post per day. I really didn’t think I posted that many. I guess they start to add up over time. However, even more exciting for me is that there have been over 2325 comments made on EMR and HIPAA. I love to see that much engagement and have loved so many of the conversations we’ve had. I’ve been educated and informed as much or more than I’ve helped you.

Google was by far my largest source of traffic with the following search terms being the most popular: EMR companies, EMR Stimulus, EMR vendors, “health it resource center” arra, ehr vendors. However, I’ve also seen a huge increase in traffic from my techguy and EHR and HIT twitter accounts. I’m amazed at how many people are discussing EMR on Twitter. It’s an amazing tool.

Of course, I also want to thank all of those companies that have sponsored EMR and HIPAA this year: Medscribbler, InterSystems,MxSecure, EMR Consultant, EHR Scope, Medical Voice Products, Plextra, MD-IT, Sfax, NextGen, My EMR Choice, EMR Jobs, andDigiDMS. Their sponsorship of EMR and HIPAA really does make a huge difference. It seems like it’s been mutually beneficial since almost all of the above advertisers have renewed their ad on EMR and HIPAA (and many of them multiple times). I have a feeling that 2010 will be an even bigger year for EMR advertising.

EMR and HIPAA has a lot of things in the works for 2010. I’ll follow up this post with a post talking about some of our plans for 2010. It’s going to be an exciting year.

ONC Blog – Federal Advisory Committee – Judy Sparrow

All I can say is that it’s very cool that ONC now has a blog. This is probably right up there with when I found past HHS secretary Mike Leavitt’s blog. Ok, yes I am a complete blog nerd. At least I’m able to admit it up front.

Basically, Judy Sparrow has just done an introduction post where she talks about the Federal Advisory Committees and their role at ONC. She’s the ONC liason for these committees and so hopefully she’ll keep us updated on progress with these two very important committees. She also provides this explanation about the committees in her first ONC blog post:

“FACAs” get their name from the Federal Advisory Committee Act, which lays out the guidelines for such committees. FACAs are advisory and intended to provide external guidance to the government. Typically members of the group are not federal employees. They are also very open committees – meetings are held in public, information on the meetings is posted in the Federal Register, and all FACA records are readily available. At the very root of the FACA mandate is transparency and collaboration.

ONC has two FACAs – the HIT Policy Committee and the HIT Standards Committee. These committees were established to obtain outside advice or recommendations on key health information technology topics from leaders who represent various stakeholder groups.

I think we generally knew this, but it was nice to have a bit more background. This would have been really useful 6 or so months ago when these committees were a new thing (at least for me).

I hope that Judy is able to keep the blog up to date and that it won’t just turn into an announcement site. I hope Judy will provide real content about the process, timelines and perspectives of ONC. If she does that, then it will be really interesting and a great part of the EMR conversation which is already happening on blogs like this one.

CCHIT EHR Certification Enters EMR Usability World

I’ve been sitting on this post for a while. I figured it was finally time that we talked an interesting development in the CCHIT EHR certification: EMR usability testing. They first presented some of the details of this testing during the CCHIT training meeting. However, they also partnered with User Centric to formulate their EHR user testing and EMR and HIPAA has had a nice connection with User Centric for a few months now.

First the good. I’m glad that CCHIT is venturing into the realm of EHR usability testing. I’ve often talked about CCHIT Certification being rather useless since just because a piece of software does a certain function doesn’t mean that it does it well or that the EMR is usable. In fact, some of the most “feature rich” EMR software is completely unusable by the majority of people. Kind of reminds me of the days of terminals. If you knew the key strokes, it was incredibly efficient. However, learning the keystrokes was so much harder than a nice graphical interface which could do the same things. Not a perfect comparison, but interesting to consider.

So, the biggest problem with CCHIT measuring an EMR’s usability is that the EMR usability rating does NOT affect the certification outcome. Also, it appears that it will be up to the EMR vendor whether they want this result published or not. I wonder if we’ll get to a place where a few EMR vendors show their usability rating and others don’t. Those that don’t we’ll have to assume scored poorly? We’ll see how all that plays out.

I admit I haven’t looked over the entire EMR usability rating process. So, I can’t say if the process is complete or effective in and of itself. Although, I do have some confidence in User Centric as a company even if they’re trying to bite off the very difficult task of measuring EMR usability.

It does look like they’ll give the EMR software a usability rating that is not just a pass fail score. A rating is a much better thing when we’re talking about a somewhat abstract concept of software usability.

I’m also concerned about the quality of the jurors that they’ll use to try and measure usability. I’m sure they’re great people with great intentions. Honestly, that’s one of the most redeeming qualities of CCHIT. They have a large base of volunteers that are very well meaning. However, I’m not sure how much confidence I have in their ability to rate a software’s usability. For that matter, I’m not sure how well I’d be able to do it and I think I’m pretty familiar with the subject.

In a related issue, when you look at the way their putting together the score, it seems pretty complicated at first look. Like I said, I don’t know the details of the methodology. However, that’s kind of the point. Even if CCHIT does post an EMR vendor’s usability score, will the listening public (Translation: doctors) be able to quickly and easily understand what that score means? Maybe it’s a simple thing to figure out. We’ll see, but the devils always in the details and if I’m selecting an EMR I want it to be usable. So, I’ll be very interested in an EMR’s usability score.

Those are just a few things I noticed with the new CCHIT EHR Usability additions. Is there some other parts of it I missed? Anything else we should know about it? Will this be a valuable addition to the CCHIT Certification? Will EMR vendors revolt against it?

EMR Interoperability and Working Together

I recently got the following email which highlights my point that the EHR stimulus money should have been focused on things like interoperability standards and not funding EMR adoption the way it is doing it. He also makes some interesting comparisons worth considering:

I see an uncoordinated money pot out there, attracting uncoordinated work on EMR. — about as effective technically as HDTV (since mid-80’s), W3C, the space station. Non-profit efforts seem to generally fail, or to work so slowly as to be irrelevant.

EMR standardization would likely benefit from an authoritative organization (similar to IEEE) that would work with existing systems as provided by Kaiser, Walmart, GE, etc. and grind out a solution acceptable to these and other major (and minor) players. Then a de facto standard would exist in a well-defined form, and other players would join the effort.

I may be wrong, but I don’t see this happening. Everyone seems to be drawing out the money and just going on their separate ways. People like me that try to help doctors into the electronic age thus have to develop their own protocols, as anything resembling a portable data standard simply doesn’t seem to exist.

Of course, whenever I think about and post something like this, I feel like it’s too late too change anything. The legislation is what it is and we have to make the most of it. It’s just really sad to consider what it could be.

I guess maybe the message to consider is that we can still start having EMR working together even if it’s not government funded.

Minimum EMR Functionality DOES NOT Equal Usable EMR

Sometimes I feel like it’s my mission to combat the myths associated with EMR certification, selection and implementation. Ok, so maybe it’s mostly the EHR certification, but selection and implementation are closely tied to EMR certification. On that note…

An EMR certification that verifies “minimum EMR functionality” DOES NOT equal a usable EMR.

Yes, it’s a subtle difference, but an important one that far too many people ignore. Call it good marketing by the certification body. Call it a misunderstanding. Regardless, it’s scary how many people think that by testing for a “minimum EMR functionality” they are more likely to have a successful EMR implementation. The problem is, it doesn’t. If it did, then we’d have a lot more successful EMR implementations.

Sole Reliance on One EHR Certififying Body – CCHIT

There’s a whole lot of discussion going on (rightfully so) right now about CCHIT EHR certification and of course the term “certified EHR.” I don’t know if anyone else has noticed or not, but there seems to be a bit of a growing movement towards not having ONE EHR certifying body (presumably CCHIT).

A post over on John Chilmark’s blog highlights a really interesting point about having only one EHR certifying body. The point is that there’s little accountability if CCHIT is the only body that’s certifying EHR vendors. What reason would CCHIT really have to improve its certification if it’s the de facto standard for certification? CCHIT admitted that their CCHIT EHR certification wasn’t up to the ambitious goals of HITECH/ARRA. That doesn’t mean they can’t change (although I have my reasonable doubts). However, if they are set up as the sole EHR vendor certification body, then what reason would they have to change?

OK. Yes, you could make an argument that they would want to change for the common good of man. Yes, that means we would see some change on their behalf towards that goal. However, to really change the game in EHR, we need something that requires people to innovate and a sole EHR certification of any kind will have a rough time doing that.

What scares me is that I think that CCHIT is aware of its weaknesses and realizes that it wouldn’t be able to iterate it’s EHR certification to meet the ever changing technology. It seems like the market is ripe for some really smart person to do something to better certify EHR. I wonder what type of game changing certification that will be.

Kathleen Sebelius Sworn in as HHS Secretary – Impact on EHR

I’m sure that most of you in healthcare saw that Kathleen Sebelius was finally sworn in as the new HHS secretary. You can read the reuters report on the confirmation and swearing in of Kathleen Sebelius.

From the report, there’s no doubt that a lot of Kathleen Sebelius’s first job will be to work on this swine flu. No doubt a very important thing for her to keep an eye on and do what she can to protect us from having a major outbreak.

However, I must admit that I get the feeling that were going to hear very little from this new HHS secretary about EMR and EHR. I could be wrong, but I just don’t see her getting really involved in all the discussions of EHR implementation and the $18 billion of EHR stimulus money as part of the HITECH Act (ARRA).

Certainly she’ll be around for major announcements, but I get the strong impression that it’s actually David Blumenthal that’s going to be in the trenches doing the work of defining “certified EHR” and “meaningful use.”

Anyone know more about the situation that can help clarify what might happen, who will be responsible and whether Kathleen Sebelius will do much for EMR as HHS secretary?

Social Network for Prescription Drug Consumers

bout a month ago I got an email that I just got around to reading today. Essentially it was someone announcing a new social network for prescription drug consumers. Here’s a part of the release that I was sent about the prescription drug social network:

I’d like to invite you to try out the eDrugSearch.com Community — a brand new social network for prescription drug consumers. To join, just go to www.edrugsearch.com/register and sign up; it takes only a couple of minutes.

Why a social network for drug consumers? At eDrugSearch.com, we believe that online communities will forever change the face of healthcare — by giving consumers the information and resources they need to ask better questions of caregivers, to support one another, and to save money on treatments and medications.

Prescription drug consumers, in particular, have shown a strong interest in social networks on general health sites, indicating an unmet demand for a niche community. U.S. drug consumers relish the opportunity to share their experiences — their discoveries, their frustrations, their solutions. These Americans are turning to each other rather than relying solely on pharmaceutical company advertising or rushed doctor’s appointments.

We want the eDrugSearch.com Community to be a place you can come for help, reassurance and advice.

Of course, this really begs the question of if we need a social network around prescription drugs. Of course, my gut reaction is that prescription drugs sounds like much to small of a category for a social network. I’m certain that a lot of niche social networks are going to do very well (in fact, I’m working on a sports one myself), but can prescription drug consumers support a social network.

Seriously, when I’m taking prescription drugs I want to get off them as soon as possible. Are people going to just visit the site for entertainment. Certainly there are people who have chronic illnesses that take drugs for a long time, but won’t they stop visiting the site after taking the same drug for so many years? I guess maybe they’re hoping for advancements or alternatives to that drug, but that still feels like a stretch.

The other part of me thinks that something like this might work. I’ve always felt like one of the advantages of my job is that I had access to not only a bunch of doctors, nurse practioners and PAs, but I also support a pharmacy. In the past three years, there have been a number of times where I make the rounds of doctors, APNs and the pharmacist to learn about the drugs that were prescribed to myself or my family. To me this illustrates the need for information that people have when they are prescribed a drug.

Of course, the biggest challenge of this all is can you trust the information that this prescription drug social network provides? How do you know when someone is qualified in the area or not? Not to mention I could see the drug companies really abusing this site with false information. I think we all have been to hotel sites where the ratings just sounded too good to be true. Sounds pretty easy for the drug companies to do the same thing.

Now, if they had a way to certify providers (MD, DO, APN, PA), then you could give some credibility to what was being said. In fact, a social network for these providers to discuss the various drugs is something that could be very strong and useful. That sounds pretty Health 2.0 to me.

EHR Adoption Will Be Slowed Significantly by HITECH

I recently posted what I think is a relatively reasonable timeline for EHR adoption. It’s very broad, but I think that most doctors could use it as a reasonable estimate of how long it will take to implement an EHR or EMR in their clinic.

Of course, the above EHR implementation timeline doesn’t start until a doctor or clinic makes the decision to actually implement an EHR in their clinic. Unfortunately, I’m afraid that HITECH is going to dramatically delay many doctor’s decision to implement an EHR.

The HITECH act just gave doctors who were on the fence about implementing an EMR will now have a bunch of great excuses why they should wait longer to implement an EMR:

• We need to know what certification criteria is chosen by HHS
• How will HHS define meaningful use? Will we even be able to show that?
• Will our preferred EHR be able to satisfy the HITECH act reporting requirements?
• Let’s wait to see what open source EHR HHS gives away

I’m sure there are other reasons. While I’d usually say that these were just excuses for people who don’t want to use an EHR, I actually think this is probably the best plan for those looking to implement an EHR. I don’t think I’d be signing any contracts with a vendor right now. Unless I didn’t care about getting the EHR stimulus (which might actually be a good line of thinking).

What shouldn’t be delayed is the evaluation of the various EHR on the market today. In fact, I highly suggest this evaluation takes place before HHS defines the above items. EHR stimulus money should not be a major factor in your EHR selection process, but instead should be an added side benefit or a tie breaker for 2 equally great EHR companies.

Certainly some will argue that some doctors will be motivated by the HITECH act to implement an EHR quickly in order to receive the EHR stimulus that begins in 2011. Doctors who can’t show meaningful EHR use by 2011 could possibly miss out on the medicaid and medicare bonuses. I just honestly don’t think that most doctors will care that much about it.

Those who would have been proactive in implementing an EHR because of this already have an EHR and are just licking their chops at the idea that they might get some extra money from government for little additional work. I don’t see many of those who haven’t implemented an EHR being that motivated by a few thousand possible government dollars.

Reasons Health Care IT Can’t Spend $20 Billion

I think it’s reasonable to consider some of the reasons why health care IT won’t be able or willing to have $20 billion of government money invested in health care IT.

Not Enough Healthcare IT Professionals – It’s been widely suggested that the number of health care IT professionals might not be sufficient to support this type of invesment in health care IT. I hope my fellow IT professionals from every field can easily make the transition to health care IT. Certainly many will without a problem. However, the question remains if enough will be able to do so.

Other Reasons Not to Adopt EMR – I’m certain that a study on why doctors haven’t implemented an EMR yet would not show money as the main factor preventing adoption of EMR. There are many other reasons a doctor chooses not to implement EMR and money isn’t going to resolve those concerns.

CCHIT Requirement – Of course, this assumes that the government chooses to make CCHIT a requirement for receiving funds. Doing so will limit the choices a doctor has in selecting an EMR. I think it’s very likely that many doctors will forgoe government funding in order to use a non CCHIT EMR. This could be especially true for specialists who would rather select a non CCHIT certified EMR that focuses on their specialties needs.

Paperwork Required – The government won’t just be going around handing people checks. We’ll have to wait and see how much paperwork and reporting will be required to obtain these government funds, but many doctors will shun the paperwork and beuracracy associated with receiving the government funds.

EMR Vendor Selection Process – With over 400 EMR companies to choose from, it will take doctors some time to decide which EMR they like best. Even if you narrow the list of EMR companies to CCHIT certified companies, you’re still looking at a lengthy evaluation process. Most doctors want to practice medicine not learn about software. So, evaluating EMR software often gets pushed down on their list of things to do.

We’ve all seen or heard it said that it’s harder to spend $20 billion than you would think. This couldn’t be more true when it comes to investment in health care IT and electronic medical records. Let me know in the comments if there were any other reasons I might have missed on why the spending in health care IT might not occur.