OUTSURCING MEDICAL TRANSCRIPTION

There are two things we Humans should accept in life, one being unnervingly optimistic even in highly impossible situations and second and most annoying of all, believing any type of testimonials and accepting it to be true without any second thought.

I say this basis my personal experience, because today I am actually annoyed at our immaturity towards decision making. No this is not on account of any type of loss which I have suffered, but it is on account of all the losses WE as humans are suffering from.

One brilliant example would be outsourcing medical transcription. Accept it, they cost you a fortune in terms of time. Health professionals who’ve invested their man hours on medical transcription know how and what it costs (in terms of opportunity cost).

And when other countries offer to provide the same services at a cheaper rate we develop perceptions about them being unreliable and poor in quality.

India for one has been blamed to have outsourced really poor quality of medical aid. That would have happened once and people have generalized the whole country for it. This is indeed very disappointing. I myself have outsourced medical transcription to an Indian company called Acroseas Global Solutions, I didn’t find any such problem with my report. In fact, the transcriptions were accurate and impeccable.

We need to think from our heads and not from others’.

HHS Says Certified EHR Available in Fall 2010

Well, it always seems to happen when I go out of town on vacation that HHS finally decides to go to work and make some announcements. The final rule for the Temporary EHR certification rule is out and will be published to the Federal Register on June 24th. It’s non-final format is available at the Federal Register’s Public Inspection Desk. Does anyone else kind of squirm when they read about this final rule for a temporary EHR certification. Final and temporary just don’t sound right together, but that’s what we have.

The Healthcare IT Guy attended an HHS ONC press conference and added a nice little summary of what was said:

*As of today if you’re interested in being a certification body you must request the HHS Certifying Body application in writing
*On July 1 ONC will start accepting applications
*By the “end of the summer” (HHS’s words) there will be one or more certifying bodies open for business (accepting products)
*By “this fall” (again, their words) there will be fully HHS certified products available

One important clarification was made by ONC — there is no grandfathering in CCHIT or previously certified products. Everybody is going to be re certified using the new NIST rules. This means that if you have even 2011 CCHIT certification now it won’t mean anything, you have to go through the process again. CCHIT is offering their “ARRA Interim Certification” but beware — the rules say that you have to follow the NIST plans, not what CCHIT developed. So, if you have the ARRA Interim Certification you may not have pay again but you still will be required to change your software to meet the HHS/NIST test plans and requirements.

Nothing that’s all that newsworthy, except it’s nice to finally have a little bit more solid timeline for when there will be some ARRA EHR certification bodies.

I think that Shahid’s analysis of the now meaningless 2011 CCHIT certification is spot on as well. Although, I’m sure we’ll still see quite a few EMR vendors using the marketing power of the CCHIT certification on unsuspecting clinics who don’t know the difference.

Yes, it does also mean that clinics will have to wait until Fall of 2010 (or later) before they’ll really know if an EHR will be a certified EHR or not. Of course, I’ll be very surprised if less than 98% of EMR vendors don’t become ARRA certified.

ARRA Q&A: Are imaging costs recoupable under the HITECH act?

I got the following question from Brandon about the need to have a domain controlled network in order to comply with HIPAA.

I am currently trying to implement an EMR system in a small practice. I am trying to convince the parties involved that it is necessary to transition to a domain controlled network for security reasons even though this type of network is not required for our EMR system or its server. My understanding of HIPAA is that simply having a firewall does not qualify as a “secured network”. Am I right on this?

Brandon,
You are correct that just having a firewall does not likely qualify as a “secured network.” However, that doesn’t necessarily mean that you need to have a domain controlled network to meet the HIPAA security standards. You could still manually apply the domain security policies on to individual computers and achieve the same level of security.

Of course, the key word in that statement is the word “manually.” If you have less than 10 computers, then this probably isn’t a huge deal and can be done manually. Once you pass 10 computers (or somewhere in that range) you probably want to consider using active directory to manage the security policies on your computers. It’s much easier to apply policies on a large number of computers using active directory. Plus, you can know that the policy was applied consistently across your network.

You also shouldn’t ignore the other benefits of a domain controlled network. I’ve written previously about the benefits of things like shared drives as a nice companion to an EMR. Active Directory makes adding these shared drives trivial. It’s also a nice benefit to have a universal login that’s managed by the domain and can work on every computer in the office.

Plus, if your EMR runs on SQL Server and you buy a nice but inexpensive server with Windows Small Business Server, then you already have the software for active directory. So, it’s really an easy decision to use it. I’ve implemented it at a site with 5 computers and it’s been a great thing to have even if it’s a bit of overkill.

EMR on Twitter

I imagine that many of my readers use Twitter to find EMR information. Twitter is an interesting beast. It takes a little getting used to, but can be used in a whole number of ways. However, what people don’t realize is that you don’t have to be on Twitter and have a Twitter account to enjoy many of the benefits of Twitter.

I especially like Twitter during conferences. For example, during the HIMSS 2010 conference I would just search for the tag HIMSS2010 and found all sorts of interesting information about what was happening at HIMSS. Here’s a simple search for people talking about EMR on Twitter.

I think one of the main uses of Twitter is a way to share some of my favorite EMR links. I use this EHR and HIT twitter account to do that for some of my favorite bloggers. It’s also fun to see people’s reactions to the various items I post on that account. I guess people like what I’ve done since that account has 4232 followers of it.

At the end of the day, Twitter for me is a way for me to connect with lots of interesting people. Tomorrow, I’m going to lunch with a local CPA and blogger that I met on Twitter. It’s timely, since I’ve been looking around for a CPA. So, we’ll share lunch, I’ll teach him about blogging and we’ll see if his CPA services are a good fit for my needs.

Beyond that I’ve connected with so many people on Twitter. I’ve gotten free tickets to shows in Las Vegas. I’ve gotten free graphic design work. I’ve seen some of the latest breaking news before CNN and the likes are broadcasting it. I’ve found side work on Twitter. Plus, I’ve gotten hundreds of questions answered by my smart twitter friends.

Obviously, I’m a pretty big fan of Twitter. In fact, many of you likely found this blog through Twitter. I love Twitter because it can be used in so many ways. How do you use Twitter?

Also, if you want to connect to my personal twitter account (which also does quite a bit of EMR related content), I’m @techguy.

EMR Stimulus Q&A: Government Incentives for EMR Adoption Outside of Medicare and Medicaid

Time again for everyone’s favorite topic (or so it seems), EHR stimulus questions and answers. Today’s EMR stimulus question comes from Jamie who asked the following question on a previous post:

Does anyone know whether or not the government is implementing some kind of incentive benefit for non-Medicare/Medicaid users? Or are these practices totally out of luck?

The short answer (at least for now) is not really. The ARRA EHR stimulus money is provided through Medicare and Medicaid programs as “bonuses” for those who show “meaningful use” of a “certified EHR.”

With that said, there are some grants available for special situations. For example, they have a beacon communities program which are given to organizations that will supposedly take EHR software to the next level and be examples for their communities of what can be done with IT and EMR software.

I’ve heard there’s other grants that people can apply for also, but I’m not sure all of the details. I also hear that there might be some EMR stimulus money available in the latest healthcare reform bill. For example, I read somewhere recently that the healthcare reform bill includes some stimulus money for long term care which has basically been left out of stimulus money as well.

Clinics interested in EMR software should also be able to get some help from the RECs and HITRCs. At least their stated mission is to assist doctors to adopt and meaningfully use EMR software. I think the jury’s still out on how helpful these RECs will actually be. It’s a nice idea, but could go horribly wrong if not done right.

I won’t go into all the details here, but not qualifying for the EMR stimulus money might just be the best thing that’s happened to your practice. That means you won’t be distracted and you don’t need to wait. You can hone in on the other EMR benefits and start reaping those benefits without all the bureaucracy.

Offsite Backup Services for an EMR

I’ve been seeing a number of new offsite backup services for EMR software. They are becoming quite sophisticated and are an option that I think many doctors offices should consider. I know that in one doctors office I setup a USB hard drive which they could take home with them in order to have some semblance of an off site backup.

This is far from perfect and even harder to secure the right way. Not something that most doctors offices will want to take on alone. However, the real problem with this type of “off site” backup is that they too often forget to take the backup offsite. They don’t verify that the backup was done. I’m sure there’s more, but you get the picture.

Seems like many of these off site backup services provide a really great service that solves a lot of these problems. Not all of them (like verifying that the backup can be restored), but they are becoming quite sophisticated.

I’m interested to hear other people’s experiences with these type of offsite backup services. What do you like? What do you dislike? What do you wish they’d do?

I have a feeling these type of really useful services won’t be in rich supply on the HIMSS vendor floor, but I’ll be keeping my eyes out for useful and practical services like this at HIMSS. If you’re a vendor of a service like this that will be at HIMSS, let me know so we can meet. Same goes for any ambulatory EMR vendors. I’d love to meet with you at HIMSS too.

Large EMR Vendor Bias Towards EMR Stimulus

One thing I’m starting to notice is that it seems that ALL of the large EMR vendors are strong proponents of the EMR stimulus. All but a couple of the comments I’ve found from large EMR vendors laud praise upon the HITECH act. Listening to the information they’re putting out, you’d think that this was a fantastic stimulus package that will just be too good to pass up.

Now, I’m not saying that what these EMR vendors are saying is a lie (although some of the things they’ve said are). What I am saying is take a look at what motivation an EMR vendor has to do anything but prop up the EMR stimulus package. As far as I can see, there’s little benefit to their EMR business to talk poorly about the EMR stimulus. EMR vendors want people to think that the EMR stimulus is simple, effective and incredibly well done. If this were the case, many doctors should and would be all over it and EMR vendors would see increased sales. If EMR vendors were to describe it as complicated, ineffective and poorly defined, then that means fewer sales for those EMR vendors.

My point here isn’t to argue whether the EMR stimulus is good or not. It’s just to highlight that EMR vendors are (and probably should be) biased in their opinions of the EMR stimulus package.

Interestingly, a few smaller EMR vendors have made the opposite case. They’ve come out that the EMR stimulus is an atrocity, does little to improve doctors’ productivity and often hurts productivity.

The battle lines have been drawn. Just make sure you’re not a casualty of biased information.

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.

Thank You EMR and HIPAA Sponsors

As EMR and HIPAA passes our 3 year anniversary, I thought I’d take a moment to thank the sponsors of this blog. Their sponsorship makes this website possible. This is especially true at Christmas time. So, thanks to both EMR Choice and EMR Experts for your sponsorship and advertising on EMR and HIPAA. Our relationship with EMR Experts goes back almost 2 years and so hopefully they’ve found our relationship as beneficial as I have found it. EMR Choice is a new sponsor that’s really trying to do some good things in the EMR market.

It’s hard to believe that it’s been over 3 years since I started this blog. I first started out just wanting to document my experience with EMR. I still do that to a large extent, but it’s grown to a lot of other things including some of the various EMR related technologies like the ever popular Dragon Naturally Speaking medical. Regardless of the topic, I still am passionate about EMR and the effect that it can have on healthcare. I think a ton of things need to be done to improve its implementation, but it’s needed as a platform for the future of healthcare. It will be fun to see it evolve over the years.

Also, I wanted to wish everyone a Merry Christmas and a Happy Holidays. May you enjoy the season and celebrate with those you love and care about.

Generic Electronic Medical Record Description

I get a bunch of email from all sorts of electronic medical record vendors telling me about their software and their company. I don’t mind when people contact me with something innovative and interesting. The problem is that most company press releases are all the same. They all tout the more or less the same feature set of every other emr company out there. I’ll put an example press release I got below so you can see what I mean.

At the end of the day, reading press releases like the one below I wonder if 1. companies understand what it gets bloggers and media to use their press release and 2. emr companies have really stopped innovating the way they should.

On the first point, if you want me to write about you or your company then you better tell me something cool and different. Sure, add in the list of standard features at the bottom, but sell me on a feature that makes you better than every other EMR company out there. Otherwise, I’m just going to ignore you as one of the other on the long list of EMR vendors. You’ll notice I didn’t even put a link to the company whose press release is found below, because there’s nothing interesting or unique enough about the company in that press release that makes me want to send people to their website.

As far as the second point, it’s been a while since I’ve seen some truly creative and innovative thinking from an EMR company. I’m talking about things like Medtuity’s granular method of data entry or Brendon’s beloved eMedRec which is a really interesting hybrid of a scanning/document work flow with some of the EMR features layered on top. I’m sure there are more cool things being done with EMR, but it gets lost in everyone needing the standard boring features.

So, keep the emails coming, but make them interesting so I don’t just go straight for the delete button.

WITH MTBC, THE LOCAL DOCTOR�S OFFICE FINALLY JOINS THE PRESENT � AND FUTURE � OF HEALTHCARE IT

New integrated IT system provides patient scheduling, touch-screen check-in, integrated records and billing with mobile access, real-time adjudication of insurance claims and more

SOMERSET, N.J. � Sept. 9, 2008 � Unable for years to match the cost-cutting IT advances of deep-pocketed insurance companies and hospitals, private physician practices are now embracing a level playing field with innovator MTBC.
This playing field extends throughout the patient-physician-insurer continuum, from the Internet to the paperless doctor�s office, creating enormous efficiency for all involved parties�even the pharmacy and medical laboratory. Through MTBC�s integrated system, patients schedule appointments online, receive automated reminders by phone, and check in at the doctor�s office at a touch-screen kiosk.
�Technology becomes far more dynamic as it enhances the patient-physician relationship,� said David Rosenblum, president of MTBC. �Our newest services reduce the time the patient spends in the doctor�s office and increase the care the physician can provide.�
Patients whose physicians use MTBC can schedule appointments privately with their doctors on a secure web site, while viewing available blocks of time. The reason for the appointment and medical symptoms may be entered, along with current insurance information. The patient will receive automated reminder calls prior to the appointment, minimizing no-shows�a bane of most doctors� offices.
At the doctor�s office, the kiosk scans a patient�s insurance information with a swipe of a card and then conducts a brief survey of medical questions. This information is integrated into MTBC�s EMR software for easy access by doctor and staff.
During and after the appointment, doctor and staff enter notes, diagnoses, and prescriptions into MTBC�s EMR software. Prescriptions are transmitted by electronic fax to any pharmacy�handwritten prescriptions are obsolete. Lab reports are also electronic, accessible securely by the doctor on the web.
Insurance claim data, such as procedure and diagnosis coding, is entered and transferred securely via automated synchronization on a daily basis to MTBC�s web-based billing platform, with its real-time financial reporting and array of practice management tools. MTBC�s dedicated teams in billing, practice and patient support complement the cutting-edge service package.
After the patient examination, MTBC will determine exactly how much of the visit is covered, and how much the patient needs to pay out of pocket, thanks to Real-time Adjudication (RTA), a new service spearheaded by certain insurance companies.
MTBC�s system means no more waiting in a doctor�s office for hours due to poor scheduling practices. It means having the physician know what the problems are the moment the appointment begins. It means no more uncertainty or confusion over insurance payments, avoiding the unpleasantness of an unexpected bill that arrives weeks later.
And for the physician, MTBC creates a streamlined scheduling and billing system that allows substantially more time to be spent on the patient�s needs and questions.
�These advances demonstrate that we�re a nimble technology company that acts quickly on the issues reshaping the entire healthcare industry,� said Mr. Rosenblum. �We are always committed to maximizing and accelerating our clients� collections.�
MTBC�s system integrates several advances in healthcare IT�previously available only at hospitals or insurance companies� to revolutionize private practices:
� Doctors migrate to MTBC�s free EMR (electronic medical records) software and slash records-related administration.
� MTBC provides access to real-time adjudication (RTA) of insurance claims for patients with UnitedHealthcare insurance, greatly accelerating related payment.
� MTBC recently launched the PDA version of its billing platform so that clients can access their practice�s financial reporting, claims data, and scheduler through an iPhone, Blackberry and Windows Mobile device.
� MTBC is now rolling out physician web sites that allow patients to schedule appointments online.
� MTBC conducts automated phone reminders to patients.
� MTBC is integrating a detailed survey program that patients can access online when an appointment is made. This survey gives a physician a better sense of the patient�s symptoms before the appointment even begins. And unlike other companies that have started to offer patient survey services, MTBC does not sell patient information to third parties � everything is kept confidential between doctor and patient.
� MTBC is testing patient kiosks that read a patient�s insurance card, take his or her picture, and conduct brief medical surveys. This will dramatically reduce waiting times and bottlenecks in physician offices.
�We�ve always been committed to bringing state-of-the-art technology to private practice physicians and practice administrators,� said Mr. Rosenblum. �Our business model makes all these innovations easy to use, integrated, and remarkably affordable.�

When EMR Software Became Free…Or Does It Cost

I’ve been meaning to write about a new Free EMR for a while. One of my most blogged and searched about topics is free EMR. I guess everyone loves to get something free. Why should free EMR be any different?

The problem with free EMR is that while it may be free from a financial perspective there are always other costs associated with free EMR. Here’s an example of a parts of an email I recently got about a new Free EMR. The company is called Practice Fusion and the following is excerpts from the email I received:

Today we have a press release going out (below) about Practice Fusion releasing a suite of physician applications, including Practice Management, Scheduling, Secure Email and Patient Management that are free and web-based. These are effectively ‘Google Apps’ for doctors – everything a practice needs to run their office, manage and schedule their patients, communicate with other members of the office – all web-based and at no cost.

I really liked the marketing angle that this company is taking. I personally am a devoted google apps user and I absolutely love what google apps is doing for me. Google apps is a completely free application that gives my businesses (EMR and HIPAA included) a whole bunch of business services with my very own branding. Most important of which are Email and Google documents. In return for using this free service, Google puts ads around the various services. A small price to pay for me to receive free email.

Turns out, Practice Fusion is offering a free EMR using the same model as Google Apps. My email described Practice Fusion’s free EMR revenue model as follows:

We generate revenue by embedding advertising, including pharmaceutical products, into our physician tools. We also incur revenue through the sale of anonymized patient data to research groups, pharmaceuticals, and health plans.

Basically, their planning on selling ads around people’s patient information. People are still freaking out about Gmail and Google apps placing targeted ads around their email. Why? Because in order to target the ads properly, that means Google has to search all of your “private” emails. Does this mean that Practice Fusion is going to be searching through all of your patient data?

Being completely honest, I personally don’t have much to hide and so Practice Fusion could have a hey day looking through my health information. However, I’m not sure most patients will share my same view. My guess is that most patients would feel very uncomfortable going to a doctor that is using a service like this. I think they’ll feel like their doctor was selling their information to save a buck. It might be one thing if the patient saved some money too, but that’s not going to happen.

Certainly a doctor using this free emr didn’t have to tell their patients that it was paid for by advertising and getting their information sold. However, could you imagine the backlash that would occur if they didn’t tell their patients and then someone found out. I’m honestly not sure how many doctors would want to take that risk. Sounds like the perfect 11 o’clock (it’s later in Vegas) news story to me. Lead Story: “Doctor Sells Patients Data to Save Money.”

Maybe I’m wrong and people won’t care about this or those that do care won’t find out. If that happens, then it’s hard for a doctor to argue with free. I personally haven’t looked at the feature set to know how it compares to other EMR vendors. However, there’s no arguing some of the benefits described in the email I received:

Practice Fusion offers a unique product to small and medium sized physician practices, which was developed using Adobe® Flex® 3 software for creating Rich Internet Applications (RIAs). Practice Fusion’s solutions are web-based, require no upfront costs, no extra hardware, no large software applications to install and rollout, and no backend databases, which are required by traditional vendors such as Misys and NextGen. Where enterprise solutions may take weeks or even months to implement, Practice Fusion’s services utilizes its exclusive ‘Live in Five’ process to enable physician practices to be deployed and up and running within minutes.

Web Based – Awesome! Certainly the future of almost every software application.
No Upfront Costs – Nothing to lose, but also no motivation to avoid EMR implementation failure either.
No Extra Hardware – Very nice for the doctors. Not so much for the IT support people.
No Large Software Applications to Install and Rollout - I hate managing client applications. This is a big plus.
No Backend databases – This isn’t really true since they certainly have a back end database, but the point being you don’t have to manage the backend database. A nice benefit for most doctors.

Now a word about Practice Fusion’s “exclusive ‘Live in Five’ process.” I’m certain that it is true that they can create an instance of their EMR in 5 minutes. However, don’t be misled to think that you can spend 5 minutes and have a fully functioning and fully configured EMR. It’s just not reasonable to think. It’s a nice marketing angle, but it’s just impossible.

Think about this for a second. Assuming a very small practice of 5 staff. It’s going to take you somewhere around 5 minutes just to gather the information and create the user accounts for your 5 staff members. Now add in the myriad of other configurations you’ll certainly have to do and you start to realize that your EMR won’t be setup and ready to go in 5 minutes. In fact, my experience is that the EMR configuration process is an ongoing process that never ends. Practice Fusion’s free EMR could certainly argue that setting it up is faster than setting up other traditional EMR softare, but don’t be fooled by the “Live in Five” marketing.

One final thought before I end this. Let’s go back to my current Google Apps experience. What do I do if Google changes their mind and shuts down their service? There’s not really much you can do. Google’s giving you a free service which they can terminate at any time. Luckily a number of creative IT users have found ways for people to backup their email stored on Google servers.

I finally found a link to this topic buried on the Practice Fusion website. Most of that page talks about how their more reliable than an in house system. Interesting that they didn’t address what happens when your internet goes down and you’re left up a creek without a paddle, but that’s a topic for a different post.

The thing that isn’t addressed by Practice Fusion is what happens if Practice Fusion disappears. Sure, it would be nice to think that Practice Fusion will be around forever and it’s great for them to have that confidence, but it’s just not realistic. What if Practice Fusion sells to another company? What if Practice Fusion goes under? What if the free EMR model doesn’t work and Practice Fusion decides to start charging?

It does alleviate some fear that at the bottom of the linked page Practice Fusion says “It’s your data – always.” However, we’re not talking about a bunch of linear data like email. We’re not talking about something in a standard format that can easily be exported between one software to another. We’re talking about Practice Management, Scheduling, Secure Email, Electronic Medical Record and Patient Management. How do you expect them to provide you a “copy” of this data? Would be an interesting experience to try and see what they provide and how responsive they are to the request.

I’m not trying to be overly critical of Practice Fusion. Maybe they have a great product that’s worth every penny. Wait, of course it’s worth every penny since it’s free. Sorry I couldn’t resist. My point here is that doctors should be careful when evaluating free EMR software. There are certainly benefits to a free hosted EMR solution. Just don’t be blown away by the free tag and make sure you know the challenges of free.

By the way, I hope that Practice Fusion will respond to my various assertions and comments with a response in the comments. They seem like they’re pretty tech savvy. Just the fact that they have a Practice Fusion Blog is enough for me to give them some props (even if they did use typepad and not wordpress). You can expect some future blog posts linking to their blog.