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.