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All Things HIT

September 16, 2012  10:45 AM

EHR’s generational gap just breaks my heart!

Posted by: AllinHIT
EHR adoption, Meaningful use

Changing my company focus from consulting to independent physicians will undoubtedly pay off financially. However, assisting small practices with EHR implementations will always have a special place in my heart. That’s why I made an effort to check back in with former clients and friends during this break between assignments. I was quickly reminded of the generational difference in attitudes among physicians and office managers about the purchasing of an EHR, as I talked with them and/or visited their offices. I needed reminding about the world of the independent physician, being in the hospital world now. EHR adoption and acceptance is still a quagmire filled with juxtapositions! Choice of system, cost, managing meaningful use (MU) and physician quality reporting initiative (PQRI) programs, lab and other interfaces, transferring patient files, and staff training are all annoying processes filled with dos and don’ts!

I visited an internist client who has not converted to EHR, despite my previous recommendations. I was told their EHR implementation has been placed on hold because their office manager quit. The former office manager is managing an EHR implementation at her new employer, I found out through other staff members.  Having a personal interest, I discovered this physician’s lack of commitment to an EHR drove the office manager to quit. The former office manager was considered by all to be young and bright! I remember that she wanted the office to implement an EHR not because of MU or patient care, but because operating an office where files are misplaced and misfiled was stupid! She felt the inefficiencies of answering pharmacy calls, looking for charts, signing into three different systems, etc. I understand leaving a practice because of non-adoption; It represents a new generation, not only embracing technology, but demanding it.

I had other experiences while touching base with old physician clients. Some have implemented an EHR, I’m happy to report, and are going after MU dollars.  However, I could not help but notice the generational gap between those that implemented, and those that were talking about it two years ago.  Of course, there were many reasons/excuses not to adopt, and some were valid. Refusing to adopt due to the threat of retirement by a long-time office manager was my favorite excuse. Sadly, the EHR generational gap also exists with users as well as physicians and it breaks my heart!


August 31, 2012  3:26 PM

CMS, a hero for influencing health IT adoption!

Posted by: AllinHIT
CMS, E-prescribing, Medicare

Recently I had a discussion on EHRs with a group of strangers at a party.  It was the old “what do you do?” question that started the conversation among this group that was unfamiliar to the industry.  It was discussed that a common link among us was that we all are patients. Then, I was asked, why these type of systems are just being implemented in health care. It was then I thought about my health IT career and how the Centers for Medicare and Medicaid Services (CMS) influenced health IT, starting back to the mandate for online, real-time adjudication of Medicare claims. I must say, CMS has had such an effect on health IT, and this was just the beginning!

I thought about how CMS affected the adoption of e-prescribing.  If you remember, roughly four years ago, the CMS e-prescribing incentives started.  Providers were given a two percent revenue uplift on their monthly Medicare billings, if they sent a large percentage of Medicare scripts electronically. When this program started, I was a technology consultant for Quest Diagnostics given the task of educating their physician clients on the incentive, and surprise, surprise….I was responsible for leading their sales team in signing up providers for Quest’s e-prescribing solution.  Without a doubt, the benefits of e-prescribing more than justifies the cost of implementing and causing a disruption of workflow. However, it took this incentive for significant adoption to occur.  This again, is just another way CMS was able to influence health IT.

Lastly, the latest numbers show a significant increase in EHR adoption.  Of course, CMS incentives again are the reason! I could go on and write about CMS influences on the adoption of HIEs, ACOs, and Beacon Communities. That is why, I must crown CMS for being an adoption hero for health IT.  Thanks CMS, your influence, although not perfect, has reached hero status just the same!

August 24, 2012  4:41 PM

Core measure #13, giving patients unmeasurable value

Posted by: AllinHIT
EHR, EpicCare, Meaningful use, Patient Satisfaction

Whether you are in customer service, customer support, or delivering care to patients, it’s a great feeling to know you had a quick impact on someone’s life.  This is one of the primary reasons I enjoy doing go-lives, for the immediate reward of helping both physician and patient.  Since the implementation of meaningful use, I must say the rewards have been mounting fast, a snowball effect I’m certain CMS expected.  The Health IT industry is full of commentary on meaningful use. Experts have reviewed, discussed, and appropriately, recommended changes to core measures!  Although much attention has been drawn to implementing measures like CPOE, e-prescribing, and reporting clinical quality measures, the actual use of these measures is providing real patient value.  Measure # 13 ( providing clinical summaries for patients), is the one I most recently witnessed provide true value.

I was assisting a cardiologist with printing an after-visit summary (an “AVS” in EpicSpeak).  As I was providing support to rectified the printing issue, the physician wisely talks to the patient and explains the new Epic system provides this “AVS”, which summarizes their office visit showing useful information on their vitals, medication list, and other clinical information. Afterwards, I solved the problem and left the room.      Five (5) minutes later, as I was leaving, I ran into the patient by the parking lot.  The patient explained to me the doctor talked about putting the patient on Coumadin during the visit and gave a prescription for it.  However, upon the patient reviewing the AVS, they went back to the office and talked with the doctor. The patient, noticed the word “Warfarin” was in parentheses alongside Coumadin, and realized it was the same drug. Already on “Warfarin”, the patient avoided an overdose, just by reviewing the AVS.  Hence, the patient thanked me for assisting the physician with printing the document, and told me they now understand the importance of reviewing this information!

As we discuss, dissect, and influence meaningful use, (by the time this blog is finished we will be reviewing final stage 2 reqs) let’s remember the impact these measures have on patient care. I think sometimes we can get lost addressing corresponding changes to workflow, integration issues, reporting requirements, data governance, data breaches, PHI security, and I could go on.  With the patient thanking me in the aforementioned scenario, I was reminded why I love what I do and I saw the epitome of meaningful use, preventing errors and increasing patient satisfaction!

August 17, 2012  1:00 PM

Recent studies link importance of PHR use

Posted by: AllinHIT

With some “free” time, back from a 6 month Epic training and go-live gig, I immersed myself in the last 30 days worth of HealthIT news, CMS HealthIT deliverables, and ALL THINGS HIT. During my studies, I noticed a common theme in the last month, the multi-dimensional affect of Personal Health Records (PHR) was being reported on. PHR usage, based on studies we will discuss, has a positive effect on payor membership, preventative medicine, and of course this all translates to enhancing patient care. So, what were these studies reflecting PHR’s importance?

Kaiser Permanente in mid July, published the results of a three (3) year study on the link between PHR usage and membership retention.  The study ( examined the relationship between patient loyalty and member retention with those frequent users of Kaisers’ “My Health Manager” PHR.  The study concluded members were 2.6 times more likely to remain members. What I also found interesting was the strongest loyalty was among the members with the shortest tenure. Can we conclude that new members are a part of a younger, more tech-savvy workforce? As the economy improves for college grads, will the demand and use of PHR’s increase?  Another interesting publication on PHR’s, came from the July/August issue of the Annals of Family Medicine.  The publication relates PHR use with increasing patients compliance with performing preventative screenings. Commissioned by the Virginia Commonwealth University, the study reveals PHR benefits like providing alerts for needed services, generating reminders, empowers patients to better manage and monitor their care.

There is no doubt, patients using PHRs will benefit all in the delivery chain.  However, the key word is usage, and it will take a collaborative effort within the delivery chain to increase it. Efforts similar to CMS’s Agency for Healthcare Research & Quality (AHRQ), recent publication “An Interactive Preventive Care Record..a Handbook Using Patient-Centered Personal Health Records To Promote Prevention”.  This handbook gives helpful tips to physicians.  Information such as, how to choose/market PHRs, and what I really like, suggested workflows for PHR registration, are detailed. This is a great first step for CMS, however, some incentive for Medicare and Medicaid members to use the PHR is also needed.  In takes physicians, employers, payors, organization stakeholders (HIE’s, ACO’s, etc.), working together to educate patients on PHR benefits. However, the patient role is also crucial!  Linking PHR use with member incentives, would be the main driver is showing the importance of PHRs ….especially if it hits them in the “pockets”!

July 31, 2012  8:50 PM

Is the two week deadline for MU Audits fair?

Posted by: AllinHIT

I have been audited before, and I didn’t like it. Besides being frightening , audits mean you have some unexpected, time-taking, tasks ahead. On another hand, if you have systems in place you should feel less frightening and it should require less effort. Either way, do you think two weeks a fair amount of time to develop your proof of adherence?  Evidently, the government does when it comes to proving meaningful use.

CMS’s Medicare audit enforcer, Figloiozzi and Company, has recently sent out letters to some physicians, preparing them for a Meaningful Use audit. Given only two weeks to prove the four requirements of Meaninful Use, EPs and EHs should easily provide with a ATCB certified EHR. For example, requiring proof their EHR is certified, and reporting the core and menu requirements, should be a matter of pulling a report (i.e. dashboard).  However, is a two week deadline enough time for EP’s and EH’s?

I believe this deadline is ridiculous, and puts unecessary burden on the physicians and hospitals. After all, for hospitals a whole committee will have to be formed, which will take a week itself!  What of the small, independent physician?  This group will have to dedicate their resources to this task, taking away valuable time for patient care.

Again, I know with the appropriate EHR, these audits shouldn’t be a problem. Whether its income tax, compliance, and/or MU, when it comes to audits, I do believe 30 days should be the norm. Hence, I’m deeming this two week deadline to be unfair, do you?

July 23, 2012  12:35 AM

SAIC & Harris aren’t sleeping on “COTS”, nor services

Posted by: AllinHIT
Accountable Care Organizations, ACO, Best in KLAS, Carefx, COTS, Harris Corporation, HIMSS, KLAS, MaxIT, SAIC

After reading about SAIC’s purchase of health IT consulting firm elite, MaxIT last week, I reflected on a conversation I had with Jim Traficant, President of Harris Corporation’s healthcare division.  I was interviewing Jim for my “HIMSS Homecourt” series during the 2010 conference held in Orlando, literally an hour after it was announced that Harris Corporation had just purchased Carefx, one of the leaders in clinical portal and HIE solutions. 

I asked Jim, was this purchase due to Harris’s need to diversify to commercial markets.  Of course, his answer was “certainly”. If I could have that same discussion with Steve Comber, SAIC’s healthcare unit leader, I believe he would give the same answer. It was Steve where I first heard the term “COTS”. After SAIC purchase of Vitalize Consulting Services, Steve referred their desire to have COTS or commercial off – the – shelf solutions. In the current times of possible defense cuts due to an uncompromising political logjam, both SAIC and Harris Corporation, seem to be adopting a commericial strategy. However, I believe this is only the beginning for both firms. 

Stating what is the obvious by now, both Harris and SAIC are huge defense contractors. They could be viewed as competitors since both provide technological solutions to the DOD, CIA, and other governmental agencies.  As I mentioned, Harris bought Carefx a true “COT” solution. However, SAIC is taking the service approach by purchasing both MaxIT and VCS, both was BEST of KLAS in 2011 for consulting services.

I suspect that both are looking to further buy their way into the commercial markets.  SAIC will probably look at COT targets, and Harris will be looking at service companies.  In this HITECH, ACO and Obamacare vibrant market, it only makes sense that they continue to stay awake and invest in health IT solutions.  Whether COTS and/or services, both have deep enough pockets to have a major impact on health IT. Of course, I’m commercially speaking!

July 15, 2012  11:20 AM

A quest to be the best…in go-lives!

Posted by: AllinHIT

I love being a part of Epic go-lives. In the past two months, besides doing my regular duties as an executive with Webmenders, I’ve worked with Intellect Resources on two go-lives.  Although there were vast differences between the two, Mt. Sinai was an inpatient go live, Ochsner, an ambulatory one, there are also similarities. Of course being competent on the software is most crucial to being a valued resource.  However, it is not the “be all” in your quest to be the best go-live consultant.  Here are a few recommendations and points I would like to make.  

First, it is important to be very flexible.  Flexibility is one of the main attributes, besides being competent with the software, of being a valued go-live resource for the client.  Changing workflows, constantly changing go-live schedules, and the changing needs of the hospital system, are just some of the aspects which being flexible comes into play.   

Secondly, you can be competent with the software, but its the ability to understand the learning mode of the physicians you are supporting that can make the difference.  Early in my professional career, I had a manager that told me he was going to manage me, the same as he managed everyone else. Needless to say, I knew immediately that he wasn’t a good manager.  You can not treat everyone the same, and be successful.  The same with assisting physicians with go-lives, every physician is different and you must adjust to those differences.  For example, some physicians do not want you to approach them while they attempting to practice CPOE. Some want to figure it out on their own, and if they need assistance, just within “yelling” distance.  Others, however, want you to hold their hand throughout the process. You can usually distinquish one from the other with body language, input from their nursing staff, and if you are listening, some will even tell you in a roundabout way!  Having excellent communication skills, can sometimes, compensate for your lack of knowledge!

Lastly, understand that you don’t have to know every answer, nor does the client expect it!  However you must “own” every question, from every hospital employee, whether they are pertaining to scheduling, nursing, and/or CPOE! By owning the question, I mean you must be responsible for getting an answer in a timely, proficient manner.  We all have “brain farts”, and its impossible to know every answer to their questions. As most of us know, during go-lives you are asked questions outside of your certifications and credentials.  You may be very competent on CPOE, but know nothing of appointment scheduling, but the scheduler sees you and ask for help.  Again, own the question regardless!  Sometimes a question can pertain to your expertise, but its not a matter of not knowing the answer, but a question of the hospitals chosen workflow, hospital goals, and what interfaces are in place (LIS, RAD, and CVIS).

Here are just a few suggestions on your quest to be the best go live resource!  However, its definitely a good start!                      

June 27, 2012  9:42 PM

Senate stops FDA delay for mHealth

Posted by: AllinHIT

Thanks to the Senate, the proposed bill on mobile medical app guidance will not face the delay originally planned. Senate bill S.3187, proposed by Sen. Tom Harkin, originally wanted the FDA to submit a “full scale” report to the Senate pertaining to regulating mobile medical apps….within 18 months!  Industry proponents, like myself, thought this timeframe was very detrimental to the industry, and gladly, I think the Senate agreed. Due to the hypergrowth of mobile health technologies, similar to the Internet industry in the 90’s, eighteen months would be an eternity.  It certainly would have negatively impacted innovation and growth, at a time when delivering care mobilily is essential.  

The Senate decided that the “guidance report” instead should be the responsibility of HHS, with input from the FDA, the FCC, and the ONC. I suspect the ONC will be driving this effort, as they should.  Don’t get me wrong I believe everyone, including the FDA, has a valid reason to influence the outcome.  However, the ONC, has a better understanding of industry needs, the innovative products currently being used and developed, all thanks to HITECH.  

Lastly, there was one good thing about the previous version of the bill I liked. It originally required input from those outside of Washington, such as vendors, consultants, and industry organizations.  Now, the new version gives HHS the authority to receive this input, but it is NOT required. This in my opinion is a mistake.  Similar to the importance EHR vendors, AHIMA, MGMA, and the AMA, had on Meaningful Use and the implementation of 5010, it would give the industry a needed voice at the table.  Lets hope HHS agrees with me and invites industry vendors and organizations to the table.  If not, the uncertainty of “what is to come” could stifle business plans, putting on hold innovations for ACO’s, access to care, and most importantly, patient care!                    


June 15, 2012  3:32 AM

New York’s new e-Pre Act, has one problem!

Posted by: AllinHIT
E-prescribing, EHR, eRx, I-Stop, Mt. Sinai, workflow

If you read my last blog you are aware I am in NYC working at Mt. Sinai hospital. Hence, I’ve been sort of “checking out” the health IT scene here, and so far, I must say I am impressed.

Previously, I wrote about Mt. Sinai and their participation in the Image Share project, in conjunction with the RSNA. Now, I’ve read within three (3) years physicians will be required to send prescriptions electronically for pain narcotics under the Internet System for Tracking Over-Prescribing Act (I-Stop). Yes, you heard it right. In the State of NY, physicians will electronically send schedule II, III, and IV drugs!

At first, I thought this was great news. As a former advisor to ePrescribeFlorida, a nonprofit organization promoting the use of e-prescribe in the State of Florida, we worked tirelessly on trying to get the State of Florida on this same path. Our efforts, although less ambitious, were to be less disruptive. Hence, there is a huge problem with this legislation, as it puts unnecessary burden on the physician and the pharmacist! 

The problem with I-Stop is it requires the physician to review a patient’s prescription history, on a yet to be built real-time database, hence effecting workflows! I-Stop, however, is an equal opportunity workflow disrupter (is that a word?), as it requires the pharmacist to report when such prescriptions are being filled! The I-Stop database is separate from the physicians EHR and the pharmacist’s back-end pharmacology system, hence, will require both offices to access yet another system in their workflow! I continue to be an advocate for e-prescribing controlled substances, however, I believe there is a better way to accomplish it and still attain the goals of the I-Stop Act (reducing drug abuse and identifying those that need help with substance abuse).

What is a better way? It requires collaboration between software vendors, network aggregators, and of course, the stakeholder State.  The solution begins with having the pharmacist’s system, which is certainly tied to SureScripts, automatically update these prescriptions to a database which is tied to the physicians’ EHR. When the prescription is written in the EHR for those drugs, it will automatically check the pharmacist database (SureScripts), then creates an alert to the physician if abuse is suspected! This solution will not require a drastic change in their workflow, but requires systems to do what they do — talk to each other!

I applaud New York in allowing schedule drugs to be electronically sent. However, I would like a more system approach, as described above. The physicians’ workflow is already going through changes considering the implementation of EHRs due to HITECH. I-Stop is a perfect example of good intentions gone disarray, but it deserves a reprieve with changes!

June 12, 2012  10:33 AM

RSNA Image Share Project, a step forward for PHR

Posted by: AllinHIT

I am honored to be a part of a go-live at Mt. Sinai hospital in NYC. Ranked 16th last year, according to U.S. News & Report, Mount Sinai has an excellent reputation on safety, its medical school, most importantly to me, patient-care factors. Hence, it was no surprised I learned the other day, that Mt. Sinai is one of the first hospitals to participate in the “RSNA Image Project. The Radiological Society of North America (RSNA) image project will give patients access to their images in a cloud environment. This step, could move PHR’s towards acceptability and use, however, PHR’s still have a long ways to go in producing a longitudinal chart.

As a technology consultant for Quest Diagnostics, I participated in the launching of the now abolished, Google Health’s PHR. One of the issues with the product was not having electronic access to enough clinical data, including images. Depending on the patient to upload some clinical data to update the PHR, and not having access to images for the PHR, are obviously two issues related to the short-comings of PHR’s. The RSNA project, in two phases, will allow for patients to first upload the images to a PHR, but in the second phase will allow for the image to be encrypted, and sent to other providers for second opinions, etc. I believe with images, having online access is good enough, but having the ability to send it to others, is a bonus.

What I really like about providing these images is how it can cut cost and its affect on patient care! As David Mendelson, MD FACR and Chief of Clinical Informatics at Mt. Sinai, states “It gives the patient ownership over their records and makes the information more accessible to physicians. Plus it decreases unnecessary radiation exposure that can be caused by physicians ordering duplicate examinations due to records not being easily available.” I couldn’t of said it better myself! My hope is that other hospitals join this effort and move PHR’s a step forward for us all!

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