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Meaningful Health Care Informatics Blog

October 1, 2010  11:53 PM

The first certified Products in the market place and the future of EHR vendors

Posted by: RedaChouffani
ceertified EHR, future of EHR, too big to fail EHR


On October 1st, 2010 the Certification Commission for Health Information Technology (CCHIT) has announced the first set of “Certified EHR” solutions that are capable of meeting the Stage 1 of meaningful use outlined as art of the requirements from the American Recovery and reinvestment Act (ARRA). As expected certain packages applied for certification under Complete EHR, and her Modules certification.


For many organizations who have been awaiting for announcement of which vendors are certified, may find relief in knowing that over 33 packages are officially certified. While, there will most likely be more to come, this represents the first step in a long road of meaningful use.


Looking closely at the list of vendors that have been certified thus far, one can only assume that the rest “Should” follow soon. while everyone awaits the future certified products, a common opinion is dominating the blogger’s world. It is not uncommon to hear that “Eventually the market will have a selective few EHR vendors left that will provide a comprehensive EHR product, the rest would either be out of business or simply acquired by the bigger ones”. This opinion of course is nothing more than a possibility, but here is an alternative one that can prove to be the complete opposite of the first. What if the large EHR vendors create packages that are too large to keep up with some of the technology trends. To provide a quick example let’s look at some of the software solutions that were developed in the early computing years. Systems that were running on risk machines, or simple dos screens. Many of which continue to exist, but clearly while vendors recognized that it would not be cost effective to completely rewrite the software, they continue to maintain hat the clients they have and hope to have other products in the futures that may “hopefully” replace their old one. Another example is how quickly certain successful products labeled too popular to fail (MySpace) are continously loosing subscribers to their rival “facebook”.


But one thing worth noting is that one of the dominating technology trends we continue to see is the shift of software products toward a web based solution. There are numerous examples that show how other industries have successfully shifted to a web based platform for their core business applications. Which begs the questions, why wouldn’t the healthcare do so. To my surprise very few vendors have been planning for this. Few has been successfully wiring many of their screens (and architecture) within the EHR to be web ready. From eClinicalWorks to Epic, many of the template’s and patient summary areas are browser based documents. This would mean that they recognized what architecture would benefit their product in the long run, and for the vendors that are still compiling windows forms, then they are increasing complexity of their product, and making a software redesign or switch to web based while maintaining the differentiating features almost impossible.


Of course, the discussion here is NOT that a product can be accessed via a browser, the discussion is about a true native browser based solution. A model that has been available in many different flavors. AthenaHealth that is rendered web pages that contains all the necessary EHR features that a traditional EHR contains. Also another fun example is the Silverlight based Patient Journey developed by Microsoft to show case the capabilities of Silverlight (can be viewed in a web browser).


So, the question here is: would it be possibly that as functionality amongst EHR solutions becomes equal across most vendors, and that new innovators enter the healthcare market with fresh solutions that are comparable in functionality while easy to use and affordable might steer the market towards them? Who knows, but with all the new healthcare standards that affects Healthcare technology, it is clear that this will most likely open up new doors for innovation, and also can threaten larger EHR that are too big to fall.


September 26, 2010  8:56 PM

The development of Evidence Based Order Sets

Posted by: RedaChouffani
CPOE, Order sets

For many of us technologists, we recognize that as technology becomes more integrated into the healthcare, clinical informatics becomes crucial to improve patient care. One area that will be deeply impacted with technology based solutions is the Computerized Physician Order Entry (COPE). While this is a commonly used Acronym, it would be beneficial to visit it again in greater detail.


Let’s first define what CPOE and its components are. We will first need to discuss the Evidence Based Order Sets with are the bases of CPOE. Oder sets would be the collection of orders for a select group of patients throughout the different disciplines and it is usually derived based on best practice guidelines. As for Evidence-Based Medicine, we can simply identify that as the use of best current evidence available to justify the decisions for the care of a patient with certain conditions.


Clearly using an Electronic Health Record will allow an organization to drastically reduce its paper foot print, automate processes, but most importantly, enable the use of CPOE. For large organizations, this can simply translate into reduction of costs from repeat test orders, having guided orders, and also lower the adverse effects that are associated with medication orders. But one simple factor that affects the adoption rate of the CPOE despite the push from MU during Stage 1, is clearly the complexity of implementation, and fear of change. With the combination of additional time needed from clinicians, not user friendly systems, and hight capital investment requirements many organizations are embracing for a long and difficult project implementation.


During the planning states of COPE implementation, the organization will have the ability to use internal or external order sets. The internally generated ones will be the result of the collaboration of several clinical departments and would require careful review and clinical expertise, as for the externally purchased sets, they can be acquired directly from the EHR vendor. With all the available third party healthcare solution providers, order sets can vary from vendor to vendor. But in recent years several projects have been initiated to attempt to standardize the content of the clinical practice guidelines that the order sets use. From HL7 to SAGE project, the goal is to deliver an interoperability guideline model and a common layer of information models and terminologies to mediate guideline content.

September 25, 2010  9:41 PM

Improved patient outcome measures

Posted by: RedaChouffani

Health promotion advocates have been for a very long time outlining the importance of healthy lifestyles and how it can reduce our overall healthcare costs.  While hearth disease continues to be the leading cause of death, other risk factors such as obesity are taking center stage.  The growing obesity has everyone encouraging for more actions to help fight this epidemic.  It is common knowledge that being obese or overweight does in fact increase the risk of several chronic diseases ranging from heart disease, diabetes and strokes. 
Many physicians recognize that to ensure improved patient outcome the traditional approach may no longer be appropriate.  It is become more and more difficult to get patients to adopt healthier life style due to the environmental factors (lack of access to full-service grocery stores, increasing costs of healthy foods and the lower cost of unhealthy foods, and lack of access to safe places to play and exercise, lack of wellness programs).

With the recently creation Medicaid/Medicare Incentive programs, wellness programs and measuring improved patient outcomes are becoming more important than ever.  This create a new challenge for physicians as they will may possibly be paid based on improved patient outcomes and not simply for treating the patient for their symptoms.

Some groups have found a creative way.  By creating a new business model that brings under one facility a variety of health providers and establishes several wellness programs, it is a receipt that can enable patients to received care, work with nutritionists, exercise and be monitored to ensure improved health outcome.  This model also enables the the patient to be tracked throughout the treatment plan while ensuring that all care providers at continuously aware of the patients progress.

September 19, 2010  9:31 PM

ONC anounces a new testing body for EHR certification

Posted by: RedaChouffani
ATCB, Certified-EHR

On September 17thof 2010 InfoGard Laboratories, Inc. from San Luis Obispo, CA announced that they will be the third ONC-Authorized testing and certification body. This will allow now all EHR vendors to select from one of the three established ATCBs available.


Some of the current certifying entities have already provided certain certification criteria,but one must note that the actual HHS certification program will not be released until the 20th, of September of 2010.


One key concern in the hospital setting is the unclear classification of interface engines that provide the exchange vehicle as well as conversion platform for vocabulary. This is keeping everyone watching to see if CMS will enforce certification of these “interfaces” or not. It is clear that an interface technically is not the actual EHR, however, it is the entity that will most likely interact with the HIE or outside entity to exchange health data.


The current certification criteria has been established to cover the stage 1 of meaningful Use. The published rate for one of the certifying bodies ranges from 19,500.00 to 23,500. This does seem to be a much more affordable cost than the previously anticipated costs.


For any vendor seeking a sneak preview of the current test procedures, the approved test criteria has been published and finalized on august 13th, of 2010 in the following NIST site:


September 19, 2010  7:00 PM

How can an HIE be a sustainable business

Posted by: RedaChouffani

 With the increased emphases on improved care delivery, more efficient and cost effective care, the costs of the heath care system in our nation continue to grow. While the previous rate has been somewhat sustainable, the new wave of initiatives will prove to be difficult to sustain for much of the private and public sectors.

Clearly while the population has not doubled since 1995, the data published by the WHO (World Health Organization) shows that the US Gross domestic product has gone from 7,359,300 to almost 14,369,400 in 2008 which is almost double. We have also seen the expenditure of the GGE (General government expenditure) increase from 2,732,600 to 5,568,800. This may be a clear indicator that most HIEs or healthcare initiatives can no longer continue to count on government funding for the future.


This brings us to our next topic. With most of the current new initiatives such as HIEs, and Medicare/Medicaid incentives the challenge that many recipients of these grants will be “How to sustain these large scale health initiatives”. While many of us believe that HIT holds a great promise to address the increasing costs by improving efficiency and quality of care delivery, there must be additional source of income for many of the HIE to maintain there services.


The principle to ensure a sustainable HIE are very simple:

  • Offer meaningful data that is not otherwise available to participants for a subscription fee

  • Offer Nationwide connectivity for Hospitals and other regional or local HIE/RHIO

  • Offer services such as light EHR for physicians not implementing EHR.

  • Offer testing capabilities for Meaningful use

  • Distribute DEINDENTIFIED health data for clinical research or other private entities.

  • Provide Vocabulary services

  • Request for Medical records services

With the increase of HIEs, it is clear that many will be looking for creative ways to provide valuable services that not only will health improve care delivery, but also increase the participation of physicians, hospitals and other Entities. But ensuring that an HIE is a sustainable business will be the biggest challenge that everyone will face.


September 12, 2010  9:10 PM

Conference to help local CIO’s answer some key MU questions

Posted by: RedaChouffani

Staring tomorrow Monday September 13, 2010, I will be attending the NCHICA 16th annual Conference.  The conference theme will be cover all three critical branches of meaningful Use.  Ranging from EHR, HIE and Quality measures. 
I will be attending several sessions and I am looking forward to additional writing from each one. 

This conference provides an opportunity to meet with regional CIOs and healthcare professional to discuss their challenges and accomplishments.  Some of the sessions I will be looking forward to attend are:

The Tactical & Practical Realities of Meaningful Use: CIO Perspectives
Physician Response to HITECH and Other HIT Challenges
Improving Physician Order Workflow & Care Coordination in Disparate EHR/EMR Environments
Assessing & Managing Technical Risks within Health Information Exchange
Transitioning to Electronic Records & Workflows
Enabling Meaningful Use:  Emerging Policies & Technology for Secure Nationwide Health Information Exchange

With the findings outlined by a recent survey in august 2010 from CHIME that found healthcare CIOs are very cautious when it comes to engaging in the Meaningful Use band wagon.  Several concerns around the certification process, the full impact on providers, questions about interfacing engines and the need to certify those potentially is providing to be the questions du jour.

I am confident that during these types of interactive sessions in the NCHICA conference several of these concerns will be resolved.

September 12, 2010  8:17 PM

Coming soon to a college near you Flash Healthcare IT courses

Posted by: RedaChouffani


In North Carolina several community colleges and universities are keeping busy with creating the new and federally funded fast track to Health IT training. These ARRA funded programs will make available th the NC state skill training to enable quick readiness for the IT workforce to enter the healthcare industry with some basic skills.



It is clear that Health IT talent has been in more demand in the last few years, and with the high unemployment, this can be a creative way to get individuals ready for the major shift of healthcare organizations from paper based charts to full electronic patient records.


There are over 3 colleges in North Carolina that are participating in the statewide initiative. Several of these courses are available online residents that are looking to learn while still on the job. Some of the subjects that will be covered are:



  • Practice workflow and information management redesign specialist

  • Clinician/practitioner consultant

  •  Implementation manager

  •  Implementation support specialist


These programs do not currently require bachelors degree, nor do they offer credits toward advanced degrees, however, with this type of crash course, an IT individual can at least have some basis of what a medical organization requires from technology as well as some of the commonly used healthcare specific terminologies.



September 7, 2010  1:49 AM

The different automatic log on options available in healthcare

Posted by: RedaChouffani

On many occasions I have been asked about what I can recommend to simplify authentication on workstations in the clinical setting. Whether in the ER, exam room or nurses stations It is that one thing that seems to slow things down just a little bit. Most common requests are to implement a solution that allows a clinical staff to simply swipe or wave a card around the PC screen and have it automatically recognize and log the users in.

Unfortunately the market place does offer such simple and easy to use tools for automatic log on or authentication, however, HIPAA may impose some requirements that some of these products may not be compliant with. For example, as part of the HIPAA rules, an authentication method must employ mechanisms that enable automatic log off, require passwords, tokens, PIN codes as well as biometric authentication.

So, if we are looking for a key less or touch less access or authentication method then we can select one of the four following methods:

  • Palm Scanners that analyze your unique signature by using near-infrared light to create a “vein map” and compare it to a stored “map” in the ID management server.
  • RFID authentication with HMAC (Hash Message Authentication Code) which ensure the tag authenticity.
  • Retina scanners (we all are familiar with this as seen in several Hollywood movies)
  • Heath beat recognition technology (most likely will only work on iPhones / iPad or all Apple products basically).

The rest of the options on the market do require some interaction from the end user.

  • Keyfob which require a PIN to be enter or the code listed in the keyfob as the password to logon to the system
  • Fingerprint authentication which most new laptops or tablets do have fingerprint readers built-in in most cases
  • Code-2-Text where you are sent a new PIN anytime you need access to the system or attempt to logon.
  • Traditional user name and password to authenticate the end user.

I am certain there are other methods of authentication available in the market place that I missed. But keep in mind when shopping for one, you must plan ahead and identify what hardware would be needed, what are the costs associated with the system, are the solutions being evaluated HIPAA compliant, and how are they going to impact the current work flow.

Of course other items that may be a value add in some of these systems are the single sign on (SSO) which would be in most cases welcomed by most as it would consolidate all access to other applications through one single Sign On.

September 5, 2010  12:13 AM

Can IT do more than just keep the lights on

Posted by: RedaChouffani
CIO, role of IT, technology value add services

 Technology has always played an important role in healthcare. But with the increased interest and adoption of EMR it is clear that the IT departments must ensure alignment with organizational objects and goals in every way.


The old perception of IT being just a service department will not be sufficient enough to meet today’s challenges. While in many cases some are only concerned about making sure that “when I turn on the switch in the room the light comes on”, we must seek to strengthen the role and the level of involvement of IT in the decision making. Consider the simplicity of the statement above and how often physicians and other stakeholders portray the IT role in the organization. A statement like that does not do justice to the role of IT. As it is in most cases, IT can always be a value add:


  • Ensure that the light bulb is due for replacement when it nears its end of life (this is a proactive approach to ensure continuity)

  • Ensure that the wiring of the light bulb is in compliance with electrical code

  • Ensure that the type of light bulb consumes less electricity to save on costs

  • Ensure that the light is user friendly and not too bright not to dim.


As we see in the above value add services that IT can perform, IT can perform much more than just ensuring that the light come on. Seeing IT in this eye not only will engage the department into assisting in applying solutions and services that can meet at least the four common healthcare organizational goals:



  • Quality & Safety:

    • Improved clinical work flows

    • Uptime of EHR system

    • Clinical Decision support system through EHR

  • Service development:

    • Technology Infrastructure to allow “plug and Go”

    • Up time

    • Scalability

  • Patient Satisfaction:

    • Electronic services to benefit patients

    • Efficiency in scheduling, reminders, and care follow up

    • Improved communication methods

  • Financial Strength

    • Predictable budgetable Technology costs

    • Technology solutions with High ROI

    • On time & on budget projects

    • Improved processes


While in some cases techs may not be as interested in the business overall objectives, and are solely focused on the “Machine” support, there will always be a need to identify in the IT organization a liaison between the technology and line of business. This role in most cases is filled by CIOs, but for some organizations that may not have these resources, finding the right candidate to bridge that GAP will be crucial. As we continue to move toward electronic patient records, it becomes more important than ever to ensure Technology alignment with the organizational goals.

August 29, 2010  11:05 PM

State HIE, NHIN CONNECT and now NHIN Direct

Posted by: RedaChouffani
In the last few months NHIN Direct (National Health Information Network) continued to work toward getting the system live and running. Currently the focus seems to be on the Pilot projects for the following entities:

  • Pilot Project Brief – Rhode Island Quality Institute
  • Pilot Project Brief – Medical Professional Services (MPS)
  • Pilot Project Brief – MedAllies
  • Pilot Project Brief – CareSpark
  • Pilot Project Brief – Carolina eHealth Alliance
  • Pilot Project Brief – Redwood MedNet
  • Pilot Project Brief – VisionShare and Public Health

It is clear that plenty of progress is being made from the reported success for these pilots. The goal of NHIN Direct since its introduction in 2010 was to test and facilitate the set of standards proposed under the NHIN specifications and requirements. By using several use cases, the NHIN direct and the organizations listed as part of the Pilot projects are able to perform some of the early testing to ensure that the solution is ready for release.

Currently the NHIN Direct has over 23 use cases or User stories that it uses. These are being used as part of the testing of the functionality of the system. Within the proposed use cases, a subset is focused on testing the Meaningful Use criteria. This will ensure that the system will assist in meeting the stage 1 requirements for the CMS incentive program. Some of the stories include:

  • Incorporating lab results back into the EHR as structured data (Not scanned documents or Image PDF, but structured data)
  • Submission of CCD (summary record) to another provider
  • Receiving summary of care from specialists
  • Receiving discharge information from Hospitals
  • Submission of Immunization data electronically
  • Hospitals submitting chief complaint data to public health agencies
  • Submission of specific lab results for specific conditions to public health agencies
  • Patient reminders to preventative care
  • Providing access to patients for their PHR

It is clear that not only many states have already engaged in the creation of a state wide or community based HIEs to facilitate the exchange of health information, but with the current capabilities of NHIN CONNECT and NHIN Direct, it seems that it can be also a viable alternative to many organizations. Ultimately the selection will most likely be based on the several other criteria.  From the availability of specific integrations at that state, to the added value services that may be offered.


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