Showing posts with label ehr. Show all posts
Showing posts with label ehr. Show all posts

Thursday, September 22, 2016

The Top Gun of Health Train Express Blogs for 2016 (so far)

Our readership fluctuates quite a bit, averaging a paltry 200-300 users/day. Most of the readership is from the U.S. and the U.K.

This year we had several posts that went well above 1000 readers/day.  Like most internet publications readership depends heavily upon Google searchs.  Readership continues for days, weeks months and even years.  We network our contributions on facebook, twitter Newsana, Digg, Redditr and a list of email subscribers. We have an RSS  feed as well.




Top Gun Posts:






Friday, June 12, 2015

I temporarily went back to paper records.  And it wasn't so bad.

I temporarily went back to paper records.  And it wasn't so bad.



The real story. Hopefully his database is still intact.  The big question is why this cloud based EMR did not have a mirror which would allow for uninterrupted service.  Another important question for EHR cloud vendors is do they have redundancy in several data warehouses. Fire or other catastrophic events could effect thousands of physicians.  Any physician considering cloud based EHR should insist on this feature.

A refesher look at prior technology. We recomend always keeping some progress notes in the store room.  An alternative to typing in the hand-wriiten notes, just scan them into the EHR when ready. It is ill-advised to use a physicians time to transcribe data. There are many affordable scanners that are also scanning devices:


Hewlett Packard AIO Printer


In the overall scheme of things 20 medical records don't mean anything to the data geeks.







EHRs do afford more legibility and better data retrieval.

Sunday, May 18, 2014

Affordable Care Act------Silk Scarf or Pig's Ear ?

Silk Scarf or Pig’s Ear ?

President Obama and the Democrats insist that the Affordable Care Act is working and has increased the number of insured, yet most Americans do not like the law.


Figures from the Heritage Foundation in their Consumer Power  Report “Obamacare Squandered $1.2 Billion on Failed Exchanges

It all began when HBX was enrolling carriers for each state. At best it was a difficult sell with much arm-twisting   In Maryland, Mississippi, New Mexico, and South Dakota, officials had to beg and plead just to get one carrier into the state’s private market.

Continuing problems are ongoing in many state exchanges. There’s only one insurance carrier – Blue Cross Blue Shield – in West Virginia’s exchange.

Hawaii is another consensus pick, and some experts say the state might never be able to support its Obamacare exchange. Hawaii was near the bottom for total enrollment, signing up just 15 percent of its eligible population, and had the second-worst mix of young adults. The state’s exchange also suffers from the fact that Hawaii had a low uninsurance rate to begin with – meaning there’s a smaller pool of potential customers there, which makes the state less attractive to insurers. Hawaii’s “Health Connector” has signed up the smallest number of people of any state in the country and has no plans to finance their operations moving forward. Their current plan appears to be to all-but-close-up-shop and outsource all of the exchange functions to the state Department of Human Services. The state’s leading insurance company says it is time to pull the plug. Expect this one to be official any day now.

Health care analysts are also keeping an eye on premiums in Maryland, Mississippi, New Mexico, and South Dakota, where officials had to beg and plead just to get one carrier into the state’s private market.

The expected rise in premiums will vary greatly from state to state, smaller states with fewer enrollees and a bias toward older and sicker people will see sharp rises in premiums.  It’s impossible, though, to say with any certainty whether a particular state will see an above-average price increase next year.   Maryland, Mississippi, New Mexico, and South Dakota,  are among those HBXs to watch.   Minnesota’s exchange has been a disaster, and they recently brought in [Deloitte] on a nine-month $4.95 million contract to fix it. It is unclear whether they will be successful.

Vermont, the tiny state with giant ambitions to use Obamacare as a stepping stone to single-payer, government-run health care is still facing enormous problems dealing with its tiny population. They are using CGI, the same vendor that failed on the federal healthcare.gov, and have given them a deadline of July 2 to get the site working. It is unclear what Vermont will do if they fail to deliver by that date.



HTE DIGEST Vol 1 No. 3

Honeywell HomeMed President John Bojanewski takes a look at the evolution of telehealth and its impact on the provider-patient relationship
Reimbursement issues have delayed adoption of telehealth, however
insurers and CMS are gradually accomodating it’s use.


For the most part, providers are still wary over the mHealth movement. And this caution just might be preventing them from big care improvement opportunities, say the findings of a new study.


In a sign that some companies are swinging back from consumer-directed healthcare and looking to help the providers, one firm is developing a web-based and mobile platform to assist doctors in talking to patients about changing difficult behavior patterns.
“The past and current model of direct to consumer marketing and sales leaves
the patient to making treatment decisions without collaboration with their provider”


“As a corollary to consumers purchasing mHealth apps, doctors must provide leadership
collaboration with their patients.”  If patients are going to accept this a formula should be available for some insurance coverage or be certain the patient can and will be able to afford the application. A verbal recommendation should be reinforced with a written prescription, which has a stronger meaning.


“It's no easy feat to be the best, even in the healthcare IT space, but one EHR vendor has come out on top, earning the highest scores for client experience and customer satisfaction in the small practice category.” This news is germane because a large number of users are very dissatisfied with current EHRs.
More modern and contemporary EHRs are now in the market.  Replacement costs will be significant.



The way John Berneike, MD, sees it, being an early adopter of electronic health records has put him in line for unintended punishment under Stage 2 meaningful use.  Many providers purchased new EHRs several years ago to meet requirements for interoperabilty and now are faced with additonal mandates, as well as another expensive change to diagnostic coding, expanding ICD-9 to ICD-10.

Friday, May 9, 2014

Health IT Potpouri

There is an overwhelming amount of information about HIT on the web, blogs, email newsletters and a Google search will turn up literally hundreds of resources.

For this week, May 8 2014 I have compiled this list of hot topics and links:


ROI -- whether the "I" stands for innovation or for investment -- will be among the many topics up for discussion at the National Healthcare Innovation Summit, which kicks off May 13 in Boston. The organizers promise "the kinds of innovations that people can take home and use tomorrow."

Among the healthcare developers workshopping better approaches to technology design at HxRefactored in Brooklyn next week will be Stephen Buck, who'll offer some "lessons learned" from looking closely at leading EHRs -- specifically, how not to design a user interface.

More than 370,000 Medicare and Medicaid eligible providers have earned an EHR incentive payment so far, with 64,000 new participants attesting to meaningful use for the 2013 reporting year.

The Defense Health Agency has put a foot forward with revamping its clinical information systems after it inked a bridged contract with a Reston, Va.-based technology and defense company.
The current landscape of data exchange networks is disjointed, with health care systems scrambling to uncover sustainable business models. The need for interoperability is greater than ever. What will the model look like in the future and what are organizations doing to move toward more valuable data exchange? Ashish Shah, Medicity’s CTO, and I recently discussed these industry drivers with Anthony Brino, editor of Government Health IT. Read the article HIE at a Crossroads.
Carolinas HealthCare System CareConnect got an early start on creating a robust network for data exchange. Take a look at this recent case study highlighting Medicity’s role in connecting the health care ecosystem to enable a 360-degree view of patients across the care continuum.


Posted: 06 May 2014 10:06 PM PDT
A while back — three months, to be exact — I asked readers if they had a preferred term to describe “the application of new, personalized technologies to healthcare.” I gave you the choice of digital health, connected health, wireless … Continue reading →

HIE among U.S. non-federal acute care hospitals has been trending upward since 2008, in fact, and it took some major leaps forward in 2013.



Posted: 05 May 2014 09:01 AM PDT
Understanding that physicians require more comprehensive, flexible clinical documentation solutions that reflect the fast-paced highly mobile health care environment, M*Modal today announced enhancements to its Fluency Flex™ Mobile dictation application for iOS 6.0+ devices. Moving beyond the capture of clinical notes during … Continue reading →

More than half of people with chronic conditions say the ability to get their electronic medical records online outweighs the potential privacy risks, according to a new survey by Accenture.

New guidelines issued by the Federation of State Medical Boards could have a chilling effect on the growth of telemedicine -- especially in rural areas and among low-income patients, say some patient advocates, healthcare providers and healthcare companies.

Some analysts are predicting the next "great wave" in EHR purchasing among U.S. hospitals to be just around the corner. But do the numbers really bear that out?

The hits keep on coming for the new EHR certification criteria, as the American Medical Association and Telecommunications Industry Association send their complaints to ONC on the heels of similar criticism submitted earlier by the EHR Association.

The “unconfirmed rumor of a huge acquisition” that HIStalk (a.k.a. the National Inquirer of health IT) tweeted about on Wednesday apparently is that IBM was going to acquire Epic Systems. Mr. HIStalk on Thursday expressed some reservations.   @DaLAWon Much … Continue reading →


The hits keep on coming for the new EHR certification criteria, as the American Medical Association and Telecommunications Industry Association send their complaints to ONC on the heels of similar criticism submitted earlier by the EHR Association.


Posted: 01 May 2014 10:51 AM PDT
Nextgov has a great article up which outlines many of the details of the soon to be bid out Healthcare Management Systems Modernization contract. I’d prefer to call it the DoD EHR Contract or AHLTA replacement contract. Certainly there’s more … Continue reading →

Explore Medical Practice Insider's guide to emerging apps and devices for the medical practic

If you want to learn more about ACO formation and Operational Issues: Attend
this event either in person, or as a webinar.
Press Release: Brookings/Dartmouth Fifth ACO Summit Announces New Keynote Speakers Sean Cavanaugh & Alice Rivlin

  • A Hybrid Conference and Internet Event
  • The Leading Forum on Accountable Care Organizations (ACOs) and Related Delivery System and Payment Reform
  • Sponsored by Engelberg Center for Health Reform at the Brookings Institution and Dartmouth Institute for Health Policy and Clinical Practice
  • June 18 - 20, 2014
  • Hyatt Regency on Capitol Hill, Washington, DC
  • Online In Your Own Office or Home live via the Internet with 24/7 Access for Six Months


For Summit registration information, visit www.ACOSummit.com/registration.php, email registration@hcconferences.com, or call 800-503-3597.





Thursday, March 27, 2014

SAYING GOODBYE.....TO YOUR EHR

What remains the same in HIT since 2004 is a farily uniform opinion on the usability of EHR in daily clinical practice. (Doubt)





What  MD has not already spoken about the unusability factor buried deep in your key board and/or mouse. The requirements for HIPAA security, Meaningful use attestations, and interoperability are key requirements for MU.


30% of   EHR  users are dissatisfied with their current EHR and plan to replace them. (KLAS)   If your practice is one of them and you are faced with a large expense to upgrade your HIT system you will want to find a new EHR that meets all MU requirememts.


Vendors have received considerable feedback (criticism) about their present system’s inadequate framework for clinical patient flow and have time to redesign their software.


Prior to the finality of MU3 now may be the time for a new EHR.


The confluence of the Affordable Care Act, proposed Accountable Care Organizations, Increasing meaningul use mandates, improved Cloud services, vendor experience leading to some improvement in user friendliness, and user experiences and demand provide a fertile environment for change.


Calculating ROI with the old system vs a new one has to do with flow, efficiency, and the cost of replacement. If your EHR runs in the cloud the decision is simple...the changes are done at the host site. All software changes are performed off site in the vendor’s facility. eliminating any work disruption at the clinic.  Your original vendor contract should have had stipulations for the added expense of upgrading to meet eventualities of MU or other requirements. Since there is much competition among vendors, a competitive advantage may be the offering of enhanced maintenance and software upgrades.


If you are ‘retiring” your present system due to regulatory changes, consult with your accountant and legal counsel whether you can accelerate the depreciation and write off a portion of the expected life of your old system.  If possible this may ease some of the pain of a poor investment.


Most EHRs were built upon  features present in a practice management system, designed to maximize reimbursement, and maximize charge for each encounter. The new paradigm will be based not upon volume but upon improved outcomes, and decreased cost, for at least some of the encounters.


The field of ACO is new,  everyone knows what an ACO is supposed to do, but it is hard to find one. Several ACOs now are operating and some early statistics show savings and reduction in costs.


Interoperability is a requirment of MU1 and the ONC encouraged this with a framework for disparage EHRs to communicate with each other. Regional Health Information Exchanges experienced a challenge in developing sustainable business plans not dependent upon long term government grants, although the HITECH Act provided start up capital.  A new niche industry developed for HIE infrastructure.  


Some hospitals and providers have committed to these HIEs, but there is a significant difference between potential users and those in the HIE.  Many providers have interoperable systems, and have attested to it’s use. However many do not use the feature either because pre-existing methods are in use or there are no other providers to communicate.


An analysis of our regional health information exchange IHIE.org reveals this fact. The analysis is from the largest HIX in Southern California, and may differ significantly from other organizations.


Accountable Care Organizations will require data and the HIX may provide that avenue to collect and display operational numbers for the ACO.  HIX may become more affordable with expanding functionality to include ACOs requirments without building an entire new infrastructure.

Saturday, February 22, 2014

HealthLeadersMedia: Search for ROI in EMR Patient Safety and Life and Death of Small Systems

HealthLeadersMedia , a publication produced as an online and print journal measures and reports on opinions of CEOs in hospital and group medical practices.  HCLDRs reports on ‘hot topics’ in the economics of the health systems.



ln the January/February 2014 edition several areas emerge as newsworthy.


Front page:


In Search of EHRs ROI
Life or Death of Small Systems
Patient Safety


Table of Contents


Addressing Physician Engagement
Post-acute Care and the Care Coninuum
The Uneasy Journey
Cost- Cutting and the Revenue Cycle
Analytics and Value
Tech Takles Medication Managment


A recent HealthLeaders conference when asked what the most pressing problems were for CEOs and CFOs, responded with the challenges of investing and cutting costs. Any investment of  capital will reduce operating expense, and must show a return of investment over a planned recapture period.


According to CEOs and CFOs the biggest  waste is electronic health records. Many, but not all state, the reasons given are multiple:


In Search of ROI in EHRs


“Rip it and Replace it”.  Installation of EHRs requires a total redesign of work flow, and not just pasting an EHR on present administration. In additon to the cost of the physical EHR and software significant time, and expense are added in  training and loss of efficiency in operations. Initial EHRs are often  not designed with this in mind.


The “hunt for ROI” is a challenge, at the start. Are the measures strictly financial or should they include other metrics, such as reduction in errors, quality of care, safety issues, workplace satisfaction, measurement of multiple metrics. The shift to EHR also creates a shift in worker skills, proficiency in typing,and computer skills as well as experience in  specific EHRs.  Not only are clinical skills and scientific prowess important but familiarity with multiple  software systems.become critical for the search by HR for suitable employees. This also extends the training period for new employees which has an indirect effect on the costs of  hiring new employees.


Scott Mace writes, “The key to ROI is to start with a baseline and ‘redesign your thought system and processes to leverage the value of electronic records, or any IT solution. There are lessons to be learned from other industries. (HBR “Don’t automate, Obliterate”) describes how Ford first implemented information systems.


Life or Death of Small Systems:


Perhaps the greatest indicators for this threat has been the rapidity of mergers and acquisitions.  Scaling upward seems to imply stability and a major advantage to market share and negotiating   power for hospitals and providers when dealing with insurers.  This will only increase as the PPACA effect grows.  For small systems the risks are inherently greater making strategic changes quickly.  For some doing nothing does not seem to be a viable option, however making a big change may mean nothing in the long run.   Large systems are no  longer giving lip service to the promise of reduced overhead and making a serious commitment to efficiency by integrating their hospitals into an operating company structure as opposed to the holding company structures of the recent past.


Community health systems require a unique approach to ACO and develop a creative approach, such as offering PCP services in physician drought areas.  Some even develop a presence close to mega-hospitals such as the Mayo Clinic.  (Ridgeview, in Minnesota).


Patient Safety
A decade ago young new graduates would enter the system and would loyally follow their senior mentors, diligently follow their lead and rarely second guess. Several things have ocurred to change the relationship.  There are now fewer opportunities to buy a senior physician’s practice, so there is less impetus to follow along passively.  


In some hospitals the tables have turned on the senior guard. A new world order is now leading upstart youngsters to teach their senior attendings and physician leaders a new paradigm.  These changes improve quality while reducing waste, inappropriate care, and the opportunity for medical error and  harm.  The new doctors say their strategies avoid millions in unnecessary spending, tens of thousands here and there adding up into millions of dollars.


The ‘new’ order leads one CEO who recites a quote attributed to Ghandi,


“There goes my people. I must follow them, for I am their leader”.


“The fact is they are ‘doing the right thing’, putting us on course to control utilization and cost. Basic routines are questioned, such as lab sets, use of IV antibiotics in lieu of effective oral antibiotics, and even such things as packaging gloves singly if only one glove is needed.”


The current edition of HealthLeaders dives into many other areas as well. It is a good reference for anyone in the hospital industry, and physician leaders as well.  Medical staff leaders will find this to be an excellent source when interfacing with the hospital “C”suite.




The insertion of the Accountable Care Organization into provider/hospital relations requires a team approach, and HealthLeadersMedia facilitates  this progress.


The ultimate goal is to improve the quality of patient care and insure wellness.


Readers can find the entire content of this edition at Health Leaders