EMR/EHR Blazing A Path For BI

For most of last year I did Business Intelligence (BI) consulting in the consumer goods industry, hence the long time between my last post and now. So for my first post of the new year, and probably many more posts throughout the year, I will highlight EMR/EHR implementation and BI.

As some of the EMR implementation goals are now beginning to be realized and providers becoming more prepared to handle electronic records, BI possibilities are emerging. Healthcare providers can utilize BI strategies to not only improve business practices, but also improve patient care.

KLAS released an in-depth report, “Business Intelligence: Making Cents of Performance,” including research on market trends, BI needs, and vendor performance. Healthcare IT News summarized the key findings as follows:

• The ‘pay for performance’ model and other reforms will force hospitals to more carefully analyze performance measures to identify inefficiencies, quality gaps, supply chain inadequacies and overall performance metrics.
• Although enterprise BI solutions are growing in acceptance, industry-agnostic solution vendors are still making a good showing in healthcare.
• Using BI to make key decisions is just the beginning; providers need their analytics solutions to help them perform predictive analysis with a reasonable level of confidence.

I’ll explore the current state of BI and EMR/EHR based on the key findings by KLAS in upcoming posts.

Envelope Please?

Back in 2009, when President Obama signed the Recovery Act that contained a number of healthcare provisions, including the Health Information Technology for Economic and Clinical Health Act (HITECH), we all heard naysers say “this wouldn’t reduce the cost of health care,” “only a few, or better yet, the well endowed practices could implement EHR before the deadline,” and ”this would reduce the number of practicing physicians because of the demanding requirements and surrounding meaningful use.” Well it’s been a little over 3 years, and by all measures HITECH has exceeded expectations.

Ezekiel Emanuel in a Reuters article, An unsung victory in healthcare, reported:

It’s now been a year since the administration released the regulations specifying meaningful use and what it takes to be certified — the nuts and bolts of implementing the law. The results have been nothing short of spectacular.

As of December 2011, the use of EHR among office-based physicians has nearly doubled to 34 percent with e-prescribing exceeding 40 percent. Over 41,000 physicians have received more than $575 million in incentive payments. Going electronic will allow physicians to more closely track patients, especially the chronically ill, enabling the seamless exchange of data across multiple physicians, hospitals and other providers.

The story is much the same among hospitals: 35 percent have adopted EHRs, and nearly 2,000 of the 4,700 hospitals have, collectively, received more than $2 billion in incentive payments. Every month has surpassed the previous month as measured by the number of physicians and hospitals that have signed up with the government for the EHR program, suggesting that these numbers will continue to rise.

Another great byproduct of the law is that the entire healthcare IT industry has been refocused away from developing new, improved ways for physicians and hospitals to code and bill the insurance industry and the government for payment. Instead, they now focus on making electronics work to improve care, enhance coordination among physicians and facilitate physician-patient communication.

HITECH has presented an myriad of IT opportunities, i.e. data warehousing, business intelligence, EHR implementations, etc. so this is great news for those of us in the IT industry. However, it’s even better news for those of us who will be patients because improving patient care while controlling costs is the corner stone imperative for implementing EHR.

EHR Progress in Spite of Politics

In spite of the proverbial cloud politics hung over the HITECH Act, Harvard School of Public Health professor, former Health IT Standards Committee co-chair and current Veterans Health Administration senior advisor for quality and safety Ashish Jha, M.D., said that the HITECH Act is accomplishing what it set out to do three years ago, expedite health information exchange (HIE) and electronic health record (EHR) implementation.

Jha reported during the Massachusetts Health Data Consortium’s recent HIT ’12 conference that the National Center for Health Statistics showed that 35% of U.S. physicians are using either a basic or comprehensive EHR system. Although he could not comment publicly on hospital HIT adoption, he stated that when those figures are release next month they will show a dramatic upward trend also.

Jha also stated small offices, which administers half of healthcare treatment in the US, are still lagging behind. On the upside of this warning, there are still plenty of IT opportunities to be had for healthcare IT integrators.

Choosing the right Cloud Provider

Typically, the healthcare sector lags behind other industries when it comes to embracing new technologies. Ironically this industry is embracing cloud computing on par with other industries.

Nearly one-third of healthcare sector decision makers said they are using cloud applications, and 73% said they are planning to move more applications to the cloud, according to a recent report by Accenture. Those figures fall in line with findings about cloud adoption plans in other industries, according to the report.

What’s the attraction of cloud computing that has the healthcare industry adopting it at the same pace as other industries? Basically, smaller practices are finding it economical to do away with their own modest IT operations and rely on cloud service providers for electronic health record (EHR) services, while larger institutions are building internal, private health care clouds for easier accessibility.

However, before jumping to the cloud, healthcare providers should consider the following elements before choosing a cloud services provider:

An assessment of the associated risks and benefits should be taken. Evaluate all potential cloud computing service providers to understand key areas from compliance and data location to availability, recovery and viability. Ensure the service provider’s security, access, and control methods surpass, or at least equals, your current security measures. As I stated in a previous blog post (Due Diligene Is In, Google Health Is Out), perform due diligence on the provider. Even if the service provider is a well known multi-national firm don’t assume vendor due diligence isn’t needed.

As healthcare providers rapidly embrace this new technology, it’s important that they assess all of their needs and options so that the right solution and cloud computing partner is chosen.

Mobile Devices, a Security Risk?

Mobile devices are allowing health care workers 24-7 access to critical information from virtually anywhere. While mobile computing in health care is reducing costs and improving quality care, they pose huge security risks to patient information.

In less than two years, from September 22, 2009 through May 8, 2011, the U.S. Department of Health and Human Services Office for Civil Rights indicated that 116 data breaches of 500 records or more were the direct result of loss or theft of a mobile device, exposing more than 1.9 million patients’ PHI [Personal Health Information].

What's surprising about this report is that the biggest cause of breaches isn’t from hackers but from the theft or loss of mobile devices. The issue of data breaches isn’t a new one, but it is coming into greater focus with mobile devices increasing popularity.

Rick Kam, president and co-founder, ID Experts, gives a number of suggestions for protecting sensitive patient data. Among them:
• Whenever possible, don’t store sensitive data on wireless devices. If required, ensure the data is encrypted.
• Enable password protection on wireless devices, and configure the lock screen to come on after a short period of inactivity.
• Turn on the Remote Wipe feature of wireless devices.

Bottom line, to mitigate the loss when a mobile device has been stolen or lost a solid mobile device security plan must be in place.

EHR, Cloud Computing

Cloud computing is becoming a standard method of software and hardware operation for many businesses. SearchHealthIT reported health care cloud adoption is on the rise, thanks in part to EHR systems.

Cloud computing advantages for healthcare are undeniable (especially for smaller providers), faster EHR implementation, low cost of ownership, and system access mobility. However, cloud computing risks should not be ignored when deciding to transition to a cloud-based system. Cloud computing risks include vendor dependency, security, data privacy and confidentially issues.

Because of the substantial cost savings associated with cloud-based systems, cloud computing is here to stay. However like any other IT project, appropriate steps should be taken to reduce and mitigate those risks. Seek out advice and guidance from cloud computing subject matter and legal experts to hammer out contingency plans, service level, data ownership, and security agreements in the event of system down time, security and privacy breaches.

A Week in Review, July 18

Healthcare IT booming but faces talent drought

[ZDNet] The healthcare IT sector is on a roll but the market's fast demand and growth is hindered by a lack of talent skilled with both clinical and IT know-how, note industry players, who add that clinical analysis, interface management and electronic medical records are some of the most sought-after skills in the industry. Read full story.


The Costs and Implications of EHR System Downtime on Physician Practices

[SYS-CON] Government funding incentives (ARRA HITECH Act) to implement electronic health record systems (EHR) are driving most physicians towards the selection and implementation of EHR applications that are appropriate to their practice. However, even though the average practice takes more than 120 days to select their EHR solution, 87% of practices spend no time evaluating the service levels and uptime associated with these installations, instead leaving this important criterion in the hands of the software provider. Read full story.


Do EHRs leave out your personal story? Social media response

[Healthcare IT News] The idea of a nationwide electronic health record system is brilliant. Patients could use their own personal health record to request prescription refills, schedule future appointments and evaluate their own test results. The record could live on thumb drives, mobile devices, personal computers, or in the cloud. Read full story.

EHR Implementation Tutorial

Craig Byer with SearchHealthIT has written a good paper, EHR implementation tutorial: From vendor selection to maintenance, that succinctly conveys the EHR message, from why it needs to be done to vendor implementation. Byer's article can be used as a resource by organizations, practices and/or healthcare IT consultants to help articulate the EHR message and the process to transition from paper records to electronic records.

I find Byer’s resource particular useful for IT consultants in the trenches trumpeting the EHR horn. Getting medium to small-sized providers to grasp the importance of transitioning to electronic records can be an arduous task, especially if the practice is information technology adverse. Having additional third party information to assist in conveying the EHR message is never a bad thing.

Due Diligence Is In, Google Health Is Out

Google announced it’s pulling the plug on their Google Health personal health record (PHR). Developers that built connectors between their EHR and Google's PHR systems will be left out in the cold. The take-away from this shutdown is that, when choosing a third party partner, provider, and/or vendor due diligence must be performed, even if it’s a Fortune 100 company like Google. For instance, in addition to validating Google's ability to actually deliver the product, there were 4 other areas that should have been investigated also.

Financial: In 2010 Google had annual revenue in excess of $29 billion and roughly $8 billion in profits, so financial stability and resources were not a problem.

Capability: Over the past decade Google has been one of the most technically innovative companies around, i.e. Internet search, Android, etc., so Google’s technical capability was not an issue.

Support: Although Google was only founded about 13 years ago -- barring any illegal activity -- a multinational company with over 24,000 employees and several billion dollars in revenue doesn't disappear overnight. Google’s viability to provide long term support was strong.

Competence: Google is an Internet search company that hosts and develops a number of Internet-based services and products. However none (or very little) are federally regulated like EHR systems, this should have raised a few eyebrows. A healthy discussion should have occurred around Google’s inexperience and competency with developing federally regulated healthcare software. Unfortunately, entities that did perform due diligence and decided to proceed with Google's PHR development, Google's lack of experience was probably overshadowed by their very strong financial and technical positions.

Currently, both public and private entities have not settled upon health data standards and the execution of national health information exchange. According to former U.S. HIT coordinator David Blumenthal this could be a decade-long health IT construction project. Basically, Google did not have the stomach to tough it out. PHR development is not at the pace, and space, for a savvy, leading-edge, technical innovative company such as Google.

During my IBM days, I remember a CFO stating that no one loses their job for choosing IBM as a partner. For those healthcare IT executives that chose to hitch their wagon to Google’s PHR, hopefully none of them will lose their job for choosing Google as a partner.

EHR software market to exceed $6 billion

Markets and Markets reported the electronic health record (EHR) software market is poised to exceed $6 billion by 2015. In addition to government initiatives toward development of EHR, they also attribute the rising demand for healthcare cost containment and the need to improve the quality of healthcare services are driving the growth rate in this market. This is a huge jump as the EHR market was only about a $2 billion industry in 2009.

Not so surprising, they also noted that web-based EMR solutions or ASP models are gaining popularity with small-sized healthcare practices and physician offices. The popularity of web-based and ASP EHR solutions for smaller providers will force many smaller providers to upgrade their IT infrastructure, i.e. broadband access, hardware, LAN/WAN, software platform, etc. Therefore, IT opportunities should trickle down to smaller IT integrators and consultants.

A Week in Review, June 20

HITECH Act moves healthcare IT industry forward

[MedCity News] As I travel the world speaking about the Health Information Technology for Economic and Clinical Health (HITECH) Act, I’m often asked to present objective evidence that it is making a difference. Read full story.


Consumer confidence about health data safety is key to EHR adoption

[Government Health IT] As the healthcare system becomes more connected, it will increasingly become a breeding ground for risk to individual privacy, confidential information, data integrity and service availability, according to health IT security experts. Read full story.


Are Health Insurers Prepared for Healthcare Reform?

[Insurance & Technology] Countless papers have been written about the impact of healthcare reform on the insurance industry, but few look at these changes from the perspective of how these mandates will impact healthcare payers -- particularly, technology, people and processes. In the interest of bridging that gap, let's take a look some of the challenges health insurers face, and some solutions they might consider. Read full story.

iPad, Embraced By Health Care Providers

In one of my previous blog posts, Rapid Integration, I discussed the rapid adoption rate of tablet computers, iPads in particular, by physicians. One of my blog readers asked what were my thoughts on why the iPad was readily embraced by physicians?

Actually, healthcare providers have been using the iPhone for several years now for everything from voice recording to clinical data entry via the mass selection of apps that are available for this platform. So the rapid adoption rate of iPad by physicians really came as no surprise. However, I think there are a couple of characteristics that made the iPad even more attractive to health care providers.

First the price, for a few hundred bucks you can have the processing power of a desktop computer in your hands and/or lab jacket at a fraction of the weight and size. Secondly the apps, basically the iPad can run all of the apps available on the iPhone, and it can be used to enter data directly into EHR and CPOE systems. Thirdly the size, the iPad is about the same size as patient charts so carrying around an iPad is not awkward. Also the larger screen on the iPad makes it easier to obtain and enter information, and share this info with the patient.

Now if Jobs (Apple’s CEO) and Narayen (Adobe’s CEO) could settle their differences so the iPad can run Adobe’s Flash, this would open the iPad to many more applications.

The ONC Wants Your Feedback

Let your voice be heard, the Office of the National Coordinator for Health Information Technology Health IT Standards committee is requesting public comment about the temporary electronic health record certification for Stage 1 of the meaningful use program. One of the specific areas they are seeking input on is should it be required to test and certify that any EHR Module presented for testing and certification properly integrates with another EHR Module by a different vendor.

On some level, this debate boils down to a closed proprietary ecosystem-think Adobe’s Flash platform versus a more open ecosystem-think Apple’s app for their iPhone platform, basically, will interoperability among vendors be forced for certification? Even today with the examples I gave-which by the way is Apple’s point of view-there’s healthy dialogue among informational technology professionals on which system, Apple or Adobe is closed and/or more opened. These platforms have been out for decades with millions of users, and they still do not interact with each other.

EHR is too important and critical to let permanently defining the certification program of meaningful use drag on for decades. Take the discussion about EHR certification out of the break room, cubicle pod and conference room, and let the ONC officially hear your opinion by June 17.

EMR Implementation Training

One of the things that always surprised me was the level, or lack thereof, of basic computer skills that existed within most providers’ offices. This low level of computer skills existed not only with office personnel, but also with doctors and nurses. Therefore, when implementing new computer software a lot of time was spent providing basic computer training in addition to software specific training.

With EMR implementation it’s highly critical that both medical and office personnel are trained on EMR systems. If they are not properly trained they will become frustrated, and possibly, unproductive. An unproductive doctor and/or nurse in a clinical setting is not a good thing. If that happens it could sabotaged the best of EMR implementation projects.

Keep in mind that no two providers are alike and work flow processes differ from one provider to another, here are a couple of training recommendations when providing EMR training that are applicable across the board. First, access the computer skills of everyone that will be using the new system. If basic computer training is needed, include it in your training curriculum. When providing basic computer training take nothing for granted, heck, you may have to teach keyboarding, how to operate a mouse, etc., just be prepared to get the users up to speed on the most basic of computer skills. Secondly, provide one-on-one training when feasibly possible. I found one-on-one training works best for this set of users, especially for smaller to medium sized providers. If this is not possible, try to have at least one experienced (or a well-trained user) to support every two doctors during the initial days of “go live.” And thirdly, require ALL medical personnel to attend training, even if it means night and/or weekend training sessions. This may require flexibility on your part to accommodate everyone’s schedule, but it will be time well spent to have trained doctors/nurses using the system on day one of “go live” versus doctors/nurses doing OJT on the day of “go live”...

Remember the best way to eat an elephant is one bite at a time, so save yourself a headache by implementing EMR in phases. Implement only one process at a time before turning up the next process. Because if glitches are caused by implementing an EMR system, i.e. billing, clinical, prescriptions, etc., the emergency system just may get activated (see cartoon)...

EMR App for the iPhone

In a previous blog entry, “A Gadget Kind of Day” I blogged about Sling Box finally releasing the Sling Player Mobile app for the iPhone and iPod Touch. Because of my excitement to finally get a chance to watch TV on my iPod Touch, I proudly stated the blog entry had nothing do with HIT, other than possibly up selling a techno-geek physician that had to have the latest gadget. Thanks to blogger Fred Pennic of Healthcare IT Consultant Blog for his blog post on an EHR app for the iPhone.



A company in California, Caretools, have developed an award winning app, iChart, specifically designed for the iPhone and iPod Touch platforms. In addition to the charting, iChart also includes prescription, billing and lab report modules. Basically, all patient data is entered on the iPhone app, or from a web based desktop computer. Once new information is added to a patient’s record via the iPhone, the data is first stored on the iPhone and then synchronized to an iChart Web based account.

So in a nutshell, iChart is a SaaS EMR with an iPhone front-end. Therefore, the same risks identified when evaluating a SaaS EMR must be taken into consideration when evaluating this app. Also, because patient data is stored on the iPhone, in order for this app to be HIPAA compliant the dreaded iPhone password must be enabled. Honestly, do you know anyone with an iPhone that has their password enabled? However from a price standpoint, Cartetools have competitively priced the iChart app. The basic product is priced at $139.00 for the first year with an annual renewal subscription fee of $99.

Here again, for the techno-geek type provider, this app can’t miss, its way cool!! For the bread and butter type provider, a desktop anchored down in the examination room or a nice size handheld tablet is more in line.

Click here to visit Caretools' website.

Read Fred Pennic’s complete blog article here.

Healthcare Reform Noise

Since there is so much noise in the system about the troubled waters President Obama’s overall Healthcare reform package is facing, let’s not forget that Healthcare IT reform is still on pace. The previously approved federal stimulus package included about 10 billion dollars in net Medicare and Medicaid incentives for EHR adoption.

In a recent interview, the National Coordinator for Health IT, David Blumenthal, discussed timetables for electronic health record adoption with American Medical News. Blumenthal said officials are still promoting EHR adoption in an effort to meet the President’s goal of providing all U.S. residents with an EHR by 2014. He also added that his office is still working under the guidelines of the federal economic stimulus law, which imposes penalties on health care providers who do not adopt health IT tools by 2015. However, Blumenthal acknowledged the challenges facing his office and physicians to make this happen but he believes his office and the physicians are up to meeting the challenge.

EHR adoption is alive and well, so now is not the time to let up on pushing EHR solutions. When presenting to clients and the user community it’s imperative that IT professionals deliver a clear and concise message that the current noise in the system does not affect the federal requirement for EHR adoption by 2015.

Read the complete American Medical News article here.

MJ, A Case For EHR

Could EHR have prevented Michael Jackson’s allegedly abuse of prescription drugs? Saying EHR could “prevent” prescription drug abuse may be a bit far reaching, but it definitely makes it more difficult for prescription drugs to be obtained fraudulently. Before you close your browser session, navigate to another web page, or write me off as having drank the “EHR Kool-Aid,” hear me out.

There's basically only one of three ways, or a combination thereof, for a person to easily obtain and abuse prescription drugs. The abuser must either visit several different physicians to obtain several prescriptions, enlist the help of others to obtain unnecessary prescriptions written in their name that eventually gets passed on to the abuser, and/or find a physician that would write fraudulent prescriptions.

The first scenario, one person visiting several doctors, currently physicians depend on the patient to self identify their past medical and medication history. What makes scenario one plausible is that a patient can see several doctors and conveniently forgets to inform the other physician of their current medications. With EHRs, all doctors will have access to the patients’ history as reported by the patient’s providers. Since the overwhelming majority of doctors are honest, this scenario is unlikely to contribute to the abuse of prescription drugs under an EHR system.

The second scenario, multiple people obtaining unneccessary prescriptions to be later passed on the abuser. Under EHR would someone really want to risk getting a prescription for someone else, to later be possibly denied this prescription when actually needed? Or worse yet, run the risk of altering their future treatment plans because of fraudulent prescriptions in their EHR?

The last scenario a dishonest provider writing uneccessary prescriptions. Although EHRs cannot prevent a physician from writing fraudulent scripts, but because EHR captures the patient’s history, and the visibility of EHR records by other providers may deter some from being dishonest. Similarly to home alarms, if a burglar wants to break into your specific house, a home alarm system would not stop it. Just like EHR doesn’t stop a dishonest physician from writing fraudulent scripts. However, a Rutgers University study, using five years of data, scientifically proved that burglars tend to avoid homes with alarm systems. So the fear of physicians being exposed by EHR’s historical prescription data, individuals not wanting to risk their own health and treatment with fraudulent data in their EHR, and physicians would have an accurate picture of a patient’s current and past treatments would inherently would reduce the number of fraudulent scripts written hence reducing the opportunity to abuse prescription drugs.

Maybe I did have a sip, or two, of the “EHR Kool-Aid.”

Read the complete Rutgers press release here.

Click here to see HIMSS definition of HER.

For Everything Else, VistA

I haven’t hid my affinity for open source code, especially as it relates to HITECH’s requirement for providers to implement EMRs. I’ve come across an interesting article from Washington Monthly, "Code Red," that does a nice job articulating my viewpoint. This article contrasts two EMR implementations, one institution uses the much touted open source system initially written for the Veterans Administration hospitals called VistA and the other institution implemented a proprietary solution developed by Cerner Corporation.

In a nutshell, the institution that used the open source system achieved dramatic positive results, i.e. the number of medical errors and deaths decreased drastically. Whereas the institution that installed the proprietary system, experienced disastrous results, i.e. in some cases two doctors were required to attend to a patient whereas previously only one was needed and the mortality rate for certain patient populations more than doubled. Although I’m sure a similar contrast could be made extolling the virtues of using a proprietary system, however, I think this article does a good job of articulating my position overall for open source code EHR.

In addition, this article also shed light on other possible unintended outcomes resulting from HITECH requiring providers to implement EHR a such a fast pace.

Read the complete Washington Monthly article here.

A Healthy Discussion on EHRs

Medscape reported although physicians agree with the potential advantages of electronic medical records (EMRs), they are taking issue at the current administration push for EHR’s on three fronts:

1. the incentive program for providers to implement EHRs;
2. quality of existing EMR systems; and
3. the drive to put EHR on every doctor’s desk.

In the words of President Obama, there’s nothing wrong with a healthy discussion on the issues. Although I don’t agree with all three of the physicians’ reasons (reason number 2 is a valid concern), I do believe this dialogue with physicians, bureaucrats, and the IT community will yield a better solution. However, the question becomes can all of the stakeholders stomach a painstakingly long “healthy discussion?” Or will everyone pick-up their marbles and go home, then in 2012 healthcare reform will be the bat used to beat up those that supported it?

Read the complete Medscape report here.

Open Source EHR, Back On Main Street

As I’ve stated many times before in this blog, I’m a proponent of open source software. Unfortunately, the required certification needed from Certification Commission for Health Information Technology (CCHIT) in order for providers to receive EHR stimulus put open source EHR on life support. Much to everyone’s delight, well open source advocates' delight, CCHIT recently announced they were modifying the EHR certification process.

To understand why this recently announced EHR certification modification could possibly put open source EHR back on Main Street, you must first understand why the original CCHIT’s certification process impacted EHR open source. In a nutshell, the impact boiled down to two major reasons. First, the cost for CCHIT certification is significant. By nature of open source software, no one particular entity owns the source code, so the issue is not only the cost, but also who pays for the certification, providers (users) or the developers? If providers are required to pay CCHIT certification is open source EHR really free? In addition, if the provider had to pick up the CCHIT certification fee, it would be easier to justify implementing a certified proprietary EHR package. Secondly, the current certification approach supports the certification the “end-to-end” solution versus integrated solutions that could be implemented to support the “end-to-end” business process. This could force some providers into needlessly retiring previously installed proven software in favor of a CCHIT certified “end-to-end” solution.

CCHIT announced they were replacing the single certification approach with multiple certification paths. One of the new certification paths would have a simplified, low cost site-level certification path. In addition, a path was created to allow for modular certification. This would be welcomed from providers who prefer to integrate technologies from various certified sources.

Once the details are ironed out for the new CCHIT EHR certification, this has the potential of putting open source EHR back in play for smaller providers.

Read the official CCHIT announcement article here.