We Need More HIM Professionals Actively Using Twitter

We’d like to welcome a new guest blogger to our ranks. If you’re on social media and enjoy HIM topics, then you’ve probably seen Erin Head (@ErinHead_HIM) tweeting about those subjects. Erin is the HIM Director at an acute care hospital in Florida and a real advocate for the HIM profession. I’m excited to have her blogging with us from her unique perspective.

When I look around on Twitter, I don’t see enough Health Information Management (HIM) professionals. Most of the people I interact with have health IT or Informatics-focused careers and are not what we refer to as “traditional HIM professionals.” Don’t get me wrong, there are many engaged HIM professionals on Twitter; however the participation level is nowhere near matching the workforce population.

Why is that? I do not believe it is a generational difference as my Twitter interactions have been with people from all ages and backgrounds. There has to be another reason. Are HIM professionals really “too busy” to take advantage of the wealth of knowledge and networking available on social media? Is it rude or disengaging to use social media in the physical presence of others?

This is no excuse – Twitter is very easy to navigate and the content is constantly updating so it is available no matter what time of day or how long you choose to login and interact. Following thought leaders on Twitter or a simple hashtag search will get you instantly connected with others and will get you comfortable using the application quickly. Do HIM professionals feel they are already subject matter experts and don’t need to join the Twitter conversation about new innovations, technology, and changing regulatory matters? If that is the case, I would certainly hope that traditional HIM professionals are garnering this knowledge somewhere else other than social media.

HIMers are a tight-knit group who look forward to annual conferences and events to catch up with fellow HIM professionals and gather information. This in-person interaction is great, but why wait for these events to network and converse? If you are unable to travel to attend an event, a great benefit is “live-Tweeting” where others will share the information that is being learned at an event with those who may not be able to attend in-person. But you must follow the event attendees by using the hashtag associated with the conference; in other words, you must be an active participant in social media to take advantage of this benefit.

Social media gives us an instant connection to other engaged professionals and gives us an opportunity to learn from each other, no matter where we are located physically. Selfishly, I want more interaction with HIM professionals through social media- traditional and non-traditional alike! I encourage all HIM professionals to create a Twitter account (or dust off an unused account) and start connecting. There really is no excuse to miss out on valuable, real-time HIM networking and information that is available at your fingertips.

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CHIME Applauds Bill (Flex-IT 2 Act) that Makes Necessary Improvements to Meaningful Use Program

Statement from CHIME CEO and President Russell P. Branzell, FCHIME, CHCIO and CHIME Board of Trustees Chair Charles E. Christian, CHCIO, LCHIME, FCHIME

ANN ARBOR, MI, July 30, 2015 – We commend Congresswoman Renee Ellmers for introducing the Further Flexibility in HIT Reporting and Advancing Interoperability Act of 2015 or “Flex-IT 2 Act” and appreciate her continued leadership on this critically important issue.

While CHIME remains committed to the success of Meaningful Use, and to making sure improved patient care is its lasting legacy, we believe significant changes are needed to address increased dissatisfaction with EHRs and growing provider dissatisfaction with the program. The introduction of the Flex-IT 2 Act serves to strengthen accountability and effectiveness of an e-enabled healthcare system and ensure long-term vitality of Meaningful Use.

There is no doubt that the EHR Incentive Payments program has been a vital and successful driver of health IT adoption nationwide, setting the foundation for better population health, improved care delivery and lower costs. However, the ongoing challenges with program implementation must be addressed. Our members believe in the intent and promise of Meaningful Use, but providers and hospitals alike have been hamstrung by its often overly prescriptive requirements. We view the Congresswoman’s legislation as an opportunity to reevaluate and reorient this vital program that will provide the digital infrastructure to support a 21st century healthcare system.

We look forward to working with Congresswoman Ellmers, our membership, and colleague provider organizations toward the passage of this important bill.

About CHIME:

The College of Healthcare Information Management Executives (CHIME) is an executive organization dedicated to serving chief information officers and other senior healthcare IT leaders. With more than 1,600 CIO members and over 150 healthcare IT vendors and professional services firms, CHIME provides a highly interactive, trusted environment enabling senior professional and industry leaders to collaborate; exchange best practices; address professional development needs; and advocate the effective use of information management to improve the health and healthcare in the communities they serve.

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What’s the Future of Health Information “Disposal”?

While at the HIM Summit, Deborah Green from AHIMA talked about the information lifecycle in healthcare. She showed a number of representations and flow charts of how information is collected and used in healthcare. Although, the part of the chart that intrigued me the most was the “disposal” element at the end. In fact, it prompted me to tweet the following:


As you look back at history disposal of paper charts was pretty straightforward. Most of the charts were organized by year and so you could have a 6 year retention policy. You’d collect all the charts that were older than 6 years and then either shred the old charts or move them to a more long term storage facility.

This concept gets much murkier in the world of EHR and digital charts. In fact, I talked with Deborah after her talk and asked if they’ve ever seen an EHR vendor which had a feature that would allow them to digitally “dispose” of an electronic chart. I’ve talked to hundreds of EHR vendors and I’ve never seen such a feature.

As a tech guy, I’ll admit that I wouldn’t want to be the programmer responsible for writing the code that “disposes” of an electronic chart. EHR software has been coded to never delete anything. At a maximum it might mark a record as inactive or essentially hide a record, but very few things in an EHR are ever really deleted. The concept of deletion is scary and has lots of consequences. Plus, what happens if your algorithm to delete old charts goes wrong and deletes the wrong information? You can fix that with some great backups, but I can imagine a lot of scenarios where even the backup could fail.

Technical challenges of an EHR delete feature aside, what does the future of digital chart “disposal” look like? What should digital chart disposal look like? Do we “shred” digital charts? Do we “shred” part of them? Do we keep them forever?

The reality is that the decision of what to do with the electronic chart is also dependent on the culture of the hospital. Research organizations want to keep all of the data forever and never ever delete anything. That old data might be a benefit to their research. Rural organizations often want to keep their data as long as possible as well. The idea of deleting their friends and neighbors data is foreign to them. In a larger urban area many organizations want to dispose of the chart as soon as the retention requirements are met. Having the old chart is a liability to them. Not having the chart helps remove that liability from their organization. Those are a few, but EHR vendors are going to have to deal with the wide variety of requirements.

If you think of the bigger picture, what’s the consequence if we shred something that could benefit the patient later? Will we need all of the historical patient information in order to provide a patient the best care possible?

These are challenging issues and I don’t think EHR vendors have really tackled them. This is largely because most organizations haven’t had an EHR long enough that they’re ready to start purging digital charts. However, that day is fast approaching. It will be interesting to see the wide variety of requests that organizations make when it comes to disposing of digital charts. It will also be interesting to see how EHR vendors implement these requests.

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9 Sectors of Healthcare IT Investment

Much of what we talk about here is new investments and new companies in healthcare IT. Much of the future of healthcare is built around these investments. SoCal HIMSS recently shared a great image that broke out the healthcare IT investment environment into 9 sectors:

Here are the 9 healthcare IT investment sectors mentioned:

  • ACO Tools
  • ACO-Oriented RCM
  • Employer Wellness
  • Benefits Management
  • Health Consumers
  • Patient Engagement
  • Big Data
  • PM & EMR
  • Remote Care

I always love seeing healthcare IT opportunities broken down into sectors like this. No doubt, we could all think of a company we could start in pretty much every sector. Although, certainly some are more saturated than others (see PM & EMR for example).

Are there any other sectors of healthcare IT investment that you don’t think are included in the sectors listed above?

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Would Cerner DoD Loss Seal Its Fate As An Also-Ran?

Update: Cerner has been announced as the winner of the DoD EHR Contract.

As everyone knows, Epic has attained a near-unbeatable place in the race for U.S. hospital market share. By one important criterion, Meaningful Use attestations, Epic has the lead hands down, with about 186,000 attestations as of March 2015 compared with 120,331 attestations on Cerner systems.

That being said, Cerner is hardly an insignificant force in the hospital EMR marketplace. It’s a multibillion-dollar powerhouse which still holds a strong #2 position and, if a casual survey of Web and social media commentary is to be believed, has done far less to alienate its customers with high-handed tactics. And while Cerner systems are far from cheap, you don’t regularly see headlines citing a Cerner investment as pivotal in a hospital’s credit rating taking a pratfall. Also, Cerner has the most contracts with MU-eligible hospitals, holding contracts with about 20% of them.

Nonetheless, there’s an event looming which could tip the scales substantially further in Epic’s direction. As many readers know, Epic is part of a team competing for the Department of Defense’s $11B Healthcare Management Systems Modernization contract (Word on the street is that we could hear the winner of the DoD EHR bid this week). I’d argue that if Epic wins this deal, it might have the leverage to push Cerner’s head under water once and for all.  Cerner, too, is fighting for the deal, but if it wins that probably won’t be enough to close the gap with Epic, as it’s harder to play catch up than to zoom ahead in a space you already control.

Now my colleague John argues that winning the DoD contract might actually be bad for Epic. As he sees it, losing the DoD deal wouldn’t do much damage to its reputation, as most hospital leaders would understand that military healthcare bears little resemblance to commercial healthcare delivery. In fact, he contends that if Epic wins the contract, it could be bad for its customers, as the Verona, Wisc.-based giant may be forced to divert significant resources away from hospital projects. His reasoning makes sense.

But losing the DoD contract would almost certainly have a negative impact on Cerner. While Epic might not suffer much of an image loss if it loses the contest, Cerner might. After all, it doesn’t have quite the marquee list of customers that Epic does (such as the Cleveland Clinic, Massachusetts General Hospital, Mayo Clinic and the Johns Hopkins Hospital). And if Cerner’s rep suffers, look out. As a surgeon writing for investor site Seeking Alpha notes, the comparatively low cost of switching TO Cerner can just as easily be used as a reason to switch AWAY FROM Cerner.

What’s more, while Cerner’s acquisition of Siemens’ health IT business — adding the Soarian product to its stable — is likely to help the company differentiate itself further going forward, but that’s going to take a while.  If Cerner loses the DoD bid, the financial and PR hit could dampen the impact of the acquisition.

Net-net, I doubt that Cerner is going to lie down and play dead under any circumstances, nor should it. Epic may have a substantial advantage but there’s certainly room for Cerner to keep trucking. Still, if Cerner loses the DoD bid it could have a big impact on its business. Now is the time for Cerner to reassure current and potential customers that it’s not planning to scale back if Epic wins.

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Kareo Secures over $55 Million in Investment to Extend Market Leadership

Fully subscribed round led by Montreux Equity Partners, with participation from all current Kareo investors, to accelerate expansion of cloud-based product line for independent physicians

Irvine, CA – July 28, 2015Kareo, the leading provider of cloud-based solutions for independent medical practices, today announced it has closed $55.4 million in additional funding. This investment is led by Montreux Equity Partners with participation from Silver Lake Partners and all of Kareo’s existing investors. This capital will finance the continued development of Kareo’s product line—which enables physicians to manage all major aspects of their practice—as well as expand the company’s market access.

“With this new investment from Montreux, Silver Lake and our current investors, we’ll be able to accelerate the development of our comprehensive, cloud-based, medical office management platform for independent practices,” said Dan Rodrigues, founder and CEO of Kareo. “Concurrently, we will further expand our market reach, helping even greater numbers of physicians meet their care delivery and practice growth objectives.”

Montreux Equity Partners, a growth capital firm investing in high growth, commercial stage companies with category leading products, technologies and services has a history of investing in high-profile healthcare companies including MINDBODY Online (NASDAQ: MB), Glaukos (NYSE: GKOS) and MAKO Surgical (NASDAQ: MAKO, acquired by Stryker), among others. Along with the investment, Montreux Principal, Michael Matly, MD, will join the Kareo Board of Directors and will provide consultative guidance around the company’s market strategy. Dr. Matly brings valued experience in the health services and technology sectors and is actively involved in Montreux’s late stage investments. He previously represented Montreux on the board of MINDBODY Online (NASDAQ: MB) and currently serves on the board of Pure Life Renal. Before joining Montreux, Dr. Matly led Business Development and New Ventures at the Mayo Clinic Center for Innovation.

“We are very excited to invest in Kareo, a company dedicated to helping physicians deliver outstanding patient care without getting bogged down by administrative tasks and external mandates,” said Matly. “Independent practices are the foundation of the U.S. healthcare system, but they have been underserved by technology, often facing the choice of forgoing technology or deploying expensive and cumbersome enterprise solutions. Kareo is changing this.”

Montreux joins Kareo’s top-tier institutional investors, which include OpenView Venture Partners, Greenspring Associates, Stripes Group, Silicon Valley Bank and Western Technology Investments.

Kareo has been recognized as one of the nation’s fastest growing private companies, realizing a 368 percent increase in revenue over the past three years. In 2015, Kareo was named the leading vendor for integrated health records, practice management and physician billing solutions for the third consecutive year by Black Book and was identified by KLAS as a top-three practice management provider for practices with 1-10 physicians. The company serves over 30,000 healthcare professionals caring for 40 million patients and processes over $1 billion in medical claims monthly. In March, Kareo announced its acquisition of DoctorBase, an innovative developer of medical practice marketing and patient engagement solutions, and these solutions are now available to Kareo’s existing customers.

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About Kareo
Kareo is the only cloud-based medical office solutions platform purpose-built for small practices. At Kareo, we believe that, with the right tools and support, small practices can do big things. We offer an integrated solution of products and services designed to help physicians get paid faster, find new patients, run their business smarter, and provide better care. Our practice management software, medical billing solution, practice marketing tools and free, award-winning fully certified EHR help more than 30,000 medical providers more efficiently manage the business and clinical sides of their practice. Kareo has received extensive industry recognition, including the Deloitte Technology Fast 500, Inc. 500/5000, Red Herring Top 100 Company, and Black Book #1 Integrated EHR, Practice Management and Billing Vendor. Headquartered in Irvine, California, the Kareo mission is to help providers spend their time focused on patients, not paperwork. For more information, visit www.kareo.com.

About Montreux Equity Partners
Montreux is dedicated to making growth capital investments in category-leading companies with products, technologies and services that are advancing health. Since 1993, Montreux has invested in more than 50 companies including MINDBODY (NASDAQ: MB), Glaukos (NYSE: GKOS), MAKO Surgical (acquired by Stryker), SkinMedica (acquired by Allergan), Renal CarePartners (acquired by Ambulatory Services of America), Great Lakes Health Plan (acquired by United Healthcare), and Orexigen (Nasdaq: OREX). Montreux is based in San Francisco, CA, and is currently investing out of its fifth fund. For more information, visit www.mepvc.com.

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Why Not “Meaningful Interoperability” For EMR Vendors?

At this point, arguably, Meaningful Use has done virtually all of the work that it was designed to do. But as we all know, vendors are behind the curve. If they aren’t forced to guarantee interoperability — or at least meet a standard that satisfies most interconnectivity demands — they’re simply not going to bother.

While there’s obviously a certification process in place for EMR vendors which requires them to meet certain standards, interoperability seemingly didn’t make the cut. And while there’s many ways vendors could have shown they’re on board, none have done anything that really unifies the industry.

PR-driven efforts like the CommonWell Alliance don’t impress me much, as I’m skeptical that they’ll get anywhere. And the only example I can think of where a vendor  is doing something to improve interoperability, Epic’s Care Everywhere, is intended only to connect between Epic implementations. It’s not exactly an efficient solution.

A case in point: One of own my Epic-based providers logged on to Care Everywhere a couple of weeks ago to request my chart from another institution, but as of yet, no chart has arrived. That’s not exactly an effective way to coordinate care! (Of course, Epic in particular only recently dropped its fees for clinical data sharing, which weren’t exactly care coordination-friendly either.)

Increasingly, I’ve begun to think that the next stage of EMR maturation will come from some kind of “Meaningful Interoperability” incentive paid to vendors who really go the extra mile. Yes, this is iffy financially, but I believe it has to be done. As time and experience have shown, EMR vendors have approximately zero compelling reasons to foster universal interoperability, and perhaps a zillion to keep their systems closed.

Of course, the problem with rewarding interoperability is to decide which standards would be the accepted ones. Mandating interoperability would also force regulators to decide whether variations from the core standard were acceptable, and how to define what “acceptable” interoperability was. None of this is trivial.

The feds would also have to decide how to phase in vendor interoperability requirements, a process which would have to run on its own tracks, as provider Meaningful Use concerns itself with entirely different issues. And while ONC might be the first choice that comes to mind in supervising this process, it’s possible a separate entity would be better given the differences in what needs to be accomplished here.

I realize that some readers might believe that I’m dreaming if I believe this will ever happen. After all, given the many billions spent coaxing (or hammering) providers to comply with Meaningful Use, the Congress may prefer to lean on the stick rather than the carrot. Also, vendors aren’t dependent on CMS, whose involvement made it important for providers to get on board. And it may seem more sensible to rejigger certification programs — but if that worked they’d have done it already.

But regardless of how it goes down, the federal government is likely to take action at some point on this issue. The ongoing lack of interoperability between EMRs has become a sore spot with at least some members of Congress, for good reasons. After all, the lack of free and easy sharing of clinical data has arguably limited the return on the $30B spent on Meaningful Use. But throwing the book at vendors isn’t going to cut it, in my view. As reluctant as Congressional leaders may be to throw more money at the problem, it may be the only way to convince recalcitrant EMR vendors to invest significant development resources in creating interoperable systems.

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Hospital to Turn Off EHR Access for Doctors Who Haven’t Finished ICD-10 Training

This article is pretty shocking. I can imagine how well this would go over at most hospitals. I hope we get to hear how well this strategy works and who will win what appears like a game of chicken between the doctors and hospital. Does the hospital need the doctors more or do the doctors need the hospital more?

Here’s an excerpt from the article linked above that describes what they’re doing:

“There is a ‘go live’ date for these changes that is Oct. 1 for everyone across the country, including us, so we felt it was very important that all medical providers be trained,” Groves said. “We set a date of July 27, which is Monday — if they have not done the training by then, their access to Soarian will be cut off.”

If they don’t have access to the EHR, that’s basically saying that a doctor can’t practice at that hospital, no? It’s interesting that access to the EHR is being used as essentially revoking privileges to be a doctor at a hospital. I can hear many doctors initial reaction being that they didn’t want to access the EHR anyway. Although, it’s a lot more complex than that response would describe. Can you practice medicine at a hospital that has an EHR without having access to the EHR? I believe the answer is no unless the hospital makes some extraordinary concessions to a doctor (not likely to happen in the hospital mentioned above).

What do you think about using EHR access as a way to motivate doctors to do something? Is that a good strategy? Will we see it happen more?

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Physicians Interactive Continues Growth with Acquisition of Quantia, Inc.

Quantia’s online physician community provides expert-led medical content and peer-to-peer collaboration to support clinical decision-making

READING, Mass. – (JULY 23, 2015) – Physicians Interactive (PI), the leading provider of insight-driven, digital engagement solutions for healthcare professionals and consumers, today announced that it has acquired Quantia, Inc. whose award-winning web and mobile community QuantiaMD, reaches more than one-third of U.S. physicians.

Physicians Interactive’s acquisition of Quantia, Inc., reflects PI’s continuing commitment to supplying  the best in expert medical content, tools and resources to healthcare professionals by integrating a digital physician community that enhances clinical decision-making, along with a talented team steeped in highly effective, online physician engagement.

“Healthcare professionals are inundated by data and, more than ever, need a solution that offers targeted medical information, education and peer-to-peer physician networks that keep them abreast of the latest in evidence-based medicine – and help ensure that they can deliver the best care to their patients,” said Donato Tramuto, Physicians Interactive Chairman and CEO. “By bringing Physicians Interactive and Quantia together, we continue to develop new ways to provide our customers, including health systems and life sciences companies, with the leading digital and mobile engagement platforms to help improve the quality and value of healthcare delivery.”

“On QuantiaMD, physicians average more than 20 minutes per session, learning from experts and peers within a highly dynamic web and mobile community,” said Nick Werthessen, Quantia Chief Operating Officer. “By combining our community with Physicians Interactive’s digital health platform, we can offer an unmatched level of healthcare professional reach and engagement to our customers, while empowering physicians to save time and enhance care via innovative digital and social technologies.”

About Quantia, Inc.

Quantia is on a mission to nurture the wisdom of the physician community – and tap into it to deliver better care. Every day, our membership of over 225,000 physicians (about one in three nationwide) visits the award-winning web and mobile community, QuantiaMD, to learn from top experts and collaborate on a wide range of topics. Our blend of expert-led content, gamification, and social framework creates an environment physicians want to explore, serving up high quality interactions that inspire change. Health systems and life sciences organizations use this platform to boost engagement among physicians, improving performance and delivering higher quality, more consistent care. Visit www.quantia-inc.com for more information.

About Physicians Interactive

Physicians Interactive has the largest global, digital health platform that engages and empowers consumers and healthcare professionals with instant access to content, solutions and data to improve health outcomes. The company provides payers, retailers and life sciences companies with sophisticated digital engagement solutions to reach, message, educate and change behaviors. Visitwww.physiciansinteractive.com for more information.

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Twitter Has A Community for Every Chronic Disease

I know that sites like PatientsLikeMe have been a huge success and really brought together similar patients to share in their healthcare journey. It’s an incredibly powerful thing to have a supportive community there to help you. It’s even more powerful if it’s someone who understands specifically what you’re going through.

This was the thought I had today when I tried to show some sympathy to Tiffany (better known as @TiffanyAndLupus):

I don’t really know Tiffany. I’ve just seen her tweets occasionally since I follow her. When I saw the above tweet, I had to respond with my own experience. Hopefully the interaction will help distract her from the pain and trouble. She favorited it, so I’m going to assume it helped…even if just for a second.

While my tweet might not mean much to her, Tiffany is the founder of the #LupusChat and so she’s well connected to a community of people who understand Lupus much better than I do. It’s hard to underestimate the power of community in our lives. We all long for it. We want to belong. Belonging and being loved is a great thing no matter your state, but especially if you have a health problem.

The beauty of Twitter is that you can find just about anyone on there. There may be some edge cases that are hard to find, but even then you can find supportive people who are in similar positions and can’t find anyone with their unique disease. I think that’s powerful. It’s one reason I love Twitter.

While many topics on Twitter get heated and brutal, I haven’t seen the trolls come out nearly as bad in the chronic care communities. Most of them are very supportive of each other and the health challenges people face. For the most part you see compassion in action. It’s beautiful to watch.

As I was writing this post, Tiffany replied to my tweet and I replied back:

I’m not sure the impact of my tweets on Tiffany. She might not notice a difference either. However, she’s brightened my day and made me smile. As is usually the case, those who extend the hand of kindness often receive the most in return. How could you not appreciate health a little bit more when you read tweets like this:

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