Free Healthcare IT Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Get all the latest Health IT updates from Neil Versel for FREE!

Join me for some upcoming speaking gigs

Hey all. I bet you thought I abandoned this blog when I took the job with MedCity News in April. I kind of did, because this is a health IT blog, and the people who pay my salary want me covering health IT exclusively for them. However, I’m allowed to promote myself, so promote I shall. As a bonus, all of what I’m about to tell you is related to health IT, which is why you came here in the first place.

I’ve got several speaking gigs coming up next month. Some are open to the public, others are not.

  • Oct. 1, I will moderate a panel discussing trends in patient engagement as part of the kickoff event for the new Chicago chapter of Health Technology Forum. RSVP here for the event, which starts at 6 pm CDT at SAS Institute’s Chicago office, Two Prudential Plaza, 180 N. Stetson Ave., Suite 1600. Panelists TBA.
  • Oct. 7, I will be at the Surescripts 2015 Customer Forum in Alexandria, Va., on a panel hosted by Surescripts CEO Tom Skelton. I’ll be joined by my friends Mandi Bishop of Dell and Shahid Shah, a.k.a. the Healthcare IT Guy, to discuss interoperability. That session runs 8:30-9:15 a.m. EDT.
  • Oct. 26, I am scheduled to be on a panel called “The Intersection of Digital Health and Patient Centricity,” alongside Sean Katz, CIO of the Vitality Group, and Maryam Saleh, director of member experience at health technology incubator Matter. That’s hosted by marketing firm APCO Worldwide, and starts at 5:30 p.m. CDT in the Wacker Room of the CME Building, 10 S. Wacker Drive, Suite 1200, Chicago.

Perhaps I’ll see you at one or more of those.

September 18, 2015 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Docs, stop whining, start e-prescribing

The whining is getting old.

Per Surescripts, in 2012, the latest year for which statistics are available, about 69 percent of physicians nationwide used e-prescribing technology in one way or another, and 44 percent of all prescriptions written nationwide were routed electronically. (That report came out in early May 2013, so expect some new numbers soon.) Both are up substantially from the previous year, probably due in no small part to the Meaningful Use EHR incentive program, which does require a minimal level of e-prescribing.

But what about the holdouts? A recent article in the journal Perspectives in Health Information Management found that cost remains the No. 1 reason why physicians still haven’t ditched the paper prescription pad in favor of electronic prescribing.

“While e-prescribing offers many benefits, not all providers have been excited about implementing e-prescribing systems. A major barrier, reported by more than 80 percent of primary care physicians, has been lack of financial support. New technology requires training and information technology support for installation and upkeep. A practice must take these costs into account when deciding whether to implement an e-prescribing system and also when choosing a stand-alone system or one that is integrated into an EHR system. According to the Health Resources and Services Administration, in a 2007 study the total cost of implementing an e-prescribing system was found to be $42,332, with annual costs after implementation of about $14,725 per year, for a practice of 10 full-time equivalent psychiatrists,” the authors reported.

Yes, but the paper also says this: “E-prescribing improves the efficiency of the prescribing process. Though the actual entering of a new prescription takes about 20 seconds longer per patient than writing a prescription, this time is offset by the time saved because of the fact that less clarification is needed for electronic prescriptions. Prescribers spent more time on the computer, on average an extra 6 minutes per prescriber per day or an increase of 20 seconds per patient when seeing 20 patients per day. If implemented correctly, e-prescribing should cause little disruption in the workflow of ambulatory care settings.”

In other words, those resisting the switch are being penny-wise and pound-foolish.

Besides, e-prescribing systems don’t have to cost that much. In fact, they don’t have to cost anything. Allscripts offers a free, standalone e-prescribing system online, while PracticeFusion, DrChrono and Kareo have e-prescribing modules in their free EHRs. A startup named ScriptPad has an e-prescribing app for Apple iOS that’s free to prescribers; transaction fees get billed to pharmacies. I can’t vouch for the efficacy of any of this software, but cost doesn’t have to be an issue.

I think the real problem here is intransigence. Some doctors simply don’t want to get with the times, and the only losers are patients.

April 24, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

CCHIT, KLAS might signal new era in EHRs

Two stories that have hit in the last 48 hours illustrate how the status quo in EHRs is being upset.

First off, as John Lynn broke late Tuesday night—first as a rumor and then as a confirmed fact—on his EMR and HIPAA blog, CCHIT, formerly known as the Certification Commission for Health Information Technology, is getting out of the health IT certification business, thus making sense out of the name change. The organization will continue to offer preparatory courses for ONC-sanctioned testing and certification, but no more actual certification.

CCHIT recommended that vendors turn to another authorized testing and certification body, Verizon-owned ICSA Labs, though there are others that still do offer certification, including Drummond Group, SLI Global Solutions, InfoGard Laboratories, and, for e-prescribing technology, Surescripts. Interestingly, CCHIT also announced that it will partner with HIMSS to offer a series of health IT events for vendors and providers. This is interesting because HIMSS was one of the three founding organizations of CCHIT in 2004, and CCHIT was under fire five years ago for maintaining too close of a relationship with HIMSS (also see this link).

When Meaningful Use came along with the passage of the American Recovery and Reinvestment Act in 2009, CCHIT lost its exclusivity in certifying health IT products, as EHR certification essentially became commoditized. Other certifying bodies also have undercut CCHIT on price, so this move really does not surprise me.

The other big story, if you pay attention to things such as vendor rankings, is that Athenahealth just unseated Epic Systems as KLAS Research’s “Best in KLAS Overall Software Vendor” of 2013. Epic had held the top spot for eight years in a row. “The old guard of HIT leaders is finally being displaced by more nimble, innovative models designed for health care’s future—not for its past. The latest KLAS rankings show that closed-system, traditional software offerings are not robust or flexible enough to meet providers’ demands anymore,” Athenahealth CEO Jonathan Bush said in a statement.

I’m not sure I’d go that far, as Epic is still eating everyone else’s lunch in the enterprise market. But, to me, this shows that smaller physician practices that don’t have IT departments are adopting EHRs and want a cloud-based product that is easy to maintain. That certainly heralds a major shift in health IT.

January 30, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Blumenthal talks e-prescribing

As you may have already heard, Surescripts today gave its annual update of progress in e-prescribing. About one-third of office-based clinicians now write at least some prescriptions electronically and the overall e-prescribing rate is up to 12 percent.

Surescripts had a transcription service present and provided these remarks from featured speaker Dr. David Blumenthal:

Well, thank you, Mr. [Harry] Totonis [president and CEO of Surescripts]. I appreciate your kind words. And it’s a pleasure to be here. It’s a pleasure to be part of the recognition of these ten states, who are pioneering and meeting on a very important contribution to the health and welfare of Americans.

As I go down the list, I can’t help noticing that my home State of Massachusetts is at the top.

And I want you to know that until 17 months ago, I was a proud electronic prescriber in Massachusetts contributing to that first place finish.

I’m sorry Senator Reed has left because I would have noted that Rhode Island, though it has a lot to teach the rest of the country, also has a lot to learn from Massachusetts.

I also notice that I have visited five of those ten states in the last three months. I hope to get to the rest of them before I run out of steam. I also note that six of them had been recipients of our Beacon [Communities] Award Program, which is a way of saying that e-prescribing is a gateway into success along a whole range of electronic and health care performances because our Beacon Program really was about health care improvement through electronic systems, rather than about electronic systems.

Though the senators have left, I can’t help noting that Senator Whitehouse was indeed a terrific champion for the legislation that created my office. It is to him that I owe the privilege of serving in this role because he and his colleagues equipped it with such important tools to move the needle on adoption and meaningful use of electronic health information systems in the United States.

And he I know was a leader in Rhode Island as well through the Rhode Island Quality Institute, which has provided an example on many levels to other communities that have sought to emulate their work on e prescribing and electronic exchange of information.

I find his notion of enjoyment a little bit paradoxical. I’m sure for those of us sitting under that scrutiny, it’s a little less enjoyable. But I do look forward at some point to having the opportunity to experience Senator Whitehouse’s prosecutorial skills (Laughter.) at the other side of that exchange.

I also want to congratulate Surescripts and Harry Totonis for their leadership. It is the private sector that is moving this work forward. The federal government is a catalyst. We can help correct market failures. We can help make the playing field more hospitable for the private sector. But it is thousands upon thousands of providers and thousands of companies and community leaders, insurance companies, and businesses outside of the health sector who are making it possible for communities to lift themselves up on every dimension of health care, not just on health information technology, though that is, we believe, obviously a foundational element.

To argue that there are 200,000 physicians e-prescribing is really reassuring. We, however, have a long way to go. Two hundred thousand is probably about a third of the practicing physicians in the United States. And it’s that two thirds that we are concerned about and making sure that they have the tools, incentives, the rewards for becoming e-prescribers in the very near future.

We know that there are important gains from e-prescribing. I know there are important gains. I have spoken in the past of my own personal use of the electronic health record, of the experience that I had using an e-prescribing capability through computerized provider order entry, in which the drug allergy checks that are brought to bear by e-prescribing prevented me from prescribing medication to which a patient was allergic. And I know that that kind of feedback in real time at the point of decision is only possible through order entry and e-prescribing with the drug-drug interaction and drug allergy checks that are possible to add on to the e-prescribing and computerized provider order entry functionalities.

We did some work in my own research group at the Mass General Hospital before I left documenting the cost reductions associated with electronic prescribing. So I know and have seen through my own group’s work the potential impact in well done scientific studies of electronic prescribing in terms of moving from brand to generic medications.

And also I saw in my own e-prescribing the way in which it enabled me to prescribe drugs that were on a patient’s formulary in which I could check the cost of the medication in real time looking at all of the options available for that class of medication and picking not only the one that was covered by that patient’s insurance but the least expensive one covered by that patient insurance. That would be hours of work without the electronic prescribing capability.

The states which are recognized here, of course, are recognized for the work of their clinicians in prescribing, but we also know at the Office of the National Coordinator that states have a very important leadership role.

We have given over $560 million to the 56 states and territories to encourage them to play a leadership role to build in their state government or in related entities that they have chosen the capacity to provide leadership for health information technology in their states. And one of the things that we have prioritized is creating e-prescribing as a leading effort at information exchange.

And we have also, of course, included e-prescribing in many ways within the Meaningful Use framework. And I should give credit to my colleagues at the Centers for Medicare and Medicaid Services who have actually lead responsibility for that Meaningful Use framework, but our Policy Committee, the [Health IT] Policy Committee for the Office of the National Coordinator, was also extremely helpful and highlighted four functionalities in Meaningful Use that relate to e-prescribing or support it; first of all, the maintenance of an active medication list; secondly, directly the generation and transmission of permissible prescriptions electronically; thirdly, the implementation of drug formulary checks; and, fourthly, the performance of medication reconciliation between care settings.

The latter two were in the menu set, the menu set, from which you could pick five. But we have suggested in that regulation that some of these menu set, actually, all of these menu set functionalities would be part of the required set for stage 2 of Meaningful Use.

Of course, e-prescribing under the influence of the Health HITECH Act was one of the required functionalities for Meaningful Use. So I can’t claim that we dreamed this up entirely. But we do see that it is one of the ways in which Meaningful Use will create value for the American people.
A lot has been done, but an enormous amount remains to be done in our work and in the work of the recipients of these awards and throughout the offices and around the nurses’ stations of America’s physicians and hospitals.

We are looking forward and beginning, actually, to some early reconnaissance around the development of our next phase of Meaningful Use, Meaningful Use stage 2. Our Health Information Technology Policy Committee met to discuss that just about ten days ago.

We, of course, want to learn before we jump into stage 2 of Meaningful Use how things have gone in stage 1, but we also know that there was a set of unfinished tasks and things that we passed over in the effort to get the first Meaningful Use stage, the first stage of Meaningful Use, out the door in a timely way.

There are two areas that I think really deserve much more attention in the second stage of Meaningful Use. And one of them is the area of health information exchange. The first stage of Meaningful Use set the groundwork technically for health information exchange but didn’t complete that task and didn’t require really robust exchange on the part of potential recipients of incentive payments.

So I think that the provider community and the vendor community should look forward to a much more robust set of requirements around health information exchange, an exchange that consciously transcends, ignores economic relationships, institutional relationships, and geographic relationships, and political jurisdictions. Again, we want information to follow patients.
The second thing that we hinted at but did not push very hard in the first stage of Meaningful Use was the second functionality, the second type of capability that adds so much value to the electronic health record. And that is clinical decision support.

I can tell you that as a user of electronic health record, I valued the availability of information that it made possible, not having to look through those paper charts anymore and knowing that I could find the old radiology reports without scrambling through a folder or ordering up a record from Stone Mountain, which would never be there anyway in time for my patient visit, but even more I valued the way it made me, the way clinical decision support made me a better doctor, the way in which it made my decisions better, the way it made them more scientific, more consistent with the patients’ needs.

And those are the things that I think will really sell the health care industry on this technology, not the recording, the physical recording, of information electronically but the ability to be better at what you do as a result of a technology that supports you in your role as a professional.
If you’re a nurse or a doctor or a respiratory therapist or a laboratory technician, having that reinforcement, that instruction, that access to new scientific information is really what makes the provider go home with a smile on his face or her face.

We are also going to be working to improve quality metrics contained in the Meaningful Use framework and to make sure that those are electronically compatible and take advantage of the electronic capabilities of records. And we have an enormous amount to do in terms of implementing the large array of programs that we have started: our Beacon Community grants; our regional extension centers, which are there to make physicians able to become meaningful users; our state grants to health information exchanges; our training, our effort to train, over 40,000 new health information technology workers, giving them good jobs with a future in an economic sector that is exploding and will continue to explode throughout our lifetimes; and our research work through our strategic health IT advanced research programs, one of which focuses on enhancing the exchange of health information.

So we have an enormous remaining set of tasks, but it has been a privilege to be here over the last 17 months or so and watch the federal government and the private sector and the state government sector come together to set the groundwork for this, set the foundation for this revolution in health information management.

And I again want to congratulate both the states, the congressional delegations, and Surescripts for their role in making all of this possible. Thanks again.

September 21, 2010 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Early HIMSS news

HIMSS09 doesn’t officially start until Sunday, but the announcements already are starting to come fast and furious:

First off, you may have already heard the news that Pamela Pure is out as president of McKesson‘s Technology Solutions division. The company’s planned media briefing at HIMSS on Monday now will be led by Sunny Sanyal, chief operating officer of the IT division.

In other executive news, the recently re-named Surescripts—formerly SureScripts-RxHub—has hired Harry Totonis as president and CEO. Totonis previously led the analytics division of MasterCard Worldwide and was a senior partner at Booz Allen Hamilton.

I expect that this experience running an analytics operation might give pause to the privacy and anti-data-mining camps. Surescripts and the rest of the e-prescribing industry may have to completely overhaul some of their policies in light of the forthcoming new HIPAA regulations called for in the stimulus legislation.

By the way, Surescripts says previous co-CEOs JP Little and Rick Ratliff will remain with the company in undisclosed roles.

Medsphere announced that it will debut OV Meds, the first of a series of modular upgrades to the OpenVista 2.0 EHR. OV Meds includes medication reconciliation technology, a pharmacy dashboard, a drug-pricing engine and a patient drug information library.

I don’t want to get bogged down in contract “wins” for vendors because I’ll never get anything else done, but I’ll mention that Allscripts announced its first end-to-end sale of technology for a hospital, physician offices, emergency department and home care. The customer is 118-bed Ottawa (Ill.) Regional Hospital and Healthcare Center.

April 2, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Catching up

It’s been a while since I’ve blogged, but being busy means I’m working. Usually.

In this case, I certainly have been working hard for the last few weeks, but I’ve also been toying with the idea of going to Australia for the triennial MedInfo conference, which takes place next week in Brisbane. After much contemplation, story pitching and even a preliminary discussion with someone who may have been able to cover the considerable expenses until the boss said no, I will indeed be departing for Australia this weekend.

With 17.5 hours of flying time each way—not counting connection time—and the need to do a whole lot of work to pay for the trip, this could be the last blog post for a while. It probably won’t, however, since I have something else to write tonight or tomorrow that I believe warrants its own post.

As I finish up some lingering assignments and prepare for my latest junket, here are a couple of items of interest that I’ve been sitting on for a bit.

This week, Alaska became the final state to legalize e-prescribing, meaning that electronic prescribing is now legal nationwide, including in the District of Columbia and Puerto Rico. Pharmacy connectivity network SureScripts has a map of e-prescribing status by state at At the right of the screen is a link to a high-resolution map showing where e-Rx laws have changed since 2004.

Then there’s this: A planned high-rise in New York would have 1 million square feet of space to showcase medical devices and other technology, with the goal of “making New York City the prime center of commerce and innovation for the US$260 billion global market for medical devices and diagnostics,” according to the press release.

The proposed World Product Centre would be at 11th Avenue and 34th Street in Manhattan, on the former site of the Copacabana nightclub, across the street from the Jacob Javits Convention Center. Is someone perhaps trying to lure the Radiological Society of North America annual conference to New York?

August 15, 2007 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Podcast: SureScripts COO Rick Ratliff on proposed Medicare e-Rx rule changes

Right before America effectively shut down for an Independence Day that fell on a Wednesday and surely prompted some very long weekends, the Centers for Medicare and Medicaid Services proposed some modifications to various Medicare payment and provider eligibility rules. Among the proposals is a plan to remove computer-generated faxing from the CMS definition of electronic prescribing.
alter the Medicare Part D electronic prescribing regulations.

This move is bound to make some e-prescribing advocates very happy, particularly on the pharmacy side and among the patient-safety crowd. Case in point is Rick Ratliff, chief operating officer of e-prescribing connectivity network SureScripts, who joins me for this podcast to discuss the CMS proposal and the future of e-prescribing.

Podcast details: Interview with SureScripts COO Rick Ratliff on proposed Medicare Part D e-prescribing regulations. MP3, 64 kbps, 10.2 MB, running time 22:14.

1:00 What SureScripts does
2:08 Fax exemption in existing rule
3:07 What CMS is proposing
4:02 Impact of the proposed change
4:26 What vendors might have to do
5:37 Lack of financial incentives in Medicare e-prescribing rules
6:35 Why it’s a “potentially enormous” change
7:45 Two-way communication in e-prescribing
8:35 Savings from efficiency gains
9:33 Private payers following the lead of CMS
10:00 True electronic prescribing vs. electronic faxing
11:30 Public comment period for the proposal
12:43 What SureScripts might tell CMS
13:22 How to encourage physicians to adopt e-prescribing
15:02 Physician attitudes toward patient suggestions
16:45 The tipping point
17:50 Is this a competitive battleground for pharmacies?
18:37 How retail pharmacies view e-prescribing
19:30 Effect of e-prescribing on patient and physician expectations
20:07 New SureScripts technology to report back to physicians on fill rates
21:25 E-prescribing effect on healthcare quality

July 5, 2007 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Hey Salu, where are you?

In rifling through my paper files (hey, I’m a journalist, not a doctor, and I don’t type quickly enough to take my notes on the computer), I came across a company called Salu, a physician specialty hub from early this decade. The company, at one point headed by Jim Steeb, hosted sites called Dermdex for dermatologists and plastic surgeons, and NeuroHub for neurologists.

I have a report that said in January 2002, the company built research panels from among the various sites’ membership to study physician attitudes. My undated notes from a phone interview with Steeb said that Salu also offered secure online messaging, Web sites for practices within each hub’s specialty and a prescription writer that worked on either PocketPC (now Windows Mobile) or Palm platforms. (It was not true e-prescribing because back in the pre-RxHub and SureScripts era, it didn’t transmit information to pharmacies.

Also, from what I could gather from searching the Internet, Salu had partnerships with Healthwise, Payerpath (now part of Misys Healthcare Systems) and a few others.

But what ever happened to Salu and its brands? If the company went out of business, did someone else take over the sites? I found no sign that either Dermdex or NeuroHub was still active. Help, please!

May 18, 2007 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.