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No More Unsubstantiated Blame Shifting on EHRS, Doctors, Hospitals, Developers, Patients Or Whatever Your Role Happens To BeR

Posted Feb 07 2013 11:26pm

Ok I can go back to the real wild west with EMRs and tell stories here and it is better than what it was in those days.  There were cases of MDs not paying their EMR bill and vendors holding records ransom and one big one via business disputes in Irvine, CA called AcerMed that left a bad taste in everyone’s mouth as one day they were gone and it was not a cheap system to buy.  Again, it is better today but also it’s more complex as we are talking web based records and in those days it was pretty much all still client server as computers were not yet fast enough to allow for the speed we have today.  All that changed though when the the hardware was improved to web based medical records but there are still many solid client/server medical record systems out there. 

I think when you address situations as such though, you should bring some examples to the table so people you have really found issues.  It’s not always the vendor’s fault either.  There’s the responsibility of the buyer to know a bit about what they are buying, just as you would with buying a car to know what you are going to get and what the price is.  Sometimes though in the software business there are unexpected expenses that arise and that portion is just the nature of the business but it should not be expenses that soak anyone either.  I can describe instances with clients who were mad as all get out when something didn’t work or it was not what their perception was but a conversation and educational experience was usually all it took and vendors do that.  Sure there’s the occasional bad experience to where you come in contact with an employee who got up out of the wrong side of the bed that day, and sadly there’s everywhere and repairable. 

There are complaints on every medical record system all over the web, I read it all the time, there’s nobody that’s going to be 100% happy, even the satisfied customers will say “but I wish it did this” which is really not a complaint but some would judge it as that, so do you call that a satisfied customer, I would, one with a “wish list”.  Here’s a post below about a lawsuit brought about from the hospital and myself and most others that read this one pretty much said it went back to the hospital for the issues here.  The hospital didn’t have a qualified IT Department that did  their homework. 


I ran into something like this with a community hospital I did some contracted data work for and the IT manager didn’t know how to install a SQL server. He was one who had been promoted when the former IT manager left and the CEO of the hospital thought he was getting a good cheap deal, not. The CEO was not tech minded either and used to just run for the hills when I tried to share some new tech knowledge with him, but that’s what you run into in the real world with CEOs that don’t an interest, bad decisions. 

The real problem with the issue at the link above was “the consultants” and this is where a lot of hospitals get into trouble and if anyone going to cross a line to make a buck, some of them do as in their sales pitch they promise a certain percentage of savings with IT efficiencies and they will do anything as otherwise they don’t get paid if the promise too much, remember Accretive with violating HIPAA with actual patients records being shown to a Wall Street investor?  That only came out when the notebook was stolen:)

Medical record vendors want the buyer to be happy and bend over backwards and of course varies from one installation to another as remember this is the internet age and anyone can put anything they want out there.  I can’t tell you the hours and days and months that I spent as a single developer working on the software and actually I probably gave up a few good years of life doing programming and coding.  It’s not easy and today it’s a lot more complex and a single developer can’t do it, that’s why I folded up my little business. 

I really like to read what Dr. Halamka does up at Harvard too as those folks have the only ‘homegrown” hospital EHR around that is certified and they have something that others don’t have “hands on” so they know the mechanics of building a system well, top of the line and they integrate and wrote a lot of their own integration software as well.  That’s one of the reasons why the good Doctor/CIO is tops in this business and he’s a great hybrid being a doctor and a CIO, now that we have his genome maybe we can clone him (just kidding).   I only had hands on with an ambulatory system, but we see things a lot differently than one who is only a user or one with limited exposure to the mechanics of one.

In September we had this letter go out about medical records systems gaming the system when the Medicare bills went up.  You do have to remember with medical records it is easier for MDs to document for work that they have in fact performed and thus they got better.  I used to help doctors with that so they could get paid for the additional time instead of always using a 99213 code for everything as they were afraid to bill at the higher levels when they spent the time so they left money on the table for years.  Again this letter accusing all of gaming was more of “fear” reaction as if you have not lived in the medical world with doctors or hospitals, you run scared and witch hunts result. 


At the same time HCA was bragging about their coding being the reason for making more money and they were so far ahead of the rest of the pack, so why didn’t we hear about audits there?  This is why I really ask that we have people at top levels that have some hands on experience as items as such generated by fear would not happen.  We had the same stuff come from some members of Congress too questioning the stimulus money and they don’t get it either as most of them are what I call “non participants” anyway with technology and are stuck in the old paradigm of “its for those guys over there”.  I keep hinting around for all the folks at HHS and departments included to be a little social and be a role model, you’ll get miles out of it but that suggestion still sits on deaf ears.  You have to get over yourself at some  point (grin). 

Again if you want to look for someimage dirty areas in Health IT, look to the payer side as nobody questions them and basically they run circles around the government  and they use models and math to do it.  Nobody looks or doubts United Healthcare and their formulas, which in the past they used for 15 years to pay doctors and hospitals short.  Me being a data person, I see keep a look out as if someone did something like that once, they might do it again and the AAFP had an interesting find lately.  It is scary when the other side is so far ahead of you, it makes you head spin and fear sets in and crazy letters like the one at the link above go out.  Everyone at the other end scratches their heads. I think the 3rd party consultants are the areas to really watch and hey some of those are owned by insurance companies too, so those with many subsidiaries run business intelligence if there’s more than one entity involved to model how a change in one will reflect another subsidiary, it’s business intelligence.  Most of the time every is obvious as to who owns the consultants too. 

So let’s take a little time out for a video here and you also see this on the left hand side of my blog with the other videos that will wake you up to the world of math and modeling.  They are not that complicated to understand to the layman can get something out of them too.  Listen to this former quant from Wall Street.  Insurance companies use quants as well and if you look at the job listings United has tons of them open all the time.  This is how they think and do math on the other side.  Pay attention as this has evolved in to all walks of business and she will tell you exactly that.  I like her as besides myself she’s the only one that could see the model and math issues with educating the Occupy folks.  So let’s get educated together on how this works on the other side with how publicly traded companies think.



HHS now has data tools which they have lacked for years to audit and I’m sure they will make good use of them as this saves time. I know the stress from a digital illiterate Congress is tough and getting called to testify is no fun either and trying to put something across the way they will understand it, again as most are non participants is difficult and they still want the ride em cowboy routine to allow emotions to flow and so we get our media side shows:)  Also there’s the lobbyists who just absolutely pull the wool over their eyes sometimes too and that’s another battle as non participants are so very easy to snow over with the right talk…look the the mortgage scheme for one, there you go.  Now time for another learning video…Quants again..a documentary and this should open your eyes to imagesee what level of intelligence the government and those who work there are dealing with…they are way, way ahead and calculating, and all I want is some effort on the other side to grab some of this intelligence and battle back.  It’s not the government you need to worry about with data, it’s private industry and they have been doing it for years and it’s to the point you can’t ignore it any more.  I have actually had the pleasure of exchanging a few tweets with Derman, bright man.  Computer programs here reference banks but this stands for all businesses, wake up please.  As a side note, I can relate to the programmer here, spending hours and hours writing code as whether it’s financial software or an EMR, its all time consuming.  AGain this is how business and models work today and why we have attorneys in key spots is beyond me as they can’t think and act quick enough, no hands on with them. 



Basically we need to get smarter and the fear of the unknown is tremendous, we all have it but we have reached a time to where we have look at how we are dealing with it.  First we had the House and then the Senate questioning the Stimulus money, a subject so complex in the way that it functions and the players in it, they can only see the surface.  Sometime I wonder if Senator Coburn is an EMR doctor or does he still use paper records as I never hear him talk much about it.  Anyway moving on this was the big meeting and yes this stressful as they basically ranted on something they knew little about.

I loved it when Dr. Halamka said he would go meet with them and explain and who better as he has a very good way of taking complex issues and communicating, but again he has that hands on and nobody’s going to contest.  But it hit him too with all the work and time done, and yes he does code too, that all of a sudden some very simple thought processes were ready to dump all this work and funding down the tube.  This is a quote from his blog below.

“I'm happy to walk them through the Standards and Certification Regulations (MU stage 1 and stage 2) so they understand that the majority of their letter is simply not true  - it ignores the work of hundreds of people over thousands of hours to close the standards gaps via open, transparent, and bipartisan harmonization in both the Bush and Obama administrations.”

So coming back around let’s not fault hospitals, vendors, doctors, programmers or even patients for that matter until you do your  homework.  We shouldn’t have to function this way in fear and sure there’s a ton of extra expense in the US Health IT business and as long as people are writing tons of code to make things work, it’s not going away but at the same time sure we need to be alert, not be snowed and not try to turn this entire situation into a few bullet points because you cant’ do that.   Take all these reports that promise trillions of savings and know they are not true and excuse that falsified sense of urgency they create along with the report, not going to happen.  There will be savings and plenty of bright spots but remember the report are created from publicly traded companies who are there to serve shareholders.  I wonder if that is why Dell went private to get out from underneath digital illiterate shareholder:)

That’s old time thinking and it won’t work.  When it comes to wanting items sooner, what are you going to do hog tie developers to the computer and demand they work faster, don’t think so as they will walk.  I think Allscripts tried some variation of that (grin) and it didn’t work. That was a joke but you can see how long it is taking them to get their integrated code and not much the CEO can do about it either except ensure progress is being made and run the rest of the company as a business until it is done. 

“The short order code kitchen burned down a few years ago”

So let’s stop looking for a place to put blame as there’s not one single area you can fault or one single decision in all of this and when there are big issues, bring something to the table for the benefit of all.  BD



At a Feb. 6 meeting of the Health IT Policy Committee , National Coordinator for Health Information Technology Farzad Mostashari , MD, said that, by and large, electronic health record vendors have their customers’ best interests at heart.

But to the few who don’t, he gave a stern warning: Abide by what is "moral and right," or face more regulation.

Mostashari’s comments came by way of clarification to opening remarks he gave at last month's HIT Policy Committee meeting. He wanted to make sure that the vendors who are doing right by providers and society’s interest do not mistake him for coming down on them. He was speaking to the few exceptions, when he made remarks at the Jan. 8 meeting, as contained in these meeting minutes:

Mostashari said that some vendors go beyond the boundaries of what society views as proper, in their lack of opaque pricing. He said he gets complaints from providers on a daily basis, saying that some pricing or contract requirements are unfair to them, and asking if there could be some federally regulated norms around pricing.

Some vendors include what Mostashari called "chilling language" in their contracts that discourage providers from moving to another vendor. These vendors may tell providers they will lose the ability to report safety events. Mostashari said there is no explicit language in the current meaningful use regulations to prohibit this. “We are expecting vendors to step up,” he said, “but if we have to, we will go back to the regulatory process.”

http://www.healthcareitnews.com/news/mostashari-calls-vendors-play-fair?topic=,08,18

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