Tag: EHR

EMR Integration Done Better, Cheaper, & Faster…Again? | Sansoro Health CEO Jeremy Pierotti


Sansoro Health is a next-gen EHR integration platform for Health IT companies that need a better, cheaper, and faster way to integrate their products into EMR systems. What sets them apart in this crowded space? Listen in to hear co-founder and CEO Jeremy Pierotti paint a picture of perfect-world of interoperability.

Filmed at HIMSS 2019 in Orlando, Florida, February 2019

Jessica DaMassa is the host of the WTF Health show & stars in Health in 2 Point 00 with Matthew Holt.

Get a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out

Creating an Infrastructure of Health Data to Support Amazon’s Leap into Healthcare

Claudia Williams, Manifest MedEx, Amazon


Amazon has transformed the way we read books, shop online, host websites, do cloud computing, and watch TV. Can they apply their successes in all these other areas to healthcare?

Just last week, Amazon announced Comprehend Medical, machine learning software that digitizes and processes medical records. “The process of developing clinical trials and connecting them with the right patients requires research teams to sift through and label mountains of unstructured clinical record data,” Fred Hutchinson CIO Matthew Trunnell is quoted saying in a MedCity News article. “Amazon Comprehend Medical will reduce this time burden from hours to seconds. This is a vital step toward getting researchers rapid access to the information they need when they need it so they can find actionable insights to advance life-saving therapies for patients.”

Deriving insights from data and making those available in a user-friendly way to patients and clinicians is just what we need from technology innovators. But these tools are useless without data. If an oncology patient is hospitalized, her provider may not be informed of her hospitalization for days or even weeks (or ever). And the situation is repeated for that same patient receiving care from cardiologists, endocrinologists, and other providers outside of her oncology clinic. When it comes to personalized health and medicine, both the quantity and quality of data matter. Providers need access to comprehensive patient health data so they can accurately and efficiently diagnose and treat patients and make use of technology that helps them identify “actionable insights.”

Continue reading…

Putting Patients into “Meaningful Use”

The Health Research Institute at PricewaterhouseCoopers released a report today entitled Putting patients into “meaningful use.” It begins with the anecdote I’ve blogged about previously regarding a diagnosis by Facebook in lieu of a PHR, which some have highlighted as a great success for social media in health care.  I am much less sanguine on that front.

The PwC report, of course, has much more than that story in it; here are the key takeaways, backed up with some survey data and interviews:

  1. Engaging external constituents may postpone achievement of “meaningful use.”
  2. Patient awareness of and access to available health IT tools is low; social, expectation, and education hurdles also exist.
  3. Patient engagement in “meaningful use” is still low, despite consumer interest.
  4. “Meaningful use” has yet to explicitly call for measuring the level of patient engagement.
  5. Health systems will need to compete for consumers in the PHR market.Continue reading…

Think Medical Billing, Not “EMR First”

I have heard from our sales force (and at more than one cocktail party) that most hospitals and practices around the country are focused on Electronic Medical Records (EMR) these days and not so much on medical billing or Revenue Cycle Management (RCM) now because they want to “Do EMR first.”

But what if you are doing EMR first for revenue cycle reasons?

Isn’t the bonus money offered for “Meaningful Use” of an EMR the main driver behind the rush to implement them?  And isn’t the rush intensified by the threat of reduced Medicare rates for those who don’t “meaningfully use” health information???

Okay, so how will you get the incentive money?  My guess is that you will claim to the Feds—through the attestation process—that you are a meaningful user, right?  Claim it?  Like as in file a claim?

I don’t care if it’s MU, PQRI, BTE, or LFG for Do-Re-Mi, if you are going to be glad you moved to EMR, it’s going to be because you’re able to include clinical information in your medical billing system! If you don’t have this in mind from the get-go, you will lose LOTS and LOTS of money on your choice to do “EMR First.”Continue reading…

Google Health: What Did We Learn About PHRs?

As I mentioned by way of the Wall Street Journal back at the end of March, Google Health was supposed to get less support under the new CEO. We learned today that “less support” meant that it would be retired on January 1, 2012 and eventually shut down on January 1, 2013. Basically this means that the grand experiment didn’t work out, but it was valiant and worthy try.

The folks at Google raised the bar for PHRs and I for one was a fan; however,  if Google couldn’t make it work, does it mean that Personal Health Records (PHRs) in general aren’t worthwhile or won’t be successful? I don’t think so, but what we learned from the Google experiment is that there’s little or no demand from the general consumer to store their personal medical records — at least in numbers that would matter. Here’s what Google said in their retirement letter:

There has been adoption among certain groups of users like tech-savvy patients and their caregivers, and more recently fitness and wellness enthusiasts. But we haven’t found a way to translate that limited usage into widespread adoption in the daily health routines of millions of people.

PHRs managed and maintained by patients themselves has been sort of a holy grail for years — but no one has been able to figure out how to make enough money from them or keep the data accurate enough to make PHRs useful enough to clinicians. And, it’s not for a lack of trying; in fact, Microsoft’s got a nice offering (HealthVault) that’s still in good shape so far. But, it’s not clear how long even they can last without a sustainable business model. It’s not like Google didn’t have the money to continue the experiment — they just realized that there were not users in quantities high enough for them to be able to monetize it sometime in the future.


Continue reading…

The Usefulness and Uselessness of Electronic Medical Records

Nothing is so useless as a general maxim.

Lord MacCaulay (1800-1859), On Machiavelli (1827)

I dare say that I have worked off my fundamental formula on you that the chief end of man is to frame general propositions and that no general proposition is worth a damn.

O.W Holmes, Jr. (1809-1904), as quoted in The Practical Cogitator, 1962

The general maxim and general proposition behind the rationale of a national interoperative electronic medical record system in every physician’s office is that you can never get too much information and that government can use digital data to cut costs and improve care.

The Problem

Sounds good, doesn’t it? The problem is that so far, after nearly a decade of advancing this maxim and proposition, perhaps 80% of physicians in independent practice aren’t buying. And this, in face of the reality, that government has proposing spending $27 billion to get EHRs off the ground. And beginning this year, CMS will start offering as much as $44,000 per physician over a staggered five years if physicians make “meaningful” use of “certified” medical records. Many doctors regard such rhetoric as empty talk that will accompanied by unreasonable bureaucratic requirements, as surely as dawn following night.

Why no “buy-in” among doctors? Why have two national IT coordinators appointed by Obama, David Brailer,ND, in 2005 and David Blumenthal, MD, in 2011, resigned in frustration over the failure to persuade doctors that gathering electronic data and measuring care is a good thing? If universal EHRs are such a good thing, why have physicians and hospitals not raced to embrace EHRs?

As Steve Lohr of the New York Times, a leading thinker in health care innovation, says in yesterday’s Times (“Seeing Promise and Peril in Digital Records,”

“What is beyond doubt is that the promise of digital records will be unfulfilled if doctors refuse to adopt them, because they regard the technology as cumbersome, time consuming, and possibly dangerous.”

To date, most doctors, except for enthusiastic early adopters, IT nerds, and those in large organizations, have found EHRs “useless” in their daily work. EHRs cost excess money, show little return on investment, change the very nature of practice, slow productivity, tell no narrative tales, cause conflicts among staff and colleagues, require extensive record keeping, are subject to hacking, and, more often than not, are useless as a tool for communicating to colleagues, hospitals, and other doctors outside your practice.

When the government establishes “usability standards” that work, maybe doctors will come on board the electronic train. Until then, says Dr. Edward H. Shortliffe , a professor at the University of Texas Health Science Center in Houston, “Usability is going to be the single greatest impediment to physician acceptance. “

If EHRs are not made more useful and soon, universal digital records may turn out to be a giant boondoggle rather than a scientific bonanza.

Richard L. Reece, MD, is pathologist, editor, author, speaker, innovator, and believer in abilities of practicing doctors and their patients to control and improve their health destinies through innovation. He is author of eleven books. Dr. Reece posts frequently at his blog, Medinnovation.

HIT Trends Summary for August 2011

This is a summary of the HIT Trends report for August 2011.  You can get the current issue or subscribe here.

Incentives driving the EMR market. According to a report by Sage Healthcare, most physicians (65%) buying EMRs are doing so because of federal incentives.  The biggest obstacle is still cost with 32% of non-users saying it’s the number one issue.  This is creating a mainstream market, even in solo practices, which report over 30% EMR adoption rates in a new survey by SK&A.

Incentives may also be driving hospital implementation of computerized physician order entry (CPOE).  80% of hospitals still lack CPOE capabilities as of last year.  Meaningful use requires providers to order at least one medication for 30% of unique hospital patients.  In a new KLAS report, CPOE projects have more than doubled, being led by Cerner and Epic.

It is a likely unintended consequence that the incentives are speeding the dominance of market leaders.

Continue reading…

EHR and Practical, Tactical Outcomes

I hope people are watching the news around the Meaningful Use attestation data released by CMS recently, because it is so instructive as to the difference between where we are in health care and where the deliverers of keynotes THINK we are. Since last September, we’ve been publishing our Meaningful Use (MU) dashboard data and as of this week for example, we know that 83% of our Medicare MU doctors have attested to the measures.

But our constraints as a marketplace are at the practical, tactical level. According to our analysis, some 48% of what doctors order does NOT turn into a documented update to the chart within 60 days of that order. And we all know the average EHR makes docs go slower—causing employment by hospitals in large numbers—at large losses to the hospital. And NOW, based on the CMS data, it looks like a large percentage of docs are on track to miss a bloody lay-up of a bonus from the federal government! Do you guys really think we are going to build integrated ACOs that drive down hospitalization?

Pass it on—we are further behind than we think we are, and we need to hold ourselves accountable for PRACTICAL, TACTICAL outcomes before we even talk about grand outcomes like “total quality.” So what do we do? So glad you asked. I hazard three guesses, and you guys can throw in more… or challenge mine.

1. Make a market for health information exchange. Today, HIE is universally used as a NOUN. It’s a thing you buy from Aetna or Lockheed Martin or IBM. In every other information supply chain I know of, people who WANT info PAY others to give that info to them. They pay only when the info is delivered in usable form. This is, of course, not allowed in health care, but it can be. We should get behind legislation that allows for the most rudimentary mechanism for exchange in the history of man.

Continue reading…

5 Things Parents Should Look for in Their Children’s Medical Record

Many of us are clueless about the valuable information contained in our children’s medical records. Knowing what’s there can help us make smart decisions; not knowing can leave us navigating in the dark. Getting ahold of your child’s records has never been easier – or more important. It’s powerful knowledge anytime, and all the more so during the holiday travel season when you might be seeing an unfamiliar face in a clinic or ER.

Here are five things I think parents should look for in their children’s medical record and have at their fingertips:

1. BMI Percent – Parents are often stunningly wrong about whether or not their children are at a healthy weight, highlighted by a study released December 2011 in the Archives of Pediatrics and Adolescent Medicine. We are so familiar with our kids – and so many of their peers are overweight – that they often look normal to us even when they are not. And more than 75% of parents of overweight children aged 2 to 15 report never being told the child is overweight by the pediatrician – it can be uncomfortable to talk about and difficult to hear.

But childhood obesity is the great epidemic of our time, one of the biggest threats to our kids’ health. What’s a parent to do?

Know your child’s BMI Percent. The Body Mass Index is a calculation that looks at appropriate weight for height for a given age and gender. If children’s BMI is below the 5th percentile, they are likely underweight. If they are at the 85th percentile or above, they are likely to be overweight. Above the 95th percentile? Obese. Knowledge is the first step toward health.

Continue reading…

Lessons Learned from China

On Sunday I returned from a week in Shanghai and Hangzhou.   A remarkable trip that included daily meetings with government, academic, and clinical leaders.   What did I learn?

In China, about 5% of the GDP is spent on healthcare per year compared to 16% in the US.    Although there is wide variation in lifespan and other population health measures between rural and urban settings, there are few interesting observations about Chinese healthcare:

*It’s a single payer, publicly funded system that provides universal healthcare via a 14% payroll tax.

*There is a single national set of regulations and policies applied to all hospitals, clinics, and doctors

*There is a single set of national privacy laws

*Immunization is mandatory for the entire population

*There’s a single national healthcare identifier

EHRs are widely used in China, however they are optimized for episodes of care, using templates for capture of selected data elements specific to a disease i.e. hypertension, hepatitis, diabetes.    The volume of patients is overwhelming – in one hospital I visited (Huashan), the  dermatology clinic sees 4000 patients per day.    The Chinese EHR enables clinics to document the basics of a problem specific encounter, facilitating extremely fast throughput.   The downside of this is that there is not a longitudinal problem list, medication reconciliation, or coordination of care to avoid repeat testing.

Continue reading…