Posts Tagged ‘meaningful use’

Halamka: Rethinking Certification

October 2, 2013

Dr. Halamka of BIDMC has been a supporter of the ONC and their quest for meaningful use. He has been a “no whining, just solutions” voice in the industry, helping the ONC gain at least a little bit of traction to test their Meaningful Use wings.  I applaud him for his patience and stoicism,   but also now welcome his constructive criticisms of the meaningful use guidelines.   He calls for the ONC to make up it’s mind on which standards to use. Hear! hear!


We have recently re-visited our schedule for meeting meaningful use and put in a list of high/medium/low priorities for what tasks we have left. The tasks that are uniformly low on our priority list are functions such as “reporting to immunization health agencies”.  We run a cancer clinic. We MIGHT give out a flu shot or two, but we are not giving assays of immunizations to two year-olds.

Another feature is the displaying of growth charts. Why do we need to clutter our interface so that you can display a pediatric growth chart when our patients are reliably all over 20? The are just two examples of the ‘plumpness’ that still exists in the meaningful use guidelines that is nearly irrelevant to the success of medical specialty software.


And it is clear why such requirements are there. Our politicians want to show us how to make software by pointing to the horizon and shooting some money out of a cannon.  All of the software vendors start running in the same direction without asking “why?”, or saying “can you check the map again’?”  Instead, they fall in and throw enough money at a problem until all the tests pass. Success.


I can’t put it better than Dr. Halamka about how to foster a better healthcare software ecosystem:

Certifying organizations would not be prescriptive about user interfaces, workflow, or exhaustively test every variation of every option.   Instead, they would certify that an EHR can securely send a precisely formatted clinical summary and securely receive a compliant but less than perfect clinical summary.


How simple, succinct, successful.

Ankhos is Paperless; Next step: CCHIT Oncology Certification

April 30, 2013

I am proud to report that we have reached a major implementation milestone in the development of Ankhos: no new paper is going into any chart! All new patient referral material is being scanned and all incoming documents are reviewed and signed electronically… and our users love it.


We have had our nose to the grindstone for 2+ years and it is now time to look up and make sure we are headed in the right direction.


In the light of the recent meaningful use audits, I think it was a good decision to finish these core features before attempting meaningful use certification.   The physicians I work with are quickly realizing that it is much easier, desirable and predictable to squeeze money out of increased productivity than to hope that the government hands us a check (and doesn’t take it back).  While we are still headed towards meaningful use, we are going to take a short detour – to CCHIT Ambulatory Oncology Certification. 


It’s not that large of a detour either. Because we started with the fundamentals of oncology: regimens, propagating dose changes, a timeline-oriented mentality, and a strong drug administration workflow, we are probably 85-90% towards complete test script coverage.  Having the CCHIT seal of approval for both oncology and meaningful use should help this rocket take off even faster.


Are we and EMR vendor? I’m not sure anymore. I’m beginning to think of us as an Oncology Software Vendor.

Meaningful use certification for 2014

October 4, 2012

It has come time for us to work seriously towards Meaningful Use certification.  We have decided to set our target to the 2014 certification rules. I have spent a great deal of time reading the ruling and searching for information. I’m sure others are, as well, so I am providing some of the links I have found.

Our plan is to start with a Base EHR certification and become fully certified as we implement more of the requirements.

In doing research, I investigated other certified EHR systems. It became apparent to me that these systems were developed with a mindset that started with these rules.  Ankhos has been developed from day one with the nurses, doctors and clinic staff in mind.

We have usability features in Ankhos that we will have to remove for compliance. But I would rather have that problem than the problem of making a compliant piece of software usable.

Not bad – opinion

Quick summary

Short cheatsheet

Some slides

[Edit: cleaned up the links, was in a rush]




I found a great set of slides

Atomizing healthcare IT

May 19, 2010

There has been a lively discussion on one of the posts of EMR and HIPAA about why Medical IT adoption is so slow relative to, say, the financial sector (or the library system for heaven sakes!)

Some blame doctors, some blame lack of real government stimulus and some blame un-enthusiastic IT companies but I think the real problem is the perspective that the industry has had on this subject.

It is true that there will always be a ‘workflow’ framework and a software design process centered around leveraging existing software for new workflows, but that doesn’t mean all strategies of ‘molding software to the workflow’ will work.

At some point the differences are so fundamental that in order to create effective software more than just conforming is required.

Heathcare workflows will have to be atomized in order for software to be beneficial. You wouldn’t expect a mom and pop local bank to be productive/cost-effective with stock-trading software from Goldman Sachs just because they are both in the financial sector!

I think it’s going to take some fresh thinking and willingness to start over to bring productivity and cost-effectiveness to healthcare IT.

For all the Health IT nerds out there…

March 9, 2010

John from EMR and EHR posted this surprisingly well-performed video of a rap… yes… a rap, (as in beatbox, Fresh Prince and Biggy) about the meaningful use guidelines. (link)


February 24, 2010

EMR and EHR Acronyms are Great. I listened in on a teleconference yesterday on the meaningful use guidelines and I thought I’d share the list of acronyms they were using. As for the call, there were no surprises.

A/I/U –Adopt, implement or upgrade
CAH –Critical Access Hospital
CCN –CMS Certification Number
CDS –Clinical Decision Support
CMS –Centers for Medicare & Medicaid Services
CY –Calendar Year
EHR –Electronic Health Record
EP –Eligible Professional
eRx –E-Prescribing
FFS –Fee-for-service
FY –Federal Fiscal Year
HHS –U.S. Department of Health and Human Services
HIT –Health Information Technology
HITECH Act –Health Information Technology for Electronic and Clinical Health Act
HITPC –Health Information Technology Policy Committee
HIPAA –Health Insurance Portability and Accountability Act of 1996
HPSA –Health Professional Shortage Area
IFR –Interim Final Rule
MA –Medicare Advantage
MCMP –Medicare Care Management Performance Demonstration
MITA-Medicaid Information Technology Architecture
MU –Meaningful Use
NPI –National Provider Identifier
NPRM –Notice of Proposed Rulemaking
OMB –Office of Management and Budget
ONC –Office of the National Coordinator of Health Information Technology
PQRI –Medicare Physician Quality Reporting Initiative
Recovery Act –American Reinvestment & Recovery Act of 2009
TIN –Taxpayer Identification Number

The future of meaningful use

January 22, 2010

As with most engineering/planning professions, part of my job is to build into my project the capability to accommodate moderate, somewhat forseen changes. In software, this requires designing data structures and logic flows in such a way that they can be easily modified to fulfill future requirements.

For many EMR product vendors, meeting meaningful use guidelines  is their requirement.  For my client, improved safety and efficiency are the main requirements. Whose requirements are more likely to change? The requirements ”standardized’ by the government?  (a entity designed to be in constant flux) or the requirements of the compounded expertise of doctors, nurses and administrative experts in the field?

As a programmer, I always assume that requirements will change to some degree and I am sure that these meaningful use guidelines are no different.  As with nearly everyone else, I think that the guidelines won’t be met to any significant degree this year, or probably by 2014. Will the guidelines stand and roll on to the penalties in 2015 or will lawmakers listen expert advice and change the guidelines?

Let’s be optimistic. Let’s say they listen to the experts. What are the meaningful use guidelines 6 or 9 months from now? How can lawmakers describe their intent to us without dictating crippling specifics that might not even be relevant with furture technologies? How can we infer  ‘Desired Functionality‘ from these ‘Meaningful Use‘ guidelines? If we can do that, maybe we can make good guesses about what future specifc requirements might be.

Cynics will say that all of this hubub is so the government can dictate your practice. A believer would tell you that the government wants to humbly ask for some patient data (and a glass of milk) so that it can make people safer. I think both the cynic and the believer are right, because they both describe a situation where the government wants your information. And they don’t want just YOUR information, but the information of with whom you consult, what drugs you use, whether they should fire one of your employees for a mis-treatment, the list goes on.

So let’s rename “Meaningful Use ” guidelines to “Information reporting ” requirements. Maybe with this mindset we can stay out of the quagmire of the specifics of meaningful use, but leave thMeaningful usee door open for the inevitable reporting requirements down the road.

From EMR and EHR: easy meaningful use matrix

January 15, 2010

John from EMR and EHR posted a link to a great 12 page pdf of the meaningful use guidelines. I thought it deserved a link.

How I learned to stop worrying…

January 14, 2010

This post by Paul Roemer helped me confront some of the unconcious fears and stressors I have been having about the rush to satisfy the meaningful use criteria.  I need to remind myself  that the ‘meaningful use’ money is like  a one dollar bill in the middle of the street, and that it’s worth waiting for the light to change.   The hectic pace of leading the development of an oncology EMR/EHR project is real enough. I’m going to learn to stop worrying and love the EMR.

Connectivity, not completeness will create a winning EMR product

January 7, 2010

In a recent post, I have expressed my belief that a comprehensive EMR product will not necessarily guarantee a successful/profitable one. It’s not that I don’t think comprehensiveness is impossible, just that it is unlikely for a comprehensive product to be maximally relevant to and productive for a private practice.

So if comprehensiveness is not always a goal, is there a goal to which all EMR products should aspire? I think so, and I think that goal is connectivity.