The CommonWell Health Alliance: Can The Private Sector Push Interoperability Over the Finish Line?

CommonWell Health Alliance

The HIMSS13 Conference in New Orleans, one of the biggest gatherings of Health Information Technology professionals of the year, was host to speakers, panel discussions, and one pretty large announcement from some of the big names in the electronic health record industry.

Allscripts, AthenaHealth, Cerner, Greenway, and McKesson have announced the founding of the CommonWell Health Alliance, a non-profit trade group designed to implement standards around some of the most difficult problems with interoperability between systems. CommonWell will focus on working to standardize three areas: patient matching, patient access consent, and record location. Once standards are set for these areas, they can be made public and licensed at a “reasonable cost”. The Alliance’s formation was inspired in part by a Bipartisan Coalition meeting, and especially a comment from National Coordinator for HIT Farzad Mostashari. The conversation was recalled by David McCallie, vice president of informatics at Cerner, in an interview with HealthcareITNews:

“…everyone was sort of complaining to Farzad: “You’ve got to go solve this identifier problem, it’s killing us.” And Farzad said, “Look, it’s against the law! I can’t do it. You guys have to solve it.” I came back and literally quoted that – “you guys have to solve it” – I sent an email to Arien and he said, “We think the same thing. Let’s talk about it.” And within a week, we knew this was what to do.”

Interoperability is the principle that patient information that is shared between two different software packages should work seamlessly. Think about the interoperability of the Internet. A web page can be read on any brand of computer, any browser, and with any internet service provider. It just works. Interoperability between EHR software would look very similar. Anywhere a patient needs care, their records could be transferred and read electronically, without having to worry about the different software formats. It’s important to distinguish between interoperability, which allows different software packages to understand each other, and Health Information Exchange, which is simply a means of communication between locations and providers. To extend the analogy, a telephone can connect two people, but if they speak two different languages, you will need a translator between them.

The founders of the CHA have extended an open invitation for other vendors to join the alliance, but one big name was conspicuously absent from the list of participants: Madison, Wisconsin’s Epic Systems, who serves almost half of the US market. Epic founder and CEO Judith Faulkner was dismissive of the announcement:

“We did not know about it. We were not invited,” Faulkner said. “It appears on the surface to be used as a competitive weapon and that’s just wrong. It’s wrong for the country.”

Epic COO Carl Dvorak was even more to the point, calling CommonWell a “marketing opportunity.” Epic System made a collaborative announcement of their own during HIMSS, introducing the DRIVE program to test Epic software in virtualized environments with the help of Dell, Red Hat, Intel and VMWare. The program would be especially useful to facilities looking to bridge older, closed software installations, with more modern and open systems.

Whether or not CommonWell will be a net win for patients or just an opportunity for vendors to make up ground with Epic remains to be seen. Proponents argue that CHA is a step in the right direction for the industry to achieve real interoperability, even if the gains are only modest. The skeptical take, articulated very well by Adrian Grooper, MD at TheHealthcareBlog says there is no real difference between giants like Epic and coalitions like CommonWell.

“The shame is that another program with opaque governance by the largest incumbents in health IT is being passed off as progress. The missed opportunity is to answer the call for patient engagement and the frustrations of physicians with EHRs and reverse the institutional control over the physician-patient relationship. Physicians take an oath to put their patient’s interest above all others while in reality we are manipulated to participate in massive amounts of unwarranted care.”

So what do you think? Is CommonWell a good step for interoperability, or just another excuse for big software players to control the marketplace? Let us know in the comments!

Guest Consultant Joe Hage Talks With Expert Michael Pacquin on Choosing the Right EMR

This is a guest post from Joe Hage, CEO of medical device marketing consultancy Medical Marcom.

HIMMS fellow Michael Paquin advises how to set up an appropriate EMR selection meeting in this short video.


Michael Paquin: Okay, so one of the things as physicians decide to select a vendor for Electronic Medical Records that I always suggest to my clients is to select four to five EMR vendors and have them set up with what you would like to see during demonstration.

So let’s look at how this might affect your practice. If I were to call Vendor A, I would probably send two or three pieces of the papers you use mostly in your office. That could be an insurance form, that could be a doctor’s note, that could be something that you’re very familiar with maybe the top two pieces of paper in your office. I would send that to the vendor and I would say, “I’d like to see you for an appointment for a demonstration at my office and when you come I would like you to be able to show me how that paper becomes real in your Electronic Medical Record.”

All medical record companies say they can make a document electronically so I want to select a vendor that’s going to show the time and effort to show how something that is important in my practice is actually working in their Electronic Medical Record.

They all can do this for you. I’d give [the papers] to all five vendors and ask them to come and set up for their appointment.

Next, I set the location and the place for the presentation. It needs to be something such as an exam room where everybody can clearly see a monitor or a video screen and actually look at the product.

The next thing that we want to do is really set up the audience and by setting up the audience I think it’s highly important that you first look at the EMR the way the vendor would like to show it to you. Let me explain that.

What will happen quite often is you’ll get 4-5 doctors in the room or a doctor and 2-3 nurses and the vendor will start to show you the product and all of a sudden it will be, “Can you show me how it does this?” or, “Can you show me how it does that?”

What happens is the mind doesn’t see the workflow the way it would actually happen in office. You start to get confused because you have a vendor go quickly to this screen or quickly to this screen, I call it the “Puppy Dog Syndrome” and that’s where the vendor becomes the Puppy Dog and wags the tail trying to answer your question.

Save or write down all of your questions, let the vendor demo his product so you can see what the actual workflow is going to be in your practice. Take a look at that workflow and then take a small break and come back and ask the questions and then you’ll see how the vendor goes between the different templates, the different documents, the different things that they need to go through.

At that time also I would imagine you have half the questions taken off of your list and be able to see them in his first demonstration where he actually shows you the product. You’ll get a much nicer complete feeling of the product.

That’s all the tips for today and we thank you for your time.

Joe Hage: Thank you Michael.

See the first video interview with Michael Pacquin here.

Also from Medical Marcom: US Doctors on Twitter, a sortable and downloadable list.

Guest Consultant Joe Hage Talks With Expert Michael Pacquin on EMR Implementation and Training

This is a guest post from Joe Hage, CEO of medical device marketing consultancy Medical Marcom.

My friend Michael Paquin is a fellow of HIMSS, the Health Information Management Systems Society, and an expert in EMR connectivity, Meaningful Use, and the pitfalls of both. Michael shares his thoughts on both in this short video, which is also in transcript form below.

Michael Paquin: I think if we are looking at physicians today and trying to address some of the problems they’re having in their offices and what they’re afraid of in purchasing an Electronic Medical Record, I think we have to start from the beginning and that is service and implementation.

I want to empower all physicians to make vendors give them the service they need. Getting an EMR is just one part of the puzzle in being successful in achieving your Meaningful Use dollar.

The Meaning Use dollars over a five-year period can add up to about $48,000 to $64,000 depending if you’re applying for Medicare or Medicaid. What you really need to think about is that purchase price and negotiate it well, don’t overspend but do overspend if you will, I know that’s contradictory, but do overspend when it comes to implementation and training.

A lot of doctors purchase an Electronic Medical Record and think they can have the training done in 3 days. I’d like you to think about that for just a moment.

If each and every one of you just bought Microsoft Office and brought it into your practice for the first year or first training, could you get trained on PowerPoint, Outlook, Word, Excel all the different features of Microsoft Office in three days while you’re not seeing patients or you are seeing patients? Can you train all 3-4 nurses in your office? What does that mean?

So what I’m suggesting to you is take the time to get trained so that you can use the product correctly. What I’m seeing out in the marketplace is doctors starting to go with their second or third vendor for their Electronic Medical Record software because they have an unsuccessful first brush with Vendor A or Vendor B – they weren’t trained.

All these systems have workflow issues, all of them are trying to address them, and all of them are trying to get better. None of them are going to be perfect but what’s going to make a perfect EMR installation for you is the training.

  • Make sure you negotiate all the prices.
  • Make sure you buy from a vendor that is certified by the ONC.
  • Make sure you’ve got that certification.

Certification means when you get your Meaningful Use dollars you can show your product was certified. So there is a lot to getting ready for purchasing an EMR, there is a lot to choosing the right vendor.

Make sure that you get in touch with an EMR consultant, there are a lot of lessons learned that will pay for a consultant’s time. Anyway in this first video I think we’ve covered enough but feel free to contact me with any questions.

Joe Hage: So I’ll paraphrase. When you’re choosing an EMR partner make sure that it is going to be around and one that can provide you with the level of training you need.

Michael Paquin: And certified.

Joe Hage: And certified, Michael thank you very much.

PM, EMR and Portals: A Primer on Healthcare-specific Software for Ambulatory Care

Note: This article was first published as PM, EMR and Portals: A Primer on Healthcare-specific Software for Ambulatory Care on Technorati.

Few industries are currently changing as much as the US healthcare system. While many perspectives and ideas are shaping the debate on how to change the system to meet current and future demands, most believe that technology can and will have a huge positive impact on the ability of the industry to deliver quality care in a cost-effective way. Network technologies that can support the ubiquitous exchange of health information in a secure, efficient and collaborative environment hold the potential to streamline and modernize the current system to maximize resources and positive patient outcomes.

The opportunities for improvement have generated a lot of buzz in both the private and public sectors, and incentivizing adoption of Healthcare Information Technology (HIT) through the American Recovery and Reinvestment Act of 2009 (the ARRA or “Stimulus” bill) has led to considerable interest in an industry often known for lagging behind in the adoption of new technologies.

For many, the healthcare-specific technical jargon and operational knowledge of how healthcare works can be as complex as the products themselves. Here then are descriptions of the three types of medical software used by ambulatory care providers.

Practice Management (or PM) Software

Practice Management (or PM) software has been in wide use in the healthcare industry for almost three decades. Its primary use is the collection of patient demographics, patient insurance detail and the healthcare services and related diagnoses provided. This information is formatted to conform to payer requirements and is submitted electronically to request reimbursement for services. PM software also manages the responses from the payers in electronic format and invoices any balance to the patient in the form of printed and mailed statements. PM systems can be all-encompassing in functionality or can be a la carte in modules.

Functions of Practice Management Software

  • Payer billing
  • Patient billing
  • Patient scheduling
  • Patient recall for future appointments or services
  • Referral management (inward and/or outward)
  • Visit counting
  • Patient eligibility and benefits determination
  • RVU (relative value unit) reports for compensation by productivity
  • Payer contract management
  • A/R (accounts receivable) management
  • Procedure / surgery estimating

Electronic Medical Records (EMR) and Electronic Health Records (EHR) Software

EMRs require and store some of the same patient information as PM software. Patient demographics, patient insurance information and scheduling are actually found in both types of software. When the two programs are integrated, one database typically serves both sides. While the PM system focuses on relating to the financial side of the practice, the EMR system organizes patient medical data.

Although the terms “Electronic Medical Record” and “Electronic Health Record” are used interchangeably by vendors and providers these days, the strict definition of the two terms provided by the Healthcare Information and Management Systems Society(HIMSS) defines an EHR as an individual record of a specific patient’s care, defining an EMR as the software platform that houses all of the EHRs the practice generates.

EMR systems are newer to and less evident in the outpatient healthcare industry. Tools to secure the system while making the data accessible, as well as installing hardware in clinical settings like exam rooms, are still fairly recent developments, especially for small to medium-sized private physician groups. As adoption continues, and the Federal government encourages entities to move to EMR, the interoperability of the software means a patient can easily and securely have records sent from one provider, healthcare system, or location to another – reducing mistakes and costs to inform providers and patients making decisions.

Functions of Electronic Medical Record Software

  • Capture and reporting of discrete data
  • Coding assistance
  • Clinical visit summary
  • pdf record repository
  • Data aggregation in graphical form
  • Access to patient records from other locations
  • Medication reconciliation
  • Patient recall for disease management or medication review
  • Standards of care protocols / algorithms
  • E-prescribing
  • Data collection for interface with research or accreditation registries

Patient Portals

While PM and EMR systems seek to capture and organize patient data to support the practice’s operations and patient care, Patient Portals facilitate communication of sensitive health information between patients and care providers. Most Patient Portals are web-based systems that attach to the provider’s website to allow patients to securely send and receive information.

By allowing more data to be transferred securely in a digital manner, patients can save time and effort communicating with their healthcare provider. Some patient care (eVisits or virtual visits) can take place via the Patient Portal, and organizations can save overhead and human resources on phone calls and in-person visits when replaced by secure emails or chats with nurses, insurance clerks, medical records clerks or lab technologists.

Functions of Patient Portals

  • Online completion of patient paperwork – demographics, insurance information, medical history, Notice of Privacy Practices (NPP) and other signatures necessary to receive care
  • Online bill pay
  • Medication/refill requests
  • Appointment requests
  • E-commerce – secure purchase of health products
  • Secure email between physician and patients
  • Online chat with staff
  • Virtual Office Visits (reimbursed by some payers)
  • Laboratory Results Communication
  • Self-scheduling appointments
  • Patient billing via secure email
  • Online referrals (inward/outward)
  • Exchange of patient records between physicians/providers sharing a patient’s care
  • Personal Health Record (PHR)
  • Kiosk for patient check-in
  • Patient submission of vital signs and other health data

Putting it all together

All three types of software are designed to make information work for patients and providers without bogging down the delivery process with paper. By harnessing advances in network security, performance and usability, PMs, EMRs, and Patient Portals have the potential to make today’s patient experience cost-effective, efficient, pleasant and safe.

Quick Reference for Acronyms and Buzzwords of ARRA and HITECH

certification @Sgame/Dreamstime.comARRA: American Recovery and Reinvestment Act of 2009, also called “The Stimulus Package” or “The Stimulus Bill.”  Of the $850B in the bill,  $51B is pegged for the health care industry and $19B of that will be used to incent medical practices to adopt EMRs/EHRs.

CCHIT: the Certification Commission for Health Information Technology is a private organization that certifies EMRs and EHRs based on 475 criteria spanning functionality, interoperability and security.  CCHIT does not evaluate ease of use of products, financial viability of the company offering the software; or the quality of customer support offered by the software vendor.  Whether or not CCHIT will be THE certifying organization to approve “qualified EMRs” will be announced at the end of the year.  (Can be pronounced “SEA-CHIT” or each letter can be pronounced as in “C.C.H.I.T.”)

Comparative Effectiveness: Comparative Effectiveness Research (CER) compares treatments and strategies to improve health.  For CER, HITECH provides $300M for the Agency for Healthcare Research and Quality, $400M for the National Institutes of Health, and $400M for the Office of the Secretary of Health and Human Services.

EHR: The aggregate electronic record of health-related information on an individual that is created and gathered cumulatively across more than one health care organization and is managed and consulted by licensed clinicians and staff involved in the individual’s health and care.

EMR: The electronic record of health-related information on an individual that is created, gathered, managed, and consulted by licensed clinicians and staff from a single organization who are involved in the individual’s health and care.

HITECH: The HIT components of the stimulus package ”” collectively labeled HITECH are:

  1. Funding to the Office of the National Coordinator of HIT (ONCHIT)
  2. HIT adoption incentives through Medicare and Medicaid reimbursement
  3. Comparative effectiveness research for the Agency for Healthcare Research and Quality (AHRQ)
  4. Funding for the Indian Health Service
  5. Construction funds for the Health Resources and Services Administration (HRSA) for community health centers
  6. Funds for the Social Security Administration to upgrade HIT systems
  7. Funding for the Veterans Administration
  8. The Department of Agriculture will receive telemedicine funding
  9. Funds to the National Telecommunications Administration for broadband to enable telemedicine.

Interoperability (hospitals): (as defined by HIMSS- Health Information and Management Systems Society)not yet defined for ambulatory care

Meaningful Use: To qualify as a “meaningful user,” eligible providers must demonstrate use of a “qualified EHR” in a “meaningful manner.” ARRA defers to the secretary of Health and Human Services (HSS) to set specific guidelines for determining what constitutes a “qualified EHR”; however, it does specify that e-prescribing, electronic exchange of medical records, and interoperability of systems will be determining criteria.  Starting in 2011, providers deemed to be “meaningful users” of EHR systems will be eligible to receive $40,000 – $60,000 in incentive payments paid out over five years in the form of increased Medicare and Medicaid payments.

ONCHIT: Office of the National Coordinator for Health Information Technology.  In 2004 the position was created by by Presidential Executive Order.  In March 2009, President Obama appointed David Blumenthal, M.D., M.P.P. to the position. The primary purpose of this position is to aid the Secretary of HHS in achieving the President’s goal for most Americans to have access to an interoperable electronic medical record by 2014 (from the HHS.gov website.)

PHR or ePHR: An electronic, cumulative record of health-related information on an individual, drawn from multiple sources, that is created, gathered, and managed by the individual. The integrity of the data in the ePHR and control of access to that data is the responsibility of the individual.

David Blumenthal, M.D., M.P.P.:Selected by President Obama as his choice for National Coordinator for Health Information Technology Dr. Blumenthal will lead the implementation of a nationwide interoperable, privacy-protected health information technology infrastructure as called for in the American Recovery and Reinvestment Act.

What is CCHIT and Should My EMR/EHR Be Certified?


An excellent article on EHRs and CCHIT was pointed out to me recently and I thought I’d pass it along to my readers.  To answer the question “What is CCHIT?”, the site SoftwareAdvice says this:

CCHIT is a private, non-profit organization formed to certify EHRs against a minimum set of requirements for functionality, interoperability and security. It was founded in 2004 by three industry associations ( HIMSS, AHIMA and the Alliance (no longer in operation.))  It was subsequently funded further by the California Healthcare Foundation and a group of payers (e.g. United HealthGroup), providers (e.g. HCA) and software vendors (e.g. McKesson). In 2005, CCHIT was granted a $2.7 million contract by the Department of Health and Human Services (HHS) to support its mission. A number of other medical associations have since supported CCHIT. Despite the HHS contract, CCHIT is not an extension of the federal government.

As of March 2009, Eighty-some ambulatory EHRs received certification against the 2006 CCHIT criteria, sixteen EHRs received certification against the more rigorous 2007 criteria and twenty have achieved CCHIT certification for the 2008 Ambulatory EHR criteria. We estimate this equates to roughly 30% of all ambulatory EHRs being certified, while additional EHR vendors are currently pursuing certification for their systems.

In the article, SoftwareAdvice’s founder and owner, Don Fornes, also goes on to answer the questions:

  • What are the benefits of CCHIT?
  • Why does CCHIT generate some controversy?
  • Why doesn’t every vendor just get certified?
  • What are the criteria used by CCHIT to certify EHRs?
  • What important criteria does CCHIT not evaluate?
  • Does CCHIT evaluate specialty EHRs or templates for specialists?
  • Will CCHIT result in higher prices for EHRs?
  • Will a CCHIT-certified EHR improve my practice’s income?
  • Do I need a CCHIT-approved EHR to participate in my local HIE?

and ends with conclusions, recommendations and five key takeaways for helping you determine your path with EHRs and CCHIT.

Because I had never come across the SoftwareAdvice site before, I spoke with Houston Neal from Software Advice to understand what the site is and how it works.  Houston told me that the company has been helping healthcare entities choose practice management and electronic medical records software for almost 2 years and that the goal of the service is to help physicians develop a short list of vendors specific to their specialty and software needs.  There is no charge to the physician, but the software companies pay a referral fee to Software Advice.  Not all software vendors are represented on the site, but the company is working to get all vendors on board, and their representatives may discuss non-participating vendors if the needs of the physician warrant it.  Although I’ve not tried their service, it seems like a win/win situation if practices can get free software vendor recommendations based on a needs analysis.  I’d be interested in knowing if anyone out there has used SoftwareAdvice and what your feedback is.

By the way, in case you’re wondering, Houston confirmed for me that the way to pronounce “CCHIT” is either “SEA-CHIT” or :C.C.H.I.T.”  Thought you’d like to know!

Totally Geeky: I Am All Agog When I Visit Microsoft

Okay, I admit it. I am a Geek. I was so happy to be attending my first conference at Microsoft Headquarters in Redmond, Washington, that they didn’t even have to really impress me.

But they did.

I can’t say I was agog at the actual Conference Center; although everything is well-done, it is also simple and unassuming. I was very agog at the people who presented at the Health Users Conference (HUG, which is a users group alliance program sponsored by HIMSS), and with the Christmas morning of information that rained down on my head at the Developer track I chose to attend (other track choices were IT Pro, Health Plans, and Clinical Informatics.)

I have lots and lots I want to report on from the conference and will be doing so over the next few weeks:

* Interview with Bill Crounse, MD on what Microsoft has to offer the private medical practice and his predictions for the future of EHR pricing
* Interview with Melissa Markey, healthcare attorney specializing in technology on why practices come to her for advice and counsel
* Some fascinating demos of products being created with MS technology
* Some interesting perspectives of MS people and my brief experience with the MS culture
* An eye-witness report on “Surface” and how it will be used in healthcare (it went on sale today but I failed to bring my checkbook with me and my cards are all maxed out)
* Heard while at MS: some very interesting statements that I didn’t expect to hear
* My own wild ideas for my practice after being exposed to some gee-whiz products at MS

But first, back to work and the real world tomorrow, then some vacation time to spend with my daughter who’s visiting from 3,000 miles away, and hopefully, some serious posting on my blog, which is about to change from “healthpromeme.com” to “managemypractice.com.” Either name will work.