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epic_logoPartner’s Healthcare, the state’s largest healthcare provider in Massachusetts is currently in negotiations with Epic Systems to replace it’s existing number of various electronic health record systems that was built in-house with a single EHR solution. The transition is expected to cost over $600 million over 10 years will move Partners in the right direction towards a more integrated, statewide system for sharing medical records. Epic Systems will allow each patient a single up to date record that is accessible by all Partners providers.

The majority of Partners current systems was developed starting in the 1980s at Massachusetts General Hospital and Brigham and Women’s Hospital before the two institutions formed Partners and when there were no products on the market that could meet the hospitals’ needs. The hospitals have separate but related inpatient systems, distinct from those used by many of their affiliates.

Dr. David Blumenthal, Partners chief health information and innovation officer states, “The result is, when patients move from one place to another, their information often does not follow them in a complete form or as promptly as we’d like. Under the new system, data for a patient who is referred from a primary care office to an orthopedist, has surgery, and later is discharged with home care would be contained “all in the same record and all available in real time.’’ Blumenthal also stated,”the Epic system would make Partners better prepared to share data because it has a uniform interface for outside systems, rather than different “docking stations’’ for data.”[pullquote] “the Epic system would make Partners better prepared to share data because it has a uniform interface for outside systems, rather than different “docking stations’’ for data.”[/pullquote]

The potential move to Epic shows the commitment Partners is making towards information exchange; however, the move to Epic does not come with some key challenges. The transition to a new electronic health record system will not be easy for physicians and others who are already accustomed to their current systems. Physicians who have their own homegrown operation may also lose some of their control being forced to use Epic for a more streamlined system.

For Epic Systems, this would be a huge win that would make them the most dominant EHR vendor in Massachusetts further displaying the domination of Epic in the market.

thought-leadership1Written by Rita Bowen MA, RHIA, CHPS, SSGB, Sr Vice President of HIM and Privacy Officer of HealthPort

The What

If you look up governance in the dictionary it states that governance is the act of governing.  Not very revealing, is it? In fact, it is very revealing.Governance relates to defining expectations, granting power, and verifying compliance and performance. Governance occurs at the political level, corporate level, social level, or at any number of different kinds of government.  Governance relates to consistent management, cohesive policies, guidance, process, and decision rights for a given area of responsibility.

Within healthcare, governance occurs at many levels and in differing forums. However, one of the most often overlooked areas is that of data governance, particularly with EHRs.  We become so focused on the technology, the application and the users, that we ignore the actual asset: data.

Data governance is the structure, policies and procedures that allow for making strategic and effective decisions regarding the organization’s information assets.  It includes:

  • Defining roles and responsibilities for data
  • Establishing data quality policies
  • Creating metadata management policies
  • Arbitrating shared data questions
  • Releasing information to requestors

The Who

The role of data governance typically falls to the system administrator of each information technology (IT) system.  While IT should be intimately involved in data governance, they should not be the sole “governor” of data.  Often, they get stuck with the job.

True data governance is much too broad to be encapsulated in one department.  It is a system of decision rights and accountability for information related processes.  The system is executed according to agreed upon models which describe who can take what actions with what information and when under what circumstances, using what methods.

The Why

This question is easy—patient safety. But in today’s world of “accountability”, data governance addresses another important demand, compliance. Healthcare is an extremely data rich environment which requires control and structure.  If the original producer of the information is the only consumer of that data, then data governance is not really needed as we assume that the individual knows what he/she meant.  Unfortunately, there is rarely a single consumer of data.

Data is used by multiple clinicians, operations staff, external bodies, case managers, researchers and more. Everyone needs to understand the data presented and have a high degree of confidence in its validity. Lastly, healthcare data comes from many different sources and departments. These multiple input avenues require a “traffic cop” to assure that a singular output is controlled and compliant, well defined, and understood by all.

The How

If you answer, “No or I Don’t Know”, to the following questions, your organization needs an enterprise-wide data governance program for your EHR.

  • Do you know where the EHR data is?
  • Who controls the EHR data?
  • Who will use the EHR data and how will they use it?
  • Do you have to improve EHR data quality?
  • Are you ready for meaningful use/data sharing?
  • Can you streamline your release of information process through your EHR?

The nature of electronic health information has exponentially increased the ability to transmit and share, which has exploded the uses of that data.  The surge in information demand mandates governance.

Getting Started

Knowing where you are makes it easier to get to where you want to go. First steps include:

  • Identify data flow
  • Delineate and understand the rights and responsibilities of each stakeholder
  • Engage stakeholders and system administrators
  • Develop policies
  • Obtain buy in from  information organizational management and compliance

In other words, governance is an active process requiring ongoing effort. Like all active processes its success is driven by education and training.  Also like other active processes, it requires executive sponsorship to assure compliance and mediate disagreements.

A data governance council includes data stewards supported by the executive sponsors.  The council is responsible for maintaining data quality and integrity.  They must establish and maintain a data dictionary which is the cornerstone of data governance.  Of course, the steering committee must have a physician steering component to drive the clinical content. Physicians should drive all clinical decisions and influence physician use and compliance.

Assigning Data Stewards

The data steward must be a business leader and subject matter expert.  They must manage data assets on the behalf of others.  They must balance business acumen with technology and with communities of interest.  The people that perform this role are typically “found” and not “made”.  They must be a team player with excellent people skills.

Data stewards are the most critical role in data governance.  They define procedures, data meanings and implement policies for data in their areas.  It requires a very strong knowledge of their business area.  HIM professionals are often good candidates for these positions and must, at a minimum, be involved.

The data steward must have technical skills or a technical data steward partner who carries the day to day responsibility for the maintenance and operation of the data base and system environment.  This is the place where IT is key and should help lead this part of the governance effort.

Thirdly, is the “Community of Interest” aspect of data stewardship.  This facet covers the responsibility for data that spans the organizational boundaries.   It involves collaboration with other units to arrive at consistency of definitions and values.  Disputes at this level are elevated to the executive sponsors for mediation.

The When

Data governance is a needed practice that seems to receive less attention than it should.  But with effort and ongoing maintenance of the process, an effective data governance program can be established.  Success requires communication to all associates, business partners, governance program participants and EHR users. While the effort is not easy, it does provide results, including:

  • Architecture and infrastructure – organizational design and development
  • Improved ability for auditing and reporting
  • Improved data quality
  • Life cycle management for data
  • Defined metadata/business glossaries
  • Policies for risk management
  • Compliance –both privacy and security
  • Stewardship and value creation for release of information

About Rita Bowen:


Ms. Bowen is a distinguished professional with 20+ years of experience in the health information management industry.  She serves as the Sr. Vice President of HIM and Privacy Officer of HealthPort where she is responsible for acting as an internal customer advocate.

Most recently, Ms. Bowen served as the Enterprise Director of HIM Services for Erlanger Health System for 13 years, where she received commendation from the hospital county authority for outstanding leadership.

Ms. Bowen is the recipient of Mentor FORE Triumph Award and Distinguished Member of AHIMA’s Quality Management Section.  She has served as the AHIMA President and Board Chair in 2010, a member of AHIMA’s Board of Directors (2006-2011), the Council on Certification (2003-2005) and various task groups including CHP exam and AHIMA’s liaison to HIMSS for the CHS exam construction (2002).

Written by Madelyn Young from CareCloud

“Software vendors are just not playing well in the sandbox together.”

That point was recently posited by SearchHealthIT writer Don Fluckinger in a post that asked a very timely question on the state of the healthcare information technology industry: “Are HIT Vendors Selfish?”

The answer seems to be a resounding “Yes.”

It’s becoming clearer every day that healthcare needs to be a connected industry. The future of healthcare must be one in which the sharing of health information is secure and streamlined. That means whether data is shared from a nurse to a patient, from a primary care doctor to a specialist, or from the system of one HIT vendor to that of another, the process should be seamless.

Exchanging healthcare data or medical billing information in today’s healthcare environment, though, can be a huge challenge, thanks to the pervasive lack of interoperability among most of the major IT players in the industry.

Technology exists that can easily connect medical establishments to one another online, enabling secure communication and data exchange, but many healthcare IT vendors are slow to adopt it.

Despite remarkable advances in cloud computing, most HIT vendors are continuing to rely on the outdated client-server software model and failing to develop more advanced platforms that are capable of interacting with outside systems.

The medical industry wastes over $700 billion annually on avoidable, identifiable issues like administrative inefficiency, lack of coordination, unnecessary care and provider errors. Outdated technology and non-interoperable systems contribute significantly to that total by making the exchange of digital patient data an unnecessarily difficult and slow process.

Despite the fact that 57 percent of office-based physicians use an EHR or EMR system, the fact remains that in this age when you can easily do everything from buy your movie tickets to file your taxes online, medical chart transfer requests are still usually handled via fax machine and snail mail.

HIT non-interoperability is largely the reason for that. So why are vendors refusing to cooperate?

“In the health care IT world there is a perception – an incorrect one – that the key to profitability and long-term relevance is a hoarding of information, despite the open-source economy that grows exponentially each day,” wrote Jonathon Scott Feit, MBA, MA, the co-founder and CEO of Beyond Lucid Technologies, in a piece on Forbes.

Simply put, established HIT vendors have long-believed that growing to a large client base and becoming the technological “owner” of each of their customers’ data strengthens their position in the market.

That exclusivity-focused position is shortsighted, since the technology existing to serve the healthcare industry is advancing at a rapid pace. Try as legacy vendors have to “corner” the market, consumers and analysts recognize that connectivity and collaboration are critical to the future of the practice of medicine.

By keeping their data siloed and failing to engage in interoperable information exchange with other vendors, the client-server players in the market are causing mass inconvenience and administrative spending to clog up the overall healthcare system.

This is one of many reasons that a modern, up-to-date system that operates in the cloud and is designed for data exchange can better serve the evolving needs of a twenty-first century medical practice.

The core of the CareCloud philosophy is to connect healthcare, so our solutions were created to work together as a complete digital ecosystem, but were also developed with the ability to integrate with the products and services of other IT vendors. The CareCloud Central practice management system, for example, can interface with specialty-specific EHRs to easily manage patient data at every step of the claim process from scheduling to collections.

This interoperability is one reason CareCloud’s services are available “a la carte” via software-as-a-service (SaaS) offerings. Practices can choose to go on the CareCloud platform at the level they need – whether for appointment and patient administration, for electronic health records, or for full back-office revenue cycle management outsourcing – without losing connectedness to their other systems.

As more and more Meaningful Use dollars are doled out, healthcare providers are continually faced with the choice to contract with the most advanced technological systems to best serve their practices or invest in outdated technology that isolates their data.

As Jonathon Scott Feit put it in Forbes, “When companies realize that there is more money to be made in solving problems than building firewalls, health care information will flow like honey, and the cost to access vital data will drop.”

Until the old-school vendors accept an interoperable future, a cloud-based system with the capability for data exchange will be the most financially sound, connected choice for clinicians, their businesses, and their patents.

About CareCloud:

CareCloud’s mission is to create a digital ecosystem by leveraging cutting-edge technology to connect a disjointed healthcare industry and, ultimately, to improve the healthcare experience for patients, providers and healthcare professionals. We’re disrupting the status quo and giving medical practices sleek, easy-to-use software solutions to increase profitability and productivity.

Our web-based software represents a new standard in medical practice management that focuses on enhancing the user experience – a drastic improvement over the inefficient, overpriced, outdated and complicated technology traditionally sold by legacy software vendors. There is a better way to handle healthcare IT, and CareCloud delivers it.

Infographic created by Iron Mountain that highlights the time consuming and expensive task of converting paper records to EMRs that is not addressed by Meaningful Use.


There are many differences between electronic health records (EHR) and traditional paper-based medical records – probably more than you would expect. The benefits of an EHR are numerous when you compare physicians’ time and finances, the health benefits for patients and the impact to the environment. This infographic from Quest Diagnostics Care 360 compares both record-keeping systems and presents the advantages of adopting a certified EHR system.


Let’s face it, understanding Meaningful Use can be a challenge. There are a number of key requirements that must be meet to achieve each stage of Meaningful Use not including understanding the differences in EHR certification bodies such as CCHIT and Drummond Group. Care Cloud recently created this educational infographic that provides a concise timeline of Meaningful Use outlining it’s main components, stage requirements, key benefits, and barriers to implementation.

Meaningful Use Timeline

iStock_000018939372XSmallGuest post from Irene Froehlich, Director of Marketing at DrFirst:

Adopting an electronic health record (EHR) increases practice efficiency which translates to a profitable, organized practice that can focus on the quality of care provided to it’s patients. Here are six considerations for practices researching EHRs to improve efficiency and patient care:

  1. Where’s The Chart? Not quickly locating a patient’s paper chart can be  frustrating and time consuming for everyone. A typical scenario might involve: Could it be in the lab? Is it in the physician’s office, waiting to be annotated? Is it with a nurse awaiting a call to the patient? Is it at the front desk, because the patient has an appointment tomorrow? By using an EHR, anyone in the office needing the patient’s information can log in to immediately access it from anywhere in the office.
  2. Access Control - With an EHR, anyone with valid login credentials will be able to electronically access the patient record. No more misfiling of papers or shuffling through a large chart looking for one particular prescription. The staff can simply log in and perform a search for the required information.
  3. Adding Notes - When can a physician or nurse find time to add notes to the chart? It is difficult for a physician to remember what happened in an exam room, yet many doctors stack up patient charts until the end of the day and do all their charting at once. It is much more efficient to type up notes in the EHR system within the exam room. The EHR also makes it easier to quickly review a patient’s history, saving time to examine the patient and address any problems or concerns.
  4. Simultaneous Access - What if two people need the chart at the same time? With an EHR, a nurse can be in another room electronically transmitting a prescription to the patient’s pharmacy, ordering labs or sending a referral while the doctor continues an exam.
  5. Allergies and Drug Interactions - The EHR can alert a physician to past medication allergic reactions. Additionally, most EHR applications rely on a drug database and the patient’s record of active medications to alert the provider of potential dangerous drug interactions.
  6. Reminders - What about exam and vaccine reminders? An EHR can remind staff when it is time to set up patient appointments, such as wellness exams, mammograms and colonoscopies as well as adult and child immunization reminders.

Have you implemented an EHR yet? What other efficiency benefits have you experienced? Let us know in the comments!

About Irene Froehlich:

Ms. Froehlich has been with DrFirst since its inception in 2000. In her role as Director of Marketing, she oversees the planning, directing, and coordinating all marketing and public relations efforts at DrFirst. Ms. Froehlich has a B.S. in Communications from the University of Illinois, Champaign-Urbana.

Very interesting infographic that was created by Capterra solutions from examining the EMR software companies listed in their EMR Software Directory. From there, Capterra narrowed down the list by looking at web data for each of the vendors, including Alexa rankings, Compete traffic, and Google searches. While none of these are perfect indicators of popularity (particularly for B2B websites), the data gave them a way of narrowing down the list from 325 to the top 50 most visited EMR sites on the web. One major caveat for this infographic is companies that do not publicly release their user, customer, or revenue data are bumped down in the popularity due to the lack of data. No surprise to see the dominance of Epic and eClinicalWorks in the number of users.

The Top 20 Most Popular EMR Software Solutions

meaningful use

The following is a guest post written by Steve Emery, Director of  Product Management at HealthPort discussing how Meaningful Use affects records release:

The Meaningful Use Stage 2 Notice of Proposed Rule Making is out and it would bring sweeping changes to how hospitals and eligible professionals release records and other information to patients.

Essentially, CMS is dropping three Stage 1 reporting criteria and replacing them with a core requirement for patient online access to medical records. CMS’s goal is to move the release of information (ROI) process from labor intensive and paper-based to electronic and paper-free.

This is a welcome change for HIM professionals and other ancillary departments that have been pulling files, scanning or making photocopies of records, and sending information to patients via snail mail for years. The changes are as follows.


Stage One Criteria Being DroppedStage Two Criteria Added

Patient electronic copies of medical records within 3 business days.Electronic copies of discharge instructions at time of discharge.

OBJECTIVE:Provide patients the ability to view online, download and transmit information about a hospital admission.MEASURES: MUST PASS TWO

More than 50 percent of all patients who are discharged from the inpatient or emergency department of an eligible hospital of CAH have their information available online within 36 hours of discharge.  


More than 10 percent of all patients who are discharged from the inpatient or emergency department of an eligible hospital or CAH view, download or transmit to a third party their information during the EHR reporting period.


Stage One Criteria Being DroppedStage Two Criteria Added for EPs

Patient electronic copies of medical records within 3 business days. 

The “menu” requirement for “timely access” on the EP list.

OBJECTIVE:Provide patients the ability to view online, download and transmit their health information within 4 business days of the information being available to the EP.MEASURES: MUST PASS TWO

More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely (within 4 business days as above) online access to their health information subject to the EP’s discretion to withhold certain information.   


More than 10 percent of all unique patients seen by the EP during the EHR reporting period (or their authorized representatives) view, download or transmit to a third party their information.

Bottom Line for Providers

The bottom line for providers is that Stage 2 MU changes with regards to these specific criteria will drive organizations to implement a patient portal or personal health record application; and connect their EHR systems to these systems.  Through these efforts it is expected that patient requests to the HIM department for medical records will decrease; as patients will be able to obtain records themselves, online and at any time.

To make the new objective and measures truly “meaningful” facilities must advertise their portals and get patients to use them. Finally, only a minimum set of data is required to be available online. Facilities must still have a process to accommodate patients’ paper requests for other portions of their records.

To read the rule for yourself and zero-in on the items outlined above, here are a few tips:

  1.  The pdf version of the rule (pre Federal Register) can be found by clicking here.
  2. The new proposed objective for “Access” starts on page 91 for EPs or page 144 for hospitals.
  3. The list of required record data for online access (if you want to get ahead of our next blog post) starts on page 97 for EPs or page 145 for hospitals.
  4. If you prefer the table form for reviewing the requirements, that starts on page 156
  5.  And the actual rule verbiage (not the comments and table mentioned above) is on page 406 for EPs or page 414 for hospitals.

About Steve Emery:

Mr. Emery has over 24 years of experience leading teams in the development and enhancement of healthcare information technology and has authored and contributed to numerous articles which have appeared in major healthcare publications on Meaningful Use and other healthcare related topics. Steve Emery is available for questions or interview regarding these specific Meaningful Use Stage 2 Criteria. He can be reached at: steve.emery@healthport.com

When it comes to EMR and PM system implementation, every practice is asking, “What’s this going to cost me?” Download the whitepaper The Total Cost of Ownership of EHR in a Meaningful Use World for ways to make the answer, “As little as possible.”

Learn how you can assess and minimize the total cost of ownership for an EMR and PM system in your practice:

  • What costs to expect over the lifetime of your EMR and PM system
  • How to use TCO in your EMR and PM system selection process
  • How Meaningful Use impacts your TCO

Don’t saddle your practice with an EMR and PM system that is easy to afford, but hard to live with. Choose an EMR and PM system that offers the robust functionality your practice requires – and is designed to score well on many TCO metrics.

Download  ”The Total Cost of Ownership of EHR in a Meaningful Use World” and share it with your colleagues today.

 The AMA(American Medical Association) has up the stakes in the fight against ICD-10 recently writing a letter to Congress urging lawmakers to stop HIPAA’s required implementation of ICD-10 and to call on stakeholders to assess an appropriate replacement for ICD-9.  AMA is stating that the implementation of ICD-10 will create no additional burdens on the practice of medicine and have no direct benefit to individual patient care, as physicians struggle with other costly transitions associating with implementing electronic health records in their practices. AMA CEO and executive vice president, James L. Madera states, “the struggle to keep up with  the various health IT use and reporting requirements leaves little time for physicians to get engaged in the practice redesign and payment and delivery reforms envisioned in the Affordable Care Act.  Physicians will be forced to close their Medicare patient panel or limit the number of Medicare patients that they treat in order to minimize the aggregate financial and administrative blows to their practice due to the unfair penalty programs that are being and will be administered.” Yesterday on his blog, prominent physician blogger and CIO at Beth Israel Deaconess Medical Center, John D. Halamka MD also provided his thoughts that the billions of dollars to implement ICD-10 will not improve quality, safety, or efficiency. John states, “I’ve spoken to many people at HHS, CMS and the White House about the need to rethink the ICD10 timeline, deferring it until after Meaningful Use Stage 3 which enables us to focus on improving our clinical documentation and adopt SNOMED-CT to capture structured signs and symptoms.” Enclosed in the AMA letter to Congress was a table and timeline that illustrated the drastic volume of financial penalties associated with various federal programs that physicians will be facing simultaneously. 

AHIMA’s Viewpoint

AHIMA responded to AMA’s initial attack against the implementation of ICD-10 late last year expressing their disappointment with AMA stating adoption of a 21st system classification system will bring important benefits to patients, providers, and payers. AHIMA’s CEO Lynne Thomas Gordon stated, “We need to move our disease classification system towards international standards and also align it with the meaningful use incentive program as well as value based reimbursement.”  (Modern Healthcare 11/17) Gordon’s response does support the fact that the Affordable Care Act (ACA) includes financial savings associated with reduction in healthcare fraud and abuse, which is one of the key benefits of ICD-10. ICD-10 provides the more granularity of diagnosis and treatment information making it easier to detect potential healthcare fraud/abuse. The transition to ICD-10 will provide more robust codes that will help support electronic health record’s detailed requirements of information more accessible to support the move towards health information exchanges between healthcare organizations.


With only a dismal 9% of healthcare providers only halfway through ICD-10 according to a KLAS report last October, does the AMA make a valid point when it comes to all the competing priorities physicians and healthcare organizations are faced with at this time? So who is right in this debate? Should ICD-10 be delayed until Meaningful Use stage 3 or are we focused on the wrong thing and instead should focus on implementing an efficient reimbursement system instead? What do you think? To view the letter in its entirety, please click here    

Recently the Cyber Security and Information Assurance Division of Kroll Inc. released their annual top 10 security trends for 2012 highlighting the key areas of risks and trends that will impact how organizations and governments combat and respond to cyber threats.  In this interview, Alan Brill, Senior Managing Director at Kroll dives deeper into their forecasted security trends in 2012 providing his insight on how healthcare organizations can effectively minimize their threat of security breaches, monitor your network, and optimize incident response times. In volume 2 of this interview/podcast, Alan discusses:

  •  Kroll’s Risk Assessment Approach
  • Cloud Adoption in Healthcare
  • Cloud Contract Negotiations
  • How to Secure Data from Mobile Applications
  • Making Security A Priority
  • Healthcare Social Media Security Implications
  • Creating an Effective Incident Response Plan


    About Alan Brill: Alan Bill is the Senior Managing Director of Secure Information Services at Kroll. The author or co-author of seven books and dozens of articles, he is frequently quoted in the media in his field of expertise. He has conducted analyses of security for a wide range of global companies and led incident response teams handling a wide range of incidents involving personal, health, proprietary, and classified data. He has served as an expert witness in federal and state courts and as a special master for the federal courts. He has provided expert testimony before Congress, having been invited to do so by the majority and minority leaders of the committee.

    About Kroll: Kroll, the world’s leading risk consulting company, provides a broad range of investigative, intelligence, financial, security, technology and supplier management services to help clients reduce risks, solve problems and capitalize on opportunities. Headquartered in New York with offices in 52 cities in 29 countries, Kroll has a multidisciplinary team of approximately 2,800 employees and serves a global clientele of law firms, financial institutions, corporations, non-profit institutions, government agencies and individuals.