Demystifying healthcare transformation Part 1 – EMR Shortfalls #healthcare #EMR #ACA

This is Part 1 of a three-part series on The coming storm in healthcare.

There are real challenges with Electronic Medical Records (EMR) beyond getting doctors to write things down (a feat in itself). Healthcare providers are being pushed to adopt EMR, but few are at Stage 7, shown at right. Because certification at lower levels doesn’t mean system interoperability, EMR ends up a fenced-off island in a sea of medical information. EMR systems are being implemented as applications sitting on static data.

Imagine instead a world without information silos where healthcare Providers and Payers understand data in motion, meaning it can be interacted with to make sure it is helping the right people make the right decisions at the right time and most importantly, in the right context.


Discussions of electronic medical records commonly use two acronyms, EMR and EHR. The difference is part concept, part marketing: EMR refers to the electronic record of an individual that is created and stored for the purpose of treatment, while EHR is a collection of EMRs across multiple healthcare organizations. The goal is to make use of EHRs built from EMRs. These two together are the intended target of healthcare reform, but are we making meaningful progress? Not if we’re reliant on the latest patch/version of a particular EMR/EHR software.


Enter the Health Information Exchange (HIE). HIEs are intended to solve the issue of fragmented data across healthcare organizations by hosting data on a third-party platform. There is debate around whether this should be a centralized or federated model. Response? An HIE that doesn’t allow for the liberation of data merely creates another layer of fragmentation, centralized or not. HIEs serve their purpose as consolidators of data, but just like EMR and EHR, end up as silos of data that won’t improve the quality or cost of healthcare. The data needs to be available when it matters and not locked down in a database waiting to be queried.

Carrot and stick

How did we get here? It was pretty clear from the beginning that realizing EMR goals wouldn’t be easy, so the Federal Government created a carrot and stick approach. The carrot is cash payments to hospitals and clinics as they certify they’ve accomplished the previously mentioned  levels of EMR. Hospitals have the carrot of their need to control costs and grow market share. For ambulatory care, economic stimulus funding was an early driver.

The stick for everyone (hospitals, clinics and ambulatory care) is that Medicaid and Medicare, the single biggest Payers, will reduce payments to facilities not meeting EMR timelines by 1% starting in 2015, 2% in 2016 and 3% in 2017. With most healthcare facilities operating at 2% margin, that won’t be a pain tolerated for long. But that doesn’t ensure we’ll get to the true nirvana of driving healthcare decision as events occur so that outcomes can be optimized.

Just as with systems to manage and move data (EMR, EHR and HIE), the trick is data interoperability and the carrots and sticks in place don’t address that in a meaningful way.


There are currently four big EMR software players: EpicCernerMeditech and McKesson and many HIEs that are both independent and government/regional.

Each has a solution designed to capture electronic patient records. Does that mean they can connect to other solutions in place in healthcare facilities? Not necessarily. While healthcare organizations are chasing incentives, they’re not rewarded for integrating the wide array of systems that are part of patient-facing healthcare. By some estimates, for every one EMR system being certified, there are 100’s of others that aren’t bringing data together. This fragmentation won’t change by constantly rewriting silo’d software or simply connecting to exchanges. The solution is to see EMRs and HIEs as just one aspect of data capture and management while allowing for more nimble and event-driven platforms to manage data in motion.


EMR implementation rates are showing gradual rise with about half of all facilities reaching some level of adoption. But is it meaningful adoption? Several web sources report that “…only 20.4% of all physicians reported using a system described as minimally functional…” If this is true, EMR implementation isn’t driving the benefits hoped for. It would mean that the error reduction, reminders and alerts, clinical decision support and other benefits aren’t being fully realized.

This isn’t surprising when you consider that the systems being implemented capture and produce data but don’t act as event monitors, social media tools, and data integration points between systems. What needs to happen is for doctors and patients (yes, patients) to see data in motion. Only then can outcomes be driven more effectively by the system making contextual recommendations to the healthcare staff.

Mobile and Social EMR

Beyond silo’d data, limiting healthcare data to a work station would be a shame considering the wave of mobile and social technology that is coming to the workplace. Healthcare data needs to be available wherever needed and in the proper context. We have social platforms that are fast and easy to implement with security and are the most meaningful way to share protected data, and not just with between care professionals, but with the patient and their support community (family and friends they designate).

This is an answer to the some of the biggest challenges facing healthcare. Mobile and Social combined with ‘liberated’ data in motion provides access and convenience where we currently have little transparency and plenty of manual work.

Electronic records are only a first big step in healthcare transformation. Data needs to be mobile, social and event-enabled for healthcare transformation to take place.

Up Next: ICD-9 to ICD-10 challenges


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Categories: Data Analytics / Big Data, Healthcare, Mobility, Social / Collaboration

Author:Chris Taylor

Reimagining the way work is done through big data, analytics, and event processing. There's no end to what we can change and improve. I wear myself out...

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9 Comments on “Demystifying healthcare transformation Part 1 – EMR Shortfalls #healthcare #EMR #ACA”

  1. Tom Bellinson
    February 8, 2012 at 4:59 am #

    This seems like a job for an ANSI or IEEE or industry designated standards organization. The IT industry faced this challenge early on and quickly solved it by writing detailed operating specifications for interoperability. Once the specs were written and sanctioned, no software (or in that case – hardware) developer in their right mind would not certify to the spec — it would have been suicide.

    The medical industry has always been weak on prescribing IT standards, which is somewhat strange given the tight controls on other aspects of the industry. Clearly, IT is one of the keys to cleaning up many of the industry’s problems. So, they had better get a grip on standardization.

  2. February 8, 2012 at 7:36 am #

    While this isn’t scientific at all, I think that the change in these systems will be pushed forward by how the providers are paid (as you outline here). Yes, the Government will mandate it, but I think it will move to the integrated and seamless point through pressure from doctors and patients.

    While I feel it is true that most of the “old guard” physicians will resist this effort (along with their powerful lobbyists), I am seeing more and more doctors on laptops now. Granted they are logging into 3 different applications to see x-rays from one provider, the MRI from the other provider, then the medical records from their own system. But, that tide is changing and I think they will continue to push this as they are already starting to demand it on their tablet PC.

    We always hear that the patient plays a key role in managing their health. I’m seeing a tide turning, even within my own company, of patients asking questions about costs, and expecting a better patient experience. I expect not to have to go by my physician’s office to pick up an x-ray to take to the specialist I need to see, and I’m not going to allow the specialist to just take another film and bill my insurance. I know it will come back to impact my premiums sooner or later. I’ve started taking pictures of my own films and emailing to myself to use later, if needed. Lab results the same way. I’ll let the Cloud (Google) handle the security of my medical records.

    Bottom line, Government will push out the carrot and the stick, but we know from history this will cause a flurry of poor decisions on “how” to come into compliance. The market will dictate that compliance isn’t what we are looking for, and, sooner or later, logic will take over and healthcare will figure out what global organizations have already figured out with their very sensitive financial data… How to share it with all the stakeholders that need it, both within their company and outside (Government, shareholders, regulators, etc.).

    My bigger question is how we get Healthcare to speed this learning curve up? Is it adopting a standard like Tom suggests? I’d love to hear your take.

    • February 8, 2012 at 8:03 am #

      Excellent points, Ron. The great question is, “Where is the patient as the customer in this?”

      I was talking this week with a doctor in LA who doesn’t have Medicaid or Medicare customers, He is modernizing and going paperless simply because he has to be great with his customers because he competes.

      Also, where is social technology going in this as a customer service tool? I pay for a concierge plan where I text and email my doctor more often than I see him in the office. Whe can’t that be through social media?

      Great opportunities ahead if the marketplace wakes up to it.

    • February 8, 2012 at 8:04 am #

      Excellent points, Ron. The great question is, “Where is the patient as the customer in this?”

      I was talking this week with a doctor in LA who doesn’t have Medicaid or Medicare customers, He is modernizing and going paperless simply because he has to be great with his customers because he competes.

      Also, where is social technology going in this as a customer service tool? I pay for a concierge plan where I text and email my doctor more often than I see him in the office. Why can’t that be through social media?

      Great opportunities ahead if the marketplace wakes up to it.

  3. February 10, 2012 at 4:32 pm #

    Chris: I am reading Part I after being impressed with Part II….I can’t tell which is better but both are great for me getting to know Healthcare systematically. I find that you have interleaved introduction, analysis, diagnosis and remedial measures of / for Healthcare domain.

    I cannot imagine that the professionals in this domain are as dumb and bumbling as you describe. Simple application of good old TQM Quality Improvement Methods and Tools would have averted a lot of problems you seem to have discovered. Perhaps you have separate reports on introduction, analysis, diagnosis and remedial measures of / for Healthcare domain.

    While the solutions you suggested may improve Healthcare Systems and Processes, there should be scope for others experts to participate and bring their expertise to bear on every phase from analysis to remedial measures. We should also know what alternatives are considered and set aside before finalizing conclusions of each phase. This may look like needless pondering and meandering but large complex applications like Healthcare need multiple inputs and consensus for commitment and sustained benefits.

    I have made a careful study of your article and added comments to point out how systematic Business Analysis and Requirements Engineering Methods and Tools would have caught the lapses at various stages of the healthcare project. I would like to share that with those who are involved in either Healthcare or BA&RE or both.

    I found that the first comment is very helpful. I will read and reply to other comments later.

  4. Mark
    February 14, 2012 at 5:25 pm #

    Excellent article and it certainly points out some of the challenges. With a mixture of private and public players and a need to foster competition and therefore creativity, I want to respond to your question about data exchange. I favor starting with a federated system because it a least gets a provider in the game. As we get to a reasonably significant level of participation (not necessarily level 7 but high enough) I think we start pushing requirements for notification. In here somewhere is the HIE and further improvements so providers have the data they need for proper care. I’m not a big fan the big brother monolithic system run by the government. I’m not sure we need that either.

    • February 14, 2012 at 6:07 pm #

      Yes, tough problem…how to get the ball rolling without creating bureaucracy.


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