Mark:
Hi John, welcome to our podcast. Please give us a little bit about your background, your education, experience and current responsibilities.
John:
I’m a tech guy by background, although each day I kind of lose some of my tech skills even though that’s my education, that’s my background. It is where it all started but essentially, I got hired at UNLV to implement their electronic medical record. As a tech guy, I got hired to pour it into healthcare. In fact, during my first EHR training, the person that was training wasn’t teaching me software I already saw all the fields are yellow those were required fields instead she was saying here’s what CPT code is. I just had no clue about healthcare, but I understood the technology so that was kind of my baptism by fire into healthcare. Then one weekend I was bored and what do tech guys do on the weekend, I rolled out a website about electronic medical records. The original site was called EMR and HIPAA 16 years ago and I rolled that out. Long story short, Obama gave $36 billions of stimulus money to EHR. I quit the day job about 12 years ago and I have been full-time with Healthcare Scene as my company today. This includes two communities a Health IT Community at Healthcare IT today, and we also have a healthcare marketing community now at hitmc.com.
Mark:
Excellent John what are the top electronic medical record implementation challenges that you see and how do you work to overcome them?
John:
When I look at EHRs or EMRs, depending on who it is, I think we use those synonymously now. When I look at it, I think the biggest challenge that everyone faces is there’s way too much regulation. Of course, Healthcare is a regulated industry in general. However, when you look at the regulation requirements for EHR and then you layer on top of that the reimbursement requirements as far as the documentation that’s required to get paid, all of that makes EHRs tough. Everyone always comes with, ‘I wish Apple would create their own EHR’ and I hear that and I’m wondering if that is even possible. Is the problem that they implemented it poorly? Let me be fair, EHR vendors could do better than they’re doing today as far as usability and some of those things. But let’s see Apple or Google or Amazon or whoever gets into that, and they look at it, my question has always been can you implement an EHR that a doctor loves when there are so many regulations and so many reimbursement requirements? So, when I look at it and I said you know I hear doctors say I hate the EHR. I always ask him the question do you hate the EHR or do you hate the regulation and reimbursement requirements that the EHR reflects it turns out doctors like to get paid. I think that is the biggest challenge that we have today: that these EHR vendors were created as big billing engines that’s what their intent was. Their intent wasn’t I want to provide better patient care and I want to facilitate the doctor to be able to provide that care in a more efficient manner. No they were built to I want to get paid easier better etc., and I want to meet regulations and meaningful use requirements which became macro myths. When I look at the challenges it’s all the burdensome regulations and reimbursement requirements that the doctor hates and are reflected in the EMR.
Troy:
How is implementation coming along in this country? I know it’s been a number of years and there have been deadlines set, then missed and more. Where do we stand right now?
John:
The good news is that $36 billion of stimulus money got us where we have adopted EHR. Everyone has either decided I’m going to adopt or I’m not going to adopt for whatever reason. Maybe they’re in a rural environment and they really don’t have to. There are a few edge cases but for the most part, we’re in the mid-90s for hospitals. Regarding the adoption of EHR, there are only a few stragglers that just can’t for whatever reason. On the hospital side, we’re near 100% adoption as far as anyone that’s going to adopt. On the ambulatory side of things, it’s a little further behind it’s closer to around 80% less numbers than I’ve seen. So somewhere in that neighborhood, 80 might even be getting closer to 90 now. But there are some on the ambulatory side who have more autonomy where they can use paper charts, they’re like fine I just won’t take Medicare. If I don’t take Medicare, you can’t penalize me which is how they drove much of the initial adoption. The reality is we are at a point where we are near full adoption of EMR and EHR in both the hospital ambulatory space. Post-acute cares are a little bit further behind since they didn’t benefit from the stimulus money as much. Mental health is a little further behind as well. On the pure clinical ambulatory hospital side, it’s near adoption. The real challenge is, it was adopted, and, in many cases, it was slapped in so quickly because they were chasing the stimulus money that now our question is, how are we going to optimize this? The reality is that many doctors don’t want to take the time to optimize it. You can’t just roll out an EHR and use it out-of-the-box the way you can your iPhone. It takes some customization; it takes some personalization to make it hum at the efficiency that you want. There’s been a lot of studies that show, that if you spend the time to optimize it, you increase your satisfaction with the EHR dramatically. There are a lot of people that don’t want to do that, and they just suffer through it. It is an unfortunate situation, but to be fair there is a lot of optimization and personalization and customization that could still be done, and will be going for the next decade.
Troy:
We’ve certainly seen that in our careers just with the integration of the EHR piece with medical devices it’s a new technology that has come on the scene very quickly. Are you finding that people are somewhat resistant, do they still have a kind of a phobia of working with it or have they pretty much embraced it at this point?
John:
With EHR they really haven’t had a choice. The government stimulus money was louder than any of their voices and they had to push it in. But the reality is no one likes to change. We were creatures of habit for the most part and when you introduce new technology it is going to change that habit, it is scary. In some cases, many people have said, ‘hey I really hate this piece of software’ or ‘this technology that I’m using but at least I know that devil’. It’s the devil I know, the intricacies. I know where it falls short. I know how to work around it etc. I think that’s what we see, but in organizations, people are just resistant to change. Even something that may improve their lives they fear it. They are scared for a lot of different reasons some of it is they are scared for their work life. Introduce AI and automation to a workflow, a lot of people when they hear that think, is my job in jeopardy, what does this mean for my job and am I going to enjoy my job? The good news is we have seen a bit of a shift thanks to the workforce issues that have presented themselves because of all the burnout that’s happening because of COVID, and the ability to work remotely. Now many people are doing three- or four people’s jobs. Whereas before they thought ‘are you going to take my job?’ Now they are thinking, are you going to take my job? Instead, it is, are you going to take one of the other jobs I’m doing because we can’t hire someone? There has been more acceptance of this automation and this opportunity to use technology to cover some of the services that previously people would be very afraid. This technology is making people more accepting because they realize that they need to be more efficient, and they also realize that automation is going to take away the mundane tasks that doctors don’t want to do. The front desk staff do not have time to do it either, so if they can do it, that’s a big win. They want to operate at the top of their license so that they don’t have to enter data from the device they just used to take your blood pressure. Who likes to do that? So we want to create an interface that automates that information so that it is automatically entered into EHR. This is to say that it is faster and more efficient.
Mark:
Is training still a time-consuming problem? I know, with so many different platforms out there, we’re here in Kansas City we have Cerner. Are they working together some of these EHR’s are very similar and can be cross-trained with a lot of different people?
John:
You would think so. Fortunately, when you learn one EHR there are some parallels and if you know the technology you can learn it easier. But the reality is that training has become an issue because of the staff loss. If I bring in staff more regularly because I haven’t retained them because many people decide to move on due to pressures, staff or some doctors are beginning to feel they are done with medicine due to burnout. As a result, you have this churn of staff and that is where the training becomes an issue. Especially in EHR, they know how to use it if they’ve been there for a while. The problem now is customizing the experience for that person. There are all sorts of organizations that have teams that are similar to SWAT teams. When they go into a certain department or even a clinic, they ask, “How are you using the EHR?” They’re learning how they’re using it and they’re saying well did you know about this or oh why are you doing that? I want to customize that and save you some time. Many of the efforts are around customization now for the end users. Knowing how they are using it and how can we improve it for them versus training. The only caveat is that we are having a lot of staff turnover and when they’re staff turnover you got to retrain them. Even within the same EHR, you may have implemented templates and someone else didn’t implement templates. You may have order sets that are different from someone else’s order sets. You may have voice recognition, but someone else doesn’t and so even within the same EHR you must go through a training process. If there’s turnover and that’s a big problem, people must deal with it.
Troy:
Absolutely and you know I hear the word customization coming up a lot, it sounds like you need a bespoke solution that is appropriate for your environment. I wanted to ask with all the medical devices out there currently, and all of them are trying to become EHR compliant. What challenges does that present for you, to reconcile so many different companies and different brands?
John:
When you look at EHR vendors, you are right there has been an explosion of medical devices, some which are FDA cleared, some consumer – it’s all over the place. It is exploding and what’s considered a medical device is changing as well. I would say the challenge is that they are the breadth of medical devices has exploded and what’s connected and what can be connected has exploded. The other problem is that explosion makes it not evenly distributed. Some new devices are Wi-Fi enabled or can be connected. That way there is an entire company that created black boxes underneath the hospital bed to connect these medical devices that weren’t originally intended to be connected. So you have this old devices, new devices and it becomes a challenge. I think the good news is if you use something like HL7 then you’re fine every EHR vendor can do HL 7 and that’s a pretty mature standard that can share that data. If you’re building a new device that’s a problem if you want to do something that is more API based. We have seen the evolution of fire going in that direction as well and they have smart on-fire applications to be able to do it. I think what is interesting is everyone wants to connect medical devices; the question is how do we do it? We need to figure out what is the right pathway forward and how I support the legacy that we’ve been doing which is HL seven or EDT. Most healthcare organizations have an integration engine as well. Are they intending to do it with the integration engine integrated into the medical device or am I going to go straight to the EHR? The problem is not that you can’t do it with a medical device, you can. The problem is, there are ten options, and each vendor wants to do something a little bit different. I think it’s more the breadth of options that should be more of a challenge than the fact that I can connect it. I will say, one caveat as far as integrating, is if you intend to put data into the EHR there are a lot of standards for that. If you want to share like here’s the result and whatever right if you would like to pull some data from the EHR it’s okay, but if you really want to deeply integrate with the EHR and you want to update a record you know around it then that can be challenging right so if you’re just pushing a PDF / if you’re just pushing the result we can do that. But if you want to get deep into the heart of the EHR and update that in real time for the doctor that can be challenging.
Mark:
I can understand that a lot of our reports on our spirometers are PDF files and we try to make it as simple as possible so that they can integrate. I think that if you try anymore it gets in the weeds. Is data privacy a problem and in our hospitals and clinics still combating hackers? I know this week, I got snagged on an internal phishing e-mail and I had to do the retraining. What is going on with the hospitals today?
John:
I think it’s interesting, we’re talking medical devices that’s probably one of the biggest challenges because there’s been an explosion of those devices. These devices however aren’t being updated. They are not getting the security updates that they need. They must do all sorts of crazy limbo to create special subnets that are off the main network. To allow for this old device when it is running on Windows 2000 or like be able to do what they need to do. You look at the likes of the EHR and wonder if it is going to be hacked. The answer is probably or is your Salesforce system going to be hacked, probably not. But is your medical device going to be hacked and then through that they can get access to your EHR they can get access to your ERP etc?
Hackers are not stupid. The walls on hacking software directly are hard and they are high, so what do they do? They do two things; they will hack the medical device which will then give them access to your network to be able to access there. The other problem as you mentioned is phishing attacks. It is much easier to compromise someone’s credentials and now I have access to EHR, and no one even knows about it. That is where they’re heading. Hackers take the path of least resistance and if you put up walls enough that look too hard, I’m going to go somewhere else. Like a river, they just run to whatever path is easiest. The reality today is medical devices and humans. I heard one CIO say he was worried about his 21,000 points of vulnerability and he was talking about his 21,000 workers. Our challenge is how you know and interesting enough you could apply that to devices and connected networks.
We saw what happened when Cronus had ransomware. It was compromised they didn’t know how to even pay people. That became a big issue for these organizations and so I think they all must look at this. They should have a plan and a culture of security whenever they adopt. Whether it’s a medical device, whether it’s new software, whether it’s even just training their staff on security, it’s a massive problem.
Troy:
I can tell you as a medical manufacturer and we’ve certainly seen the FDA raise their scrutiny significantly when you are putting in 510K approval, I think you are right on track with that. We understand that you have a podcast of your own so I was curious if you could tell us a little bit about it and what prompted you to create it.
John:
I started blogging 16 years ago. At one point we were up to 15 blogs. They just proliferate as you start one. It is like an addiction. Luckily, I am down to two now, but the same thing happened with the podcast. We have three podcasts on healthcare IT today. Each with its own unique spin and I thought about doing a podcast for years. Obviously with blogging for the last 16 years and publishing 15,000 articles, there was always that idea – should we do a podcast, should we do it and I always resisted it. The cost to create content for the podcast was just expensive and I didn’t think the juice was worth the squeeze. It was a lot of work and I’m already doing it in the text why do I need it? But what we’ve seen is that social media companies are pushing video in a massive way.
People want to consume video in a massive way on their phones as they are travelling in a podcast as video. We saw that as an opportunity and COVID really pushed us over the edge. To be frank, we’d started one of our podcasts before that but once COVID hit we decided to do 100 interviews in 100 days. It probably took more like 200 but we ended up doing them and 75% of them the video. Once we had that content I thought, why don’t we publish this as a podcast? We already have all that, we’ve done the hard work, we’ve recorded the content so let’s push it as a podcast. As I said it just grows over time. We are up to three podcasts with over 400 episodes that we’ve published across the three different podcasts on healthcare IT today.
For me though, it’s amazing to be able to talk to smart people and hear the stories that they experience, what they go through and how they’re using technology to improve patient care. This is what I love about it and that’s what I think the people who listen love hearing. All the innovation, what’s happening in healthcare technology.
Mark:
Have you guys tried any transcription of some of your podcasts and published them that way at all? We started recently. We partnered up with the Respiratory Therapy Magazine and they are starting to publish some of our top podcasts as interviews in their publication.
John:
They are testing it right now. We have done it to a handful of ours and we want to see what their search engines are like. I think we will with most of our paid podcasts at least through the paid ones we’ll probably do a transcript because it’s nice to have. It is great for people to be able to read through if they are in a meeting or in a place where they can’t listen to or watch the video. It is nice for them to have the transcript there. We have done it with about 5% of our podcasts right now. We are evaluating to see if it is good for search engines so that more people can access our content. Two we know it’s great from a usability perspective as it is easy to access.
Mark:
Do you want to tell our listeners how they can access your podcast? What audience are you trying to connect to?
John:
The best place to go, you can go to the Healthcare Scene is the overarching company to healthcarescene.com and which links to our health IT community at healthcareittoday.com, on the right sidebar you can find the three podcasts. You can search for healthcare IT today on your favorite podcasting application as well. On our healthcare marketing side of things, you can go to hitmix.com which is our Healthcare and IT marketing community. There are links to our conference. We do an annual conference with them. It also leads to a lot of content on healthcare B2B marketing, if you’re interested in that and then search for John Lynn on LinkedIn. It is easy to find or even on Twitter if you’re on Twitter. I’m @techguy, easy to remember and find. I am always happy to connect with people and learn more about what they’re doing.
Mark:
Great John thank you. This has been really enlightening and we appreciate you being on our podcast.
John:
Thanks for having me on I really appreciate it.
