IBM developerWorks invited me to write an article that provides a technical overview of the National Health Information Network (NHIN) along with its related sub projects called NHIN CONNECT and NHIN Direct. The article was published today and covers how you can use CONNECT right now to create your own health information exchange (HIE) or connect to an existing HIE. In the article I also discuss NHIN Direct, a new project without immediately usable code yet, which you can use it to push or pull data from your medical systems to other healthcare systems directly (without necessarily going through an HIE).

The article contains the following information:

On July 14th I conducted a seminar on How Meaningful Use Impacts Healthcare Data Management and IT Professionals. It was pretty popular and I got lots of questions at the event and many afterwards as well. One of the questions that kept coming up over and over again was about how to enter the healthcare IT field. One really good question was about certification and what i thought about it — here was the gist of the query:

Since you have tremendous knowledge of the HIT environment, what do you say is the general benefit of attaining various IT related certifications aimed specifically at HIT.  For instance, although I have graduate degrees, I am a relative latecomer to HIT.  I keep reading of RHIA, CISSP, CISM, CPHIMS, CHPS, etc. and wonder if they have real value in the world of HIT.  As an aside, I am trying to quantify a broad general IT experience into marketable certifications by obtaining A+, N+, and SEC+ in the short order.  I have played with the idea of obtaining PMP since I do quite a bit of project directed activity.

Basically, the questioner asks “is it worth getting certifications?” I’m not responding below to any specific certifications but the broad idea of any technical certification.

My take on HIT (or any IT) certifications is that they will never do any harm — but you won’t get a job because you have a certification. In my years as a software engineer, technical manager, and technical executive I’ve interviewed and hired hundreds of people for many IT- and healthcare-related positions and I can’t remember one time when I hired a person because of a certification.

The reason why certifications aren’t held in very high regard by practitioners like myself is that you can pass a test (any test) without actually having the requisite knowledge necessary to perform those same tasks in the real world. Certifications don’t guarantee any knowledge but do provide a modicum of evidence of basic understanding of a subject matter. I think of it more as a low-water mark and not real expertise or experience — that can only come with actual projects under your belt.

My simple view of the world is that you need certifications on your resume if you lack experience or need to make yourself stand out; if you have experience in a field that will speak for itself and you won’t need the certifications. Expertise and experience are really what employers are looking for and they are struggling to get enough information from prospective employees and that’s why they put the certifications requirements in job postings; what we’ve found, though, is that certifications don’t imply expertise and they certainly don’t imply experience or the ability to do any particular job in a meaningful way.

I recommend employers not require certifications in their job postings — it’s more likely that you’ll lose qualified and experienced applicants rather than gain them. That’s because the more experience and expertise a person has the less likely they are to actually have professional certifications (because they don’t need them).

So, what’s the answer to the question “is it worth getting certifications?” — my advice is that if you have the time and money to get certified don’t give up the opportunity. Go ahead and get it, it never hurts. If you’re not an expert in healthcare IT, here are some ideas that could get you started in our field:

• If you’ve got experience running or working in a medical office or you’re an experienced project manager you can apply for an implementation specialist or assistant at almost any healthcare IT firm like an EMR or EHR vendor, consulting firm, or systems integrator. The thing to keep in mind is that every customer that buys an EMR needs to have it installed and deployed and that’s done by implementation folks. There is a shortage of people that can take complex products like EHRs and EMRs live.
• If you have a little or a lot of general IT experience but no healthcare IT experience you can start by working in a technical support or training capacity. You would get the opportunity to learn new products and use your IT experience to provide customer service, support, and training talent.
• If you’re interested in the software side you can think of being a tester of software; vendors need good quality assurance and configuration management personnel and that’s a great place to begin your healthcare IT career.
• If you’re good at writing, consider joining the documentation team for creating training materials, videos, screencasts, or other related artifacts necessary to teach people how to use healthcare IT.
• If you’re a developer interested in writing software but you’re not experienced in healthcare, join one of the many open source projects that are out there building open source EMRs, EHRs, PHRs, and related tools. Open source is a great way to join a community of people willing to help you if you’re willing to give back to them, too.
• If you’re an integration specialist (you know EAI, EDI, EII, ETL, ESBs, or other integration techniques) start to learn HL7, CCR, and CCD and you can write your own ticket almost anywhere. The majority of healthcare problems in the IT arena are integration and deployment problems so if you know scripting and HL7 you’re good to go.

What if you can’t find a job because you don’t have enough experience and no one will hire you due to lack of experience? Well, then find one or more open source projects where you can help with documentation, training materials preparation, quality assurance, software code, design, configuration management, or a host of other tasks. By working on an open source project you will get the experience you need without having to be hired by someone. Then, you can use that on your resume to show that you’ve got capabilities because projective employers can actually download and see what you’ve done.

Don’t forget, if you’re looking for EMR and EHR buying advice check out my free resources.

As promised, NIST has released its revised draft test procedures to adjust to the final Meaningful Use rules that were unveiled last week. Here’s how they describe the latest updates:

Approved (Pending) Test Procedures
A Final Rule on an initial set of standards, implementation specifications, and certification criteria for adoption by the HHS Secretary was issued on July 13, 2010. NIST has completed its revisions of the draft test procedures to adjust to the Final Rule. These test procedures have been provided to ONC for the National Coordinator’s approval for use under the temporary certification program by ONC-ATCBs. The test procedures will retain the “Approval (Pending)” status until formally approved by the National Coordinator.

Check it out. There’s enough to actually start making your code changes so if you haven’t started already, it’s time to get going.

Don’t forget, if you’re looking for advice on buying an EMR, check out my free resources to help you make your decisions.

NIST just posted the following on their Health IT Testing and Standards draft test plans page:

July 19, 2010 Note: A Final Rule on an initial set of standards, implementation specifications, and certification criteria for adoption by the HHS Secretary was issued on July 13, 2010. NIST is currently updating the Test Procedures to reflect the Final Rule and anticipates publication by July 22, 2010.

NIST’s test plans are what will be used by the certification bodies and form the basis of what really will be required in EHRs so it’ll be important to keep any eye on these. NIST still doesn’t have an RSS feed for their site but I’ll continue to post updates as I see them.

As you’re probably already aware, the final meaningful use rules were released by the government about 48 hours ago. Overall, I’m impressed with the transparency, quality, and timeliness of the final regulations. I think the “little guy” won one because the MU rules have mostly been reduced from the original requirements and the two additions are relatively easy. While I don’t think we should be doing any top-down initiative like MU, given that it’s the law, HHS, CMS, and NIST is doing as good a job as they can in writing the rules and attempting to make them understandable. I’m especially impressed with NIST’s draft test plans and directives which should ease the certification process for techies like me.

We’re still months away from any systems being certified for MU because NIST still has to update all of it draft test plans to match the final rules, the certifying bodies have yet to be selected, the certifying bodies haven’t prepared their test processes and plans, and the certification bodies haven’t finalized their certification requirements. My guess is that vendors will not be able to submit their products for final MU certification until September or October and that the first certified-versions of the products won’t be released until late this Fall.

Many readers have been e-mailing me about “what should I do now?” and my answer is simple:

• Don’t be in a hurry to make an EMR/EHR decision because of incentive payments; even if you start in 2012 you’ll be eligible for full payments from Medicare ($44k over 5 years) and you can start as late as 2016 to get full payments from Medicaid ($66k over 5 years). If you’re making EHR/EMR decisions based on other business benefits and not incentive payments then you should continue that research and decision-making process.

• Do be in a hurry to use technology that helps with office automation first (like document management, patient relationship management, etc.). General office automation technology won’t qualify you for incentive payments but it will help reduce your costs and you’ll run your business better. If you use the proper technology you save more in one year than you’ll get back from incentive payments in 5 years.

• Make sure to get your MU and certification information from the most trustworthy place: the government’s website at http://www.cms.gov/EHRIncentivePrograms. It’s not that other sites (like mine) would deliberately mislead you but government regulations are so new that there are no experts on those rules so anyone saying they “know” what the government expects is probably not correct because even government officials don’t know all this stuff. Whatever you’re told, always try to bounce it off the government’s site and for those that give you advice have them source their knowledge from official guidance or regulations and prove to you that they’re correct. The government doesn’t hide regulations, it’s all public and transparent and anyone providing advice should be able to quote it appropriately.

Lastly, don’t forget that there some nice sites that are providing good free “EMR decision-making” guidance. Check them out.

I’ve been doing a good deal of coaching and consulting on what Meaningful Use really means to technology professionals lately so I was pleased to accept an invitation by Embarcadero to lead a webinar on that subject for a data management audience.

Join me next Wednesday at 2:00p EDT to learn about the impacts of meaningful use and certification of electronic health record systems to data management professionals. Learn what healthcare Data Management Professionals need to know about achieving HITECH meaningful use and certification beyond the obvious list of MU requirements.

In this one hour webinar, you’ll learn:

• What ARRA, HITECH, Meaningful Use (MU), and Certification mean
• How technical personnel such as data architects, DBAs and developers will be affected by MU
• The best ways to determine the MU gaps that might be found in existing systems
• Additional expertise technical personnel may need to meet MU
• How quickly systems will need to be modified and deployed to meet MU rules

It’s free to attend and you’ll receive a companion white paper I wrote as well, register for it here.

A doctor friend of mine and I were talking about our HIMSS trip and how many physicians told us were getting “sick and tired” of the business of medical practice. I spoke with a number of docs there looking to get out of medicine and into technology, marketing, management, or other fields. I thought for sure that there couldn’t be that many physicians looking for a career change.

Boy, was I wrong. Another physician buddy of mine sent me a note about the MedicalFusion Conference being held November 5-7, 2010 at the Wynn Resort Las Vegas (it was previously set for September in San Diego). The whole purpose of the conference is to help physicians who are looking for a career change. Here’s what the organizers said about the conference:

Physician career change is the focus of the Medical Fusion conference. Non-clinical jobs, medical journalism, medical informatics, physician entrepreneurs, medical device development, and venture capital are all topics that will be covered at this exciting new event.

Whether you are a medical resident who wants to learn about all of the possibilities available to you or a retired physician looking for entrepreneurial side ventures, this is the conference for you. Come to Medical Fusion and get the tools necessary to take your career to the next level.

Medical Fusion is for physicians interested in exploring non-clinical career opportunities. Designed to teach physicians how to leverage their medical training and expand their careers, participants receive training from experts with practical knowledge on a variety of non-clinical subjects.

Medical Fusion is designed as a “tool box” for the modern physician. Clinical physicians today need to know how to leverage their clinical training in new and unique ways. Medical Fusion provides broad exposure to a variety of niche areas, leaving participants with practical steps to begin crafting the career they’ve always wanted. Come learn from physicians who’ve already developed their own unique careers.

Medical Fusion:  a new medical event for physicians, by physicians.

I found the idea of this conference so fascinating that I’m planning on attending. I hope to see you there.

One of my favorite new blogs is healthsystemCIO.com. There is some terrific reporting and more importantly unique and value-added coversations going on between healthcare CIOs. I ran across the recent “Dissecting Physician Resistance to CPOE” posting and thought it was worth sharing. Timothy Hartzog, M.D., Medical Director of IT, Medical University of South Carolina said the following about how implementing Computerized Physician/Provider Order Entry has unintended consequences but all the lessons are applicable to any clinical automation. Here’s a flavor of what he said:

Implementation of clinical informatics creates emotional aspects and unintended consequences, such as the following:

• More/New Work for Clinicians – work unit secretaries use to do, now requires physician time to complete

• Unfavorable Workflow – hard stops in CPOE are just a bad idea and lead to angry physicians.

• Never Ending Demands for System Changes – physician hate when the user interface changes too often, so have an educational plan for when changes are made.

• Problems Related to Paper Persistence – many complex items like TPN, CHEMO, etc., must be ordered on paper.

• Untoward Change In Communication Patterns and Practices – with CPOE, physicians can enter orders from anywhere in the hospital and the nurses never know.

• Negative Emotions – when Computers do not work at stressful moments, physician get angry.

• Generation of New Kinds of Errors – computers can change how meds are ordered, and confusing interfaces can lead to mistakes.

• Unexpected and Unintended Changes in Institutional Power Structure - physicians have always prided themselves on being able to treat patients their way. With CPOE, physicians are forced to use certain meds and protocol restrictions.

• Over-Dependence on Technology – one of my rules to all clinicans is: “IF the medication dose does not look right, it is NOT right until to prove otherwise.” Just because it is on a computer screen does not mean it is always correct.

• Shifts in Power Control and Autonomy – power shifts to committees like Pharmacy and Therapeutics, Medical Directors etc. Physicians loose the freedom a blank sheet of paper provides.

It’s a great posting and worth reading.

I was pleased to see the following website being launched recently:

http://www.cms.gov/EHRIncentivePrograms

If you’re looking for a “just the facts ma’am” style of answers to your frequent questions about HHS’s EHR Incentives program (the ARRA HITECH stimulus bill) I would recommend starting there now.

For example, here’s what they say about the certification program:

How Certification is related to the EHR Incentive Programs
The EHR Incentive Programs require the use of certified EHR technology, as established by these new set of standards.  Existing EHR technology needs to be certified to meet these new criteria in order to qualify for the incentive payments.

NOTE: Currently, there are no certified EHR products that meet the certification requirements for this program in order to receive an incentive.

Timing of Certified EHR Technology for the EHR Incentive Program
Once released, certification bodies will be established to test and certify EHR technology for the EHR incentive programs. In addition, vendors will definitively know the standards and criteria for certified EHR technology, and they can make adjustments to their products to include the required specifications if their products do not already include them. Upon the “opening” of the certifying bodies, vendors can submit their EHR products to be tested and certified. Hospitals and practices who have developed their own EHR systems can also seek to have their existing systems tested and certified. Complete EHRs may be certified as well as EHR modules that meet at least one of the certification criterions.  Once a product is certified, it will be published on the ONC web site. This is expected to start in fall 2010.

REMEMBER: You do not have to have your certified EHR in place by the launch of the program in order to participate.

Now when a vendor or consultant starts to spout off inaccurate data about certification, point them to the official website and let them know they’re lying if they say they’re certified. I’m seeing many unscrupulous vendors write things like “we’re CCHIT certified so we’re already certified for meaningful use.” HHS has made it very clear that CCHIT certification is not being grandfathered and it has no bearing on HHS certification so customers need to be aware of that.

Not everybody is jumping on to the ARRA HITECH (stimulus bill) bandwagon and installing EMRs and clinical software, but many are. There are many problems that are difficult to solve before you implement EHRs and EMRs — like getting optimal data entry procedures, working out the proper codes, setting up the right workflows, etc. However, one major problem I’ve seen during my recent installs, which is readily solvable using technology, is that networks often aren’t ready for the software. EMRs are bandwidth intensive and take up lots of space on a network due to large documents, images, etc. Having proactive networking monitoring in place before you install and then watching the network for bottlencks after installations is crucial. To help discuss some techniques, I invited folks from Paessler (which focuses on network monitoring) to tell us what they recommend. Here’s what they shared about one of their clients:

As one of the leading cancer treatment centers in the United States, Wilshire Oncology Medical Group operates seven clinical treatment centers throughout the Los Angeles area. The company’s leading-edge treatment practices are supported by its state-of-the-art information technology network that includes fully-electronic patient medical records, as well as a group-wide practice management system delivered as a Software as a Service solution. Given that they’re so dependent on electronic communications, small network problems or any IT failure can have a direct impact patients’ care and comfort.

Wilshire put in place a network monitoring system to help predict uptime, quality, speed and reliability of critical data connections between its corporate headquarters and 10 remote facilities. By understanding what ‘normal’ usage looks like, they are able to spot any abnormalities, identify the issue and remedy it before it causes a problem that affects patient care. It’s something that all healthcare organizations should be doing.

With 283 remote sensors deployed across the company’s network, Wilshire Oncology can monitor the network not only for Internet connectivity and VPN connections between the corporate offices and remote locations, but also the speed and reliability of connections with its third-party vendors, battery backups, 16 physical servers, 9 virtual machines and even some individual workstations.

Each remote probe reports data to the main monitoring console on a Dell PE1850 server, running Windows Server 2003 R2 x64. The data is compiled into an easy-to-use graphical snapshot of the entire network’s performance. From the main dashboard, the IT Director is able to drill down to examine specific details about particular components.

A built-in automatic reporting system delivers specific reports via e-mail to Wilshire’s IT Director on a daily, weekly and monthly basis to help him keep track of normal operating status and spot any abnormal trends. In the event of a problem, he can use the network monitoring solution to generate a report illustrating the memory usage on a server or decreased transmission speed, for example, and supply this data via email to the vendor for troubleshooting purposes.

Meanwhile, in the event of an actual outage, network traffic slowdown or any other noteworthy event, the system automatically alerts Wilshire’s IT Director via e-mail, SMS, or pager so that he may begin to immediately diagnose the problem. With multiple locations and limited resources, this allows him to work much more efficiently to resolve issues, saving both time and money in troubleshooting, travel and even hardware/software upgrades.

Network monitoring allows Wilshire to stretch its technology budget, as well. Although it is primarily used for server and network monitoring, they’ve also used it for temporary monitoring of troublesome workstations. In one case, the solution helped IT staff to determine that a problem was caused by too little RAM in the machine – a problem easily and affordably corrected by adding more memory rather than upgrading the entire workstation.

As medical offices continue to embrace technology, there is a growing demand to ensure the most efficient use of that technology. Network monitoring can help healthcare organizations identify real needs, justify the costs of upgrades, and decide where to make IT investments that will do the most good.