Government Health IT editor Tom Sullivan recently moderated a Tweet chat, hosted by HL7 Standards, and asked HIT observers and participants about the recent hubbub over EHR and upcoding, meaningful use and IT staff shortages, questions for the presidential candidates and more.

Since Twitter preserves well, here’s a compilation of the discussion:

QUESTION (via @HealthStandards): A series of media reports on EHR-linked upcoding has kindled a debate about potential upcoding and whether or not the nature of EHR leads to upcoding, or even fraud. Doesn’t a digitized health system help prevent coding transgressions and especially fraud?

EMRAnswers @HealthStandards #HITsm This has been around since EMR sales people first mentioned it! Ability to fraud is always there- digital or paper

DrNanN T1: I know it's cliche, but garbage in=garbage out. Does provider code or does the #ehr code?

cardiologyHIT A1: I think it is just easier to spot now that we are using EHRs. I think instances fraud will decline because of high visibility

EvonyDossier Our EHR has increased visibility of potential risks and threats.

GovHITeditor And what of the nuanced differences between upcoding and all-out fraud -- do EHRs matter there?

Tony_Curcio @cardiologyHIT in order for high visibility a high level of transparency must also be put in place.

MalloryKSavoie I think the issue is a lack of clear guidelines about coding

ehrandhit EHR holds u more accountable than paper. RT@evonydossier: Our EHR has increased visibility of potential risks and threats.

EvonyDossier A1: Simple answer, if you have solid F, W & A programs in place, upcoding will not be an issue

jonmertz @MelissaColeHTR @GovHITeditor: With the coding being in an electronic form vs. paper, would system have more checks? (analytics)

CLOUDHealth @jonmertz this is why CLOUD thinks about people. WHO touched my data gives context. Coding alone not enough

QUESTION (via @HealthStandards): 59 percent of IT executives say staff shortages harm earning of Meaningful Use incentives. What’s the long-term impact if HIT education lags demand?

EMRAnswers @HealthStandards #HITsm It is difficult MU 1 was: Staff up early, prepare, postpone, repeat. MU2 may be more difficult bc of ramp up.

Perficient_HC RT @VoceraCom: @HealthStandards A lack of educated#healthIT staff will eventually stagnate innovation which may hinder patient care

Omnicell Our employees closely listen to clinicians on the front lines. W/o enough clinicians, this loop of communication would stagnate.

motorcycle_guy I guess I'm not seeing the HIT staff shortage as being the problem so much as the pace of MU itself.

cardiologyHIT Maybe a lack of educated healthIT staff will draw innovation from techs in outside industries who will adapt outside technologies

juliaweatherby Lack of educated #HealthIT staff could lead to significant downtimes, security breaches, lost or inaccessible patient data.

jptingle The tech world in general seems perpetually short of trained staff and that hasn't slowed down innovation

MelissaColeHTR @GovHITeditor Yes, we are seeing it already in the field. Clients challenged to make deadlines w/current talent & resources

CertifyData @HealthStandards W/ insufficient educated HIT pros, implementation of the innovations will likely be slowed, slowing MU progress

theEHRGuy What's really hurting everything is that #HealthIT is being treated like a bubble and healthcare orgs are being reactive.

DrNanN @CertifyData @HealthStandards There are plenty of well educated unemployed IT pros that want to work in healthcare.

motorcycle_guy @theEHRGuy Hard to argue that it isn't an artificially created bubble. Will it continue after incentives disappear is my question.

ehrandhit Does anyone think the feds' HIT education programs have moved the needle in any way shape or form?

Cascadia I know many people who have done multiple EHR implementations and can't get hired as they lack certification in new module

PerminovaCardio bubble? incentives and penalties should last long enough to bring new generation of clinicians who expect good

Cascadia Many people who work in #healthIT are project based and lack health insurance - including many jobs at ONC

motorcycle_guy @GovHITeditor MU cycles mean that almost as soon as providers are done implementing one stage, it's time to start planning the next.

jonmertz @GovHITeditor Recent stat: 50% of hosp IT depts have open positions they have been unable to fill for more than 3 months

QUESTION (via @HealthStandards): What would you ask Obama or Romney about Health IT, the ACA or healthcare in general during the Oct. 3 debate?

motorcycle_guy @HealthStandards I wouldn't ask either candidate about Health IT, I don't think they are qualified, and at least one knows it.

leonardkish I'd ask how ACA will lead to more personalized care. If it doesn't, what would?

ehrandhit I'd like to hear Romney address which parts of Obamacare he'd like to include in the "replace" part of his Rip and Replace plan.

motorcycle_guy T3: On reform or healthcare in general, I don't know of a relevant question that I couldn't already predict their answer to.

jonmertz T3:Would ask if they have a PHR. Also, what apps are they using to manage their personal health? Going for the personal angle

PerminovaCardio t3: What's the difference between Obamacare and Romney care? Really?

MalloryKSavoie T3: How will you educate the general pop., especially millennials, so they understand exactly what's changing and get them engaged?

Tony_Curcio A3: How will you ensure that my kids kids will live longer than their parents?

CLOUDHealth how can we engage individuals not just in their own health decisions, but costs, to bend cost curve down?

MelissaColeHTR What would it take to move from healthcare nation to a health focused nation?