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AZ hospitals get Medicaid Meaningful Use payments

It’s always nice to be reminded that there are concrete rewards to participating in Meaningful Use programs — that the payoff’s not some sort of mirage. Such an example came this week from Arizona, where a wide range of hospitals will soon get checks totaling $15.7 million from the state’s Medicaid program.

Hospitals collecting the Medicaid booty include nine facilities with Banner Health, a multi-state delivery system with thirteen inpatient facilities in Arizona. The Banner hospitals got a total of $12.4 million.

Banner is reaping the rewards of its long-term EMR strategy, which dates back to when it opened Banner Estrella Medical Center in 2005, according to a report in the Arizona Republic.

The health system, which uses technology from NextGen Healthcare, is in the process of rolling out EMRs to all of its 23 facilities. Executives expect that Banner will collect $147 million over the next five years.

Both Banner Estrella and Banner Gateway Medical Center are designed to be paperless, with not only standard EMR technology in place, but also CPOE systems, something which should stand them in good stead as MU demands grow.

The health system has ambitious plans going forward, as well. Once Banner has rolled EMRs to all employed doctors, and portal access to all affiliated physicians, it will migrate to HIEs in Arizona and Colorado through interfaces tied directly into its inpatient and outpatient EMR installations.

Other Arizona hospitals getting Medicaid Meaningful Use payments include Tucson Medical Center, which is collecting $2.4 million. I’m not surprised to read that TMC has its EMR ducks in a row; it’s also established the first ACO in its region and has doubtless been forced to makes sure its data analytics tools are robust.

Money also went to two rural hospitals, Cobre Valley Regional Medical Center and Copper Queen Community Hospital, both of which were paid more than $400,000.

October 31, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Are Doctors Creating Useful Charts In Your EMR, Or Phoning It In?

Folks, tonight I hope to nudge everyone who reads this to realize that they’ve got a problem to solve. The problem: How you’ll get doctors interested in using that pretty EMR you bought. I mean fully use, not just do the minimum, to the point where your institution can do something with the data.

As readers know, data collection requirements are mounting as Meaningful Use requirements phase in.  And patients will get more chances to review that data over time.  You want the e-charts not only to provide a basis for good care, but also meet regulatory requirements, participate in health plan programs and even offer consumers a nice glimpse of reality through soon-to-emerge patient portals.

The thing is, here at HospitalEMRandEHR, we’re hearing increasing noise about doctors who, under tremendous stress, are essentially cutting  and pasting background info into templates.  This is a Bad Thing. Data paired with observations in text areas produces a meaningful package; data packaged with boilerplate language may translate into pages of almost worthless content.

You know, even if your doctors aren’t offering as much context on patients as they used to, the charting they do may be good enough to scrape by and get MU incentives paid to you.  The doctors may still provide enough information to convey the sense of what they did to others, and follow up too.

That being said, it just doesn’t make sense to accept the bare minimum when you’ve spent so much, and ultimately, hope to see clinical improvement as one of the payoffs from your EMR investment. So, bear in mind that you don’t just have to win over physicians to tolerating EMRs — you’d better be sure they’re willing to adapt to EMRs culturally, which means that they figure out how to produce value in an EMR-based record.

If you’re thinking “Hey, I’m not sure how to do that myself,” then figure it out, hopefully after having good talks with thought leaders on your medical staff. Create some standards for creating a rich EMR record and encourage physicians to support their colleagues in creating them.  After all, the last thing you want is to demand one more thing from your doctors if you’re not sure yourself what you want.

October 27, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Data reporting bugs found in GE EMR products

Sure, you’re an IT professional, and you’re not exactly shocked by news that a vendor has found some bugs in its code. (In fact, the more cynical out there probably start to wonder what’s up when they don’t get bug reports.)

That being said, with Meaningful Use at a white heat, this is a particularly bad time for an EMR vendor to find problems with the data reporting functions. Unfortunately for them (and possibly, you) that’s just what GE Healthcare is facing.

Last week, GE Healthcare announced what it termed “inaccuracies” in the reporting functions contained within its Centricity Electronic Medical Record and Centricity Practice Solution products.  The division’s VP and general manager sent out a letter to users last Thursday saying the problems might create flaws in results from SAP’s Crystal Reports or GE’s Medical Quality Improvement Consortium.

While the vendor promises to send out an update that will fix everything by November, right now you’d best not try to attest for MU. Not fun.

Worse, if yo u’ve already attested, GE’s suggesting nicely that you re-run reports for your attestation period and see if you still meet MU standards. Even less fun.

I’m not writing this to wail on GE  – I’m sure execs there are suffering enough  – but to simply give the story a bit more play, as I haven’t seen it tweeted or Facebooked as widely as I’d have expected.

More importantly, perhaps, I though it was worth asking the following. What happens if in the rush to help providers meet MU deadlines, other vendors have made slip ups they haven’t discovered yet? What if other major vendors discover flaws in EMRs that could jeopardize attestations nationwide?

And what do you plan to do, if anything, to make sure you’re not caught unprepared if your vendor has to fess up to serious problems like these?

October 24, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Meaningful Use May Be Slowing Down Hospital EMR/EHR Installs

It’s finally happening. After years of work, hospitals are beginning to qualify for, and even receive, their long-awaited stimulus payments.  On the other hand, having to focus on Meaningful Use seems to have drained a lot of resources and bandwidth away from actual EMR/EHR launches.

Last month CHIME (the College of Healthcare Information Management Executives) surveyed 198 members, representing 656 hospitals across the U.S., on how they were doing with the EMR/EHR adoption process.

CHIME found that the nearly all (93 percent) of CIOs surveyed expected to achieve Meaningful Use Stage 1 during the first three years of the MU program, though many are hoping Stage 2 will be delayed so they can catch up.

It also found that the number of CIOs worried about Meaningful Use has fallen — about two-thirds are still worried, down from 90 percent in March 2011 — and that more than half believe their current strategy and apps will get them there.

Thirteen percent of the hospitals responding received incentive payments during the first year of the program, which began October 1, 2010. Four percent got Medicare incentives, while 9 percent were paid by their state’s Medicaid program.

To date, though, just over half of respondents had registered for stimulus funding, and 26 percent had qualified for payments under HITECH, CHIME reports.

Not only that, twenty-one percent of members hadn’t registered because they hadn’t yet bought or installed an EMR/EHR. (Is it really that early in the adoption process still?) It’s particularly surprising among members of CHIME, who seem to be the types who work for more advanced and progressive institutions.

With a full one-fifth of respondents still fretting over compliance and holding off on EMR implementation, is seems cear Meaningful Use has had a paralyzing effect on the process. While it’s spurred some hospitals to action,  it’s arguably slowed down just as many who might be moving ahead otherwise.

Worries about Meaningful Use have created a big, huge cloud of smoke around EMR/EHR adoption. It’s not enough that hospital CIOs have to worry about getting it done — they have to get it done to the government’s standards.

I’m not taking a position on whether Meaningful Use is a good thing long-term, or whether the short-term goals are the right ones. But I think it’s fairly obvious that MU has thrown a serious monkey wrench into the usual systems adoption process. I suppose only time will tell whether it was worth the expense, pain and delays it has caused. Honestly, though, I doubt it.

October 22, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Soarian: Does Siemens Finally Have an Epic-Killer?

If you search health IT sites looking for gossip and kvetching, you’d get the impression that Siemens’ Soarian EMR is buggy, hard to use and a general pain in the tuchus.  But some of that gossip goes back a few years, and from what I can see, it’s died down a lot. These days, things may be different indeed.

I remember Soarian in the early days when it was first showing off for the HIMSS crowd.  Man, they had a gorgeous booth, all light and silvered glass anchored by an enormous, translucent television screen (yes, you heard that right.) It wasn’t just slick — it looked like a Porsche dealership. When I stopped by, I felt like I should have been in evening wear.

Still, despite the big, big, massive bucks behind Soarian (Siemens AG has a market cap of about $93 billion), to date our friend Epic has won the day often than not. I’ve reluctantly been assuming that Epic would remain on top for some time to come.

But today, I stumbled across a piece of HIStalk chatter from this summer which made me think different.

While most IT posters have taken a gotta-deal-with-it approach to Epic’s antiquated MUMPS core, one took a contrarian view that got me thinking:

“Without a J2EE or .NET underpinning, at some point [Epic] will simply be too difficult to maintain and enhance?)… guessing the logical conclusion is that ultimately Soarian will gain a lead – a sustainable lead – over Epic.”

What gives the comment some kick is that Soarian is creeping up in customer satisfaction. In late 2010, for example, KLAS reported that the Siemens had seen a “pointed increase” in adoption and a nine-point growth in customer satisfaction scores.

Not only that, within a few weeks of the HIStalk posting, Soarian racked up a few more deals which must have brought in several million bucks. Sure, that might be chicken feed to a giant like Siemens, but my feeling is that the product is gaining momentum, and that’s no joke.

Could it be that like it or not, Soarian is the Next Big Thing?  Moreover, and maybe I’m stretching here, could it be the system that steals pride of place from our Epic Systems?

Yeah, yeah, we all know the story of how little old Netflix out-maneuvered WalMart and Blockbuster to carve out an astonishing chunk of the home entertainment market for itself. But let’s face it, that’s a big story because it so seldom happens. Brute force investment usually trumps spunk.

When it comes right down to it, I’m shifting my “gonna win the big hospital business” vote to Soarian. For today. Until something else happens. Oh, OK, I don’t know more than any of you…but the whole Soarian trend’s a bit of something, isn’t it?

October 20, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

HHS To Look At How EMR/EHR Use May Violate Fraud & Abuse Laws

Thought you had your hands full merely installing a multi-million dollar EHR, bringing it up to top performance, training staff members, winning over doctors and bickering with vendors?  Well, guess again.

It seems that HHS’s Office of the Inspector General now plans to look closely at whether EHR use violates fraud and abuse laws in any way.  To me, this sounds like a bit of an institutional turf war — given how long HHS had to get Meaningful Use and other standards developed, wouldn’t someone there have thought this through already? — but it’s nothing to ignore nonetheless.

The news comes with the release of the OIG’s 2012 work plan, in which the agency promises to “identify fraud and abuse vulnerabilities” in EHRs, as well as finding out how certified EHR systems address such vulnerabilities. The OIG also plans to review Medicare and Medicaid EHR incentive payments to make sure they were doled out only to providers meeting Meaningful Use criteria.

One detail worth noting is that the OIG will be looking to find EHR documentation practices that might be associated with improper payments, something the HHS agency had targeted last year as well.

It seems the OIG has noticed, as have many doctors, a growing number of medical records with “identical documentation across services,” rather than documentation specific to the service provided. That is a definite no-no, the OIG reminds one and all.

October 17, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

HIT Bigshots Tackle Post-Hospital Care Coordination, Miss The Point

I’d be a pretty shallow gal, I would, if I didn’t take the problems patients face when transitioning from hospital to another setting seriously.  But I swear I’m not being flip when I say that holding another conference on how HIT can solve the problem is, uh, a bit lame.

The conference in question, which will bring together some bigshots in healthcare policy, politics and health IT, includes speaker spots by Farzad Mostashari, MD, National Coordinator for Health IT, Health Affairs Editor-in-Chief Susan Dentzer and Todd Park, CTO  of HHS. Wow. And that’s just some of the headliners.

The participants will cover some of the critical ways HIT can support seamless transitions from hospitals to a patient’s next location, including standards, interoperability, exchange and Meaningful Use, the event’s press release notes.

OK. Fine. I get it — to coordinate care, EMRs and other HIT systems have to be individually robust and share data fluidly. Providers have to get on board. And it’ll all work if everybody adopts the right technology and plays nicely with their pals.

It’s telling, though, that event leaders aren’t promising much talk on how patients and their families can leverage IT to help make this happen. It isn’t about empowering patients to access their health information, communicate with doctors as supportive team members or even about patient education. It’s all about making sure the machines and software do their job. A brilliantly orchestrated, thoughtfully developed, boundlessly powerful set of machines and software solutions, but technology nonetheless.

So count me as impatient. Until policy types and health IT gurus get their heads out of the enterprise IT, networking and software business, they’re going to talk around the real care coordination issue. And that’s not only a bore, it’s a dangerous waste of time. We’re fighting for people’s lives here.

Hospitals have and arguably have had for some time more than enough firepower to solve their end of the problem. But historically, they’ve done little to involve patients and families in managing their conditions once they’re gone. Discharge summaries are perfunctory at best, particularly given how much info hospitals have at their fingertips, and virtually no education takes place throughout a patient’s visit. Once they leave, it gets far worse. “Out of sight, out of mind” may be a bit too strong but I’m sure you see what I mean.

If they want to be part of the solution, hospitals will need to think about how they can support the patients directly through smart IT use, especially super-smart new mobile options and remote monitoring of chronic or emergent conditions in the home.  Otherwise, patients are likely to remain sick, puzzled and likely to fall between the cracks.

October 13, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

The Argument for Meditech


Guest Post: Jeremy Bikman is Chairman at KATALUS Advisors, a strategic consulting firm focused on the healthcare vertical. We help vendors grow, guide hospitals into the future, and advise private equity groups on their investments. Our clients are found in North America, Europe, and Asia. www.KATALUSadvisors.com

Why Meditech Continues to Be a Force in HIT
Meaningful Use is a load of white noise, and it could be argued has become a load of something else.
While it is true that certain mandates associated with HITECH are meant to help hospitals achieve real and significant milestones, these mandates also tend to skew and confine the scope of conversation to within narrow clinical parameters. Press releases also reflect this, whether it be Epic’s latest win or the newest Siemens Soarian or McKesson Horizon site to turn on CPOE. What seems to get lost in the noise are the thousands of small and mid-size hospitals and the vendors which serve them. These hospitals provide care for a substantial percentage of the population. This post focuses on one such vendor, Meditech, and the reasons behind its strong position in the industry.

Meditech: By the Numbers
Number of Hospital Clients (U.S.): approximately 2,000
Market Share Position by Total HIS/Core Clinical Installs: 1st
HIS/Core Clinical Offerings: MAGIC, C/S, and 6.0 (with 6.0 as the new standard and go-forward platform)

Serving the Underserved
Small and community hospitals typically have had the fewest choices when selecting a HIS or core clinical vendor. This has always been a function of limited hospital budget, limited IT staff, and the limited number of vendors serving the community and critical access hospital space. Meditech radically changed the paradigm by successfully targeting cash-strapped hospitals and delivering a solution which was both capable and affordable. Specifically, Meditech was able to gain a huge client base by delivering the following:
1. An integrated, comprehensive HIT platform
2. Low upfront and maintenance costs; historically lower priced than any comparable competitor
3. Utilized a proven database technology
Until now, no other vendor has been able to match this value proposition for community hospitals, and without the recent influx of billions of dollars of government funding for HIT spending, it’s unlikely almost any other major vendor could match Meditech’s value proposition today.

What Detractors Say
The following are a series of arguments typically levied against Meditech. Also included are responses which illuminate alternative points of view to these arguments and provide balance to the overall discussion:
Argument: Meditech utilizes old technology.
Response: Meditech’s core technology is really no older than that of the hottest vendor on the market right now – Epic. In fact, they use much of the same technology, with both vendors utilizing a MUMPS database, which is proven as an extremely reliable, fast system.

Argument: Meditech doesn’t support its customers.
Response: No vendor is perfect in customer service and support, and all have room for improvement. That being said, most Meditech customers believe they receive support which meets their expectations. A much higher level of support would require Meditech to hire additional staff and raise its maintenance fees, which would directly hurt their smaller hospital clients.

Argument: Meditech is just about the money.
Response: Let’s set the record straight – every vendor is in business to make money and there is nothing wrong with it. Meditech was certainly late to the game with V6 but so have most of the other major EHR/HIS vendors in the releases of their go-forward “Meaningful Use” compliant solutions. Furthermore, extremely large portions of their customer base are very small hospitals with very small IT budgets that almost no other vendor could afford to support.

Argument: Ok, Meditech might work for smaller hospitals but definitely isn’t suited for larger, more sophisticated ones.
Response: Tell that to Centura Health in Colorado, CHRISTUS Health in San Antonio, Methodist Health System in Dallas, Hospital Sisters Health System in Springfield, IL, or St. Joseph’s Health System out of Orange County, CA. These major organizations are just an example out of a much larger pool of healthcare organizations that are having demonstrable success utilizing Meditech’s core clinical offerings.

Simply put, Meditech is not for everybody, and frankly neither is Cerner, Allscripts, Siemens, McKesson, or Epic. Organizations that go in with their eyes wide open, have committed IT staffs (lead by tough and independent minded executives) and involved physician and nurse leadership can have success with Meditech on par with competing clinical IT solutions.

In summary, Meditech remains a competitive and viable enterprise vendor for hospitals of all sizes. If there is one area where Meditech truly lags behind its competitors it is in the area of trumpeting their every success across the industry. Negative spin has filled this information void. It’s time for Meditech to come back to the HIMSS conference and start making noise on influential HIT websites and blogs to share their clients’ successes and promote its hard-won reputation for value to the industry.

Disclaimer: Meditech is not a client of KATALUS Advisors.

October 12, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Hospital EMR News: Meaningful Use Payments, HIE Improvements, Mobile Physician Alerts

Hi folks: Enough of me yakking of late. Thought you’d find the following news bites to be worth a look, from vendor announcements to Meaningful Use wins. Enjoy!

-Katherine

*  Morton County Health System, located in Elkhart, KS, announced today that it was the first hospital in the state of Kansas to receive a Medicare incentive payment.  That’s got to feel nice. Press release

* Next month, diagnostic equipment provider Welch Allyn will premiere a configurable system allowing its physical assessment instruments and vital signs documentation technology to electronically capture and transmit patient data to an EMR. (You mean most devices don’t do this already? Eek!)  Press release

* St. Jude Medical has launched version 5.0 of its Merlin.net Patient Care Network. The network features Mobile DirectAlerts notifying doctors via their mobile device when patients experience key events. What’s cool is that when doctors get the alert, they can jump directly to hospital patient reports. Gotta like that. Press release

* As of Sept. 30, CMS had distributed more than $850 million in incentive payments under the Medicare and Medicaid Incentive Program, according to HIMSS. Also, more than 114,000 eligible providers and hospitals reported having registered. Looks like 2012 is going to be a huge year for Meaningful Use.  Becker’s Hospital Review

* In addition to citing 23 of its physicians as being the best in the state, U.S. News and World Report has ranked Burlington, VT based Fletcher Allen Health Care as one of the “Most Connected” in the country. That puts FAHC in the top 3.5 percent of hospitals in EMR adoption and use. Great to catch a winner outside of Chicago, New York, Boston or LA… Press release

* The e-Health Network of Long Island, an HIE serving 1.5 million patients, has adopted new technology from HealthUnity Corp. which adds several Meaningful Use-friendly features to provider EMRs, including  secure messaging, e-referral, an EHR lite provider portal and EHR adapter services. The HIE ties together a group of nine area hospitals and nursing homes. Press release

October 11, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Hospitals and Mobile Health: Time To Get Involved

You’re going to spend a boatload of money on your EMR/EHR this year. And the next year. And several years after that.  Agreed?

And at least for the time being, the only return you’ll see on the massive investment (MU payments) doesn’t come near to covering what you’re spending on that EMR. Hey, with the arguable exception of the defense business, nobody makes a fortune on government programs, right?

So, for the time being, if you’re going to get anything out of your EMR install other than frustration and expense, it’ll have to come from another direction.

As I see it, that direction is mHealth – and initiatives supporting not only doctors but patients as well. Mobile health approaches, which can include appointment reminders, chronic condition outreach and continuing care, have always been an intriguing possibility.

As they’re planning their EMR strategies, hospitals should include mobile channels. With an EMR in place, mHealth approaches becomes much more valuable, as it can deliver and capture information in a dynamic way by drawing on the patient’s own record.

I admit hospitals aren’t totally oblivious to mobile options. For example:

*  Happtique, an organization spun out from the Greater New York Hospital Association, is working with 11 healthcare organizations, is an app store presenting what it sees as the best enterprise healthcare apps.  The hospitals involved are developing (or have already developed) custom applications which will distributed through the store.

*  OhioHealth of Columbus, OH has developed a women’s health app allowing patients to easily connect with their OB/GYN providers.

* St. Christopher Hospital for Children has launched an app connecting the community with health information and data services, including ER wait times and a “my data” section.

The problem is, these type of approaches are just scratching the surface of what mHealth can do.  The big picture to think about in mHealth isn’t just keeping patients informed, or even giving them access to their data, but to use mobile devices to keep up a health dialogue.

Doctors need to monitor what patients are doing — whether they’re taking their meds, what their blood sugars or pulse-ox readings are — and your EMR needs to be able to collect and display this data.   Patients need reminders and feedback, especially chronically-ill patients, and they need those reminders wherever they are at the moment.

Ultimately, this kind of accessible, two-way communications are what both sides will need if they hope to accomplish the ambitious health goals policymakers expect you to meet.

In the mean time, if you want to begin showing some returns — even incrementally — on that giant pile of code you’ve just bought, doing some smart work with mobile health might be a good place to start.

October 7, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.